The influence of distance and quality of care on place of delivery in rural Ghana.


Nesbitt, RC; Lohela, TJ; Soremekun, S; Vesel, L; Manu, A; Okyere, E; Grundy, C; Amenga-Etego, S; Owusu-Agyei, S; Kirkwood, BR; Gabrysch, S; (2016) The influence of distance and quality of care on place of delivery in rural Ghana. Scientific reports, 6. p. 30291. ISSN 2045-2322 DOI: https://doi.org/10.1038/srep30291

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Abstract

Facility delivery is an important aspect of the strategy to reduce maternal and newborn mortality. Geographic access to care is a strong determinant of facility delivery, but few studies have simultaneously considered the influence of facility quality, with inconsistent findings. In rural Brong Ahafo region in Ghana, we combined surveillance data on 11,274 deliveries with quality of care data from all 64 delivery facilities in the study area. We used multivariable multilevel logistic regression to assess the influence of distance and several quality dimensions on place of delivery. Women lived a median of 3.3 km from the closest delivery facility, and 58% delivered in a facility. The probability of facility delivery ranged from 68% among women living 1 km from their closest facility to 22% among those living 25 km away, adjusted for confounders. Measured quality of care at the closest facility was not associated with use, except that facility delivery was lower when the closest facility provided substandard care on the EmOC dimension. These results do not imply, however, that we should increase geographic accessibility of care without improving facility quality. While this may be successful in increasing facility deliveries, such care cannot be expected to reduce maternal and neonatal mortality.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Nutrition and Public Health Interventions Research (2003-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Infectious and Tropical Diseases > Dept of Disease Control
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PubMed ID: 27506292
Web of Science ID: 381119900001
URI: http://researchonline.lshtm.ac.uk/id/eprint/2782890

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