Dataset in support of the thesis 'Emergency obstetric and newborn care quality assessment census in Eastern region, Ghana'

This data was collected to assess the quality of emergency obstetric and newborn care services in health facilities providing birthing services in the Eastern region, Ghana. Health facilities were surveyed to collect primary data through interviews with a questionnaire. A questionnaire was created by combining questions from existing service provision assessment tools. The questionnaire was loaded onto a mobile phone for faster data collection to eliminate data entry and minimise errors. Midwives were interviewed, and birth registers were examined. </span

Spatial patterns of birthing service use in Eastern region, Ghana

Maternal mortality is a major public health concern in Ghana as women continue to die from avoidable pregnancy and childbirth complications. The Eastern Region, Ghana has one of the highest maternal mortality rates in the country. While the number of women using health facility birthing services has increased, it has not led to a significant decrease in maternal deaths. The thesis examines how travel time and the quality of birthing services drives utilisation The study analyses routine birth records of women attending health facilities to give birth. Through a three paper thesis format, the first study develops health service areas from birthing care utilisation patterns derived from routine health data. The second paper assesses the quality of emergency obstetric and newborn care services in health facilities providing birthing. The final paper determines how the quality of maternal health services and travel time to health facilities are associated with health facility birthing service utilisation in Eastern region, Ghana. The thesis delineated 11 health service areas from the flows of women giving birth. Because the newly delineated boundaries are more "natural" and sensitive to observed flow patterns, areal indicator estimates showed a marked improvement over the existing administrative boundaries. The overall quality in hospitals was better than health centres and other primary level health facilities. Most districts did not have the required number of functioning emergency obstetric and newborn care health facilities. Also, most women travelling via mechanised transport were within two hours of any birthing service. In contrast, majority of women were beyond the two-hour threshold of critical comprehensive emergency obstetric and newborn care services. Higher travel time to health facilities decreased utilisation while increasing quality care promoted birthing care utilisation. The effect of quality is more profound than proximity. At similar quality, shorter travel times were associated with better use. To increase birthing service utilisation in Ghana, higher quality health facilities should be sited closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to analyse spatial patterns of birthing service use. In addition, data-driven geographic boundaries derived from public health events will improve areal health indicator estimates, planning and interventions.<br/

Healthcare-seeking behaviour in reporting of scabies and skin infections in Ghana – a review of reported cases

Background: Scabies is a neglected tropical disease. In resource-poor settings, scabies and other skin infections are often unreported to a health centre, or misdiagnosed. Dermatological expertise and training are often lacking. Little is known about patient healthcare-seeking behaviour. This study reviewed diagnosed skin infections reported to urban (Greater Accra) and rural (Oti region) study health centres in Ghana over six months in 2019. Methods: Study staff received classroom and clinical dermatology training. Skin infection diagnoses and anonymised patient information were recorded. Descriptive statistics and spatial analysis described patient demographics, and distance travelled to clinic, noting bypassing of their nearest centre. Results: Overall, 385 cases of skin infectionswere reported across the Greater Accra and Oti study clinics, with 45 scabies cases (11.6%). For scabies, 29 (64.4%) cases were in males. Scabies was the third most common diagnosis, behind bacterial dermatitis (102, 26.5%) and tinea (75, 19.5%). In the rural Oti region, 48.4% of patients bypassed their nearest clinic, travelling a mean 6.2 km further than they theoretically needed to. Females travelled further in comparison to males. Conclusions: There must be greater public and professional awareness of scabies and skin infections as highburden but treatable conditions, along with assessment of their community burden.</p

Characteristics of packaged water production facilities in Greater Accra, Ghana: implications for water safety and associated environmental impacts

