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Dadjo J, Omonaiye O, Yaya S. Health insurance coverage and access to child and maternal health services in West Africa: a systematic scoping review. Int Health 2023; 15:644-654. [PMID: 37609993 PMCID: PMC10629958 DOI: 10.1093/inthealth/ihad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND According to the United Nations, the third Sustainable Development Goal, 'Ensure Healthy Lives and Promote Well-Being at All Ages', set numerous targets on child and maternal health. Universal health insurance is broadly seen as a solution to fulfil these targets. West Africa is known to have the most severe maternal mortality and under-five mortality rates in the world. This review seeks to understand whether health insurance provides increased access to services for mothers and children in this region. METHODS The protocol for this review is registered in the International Prospective Register of Systematic Reviews database (CRD42020203859). A search was conducted in the MEDLINE Complete, Embase, CINAHL Complete and Global Health databases. Eligible studies were from West African countries. The population of interest was mothers and children and the outcome of interest was the impact of health insurance on access to services. Data were extracted using a standardized form. The primary outcome was the impact of health insurance on the rate of utilization and access to services. The Joanna Briggs Institute Critical Appraisal Tool was used for methodological assessment. RESULTS Following screening, we retained 49 studies representing 51 study settings. In most study settings, health insurance increased access to child and maternal health services. Other determinants of access were socio-economic factors such as wealth and education. CONCLUSIONS Our findings suggest that health insurance may be a viable long-term strategy to alleviate West Africa's burden of high maternal and child mortality rates. An equity lens must guide future policy developments and significant research is needed to determine how to provide access reliably and sustainably to services for mothers and children in the near and long term.
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Affiliation(s)
- Joshua Dadjo
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Melbourne Burwood, Victoria, Australia
- Deakin University Centre for Quality and Patient Safety Research – Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- George Institute for Global Health, Imperial College London, London, UK
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Rana MS, Billah SM, Moinuddin M, Bakkar Siddique MA, Khan MMH. Exploring the factors contributing to increase in facility child births in Bangladesh between 2004 and 2017-2018. Heliyon 2023; 9:e15875. [PMID: 37206020 PMCID: PMC10189511 DOI: 10.1016/j.heliyon.2023.e15875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Abstract
Background Although Bangladesh has gained rapid improvement in births at health facilities, yet far behind to achieve the SDG target. Assessing the contribution of factors in increased use of delivery at facilities are important to demonstrate. Objective To explore the determinants and their contribution in explaining increased use of facility child births in Bangladesh. Participants Reproductive-aged women (15-49 years) of Bangladesh. Methods and materials We used the latest five rounds (2004, 2007, 2011, 2014, 2017-2018) of Bangladesh Demographic and Health Surveys (BDHSs). The regression based classical decomposition approach has been used to explore the determinants and their contribution in explaining the increased use of facility child birth. Results A sample of 26,686 reproductive-aged women were included in the analysis, 32.90% (8780) from the urban and 67.10% (17,906) from the rural area. We observed a 2.4-fold increase in delivery at facilities from 2004 to 2017-2018, in rural areas it is more than three times higher than the urban areas. The change in mean delivery at facilities is about 1.8 whereas, the predicted change is 1.4. In our full sample model antenatal care visits contribute the largest predicted change of 22.3%, wealth and education contributes 17.3% and 15.3% respectively. For the rural area health indicator (prenatal doctor visit) is the largest drivers contributing 42.7% of the predicted change, hereafter education, demography and wealth. However, in urban area education and health contributed equally 32.0% of the change followed by demography (26.3%) and wealth (9.7%). Demographic variables (maternal BMI, birth order, age at marriage) contributing more than two-thirds (41.2%) of the predicted change in the model without the health variables. All models showed more than 60.0% predictive power. Conclusion Health sector interventions should focus both coverage and quality of maternal health care services to sustain steady improvements in child birth facilities.
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Affiliation(s)
- Md Sohel Rana
- Department of Statistics, Comilla University, Kotbari, 3506, Cumilla, Bangladesh
- Corresponding author.
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
- School of Public Health, The University of Sydney, Australia
| | | | - Md Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
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Olubodun T, Rahman SA, Odukoya OO, Okafor IP, Balogun MR. Determinants of health facility delivery among young mothers aged 15 - 24 years in Nigeria: a multilevel analysis of the 2018 Nigeria demographic and health survey. BMC Pregnancy Childbirth 2023; 23:185. [PMID: 36932391 PMCID: PMC10024451 DOI: 10.1186/s12884-023-05492-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/02/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Young mothers aged 15 to 24 years are particularly at higher risk of adverse health outcomes during childbirth. Delivery in health facilities by skilled birth attendants can help reduce this risk and lower maternal and perinatal morbidity and mortality. This study assessed the determinants of health facility delivery among young Nigerian women. METHODS A nationally representative population data extracted from the 2018 Nigeria Demographic and Health Survey of 5,399 young women aged 15-24 years who had had their last birth in the five years before the survey was analysed. Data was described using frequencies and proportions. Bivariate and multivariate analyses were carried out using Chi-Square test and multilevel mixed effect binary logistic regression. All the analysis were carried out using STATA software, version 16.0 SE (Stata Corporation, TX, USA).. RESULTS Of the total sampled women in the 2018 NDHS, 5,399 (12.91%) formed our study population of young women 15 -24 years who had their last birth in the preceding five years of the survey. Only 33.72% of the young mothers utilized health facility for delivery. Women educated beyond the secondary school level had 4.4 times higher odds of delivering at a health facility compared with women with no education (AOR 4.42 95%, CI 1.83 - 10.68). Having fewer children and attending more antenatal visits increased the odds of health facility delivery. With increasing household wealth index, women were more likely to deliver in a health facility. The odds of health facility delivery were higher among women whose partners had higher than secondary level of education. Women who lived in communities with higher levels of female education, skilled prenatal support, and higher levels of transportation support were more likely to deliver their babies in a health facility. CONCLUSION Strategies to promote institutional delivery among young mothers should include promoting girl child education, reducing financial barriers in access to healthcare, promoting antenatal care, and improving skilled birth attendants and transportation support in disadvantaged communities.
