The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana
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Date
2020-01-09
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Global Health
Abstract
Objectives Skilled birth attendance is the single most
important intervention to reduce maternal mortality.
However, studies have not used routinely collected health
service birth data at named health facilities to understand
the influence of distance and quality of care on childbirth
service utilisation. Thus, this paper aims to quantify
the influence of distance and quality of healthcare on
utilisation of birthing services using routine health data in
Eastern Region, Ghana.
Methods We used a spatial interaction model (a model
that predicts movement from one place to another)
drawing on routine birth data, emergency obstetric care
surveys, gridded estimates of number of pregnancies and
health facility location. We compared travel distances by
sociodemographic characteristics and mapped movement
patterns.
Results A kilometre increase in distance significantly
reduced the prevalence rate of the number of women
giving birth in health facilities by 6.7%. Although quality
care increased the number of women giving birth in
health facilities, its association was insignificant. Women
travelled further than expected to give birth at facilities, on
average journeying 4.7 km beyond the nearest facility with
a recorded birth. Women in rural areas travelled 4 km more
than urban women to reach a hospital. We also observed
that 56% of women bypassed the nearest hospital to their
community.
Conclusion This analysis provides substantial
opportunities for health planners and managers to
understand further patterns of skilled birth service
utilisation, and demonstrates the value of routine health
data. Also, it provides evidence-based
information for
improving maternal health service provision by targeting
specific communities and health facilities.
Description
Research Article
Keywords
childbirth, sociodemographic, health service, maternal mortality
Citation
Dotse-Gborgbortsi W, Dwomoh D, Alegana V, et al. The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana. BMJ Global Health 2020;4:e002020. doi:10.1136/ bmjgh-2019-002020