School of Geography and Environmental Science, University of Southampton, Southampton, S017 1BJ, UK.
WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK.
BMC Pregnancy Childbirth. 2022 Aug 31;22(1):672. doi: 10.1186/s12884-022-04998-0.
Geographic barriers to healthcare are associated with adverse maternal health outcomes. Modelling travel times using georeferenced data is becoming common in quantifying physical access. Multiple Demographic and Health Surveys ask women about distance-related problems accessing healthcare, but responses have not been evaluated against modelled travel times. This cross-sectional study aims to compare reported and modelled distance by socio-demographic characteristics and evaluate their relationship with skilled birth attendance. Also, we assess the socio-demographic factors associated with self-reported distance problems in accessing healthcare.
Distance problems and socio-demographic characteristics reported by 2210 women via the 2017 Ghana Maternal Health Survey were included in analysis. Geospatial methods were used to model travel time to the nearest health facility using roads, rivers, land cover, travel speeds, cluster locations and health facility locations. Logistic regressions were used to predict skilled birth attendance and self-reported distance problems.
Women reporting distance challenges accessing healthcare had significantly longer travel times to the nearest health facility. Poverty significantly increased the odds of reporting challenges with distance. In contrast, living in urban areas and being registered with health insurance reduced the odds of reporting distance challenges. Women with a skilled attendant at birth, four or more skilled antenatal appointments and timely skilled postnatal care had shorter travel times to the nearest health facility. Generally, less educated, poor, rural women registered with health insurance had longer travel times to their nearest health facility. After adjusting for socio-demographic characteristics, the following factors increased the odds of skilled birth attendance: wealth, health insurance, higher education, living in urban areas, and completing four or more antenatal care appointments.
Studies relying on modelled travel times to nearest facility should recognise the differential impact of geographic access to healthcare on poor rural women. Physical access to maternal health care should be scaled up in rural areas and utilisation increased by improving livelihoods.
医疗保健的地理障碍与不良的产妇健康结果有关。使用地理参考数据来模拟出行时间在量化物理可达性方面变得越来越普遍。多个人口与健康调查询问妇女在获取医疗保健方面与距离有关的问题，但尚未根据模拟出行时间对答复进行评估。本横断面研究旨在按社会人口特征比较报告和模拟的距离，并评估其与熟练分娩护理的关系。此外，我们评估与获取医疗保健方面自我报告的距离问题相关的社会人口因素。
纳入了 2017 年加纳产妇健康调查中 2210 名妇女报告的距离问题和社会人口特征。使用地理空间方法使用道路、河流、土地覆盖、行驶速度、集群位置和医疗机构位置来模拟到最近医疗机构的旅行时间。使用逻辑回归来预测熟练分娩护理和自我报告的距离问题。
报告在获取医疗保健方面存在距离挑战的妇女到最近医疗机构的旅行时间明显更长。贫困显著增加了报告距离挑战的几率。相比之下，居住在城市地区和参加医疗保险降低了报告距离挑战的几率。在分娩时接受熟练助产士护理、有四个或更多熟练产前预约和及时接受熟练产后护理的妇女到最近医疗机构的旅行时间更短。一般来说，受教育程度较低、贫困、农村地区的妇女参加医疗保险，到最近医疗机构的旅行时间更长。在调整了社会人口特征后，以下因素增加了熟练分娩护理的几率：财富、医疗保险、高等教育、居住在城市地区以及完成四个或更多的产前护理预约。
依赖于最近医疗机构的模拟出行时间的研究应该认识到地理上获得医疗保健对贫困农村妇女的影响存在差异。应在农村地区扩大获得产妇保健的机会，并通过改善生计来增加利用率。