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Affiliation(s)
- Tope Olubodun
- Department of Community Medicine and Primary Care, Federal Medical Center, Abeokuta, Ogun State, Nigeria.
| | - Semiu Adebayo Rahman
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Oluwakemi Ololade Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ifeoma P Okafor
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
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Baba MI, Kyei KA, Kyei JB, Daniels J, Biney IJK, Oswald J, Tschida P, Brunet M. Diversities in the place of delivery choice: a study among expectant mothers in Ghana. BMC Pregnancy Childbirth 2022; 22:875. [PMID: 36434532 PMCID: PMC9700980 DOI: 10.1186/s12884-022-05158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 10/26/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In this study, the factors that influence the choice of place of delivery among expectant mothers in both rural and urban settings in the northern part of Ghana were identified and compared using the conceptual framework provided by Thaddeus and Maine. METHODS A mixed-method study was used to examine expectant mothers and their responses related to factors that affect their choice of place of delivery through a concurrent triangulation using health professional interviews and a detailed participant survey. The sample consisted of 552 expectant mothers between the ages of 15 and 49 years. Individual interviews were conducted with 8 health professionals. There was also a focus group discussion with randomly selected pregnant women and lactating mothers. Themes were generated through open coding of the interview data, while multiple regression was performed to identify the factors associated with choice of place of delivery. RESULTS Major preference (60.1%) was for home delivery among rural dwellers compared to 20.7% for urban participants. Statistically significant variables affecting the choice of place of delivery among study participants were found to be educational background, the experience of previous deliveries, the attitude of hospital staff toward pregnant women during labor, and frequency of accessing antenatal care. CONCLUSION Majority of rural women prefer home delivery to facility delivery which is the opposite of the trend observed among urban women. The study's implications may lead to positive change where stakeholders develop and implement policies to promote health facility delivery for expectant mothers in Ghana.
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Affiliation(s)
- Mahama Ibrahim Baba
- grid.460777.50000 0004 0374 4427Department of Public Health, Tamale Teaching Hospital, Tamale, Ghana
| | - Kofi Adesi Kyei
- grid.8652.90000 0004 1937 1485School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana ,grid.415489.50000 0004 0546 3805Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Joseph Daniels
- grid.415489.50000 0004 0546 3805Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - John Oswald
- grid.412868.10000 0000 8553 5864Faculty of Public Health, Walden University, Minneapolis, USA
| | - Patrick Tschida
- grid.412868.10000 0000 8553 5864Faculty of Public Health, Walden University, Minneapolis, USA
| | - Michael Brunet
- grid.412868.10000 0000 8553 5864Faculty of Public Health, Walden University, Minneapolis, USA
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Exploring the Influence of Sociodemographic Characteristics on the Utilization of Maternal Health Services: A Study on Community Health Centers Setting in Province of Jambi, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148459. [PMID: 35886308 PMCID: PMC9320577 DOI: 10.3390/ijerph19148459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
The Maternal Mortality Ratio in Indonesia has remained high, making it a national priority. The low utilization of maternal health services at community health centers is considered to be one of the reasons for poor maternal health status. This study aims to assess the influence of sociodemographic factors on utilization of maternal health services. The analysis was completed using binary and logistic regression to examine the association between sociodemographic variables and maternal health services utilization. A total of 436 women participated in the survey. In the multivariable analysis, age, education, ethnicity, parity status, distance to health centers and insurance ownership were associated with the utilization of maternal health services. Ethnicity (OR, 2.1; 95% confidence interval, 1.4–3.3) and distance to the CHC (OR, 0.5; 95% confidence interval, 0.3–0.8) were significantly associated with ANC visits. The association between parity and place of delivery was statistically significant (OR, 0.8; 95% confidence interval, 0.5–1.4). A positive association between basic health insurance ownership and PNC services was reported (OR, 0.3; 95% confidence interval, 0.1–0.6). Several sociodemographic factors were positively associated with the utilization of maternal health services at the CHCs. The required measures to improve the utilization of maternal health services at the CHCs level have to take into consideration the sociodemographic factors of reproductive age women.
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Setu SP, Islam MA, Halim SFB. Individual and Community-Level Determinants of Institutional Delivery Services among Women in Bangladesh: A Cross-Sectional Study. Int J Clin Pract 2022; 2022:3340578. [PMID: 35685544 PMCID: PMC9159142 DOI: 10.1155/2022/3340578] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/14/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Improving maternal mortality attracts considerable interest with the critical invention through institutional delivery services (IDS) in reducing maternal death during delivery and ensuring safe childbirth. The influence of both individual and community-level factors is essential to using IDS. Problem Statement. Maternal death may occur at any time, but delivery without designated healthcare is by far the most dangerous time for both woman and her baby. Therefore, to combat the global burden of maternal mortality, it is necessary to ensure IDS worldwide. OBJECTIVES This study explores the current knowledge of individual and community-level covariates and examines their extent of influence on the utilization of IDS in Bangladesh. METHODS Utilizing Bangladesh Demographic and Health Survey (BDHS) data, this study has used two-level random intercept binary logistic regression, together with the average annual rate of increase (AARI) in the utilization of IDS and related variables. RESULTS This study found appreciable changes in seeking IDS, increases from 3.4% in 2007 to 51.9% in 2017, and half of the total deliveries (51%) took place in healthcare. About 26% of the total variation in the utilization of IDS is owing to differences across communities. Further, covariates including communities with higher educated women, higher utilization of ANC and access to media and at individual level, religion, maternal and parental education, wealth index, and mother-level factors (i.e., age at birth, BMI, occupation, ANC visit, birth order, own health care decision, pregnancy intention, and exposure to media) showed significant association with the utilization of IDS. CONCLUSION This study observed the association between individual and community-level factors and IDS uptake. Thus, any future strategies must address individual level and community-level challenges and undertake a multisectoral approach to enhance the uptake of IDS.
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Affiliation(s)
- Sarmistha Paul Setu
- Statistics Discipline, Science Engineering & Technology School, Khulna University, Khulna 9208, Bangladesh
| | - Md. Akhtarul Islam
- Statistics Discipline, Science Engineering & Technology School, Khulna University, Khulna 9208, Bangladesh
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Kim ET, Ali M, Adam H, Abubakr-Bibilazu S, Gallis JA, Lillie M, Hembling J, McEwan E, Baumgartner JN. The Effects of Antenatal Depression and Women's Perception of Having Poor Health on Maternal Health Service Utilization in Northern Ghana. Matern Child Health J 2021; 25:1697-1706. [PMID: 34405361 DOI: 10.1007/s10995-021-03216-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the effects of antenatal depression and women's perceived health during the antenatal period on maternal health service utilization in rural northern Ghana; including how the effect of antenatal depression on service use might be modified by women's perceived health. METHODS Probable antenatal depression was assessed using the Patient Health Questionnaire (PHQ-9). Linear regression was used for the outcome of number of antenatal care (ANC) visits, and logistic regression was used for the outcomes of facility delivery, postnatal care (PNC) within 7 days and completion of continuum of care. Continuum of care was defined as having had four or more ANC visits, delivered at a health facility and had PNC visit within 7 days. RESULTS Antenatal depression had very small or no association with maternal health service utilization. Women with self-perceived fair or poor health were significantly less likely to use PNC within 7 days and less likely to complete the continuum of care. As for effect modification, we found that for women with probable moderate or severe antenatal depression (a score of 10 or greater), those with perceived fair or poor health used fewer ANC visits and were less likely to use PNC within 7 days than those with perceived excellent, very good or good health. CONCLUSIONS Women experiencing moderate or severe antenatal depression and/or who self-perceive as having poor health should be identified and targeted for additional support to access and utilize maternal health services.
