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
Dotse-Gborgbortsi, Winfred
02d3e356-268e-4650-9fb9-9638ccdb6eff
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
10 February 2020
Dotse-Gborgbortsi, Winfred
02d3e356-268e-4650-9fb9-9638ccdb6eff
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, 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).
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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The influence of distance and quality
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Accepted/In Press date: 9 January 2020
Published date: 10 February 2020
Additional Information:
Funding Information:
Funding Wellcome Trust (grant number: 204613/Z/16/Z) and UK Department for International Development (DFID). VA is funded through a Wellcome Trust Fellowship (number 211208). Part of this work was done during WDG’s time as a Commonwealth Scholar and currently supported by the Economic and Social Research Council through the South Coast Doctoral Training Partnership (grant number ES/P000673/1).
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© 2020 Author(s) (or their employer(s)). Re-use permitted under CC BY. Published by BMJ.
Keywords:
epidemiology, geographic information systems, maternal health, obstetrics, public health
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Local EPrints ID: 437935
URI: http://eprints.soton.ac.uk/id/eprint/437935
ISSN: 2059-7908
PURE UUID: 65591f40-2941-4eef-ac58-82340f46ee9e
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Date deposited: 24 Feb 2020 17:31
Last modified: 17 Nov 2023 03:08
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Author:
Winfred Dotse-Gborgbortsi
Author:
Duah Dwomoh
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