Background Many women still deliver outside a health facility in Ghana, often under unhygienic conditions and without skilled birth attendants. This study aims to examine the social determinants influencing the use of health facility delivery among reproductive-aged women in Ghana. Methods Nationally representative data from the 2014 Ghana Demographic and Health Survey was used to fit univariable and multivariable logistic regression models to estimate the influence of the social determinants on health facility delivery. Andresen’s health care utilization model was used as the conceptual framework guiding this study.. Results Only 72% of deliveries take place at a health facility in Ghana. The results of the adjusted model indicate that place of residence, financial status, education, religion, parity and perceived need were significantly associated with health facility delivery. First, urban women had a higher likelihood of health facility delivery than rural women (Adjusted Odds ratio [AOR] =2.21; 95% Confidence interval [CI] = 1.53–3.19). Second, middle-class and rich women were 1.57 (95%CI = 1.18–2.08) times and 6.91 (95%CI = 4.12–11.59) times, respectively more likely to deliver at health facility compared to the poor. Third, women with either at least secondary education (AOR = 2.04; 95%CI = 1.57–2.64) or primary education (AOR = 1.39, 95%CI = 1.02–1.92) were more likely to deliver at health facility than women with no education. In terms of parity, first time mothers were 1.58 (95% CI = 1.18–2.12) times more likely to deliver at health facility than those who had given birth three or more times before. Finally, regarding perceived need, women who were aware of pregnancy complications were 1.32 (95%CI = 1.02–1.70) times more likely to use health facility delivery than those who were not informed about pregnancy complications. Conclusions First, in spite of Ghana’s free maternal health services policy, poorer women were much less likely to have a health facility delivery, which points to the need to understand the indirect costs and other financial barriers preventing women from delivering at a health facility. Second, many of the identified variables influence the demand and not just the supply for health care services, and highlight the importance of the social determinants of health and investments in interventions that extend beyond improving physical access.
BackgroundInappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana’s high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it.MethodsData from the nationally representative 2014 Ghana Demographic and Health Survey (GDHS) was used after permission from the Monitoring and Evaluation to Assess and Use Results (MEASURE) Demographic and Health Survey (DHS) program. Univariable and multivariable logistic regression models were fitted to examine the socioeconomic inequalities in CS use. The independent variables included maternal age, marital status, religion, ethnicity, education, place of residence, wealth quintile, and working status. Concentration index (CI) and rate-ratios were computed to ascertain the level of CS inequalities.ResultsOut of the 4294 women, 11.4% had CS delivery. However, the percentage of CS delivery ranged from 5% of women in the poorest quintile to 27.5% of women in the richest qunitle. Significant associations were detected between CS delivery and maternal age, parity, education, and wealth quintile .ConclusionsThis study revealed that first, even though Ghana has achieved an aggregate CS rate consistent with WHO recommendations, it still suffers from inequities in the use of CS. Second, both underuse of CS among poorer women in Ghana and overuse among rich and educated women are public health concerns that need to be addressed. Third, the results show in spite of Ghana’s free maternal care services policies, wealth status of women continues to be strongly and signtificantly associated with CS delivery, indicating that there are indirect health care costs and other reasons preventing poorer women from having access to CS which should be understood better and addressed with appropriate policies.
Women who are employed, cohabit with a partner and are considered middle class or wealthy are more likely than their counterparts to report having terminated a pregnancy. Ghanaian women with intermediate levels of education are more likely than both their more- and less-educated counterparts to report having terminated a pregnancy. These findings highlight the need for the development of policies aimed at reducing unsafe abortions associated with unintended pregnancies. Specific recommendations include providing family planning education and outreach to high-risk groups to reduce unintended pregnancies and improving working conditions for expectant mothers, including provisions for paid maternity leave and job protection.
Background Inequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives. Methods The 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage. Results This study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44–0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability. Conclusion The findings of this study indicate that community-level factors have an influence on women’s health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.
Objective: To investigate the sociodemographic determinants of adolescent childbearing in Ghana.Methods: This research studied reproductive-aged women who were systematically sampled in Ghana. Kaplan Meier and Cox proportional hazard regression with shared frailty were fitted on a nationwide population-based data from the 2014 Ghana Demographic and Health Survey (GDHS) to predict adolescent childbirth.Results: The analysis revealed that approximately 49% initiated childbirth during adolescence. This study found higher adolescent childbirth rates among women who were not working (adjusted hazard ratio (AHR) =1.17; 95% confidence interval (CI) = 1.07 to 1.29) and resided in rural areas (AHR =1.22; 95% CI = 1.09 to 1.37). In addition, poor women (AHR= 1.71; 95% CI = 1.49 to 1.95) and middle-class women (AHR=1.67; 95% CI = 1.48 to 1.88) had a higher likelihood of having adolescent birth compared to the rich. Lastly, secondary and higher educated women were 0.74 (95% CI= 0.67 to 0.82) and 0.10 (95% CI= 0.06 to 0.16) times less likely to have adolescent birth, respectively.Conclusions: This research revealed that adolescent childbearing was greatly influenced by socioeconomically disadvantaged background within the contexts of the women and the community in which they reside. This finding suggests the need to initiate and improve interventions that seek to reduce poverty among women and to promote and encourage adolescent girls to pursue secondary and higher education to help reduce unintended adolescent childbirths. Finally, adolescent girls should be empowered through counseling and education on reproductive and sexual health options and rights to ensure more informed decision-making about contraception.
BackgroundInequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives.MethodsThe 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage. ResultsThis study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44 - 0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability.ConclusionThe findings of this study indicate that community-level factors have an influence on women’s health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.
Background Ghana is currently experiencing higher body mass index (BMI), that is overweight and obesity, among reproductive-aged women. However, understanding the role of socioeconomic status in the high BMI among this cohort has not been studied extensively in Ghana and the few existing studies in the country have generated mixed results. This study aims to examine household wealth inequalities in high BMI among Ghanaian women of childbearing age. Methods The 2014 Ghana Demography and Health Survey (GDHS) dataset was analyzed. A univariable and multivariable regression model with a logit link function was specified to ascertain the effect of household wealth inequalities in high BMI among Ghanaian women. Furthermore, concentration index and curve were used to measure the degree of household wealth inequalities in high BMI among reproductive aged women. Results This study found high BMI prevalence of 35.9 percent with significant household wealth-related inequalities (Concentration index = 0.24, 95%CI (confidence interval): 0.22–0.26). The analysis revealed that high BMI is concentrated among wealthier women. Compared to poorest women, poorer (AOR (Adjusted odds ratio) = 2.18, 95%CI: 1.66–2.85), middle-class (AOR = 4.44, 95%CI: 3.24–6.09), richer (AOR = 7.75, 95%CI: 5.53–10.86) and richest (AOR = 11.03, 95%CI: 8.07–15.06) women were more likely to have high BMI. On top of that, socioeconomic characteristics including age, marital status, and education of reproductive-aged women were significantly associated with high BMI. Conclusions The research revealed that a woman from a wealthier household had higher likelihood of having high BMI relative to those from a less wealthy household. Also, women who were educated and cohabiting, formerly or currently married had an increased risk of having high BMI. This observation suggests targeted policy interventions and programs that promote healthy body weight to reduce the high BMI prevalence among women of childbearing age in Ghana.
BackgroundInequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives.MethodsThe 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage. ResultsThis study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44 - 0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability.ConclusionThe findings of this study indicate that community-level factors have an influence on women’s health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.
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