Spatial analysis of skilled birth attendant utilization in Ghana.

BACKGROUND: Maternal mortality is a major health problem in most resource-poor settings, especially in sub-Saharan Africa. In Ghana, maternal mortality remains high and births attended by skilled health professionals are still low despite the introduction, in 2005, of free maternal health care for all women seeking care in public health facilities.

OBJECTIVES: This study aimed to explore geographical patterns in the risk of not utilizing a skilled birth attendant during childbirth in women of different socioeconomic backgrounds in Ghana.

METHODS: Global and Geographically Weighted Odds Ratios (GWORs) were used to examine the spatially varying relationships between low socioeconomic status (low education and low income) and non-utilization of skilled birth attendants based on data from the Ghana Demographic and Health Survey (GDHS) 2008.

RESULTS: Low education and low income were associated with non-use of skilled birth attendants. The GWORs revealed a north-south spatial variation in the magnitude of the association between non-use of skilled birth attendants and low education (Log GWOR ranged from 0.75 to 9.26) or low income (Log GWOR ranged from 1.11 to 6.34) with higher values in the north.

CONCLUSIONS: The relationship between low socioeconomic status and the non-use of skilled birth attendants in Ghana is geographically variable. Effective governmental and non-governmental interventions are needed to address these regional inequalities.