@article{nokey,

title = {Distance is “a big problem”: a geographic analysis of reported and modelled proximity to maternal health services in Ghana},

author = {Dotse-Gborgbortsi, Winfred and Nilsen, Kristine and Ofosu, Anthony and Matthews, Zoe and Tejedor-Garavito, Natalia and Wright, Jim and Tatem, Andrew J},

doi = {10.1186/s12884-022-04998-0},

year  = {2022},

date = {2022-08-31},

urldate = {2022-08-31},

journal = {BMC Pregnancy and Childbirth},

volume = {22},

number = {672},

abstract = {Geographic barriers to healthcare are associated with adverse maternal health outcomes. Modelling travel times using georeferenced data is becoming common in quantifying physical access. Multiple Demographic and Health Surveys ask women about distance-related problems accessing healthcare, but responses have not been evaluated against modelled travel times. This cross-sectional study aims to compare reported and modelled distance by socio-demographic characteristics and evaluate their relationship with skilled birth attendance. Also, we assess the socio-demographic factors associated with self-reported distance problems in accessing healthcare.



Distance problems and socio-demographic characteristics reported by 2210 women via the 2017 Ghana Maternal Health Survey were included in analysis. Geospatial methods were used to model travel time to the nearest health facility using roads, rivers, land cover, travel speeds, cluster locations and health facility locations. Logistic regressions were used to predict skilled birth attendance and self-reported distance problems.



Women reporting distance challenges accessing healthcare had significantly longer travel times to the nearest health facility. Poverty significantly increased the odds of reporting challenges with distance. In contrast, living in urban areas and being registered with health insurance reduced the odds of reporting distance challenges. Women with a skilled attendant at birth, four or more skilled antenatal appointments and timely skilled postnatal care had shorter travel times to the nearest health facility. Generally, less educated, poor, rural women registered with health insurance had longer travel times to their nearest health facility. After adjusting for socio-demographic characteristics, the following factors increased the odds of skilled birth attendance: wealth, health insurance, higher education, living in urban areas, and completing four or more antenatal care appointments.



Studies relying on modelled travel times to nearest facility should recognise the differential impact of geographic access to healthcare on poor rural women. Physical access to maternal health care should be scaled up in rural areas and utilisation increased by improving livelihoods.},

keywords = {Ghana, maternal health, travel time},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Delineating natural catchment health districts with routinely collected health data from women’s travel to give birth in Ghana},

author = {Winfred Dotse-Gborgbortsi and Andrew J. Tatem and Zoë Matthews and Victor Alegana and Anthony Ofosu and Jim Wright },

doi = {10.1186/s12913-022-08125-9},

year  = {2022},

date = {2022-06-13},

urldate = {2022-06-13},

journal = {BMC Health Services Research},

volume = {22},

number = {772},

abstract = {Health service areas are essential for planning, policy and managing public health interventions. In this study, we delineate health service areas from routinely collected health data as a robust geographic basis for presenting access to maternal care indicators.



Methods

A zone design algorithm was adapted to delineate health service areas through a cross-sectional, ecological study design. Health sub-districts were merged into health service areas such that patient flows across boundaries were minimised. Delineated zones and existing administrative boundaries were used to provide estimates of access to maternal health services. We analysed secondary data comprising routinely collected health records from 32,921 women attending 27 hospitals to give birth, spatial demographic data, a service provision assessment on the quality of maternal healthcare and health sub-district boundaries from Eastern Region, Ghana.



Results

Clear patterns of cross border movement to give birth emerged from the analysis, but more women originated closer to the hospitals. After merging the 250 sub-districts in 33 districts, 11 health service areas were created. The minimum percent of internal flows of women giving birth within any health service area was 97.4%. Because the newly delineated boundaries are more “natural” and sensitive to observed flow patterns, when we calculated areal indicator estimates, they showed a marked improvement over the existing administrative boundaries, with the inclusion of a hospital in every health service area.



Conclusion

Health planning can be improved by using routine health data to delineate natural catchment health districts. In addition, data-driven geographic boundaries derived from public health events will improve areal health indicator estimates, planning and interventions.},

keywords = {Ghana, Health, maternal health, Public health},

pubstate = {published},

tppubtype = {article}

}

@article{https://doi.org/10.1016/j.ijgo.2015.11.004,

title = {Spatial distribution of emergency obstetric and newborn care services in Ghana: Using the evidence to plan interventions},

author = {Samuel Bosomprah and Andrew J. Tatem and Winfred Dotse-Gborgbortsi and Patrick Aboagye and Zoe Matthews},

url = {https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1016/j.ijgo.2015.11.004},

doi = {https://doi.org/10.1016/j.ijgo.2015.11.004},

year  = {2016},

date = {2016-01-01},

journal = {International Journal of Gynecology & Obstetrics},

volume = {132},

number = {1},

pages = {130-134},

abstract = {Abstract Objective To provide clear policy directions for gaps in the provision of signal function services and sub-regions requiring priority attention using data from the 2010 Ghana Emergency Obstetric and Newborn Care (EmONC) survey. Methods Using 2010 survey data, the fraction of facilities with only one or two signal functions missing was calculated for each facility type and EmONC designation. Thematic maps were used to provide insight into inequities in service provision. Results Of 1159 maternity facilities, 89 provided all the necessary basic or comprehensive EmONC signal functions 3 months prior to the 2010 survey. Only 21% of facility-based births were in fully functioning EmONC facilities, but an additional 30% occurred in facilities missing one or two basic signal functions—most often assisted vaginal delivery and removal of retained products. Tackling these missing signal functions would extend births taking place in fully functioning facilities to over 50%. Subnational analyses based on estimated total pregnancies in each district revealed a pattern of inequity in service provision across the country. Conclusion Upgrading facilities missing only one or two signal functions will allow Ghana to meet international standards for availability of EmONC services. Reducing maternal deaths will require high national priority given to addressing inequities in the distribution of EmONC services.},

keywords = {Emergency obstetric and newborn care (EmONC), Geospatial analysis, Ghana, Maternal mortality, Needs assessment, Signal functions},

pubstate = {published},

tppubtype = {article}

}