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

Dotse‐Gborgbortsi, Winfred; Tatem, Andrew J.; Matthews, Zoë; Alegana, Victor; Ofosu, Anthony; Wright, Jim A.

doi:10.1136/bmjopen-2022-066792

Cited by 3 publications

(4 citation statements)

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“…According to the findings, socio-demographic factors such as women's marital status, age, education, religious background, and distance have a significant relationship with mothers' use of health-care delivery services. The findings corroborated Dalaba et al [8] and Dotse-Gborgbortsi et al 's [12] findings that married women received assistance from their husbands during delivery to the nearest health facility. According to Banchani and Tenkorang [38], as well as Bellerose et al [39], studies conducted in rural Africa revealed that husbands' religious backgrounds influenced mothers' use of skill delivery.…”

Section: Discussionsupporting

confidence: 86%

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Maternal and child health care access to skilled delivery services among Ghanaian rural mothers

Adongo,

Dapaah,

Azumah

et al. 2024

Res Health Serv Reg

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Introduction Most new-born babies are born at home in rural communities which is not new phenomenon due to lack of access to primary healthcare services and trained skilled health attendants, exposing mothers and children to a high risk of labour complications. The purpose of this study was to better understand factors influence rural women's access to primary health care and skilled delivery services as well as their reasons for using or not using maternal health care and skilled delivery services. Methods The study employed a social survey design with a quantitative approach to data analysis. Cluster Sampling was used, possibly based on rural communities, to efficiently collect data from different geographic locations. Simple random sampling individuals from each cluster ensures that all eligible individuals have an equal chance of being included in the study. This enhances the representativity of the sample. A total of 366 mothers were selected from four rural communities in the North East Region of Ghana. The choice of sample size considered factors like the study's objectives, available resources, and the desired level of statistical power. Data was primarily gathered through the administration of a questionnaire to the respondents. Factors considered for achieving representativity include, geographic representation, accessibility, healthcare infrastructure and healthcare professionals’ attitudes. Findings The study found that distance to health centres limits women's access to skilled delivery services. Lack of primary health facilities in the rural communities hamper maternal and child care services delivery. The attitude of health care professionals determines a mother’s utilisation of maternal health care and skilled delivery services. Conclusion The study contributes to the limited research on maternal health services and their impact on mother and child health in the study area. This study is one of the first to investigate into maternal health care as a key predictor of mother and child health in the study area. The study's theoretical lens was the Andersen and Newman Health Behavioural Model theory, which supports the explanation of distance, lack of primary health centres, attitudes and lack of skilled personnel to the non-utilisation of maternal and health services in rural communities. The study recommended that primary healthcare facilities and trained health professionals should be a priority of government in rural communities to promote maternal and child healthcare.

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Section: Discussionsupporting

confidence: 86%

“…Maternal health service quality has a greater positive effect on utilisation rates than service proximity. Also, the quality of maternal health care in hospitals were higher than in primary care facilities [12]. Similarly, the cost of medications may discourage mothers from seeking maternal healthcare services.…”

Section: Introductionmentioning

confidence: 99%

Maternal and child health care access to skilled delivery services among Ghanaian rural mothers

Adongo,

Dapaah,

Azumah

et al. 2024

Res Health Serv Reg

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“…This study linked individual women from maternal consultation registers and surveys to their village of residence, and we accurately estimated their travel time to the nearest PHC through a combination of participatory mapping and fieldwork. These methods are in line with recent approaches for service area analysis in sub-Saharan Africa, which aim to analyze patients' addresses from health facility data to help delineate their catchment areas and identify populations who may experience challenges in accessing maternal care [39,40].…”

Section: Discussionmentioning

confidence: 89%

Persistence of geographic barriers to maternal care services following a health system strengthening initiative in rural Madagascar