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Affiliation(s)
- Eunsoo Timothy Kim
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Mohammed Ali
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - Haliq Adam
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - Safiyatu Abubakr-Bibilazu
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - John A Gallis
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.,Department of Biostatistics & Bioinformatics, Duke University, 2424 Erwin Rd, Suite 1102 Hock Plaza, Durham, NC, 27710, USA
| | - Margaret Lillie
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA
| | - John Hembling
- Catholic Relief Services, 228 W Lexington St, Baltimore, MD, 21201, USA
| | - Elena McEwan
- Catholic Relief Services, 228 W Lexington St, Baltimore, MD, 21201, USA
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.,School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St, Chapel Hill, NC, 27599, USA
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Dzomeku VM, Duodu PA, Okyere J, Aduse-Poku L, Dey NEY, Mensah ABB, Nakua EK, Agbadi P, Nutor JJ. Prevalence, progress, and social inequalities of home deliveries in Ghana from 2006 to 2018: insights from the multiple indicator cluster surveys. BMC Pregnancy Childbirth 2021; 21:518. [PMID: 34289803 PMCID: PMC8296527 DOI: 10.1186/s12884-021-03989-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Delivery in unsafe and unsupervised conditions is common in developing countries including Ghana. Over the years, the Government of Ghana has attempted to improve maternal and child healthcare services including the reduction of home deliveries through programs such as fee waiver for delivery in 2003, abolishment of delivery care cost in 2005, and the introduction of the National Health Insurance Scheme in 2005. Though these efforts have yielded some results, home delivery is still an issue of great concern in Ghana. Therefore, the aim of the present study was to identify the risk factors that are consistently associated with home deliveries in Ghana between 2006 and 2017–18. Methods The study relied on datasets from three waves (2006, 2011, and 2017–18) of the Ghana Multiple Indicator Cluster surveys (GMICS). Summary statistics were used to describe the sample. The survey design of the GMICS was accounted for using the ‘svyset’ command in STATA-14 before the association tests. Robust Poisson regression was used to estimate the relationship between sociodemographic factors and home deliveries in Ghana in both bivariate and multivariable models. Results The proportion of women who give birth at home during the period under consideration has decreased. The proportion of home deliveries has reduced from 50.56% in 2006 to 21.37% in 2017–18. In the multivariable model, women who had less than eight antenatal care visits, as well as those who dwelt in households with decreasing wealth, rural areas of residence, were consistently at risk of delivering in the home throughout the three data waves. Residing in the Upper East region was associated with a lower likelihood of delivering at home. Conclusion Policies should target the at-risk-women to achieve complete reduction in home deliveries. Access to facility-based deliveries should be expanded to ensure that the expansion measures are pro-poor, pro-rural, and pro-uneducated. Innovative measures such as mobile antenatal care programs should be organized in every community in the population segments that were consistently choosing home deliveries over facility-based deliveries.
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Affiliation(s)
- Veronica Millicent Dzomeku
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Precious Adade Duodu
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, England, UK
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Private Mail Bag, Cape Coast, Ghana
| | - Livingstone Aduse-Poku
- Department of Epidemiology, College of Public Health & Health Professions, College of Medicine, University of Florida, Florida, USA
| | | | - Adwoa Bemah Boamah Mensah
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Kweku Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pascal Agbadi
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
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Konlan KD, Saah JA, Doat AR, Amoah RM, Abdulai JA, Mohammed I, Konlan KD. Influence of nurse-patient relationship on hospital attendance. A qualitative study of patients in the Kwahu Government Hospital, Ghana. Heliyon 2021; 7:e06319. [PMID: 33665463 PMCID: PMC7907811 DOI: 10.1016/j.heliyon.2021.e06319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/20/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background The relationship of nurses and patients in healthcare settings has been central in ensuring good and efficient healthcare delivery. The total hospital attendance in the Kwahu Government Hospital have reduced in recent years. The study explored patients’ perceptions of the nurse-patient relationship and its influence on hospital attendance at the Kwahu Government Hospital. Methods A phenomenological qualitative study design, with a purposive sampling technique, was used to interview ten participants from the various wards in the hospital on their perceptions of the nurse patient relationship and its influence on hospital attendance. The data were transcribed and analysed using a thematic content analysis approach that embraces three interrelated stages, namely data reduction, data display, and data conclusion drawing. Results Many of the participants had positive perceptions regarding the attitude of nurses, and that influenced hospital attendance while others opined that nurses’ attitudes towards them made them attend a private facility. Almost all the participants suggested that patients should exhibit an equally good attitude and behaviour towards nurses, and better communication between patients and nurses as vital ways of improving the nurse-patient relationship. Nurses in the Kwahu Government Hospital are described as friendly, respectful and attend promptly to patient health care needs adequately. The range of perceived respect differed from patient to patient and include the nurse called patient by name, respond promptly to patient needs, helped “helpless patients” to feed and also assisted them change diapers, listen to patient concerns, linked patient to other professionals, work within the cultural context of hierarchy and that the nurse is sociable and interacted with patient positively. Conclusion Hospital management should conduct regular evaluations of patients' experiences as well as nurses’ experiences to address deficiencies in communication and nurse-patient interactions.
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Affiliation(s)
- Kennedy Diema Konlan
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta Region, Ghana.,College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Joel Afram Saah
- Department of Public Health, School of Allied Sciences, University for Development Studies, Tamale, Northern Region, Ghana
| | - Abdul-Razak Doat
- Tehran University of Medical Sciences- School of Nursing and Midwifery, Tehran, Iran.,Nurses' and Midwives' Training College, Tamale, Northern Region, Ghana
| | - Roberta Mensima Amoah
- Department of Public Health, School of Allied Sciences, University for Development Studies, Tamale, Northern Region, Ghana
| | | | - Iddrisu Mohammed
- Nurses' and Midwives' Training College, Tamale, Northern Region, Ghana
| | - Kennedy Dodam Konlan
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Legon, Greater Accra Region, Ghana
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Azaare J, Akweongo P, Aryeetey GC, Dwomoh D. Impact of free maternal health care policy on maternal health care utilization and perinatal mortality in Ghana: protocol design for historical cohort study. Reprod Health 2020; 17:169. [PMID: 33126906 PMCID: PMC7597017 DOI: 10.1186/s12978-020-01011-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ghana introduced what has come to be known as the 'Free’ Maternal Health Care Policy (FMHCP) in 2008 via the free registration of pregnant women to the National Health Insurance Scheme to access healthcare free of charge. The policy targeted every pregnant woman in Ghana with a full benefits package covering comprehensive maternal healthcare. Purpose This study seeks to measure the contribution of the FMHCP to maternal healthcare utilization; antenatal care uptake, and facility delivery and determine the utilization impact on stillbirth, perinatal, and neonatal deaths using quasi-experimental methods. The study will also contextualize the findings against funding constraints and operational bottlenecks surrounding the policy operations in the Upper East Region of Ghana. Methods This study adopts a mixed-method design to estimate the treatment effect using variables generated from historical data of Ghana and Kenya Demographic and Health Survey data sets of 2008/2014, as treatment and comparison groups respectively. As DHS uses complex design, weighting will be applied to the data sets to cater for clustering and stratification at all stages of the analysis by setting the data in STATA and prefix Stata commands with ‘svy’. Thus, the policy impact will be determined using quasi-experimental designs; propensity score matching, and difference-in-differences methods. Prevalence, mean difference, and test of association between outcome and exposure variables will be achieved using the Rao Scot Chi-square. Confounding variables will be adjusted for using Poisson and multiple logistics regression models. Statistical results will be reported in proportions, regression coefficient, and risk ratios. This study then employs intrinsic-case study technique to explore the current operations of the ‘free’ policy in Ghana, using qualitative methods to obtain primary data from the Upper East Region of Ghana for an in-depth analysis. Discussion The study discussions will show the contributions of the ‘free’ policy towards maternal healthcare utilization and its performance towards stillbirth, perinatal and neonatal healthcare outcomes. The discussions will also centre on policy designs and implementation in resource constraints settings showing how SDG3 can be achievement or otherwise. Effectiveness of policy proxy and gains in the context of social health insurance within a broader concept of population health and economic burden will also be conferred. Protocol approval This study protocol is registered for implementation by the Ghana Health Service Ethical Review Committee, number: GHS-ERC 002/04/19.
