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Spatial inequalities in skilled attendance at birth in Ghana: a multilevel analysis integrating health facility databases with household survey data

Spatial inequalities in skilled attendance at birth in Ghana: a multilevel analysis integrating health facility databases with household survey data
Spatial inequalities in skilled attendance at birth in Ghana: a multilevel analysis integrating health facility databases with household survey data

Objective: this study aimed at using survey data to predict skilled attendance at birth (SBA) across Ghana from healthcare quality and health facility accessibility. 

Methods: through a cross-sectional, observational study, we used a random intercept mixed effects multilevel logistic modelling approach to estimate the odds of having SBA and then applied model estimates to spatial layers to assess the probability of SBA at high-spatial resolution across Ghana. We combined data from the Demographic and Health Survey (DHS), routine birth registers, a service provision assessment of emergency obstetric care services, gridded population estimates and modelled travel time to health facilities. 

Results: within an hour's travel, 97.1% of women sampled in the DHS could access any health facility, 96.6% could reach a facility providing birthing services, and 86.2% could reach a secondary hospital. After controlling for characteristics of individual women, living in an urban area and close proximity to a health facility with high-quality services were significant positive determinants of SBA uptake. The estimated variance suggests significant effects of cluster and region on SBA as 7.1% of the residual variation in the propensity to use SBA is attributed to unobserved regional characteristics and 16.5% between clusters within regions. 

Conclusion: given the expansion of primary care facilities in Ghana, this study suggests that higher quality healthcare services, as opposed to closer proximity of facilities to women, is needed to widen SBA uptake and improve maternal health.

EmONC, GIS, maternal health, quality care, skilled birth attendance, travel time
1360-2276
1044-1054
Dotse-Gborgbortsi, Winfred
02d3e356-268e-4650-9fb9-9638ccdb6eff
Tatem, Andrew J.
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Alegana, Victor
f5bd6ab7-459e-4122-984f-2bdb5f906d82
Utazi, C. Edson
e69ca81e-fb23-4bc1-99a5-25c9e0f4d6f9
Ruktanonchai, Corrine Warren
a576fb11-a475-4d48-885a-85938b60a7a8
Wright, Jim
94990ecf-f8dd-4649-84f2-b28bf272e464
Dotse-Gborgbortsi, Winfred
02d3e356-268e-4650-9fb9-9638ccdb6eff
Tatem, Andrew J.
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Alegana, Victor
f5bd6ab7-459e-4122-984f-2bdb5f906d82
Utazi, C. Edson
e69ca81e-fb23-4bc1-99a5-25c9e0f4d6f9
Ruktanonchai, Corrine Warren
a576fb11-a475-4d48-885a-85938b60a7a8
Wright, Jim
94990ecf-f8dd-4649-84f2-b28bf272e464

Dotse-Gborgbortsi, Winfred, Tatem, Andrew J., Alegana, Victor, Utazi, C. Edson, Ruktanonchai, Corrine Warren and Wright, Jim (2020) Spatial inequalities in skilled attendance at birth in Ghana: a multilevel analysis integrating health facility databases with household survey data. Tropical Medicine & International Health, 25 (9), 1044-1054. (doi:10.1111/tmi.13460).

Record type: Article

Abstract

Objective: this study aimed at using survey data to predict skilled attendance at birth (SBA) across Ghana from healthcare quality and health facility accessibility. 

Methods: through a cross-sectional, observational study, we used a random intercept mixed effects multilevel logistic modelling approach to estimate the odds of having SBA and then applied model estimates to spatial layers to assess the probability of SBA at high-spatial resolution across Ghana. We combined data from the Demographic and Health Survey (DHS), routine birth registers, a service provision assessment of emergency obstetric care services, gridded population estimates and modelled travel time to health facilities. 

Results: within an hour's travel, 97.1% of women sampled in the DHS could access any health facility, 96.6% could reach a facility providing birthing services, and 86.2% could reach a secondary hospital. After controlling for characteristics of individual women, living in an urban area and close proximity to a health facility with high-quality services were significant positive determinants of SBA uptake. The estimated variance suggests significant effects of cluster and region on SBA as 7.1% of the residual variation in the propensity to use SBA is attributed to unobserved regional characteristics and 16.5% between clusters within regions. 

Conclusion: given the expansion of primary care facilities in Ghana, this study suggests that higher quality healthcare services, as opposed to closer proximity of facilities to women, is needed to widen SBA uptake and improve maternal health.

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Tropical Med Int Health - 2020 - Dotse‐Gborgbortsi - Spatial inequalities in skilled attendance at birth in Ghana a - Version of Record
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e-pub ahead of print date: 7 July 2020
Published date: 18 July 2020
Additional Information: Funding Information: this study was supported by the Economic and Social Research Council through the South Coast Doctoral Training Partnership (grant number ES/P000673/1).VA is supported by a Wellcome Trust Fellowship (number 211208). We are grateful to the Ghana Health Service for releasing their data to enable this analysis.
Keywords: EmONC, GIS, maternal health, quality care, skilled birth attendance, travel time

Identifiers

Local EPrints ID: 442281
URI: http://eprints.soton.ac.uk/id/eprint/442281
ISSN: 1360-2276
PURE UUID: b9067045-bc02-4e24-a00f-cef634ec4712
ORCID for Winfred Dotse-Gborgbortsi: ORCID iD orcid.org/0000-0001-7627-1809
ORCID for Andrew J. Tatem: ORCID iD orcid.org/0000-0002-7270-941X
ORCID for Victor Alegana: ORCID iD orcid.org/0000-0001-5177-9227
ORCID for Jim Wright: ORCID iD orcid.org/0000-0002-8842-2181

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Date deposited: 10 Jul 2020 16:31
Last modified: 10 Apr 2024 02:12

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Contributors

Author: Winfred Dotse-Gborgbortsi ORCID iD
Author: Andrew J. Tatem ORCID iD
Author: Victor Alegana ORCID iD
Author: C. Edson Utazi
Author: Corrine Warren Ruktanonchai
Author: Jim Wright ORCID iD

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