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Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data

Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data
Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data
Objectives: to investigate how the quality of maternal health services and travel times to health facilities affect birthing service utilisation in Eastern Region, Ghana.

Design: the study is a cross-sectional spatial interaction analysis of birth service utilisation patterns. Routine birth data were spatially linked to quality care, service demand and travel time data.

Setting: 131 Health facilities (public, private and faith-based) in 33 districts in Eastern Region, Ghana.

Participants: women who gave birth in health facilities in the Eastern Region, Ghana in 2017.

Outcome measures: the count of women giving birth, the quality of birthing care services and the geographic coverage of birthing care services.

Results: as travel time from women’s place of residence to the health facility increased up to two2 hours, the utilisation rate markedly decreased. Higher quality of maternal health services haves a larger, positive effect on utilisation rates than service proximity. The quality of maternal health services was higher in hospitals than in primary care facilities. Most women (88.6%) travelling via mechanised transport were within two2 hours of any birthing service. The majority (56.2%) of women were beyond the two2 -hour threshold of critical comprehensive emergency obstetric and newborn care (CEmONC) services. Few CEmONC services were in urban centres, disadvantaging rural populations.

Conclusions: so increase birthing service utilisation in Ghana, higher quality health facilities should be located closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to understand the interaction of service proximity and quality.
epidemiology, health policy, maternal medicine, public health
2044-6055
e066792
Dotse-Gborgbortsi, Winfred
02d3e356-268e-4650-9fb9-9638ccdb6eff
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Matthews, Zoe
ebaee878-8cb8-415f-8aa1-3af2c3856f55
Alegana, Victor A.
17871690-1cac-4acd-9371-31c71cded2f4
Ofosu, Anthony
32461b6f-8de7-4289-bd29-923f9f042d53
Wright, Jim
94990ecf-f8dd-4649-84f2-b28bf272e464
Dotse-Gborgbortsi, Winfred
02d3e356-268e-4650-9fb9-9638ccdb6eff
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Matthews, Zoe
ebaee878-8cb8-415f-8aa1-3af2c3856f55
Alegana, Victor A.
17871690-1cac-4acd-9371-31c71cded2f4
Ofosu, Anthony
32461b6f-8de7-4289-bd29-923f9f042d53
Wright, Jim
94990ecf-f8dd-4649-84f2-b28bf272e464

Dotse-Gborgbortsi, Winfred, Tatem, Andrew, Matthews, Zoe, Alegana, Victor A., Ofosu, Anthony and Wright, Jim (2023) Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data. BMJ Open, 13 (1), e066792, [e066792]. (doi:10.1136/bmjopen-2022-066792).

Record type: Article

Abstract

Objectives: to investigate how the quality of maternal health services and travel times to health facilities affect birthing service utilisation in Eastern Region, Ghana.

Design: the study is a cross-sectional spatial interaction analysis of birth service utilisation patterns. Routine birth data were spatially linked to quality care, service demand and travel time data.

Setting: 131 Health facilities (public, private and faith-based) in 33 districts in Eastern Region, Ghana.

Participants: women who gave birth in health facilities in the Eastern Region, Ghana in 2017.

Outcome measures: the count of women giving birth, the quality of birthing care services and the geographic coverage of birthing care services.

Results: as travel time from women’s place of residence to the health facility increased up to two2 hours, the utilisation rate markedly decreased. Higher quality of maternal health services haves a larger, positive effect on utilisation rates than service proximity. The quality of maternal health services was higher in hospitals than in primary care facilities. Most women (88.6%) travelling via mechanised transport were within two2 hours of any birthing service. The majority (56.2%) of women were beyond the two2 -hour threshold of critical comprehensive emergency obstetric and newborn care (CEmONC) services. Few CEmONC services were in urban centres, disadvantaging rural populations.

Conclusions: so increase birthing service utilisation in Ghana, higher quality health facilities should be located closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to understand the interaction of service proximity and quality.

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Accepted/In Press date: 5 January 2023
Published date: 18 January 2023
Additional Information: Funding Information: The study was funded by the Economic and Social Research Council (ESRC), UK (grant number ES/P000673/1) through the South Coast Doctoral Training Partnership. Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Keywords: epidemiology, health policy, maternal medicine, public health

Identifiers

Local EPrints ID: 474508
URI: http://eprints.soton.ac.uk/id/eprint/474508
ISSN: 2044-6055
PURE UUID: 08bc0aef-ec52-431b-9d01-53876a1cd842
ORCID for Winfred Dotse-Gborgbortsi: ORCID iD orcid.org/0000-0001-7627-1809
ORCID for Andrew Tatem: ORCID iD orcid.org/0000-0002-7270-941X
ORCID for Zoe Matthews: ORCID iD orcid.org/0000-0003-1533-6618
ORCID for Jim Wright: ORCID iD orcid.org/0000-0002-8842-2181

Catalogue record

Date deposited: 23 Feb 2023 17:40
Last modified: 12 Jun 2024 02:09

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Contributors

Author: Winfred Dotse-Gborgbortsi ORCID iD
Author: Andrew Tatem ORCID iD
Author: Zoe Matthews ORCID iD
Author: Victor A. Alegana
Author: Anthony Ofosu
Author: Jim Wright ORCID iD

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