Introduction
Methods
Study design and setting
Sampling and sample size
3.842 0.25 / 0.042 = 600
Data collection and analysis
Variable | Description |
---|---|
Maternal healthcare utilization | |
Antenatal care | Three or more antenatal care visits during previous pregnancy. |
Skilled delivery | Previous childbirth attended by a skilled birth attendant |
Postnatal or postpartum care | Postnatal care for mother and baby received from a trained Health Care Worker (HCW) within three days or more during the previous pregnancy |
Mothers socioeconomic characteristics | |
Age | Maternal age (years) at the time of survey data collection; < 24 years, 24–34, and > 34. |
Educational level | Mothers highest level of educational attainment (no education, primary, middle/JHS, secondary or tertiary level education) |
Marital status | Married, cohabiting, single. Single included widowed, divorced/separated and never married. |
Employment status | Employed; Unemployed, student, other |
Number of children | Number of living children mothers had had prior to data collection |
Religion | Christian, Islam, and other (other mainly consisted of traditional African religion, no religion) |
Household wealth | Wealth class status of household expressed in quartiles: first quartile (lowest), second, third, fourth (highest). |
Perceived socio-economic status | Self-rated socio-economic status; rich, moderately rich, poor, very poor. |
Access to healthcare | |
Registered with NHIS | Registered, not registered |
Proximity to health facility | Time (in minutes) spent to travel to the health facility (< 30, 30–60, > 60). |
Health behaviour and practices | |
Use of family planning | Used any family modern planning method at six weeks postpartum; yes or no |
Preferred source of healthcare | Place healthcare is sort for when mother or new-born baby is sick; herbalist, drugs at home, health facility, chemist, other sources |
Knowledge level | |
Knowledge of pregnancy-related conditions | |
Knowledge of danger signs | |
Breastfeeding | Initiation of breastfeeding within 24 h after birth |
Tetanus toxoid vaccination | Have had active immunization against tetanus |
Results
Relationship between respondents’ background characteristics and maternal healthcare
Variables | Frequency N = 720 | Percentage | Antenatal care visits > 3 (N = 493) | p-value | Skilled delivery (N = 602) | p-value | Postnatal care (N = 242) | p-value |
---|---|---|---|---|---|---|---|---|
% | % | % | ||||||
Age | ||||||||
− < 24 | 319 | 44.3 | 71.5 | < 0.001 | 60.8 | 0.411 | 30.2 | < 0.001 |
− 24–34 | 316 | 43.9 | 88.8 | 64.0 | 46.6 | |||
− 34 and above | 85 | 11.9 | 92.8 | 70.3 | 53.6 | |||
Highest educational level | ||||||||
− None | 121 | 16.8 | 83.2 | 0.048 | 53.5 | 0.123 | 39.3 | 0.254 |
− Primary | 148 | 20.6 | 86.2 | 65.7 | 46.3 | |||
− Middle/JHS | 357 | 49.6 | 81.9 | 67.0 | 40.1 | |||
