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Abstract
Networks of care are a promising way to provide support and resources for isolated primary care workers and deserve more research, argue Enoch Oti Agyekum and colleagues
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Affiliation(s)
- Enoch Oti Agyekum
- World Bank Group, Health Nutrition and Population, Country Office, Accra, Ghana
| | | | - Blerta Maliqi
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | | | - Sanam Roder-DeWan
- World Bank Group, Health Nutrition and Population, Global Practice, Washington, DC, USA
- Dartmouth Medical School, Hanover, NH, USA
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Sakeah E, Okawa S, Rexford Oduro A, Shibanuma A, Ansah E, Kikuchi K, Gyapong M, Owusu-Agyei S, Williams J, Debpuur C, Yeji F, Kukula VA, Enuameh Y, Asare GQ, Agyekum EO, Addai S, Sarpong D, Adjei K, Tawiah C, Yasuoka J, Nanishi K, Jimba M, Hodgson A, The Ghana Embrace Team. Determinants of attending antenatal care at least four times in rural Ghana: analysis of a cross-sectional survey. Glob Health Action 2018; 10:1291879. [PMID: 28578634 PMCID: PMC5496066 DOI: 10.1080/16549716.2017.1291879] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Improving maternal health is a global challenge. In Ghana, maternal morbidity and mortality rates remain high, particularly in rural areas. Antenatal care (ANC) attendance is known to improve maternal health. However, few studies have updated current knowledge regarding determinants of ANC attendance. OBJECTIVE This study examined factors associated with ANC attendance in predominantly rural Ghana. METHODS We conducted a cross-sectional study at three sites (i.e. Navrongo, Kintampo, and Dodowa) in Ghana between August and September 2013. We selected 1500 women who had delivered within the two years preceding the survey (500 from each site) using two-stage random sampling. Data concerning 1497 women's sociodemographic characteristics and antenatal care attendance were collected and analyzed, and factors associated with attending ANC at least four times were identified using logistic regression analysis. RESULTS Of the 1497 participants, 86% reported attending ANC at least four times, which was positively associated with possession of national health insurance (AOR 1.64, 95% CI: 1.14-2.38) and having a partner with a high educational level (AOR 1.64, 95% CI: 1.02-2.64) and negatively associated with being single (AOR 0.39, 95% CI: 0.22-0.69) and cohabiting (AOR 0.57, 95% CI: 0.34-0.97). In site-specific analyses, factors associated with ANC attendance included marital status in Navrongo; marital status, possession of national health insurance, partners' educational level, and wealth in Kintampo; and preferred pregnancy timing in Dodowa. In the youngest, least educated, and poorest women and women whose partners were uneducated, those with health insurance were more likely to report at least four ANC attendances relative to those who did not have insurance. CONCLUSIONS Ghanaian women with low socioeconomic status were less likely to report at least four ANC attendances during pregnancy if they did not possess health insurance. The national health insurance scheme should include a higher number of deprived women in predominantly rural communities.
