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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Spatial inequalities in skilled attendance at birth in Ghana
T2 - a multilevel analysis integrating health facility databases with household survey data
AU - Dotse-Gborgbortsi, W.
AU - Tatem, A.J.
AU - Alegana, V.
AU - Utazi, C.E.
AU - Ruktanonchai, C.W.
AU - Wright, J.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - 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. © 2020 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd
AB - 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. © 2020 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd
KW - EmONC
KW - GIS
KW - maternal health
KW - quality care
KW - skilled birth attendance
KW - travel time
KW - adult
KW - article
KW - controlled study
KW - demography
KW - female
KW - Ghana
KW - health survey
KW - household
KW - human
KW - human experiment
KW - human tissue
KW - maternal welfare
KW - multilevel analysis
KW - observational study
KW - primary medical care
KW - probability
KW - secondary care center
KW - travel
KW - urban area
U2 - 10.1111/tmi.13460
DO - 10.1111/tmi.13460
M3 - Journal article
VL - 25
SP - 1044
EP - 1054
JO - Tropical Medicine and International Health
JF - Tropical Medicine and International Health
SN - 1360-2276
IS - 9
ER -