− Secondary/Tertiary/others | 94 | 13.1 | 70.7 | 66.7 | 32.0 | |||
Religion | ||||||||
− Christianity | 633 | 87.9 | 83.5 | 0.005 | 64.4 | 0.081 | 40.0 | 0.695 |
− Islamic | 65 | 9.0 | 71.2 | 66.7 | 44.1 | |||
− Other | 22 | 3.1 | 61.1 | 33.3 | 33.3 | |||
Marital status | ||||||||
− Single* | 55 | 7.7 | 81.9 | < 0.001 | 66.9 | 0.485 | 47.4 | 0.032 |
− Married | 208 | 28.9 | 85.3 | 61.8 | 38.5 | |||
− Cohabitation | 457 | 63.5 | 53.8 | 70.0 | 28.8 | |||
Employment status | ||||||||
− Unemployed/student/other | 562 | 78.1 | 68.5 | < 0.001 | 59.7 | 0.403 | 27.7 | 0.001 |
− Employed | 158 | 21.9 | 85.8 | 64.9 | 43.9 | |||
Number of living children | ||||||||
− None | 200 | 27.8 | 50.6 | < 0.001 | 30.6 | < 0.001 | 5.5 | < 0.001 |
− 1 | 160 | 22.2 | 96.3 | 75.2 | 60.4 | |||
− 2 | 118 | 16.4 | 92.5 | 63.4 | 49.7 | |||
− 3 or more | 342 | 33.6 | 91.5 | 61.6 | 50.4 | |||
Registered with NHIS | ||||||||
− Yes | 697 | 97.1 | 88.9 | 0.426 | 76.9 | 0.318 | 40.5 | 0.543 |
− No | 23 | 2.9 | 81.5 | 63.4 | 33.3 | |||
Card active (n = 697) | 695 | 99.7 | ||||||
Proximity to health facility (minutes spent) (n = 719) | ||||||||
− < 30 | 373 | 51.9 | 82.9 | 0.665 | 60.6 | 0.270 | 40.3 | 0.881 |
− 30–60 | 304 | 42.3 | 80.0 | 68.1 | 40.4 | |||
− > 60 | 42 | 5.8 | 80.6 | 63.3 | 36.1 | |||
Household wealth (n = 641) | ||||||||
− First quartile (lowest) | 137 | 21.4 | 85.7 | 0.031 | 61.1 | 0.598 | 29.5 | < 0.001 |
− Second quartile | 187 | 29.2 | 76.9 | 61.2 | 36.1 | |||
− Third quartile | 142 | 22.1 | 81.8 | 64.5 | 40.5 | |||
− Fourth quartile (Highest) | 175 | 27.3 | 89.0 | 68.5 | 56.1 | |||
Perceived socio-economic status | ||||||||
− Rich | 46 | 6.4 | 92.5 | < 0.001 | 88.6 | 0.014 | 65.0 | 0.010 |
− Moderately rich | 486 | 67.5 | 85.5 | 62.8 | 37.7 | |||
− Poor | 143 | 19.9 | 70.5 | 58.8 | 40.2 | |||
− Very poor | 45 | 6.3 | 71.1 | 60.7 | 40.0 |
Respondents’ healthcare behavior and knowledge related to pregnancies and childcare
Variables | Frequency | Percentage |
---|---|---|
Breastfed within 24 h after delivery (n = 629) | ||
− Yes | 447 | 71.1 |
− No | 182 | 28.9 |
Used family planning (any modern methods) at six weeks postpartum (n = 630) | ||
− Yes | 271 | 43.0 |
− No | 359 | 57.0 |
Preferred source of healthcare (n = 630) | ||
− Herbalist | 6 | 1.0 |
− Drugs at home | 38 | 6.0 |
− Health facility | 337 | 53.5 |
− Chemist | 71 | 11.5 |
− Prayer camps | 35 | 5.6 |
− Others | 143 | 22.7 |
Variables | Frequency N = 720 | Percentage |
---|---|---|
Number of antenatal visits during the last pregnancy | ||
− None | 89 | 12.4 |
− 1 | 8 | 1.1 |
− 2 | 14 | 1.9 |
− 3 or more | 493 | 68.5 |
− Unknown | 116 | 16.1 |
Mean (SD) | 5 (2.3) | |
Last childbirth attended by a skilled birth attendant | 602 | 83.6 |
Number of tetanus toxoid vaccines received during previous pregnancy | ||
− None | 145 | 20.1 |
− 1 | 178 | 24.7 |
