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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, 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.
1360-2276
Dotse-Gborgbortsi, Winfred Worlanyo
11fe21e7-431a-442b-a8c7-6a7cb05176d9
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Alegana, Victor
f5bd6ab7-459e-4122-984f-2bdb5f906d82
Utazi, Chigozie
e69ca81e-fb23-4bc1-99a5-25c9e0f4d6f9
Ruktanonchai, Corrine Warren
a576fb11-a475-4d48-885a-85938b60a7a8
Wright, James
94990ecf-f8dd-4649-84f2-b28bf272e464
Dotse-Gborgbortsi, Winfred Worlanyo
11fe21e7-431a-442b-a8c7-6a7cb05176d9
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Alegana, Victor
f5bd6ab7-459e-4122-984f-2bdb5f906d82
Utazi, Chigozie
e69ca81e-fb23-4bc1-99a5-25c9e0f4d6f9
Ruktanonchai, Corrine Warren
a576fb11-a475-4d48-885a-85938b60a7a8
Wright, James
94990ecf-f8dd-4649-84f2-b28bf272e464

Dotse-Gborgbortsi, Winfred Worlanyo, Tatem, Andrew, Alegana, Victor, Utazi, Chigozie, Ruktanonchai, Corrine Warren and Wright, James (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. (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, 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.

Full text not available from this repository.

More information

e-pub ahead of print date: 7 July 2020

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 Worlanyo Dotse-Gborgbortsi: ORCID iD orcid.org/0000-0001-7627-1809
ORCID for Andrew Tatem: ORCID iD orcid.org/0000-0002-7270-941X
ORCID for Victor Alegana: ORCID iD orcid.org/0000-0001-5177-9227
ORCID for James Wright: ORCID iD orcid.org/0000-0002-8842-2181

Catalogue record

Date deposited: 10 Jul 2020 16:31
Last modified: 29 Jul 2020 01:53

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