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Affiliation(s)
- John Azaare
- Department of Health Policy Planning and Management, University of Ghana School of Public Health, Legon, Accra, Ghana.
| | - Patricia Akweongo
- Department of Health Policy Planning and Management, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Genevieve Cecilia Aryeetey
- Department of Health Policy Planning and Management, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, University of Ghana School Public Health, Legon, Accra, Ghana
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Alhassan RK, Owusu-Agyei S, Ansah EK, Gyapong M, Ashinyo A, Ashinyo ME, Nketiah-Amponsah E, Akorli-Adzimah E, Ekpor E. Trends and correlates of maternal, newborn and child health services utilization in primary healthcare facilities: an explorative ecological study using DHIMSII data from one district in the Volta region of Ghana. BMC Pregnancy Childbirth 2020; 20:543. [PMID: 32943004 PMCID: PMC7499957 DOI: 10.1186/s12884-020-03195-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Sustainable Development Goal 3 aims at reducing global neonatal mortality to at least 12 per 1000 livebirths, under-five mortality to at least 25 per 1000 livebirths and maternal mortality ratio to less than 70 per 100,000 livebirths by 2030. Considering the achievement so far, many countries in sub-Saharan Africa, including Ghana are not likely to achieve these targets. Low utilization of maternal, newborn and child health (MNCH) services partly account for this predicament. This study explored the trend and correlates of MNCH services utilization in one administrative district in the Volta Region of Ghana. Methods This is an explorative ecological study employing trend analysis of 2015–2017 data from Ghana Health Service District Health Information Management System II. Univariate Poisson regression models were used to determine the factors associated with MNCH services utilization at 95% confidence level. Results Cumulative record of 17,052 antenatal care (ANC) attendance and 2162 facility-based spontaneous vaginal deliveries (SVDs) was discovered. Compelling evidence of potential unskilled deliveries was observed in 23% of the 26 facilities reported in the DHIMSII data. High cumulative number of midwives in health facilities associated positively with high records of ANC visits (IRR = 1.30, [95% CI:1.29, 1.32]; p = 0.0001), facility-based SVDs (IRR = 1.30 [95% CI:1.25, 1.35]; p = 0.0001) and BCG immunizations (IRR = 1.32 [95% CI:1.29, 1.34]; p = 0.0001). Likewise, high records of ANC visits correlated positively with high facility-based SVDs and child immunizations records (p < 0.0001). Conclusion Targeted health system and community level interventions alongside progressive frontline health staff motivation and retention strategies could further enhance enrollment and retention of mothers in pre-natal and postnatal care services throughout the continuum of care to guarantee better MNCH health outcomes. Investments in universal coverage for quality ANC services has the potential to enhance utilization of supervised deliveries and post-natal care services such as immunizations.
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Affiliation(s)
- Robert Kaba Alhassan
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana.
| | - Seth Owusu-Agyei
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Evelyn Korkor Ansah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Anthony Ashinyo
- Ghana AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana
| | - Mary Eyram Ashinyo
- Department of Quality Assurance and Safety, Ghana Health Service, Accra, Ghana
| | | | | | - Edith Ekpor
- Ho West District Health Directorate, Volta Region, Ho, Ghana
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12
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Budu E. Predictors of home births among rural women in Ghana: analysis of data from the 2014 Ghana Demographic and Health Survey. BMC Pregnancy Childbirth 2020; 20:523. [PMID: 32912164 PMCID: PMC7488046 DOI: 10.1186/s12884-020-03211-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2023] Open
Abstract
Background Home births is one of the factors associated with maternal mortality. This study examined the predictors of home births among rural women in Ghana. Methods Data for this study was obtained from the 2014 Demographic and Health Survey (DHS) of Ghana. For the purpose of this study, a sample size of 2,101 women in the rural areas who had given birth within five years prior to the survey and had responses on variables was considered. Data processing, management and analysis were carried out using STATA version 14.0. This study carried out bivariate and multivariate analyses and results were tested at 95% confidence interval. The Adjusted odds ratios were used to present the results and the level of statistical significance was assessed using 95% confidence intervals. Results Home births was found to be high among women who resided in the Northern region compared to those in the Western region [AOR, 1.81 CI = 1.10–2.98]. Similarly, the likelihood of home birth was high among women with four or more births [AOR, 1.46 CI = 1.03–2.05] and Traditionalists [AOR, 2.50 CI = 1.54–4.06]. Conversely, giving birth at home was low among women with higher level of education [AOR = 0.58, CI = 0.43–0.78], those with rich wealth status [AOR = 0.19, CI = 0.10–0.38], those with four or more ANC visits [AOR = 0.11, CI = 0.15–0.23] and those who were covered by NHIS [AOR = 0.58, CI = 0.46–0.72]. Conclusions Over the years, there have been efforts by governments in Ghana to make maternal health services free in the country. However, a substantial proportion of women still undergo home births. To reduce the utilization of home births in Ghana, it is essential that government and non-governmental organisations make the cost of delivery services part of the free maternal health care policy and take into consideration the factors associated with the high rates of home births among rural women in Ghana.
