2015 APHA Annual Meeting & Expo

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Online Program

335189
Paradox of care seeking behavior in maternal, neonatal, and child health: Socio-economic status, choice of facilities, and continuum of care


Tuesday, November 3, 2015 : 9:22 a.m. - 9:35 a.m.

Akira Shibanuma, Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
Francis Yeji, Navrongo Health Research Centre, Navrongo, Ghana
Sumiyo Okawa, Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
Evelyn Ansah, Research and Development Division, Ghana Health Service, Accra, Ghana
Kimiyo Kikuchi, Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
Margaret Gyapong, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
Keiko Nanishi, Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
Seth Owusu-Agyei, PhD, Kintampo Health Research Centre, Ghana, Kintampo, Ghana
Abraham Oduro, Dr., Navrongo Health Research Centre, Navrongo, Ghana
Gloria Asare, Headquarters, Ghana Health Service, Accra, Ghana
Junko Yasuoka, Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
Abraham Hodgson, Research and Development Division, Ghana Health Service, Accra, Ghana
Masamine Jimba, Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
  
Audio (mp3) recording Recorded Presentation (mp4)
Background: Socio-economic status (SES) is one of the key predictors of care seeking behavior of antenatal care (ANC), institutional delivery, and postnatal care (PNC). Women with better SES tend to receive care at higher-tier public health facilities and private facilities in developing countries. However, these facilities do not necessarily provide appropriate care and health education. This study examined how women from different SES sought care for ANC from various types of health facilities. It also evaluated their continuous care seeking behavior at delivery and PNC.

Methods: In this retrospective cross-sectional survey from July to September 2014, data were collected from 1,500 randomly selected women in Ghana on their records of receiving ANC, delivery, and PNC as well as SES and other characteristics. Multilevel logistic regression was employed to investigate the factors associated with continuous visits to health facilities.

Results: Women who received ANC at public hospitals and private facilities had 0.68 and 0.82 standard deviations higher SES score than those received at community-level facilities (p<0.001, p<0.001), respectively. Birth preparedness score was significantly higher among women who received ANC at public hospitals (p<0.001) and private facilities (p=0.011) than those who received ANC at community-level facilities. However, received ANC at community-level facilities was associated with increased receiving care continuously at health facilities during delivery and PNC (AOR=3.40, p=0.045).

Conclusions: Public hospitals and private facilities were attracted by women with better SES in Ghana. However, women who received antenatal care at these facilities were not more likely to receive appropriate care continuously during and after delivery, compared with those received antenatal care at community-level facilities. This result highlights the importance of enhancing health education for continuum of care at higher-tier facilities, which tend to be ignored when policy focuses on supplying more community-level facilities.

Learning Areas:

Assessment of individual and community needs for health education
Provision of health care to the public
Public health or related education
Social and behavioral sciences

Learning Objectives:
Compare the difference in women's continuous care seeking behavior in delivery and postnatal care by the type of a health facility at ANC and women's socio-economic status. Discuss an adverse relation between the popularity of a health facility and a client' subsequent care seeking behavior.

Keyword(s): Health Care Access, Community Health Programs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a researcher in community health and development economics, I have been involved in a number of research projects that focus on behaviors among people regarding their seeking health services and adopting good knowledge and practices. One of my key research interests is inequity and inequality in accessing to community health services, including maternal, neonatal, and child health.
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: 4048.0: Maternal Newborn and Child Health II