Abstract
BackgroundMaternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan African countries. Both maternal and neonatal health outcomes improve when skilled personnel provide delivery services within health facilities. Determinants of delivery location are crucial to promoting health facility deliveries, but little research has been done on this issue in Ghana. This study explored factors influencing delivery location in predominantly rural communities in Ghana.MethodsData were collected from 1,500 women aged 15–49 years with live or stillbirths that occurred between January 2011 and April 2013. This was done within the three sites operating Health and Demographic Surveillance Systems, i.e., the Dodowa (Greater Accra Region), Kintampo (Brong Ahafo Region), and Navrongo (Upper-East Region) Health Research Centers in Ghana. Multivariable logistic regression was used to identify the determinants of delivery location, controlling for covariates that were statistically significant in univariable regression models.ResultsOf 1,497 women included in the analysis, 75.6% of them selected health facilities as their delivery location. After adjusting for confounders, the following factors were associated with health facility delivery across all three sites: healthcare provider’s influence on deciding health facility delivery, (AOR = 13.47; 95% CI 5.96–30.48), place of residence (AOR = 4.49; 95% CI 1.14–17.68), possession of a valid health insurance card (AOR = 1.90; 95% CI 1.29–2.81), and socio-economic status measured by wealth quintiles (AOR = 2.83; 95% CI 1.43–5.60).ConclusionIn addition to known factors such as place of residence, socio-economic status, and possession of valid health insurance, this study identified one more factor associated with health facility delivery: healthcare provider’s influence. Ensuring care provider’s counseling of clients could improve the uptake of health facility delivery in rural communities in Ghana.
Highlights
MethodsData were collected from 1,500 women aged 15–49 years with live or stillbirths that occurred between January 2011 and April 2013
Maternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan African countries
After adjusting for confounders, the following factors were associated with health facility delivery across all three sites: healthcare provider’s influence on deciding health facility delivery, (AOR = 13.47; 95% CI 5.96–30.48), place of residence (AOR = 4.49; 95% CI 1.14–17.68), possession of a valid health insurance card (AOR = 1.90; 95% CI 1.29–2.81), and socio-economic status measured by wealth quintiles (AOR = 2.83; 95% CI 1.43–5.60)
Summary
Data were collected from 1,500 women aged 15–49 years with live or stillbirths that occurred between January 2011 and April 2013 This was done within the three sites operating Health and Demographic Surveillance Systems, i.e., the Dodowa (Greater Accra Region), Kintampo (Brong Ahafo Region), and Navrongo (Upper-East Region) Health Research Centers in Ghana. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript This cross-sectional study was conducted in three predominantly rural areas of Ghana from July to September 2013. Each study site has a Health and Demographic Surveillance System (HDSS), which collects longitudinal data on population risks, exposures, and outcomes [25]. Navrongo, located in the northern part of the country, has its HDSS covering the Kassena-Nankana East and West Districts [28]. Community Health Officers (CHOs) in the CHPS compounds have midwifery skills in Navrongo and Dodowa, whereas those in Kintampo do not have these skills
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