Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1988 – 2008
Identifieur interne : 000464 ( Main/Exploration ); précédent : 000463; suivant : 000465Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1988 – 2008
Auteurs : Benedict O. Asamoah [Suède] ; Anette Agardh [Suède] ; Karen Odberg Pettersson [Suède] ; Per-Olof Östergren [Suède]Source :
- BMC Pregnancy and Childbirth [ 1471-2393 ] ; 2014.
Abstract
Improving maternal and reproductive health still remains a major challenge in most low-income countries especially in sub-Saharan Africa. The growing inequality in access to maternal health interventions is an issue of great concern. In Ghana, inadequate attention has been given to the inequality gap that exists amongst women when accessing antenatal care during pregnancy and skilled attendance at birth. This study therefore aimed at investigating the magnitude and trends in income-, education-, residence-, and parity-related inequalities in access to antenatal care and skilled attendance at birth.
A database was constructed using data from the Ghana Demographic and Health Surveys (DHS) 1988, 1993, 1998, 2003, and 2008. The surveys employed standard DHS questionnaires and techniques for data collection. We applied regression-based Total Attributable Fraction (TAF) as an index for measuring socioeconomic inequalities in antenatal care and skilled birth attendance utilization.
The rural–urban gap and education-related inequalities in the utilization of antenatal care and skilled birth attendants seem to be closing over time, while income- and parity-related inequalities in the use of antenatal care are on a sharp rise. Income inequality regarding the utilization of skilled birth attendance was rather low and stable from 1988 to 1998, increased sharply to a peak between 1998 and 2003, and then leveled-off after 2003.
The increased income-related inequalities seen in the use of antenatal care and skilled birth attendance should be addressed through appropriate strategies. Intensifying community-based health education through media and door-to-door campaigns could further reduce the mentioned education- and parity-related inequalities. Women should be highly motivated and incentivized to attend school up to secondary level or higher. Education on the use of maternal health services should be integrated into basic schools so that women at the lowest level would be inoculated with the appropriate health messages.
Url:
DOI: 10.1186/1471-2393-14-295
PubMed: 25169877
PubMed Central: 4155087
Affiliations:
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Asamoah</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation></author><author><name sortKey="Agardh, Anette" sort="Agardh, Anette" uniqKey="Agardh A" first="Anette" last="Agardh">Anette Agardh</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation></author><author><name sortKey="Pettersson, Karen Odberg" sort="Pettersson, Karen Odberg" uniqKey="Pettersson K" first="Karen Odberg" last="Pettersson">Karen Odberg Pettersson</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation></author><author><name sortKey="Ostergren, Per Olof" sort="Ostergren, Per Olof" uniqKey="Ostergren P" first="Per-Olof" last="Östergren">Per-Olof Östergren</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25169877</idno><idno type="pmc">4155087</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155087</idno><idno type="RBID">PMC:4155087</idno><idno type="doi">10.1186/1471-2393-14-295</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000109</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000109</idno><idno type="wicri:Area/Pmc/Curation">000108</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000108</idno><idno type="wicri:Area/Pmc/Checkpoint">000241</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000241</idno><idno type="wicri:Area/Ncbi/Merge">000691</idno><idno type="wicri:Area/Ncbi/Curation">000691</idno><idno type="wicri:Area/Ncbi/Checkpoint">000691</idno><idno type="wicri:Area/Main/Merge">000464</idno><idno type="wicri:Area/Main/Curation">000464</idno><idno type="wicri:Area/Main/Exploration">000464</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1988 – 2008</title><author><name sortKey="Asamoah, Benedict O" sort="Asamoah, Benedict O" uniqKey="Asamoah B" first="Benedict O" last="Asamoah">Benedict O. Asamoah</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation></author><author><name sortKey="Agardh, Anette" sort="Agardh, Anette" uniqKey="Agardh A" first="Anette" last="Agardh">Anette Agardh</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation></author><author><name sortKey="Pettersson, Karen Odberg" sort="Pettersson, Karen Odberg" uniqKey="Pettersson K" first="Karen Odberg" last="Pettersson">Karen Odberg Pettersson</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation></author><author><name sortKey="Ostergren, Per Olof" sort="Ostergren, Per