A COMPARATIVE STUDY OF THE UPTAKE OF SKILLED DELIVERY SERVICES IN TAMALE METROPOLIS AND THE NANUMBA NORTH DISTRICT OF GHANA

Abstract

There are disparities in the use of skilled delivery services between women in Tamale Metropolis and women in the Nanumba North District. Information on factors responsible for these disparities has not been adequately explained. The aim of this study was to compare the uptake of skilled delivery services among Nanumba North and Tamale Metropolis women. A comparative cross sectional study was conducted in the T31D.ale Metropolis and the Nanumba North District in the Northern Region of Ghana. The study population comprised 720 postpartum women who had delivered within the last three months prior to the study. Both qualitative and quantitative methods were used in the data collection. A two-stage cluster sampling was used to extract the study population. Younger mothers were found in the Nanumba North district than i the Tamale Metropolis (52.9% versus 47.1 %). The proportion of women who made at least four antenatal care (ANC) visits in the Tamale Metropolis was 48.6 % compared to 37.5% in the Nanumba North (Chi = 9.1, P = 0.003). Higher but insignificant proportion of Tamale Metropolis women delivered in health facilities than Nanumba North women (48.6% versus 41.7%) (Chi = 3.5 P = 0.06). The most frequently cited reason for not delivering in health institution in the Nanumba North was fear of caesarean delivery but in the Tamale Metropolis slow response of nurses (51.1 %) and lack of privacy (52.6%) were given for non-patronage of skilled delivery services. The factors that were found to influence the use of skilled delivery services in Nanumba North and Tamale Metropolis were not exactly the same. In the Nanumba North, women who attended fu~C at least four times were 15.6 times more likely to deliver in a health institution, compared to women who attended for less than 4 times (AOR= 15.63, 95 % CI [8.16, 29.95]). The corresponding association for the Tamale Metropolis women was greatly reduced (AOR= 3.8, 95 % CI [2.33, 6.13]). Women who were far from health facility (> 4 km) had 85% protection against patronizing institutional delivery services (AOR= 0.15, 95 % CI [0.07, 0.29]). In the Nanumba North, distance «> 4 km) was more of a constraint, compared to Tamale Metropolis since that protected 94 % of women from patronizing institutional delivery services (AOR= 0.06, 95 % CI [0.02, 0.13]). In Tamale Metropolis, maternal autonomy and parity were not important predictors of utilization of health facility for child birth but they were major determinants in Nanumba North. In Nanumba North, women of high parity (> 4) were 11 times more likely of delivering in a health facility, compared to women of lower parity (1-2) (AOR= 11.21, 95 % CI [4.56,27.58]). Women of high autonomy (economic independence, decision making, freedom of movement) were 3.4 times more likely of delivering in a health facility, compared with women oflow autonomy (AOR= 3.44, 95 % CI [1.85, 6.39]) in the Nanumba North. In Nanumba North, socio-economic status as measured by household wealth index was not an important predictor of utilization of health institutions for birth. Women of high household wealth index were likely to deliver in a health facility in the Tamale Metropolis. It can be concluded that women in the Tamale Metropolis attended ANC more frequently than Nanumba North women. However, the prevalence of institutional deliveries was not significantly different in the two settings. The large disparity in ANC adequacy between the two settings suggests more priority ANC services should be given to the Nanumba North. Enhancement of women autonomy in Nanumba North may greatly promote institutional delivery.