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Affiliation(s)
- Evelyn Sakeah
- a Social Science Department , Navrongo Health Research Centre, Ghana Health Service , Navrongo , Upper East , Ghana
| | - Sumiyo Okawa
- b Department of Community and Global Health , The University of Tokyo , Tokyo , Japan
| | - Abraham Rexford Oduro
- c Navrongo Health Research Centre, Research and Development Division , Ghana Health Service , Navrongo , Upper East , Ghana
| | - Akira Shibanuma
- b Department of Community and Global Health , The University of Tokyo , Tokyo , Japan
| | - Evelyn Ansah
- d Research & Development Division , Ghana Health Service , Accra , Ghana
| | - Kimiyo Kikuchi
- b Department of Community and Global Health , The University of Tokyo , Tokyo , Japan
| | - Margaret Gyapong
- e Dodowa Health Research Centre, Research and Development Division , Ghana Health Service , Dodowa , Greater Accra , Ghana
| | - Seth Owusu-Agyei
- f Kintampo Health Research Centre, Research and Development Division , Ghana Health Service , Kintampo , Brong Ahafo , Ghana
| | - John Williams
- g Population Department , Navrongo Health Research Centre, Ghana Health Service , Navrongo , Upper East , Ghana
| | - Cornelius Debpuur
- a Social Science Department , Navrongo Health Research Centre, Ghana Health Service , Navrongo , Upper East , Ghana
| | - Francis Yeji
- a Social Science Department , Navrongo Health Research Centre, Ghana Health Service , Navrongo , Upper East , Ghana
| | - Vida Ami Kukula
- h Maternal and Child Health Unit , Dodowa Health Research Centre, Ghana Health Service , Dodowa , Greater Accra , Ghana
| | - Yeetey Enuameh
- i Maternal and Child Health Unit, Kintampo Health Research Centre , Ghana Health Service , Kintampo , Brong Ahafo , Ghana
| | | | - Enoch Oti Agyekum
- k Japan International Cooperation Agency Health Section , Accra , Ghana
| | - Sheila Addai
- l Dodowa Health Research Centre , Ghana Health Service , Dodowa , Greater Accra , Ghana
| | - Doris Sarpong
- m Dodowa Health Research Centre and Regional Institute for Population Studies , University of Ghana , Accra , Ghana
| | - Kwame Adjei
- i Maternal and Child Health Unit, Kintampo Health Research Centre , Ghana Health Service , Kintampo , Brong Ahafo , Ghana
| | - Charlotte Tawiah
- n Maternal and Child Health Unit , Kintampo Health Research Centre , Kintampo , Brong Ahafo , Ghana
| | - Junko Yasuoka
- b Department of Community and Global Health , The University of Tokyo , Tokyo , Japan
| | - Keiko Nanishi
- o Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine , The University of Tokyo , Tokyo , Japan
| | - Masamine Jimba
- b Department of Community and Global Health , The University of Tokyo , Tokyo , Japan
| | - Abraham Hodgson
- p Research and Development Division , Ghana Health Service , Accra , Greater Accra , Ghana
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Shiratori S, Agyekum EO, Shibanuma A, Oduro A, Okawa S, Enuameh Y, Yasuoka J, Kikuchi K, Gyapong M, Owusu-Agyei S, Ansah E, Hodgson A, Jimba M. Motivation and incentive preferences of community health officers in Ghana: an economic behavioral experiment approach. Hum Resour Health 2016; 14:53. [PMID: 27549208 PMCID: PMC4994421 DOI: 10.1186/s12960-016-0148-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/04/2016] [Indexed: 05/09/2023]
Abstract
BACKGROUND Health worker shortage in rural areas is one of the biggest problems of the health sector in Ghana and many developing countries. This may be due to fewer incentives and support systems available to attract and retain health workers at the rural level. This study explored the willingness of community health officers (CHOs) to accept and hold rural and community job postings in Ghana. METHODS A discrete choice experiment was used to estimate the motivation and incentive preferences of CHOs in Ghana. All CHOs working in three Health and Demographic Surveillance System sites in Ghana, 200 in total, were interviewed between December 2012 and January 2013. Respondents were asked to choose from choice sets of job preferences. Four mixed logit models were used for the estimation. The first model considered (a) only the main effect. The other models included interaction terms for (b) gender, (c) number of children under 5 in the household, and (d) years worked at the same community. Moreover, a choice probability simulation was performed. RESULTS Mixed logit analyses of the data project a shorter time frame before study leave as the most important motivation for most CHOs (β 2.03; 95 % CI 1.69 to 2.36). This is also confirmed by the largest simulated choice probability (29.1 %). The interaction effect of the number of children was significant for education allowance for children (β 0.58; 95 % CI 0.24 to 0.93), salary increase (β 0.35; 95 % CI 0.03 to 0.67), and housing provision (β 0.16; 95 % CI -0.02 to 0.60). Male CHOs had a high affinity for early opportunity to go on study leave (β 0.78; 95 % CI -0.06 to 1.62). CHOs who had worked at the same place for a long time greatly valued salary increase (β 0.28; 95 % CI 0.09 to 0.47). CONCLUSIONS To reduce health worker shortage in rural settings, policymakers could provide "needs-specific" motivational packages. They should include career development opportunities such as shorter period of work before study leave and financial policy in the form of salary increase to recruit and retain them.
