Assessing the contextual effect of community in the utilization of postnatal care services in Ghana

Emmanuel Dankwah,Cindy Feng,Rein Lepnurm,Marwa Farag,Shelley Kirychuck,Wu Zeng

doi:10.1186/s12913-020-06028-1

Abstract

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.

Highlights

Inequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes
This cluster had a relative risk of 3.97 (p-value < 0.00001) which indicates that study participants who dwell in the area were 3.97 times more likely to miss PNC services than surrounding communities
The cluster diameter was 78.8 km and the relative risk of not using PNC services in the clustered area was 2.36. This revealed that study participants who live in this locality were 2.36 times more likely not to utilize PNC services relative to bordering communities (Fig. 5)

Summary

Introduction

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. Researchers contend that achieving a post-natal care (PNC) services utilization rate of 90% in Africa could save between 10 to 27% of neonatal deaths [2]. Despite the benefits derived from PNC services, a large proportion of sub-Saharan Africa mothers and babies especially those that delivered outside health facility do not use post-natal services [6]. Ghana is a western African country that spans a land area of 238,535 km2 [7]

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