Determinants of Utilisation of Maternal Health Care Services among Pregnant Women in Kwahu South District

ABSTRACT

Maternal mortality remains a major Public Health challenge although various interventions have been devised by the international community to reduce it. Most of these deaths occur in Sub-Saharan Africa for which Ghana is no exception. The use of maternal health care services has been documented to reduce maternal deaths. However, utilisation of antenatal care has been declining. The study sought to examine the determinants of utilisation of maternal health care services among pregnant women using Andersen and Newman’s health care utilisation model as a theoretical framework. The study site was Kwahu South District with the study population consisting of pregnant women. A quantitative, descriptive cross sectional survey was used and data was collected from 430 pregnant women using a structured questionnaire. Lubben social network scale, Euro Qol self-reported health status and a modified version of Kotel chuck index were used. Data were processed and analysed using Statistical Package for Social Science version 17.0 and Microsoft Excel. Descriptive statistics was used to describe socio-demographic variables whiles Pearson’s chi square (X2) was used to determine the relationship between the independent variables (environmental factors and population characteristics) and the dependent variable (utilisation). Bivariate and multivariate logistic regression was used to identify variables that predict the use of maternal health care service. Results show that 68.8% utilise antenatal care services adequately whiles 61.4% commenced ANC early. Environmental factors such as the presence of health personnel, logistics, reduced waiting time, coordination and control are strong determinants of utilisation. Age, marital status, education, occupation, partner’s occupation, means of transport, income level and parity have a significant relationship with the utilisation of maternal health care services. The results also show that marital status, occupation and level of education accounts for 19% of the variance in utilisation. However, the significant predictors were marital status and occupation. Married women were twice more likely to have adequate utilisation than single women and women who are cohabiting (OR=2.046, CI: 1.024-4.086, P=0.043). Farmers (OR=0.186, CI: 0.361-0.563, P=0.003) and women who are unemployed (OR=0.364, CI: 0.165-0.824, P=0.015) were less likely to have adequate utilisation. These findings have implications for nursing practice and management, health promotion and education. Continuous public education about the need for adequate utilisation of maternal health care services is required.