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Affiliation(s)
- Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
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13
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Aboungo V, Kaselitz E, Aborigo R, Williams J, James K, Moyer C. Why do community members believe mothers and babies are dying? Behavioral versus situational attribution in rural northern Ghana. Midwifery 2020; 83:102657. [PMID: 32035341 DOI: 10.1016/j.midw.2020.102657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Rates of maternal and neonatal death remain high in the Global South, especially in Sub-Saharan Africa. In addition, indicators vary significantly by geography. This study aimed to understand what communities in northern Ghana with frequent maternal and newborn deaths or near deaths (near-misses) perceive to be the causes. As part of a larger study, four communities in Ghana's Northern Region were identified as areas with high concentrations of deaths and near-misses of mothers and babies. DESIGN Stakeholders were interviewed using in-depth interviews (IDIs) and focus-group discussions (FGDs). Field workers conducted 12 FGDs and 12 IDIs across a total of 126 participants. SETTING This exploratory descriptive study was conducted in the East Mamprusi District in the Northern Region of Ghana, in the communities of Jawani, Nagboo, Gbangu and Wundua. PARTICIPANTS FGDs were led by trained field workers and attended by traditional chiefs and their elders, members of women's groups, and traditional birth attendants in each of the four study communities. IDIs, or one-on-one interviews, were conducted with traditional healers who manage maternal and neonatal cases, community health nurses, and midwives. MEASUREMENTS AND FINDINGS Qualitative data were audio-recorded, transcribed, and thematically analyzed using the Attride-Sterling analytical framework. Discussions focused on where blame should be attributed for the negative outcomes of mothers and babies - with blame either being directed at the actions or inactions of the mothers (behavioral), or at the larger factors associated with poverty (situational) that necessitate mothers' behavior. For example, some respondents blamed women for their poor diets, while others blamed the lack of money or household support to buy nutritious foods. Blame was rarely attributed to the fathers despite local gender norms of males being the household decision-makers with regard to spending and care-seeking. KEY CONCLUSIONS These findings contribute to a small but growing body of literature on the blaming of mothers for their own deaths and those of their newborns - a phenomenon also described in high-income countries - and is supported by blame attribution theories that explain the self-protective nature of victim-blaming. IMPLICATIONS FOR PRACTICE These results carry important implications for education and intervention design related to maternal and neonatal mortality, including more focused efforts at incorporating men and the larger community. More research is warranted on blame attribution for these adverse outcomes and its effects on the victims.
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Affiliation(s)
- Victoria Aboungo
- Baptist Medical Center, BMC Road Nalerigu via N/R, Gambaga, Ghana
| | - Elizabeth Kaselitz
- Department of Global REACH, University of Michigan Medical School, 1111 Catherine St., Ann Arbor, MI 48109, USA.
| | - Raymond Aborigo
- Navrongo Health Research Center, Navrongo Post office Box 114, Ghana
| | - John Williams
- Navrongo Health Research Center, Navrongo Post office Box 114, Ghana
| | - Kat James
- Department of Learning Health Sciences, University of Michigan Medical School, 1111 Catherine St., Ann Arbor, MI 48109, USA.
| | - Cheryl Moyer
- Department of Global REACH, University of Michigan Medical School, 1111 Catherine St., Ann Arbor, MI 48109, USA; Department of Learning Health Sciences, University of Michigan Medical School, 1111 Catherine St., Ann Arbor, MI 48109, USA; Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA.
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Okawa S, Gyapong M, Leslie H, Shibanuma A, Kikuchi K, Yeji F, Tawiah C, Addei S, Nanishi K, Oduro AR, Owusu-Agyei S, Ansah E, Asare GQ, Yasuoka J, Hodgson A, Jimba M. Effect of continuum-of-care intervention package on improving contacts and quality of maternal and newborn healthcare in Ghana: a cluster randomised controlled trial. BMJ Open 2019; 9:e025347. [PMID: 31511278 PMCID: PMC6738678 DOI: 10.1136/bmjopen-2018-025347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To evaluate the effect of a continuum-of-care intervention package on adequate contacts of women and newborn with healthcare providers and their reception of high-quality care. DESIGN Cluster randomised controlled trial. SETTING 32 subdistricts in 3 rural sites in Ghana. PARTICIPANTS The baseline survey involved 1480 women who delivered before the trial, and the follow-up survey involved 1490 women who received maternal and newborn care during the trial. INTERVENTIONS The intervention package included training healthcare providers, using an educational and recording tool named 'continuum-of-care card', providing the first postnatal care (PNC) by retaining women and newborns at healthcare facility or home visit by healthcare providers. OUTCOME MEASURES Adequate contacts were defined as at least four contacts during pregnancy, delivery with assistance of skilled healthcare providers at a healthcare facility and three timely contacts within 6 weeks postpartum. High-quality care was defined as receiving 6 care items for antenatal care (ANC), 3 for peripartum care (PPC) and 14 for PNC. RESULTS The difference-in-difference method was used to assess the effects of the intervention on the study outcome. The percentage of adequate contacts with high-quality care in the intervention group in the follow-up survey and the adjusted difference-in-difference estimators were 12.6% and 2.2 (p=0.61) at ANC, 31.5% and 1.9 (p=0.73) at PPC and 33.7% and 12.3 (p=0.13) at PNC in the intention-to-treat design, whereas 13.0% and 2.8 (p=0.54) at ANC, 34.2% and 2.7 (p=0.66) at PPC and 38.1% and 18.1 (p=0.02) at PNC in the per-protocol design that assigned the study sample by possession of the continuum-of-care card. CONCLUSIONS The interventions improved contacts with healthcare providers and quality of care during PNC. However, having adequate contact did not guarantee high-quality care. Maternal and newborn care in Ghana needs to improve its continuity and quality. TRIAL REGISTRATION NUMBER ISRCTN90618993. .
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Affiliation(s)
- Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Margaret Gyapong
- Dodowa Health Research Centre, Dodowa, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Hannah Leslie
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kimiyo Kikuchi
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan
| | - Francis Yeji
- Navrongo Health Research Centre, Navrongo, Ghana
| | | | | | - Keiko Nanishi
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | - Evelyn Ansah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | | | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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15
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Amporfu E, Grépin KA. Measuring and explaining changing patterns of inequality in institutional deliveries between urban and rural women in Ghana: a decomposition analysis. Int J Equity Health 2019; 18:123. [PMID: 31399050 PMCID: PMC6688245 DOI: 10.1186/s12939-019-1025-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background Despite recent progress in improving access to maternal health services, the utilization of these services remains inequitable among women in developing countries, and rural women are particularly disadvantaged. This study sought to measure i) disparities in the rates of institutional births between rural and urban women in Ghana, ii) the extent to which existing disparities are due to differences in the distribution of the determinants of institutional delivery between rural and urban women, and iii) the extent to which existing disparities are due to discrimination in resource availability. Methods Using Demographic and Health Survey data from 2003, 2008, and 2014, this study decomposed inequalities in institutional delivery rates among urban and rural Ghanaian woman using the Oaxaca, the Blinder, and related decompositions for non-linear models. The determinants of the observed inequalities were also analyzed. Results Institutional delivery rates in urban areas exceeded those of rural areas by 32.4 percentage points due to differences in distribution of the determinants of institutional delivery between the two areas. The main determinants driving the observed disparities were wealth, which contributed to about 16.1% of the gap, followed by education level, and number of antenatal visits. Conclusion Relative to urban women, rural women have lower rates of institutional deliveries due primarily to lower levels of wealth, which results in financial barriers in accessing maternal health services. Economic empowerment of rural women is crucial in order to close the gap in institutional delivery between urban and rural women.
