142nd APHA Annual Meeting and Exposition

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313750
Does quality of antenatal care explain rural-urban differentials in use of skilled birth attendants?

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

Patience A. Afulani, MBChB, MPH , Department of Community Health Sciences, UCLA Fielding School of Public Health, los Angeles, CA
Background: About 800 maternal deaths occur each day, with over half in Sub-Sahara-Africa (SSA) alone. Delivery by Skilled-Birth-Attendants (SBAs) is critical to reducing maternal mortality.  Yet, less than half of births in rural SSA are assisted by a SBA. This is usually attributed to poor health service accessibility, but few studies have actually examined the intervening factors. Qualitative studies suggest quality of maternal health services influences use of SBAs, but few quantitative studies have examined this; and fewer have examined the factors that influence the quality of maternal health care women in SSA receive.

Aim: The purpose of this study is to examine the factors that influence quality of antenatal care (ANC) and use of SBAs in SSA; and whether quality of ANC partially mediates the effect of place of residence on use of SBAs.

Methods: The World Health Survey data for Ghana and Burkina Faso are used (N=2,049). The analysis includes logistic regression with mediation and moderation analysis.

Results: Net of other factors, urban residence is positively associated with better ANC quality. Urban residence and ANC quality are both positively associated with use of SBAs – controlling for socioeconomic and other factors. Quality of ANC care explains a significant amount of the rural/urban differential in use of SBAs. 

Implications: Improving basic quality of ANC provided to rural women is a potential approach to bridging the rural/urban difference in use of SBAs in SSA. This may be more feasible in the short term in many SSA countries than improving access.

Learning Areas:

Program planning
Public health or related public policy
Public health or related research

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

Keyword(s): Maternal and Child Health, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: 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.