142nd APHA Annual Meeting and Exposition

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Decomposing rural urban differences in use of skilled birth attendants: Does quality of antenatal care matter?

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 8:42 AM - 8:54 AM

Patience A. Afulani, MBChB, MPH , Department of Community Health Sciences, UCLA Fielding School of Public Health, los Angeles, CA
Audio (mp3) recording Recorded Presentation (mp4)
Background: Use of skilled birth attendants (SBAs) is critical to reducing maternal mortality. Although place of residence (rural/urban) is recognized as a contextual factor that affects use of SBAs, the intervening pathways by which this occurs has received less attention. Also, many qualitative studies suggest quality of  health services influences women’s use of SBAs, but few quantitative studies have examined this; and even fewer have examined the factors that influence the quality of maternal health care women in sub-Sahara Africa receive.

Aim: The purpose of this study is to examine the factors that influence quality of antenatal care (ANC) and use of SBAs; and whether quality of ANC explains some of the effects of place of residence on use of SBAs.

Methods: The World Health Survey data for Ghana and Burkina Faso are used (N=2,049). Analytic techniques include linear and logistic regressions with mediation and moderation analysis.

Results: Net of other factors, urban residence and higher education are positively associated with better quality of ANC; but the effect of education is conditional on country. Urban residence, higher education, greater wealth, quality of ANC and perceived accessibility of health facilities are also positively associated with use of SBAs. Quality of ANC and perceived accessibility of health facilities explain some of the effect of place of residence on use of SBAs, but this is also conditional on country. 

Implications: Improving quality of ANC provided to rural women is a potential approach to bridging rural urban differences in use of SBAs.

Learning Areas:

Planning of health education strategies, interventions, and programs
Program planning
Provision of health care to the public
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Analyze the determinants of use of skilled birth attendants Analyze the determinants of quality of antenatal care Assess if quality of antenatal care explains some of the rural urban differential in use of skilled birth attendants

Keyword(s): International MCH, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am currently a PhD candidate in the Department of Community Health Sciences at UCLA School of Public Health. I am also from Ghana where I was trained as a medical doctor. My area of specialty is maternal and child health. I conceived the study, conducted the analyses and wrote up the content of this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4049.0: Maternal & child health I