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Rural/Urban and Socioeconomic Differentials in Quality of Antenatal Care in Ghana

BACKGROUND: Approximately 800 women die of pregnancy-related complications every day. Over half of these deaths occur in sub-Saharan Africa (SSA). Most maternal deaths can be prevented with high quality maternal health services. It is well established that use of maternal health services vary by pla...

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Autor principal: Afulani, Patience A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4335004/
https://www.ncbi.nlm.nih.gov/pubmed/25695737
http://dx.doi.org/10.1371/journal.pone.0117996
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author Afulani, Patience A.
author_facet Afulani, Patience A.
author_sort Afulani, Patience A.
collection PubMed
description BACKGROUND: Approximately 800 women die of pregnancy-related complications every day. Over half of these deaths occur in sub-Saharan Africa (SSA). Most maternal deaths can be prevented with high quality maternal health services. It is well established that use of maternal health services vary by place of residence and socioeconomic status (SES), but few studies have examined the determinants of quality of maternal health services in SSA. The purpose of this study is to examine the determinants of antenatal care (ANC) quality in Ghana–focusing on the role of place of residence and SES (education and wealth). The analysis also examines the interactions of these variables and the mediating role of ANC timing, frequency, facility type, and provider type. METHODS: The data are from the Ghana Maternal Health Survey (N = 4,868). Analytic techniques include multilevel linear regression with mediation and moderation analysis. RESULTS: Urban residence and higher SES are positively associated with higher ANC quality, but the urban effect is completely explained by sociodemographic factors. Specifically, about half of the urban effect is explained by education and wealth alone, with other variables accounting for the remainder. The effects of education are conditional on wealth and are strongest for poor women. Starting ANC visits early and attending the recommended four visits as well as receiving ANC from a higher level facility and from a skilled provider are associated with higher quality ANC. These factors partially explain the SES differentials. IMPLICATIONS: Ghanaian women experience significant disparities in quality of ANC, with poor illiterate women receiving the worst care. Targeted efforts to increase quality of ANC may significantly reduce maternal health disparities in Ghana and SSA. A particularly crucial step is to improve ANC quality in the lower level health facilities, where the most vulnerable women are more likely to seek ANC.
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spelling pubmed-43350042015-02-24 Rural/Urban and Socioeconomic Differentials in Quality of Antenatal Care in Ghana Afulani, Patience A. PLoS One Research Article BACKGROUND: Approximately 800 women die of pregnancy-related complications every day. Over half of these deaths occur in sub-Saharan Africa (SSA). Most maternal deaths can be prevented with high quality maternal health services. It is well established that use of maternal health services vary by place of residence and socioeconomic status (SES), but few studies have examined the determinants of quality of maternal health services in SSA. The purpose of this study is to examine the determinants of antenatal care (ANC) quality in Ghana–focusing on the role of place of residence and SES (education and wealth). The analysis also examines the interactions of these variables and the mediating role of ANC timing, frequency, facility type, and provider type. METHODS: The data are from the Ghana Maternal Health Survey (N = 4,868). Analytic techniques include multilevel linear regression with mediation and moderation analysis. RESULTS: Urban residence and higher SES are positively associated with higher ANC quality, but the urban effect is completely explained by sociodemographic factors. Specifically, about half of the urban effect is explained by education and wealth alone, with other variables accounting for the remainder. The effects of education are conditional on wealth and are strongest for poor women. Starting ANC visits early and attending the recommended four visits as well as receiving ANC from a higher level facility and from a skilled provider are associated with higher quality ANC. These factors partially explain the SES differentials. IMPLICATIONS: Ghanaian women experience significant disparities in quality of ANC, with poor illiterate women receiving the worst care. Targeted efforts to increase quality of ANC may significantly reduce maternal health disparities in Ghana and SSA. A particularly crucial step is to improve ANC quality in the lower level health facilities, where the most vulnerable women are more likely to seek ANC. Public Library of Science 2015-02-19 /pmc/articles/PMC4335004/ /pubmed/25695737 http://dx.doi.org/10.1371/journal.pone.0117996 Text en © 2015 Patience A. Afulani http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Afulani, Patience A.
Rural/Urban and Socioeconomic Differentials in Quality of Antenatal Care in Ghana
title Rural/Urban and Socioeconomic Differentials in Quality of Antenatal Care in Ghana
title_full Rural/Urban and Socioeconomic Differentials in Quality of Antenatal Care in Ghana
title_fullStr Rural/Urban and Socioeconomic Differentials in Quality of Antenatal Care in Ghana
title_full_unstemmed Rural/Urban and Socioeconomic Differentials in Quality of Antenatal Care in Ghana
title_short Rural/Urban and Socioeconomic Differentials in Quality of Antenatal Care in Ghana
title_sort rural/urban and socioeconomic differentials in quality of antenatal care in ghana
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4335004/
https://www.ncbi.nlm.nih.gov/pubmed/25695737
http://dx.doi.org/10.1371/journal.pone.0117996
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