Aheto Justice Moses K, Gates Tracy, Tetteh Isaac, Babah Rahmatu
Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom.
PLOS Glob Public Health. 2024 Mar 13;4(3):e0001254. doi: 10.1371/journal.pgph.0001254. eCollection 2024.
Health facility delivery has the potential to improve birth and general health outcomes for both newborns and mothers. Regrettably, not all mothers, especially in low-and-middle income countries like Ghana deliver at health facilities, and mostly under unhygienic conditions. Using data from the 2014 Ghana Demographic and Health Survey, we fitted both weighted single-level and random intercept multilevel binary logistic regression models to analyse predictors of a health facility delivery among mothers aged 15-49 years and to quantify unobserved household and community differences in the likelihood of health facility delivery. We analysed data on 4202 mothers residing in 3936 households and 427 communities. Of the 4202 mothers who delivered, 3031 (75.3%-weighted and 72.1%-unweighted) delivered at the health facility. Substantial unobserved household only (Median Odds Ratio (MOR) = 5.1) and household conditional on community (MOR = 4.7) level differences in the likelihood of health facility delivery were found. Mothers aged 25-34 (aOR = 1.4, 95%CI: 1.0-2.1) and 35-44 (aOR = 2.9, 95%CI: 1.7-4.8), mothers with at least a secondary education (aOR = 2.7, 95%CI: 1.7-4.1), with health insurance coverage (aOR = 1.6, 95%CI: 1.2-2.2) and from richer/richest households (aOR = 8.3, 95%CI: 3.6-19.1) and with piped water (aOR = 1.5, 95%CI: 1.1-2.1) had increased odds of health facility delivery. Mothers residing in rural areas (aOR = 0.3, 95%CI: 0.2-0.5) and with no religion (aOR = 0.5, 95%CI: 0.3-1.0) and traditional religion (aOR = 0.2, 95%CI: 0.1-0.6), who reported not wanting to go to health facilities alone as a big problem (aOR = 0.5, 95%CI: 0.3-0.8) and having a parity of 2 (aOR = 0.4, 95%CI: 0.3-0.7), 3 (aOR = 0.3, 95%CI: 0.2-0.6) and ≥4 (aOR = 0.3, 95%CI: 0.1-0.5) had reduced odds of health facility delivery. Our predictive model showed outstanding predictive power of 96%. The study highlights the need for improved healthcare seeking behaviours, maternal education and household wealth, and bridge the urban-rural gaps to improve maternal and newborn health outcomes.
在医疗机构分娩有潜力改善新生儿和母亲的出生状况及总体健康结果。遗憾的是，并非所有母亲，尤其是在加纳这样的低收入和中等收入国家，都在医疗机构分娩，而且大多是在不卫生的条件下分娩。利用2014年加纳人口与健康调查的数据，我们拟合了加权单水平和随机截距多水平二元逻辑回归模型，以分析15至49岁母亲在医疗机构分娩的预测因素，并量化家庭和社区在医疗机构分娩可能性方面未观察到的差异。我们分析了居住在3936户家庭和427个社区的4202名母亲的数据。在4202名分娩的母亲中，有3031名（加权后为75.3%，未加权为72.1%）在医疗机构分娩。发现家庭层面（中位数优势比（MOR）=5.1）以及社区层面家庭条件下（MOR = 4.7）在医疗机构分娩可能性存在大量未观察到的差异。年龄在25至34岁（调整后优势比（aOR）=1.4，95%置信区间：1.0 - 2.1）和35至44岁（aOR = 2.9，95%置信区间：1.7 - 4.8）的母亲、至少接受过中等教育的母亲（aOR = 2.7，95%置信区间：1.7 - 4.1）、有医疗保险的母亲（aOR = 1.6，95%置信区间：1.2 - 2.2）、来自较富裕/最富裕家庭的母亲（aOR = 8.3，95%置信区间：3.6 - 19.1）以及有自来水的家庭（aOR = 1.5，95%置信区间：1.1 - 2.1）在医疗机构分娩的几率增加。居住在农村地区的母亲（aOR = 0.3，95%置信区间：0.2 - 0.5）、没有宗教信仰的母亲（aOR = 0.5，95%置信区间：0.3 - 1.0）和信仰传统宗教的母亲（aOR = 0.2，95%置信区间：0.1 - 0.6）、报告称不想独自去医疗机构是个大问题的母亲（aOR = 0.5，95%置信区间：0.3 - 0.8）以及生育次数为2次（aOR = 0.4，95%置信区间：0.3 - 0.7）、3次（aOR = 0.3，95%置信区间：0.2 - 0.6）和≥4次（aOR = 0.3，95%置信区间：0.1 - 0.5）的母亲在医疗机构分娩的几率降低。我们的预测模型显示出96%的出色预测能力。该研究强调需要改善寻求医疗保健的行为、提高孕产妇教育水平和家庭财富，并缩小城乡差距，以改善孕产妇和新生儿的健康结果。