Packaged water (sold in bags or bottles) is widely consumed in many countries and is the main drinking-water source for most urban Ghanaian households. There are however few studies of packaged water production. This study aims to assess the source water, treatment and manufacturing characteristics of sachet water (vended in 500ml plastic bags), together with point-of-manufacture risks to hygienic production. A sample of 90 sachets was collected of brands sold in four neighbourhoods in Accra, Ghana, their packaging and physical characteristics recorded, and a risk score calculated from these. Production processes were observed at 60 associated sachet factories, producers interviewed, and surrounding neighbourhoods surveyed for contamination hazards. 80% of producers packaged groundwater from boreholes and all treated water via reverse osmosis. Almost all manufacturers (95%) reported site visits by regulators in the previous year and few risks to hygienic production were observed at factories. Sanitary risk scores were 9.2% higher at the seven factories never visited by a regulator, though this difference was not significant (t=1.81; p=0.07). This survey suggests most Ghanaian sachet water originates from groundwater and is comparatively safe, though a minority remains unregulated. Groundwater governance policy could support this industry in meeting Greater Accra’s growing water demand through the designation of protected municipal wellfields

Geographic Distribution of Registered Packaged Water Production in Ghana: Implications for Piped Supplies, Groundwater Management and Product Transportation

Packaged water consumption has grown rapidly in urban areas of many low�income and middle�income countries, but particularly in Ghana. However, the sources of water used by this growing packaged water industry and the implications for water resource management and transport�related environmental impacts have not been described. This study aimed to assess the spatial distribution of regulated packaged water production in Ghana, both in relation to demand for natural mineral water and hydrogeological characteristics. A total of 764 addresses for premises licensed to produce packaged water from 2009 to 2015 were mapped and compared to regional sachet water consumption and examined beverage import/export data. We found evidence to suggest that packaged water is transported shorter distances in Ghana than in developed countries. Groundwater abstraction for packaged water is low relative to piped water production and domestic borehole abstraction nationally, but may be locally significant. For natural mineral water, producers should be able to address the most widespread water quality hazards (including high salinity, iron and nitrates) in aquifers used for production through reverse osmosis treatment. In future, packaged water producer surveys could be used to quantify unregulated production, volumes of piped versus groundwater abstracted and treatment processes used

The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana

Objectives: Skilled birth attendance is the single most important intervention to reduce maternal mortality. However, studies have not used routinely collected health service birth data at named health facilities to understand the influence of distance and quality of care on childbirth service utilisation. Thus, this paper aims to quantify the influence of distance and quality of healthcare on utilisation of birthing services using routine health data in Eastern Region, Ghana.Methods: We used a spatial interaction model (a model that predicts movement from one place to another) drawing on routine birth data, emergency obstetric care surveys, gridded estimates of number of pregnancies and health facility location. We compared travel distances by sociodemographic characteristics and mapped movement patterns.Results: A kilometre increase in distance significantly reduced the prevalence rate of the number of women giving birth in health facilities by 6.7%. Although quality care increased the number of women giving birth in health facilities, its association was insignificant. Women travelled further than expected to give birth at facilities, on average journeying 4.7 km beyond the nearest facility with a recorded birth. Women in rural areas travelled 4 km more than urban women to reach a hospital. We also observed that 56% of women bypassed the nearest hospital to their community.Conclusion: This analysis provides substantial opportunities for health planners and managers to understand further patterns of skilled birth service utilisation, and demonstrates the value of routine health data. Also, it provides evidence based information for improving maternal health service provision by targeting specific communities and health facilities

Delineating natural catchment health districts with routinely collected health data from women's travel to give birth in Ghana

BackgroundHealth 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. MethodsA 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.ResultsClear 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.<br/

Spatial inequalities in skilled attendance at birth in Ghana: A multilevel analysis integrating health facility databases with household survey data

