Spatial inequalities in skilled attendance at birth in Ghana: a multilevel analysis integrating health facility databases with household survey data.
Spatial inequalities in skilled attendance at birth in Ghana: a multilevel analysis integrating health facility databases with household survey data.
复制标题
DOI：
10.1111/tmi.13460
复制
发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Wright J
中科院分区：
文献类型：
--
作者：
Dotse-Gborgbortsi W;Tatem AJ;Alegana V;Utazi CE;Ruktanonchai CW;Wright J
这项研究旨在使用调查数据从医疗质量和卫生设施可获得性两个方面预测加纳各地的熟练分娩次数(SBA)。通过一项横断面的观察性研究，我们使用随机截距混合效应多水平Logistic建模方法来估计发生SBA的几率，然后将模型估计应用于空间层来评估加纳高空间分辨率下发生SBA的概率。我们结合了人口与健康调查(DHS)、常规出生登记、产科急诊服务的服务提供评估、网格化人口估计和到卫生机构的建模旅行时间的数据。在一小时的路程内，97.1%的国土安全部抽样调查的妇女可以到达任何医疗机构，96.6%的妇女可以到达提供分娩服务的设施，86.2%的妇女可以到达二级医院。在控制了妇女的个体特征后，居住在城市地区以及靠近提供高质量服务的卫生机构是影响SBA摄入量的重要积极决定因素。估计的方差表明集群和地区对SBA有显著影响，因为使用SBA倾向的剩余变异中有7.1%归因于未观察到的区域特征，16.5%归因于区域内集群之间的差异。鉴于加纳初级保健设施的扩大，这项研究表明，需要更高质量的医疗服务，而不是更接近妇女的设施，以扩大SBA的普及和改善产妇健康。
This study aimed at using survey data to predict skilled attendance at birth (SBA) across Ghana from healthcare quality and health facility accessibility. Through a cross-sectional, observational study, we used a random intercept mixed effects multilevel logistic modelling approach to estimate the odds of having SBA and then applied model estimates to spatial layers to assess the probability of SBA at high-spatial resolution across Ghana. We combined data from the Demographic and Health Survey (DHS), routine birth registers, a service provision assessment of emergency obstetric care services, gridded population estimates and modelled travel time to health facilities. Within an hour’s travel, 97.1% of women sampled in the DHS could access any health facility, 96.6% could reach a facility providing birthing services, and 86.2% could reach a secondary hospital. After controlling for characteristics of individual women, living in an urban area and close proximity to a health facility with high-quality services were significant positive determinants of SBA uptake. The estimated variance suggests significant effects of cluster and region on SBA as 7.1% of the residual variation in the propensity to use SBA is attributed to unobserved regional characteristics and 16.5% between clusters within regions. Given the expansion of primary care facilities in Ghana, this study suggests that higher quality healthcare services, as opposed to closer proximity of facilities to women, is needed to widen SBA uptake and improve maternal health.
登录
查看更多内容
影响因子：
3.1
作者：
Amano A;Gebeyehu A;Birhanu Z
通讯作者：
Birhanu Z
衡量潜在的空间进入城市卫生服务的方法：距离类型和聚合 - 错误问题。
影响因子：
4.9
作者：
Apparicio P;Gelb J;Dubé AS;Kingham S;Gauvin L;Robitaille É
通讯作者：
Robitaille É
影响因子：
3.4
作者：
Bartholomé, E;Belward, AS
通讯作者：
Belward, AS
DOI：
10.5539/gjhs.v6n4p117
发表时间：
2014-04-13
期刊：
Global journal of health science
影响因子：
--
作者：
Asamoah BO;Agardh A;Cromley EK
通讯作者：
Cromley EK
影响因子：
3.1
作者：
Asamoah BO;Agardh A;Pettersson KO;Östergren PO
通讯作者：
Östergren PO