Olof" uniqKey="Ostergren P" first="Per-Olof" last="Östergren">Per-Olof Östergren</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Pregnancy and Childbirth</title><idno type="eISSN">1471-2393</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Improving maternal and reproductive health still remains a major challenge in most low-income countries especially in sub-Saharan Africa. The growing inequality in access to maternal health interventions is an issue of great concern. In Ghana, inadequate attention has been given to the inequality gap that exists amongst women when accessing antenatal care during pregnancy and skilled attendance at birth. This study therefore aimed at investigating the magnitude and trends in income-, education-, residence-, and parity-related inequalities in access to antenatal care and skilled attendance at birth.</p></sec><sec><title>Methods</title><p>A database was constructed using data from the Ghana Demographic and Health Surveys (DHS) 1988, 1993, 1998, 2003, and 2008. The surveys employed standard DHS questionnaires and techniques for data collection. We applied regression-based Total Attributable Fraction (TAF) as an index for measuring socioeconomic inequalities in antenatal care and skilled birth attendance utilization.</p></sec><sec><title>Results</title><p>The rural–urban gap and education-related inequalities in the utilization of antenatal care and skilled birth attendants seem to be closing over time, while income- and parity-related inequalities in the use of antenatal care are on a sharp rise. Income inequality regarding the utilization of skilled birth attendance was rather low and stable from 1988 to 1998, increased sharply to a peak between 1998 and 2003, and then leveled-off after 2003.</p></sec><sec><title>Conclusions</title><p>The increased income-related inequalities seen in the use of antenatal care and skilled birth attendance should be addressed through appropriate strategies. Intensifying community-based health education through media and door-to-door campaigns could further reduce the mentioned education- and parity-related inequalities. Women should be highly motivated and incentivized to attend school up to secondary level or higher. Education on the use of maternal health services should be integrated into basic schools so that women at the lowest level would be inoculated with the appropriate health messages.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zureick Brown, S" uniqKey="Zureick Brown S">S Zureick-Brown</name></author><author><name sortKey="Newby, H" uniqKey="Newby H">H Newby</name></author><author><name sortKey="Chou, D" uniqKey="Chou D">D Chou</name></author><author><name sortKey="Mizoguchi, N" uniqKey="Mizoguchi N">N Mizoguchi</name></author><author><name sortKey="Say, L" uniqKey="Say L">L Say</name></author><author><name sortKey="Suzuki, E" uniqKey="Suzuki E">E Suzuki</name></author><author><name sortKey="Wilmoth, J" uniqKey="Wilmoth J">J Wilmoth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mohammed, Aa" uniqKey="Mohammed A">AA Mohammed</name></author><author><name sortKey="Elnour, Mh" 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Williams J">JK Awoonor-Williams</name></author><author><name sortKey="Phillips, Jf" uniqKey="Phillips J">JF Phillips</name></author><author><name sortKey="Jones, Tc" uniqKey="Jones T">TC Jones</name></author><author><name sortKey="Miller, Ra" uniqKey="Miller R">RA Miller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Owusu, G" uniqKey="Owusu G">G Owusu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stephens, C" uniqKey="Stephens C">C Stephens</name></author><author><name sortKey="Akerman, M" uniqKey="Akerman M">M Akerman</name></author><author><name sortKey="Avle, S" uniqKey="Avle S">S Avle</name></author><author><name sortKey="Maia, Pb" uniqKey="Maia P">PB Maia</name></author><author><name sortKey="Campanario, P" uniqKey="Campanario P">P Campanario</name></author><author><name sortKey="Doe, B" uniqKey="Doe B">B Doe</name></author><author><name sortKey="Tetteh, D" uniqKey="Tetteh D">D Tetteh</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Suède</li></country></list><tree><country name="Suède"><noRegion><name sortKey="Asamoah, Benedict O" sort="Asamoah, Benedict O" uniqKey="Asamoah B" first="Benedict O" last="Asamoah">Benedict O. Asamoah</name></noRegion><name sortKey="Agardh, Anette" sort="Agardh, Anette" uniqKey="Agardh A" first="Anette" last="Agardh">Anette Agardh</name><name sortKey="Ostergren, Per Olof" sort="Ostergren, Per Olof" uniqKey="Ostergren P" first="Per-Olof" last="Östergren">Per-Olof Östergren</name><name sortKey="Pettersson, Karen Odberg" sort="Pettersson, Karen Odberg" uniqKey="Pettersson K" first="Karen Odberg" last="Pettersson">Karen Odberg Pettersson</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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