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Research article
Marwa Farag
University of Saskatchewan
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4577-3384
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Inequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives.
Methods
The 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage.
Results
This study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44 - 0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability.
Conclusion
The findings of this study indicate that community-level factors have an influence on women’s health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.
Keywords
Postnatal care, Contextual effect, Community, Utilization
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CURRENT STATUS: Published
View the published article at BMC Health Services Research.
Version 3
Posted 04 Jan, 2021
No community comments so far
Submission checks complete
On 18 Dec, 2020
Editorial decision: Accept
On 15 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 08 Dec, 2020
Review #1 received
Received 02 Dec, 2020
Reviewer #1 agreed
On 12 Nov, 2020
Reviewers invited
Invitations sent on 09 Nov, 2020
Editor assigned
On 08 Nov, 2020
Submission checks complete
On 08 Nov, 2020
Editor invited
On 08 Nov, 2020
No comments provided
Editorial decision: Major revision
On 21 Sep, 2020
Review #3 received
Received 11 Sep, 2020
Review #2 received
Received 11 Sep, 2020
Reviewer #3 agreed
On 30 Aug, 2020
Review #1 received
Received 03 Jul, 2020
Reviewer #2 agreed
On 15 Jun, 2020
Reviewer #1 agreed
On 05 Jun, 2020
Reviewers invited
Invitations sent on 04 Jun, 2020
Editor assigned
On 03 Jun, 2020
Submission checks complete
On 02 Jun, 2020
Editor invited
On 02 Jun, 2020
First submitted
On 24 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
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See the published version of this preprint at BMC Health Services Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Marwa Farag
University of Saskatchewan
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4577-3384
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Health Services Research.
Version 3
Posted 04 Jan, 2021
No community comments so far
Submission checks complete
On 18 Dec, 2020
Editorial decision: Accept
On 15 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 08 Dec, 2020
Review #1 received
Received 02 Dec, 2020
Reviewer #1 agreed
On 12 Nov, 2020
Reviewers invited
Invitations sent on 09 Nov, 2020
Editor assigned
On 08 Nov, 2020
Submission checks complete
On 08 Nov, 2020
Editor invited
On 08 Nov, 2020
No comments provided
Editorial decision: Major revision
On 21 Sep, 2020
Review #3 received
Received 11 Sep, 2020
Review #2 received
Received 11 Sep, 2020
Reviewer #3 agreed
On 30 Aug, 2020
Review #1 received
Received 03 Jul, 2020
Reviewer #2 agreed
On 15 Jun, 2020
Reviewer #1 agreed
On 05 Jun, 2020
Reviewers invited
Invitations sent on 04 Jun, 2020
Editor assigned
On 03 Jun, 2020
Submission checks complete
On 02 Jun, 2020
Editor invited
On 02 Jun, 2020
First submitted
On 24 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background
Inequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives.
Methods
The 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage.
Results
This study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44 - 0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability.
Conclusion
The findings of this study indicate that community-level factors have an influence on women’s health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
This is a list of supplementary files associated with this preprint. Click to download.
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