Dotse-Gborgbortsi Winfred, Dwomoh Duah, Alegana Victor, Hill Allan, Tatem Andrew J, Wright Jim
School of Geography and Environmental Science, University of Southampton, Southampton, UK.
WorldPop Research Group, School of Geography and Environmental Science, University of Southampton, Southampton, UK.
BMJ Glob Health. 2020 Feb 10;4(Suppl 5):e002020. doi: 10.1136/bmjgh-2019-002020. eCollection 2019.
Skilled birth attendance is the single most important intervention to reduce maternal mortality. However, studies have not used routinely collected health service birth data at named health facilities to understand the influence of distance and quality of care on childbirth service utilisation. Thus, this paper aims to quantify the influence of distance and quality of healthcare on utilisation of birthing services using routine health data in Eastern Region, Ghana.
We used a spatial interaction model (a model that predicts movement from one place to another) drawing on routine birth data, emergency obstetric care surveys, gridded estimates of number of pregnancies and health facility location. We compared travel distances by sociodemographic characteristics and mapped movement patterns.
A kilometre increase in distance significantly reduced the prevalence rate of the number of women giving birth in health facilities by 6.7%. Although quality care increased the number of women giving birth in health facilities, its association was insignificant. Women travelled further than expected to give birth at facilities, on average journeying 4.7 km beyond the nearest facility with a recorded birth. Women in rural areas travelled 4 km more than urban women to reach a hospital. We also observed that 56% of women bypassed the nearest hospital to their community.
This analysis provides substantial opportunities for health planners and managers to understand further patterns of skilled birth service utilisation, and demonstrates the value of routine health data. Also, it provides evidence-based information for improving maternal health service provision by targeting specific communities and health facilities.
熟练的助产服务是降低孕产妇死亡率的最重要单一干预措施。然而，此前的研究尚未利用在指定医疗机构定期收集的卫生服务分娩数据，来了解距离和护理质量对分娩服务利用情况的影响。因此，本文旨在利用加纳东部地区的常规卫生数据，量化距离和医疗保健质量对分娩服务利用情况的影响。
我们使用了一种空间相互作用模型（一种预测从一个地方到另一个地方移动情况的模型），该模型基于常规分娩数据、紧急产科护理调查、妊娠数量的网格估计以及医疗机构位置。我们按社会人口学特征比较了出行距离，并绘制了移动模式图。
距离每增加一公里，在医疗机构分娩的女性人数患病率显著降低6.7%。尽管优质护理增加了在医疗机构分娩的女性人数，但其关联并不显著。女性前往分娩机构的距离比预期更远，平均比有记录分娩的最近机构远4.7公里。农村地区的女性比城市女性多走4公里才能到达医院。我们还观察到，56%的女性绕过了社区最近的医院。
该分析为卫生规划者和管理者进一步了解熟练分娩服务利用模式提供了大量机会，并证明了常规卫生数据的价值。此外，它还为通过针对特定社区和医疗机构改善孕产妇保健服务提供了循证信息。
