Inequalities in the prevalence of skilled birth attendance in Ghana between 1993 and 2014

Justice Kanor Tetteh; Edward Kwabena Ameyaw; Collins Adu; Ebenezer Agbaglo; Pascal Agbadi; Jerry John Nutor

doi:10.1093/inthealth/ihac071

Inequalities in the prevalence of skilled birth attendance in Ghana between 1993 and 2014

Int Health. 2023 Mar 1;15(2):224-232. doi: 10.1093/inthealth/ihac071.

Authors

Justice Kanor Tetteh¹, Edward Kwabena Ameyaw², Collins Adu^{3

4}, Ebenezer Agbaglo⁵, Pascal Agbadi⁶, Jerry John Nutor⁷

Affiliations

¹ Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
² Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong.
³ Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
⁴ College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland 4811, Australia.
⁵ Department of English, University of Cape Coast, Cape Coast, Ghana.
⁶ Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
⁷ Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, 2 Koret Way, Suite N431G, San Francisco, CA 94143, USA.

Abstract

Background: Globally, maternal and neonatal health remains a public health priority, particularly for resource-constrained regions like sub-Saharan Africa (SSA). Skilled birth attendance (SBA) is essential in promoting maternal and neonatal health. This study investigated the inequalities in the prevalence of SBA in Ghana using data from the Ghana Demographic and Health Survey (GDHS) between 1993 and 2014.

Methods: Data were analysed using the World Health Organization's Health Equity Assessment Toolkit software. In analysing the data, we first disaggregated SBA by four inequality stratifiers: wealth index, education, residence, and region. Second, we measured the inequality through summary measures, namely difference, population attributable risk, ratio, and population attributable fraction. A 95% confidence interval was constructed for point estimates to measure statistical significance.

Results: Throughout the period, SBA was highest among women in the highest wealth quintile and those with a secondary or higher level of education. The analysis also indicated that SBA was highly concentrated among urban residents in 1993 (80.78 [95% uncertainty interval {UI} 76.20-84.66]) and persisted to 2014 (91.55 [95% UI 88.80-93.68]). In 1993, Northern region recorded the lowest prevalence of SBA in Ghana (15.69 [95% UI 11.20-21.54]) and the region consistently recorded the lowest SBA prevalence even into 2014 (38.21 [95% UI 27.44-50.27]).

Conclusions: There are significant inequalities in SBA across education, wealth, residence, and region in Ghana. To enhance SBA, there is the need for policymakers and interventionists to design and develop targeted policies and programs that are tailored to the needs of the subpopulations at risk of low SBA: women with no formal education, those within the poorest wealth quintile, rural-dwelling women and women in the Northern region. This will facilitate the uptake of SBA and ultimately translate into the realization of Sustainable Development Goals 3.1 and 3.2.

Keywords: Ghana; demographic and health surveys; global health; inequality; maternal health; skilled birth attendance.

MeSH terms

Educational Status
Female
Ghana
Healthcare Disparities*
Humans
Infant, Newborn
Parturition*
Pregnancy
Prevalence
Socioeconomic Factors