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Affiliation(s)
- Eugenia Amporfu
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Karen A Grépin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
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16
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Adjei KK, Kikuchi K, Owusu-Agyei S, Enuameh Y, Shibanuma A, Ansah EK, Yasuoka J, Poku-Asante K, Okawa S, Gyapong M, Tawiah C, Oduro AR, Sakeah E, Sarpong D, Nanishi K, Asare GQ, Hodgson A, Jimba M. Women's overall satisfaction with health facility delivery services in Ghana: a mixed-methods study. Trop Med Health 2019; 47:41. [PMID: 31320830 PMCID: PMC6612170 DOI: 10.1186/s41182-019-0172-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Skilled birth delivery has increased up to nearly 74% in Ghana, but its quality has been questioned over the years. As understanding women's satisfaction could be important to improving service quality, this study aimed to determine what factors were associated with women's overall satisfaction with delivery services quantitatively and qualitatively in rural Ghanaian health facilities. Results This cross-sectional, mixed methods study used an explanatory sequential design across three Ghana Health Service research areas in 2013. Participants were women who had delivered in the preceding 2 years. Two-stage random sampling was used to recruit women for the quantitative survey. Relationships between women's socio-demographic characteristics and their overall satisfaction with health facility delivery services were examined using univariate and multiple logistic regression analyses. For qualitative analyses, women who completed the quantitative survey were purposively selected to participate in focus group discussions. Data from the focus group discussions were analyzed based on predefined and emerging themes. Overall, 1130 women were included in the quantitative analyses and 136 women participated in 15 focus group discussions. Women's mean age was 29 years. Nearly all women (94%) were satisfied with the overall services received during delivery. Women with middle level/junior high school education [adjusted odds ratio (AOR) = 0.50, 95% confidence interval (CI) = (0.26-0.98)] were less likely to be satisfied with overall delivery services compared to women with no education. Qualitatively, women were not satisfied with the unconventional demands, negative attitude, and unavailability of healthcare workers, as well as the long wait time. Conclusions Although most women were satisfied with the overall service they received during delivery, they were not satisfied with specific aspects of the health services; therefore, higher quality service delivery is necessary to improve women's satisfaction. Additional sensitivity training and a reduction in work hours may also improve the experience of clients.
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Affiliation(s)
- Kwame K Adjei
- 1Kintampo Health Research Centre, Kintampo, Brong-Ahafo Ghana
| | - Kimiyo Kikuchi
- 2Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan
| | - Seth Owusu-Agyei
- 1Kintampo Health Research Centre, Kintampo, Brong-Ahafo Ghana.,3University of Health and Allied Science, Ho, Ghana
| | - Yeetey Enuameh
- 1Kintampo Health Research Centre, Kintampo, Brong-Ahafo Ghana.,4Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Akira Shibanuma
- 5Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Evelyn Korkor Ansah
- 3University of Health and Allied Science, Ho, Ghana.,11Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Junko Yasuoka
- 6Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | | | - Sumiyo Okawa
- 5Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | | | | | | | | | - Doris Sarpong
- 8Dodowa Health Research Centre, Dodowa, Greater Accra Ghana
| | - Keiko Nanishi
- 9Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Abraham Hodgson
- 11Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Masamine Jimba
- 5Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
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17
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Zhang C, Rahman MS, Rahman MM, Yawson AE, Shibuya K. Trends and projections of universal health coverage indicators in Ghana, 1995-2030: A national and subnational study. PLoS One 2019; 14:e0209126. [PMID: 31116754 PMCID: PMC6530887 DOI: 10.1371/journal.pone.0209126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/30/2019] [Indexed: 11/18/2022] Open
Abstract
Ghana has made significant stride towards universal health coverage (UHC) by implementing the National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC indicators in Ghana from 1995 to 2015 and makes future predictions up to 2030 to assess the probability of achieving UHC targets. National representative surveys of Ghana were used to assess health service coverage and financial risk protection. The analyses estimated the coverage of 13 prevention and four treatment service indicators at the national level and across wealth quintiles. In addition, we calculated catastrophic health payments and impoverishment to assess financial hardship and used a Bayesian regression model to estimate trends and future projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 health service indicators are projected to reach the target of 80% coverage by 2030. Across wealth quintiles, inequalities were observed amongst most indicators with richer groups obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all regions will achieve the 80% coverage target with high probabilities for the prevention services, the same cannot be applied to the treatment services. In 2015, the proportion of households that suffered catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure were 1.9% (95%CrI: 0.9-3.5) and 0.4% (95%CrI: 0.2-0.8), respectively. These are projected to reduce to 0.4% (95% CrI: 0.1-1.3) and 0.2% (0.0-0.5) respectively by 2030. Inequality measures and subnational assessment revealed that catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant improvements were seen in both health service coverage and financial risk protection over the years. However, inequalities across wealth quintiles and regions continue to be cause of concerns. Further efforts are needed to narrow these gaps.
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Affiliation(s)
- Cherri Zhang
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Md. Shafiur Rahman
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Md. Mizanur Rahman
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Alfred E. Yawson
- Department of Community Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Kenji Shibuya
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- University Institute for Population Health, King’s College London, London, United Kingdom
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18
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Kaselitz E, James KH, Aborigo RA, Agorinya I, Moyer CA, Williams J. Understanding the gap in emergency obstetric and neonatal care in Ghana through the PREventing Maternal And Neonatal Deaths (PREMAND) study. Int J Gynaecol Obstet 2019; 145:343-349. [PMID: 30874303 DOI: 10.1002/ijgo.12803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/29/2018] [Accepted: 03/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore basic and comprehensive emergency obstetric service provision across four districts in rural northern Ghana, and whether women were more likely to deliver at facilities with more skilled care. METHODS Field workers geo-coded all health facilities in East Mamprusi, Sissala East, Kassena Nankana Municipal, and Kassena Nankana West districts, and administered surveys to assess providers and emergency obstetric care available. Data were also prospectively collected on delivery locations of women and neonates who died, or nearly died (near misses), between September 1, 2015 and April 30, 2017. RESULTS There were 14 physicians for a population of nearly 360 000 women. Six (6%) facilities could provide basic emergency care, and 3 (3%) could provide comprehensive care. Services were distributed unequally, with 6 (67%) of the emergency facilities located in the least populated district. Among the sample of women and neonates who died or nearly died, 175 (39%) delivered at locations unable to provide basic emergency services. CONCLUSION Access to emergency obstetric and neonatal care was distributed inequitably across these districts, suggesting the need to revisit geographic placement of facilities relative to population. The study also raised the question of how to ensure facilities are equipped to respond to emergencies.
