Abstract
Background There are wide differences in the uptake of skilled delivery services between urban and rural women in the northern region of Ghana. This study assessed the rural-urban differences in the prevalence of and factors associated with uptake of skilled delivery in the northern region of Ghana. Methods The study population comprised postpartum women who had delivered within the last three months prior to the study. The dataset was analyzed using the chi-square test and multivariable logistic regression. Results The odds of skilled birth attendance (SBA) adjusted for confounding variables in urban areas were higher compared with their rural counterparts (AOR = 1.59; CI: 1. 07–2.37; p=0.02). The determinants of skilled delivery were similar but of different levels and strength in rural and urban areas. The main drivers that explained the relatively high skilled delivery coverage in the urban areas were higher frequency of antenatal care (ANC) attendance, proximity (physical access) to health facility, and greater proportion of women attaining higher educational level of at least secondary school. Distance from health facility less than 4 km was the greatest independent contributor to the variance in skilled delivery in the urban areas, whereas frequency of ANC attendance was the greatest independent contributor in the rural areas. Conclusions This study identified underlying determinants accounting for rural-urban differences in skilled delivery, and covariate effect was more dominant than coefficient effect. Therefore, urban-rural differences in SBA outcomes were primarily due to differences in the levels of critical determinants rather than the nature of the determinants themselves. Therefore, improving skilled delivery outcomes in this study population and other similar settings will not require different policy frameworks and interventions in dealing with rural-urban disparities in SBA outcomes. However, context-specific tailored approaches and strategies including targeting mechanisms have to be designed differently to reduce the rural-urban differences.
Highlights
Ough facility-based deliveries in Ghana have increased from 42% in 1988 to 73% in 2014, skilled delivery care service utilization is still below set targets. e 2014 Ghana Demographic and Health Survey (GDHS) indicated that nearly three-quarters of births (74.0%) in Ghana occurred with the assistance of a skilled health professional
E Nanumba North District was created as a separate district in 2004 under Legislative Instrument (LI) 1754 of Ghana from the Nanumba District which was split into two areas: North and South. e district covers an area of 1,986 sq. km and it is located in the eastern part of the Northern Region and lies between latitudes 8.5°N and 9.25°N and longitudes 0.57°E and 0.5°E
More Christians were resident in the urban than the rural areas, whereas more people who practice the African traditional religion were concentrated in the rural areas (Table 1)
Summary
Maternal mortality ratio (MMR) in Ghana is still a big problem as the WHO puts the current MMR estimates at 319 maternal deaths per 100,000 live births [1]. e current situation shows that a lot more have to be made in order to achieve the Sustainable Development Goal-3 (SDG-3) [2].ough facility-based deliveries in Ghana have increased from 42% in 1988 to 73% in 2014, skilled delivery care service utilization is still below set targets. e 2014 Ghana Demographic and Health Survey (GDHS) indicated that nearly three-quarters of births (74.0%) in Ghana occurred with the assistance of a skilled health professional.Efforts to make skilled birth services available to pregnant women in Ghana started in 2005 when the Government of Ghana implemented a number of social interventions including the nationwide free maternal health services policy, the National Health Insurance Scheme (NHIS), and the Maternal Healthcare Program [3].In spite of all these strategic measures, maternal mortality still remains a risk factor for women in Ghana, especially in rural areas where utilization of skilled delivery services is reported to be 59.0% among rural women compared to 90.0% in urban areas [4, 5].One potential intervention that could help reduce maternal mortality and improve perinatal outcomes for newborns is pregnant women seeking skilled assistance during childbirth. Efforts to make skilled birth services available to pregnant women in Ghana started in 2005 when the Government of Ghana implemented a number of social interventions including the nationwide free maternal health services policy, the National Health Insurance Scheme (NHIS), and the Maternal Healthcare Program [3]. In spite of all these strategic measures, maternal mortality still remains a risk factor for women in Ghana, especially in rural areas where utilization of skilled delivery services is reported to be 59.0% among rural women compared to 90.0% in urban areas [4, 5]. One potential intervention that could help reduce maternal mortality and improve perinatal outcomes for newborns is pregnant women seeking skilled assistance during childbirth. If there were skilled birth attendants (SBAs) at all deliveries, maternal mortality could be reduced by 13–33% [7]. SBA rate serves as an indicator of progress towards reducing maternal mortality worldwide [8, 9]
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