Travel time to maternity care and its effect on utilization in rural Ghana: A multilevel analysis
Travel time to maternity care and its effect on utilization in rural Ghana: A multilevel analysis
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DOI：
10.1016/j.socscimed.2013.06.012
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发表时间：
2013-09-01
影响因子：
5.4
通讯作者：
Hanlon, Michael
中科院分区：
文献类型：
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作者：
Masters, Samuel H.;Burstein, Roy;Hanlon, Michael
加纳的新生儿和产妇死亡率很高。设施内分娩和其他孕产妇服务可以减轻这一负担，但主要孕产妇服务的利用率相对较低，特别是在农村地区。我们测试了一个理论含义，即旅行时间对设施内分娩和其他孕产妇服务的使用产生负面影响。在经验上，我们使用地理空间技术来估计人口和卫生设施之间的旅行时间。为了解释加纳人口和健康调查聚类位置的不确定性，我们采用了一种将位置选择视为归算问题的新方法。我们估计了一个多水平随机截距逻辑回归模型。对于农村家庭，我们发现出行时间对设施内分娩和产前检查的可能性、教育程度、财富、产妇年龄、设施容量、女性自主性和出生季节有显著影响。相比之下，设施提供复杂的产妇护理的能力对利用率没有明显的影响。随着加纳卫生网络的扩大，我们的研究结果表明，增加基本产科服务的可用性和改善交通基础设施可能是重要的干预措施。(C) 2013 Elsevier Ltd.版权所有。
Rates of neonatal and maternal mortality are high in Ghana. In-facility delivery and other maternal services could reduce this burden, yet utilization rates of key maternal services are relatively low, especially in rural areas. We tested a theoretical implication that travel time negatively affects the use of in-facility delivery and other maternal services. Empirically, we used geospatial techniques to estimate travel times between populations and health facilities. To account for uncertainty in Ghana Demographic and Health Survey cluster locations, we adopted a novel approach of treating the location selection as an imputation problem. We estimated a multilevel random-intercept logistic regression model. For rural households, we found that travel time had a significant effect on the likelihood of in-facility delivery and antenatal care visits, holding constant education, wealth, maternal age, facility capacity, female autonomy, and the season of birth. In contrast, a facility's capacity to provide sophisticated maternity care had no detectable effect on utilization. As the Ghanaian health network expands, our results suggest that increasing the availability of basic obstetric services and improving transport infrastructure may be important interventions. (C) 2013 Elsevier Ltd. All rights reserved.