Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.
BMC Pregnancy Childbirth. 2022 Jun 13;22(1):478. doi: 10.1186/s12884-022-04803-y.
In order to effectively and efficiently reduce maternal mortality and ensure optimal outcomes of pregnancy, equity is required in availability and provision of antenatal care. Thus, analysis of trends of socio-economic, demographic, cultural and geographical inequities is imperative to provide a holistic explanation for differences in availability, quality and utilization of antenatal care. We, therefore, investigated the trends in inequalities in four or more antenatal care visits in Ghana, from 1998 to 2014.
We used the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software to analyse data from the 1998 to 2014 Ghana Demographic and Health Surveys. We disaggregated four or more antenatal care visits by four equality stratifiers: economic status, level of education, place of residence, and sub-national region. We measured inequality through summary measures: Difference, Population Attributable Risk (PAR), Ratio, and Population Attributable Fraction (PAF). A 95% uncertainty interval (UI) was constructed for point estimates to measure statistical significance.
The Difference measure of 21.7% (95% UI; 15.2-28.2) and the PAF measure of 12.4% (95% UI 9.6-15.2) indicated significant absolute and relative economic-related disparities in four or more antenatal care visits favouring women in the highest wealth quintile. In the 2014 survey, the Difference measure of 13.1% (95% UI 8.2-19.1) and PAF of 6.5% (95% UI 4.2-8.7) indicate wide disparities in four or more antenatal care visits across education subgroups disfavouring non-educated women. The Difference measure of 9.3% (95% UI 5.8-12.9) and PAF of 5.8% (95% UI 4.7-6.8) suggest considerable relative and absolute urban-rural disparities in four or more antenatal care visits disfavouring rural women. The Difference measure of 20.6% (95% UI 8.8-32.2) and PAF of 7.1% (95% UI 2.9-11.4) in the 2014 survey show significant absolute and relative regional inequality in four or more antenatal care visits, with significantly higher coverage among regions like Ashanti, compared to the Northern region.
We found a disproportionately lower uptake of four or more antenatal care visits among women who were poor, uneducated and living in rural areas and the Northern region. There is a need for policymakers to design interventions that will enable disadvantaged subpopulations to benefit from four or more antenatal care visits to meet the Sustainable Development Goal 3.1 that aims to reduce the maternal mortality ratio (MMR) to less than 70/100, 000 live births by 2030. Further studies are essential to understand the underlying factors for the inequalities in antenatal care visits.
为了有效和高效地降低孕产妇死亡率，并确保妊娠的最佳结果，需要在提供和提供产前护理方面实现公平。因此，分析社会经济、人口、文化和地理不平等的趋势对于全面解释产前护理的可用性、质量和利用方面的差异至关重要。因此，我们调查了加纳从 1998 年到 2014 年期间四次或更多次产前护理就诊的不平等趋势。
我们使用世界卫生组织（世卫组织）的卫生公平评估工具包（HEAT）软件分析了 1998 年至 2014 年加纳人口与健康调查的数据。我们通过四个平等分层因素（经济状况、教育水平、居住地和国家以下地区）对四次或更多次产前护理就诊进行了细分。我们通过综合衡量指标衡量不平等：差异、人群归因风险（PAR）、比率和人群归因分数（PAF）。为了衡量统计显著性，为点估计值构建了 95%的不确定性区间（UI）。
差异衡量值为 21.7%（95%UI；15.2-28.2）和 PAF 衡量值为 12.4%（95%UI 9.6-15.2），表明在四次或更多次产前护理就诊中存在显著的绝对和相对经济相关差异，有利于最富有五分之一的妇女。在 2014 年的调查中，差异衡量值为 13.1%（95%UI 8.2-19.1）和 PAF 为 6.5%（95%UI 4.2-8.7），表明在教育亚组中四次或更多次产前护理就诊存在广泛的差异，不利于非受教育的妇女。差异衡量值为 9.3%（95%UI 5.8-12.9）和 PAF 为 5.8%（95%UI 4.7-6.8），表明在四次或更多次产前护理就诊中存在相当大的城乡相对和绝对差异，不利于农村妇女。差异衡量值为 20.6%（95%UI 8.8-32.2）和 PAF 为 7.1%（95%UI 2.9-11.4），表明在 2014 年的调查中，四次或更多次产前护理就诊存在显著的绝对和相对区域不平等，与北部地区相比，阿散蒂等地区的覆盖率明显更高。
我们发现，贫困、受教育程度低和生活在农村地区和北部地区的妇女四次或更多次产前护理就诊的比例不成比例地较低。政策制定者有必要设计干预措施，使弱势亚群体能够受益于四次或更多次产前护理就诊，以实现旨在到 2030 年将孕产妇死亡率（MMR）降低到每 10 万活产儿 70/100 以下的可持续发展目标 3.1。进一步的研究对于了解产前护理就诊不平等的潜在因素至关重要。
