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The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana

The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana
The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana
Objectives: Skilled birth attendance is the single most important intervention to reduce maternal mortality. However, studies have not used routinely collected health service birth data at named health facilities to understand the influence of distance and quality of care on childbirth service utilisation. Thus, this paper aims to quantify the influence of distance and quality of healthcare on utilisation of birthing services using routine health data in Eastern Region, Ghana.

Methods: We used a spatial interaction model (a model that predicts movement from one place to another) drawing on routine birth data, emergency obstetric care surveys, gridded estimates of number of pregnancies and health facility location. We compared travel distances by sociodemographic characteristics and mapped movement patterns.

Results: A kilometre increase in distance significantly reduced the prevalence rate of the number of women giving birth in health facilities by 6.7%. Although quality care increased the number of women giving birth in health facilities, its association was insignificant. Women travelled further than expected to give birth at facilities, on average journeying 4.7 km beyond the nearest facility with a recorded birth. Women in rural areas travelled 4 km more than urban women to reach a hospital. We also observed that 56% of women bypassed the nearest hospital to their community.

Conclusion: This analysis provides substantial opportunities for health planners and managers to understand further patterns of skilled birth service utilisation, and demonstrates the value of routine health data. Also, it provides evidence based information for improving maternal health service provision by targeting specific communities and health facilities.
epidemiology, geographic information systems, maternal health, obstetrics, public health
2059-7908
Dotse-Gborgbortsi, Winfred, Worlanyo
11fe21e7-431a-442b-a8c7-6a7cb05176d9
Dwomoh, Duah
0d2e9843-b757-471f-8503-05e26bb4b4bd
Alegana, Victor
f5bd6ab7-459e-4122-984f-2bdb5f906d82
Hill, A G
5b17aa71-0c14-4fbf-8bc9-807c8294d4ae
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Wright, James
94990ecf-f8dd-4649-84f2-b28bf272e464
Dotse-Gborgbortsi, Winfred, Worlanyo
11fe21e7-431a-442b-a8c7-6a7cb05176d9
Dwomoh, Duah
0d2e9843-b757-471f-8503-05e26bb4b4bd
Alegana, Victor
f5bd6ab7-459e-4122-984f-2bdb5f906d82
Hill, A G
5b17aa71-0c14-4fbf-8bc9-807c8294d4ae
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Wright, James
94990ecf-f8dd-4649-84f2-b28bf272e464

Dotse-Gborgbortsi, Winfred, Worlanyo, Dwomoh, Duah, Alegana, Victor, Hill, A G, Tatem, Andrew and Wright, James (2020) The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana. BMJ Global Health, 4 (e002020), [e002020]. (doi:10.1136/bmjgh-2019-002020).

Record type: Article

Abstract

Objectives: Skilled birth attendance is the single most important intervention to reduce maternal mortality. However, studies have not used routinely collected health service birth data at named health facilities to understand the influence of distance and quality of care on childbirth service utilisation. Thus, this paper aims to quantify the influence of distance and quality of healthcare on utilisation of birthing services using routine health data in Eastern Region, Ghana.

Methods: We used a spatial interaction model (a model that predicts movement from one place to another) drawing on routine birth data, emergency obstetric care surveys, gridded estimates of number of pregnancies and health facility location. We compared travel distances by sociodemographic characteristics and mapped movement patterns.

Results: A kilometre increase in distance significantly reduced the prevalence rate of the number of women giving birth in health facilities by 6.7%. Although quality care increased the number of women giving birth in health facilities, its association was insignificant. Women travelled further than expected to give birth at facilities, on average journeying 4.7 km beyond the nearest facility with a recorded birth. Women in rural areas travelled 4 km more than urban women to reach a hospital. We also observed that 56% of women bypassed the nearest hospital to their community.

Conclusion: This analysis provides substantial opportunities for health planners and managers to understand further patterns of skilled birth service utilisation, and demonstrates the value of routine health data. Also, it provides evidence based information for improving maternal health service provision by targeting specific communities and health facilities.

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Accepted/In Press date: 9 January 2020
Published date: 10 February 2020
Keywords: epidemiology, geographic information systems, maternal health, obstetrics, public health

Identifiers

Local EPrints ID: 437935
URI: http://eprints.soton.ac.uk/id/eprint/437935
ISSN: 2059-7908
PURE UUID: 65591f40-2941-4eef-ac58-82340f46ee9e
ORCID for Winfred, Worlanyo Dotse-Gborgbortsi: ORCID iD orcid.org/0000-0001-7627-1809
ORCID for Victor Alegana: ORCID iD orcid.org/0000-0001-5177-9227
ORCID for A G Hill: ORCID iD orcid.org/0000-0002-4418-0379
ORCID for Andrew Tatem: ORCID iD orcid.org/0000-0002-7270-941X
ORCID for James Wright: ORCID iD orcid.org/0000-0002-8842-2181

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Date deposited: 24 Feb 2020 17:31
Last modified: 08 Oct 2020 16:30

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