Geographical Accessibility of Antenatal Diagnostic Services in Rural Ghana' Primary Health Care Clinics: The Role of District Hospitals/Medical Laboratories Locations in the Upper East Region

Abstract

Background: Efforts to reduce maternal mortality to less than 70 per 100000 live births is a priority of the Government of Ghana and globally. Access to district hospitals/medical laboratories from rural primary healthcare (PHC) clinics for antenatal diagnostic services is critical for improving pregnancy outcomes and reducing maternal mortality. We assessed the geographical accessibility of district hospitals/medical laboratories for antenatal diagnostic services in Upper East Region, Ghana. Methods: We assembled detailed spatial data on weighted 100 rural clinics and their district hospitals/medical laboratories; and landscape features influencing journeys in the region. These were used in a geospatial model to estimate actual distance and travel time from a PHC facility to the nearest district hospital/medical laboratory for diagnostic services. Distribution of facilities was done using spatial autocorrelation (Global Moran's I) run in ArcMap 10.4.1. Logistics regression analysis was done utilizing STATA 14 to determine the strength of association between geographical accessibility and pregnancy outcome predictors. Findings: Of the 100 rural clinics included in the analysis, only 15% were located less than 10km (travel time: 5-30 minutes) to their nearest referral health facilities. The likelihood of a pregnant woman accessing a referral facility for diagnostic services in the region was after every 25 km (range: 0.2-62). Spatial distribution of the referral facilities was shown to be dispersed (MI= -0.69, z-score= -2.05, p=0.04). Likewise, the spatial distribution of the PHC clinics appeared to be at random (MI=0.01, z-score = 0.33, p=0.74). Logistic regression showed maternal mortality (OR=1.25, [95%CI=1.1-1.4] p<0.05); stillbirth (OR=1.1, [95%CI= 1.0-1.2], p=0.01); and miscarriage/abortion (OR=1.13, [95%CI=1.1-1.2]; p<0.05) were significantly associated with poor geographical accessibility. nterpretation: Geographical location of a district hospital/medical laboratory affected geographical accessibility of antenatal diagnostic services for rural populations in Upper East Region, Ghana. Targeted improvement of essential point-of-care diagnostics in rural primary health care clinics is recommended for both maternal healthcare and the general population. Funding: University of KwaZulu-Natal, College of Health Sciences Research Scholarship. Declaration of Interest: None declared. Ethical Approval: This study was approved by the Navrongo Health Research Centre Institutional Review Board/Ghana Health Service (approval number: NHRCIRB291) and the University of KwaZulu-Natal Biomedical Research Ethics Committee (approval number: BE565/17). Permission was obtained from the Upper East Regional Health Directorate prior to conducting the study. All study participants signed an informed consent prior to participating in this study.