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Distance is “a big problem”: a geographic analysis of reported and modelled proximity to maternal health services in Ghana

Distance is “a big problem”: a geographic analysis of reported and modelled proximity to maternal health services in Ghana
Distance is “a big problem”: a geographic analysis of reported and modelled proximity to maternal health services in Ghana
Background: geographic barriers to healthcare are associated with adverse maternal health outcomes. Modelling travel times using georeferenced data is becoming common in quantifying physical access. Multiple Demographic and Health Surveys ask women about distance-related problems accessing healthcare, but responses have not been evaluated against modelled travel times. This cross-sectional study aims to compare reported and modelled distance by socio-demographic characteristics and evaluate their relationship with skilled birth attendance. Also, we assess the socio-demographic factors associated with self-reported distance problems in accessing healthcare.

Methods: distance problems and socio-demographic characteristics reported by 2,210 women via the 2017 Ghana Maternal Health Survey were included in analysis. Geospatial methods were used to model travel time to the nearest health facility using roads, rivers, land cover, travel speeds, cluster locations and health facility locations. Logistic regressions were used to predict skilled birth attendance and self-reported distance problems.

Results: women reporting distance challenges accessing healthcare had significantly longer travel times to the nearest health facility. Poverty significantly increased the odds of reporting challenges with distance. In contrast, living in urban areas and being registered with health insurance reduced the odds of reporting distance challenges. Women with a skilled attendant at birth, four or more skilled antenatal appointments and timely skilled postnatal care had shorter travel times to the nearest health facility. Generally, less educated, poor, rural women registered with health insurance had longer travel times to their nearest health facility. After adjusting for socio-demographic characteristics, the following factors increased the odds of skilled birth attendance: wealth, health insurance, higher education, living in urban areas, and completing four or more antenatal care appointments.

Conclusion: studies relying on modelled travel times to nearest facility should recognise the differential impact of geographic access to healthcare on poor rural women. Physical access to maternal health care should be scaled up in rural areas and utilisation increased by improving livelihoods.
Accessibility of health services, Childbirth, Geographic information systems, Healthcare disparities, Maternal health services, Spatial analysis
1471-2393
Dotse-Gborgbortsi, Winfred Worlanyo
11fe21e7-431a-442b-a8c7-6a7cb05176d9
Nilsen, Kristine
306e0bd5-8139-47db-be97-47fe15f0c03b
Ofosu, Anthony
32461b6f-8de7-4289-bd29-923f9f042d53
Matthews, Zoe
ebaee878-8cb8-415f-8aa1-3af2c3856f55
Tejedor Garavito, Natalia
26fd242c-c882-4210-a74d-af2bb6753ee3
Wright, Jim
94990ecf-f8dd-4649-84f2-b28bf272e464
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Dotse-Gborgbortsi, Winfred Worlanyo
11fe21e7-431a-442b-a8c7-6a7cb05176d9
Nilsen, Kristine
306e0bd5-8139-47db-be97-47fe15f0c03b
Ofosu, Anthony
32461b6f-8de7-4289-bd29-923f9f042d53
Matthews, Zoe
ebaee878-8cb8-415f-8aa1-3af2c3856f55
Tejedor Garavito, Natalia
26fd242c-c882-4210-a74d-af2bb6753ee3
Wright, Jim
94990ecf-f8dd-4649-84f2-b28bf272e464
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e

Dotse-Gborgbortsi, Winfred Worlanyo, Nilsen, Kristine, Ofosu, Anthony, Matthews, Zoe, Tejedor Garavito, Natalia, Wright, Jim and Tatem, Andrew (2022) Distance is “a big problem”: a geographic analysis of reported and modelled proximity to maternal health services in Ghana. BMC Pregnancy and Childbirth, 22 (1), [672]. (doi:10.1186/s12884-022-04998-0).

Record type: Article

Abstract

Background: geographic barriers to healthcare are associated with adverse maternal health outcomes. Modelling travel times using georeferenced data is becoming common in quantifying physical access. Multiple Demographic and Health Surveys ask women about distance-related problems accessing healthcare, but responses have not been evaluated against modelled travel times. This cross-sectional study aims to compare reported and modelled distance by socio-demographic characteristics and evaluate their relationship with skilled birth attendance. Also, we assess the socio-demographic factors associated with self-reported distance problems in accessing healthcare.

Methods: distance problems and socio-demographic characteristics reported by 2,210 women via the 2017 Ghana Maternal Health Survey were included in analysis. Geospatial methods were used to model travel time to the nearest health facility using roads, rivers, land cover, travel speeds, cluster locations and health facility locations. Logistic regressions were used to predict skilled birth attendance and self-reported distance problems.

Results: women reporting distance challenges accessing healthcare had significantly longer travel times to the nearest health facility. Poverty significantly increased the odds of reporting challenges with distance. In contrast, living in urban areas and being registered with health insurance reduced the odds of reporting distance challenges. Women with a skilled attendant at birth, four or more skilled antenatal appointments and timely skilled postnatal care had shorter travel times to the nearest health facility. Generally, less educated, poor, rural women registered with health insurance had longer travel times to their nearest health facility. After adjusting for socio-demographic characteristics, the following factors increased the odds of skilled birth attendance: wealth, health insurance, higher education, living in urban areas, and completing four or more antenatal care appointments.

Conclusion: studies relying on modelled travel times to nearest facility should recognise the differential impact of geographic access to healthcare on poor rural women. Physical access to maternal health care should be scaled up in rural areas and utilisation increased by improving livelihoods.

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More information

e-pub ahead of print date: 31 August 2022
Published date: 31 August 2022
Additional Information: Funding Information: Economic and Social Research Council (grant number ES/P000673/1). Funding Information: Bill and Melinda Gates Foundation (grant number INV-007594). Funding Information: We are thankful to the Bill and Melinda Gates Foundation (grant number INV-007594) and Economic and Social Research Council (grant number ES/P000673/1) for funding this study. Publisher Copyright: © 2022, The Author(s).
Keywords: Accessibility of health services, Childbirth, Geographic information systems, Healthcare disparities, Maternal health services, Spatial analysis

Identifiers

Local EPrints ID: 470248
URI: http://eprints.soton.ac.uk/id/eprint/470248
ISSN: 1471-2393
PURE UUID: 36b4f8c8-affe-40db-b749-bdb000cd4c9b
ORCID for Winfred Worlanyo Dotse-Gborgbortsi: ORCID iD orcid.org/0000-0001-7627-1809
ORCID for Kristine Nilsen: ORCID iD orcid.org/0000-0003-2009-4019
ORCID for Zoe Matthews: ORCID iD orcid.org/0000-0003-1533-6618
ORCID for Natalia Tejedor Garavito: ORCID iD orcid.org/0000-0002-1140-6263
ORCID for Jim Wright: ORCID iD orcid.org/0000-0002-8842-2181
ORCID for Andrew Tatem: ORCID iD orcid.org/0000-0002-7270-941X

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Date deposited: 05 Oct 2022 16:34
Last modified: 13 Jan 2023 02:58

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