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Affiliation(s)
- Elizabeth Kaselitz
- Department of Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Katherine H James
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Cheryl A Moyer
- Department of Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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Individual and community level factors associated with health facility delivery: A cross sectional multilevel analysis in Bangladesh. PLoS One 2019; 14:e0211113. [PMID: 30759099 PMCID: PMC6373895 DOI: 10.1371/journal.pone.0211113] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/08/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Improving maternal health remains one of the targets of sustainable development goals. A maternal death can occur at any time during pregnancy, but delivery is by far the most dangerous time for both the woman and her baby. Delivery at a health facility can avoid most maternal deaths occurring from preventable obstetric complications. The influence of both individual and community factors is critical to the use of health facility delivery services. In this study, we aim to examine the role of individual and community factors associated with health facility-based delivery in Bangladesh. Methods This cross-sectional study used data from the Bangladesh Maternal Mortality Survey. The sample size constitutes of 28,032 women who had delivered within five years preceding the survey. We fitted logistic random effects regression models with the community as a random effect to assess the influence of individual and community level factors on use of health facility delivery services. Results Our study observed substantial amount of variation at the community level. About 28.6% of the total variance in health facility delivery could be attributed to the differences across the community. At community level, place of residence (AOR 1.48; 95% CI 1.35–1.64), concentration of poverty (AOR 1.15; 95% CI 1.03–1.28), concentration of use of antenatal care services (AOR 1.11, 95% CI 1.00–1.23), concentration of media exposure (AOR 1.20, 95% CI 1.07–1.34) and concentration of educated women (AOR 1.12, 95% CI 1.02–1.23) were found to be significantly associated with health facility delivery. At individual level, maternal age, educational status of the mother, religion, parity, delivery complications, individual exposure to media, individual access to antenatal care and household socioeconomic status showed strong association with health facility-based delivery. Conclusion Our results strongly suggest factors at both Individual, and community level influenced the use of health facility delivery services in Bangladesh. Thus, any future strategy to improve maternal health in Bangladesh must consider community contexts and undertake multi-sectorial approach to address barriers at different levels. At the individual level the programs should also focus on the need of the young mother, the multiparous the less educated and women in the poorest households.
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Yaya S, Bishwajit G, Ekholuenetale M, Shah V, Kadio B, Udenigwe O. Factors associated with maternal utilization of health facilities for delivery in Ethiopia. Int Health 2019; 10:310-317. [PMID: 29447358 DOI: 10.1093/inthealth/ihx073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 12/19/2017] [Indexed: 11/14/2022] Open
Abstract
Background As a signatory of the Millennium Development Goals, Ethiopia has made significant achievements towards meeting the maternal mortality related goals since 1990. Despite that, the country is still experiencing unacceptably high maternal mortality rates, and challenges to improving the coverage and utilisation of health facility delivery services which represent a key strategy to combat maternal mortality. Currently, there is limited evidence on the factors associated with health facility delivery in Ethiopia. Therefore, the objective of this study was to identify the correlates of facility delivery among urban and rural women in Ethiopia. Methods This was a cross-sectional study based on data from the 2011 Ethiopian Demographic and Health Survey. Participants were 7540 women aged between 15 and 49 years with a history of at least one birth. The outcome variable was place of delivery. Data were analyzed using bivariate and multivariable regression techniques. Results The overall prevalence of health facility delivery was 17.1% (1447/7540). In the multivariable regression analysis, education, wealth status, frequency of antenatal care visits and mother's age at first birth were found to be significantly associated with women's choice of place of delivery. Among urban women, those who had primary and secondary/higher level education had increased odds of delivering at a health facility compared with those without formal education. Those who were from the richest households had higher odds of delivering at a health facility compared with those in the lowest class. In urban and rural areas, compared with those who had no ANC visits, those who had at least four visits also had increased odds of delivering at a health facility. In the urban areas, those who were over 18 years old at their first childbirth had significantly higher odds of choosing to deliver at a health facility. Conclusion Findings show that the prevalence of healthy facility delivery in Ethiopia is remarkably low. Addressing the sociodemographic and wealth inequities can help promote the utilisation of facility delivery in both urban and rural areas. Policy-makers should consider improving access to education as a strategy to meet maternal health related goals and treat education as a multipronged strategy. Providing free healthcare access could be one strategy to achieve the universal coverage of essential maternal healthcare services.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Ghose Bishwajit
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada.,School of Medicine and Health Management, Tongji Medical College. Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Vaibhav Shah
- Interdisciplinary School Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Bernard Kadio
- Interdisciplinary School Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Ogochukwu Udenigwe
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
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21
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Huda TM, Hayes A, Dibley MJ. Examining horizontal inequity and social determinants of inequality in facility delivery services in three South Asian countries. J Glob Health 2018; 8:010416. [PMID: 29977529 PMCID: PMC6008508 DOI: 10.7189/jogh.08.010416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The utilization of maternal health care services has increased in many developing countries, but persistent wealth-related inequalities in use of maternal services remained an important public health issue. The paper examined the horizontal inequities and identified the key social determinants that can potentially explain such wealth-related inequalities in use of facility delivery services. Methods The countries studied are Bangladesh, Pakistan and Nepal. We used horizontal inequity index to measure the horizontal inequity and decomposition of concentration index method to assess the contribution of different social determinants towards the wealth-related inequality. We have used household and women data from demographic and health surveys of Bangladesh (BDHS 2014), Pakistan (PDHS 2012-13) and Nepal (NDHS 2010-11). Results All three countries showed pro-rich inequality in use of facility delivery services (Observed Concentration Index: Bangladesh = 0.235; Pakistan = 0.141; Nepal = 0.263). The study showed if the utilization were solely based on need factors there would have been little disparity between the rich and the poor (Need expected Concentration Index: Bangladesh = 0.004; Pakistan = 0.004; Nepal = 0.008). The use of facility delivery remained pro-rich in all three countries after taking the need factors into account (Horizontal inequity Index: Bangladesh = 0.231; Pakistan = 0.137; Nepal = 0.254). The decomposition analysis revealed that facility delivery is driven mostly by the social determinants of health rather than the individual health risk. Household socioeconomic condition, parental education, place of residence and parity emerged as the most important factors. Conclusions Our study reiterates the importance of addressing social determinants of health in tackling wealth-related inequalities in use of facility delivery services. Health policy makers should acknowledge the importance of social determinants in determining individual health-seeking behaviour and accordingly set their strategies to improve access to facility delivery.
