Maternal Health Care Utilization through Community-based Initiatives in Periurban Accra
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Date
2018-07
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Publisher
University of Ghana
Abstract
Background: The availability of skilled care during pregnancy, childbirth, and the
postpartum period ensures the best chances of delivering a healthy infant with no
complication to the mother. Huge disparities in health exist between urban and rural
dwellers but recent research has shown that the urban poor sometimes have worse
maternal health outcomes than rural dwellers. Community-based interventions have been
shown to foster interactions between pregnant women and health care providers and can
go a long way in mitigating the adverse effects of urban poverty on maternal health. This
study aimed to highlight how such initiatives are able to improve maternal health care
utilization in a peri-urban settlement in Accra.
Methodology: This research was a cross-sectional study employing quantitative and
qualitative methods of data collection and analysis. Four hundred and forty-one (441)
women who delivered in the past 18 months were randomly sampled from two subdistricts
of the Ga East Municipality for participation in the survey. The purposive
sampling technique was then used to sample participants for the Focus Group
Discussions and the In-depth Interviews. Five (5) FGDs (n=35) were conducted amongst
mothers in the community depending on place of delivery (21), and with the Community
Health Officers (14), whilst nine (9) IDIs were conducted with formal and informal
health care providers in the communities. Analysis of the quantitative data was done
using STATA l3c and univariable, bivariable and multi variable logistic analysis were
carried out with p-value of <0.05 seen as significant. The qualitative data were audio-recorded,
transcribed verbatim and thematic analysis was done using the NVivo 11c software.
Results: Socio-demographic characteristics such as employment (p=<0.01), autonomy
(p=<0.001), and satisfaction with Antenatal Care service provision (p=<0.001) were
found to be the main determinants of adequate ANC utilization. In addition, employment
(p=<0.05), decision making (by males) (p=<0.001), having had obstetric complications
(p=<0.001) and having ever been visited by a CHO (p=<0.01) emerged as determinants
of Postnatal Care utilization in a timely manner. Barriers to maternal health care
utilization include financial and time constraints, lack of public health care facilities
within the communities, poor service provision at health care facilities, fear of having a
Caesarean section, and cultural practices, causing women to access care from private
facilities and Traditional Birth Attendant centres. There was no effect on ANC and SBA
service utilization due to CHO home visits, but surprisingly, these visits reduced the
likelihood of timely PNC service utilization (aOR=0.62, 95% CI=0.40-0.95). Mother
Support Groups did not have any significant effect on ANC, SBA or PNC utilization.
Public-private health care partnerships were weak and are dodged by lack of synchronism
and high attrition rate of Mother Support Group volunteers.
Conclusion: Although majority of women in these peri-urban communities availed
themselves of ANC, SBA and PNC services, a substantial number of them utilized these
services inadequately, and in an untimely manner. In addition, community-based
activities of formal and informal health care providers had a mixed effect on maternal
health care utilization and collaborations between them faced challenges requiring a clear
cut protocol to guide these partnerships.
Description
PhD. Public Health
Keywords
Maternal Health Care, Periurban, Community based Initiatives