Screening early childhood social emotional and mental health functioning in a low-income country context (original) (raw)

2015, Annals of Global Health

Background: Approximately 800 women die of pregnancy-related complications every day. Over half of these deaths occur in sub-Sahara Africa (SSA). Most maternal deaths can be prevented with high quality maternal health services. That use of maternal health services varies by place of residence and socioeconomic status (SES) in SSA is well established, but few studies have examined the determinants of quality of maternal health services in SSA. The purpose of this study is to examine the determinants of antenatal care (ANC) quality in Ghanaefocusing on place of residence and SES (education and wealth). The analysis examines the interactions of these variables, and the mediating role of ANC timing, frequency, facility type, and provider type. Methods: The data come from the 2007 Ghana Maternal Health Survey, a nationally representative sample of women of reproductive age who had a birth in the five years preceding the survey. This analysis is restricted to women who went for at least one antenatal visit during their last pregnancy (N¼4,868 ¼ 97% of the analytic sample). The primary outcome measure is ANC quality, operationalized as a summative index (ranging from 0 to 9) based on services received during ANC visits. Analytic techniques include multilevel linear regression with mediation and moderation analysis. This study was granted an exemption under the University of California, Los Angeles Institutional Review Board exemption category 4 for research involving the study of existing data. Findings: Urban residence and higher SES are positively associated with higher ANC quality (b¼ 0.36, 0.04, and 0.55 for urban residence compared to rural residence, years of education, and richest compared to poorest, respectively; all at p < 0.0001), but the urban effect is completely explained by sociodemographic factors. Specifically, about half of the urban effect is explained by education and wealth alone (p¼0.0002), with other variables accounting for the remainder. The effects of education are conditional on wealth and are strongest for poorest women. Starting ANC visits early and attending the recommended four visits, as well as receiving ANC from a higher level facility such as a government hospital and from a skilled provider (doctor, nurse or midwife), are associated with higher quality ANC. These factors partially explain the SES differentials. The results are all significant at p < 0.05. Interpretation: Pregnant Ghanaian women experience significant disparities in the quality of ANC, with poor illiterate women receiving the worst care. Targeted efforts to increase quality of ANC may significantly reduce maternal health disparities in Ghana and SSA. A particularly crucial step is to improve ANC quality in the lower level health facilities like health centers and health posts, where the most vulnerable women seek ANC.