ObjectiveThis study aimed at using survey data to predict skilled attendance at birth (SBA) across Ghana from healthcare quality and health facility accessibility.MethodsThrough a cross-sectional, observational study, we used a random intercept mixed effects multilevel logistic modelling approach to estimate the odds of having SBA, then applied model estimates to spatial layers to assess the probability of SBA at high spatial resolution across Ghana. We combined data from the Demographic and Health Survey (DHS), routine birth registers, a service provision assessment of emergency obstetric care services, gridded population estimates, and modelled travel time to health facilities.ResultsWithin an hour’s travel, 97.1% of women sampled in the DHS could access any health facility, 96.6% could reach a facility providing birthing services and 86.2% could reach a secondary hospital. After controlling for characteristics of individual women, living in an urban area and close proximity to a health facility with high quality services were significant positive determinants of SBA uptake. The estimated variance suggests significant effects of cluster and region on SBA as 7.1% of the residual variation in the propensity to use SBA is attributed to unobserved regional characteristics and 16.5% between clusters within regions.ConclusionGiven the expansion of primary care facilities in Ghana, this study suggests that higher quality healthcare services, as opposed to closer proximity of facilities to women, is needed to widen SBA uptake and improve maternal health.<br/

Mapping access to basic hygiene services in low- and middle-income countries: A cross-sectional five-country case study of geospatial disparities

Handwashing with water and soap is among the most a cost-effective interventions to improve public health. Yet billions of people globally lacking handwashing facilities with water and soap on premises, with gaps particularly found in low- and middle-income countries. Targeted efforts to expand access to basic hygiene services require data at geospatially explicit scales. Drawing on country-specific cross-sectional Demographic and Health Surveys with georeferenced hygiene data, we developed an ensemble machine learning model to predict the prevalence of basic hygiene facilities in Malawi, Nepal, Nigeria, Pakistan and Uganda. The ensemble model was based on a multiple-level stacking structure, where four predictive modelling algorithms were used to produce sub-models, and a random forest model was used to generalise the final predictions. An inverse distance weighted interpolation was incorporated in the random forest model to account for spatial autocorrelation. Local coverage and a local dissimilarity index were calculated to examine the geographic disparities in access. Our methodology produced robust outputs, as evidenced by performance evaluations (all R2 were above 0.8). Among the five study countries, Pakistan had the highest overall coverage, whilst Malawi had the poorest coverage. Apparent disparities in basic hygiene services measured by local coverage were found across geographic locations and between urban and rural settings. Nigeria had the highest level of inequalities in basic hygiene services measured by a dissimilarity index, whilst Malawi showed the least segregation between populations with and without basic hygiene services. Both educational attainment and wealth were important predictors of the geospatial distribution of basic hygiene services. By producing geospatially explicit estimates of the prevalence of handwashing facilities with water and soap, this study provides a means of identifying geographical disparities in basic hygiene services. The method and outputs can be useful tools to identify areas of low coverage and to support efficient and precise targeting of efforts to scale up access to handwashing facilities and shift social and cultural norms on handwashing

Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data

Objectives: to investigate how the quality of maternal health services and travel times to health facilities affect birthing service utilisation in Eastern Region, Ghana.Design: the study is a cross-sectional spatial interaction analysis of birth service utilisation patterns. Routine birth data were spatially linked to quality care, service demand and travel time data. Setting: 131 Health facilities (public, private and faith-based) in 33 districts in Eastern Region, Ghana.Participants: women who gave birth in health facilities in the Eastern Region, Ghana in 2017.Outcome measures: the count of women giving birth, the quality of birthing care services and the geographic coverage of birthing care services.Results: as travel time from women’s place of residence to the health facility increased up to two2 hours, the utilisation rate markedly decreased. Higher quality of maternal health services haves a larger, positive effect on utilisation rates than service proximity. The quality of maternal health services was higher in hospitals than in primary care facilities. Most women (88.6%) travelling via mechanised transport were within two2 hours of any birthing service. The majority (56.2%) of women were beyond the two2 -hour threshold of critical comprehensive emergency obstetric and newborn care (CEmONC) services. Few CEmONC services were in urban centres, disadvantaging rural populations.Conclusions: so increase birthing service utilisation in Ghana, higher quality health facilities should be located closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to understand the interaction of service proximity and quality.<br/