DETERMINANTS OF SKILLED BIRTH ATTENDANCE IN THE MAMPRUGU MOAGDURI DISTRICT, NORTHERN REGION

Abstract

The fifth Millennium Development Goal calls for a reduction of maternal mortality ratio by 75% between 1990 and 2015. A key indicator to measure this goal is the proportion of births attended by skilled health personnel. The maternal mortality ratio of Ghana in the year 2013 was 154 deaths per 100,000 live births. High skilled birth attendance is correlated with lower maternal mortality rates globally. However, the proportion of births with a skilled attendant was only 54.7% in Ghana in the year 2013. Therefore identifying the determinants of skilled attendance for delivery is a priority area to give policy recommendations. The study design was a cross sectional descriptive study. Probability and non-probability sampling techniques were employed in the sampling procedures. At the household level data was collected from women of reproductive age between 15-49 years, to find out some of the barriers to the effective utilization of the modern health care services, with emphasis on skill birth delivery. A total of 220 women of reproductive age were part of the study and four focused group discussions were conducted among opinion leaders in four communities. The quantitative data was analyzed using SPSS 18.0 while the qualitative data was analyzed using quotes and simple narrations. Only 29.5% of births were attended by skilled attendants in the district. Women who were aware of danger signs during pregnancy had a 3.1 odds of using skilled birth attendant (AOR=3.075, 95% CI [1.082, 8.743]). Some specific danger signs during pregnancy with significant odds on the use skilled birth attendant included; baby not moving for more than one day after the 20th week of the pregnancy (AOR=0.408, 95% CI [0.175, 0.956]). Women who took HIV test during antenatal care were more likely to seek skilled attendant at birth, χ2 =9.1, p=0.011. Women who had a discussion about birth preparedness plans were significantly likely to deliver with skilled attendant, χ2 =8.5, p=0.014. However, weighing, checking the blood pressure, asking about their medical history, receiving folic acid, taking blood sample did not produce any significance. Site and the person who can handle the placenta before it is buried had statistically significant influence on place of delivery (χ2=38.3, p=0.000 and χ2=36.0, p=0.000). Also the person deemed traditionally qualified to bury the placenta yielded significant difference on place of delivery (χ2=28.6, p=0.000). Various factors accounted for the low skilled birth coverage of 29.5% in the district, which is far below both regional and national coverage of 46.8% and 54.7% respectively. Inadequate birth preparedness among women of reproductive age led to the low skilled birth coverage in the district. Women who took decisions for themselves as to where to deliver largely favored health facility delivery. Among women who accessed antenatal care services and took HIV test, most of these women delivered at the health facility. Also women whose abdomens were examined during antenatal care services had a higher likelihood of giving birth at the health facility. Women who were aware of danger signs during pregnancy had a higher likelihood of delivering at the health facility. Traditional rites performed on pregnant women were one major factor that delays the start of antenatal visits.