Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana.
Int J Health Plann Manage. 2019 Apr;34(2):727-743. doi: 10.1002/hpm.2731. Epub 2019 Jan 18.
User-fee exemption for skilled delivery services has been implemented in Ghana since 2003 as a way to address financial barriers to access. However, many women still deliver at home. Based on data from the 2014 Ghana Demographic and Health Survey, we estimated the prevalence of home delivery and determined the factors contributing to homebirths among a total of 622 women in the Northern region in the context of the user-fee exemption policy in Ghana. Binary and multivariate logistic regression analyses were employed. Results suggest home delivery prevalence of 59% (365/622). Traditional birth attendants attended majority of home deliveries (93.4%). After adjusting for potential confounders, making less than four antenatal care visits (aOR = 2.42; CI = 1.91-6.45; p = 0.001), being a practitioner of traditional African religion (aOR = 16.40; CI = 3.10-25.40; p = 0.000), being a Muslim (aOR 2.10; CI = 1.46-5.30; p = 0.042), not having a health insurance (aOR = 1.85; CI = 1.773-4.72; p = 0.016), living in a male-headed household (aOR = 2.07; CI = 1.02-4.53; p < 0.01), and being unexposed to media (aOR = 3.10; CI = 1.12-5.38; p = 0.021) significantly predicted home delivery. Our results suggest that unless interventions are implemented to address other health system factors like insurance coverage, and socio-cultural and religious beliefs that hinder uptake of skilled care, the full benefits of user-fee exemption may not be realized in Ghana.
自 2003 年以来，加纳实施了熟练分娩服务的用户费用豁免政策，以解决获得服务的经济障碍。然而，仍有许多女性在家中分娩。基于 2014 年加纳人口与健康调查的数据，我们在加纳用户费用豁免政策的背景下，对总共 622 名来自北部地区的妇女进行了家庭分娩的流行率估计，并确定了促成家庭分娩的因素。采用二项和多变量逻辑回归分析。结果表明，家庭分娩的流行率为 59%（365/622）。传统的接生员为大多数家庭分娩提供服务（93.4%）。在调整潜在混杂因素后，进行少于 4 次产前护理访视（aOR=2.42；CI=1.91-6.45；p=0.001）、是传统非洲宗教信徒（aOR=16.40；CI=3.10-25.40；p=0.000）、是穆斯林（aOR=2.10；CI=1.46-5.30；p=0.042）、没有健康保险（aOR=1.85；CI=1.773-4.72；p=0.016）、生活在男性主导的家庭中（aOR=2.07；CI=1.02-4.53；p<0.01）和未接触媒体（aOR=3.10；CI=1.12-5.38；p=0.021）显著预测了家庭分娩。我们的研究结果表明，除非采取干预措施解决其他卫生系统因素，如保险覆盖范围，以及阻碍熟练护理接受的社会文化和宗教信仰，否则加纳可能无法充分实现用户费用豁免政策的全部效益。
