On the Spatial Inequalities of Institutional Versus Home Births in Ghana: A Multilevel Analysis
On the Spatial Inequalities of Institutional Versus Home Births in Ghana: A Multilevel Analysis
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DOI：
10.1007/s10900-008-9120-x
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发表时间：
2009-02-01
影响因子：
5.9
通讯作者：
Brown, James J.
中科院分区：
文献类型：
--
作者：
Johnson, Fiifi Amoako;Padmadas, Sabu S.;Brown, James J.
在撒哈拉以南非洲，尽管采取了一系列安全孕产干预措施，但孕产妇和围产期健康结果继续恶化，与分娩护理选择有关的空间不平等尚未得到系统研究。使用1998年和2003年人口与健康调查的回顾性数据，本文调查了加纳与分娩护理类型相关的空间不平等的变化程度，重点关注三个生态区（萨凡纳、森林和沿海）内和跨三个生态区的城乡差异。加纳一半以上的分娩仍然是在保健机构之外进行的，没有任何熟练的产科护理。虽然这是已知的，我们提出的证据，从多层次的分析，存在着相当大的和日益增长的不平等，在社区之间，农村和城市地区和整个生态区的生育环境。结果显示，有证据表明，出生时对机构护理的利用率很低，而且不成比例;在萨凡纳区的城市和农村社区，不平等现象仍然很高，而且没有变化，在森林和沿海区的城市社区，这种不平等现象正在扩大。因此，加纳的主要政策挑战包括增加机构提供护理的接受率和确保公平获得公共和私营保健机构的服务。
Spatial inequalities related to the choice of delivery care have not been studied systematically in Sub-Saharan Africa where maternal and perinatal health outcomes continue to worsen despite a range of safe motherhood interventions. Using retrospective data from the 1998 and 2003 Demographic and Health Surveys, this paper investigates the extent of changes in spatial inequalities associated with type of delivery care in Ghana with a focus on rural-urban differentials within and across the three ecological zones (Savannah, Forest and Coastal). More than one-half of births in Ghana continue to occur outside health institutions without any skilled obstetric care. While this is already known, we present evidence from multilevel analyses that there exist considerable and growing inequalities, with regard to birth settings between communities, within rural and urban areas and across the ecological zones. The results show evidence of poor and disproportionate use of institutional care at birth; the inequalities remained high and unchanged in both urban and rural communities within the Savannah zone and widening in urban communities of the Forest and Coastal zones. The key policy challenges in Ghana, therefore, include both increasing the uptake of institutional delivery care and ensuring equity in access to both public and private health institutions.