Amoako Johnson Fiifi
Department of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy (GHP3), Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK.
BMC Pregnancy Childbirth. 2016 Feb 29;16:41. doi: 10.1186/s12884-016-0833-z.
Many low and middle income countries have initiated maternity fee exemption and removal policies to promote use of skilled maternity care. After two and a half decades of these policies, uptake of skilled birth care remains low and inequalities continue to exist in many low and middle income countries. This study uses 2 decades of birth histories data to examine four maternity fee paying policies enacted in Ghana over the past 3 decades and their geospatial impacts on uptake of skilled delivery care.
Bayesian Geoadditive Semiparametric regression techniques were applied on four conservative rounds of Demographic and Health Surveys in Ghana to examine the extent of geospatial dependence in skilled birth care use at the district level and their associative relationships with maternity fee paying policies focusing on the temporal trends when the policies were functional.
The results show that at the country-level, the policies had a positive influence on use of skilled delivery care; however their impacts on reducing between-district inequalities were trivial.
The findings suggest that targeted interventions at the district level are essential to strengthen maternal health programmes in Ghana.
许多低收入和中等收入国家已启动产妇费用豁免和取消政策，以促进使用熟练的孕产妇保健服务。在实施这些政策二十五年后，许多低收入和中等收入国家熟练接生护理的使用率仍然很低，不平等现象依然存在。本研究利用二十年的生育史数据，考察加纳在过去三十年里颁布的四项产妇付费政策及其对熟练接生护理使用率的地理空间影响。
对加纳四轮人口与健康调查应用贝叶斯地理加性半参数回归技术，以考察地区一级熟练接生护理使用中的地理空间依赖性程度，以及它们与产妇付费政策的关联关系，重点关注政策实施时的时间趋势。
结果表明，在国家层面，这些政策对熟练接生护理的使用有积极影响；然而，它们对减少地区间不平等的影响微不足道。
研究结果表明，在加纳，地区层面的针对性干预对于加强孕产妇健康项目至关重要。
