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Determinants of Skilled Birth Attendants at Delivery in Rural Southern Ghana Alfred Kwesi Manyeh.

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Presentation on theme: "Determinants of Skilled Birth Attendants at Delivery in Rural Southern Ghana Alfred Kwesi Manyeh."— Presentation transcript:

1 Determinants of Skilled Birth Attendants at Delivery in Rural Southern Ghana Alfred Kwesi Manyeh

2 Presentation Outline 1. 1. Background 2. 2. Objective 3. 3. Methodology 4. 4. Results 5. 5. Conclusion 6. 6. Recommendations 7. 7. Acknowledgements

3 BACKGROUND (1) Improving maternal health is one of the eight MDGs adopted by the international community in 2000 Under MDG5, countries committed to reducing maternal mortality ratio (MMR) by three quarters, 1990-2015 Between 1990-2013 MMR declined by only 2.6% per year globally Far from annual decline of 5.5% required to achieve MDG5 1 1. Trends in Maternal Mortality: 1990 to 2013, WHO, UNICEF, UNFPA and the World Bank

4 BACKGROUND (2) Ghana has recorded a decline in its MMR by 49% between 1990 and 2013 2 There remains a substantial amount of effort to reach the MDG 5 target of 185 deaths per 100,000 live births. Some 3,100 women died from pregnancy-related complications in Ghana between January and December 2013 2 2. Trends in maternal mortality: 1990 to 2013’ a Maternal Mortality Estimation Inter-Agency Group (MMEIG) of the United Nations (UN)

5 BACKGROUND (3) The giant strides made by western countries in dropping their maternal mortality ratio were due to the recognition given to skilled attendants at delivery Most obstetric complications could be prevented or managed if women had access to skilled birth attendant (doctor, nurse, midwife) during childbirth.

6 OBJECTIVE To examine the determinants of skilled birth attendants at delivery in Dodowa HDSS.

7 Methodology (1) Study Area – Dodowa Health and Demographic Surveillance Area, Ghana

8 Methodology (2) Study design: Using secondary data from Dodowa HDSS Study paticipants: All registered women aged 15 to 49 years in the Dodowa HDSS from 1 st January 2011 to 31 st December 2011 Who gave birth not more than two years prior to the study A total of 1, 874 women.

9 Methodology (3) The univariable and multivariable association were explored using logistic regression STATA 11 at 5% significant level Results are presented in tables and charts

10 Results

11 Socio-demographic characteristics of participants (1) CharacteristicsFrequency *Proportion (%) Age Group 15-1922311.9 20-2449426.36 25-2949826.57 30-3434818.57 35-3920711.05 40+1045.55 Mean=27.41 (SD=6.87) Ethnicity Ga-Dangme1,37073.11 Akan1015.39 Ewe29815.9 Northern975.18 Others80.43

12 Socio-demographic characteristics of participants (2) CharacteristicsFrequency *Proportion (%) Religion Christianity1,72792.16 Islamic1005.34 Traditional221.17 Others251.33 Occupation Unemployed47725.45 Farmer29915.96 Artisan25213.45 Petty Trader51027.21 Civil Servant301.60 Student26514.14 Others412.19 Level of Education No Education51227.32 Primary56730.26 Junior High /Middle school 64634.47 Senior High and above1497.95

13 Socio-demographic characteristics of participants (3) CharacteristicsFrequency *Proportion (%) Marital Status Single55029.35 Married34918.62 Separated/Divorced321.71 Cohabiting90748.40 Widowed90.48 Missing271.44 Parity Parity154328.98 Parity246424.76 Parity332917.56 Pariy422311.90 Parity5+31516.81 Socio Economic Status Poorest32619.90 Poorer35721.79 Poor30518.62 Less poor35521.67 Least poor29518.01 Assisted Delivery No Skilled person58331.11 Skilled Person1,29168.89 ANC Attendance during last pregnancy Yes1,84198.29 No321.71

