Seidu Abdul-Aziz, Darteh Eugene Kofuor Maafo, Agbaglo Ebenezer, Dadzie Louis Kobina, Ahinkorah Bright Opoku, Ameyaw Edward Kwabena, Tetteh Justice Kanor, Baatiema Linus, Yaya Sanni
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
BMC Public Health. 2020 Dec 17;20(1):1916. doi: 10.1186/s12889-020-10017-8.
Women's health remains a global public health concern, as enshrined in the Sustainable Development Goals. This study, therefore, sought to assess the individual and contextual factors associated with barriers to accessing healthcare among women in Ghana.
The study was conducted among 9370 women aged 15-49, using data from the 2014 Ghana Demographic and Health Survey. Barrier to healthcare, derived from four questions- whether a woman faced problems in getting money, distance, companionship, and permission to see a doctor-was the outcome variable. Descriptive and multilevel logistic regression analyses were carried out. The fixed effect results of the multilevel logistic regression analyses were reported using adjusted odds ratios at a 95% confidence interval.
More than half (51%) of the women reported to have at least one form of barrier to accessing healthcare. Women aged 45-49 (AOR = 0.65, CI: 0.49-0.86), married women (AOR = 0.71, CI:0.58-0.87), those with a higher level of education (AOR = 0.51, CI: 0.37-0.69), those engaged in clerical or sales occupation (AOR = 0.855, CI: 0.74-0.99), and those who were covered by health insurance (AOR = 0.59, CI: 0.53-0.66) had lower odds of facing barriers in accessing healthcare. Similarly, those who listened to radio at least once in a week (AOR =0.77, CI: 0.66-0.90), those who watched television at least once a week (AOR = 0.75, CI: 0.64-0.87), and women in the richest wealth quintile (AOR = 0.47, CI: 0.35-0.63) had lower odds of facing barriers in accessing healthcare. However, women who were widowed (AOR = 1.47, CI: 1.03-2.10), those in the Volta Region (AOR 2.20, CI: I.38-3.53), and those in the Upper West Region (AOR =2.22, CI: 1.32-3.74) had the highest odds of facing barriers to healthcare accessibility.
This study shows that individual and contextual factors are significant in predicting barriers in healthcare access in Ghana. The factors identified include age, marital status, employment, health insurance coverage, frequency of listening to radio, frequency of watching television, wealth status, and region of residence. These findings highlight the need to pay critical attention to these factors in order to achieve the Sustainable Development Goals 3.1, 3.7, and 3.8. It is equally important to strengthen existing strategies to mitigate barriers to accessing healthcare among women in Ghana.
正如《可持续发展目标》所体现的那样，妇女健康仍然是一个全球公共卫生问题。因此，本研究旨在评估与加纳妇女获得医疗保健障碍相关的个体因素和背景因素。
该研究对9370名年龄在15至49岁之间的妇女进行，使用的是2014年加纳人口与健康调查的数据。医疗保健障碍是根据四个问题得出的——一名妇女在获取资金、距离、陪伴以及看医生的许可方面是否面临问题——这是结果变量。进行了描述性和多水平逻辑回归分析。多水平逻辑回归分析的固定效应结果使用95%置信区间的调整比值比进行报告。
超过一半（51%）的妇女报告至少有一种形式的医疗保健障碍。45至49岁的妇女（调整后比值比[AOR]=0.65，置信区间[CI]：0.49 - 0.86）、已婚妇女（AOR =0.71，CI：0.58 - 0.87）、教育水平较高的妇女（AOR =0.51，CI：0.37 - 0.69）、从事文职或销售职业的妇女（AOR =0.855，CI：0.74 - 0.99）以及参加了医疗保险的妇女（AOR =0.59，CI：0.53 - 0.66）面临医疗保健障碍的几率较低。同样，每周至少听一次广播的妇女（AOR =0.77，CI：0.66 - 0.90）、每周至少看一次电视的妇女（AOR =0.75，CI：0.64 - 0.87）以及最富有的五分之一财富阶层的妇女（AOR =0.47，CI：0.35 - 0.63）面临医疗保健障碍的几率较低。然而，丧偶妇女（AOR =1.47，CI：1.03 - 2.10）、沃尔特地区的妇女（AOR =2.20，CI：1.38 - 3.53）以及上西部地区的妇女（AOR =2.22，CI：1.32 - 3.7）面临医疗保健可及性障碍的几率最高。
本研究表明，个体因素和背景因素在预测加纳医疗保健获取障碍方面具有重要意义。所确定的因素包括年龄、婚姻状况、就业、医疗保险覆盖范围、听广播的频率、看电视的频率、财富状况和居住地区。这些发现凸显了为实现可持续发展目标3.1、3.7和3.8而对这些因素予以高度关注的必要性。同样重要的是，加强现有战略以减轻加纳妇女获得医疗保健的障碍。