Ihantamalala,

Randriamihaja,

Miller

et al. 2023

Preprint

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Geographic access to healthcare continues to pose a significant challenge for pregnant women in rural areas of sub-Saharan Africa, resulting in consistently high rates of maternal mortality. Geographic barriers can persist even in settings where financial barriers have been reduced and health system strengthening (HSS) efforts are in place. The aim of this study is to combine analyses of a population-representative cohort and geolocated maternal consultation data at the village level to gain a precise understanding of spatiotemporal changes in the utilization of maternal care services in a rural district of Madagascar benefiting from HSS support. We collected monthly information on antenatal care visits, deliveries and postnatal visits from the registries of 18 primary care health centers in Ifanadiana District, from 2016 to 2018. Similar data were collected from a district-representative cohort via surveys on over 1500 households done in 2016 and 2018. We estimated precise travel time from each village to the nearest health center to understand spatio-temporal variations in maternal care access, and to assess the impact of geographic barriers via statistical analyses. Women who lived within a one-hour walk from a health facility in the HSS catchment area had rates of per capita utilization of most maternal health services were roughly twice that those who lived 1-2 hours away and three times higher than those who lived over 2 hours away. The exception was the first antenatal care visit (ANC1), for which travel time had more modest effect. Improvements to primary care services due to HSS in this setting were only observed among women living within two hours from health centers. Statistical models revealed that ravel of women time from a health facility was the strongest determinant of maternal care service utilization. This study shows how a combination of geo-located health system information and population-representative data can help assess the impact of geographical barriers to maternal care in rural areas of sub-Saharan Africa. It highlights that women who live more than 2 hours from a health facility had virtually no access to maternal health services despite efforts in place to reduce financial barriers to care and strengthen the health system.

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“…Therefore, working with existing government institutions to deliver agriculture, health, education, social protection and livelihood empowerment services addresses the interlinked underlying causes of malnutrition (Gillespie et al 2015). This is important in Ghana, where access to the health and agriculture services of government institutions is limited in rural areas (Abdallah and Abdul-Rahaman 2016;Colecraft, et al 2022;Dotse-Gborgbortsi et al 2023).…”

Section: Discussionmentioning

confidence: 99%

Perceptions and experiences of an intervention to improve diets of women and young children in Ghana

Kushitor,

Ewa,

Dadzie

et al. 2024

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BackgroundEfficacious integrated intervention strategies to address the drivers of malnutrition at multiple levels are hardly implemented at scale, although opportunities for cross-sectoral action exist. In 2020, the Improved Feeding Practices (IFP) Project was implemented in Ghana to improve the dietary diversity and well-being of women of reproductive age (15-49 years) and children >2 years.ObjectiveThis paper reports the perceptions and experiences of project beneficiaries and the lessons learned from the IFP project.MethodsUsing a socio-ecological framework, data from the IFP project documents (n=8) and in-depth interviews with key stakeholders, including local government officers, and direct and indirect beneficiaries (n=61), were triangulated to construct an evidence-based overview of the implementation of the complementary strategies of the IFP project. The interviews explored respondents' knowledge, experiences of the project activities, and perceptions of how the project affected their lives. The data were analysed and synthesized thematically using ATLAS.ti.ResultsThe IFP project envisaged an impact pathway through promoting community- or home-based nutrient-rich crop production and poultry to enhance diet quality, child care and feeding practices. Multi-sectoral partners facilitated training and service delivery at community, farm, facility, and household levels. Beneficiaries reported an overall positive experience of participating in the project, including enhanced dietary knowledge, capacity to produce and use eggs and orange fleshed sweet potatoes (OFSP), earned revenues, and access to nutritious foods. Caregivers reported that the IFP project contributed to enhancing children’s diet quality, reduced disease incidence, and improved child growth. Community-level program implementers experienced capacity strengthening. The dry season, increased poultry feed input prices, diseases (such as fowl pox, Newcastle and smallpox), and poultry deaths, limited the scale of benefits. Key implementation lessons include leveraging local resources to produce poultry feed at home, crossbreeding local and commercial poultry, and enhancing disease management, leading to improved potential for project sustainability.ConclusionsOverall, the communities reported a positive experience of an integrated nutrition-sensitive agriculture (NSA) intervention, leading to improved diets of households, women of reproductive age, and young children >2 years. These strategies can be adapted for use in other to improve women's and children's dietary diversity in similar settings, giving due consideration to lessons learned.

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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

Cited by 3 publications

References 54 publications

Maternal and child health care access to skilled delivery services among Ghanaian rural mothers

Maternal and child health care access to skilled delivery services among Ghanaian rural mothers

Persistence of geographic barriers to maternal care services following a health system strengthening initiative in rural Madagascar

Perceptions and experiences of an intervention to improve diets of women and young children in Ghana

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