14 Percentage distribution of home delivery by socioeconomic status

15 Crude and adjusted OR of determinants of skilled birth attendants at delivery (1) CrudeAdjusted* CharacteristicsORP-Values (95% CI)ORP-Values (95% CI) Age Group 15-191.00 20-241.340.079(0.97-1.85)1.530.039(1.02-2.30)† 25-291.87<0.001(1.34-2.60)†2.120.002(1.31-3.42)† 30-341.740.002(1.22-2.48)†2.440.002(1.40-4.24)† 35-392.15<0.001(1.42-3.25)†4.00<0.001(2.10-7.61)† 40+1.450.139(0.89-2.36)4.25<0.001(2.08-8.71)† Marital Status Single1.00 Married1.69<0.001(1.25-2.29)†1.320.192(0.87-1.10) Separated/Divorced1.560.289 (0.687-3.54)3.400.036(1.08-10.68)† Cohabiting1.090.460 (0.87-1.36)1.200.246(0.88-1.64) Widowed1.820.459(0.37-8.836)2.190.490(0.24-20.38) Missing0.880.760 (0.40-1.97)0.970.956(0.39-2.42) OR: Odd Ratio †: statistically significant. CI: Confidence Interval. * Correct classification rate of the model=72.65%,

16 Crude and adjusted OR of determinants of skilled birth attendants at delivery (2) CrudeAdjusted* CharacteristicsORP-Values (95% CI)ORP-Values (95% CI) Level of Education No Education1.00 Primary1.61<0.001(1.26-2.05)†1.520.006(1.13-2.06)† Junior High /Middle school3.09<0.001(2.40-4.00)†2.07<0.001(1.51-2.83)† Senior High and above8.88<0.001(4.90-16.10)†3.41<0.001(1.65-7.04)† Occupation Unemployed1.00 Farmer0.630.003(0.47-0.85)†0.690.050(0.48-1.00) Artisan2.30<0.001(1.59-3.33)†1.040.856(0.67-1.63) Trader1.430.010(1.09-1.88)†1.250.200(0.89-1.75) Civil Servant7.200.007(1.69-30.60)† Student0.950.756(0.69-1.30)0.870.533(0.56-1.34) Others1.400.355(0.69-2.87)1.250.609(0.53-2.91) OR: Odd Ratio † statistically significant. CI: Confidence Interval. *Correct classification rate of the model=72.65%,

17 Crude and adjusted OR of determinants of skilled birth attendants at delivery (3) CrudeAdjusted* CharacteristicsORP-Values (95% CI)ORP-Values (95% CI) Parity Parity11.00 Parity20.740.029(0.56-0.97)†0.46<0.001(0.32-0.66)† Parity30.760.075(0.56-1.03)0.34<0.001(0.22-0.52)† Pariy40.840.331(0.59-1.19)0.500.008(0.30-0.83)† Parity5+0.41<0.001(0.30-0.55)†0.24<0.001(0.14-0.39)† Socio Economic Status Poorest1.00 Poorer1.390.034(1.03-1.88)†1.170.342(0.84-1.63) Poor1.700.001(1.23-2.34)†1.310.129(0.92-1.86) Less poor3.54<0.001(2.53-4.96)†2.55<0.001(1.77-3.69)† Least poor8.75<0.001(5.60-13.67)†4.80<0.001(2.96-7.77)† ANC Attendance Attend ANC1.00 Don't attend ANC0.03<0.001(0.01-0.12)†0.05<0.001(0.01-0.22)† Type of live birth First live birth1.00 Not first live birth0.65<0.001(0.52-0.82)† OR: Odd Ratio † statistically significant. CI: Confidence Interval. *Correct classification rate of the model=72.65%,

18 Conclusion Although 69% of women in the study area had skilled birth attendants at delivery, women from: Poorest households, Higher parity, Uneducated, Not attending ANC and Younger women Were more likely to deliver without a skilled birth attendants at delivery.

19 Recommendation Future intervention in the study area to bridge the gap between the poor and least poor women Girls should be encourage to have more than junior high school level of education These recommendations may apply to similar rural settings in Ghana. To…

20

21 Acknowledgement DHRC – Ghana INDEPTH Network

22 Thank You

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