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. 2016 Mar 31;11(3):e0152235.
doi: 10.1371/journal.pone.0152235. eCollection 2016.

Factors Influencing Health Facility Delivery in Predominantly Rural Communities across the Three Ecological Zones in Ghana: A Cross-Sectional Study

Yeetey Akpe Kwesi Enuameh  1 , Sumiyo Okawa  2 , Kwaku Poku Asante  1 , Kimiyo Kikuchi  2 , Emmanuel Mahama  1 , Evelyn Ansah  3 , Charlotte Tawiah  1 , Kwame Adjei  1 , Akira Shibanuma  2 , Keiko Nanishi  2 , Francis Yeji  4 , Enoch Oti Agyekum  5 , Junko Yasuoka  2 , Margaret Gyapong  6 , Abraham Rexford Oduro  4 , Gloria Quansah Asare  7 , Abraham Hodgson  3 , Masamine Jimba  2 , Seth Owusu-Agyei  1 ; Ghana EMBRACE Implementation Research Project Team
Collaborators, Affiliations

Factors Influencing Health Facility Delivery in Predominantly Rural Communities across the Three Ecological Zones in Ghana: A Cross-Sectional Study

Yeetey Akpe Kwesi Enuameh et al. PLoS One. .

Abstract

Background: Maternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan African countries. Both maternal and neonatal health outcomes improve when skilled personnel provide delivery services within health facilities. Determinants of delivery location are crucial to promoting health facility deliveries, but little research has been done on this issue in Ghana. This study explored factors influencing delivery location in predominantly rural communities in Ghana.

Methods: Data were collected from 1,500 women aged 15-49 years with live or stillbirths that occurred between January 2011 and April 2013. This was done within the three sites operating Health and Demographic Surveillance Systems, i.e., the Dodowa (Greater Accra Region), Kintampo (Brong Ahafo Region), and Navrongo (Upper-East Region) Health Research Centers in Ghana. Multivariable logistic regression was used to identify the determinants of delivery location, controlling for covariates that were statistically significant in univariable regression models.

Results: Of 1,497 women included in the analysis, 75.6% of them selected health facilities as their delivery location. After adjusting for confounders, the following factors were associated with health facility delivery across all three sites: healthcare provider's influence on deciding health facility delivery, (AOR = 13.47; 95% CI 5.96-30.48), place of residence (AOR = 4.49; 95% CI 1.14-17.68), possession of a valid health insurance card (AOR = 1.90; 95% CI 1.29-2.81), and socio-economic status measured by wealth quintiles (AOR = 2.83; 95% CI 1.43-5.60).

Conclusion: In addition to known factors such as place of residence, socio-economic status, and possession of valid health insurance, this study identified one more factor associated with health facility delivery: healthcare provider's influence. Ensuring care provider's counseling of clients could improve the uptake of health facility delivery in rural communities in Ghana.

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Conflict of interest statement

Competing Interests: The Ghana EMBRACE Implementation Research Project is conducted and funded by the Government of the Republic of Ghana, Japan International Cooperation Agency (JICA) Human Development Department, and JICA Research Institute (http://www.jica.go.jp/english/index.html). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. System Science Consultants is a project coordination team member of the study. It is not a funder and also has no conflicting interest on the outcome of the study.

Figures

Fig 1
Fig 1. Map of Ghana showing the geographical location of the study sites.
See this image and copyright information in PMC

References

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    1. Ghana Statistical Service. Millennium development goals in Ghana Accra, Ghana: Ghana Statistical Service; 2013.
    1. GSS, GHS, ICF International. Ghana demographic and health survey 2014 Accra, Ghana: Ghana Statistical Service, Ghana Health Service, and ICF International; 2015.

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