Maternal Health Care Utilization through Community-based Initiatives in Periurban Accra

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.