− 2 | 149 | 20.7 |
− 3 or more | 248 | 34.4 |
Median | 2.0 | |
Number of postnatal care received from a trained Health Care Worker (HCW) during previous pregnancy | ||
− 1 | 38 | 5.3 |
− 2 | 110 | 15.3 |
− 3 or more | 456 | 63.3 |
− Unknown | 116 | 16.1 |
Mean (SD) | 4 (1.9) | |
Care (at least within three days) of postpartum, by a trained HCW during previous pregnancy | ||
− None | 118 | 16.4 |
− 1 | 242 | 33.6 |
− 2 | 212 | 29.4 |
− 3 times or more | 148 | 20.6 |
Median | 2.0 | |
Baby/ies receive care at least within three days after birth, by a trained HCW | ||
− None | 118 | 16.4 |
− 1 | 240 | 33.3 |
− 2 | 215 | 29.9 |
− 3 times or more | 146 | 20.3 |
Median | 2.0 |
Factors associated with access to maternal healthcare services
Variables | Antenatal care visits > 3 aOR [95% CI] | Skilled delivery aOR [95% CI] | Postnatal care aOR [95% CI] |
---|---|---|---|
A. Socio-economic | |||
Age (ref = < 24) | |||
− 24–34 | 1.48 [0.77, 2.84] | 1.64 [0.90, 3.01] | 1.63 [0.97, 2.73] |
− > 34 | 2.33 [0.58, 9.47] | 2.73 [1.13, 6.59]* | 2.06 [0.92, 4.63] |
Highest educational level (ref = none) | |||
− Primary | 1.34 [0.53, 3.39] | 2.11 [1.10, 4.05]* | 1.75 [0.97, 3.17] |
− Middle/JHS | 1.05 [0.49, 2.26] | 2.18 [1.23, 3.87]** | 1.40 [0.82, 2.40] |
− Secondary/Tertiary/others | 0.54 [0.22, 1.32] | 1.39 [0.56, 3.46] | 0.85 [0.40, 1.80] |
Religion (ref = Christian) | |||
− Muslim | 0.51 [0.22, 1.20] | 1.52 [0.73, 3.15] | 1.19 [0.63, 2.23] |
− Other | 0.30 [0.07, 1.27] | 0.45 [0.10, 2.03] | 1.11 [0.30, 4.08] |
Employed | 1.47 [0.77, 2.83] | 0.76 [0.38, 1.55] | 1.21 [0.69, 2.14] |
Marital status (ref = married) | |||
− Cohabitation | 2.07 [1.14, 3.77]* | 0.92 [0.57, 1.48] | 0.97 [0.63, 1.49] |
− Single/Divorced | 0.93 [0.31, 2.79] | 2.42 [0.46, 12.84] | 1.02 [0.38, 2.79] |
Number of children (ref = 1 and 2) | |||
− 3 or more | 2.15 [0.97, 4.77] | 0.55 [0.31, 0.98]* | 0.83 [0.49, 1.40] |
Household wealth (ref = first) | |||
− Second quintile | 0.73 [0.40, 1.50] | 1.00 [0.53, 1.91] | 1.45 [0.84, 2.49] |
− Third quintile | 0.71 [0.31, 1.63] | 1.12 [0.58, 2.19] | 1.63 [0.93, 2.86] |
− Fourth quintile (Highest) | 1.52 [0.63, 3.70] | 1.39 [0.71, 2.70] | 2.84 [1.63, 4.94]*** |
B. Access to healthcare | |||
Active NHIS membership | 0.24 [0.04, 1.64] | 0.47 [0.12, 1.86] | 1.71 [0.57, 5.13] |
Proximity to health facility (ref = < 30) | |||
− 30–60 | 0.61 [0.36, 1.03] | 1.55 [0.99, 2.43] | 0.95 [0.65, 1.39] |
− > 60 | 0.49 [0.17, 1.41] | 1.30 [0.50, 3.38] | 0.78 [0.35, 1.75] |
Health facility main source of care | 3.45 [1.97, 6.03]*** | 2.36 [1.49, 3.73]*** | 0.83 [0.57, 1.20] |
C. Knowledge level | |||
Knowledge about pregnancy related emergencies (ref = low) | |||
− Moderate | 1.14 [0.44, 2.97) | 0.88 [0.44, 1.75] | N/A |
Knowledge about danger signs of newborn (ref = low) | |||
− High | 0.47 [0.06, 3.67] | 0.15 [0.01, 2.55] | 0.33 [0.03, 3.81] |