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Affiliation(s)
- Tanvir M Huda
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Alison Hayes
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Michael J Dibley
- Sydney School of Public Health, University of Sydney, Sydney, Australia
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Kikuchi K, Yasuoka J, Nanishi K, Ahmed A, Nohara Y, Nishikitani M, Yokota F, Mizutani T, Nakashima N. Postnatal care could be the key to improving the continuum of care in maternal and child health in Ratanakiri, Cambodia. PLoS One 2018; 13:e0198829. [PMID: 29889894 PMCID: PMC5995361 DOI: 10.1371/journal.pone.0198829] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/26/2018] [Indexed: 11/18/2022] Open
Abstract
In South-East Asia, the maternal and child mortality rate has declined over the past decades; however, it varies among and within the countries in the region, including Cambodia. The continuum of care is an integrated series of care that women and children are required to avail continuously from pregnancy to the child/motherhood period. This study aimed to assess the completion rate of the continuum of care and examine the factors associated with the continuum of care in Ratanakiri, Cambodia. A cross-sectional study was conducted in Ratanakiri. Overall, 377 women were included, and data were collected via face-to-face interviews using a semi-structured questionnaire. Among them, 5.0% completed the continuum of care (antenatal care at least four times, delivery by skilled birth attendant, and postnatal care at least once). Meanwhile, 18.8% did not receive any care during pregnancy, delivery, and after birth. The highest discontinuation rate was at the postnatal care stage (73.6%). Not receiving any perinatal care was associated with neonatal complications at 6 weeks after birth (adjusted odds ratio [AOR]: 3.075; 95% confidence interval [CI]: 1.310-7.215). Furthermore, a long distance to the health center was negatively associated with completion of the continuum of care (AOR: 0.877; 95% CI: 0.791-0.972). This study indicates the need for efforts to reduce the number of women who discontinue from the continuum of care, as well as who do not receive any care to avoid neonatal complications. Since the discontinuation rate was highest at the postnatal care, postnatal care needs to be promoted more through the antenatal care and delivery services. Furthermore, given that long distance to health facilities was a barrier for receiving the care continuously, our findings suggest the need for a village-based health care system that can provide the basic continuum of care in remote areas.
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Affiliation(s)
- Kimiyo Kikuchi
- Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan
- * E-mail:
| | - Junko Yasuoka
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Keiko Nanishi
- Office of International Academic Affairs, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Ashir Ahmed
- Department of Advanced Information Technology, Kyushu University, Fukuoka, Japan
| | - Yasunobu Nohara
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Mariko Nishikitani
- Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan
| | - Fumihiko Yokota
- Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan
| | - Tetsuya Mizutani
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Naoki Nakashima
- Department of Advanced Information Technology, Kyushu University, Fukuoka, Japan
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Ngowi AF, Kamazima SR, Kibusi S, Gesase A, Bali T. Women's determinant factors for preferred place of delivery in Dodoma region Tanzania: a cross sectional study. Reprod Health 2017; 14:112. [PMID: 28877749 PMCID: PMC5588730 DOI: 10.1186/s12978-017-0373-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skilled birth attendance is one of the key factors in improving maternal health but less than 50% of women in sub-Saharan African countries do not have the opportunity to be attended to by skilled personnel during childbirth. The aim of the study was to assess the factors determining women's preference for a place to give birth in Dodoma Region, Tanzania. METHODS This study employed a cross-sectional survey design using quantitative data collection and analysis methods. Data were collected using structured questionnaire administered to 800 women obtained through multistage random sampling. Multivariable logistic regression model was applied to determine the predictors of place of delivery. RESULTS More than three quarters 629(78.6%) respondents had their last delivery in the health facilities while 171(21.4%) had their last delivery at home/on the way to hospital. Reasons for delivering at home include: abrupt occurrence of labour pain, long distance to the health facilities, lack of money to pay for transport and unfriendly experience with the health care providers. Simple logistic regression model indicate that mothers' education level, number of children, cost of transport the estimated distance to the nearby health facility and occupation were strong predictors of the preferred place of delivery. However, after controlling the potential confounder, the multivariable logistic regression model demonstrated a significant association between delivery at the health facility and the number of children and transport cost. CONCLUSION Our findings suggest a need for health care providers to enhance health education to women and their spouses about birth preparedness and the importance of delivering at the health facility. There is also a need for the government to increase the number of health facilities including maternity waiting homes and well trained health workers in both rural and urban areas.
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Affiliation(s)
- Agatha Fabian Ngowi
- Department of Public Health, College of Health Sciences, Dodoma University, P.O.Box 295, Dodoma, Tanzania.
| | - Switbert R Kamazima
- Department of Behavioral Sciences, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar-es-salaam, Tanzania
| | - Steven Kibusi
- Department of Clinical Nursing, College of Health Sciences, Dodoma University, P.O.Box 295, Dodoma, Tanzania
| | - Ainory Gesase
- Department of Anatomy,College of Health Sciences, Dodoma University, P.O BOX 295, Dodoma, Tanzania
| | - Theodora Bali
- Department of Education, Faculty of Humanities and Education, St John University, P.O Box 47, Dodoma, Tanzania
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Gudu W, Addo B. Factors associated with utilization of skilled service delivery among women in rural Northern Ghana: a cross sectional study. BMC Pregnancy Childbirth 2017; 17:159. [PMID: 28566088 PMCID: PMC5452376 DOI: 10.1186/s12884-017-1344-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 05/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ghana's current Maternal Mortality Ratio (MMR) of 319 per 100,000 live births makes achievement of the Sustainable Development Goal of 70 maternal deaths per 100,000 live births or less by 2030 appear to be illusory. Skilled assistance during childbirth is a critical strategy to reducing maternal mortality, yet the proportion of deliveries taking place within health facilities where such assistance is provided is very low in Ghana, with huge disparity between urban and rural women. To address the gap in skilled attendance in rural Upper East Region, the Ghana Health Service (GHS) in 2005 piloted a program that involved training of Community Health Officers (CHOs) as midwives. This study explored factors associated with skilled delivery services utilization in a predominantly rural district in Ghana. METHODS A cross-sectional study, data was collected from a sample of 400 women between the ages of 15 and 49 years who had given birth a year prior to the study. We used frequencies and percentages for descriptive analysis and chi-square (χ 2 ) test for relationship between independents factors and utilization of skilled delivery services. RESULTS Of the 400 women included in the analysis, 93.3% of them delivered in a health facility. Almost all of the mothers (97.3%) attended or received antenatal care at their last pregnancy with 75.0% of them having four or more ANC visits. The proportion of women who received ANC and utilized skilled delivery services was high (91.5%). Mother's educational attainment, ANC attendance, frequency of ANC visits, satisfaction with ANC services and possession of valid NHIS card significantly associated with utilisation of skilled delivery services. CONCLUSION For a predominantly rural district, the percentage of women who deliver within health facilities where skilled assistance is available is very encouraging and a significant stride towards reducing Ghana's overall MMR. Having four or more ANC visits and improving on the quality of care provided has a great potential of improving uptake of skilled delivery services.
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Affiliation(s)
- William Gudu
- Bongo District Hospital, Bolgatanga, Upper East Region Ghana
| | - Bright Addo
- Population Council, Ghana Office, 14B, Ridge Road, Roman Ridge, P.O. Box CT 4906, Accra, Ghana
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