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Affiliation(s)
- Sakiko Shiratori
- Japan International Research Center for Agricultural Sciences, 1-1, Ohwashi, Tsukuba, Ibaraki 305-8686 Japan
| | - Enoch Oti Agyekum
- Japan International Cooperation Agency Health Section, 2nd Floor, The Elizabeth, No. 68A Senchi Link, Airport Residential Area, Accra, Ghana
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Abraham Oduro
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East Region Ghana
| | - Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Yeetey Enuameh
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo Region Ghana
- Department of Epidemiology & Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Kimiyo Kikuchi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo Region Ghana
| | - Evelyn Ansah
- Research and Development Division, Ghana Health Service, MB 190, Accra, Ghana
| | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, MB 190, Accra, Ghana
| | - Masamine Jimba
- Department 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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Enuameh YAK, Okawa S, Asante KP, Kikuchi K, Mahama E, Ansah E, Tawiah C, Adjei K, Shibanuma A, Nanishi K, Yeji F, Agyekum EO, Yasuoka J, Gyapong M, Oduro AR, Quansah Asare G, Hodgson A, Jimba M, Owusu-Agyei S. Factors Influencing Health Facility Delivery in Predominantly Rural Communities across the Three Ecological Zones in Ghana: A Cross-Sectional Study. PLoS One 2016; 11:e0152235. [PMID: 27031301 PMCID: PMC4816577 DOI: 10.1371/journal.pone.0152235] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 03/10/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Maternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan African countries. Both maternal and neonatal health outcomes improve when skilled personnel provide delivery services within health facilities. Determinants of delivery location are crucial to promoting health facility deliveries, but little research has been done on this issue in Ghana. This study explored factors influencing delivery location in predominantly rural communities in Ghana. METHODS Data were collected from 1,500 women aged 15-49 years with live or stillbirths that occurred between January 2011 and April 2013. This was done within the three sites operating Health and Demographic Surveillance Systems, i.e., the Dodowa (Greater Accra Region), Kintampo (Brong Ahafo Region), and Navrongo (Upper-East Region) Health Research Centers in Ghana. Multivariable logistic regression was used to identify the determinants of delivery location, controlling for covariates that were statistically significant in univariable regression models. RESULTS Of 1,497 women included in the analysis, 75.6% of them selected health facilities as their delivery location. After adjusting for confounders, the following factors were associated with health facility delivery across all three sites: healthcare provider's influence on deciding health facility delivery, (AOR = 13.47; 95% CI 5.96-30.48), place of residence (AOR = 4.49; 95% CI 1.14-17.68), possession of a valid health insurance card (AOR = 1.90; 95% CI 1.29-2.81), and socio-economic status measured by wealth quintiles (AOR = 2.83; 95% CI 1.43-5.60). CONCLUSION In addition to known factors such as place of residence, socio-economic status, and possession of valid health insurance, this study identified one more factor associated with health facility delivery: healthcare provider's influence. Ensuring care provider's counseling of clients could improve the uptake of health facility delivery in rural communities in Ghana.
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Affiliation(s)
| | - Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | - Kimiyo Kikuchi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Emmanuel Mahama
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | - Evelyn Ansah
- Research and Development Division, Ghana Health Service, P. O. Box MB 190, Accra, Ghana
| | - Charlotte Tawiah
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | - Kwame Adjei
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Keiko Nanishi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Francis Yeji
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana
| | | | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Margaret Gyapong
- Dodowa Health Research Centre, P.O. Box DD1, Dodowa, Greater Accra, Ghana
| | | | | | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, P. O. Box MB 190, Accra, Ghana
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113–0033, Tokyo, Japan
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
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