Effect of socioeconomic deprivation and health service utilisation on antepartum and intrapartum stillbirth: population cohort study from rural Ghana.
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ABSTRACT:
SUBMITTER: Ha YP
PROVIDER: S-EPMC3396614 | biostudies-other | 2012
REPOSITORIES: biostudies-other
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Project description:ImportanceFetal death during labor at term is a complication that is rarely studied in high-income countries. There is a need for large population-based studies to examine the rate of term intrapartum stillbirth in high-income countries and the factors associated with its occurrence.ObjectiveTo evaluate trends in term intrapartum stillbirth over time and to investigate the association between the trends and term intrapartum stillbirth risk factors from 1999 to 2018 in Norway.Design, setting, and participantsThis cohort study used data from the Medical Birth Registry of Norway from 1999 to 2018 to examine rates of term intrapartum stillbirth and risk factors associated with this event. A population of 1 021 268 term singleton pregnancies without congenital anomalies or antepartum stillbirths was included in analyses, which were performed from September 2022 to February 2023.ExposureThe main exposure variable was time, which was divided into four 5-year periods: 1999 to 2003, 2004 to 2008, 2009 to 2013, and 2014 to 2018.Main outcomes and measuresThe primary study outcome was term intrapartum stillbirth. Risk ratios were calculated, and multivariable logistic regression analyses were conducted to identify factors associated with secular trends of term intrapartum stillbirth.ResultsThe study population consisted of 1 021 268 term singleton births (maternal mean [SD] age, 29.72 [5.01] years; mean [SD] gestational age, 39.69 [1.27] weeks). During the study period, there were 95 term intrapartum stillbirths (0.09 per 1000 births). Maternal age, the proportion of individuals born in a country other than Norway, and the prevalence of gestational diabetes, labor induction, operative vaginal delivery, and previous cesarean delivery increased over the course of the study period. Conversely, the prevalence of infants large for gestational age, hypertensive disorder in pregnancy, and spontaneous vaginal delivery and the proportion of individuals who smoked decreased. The term intrapartum stillbirth rate decreased by 87% (95% CI, 68%-95%) from 0.15 per 1000 births in 1999 to 2008 to 0.02 per 1000 births in 2014 to 2018. Three in 4 term intrapartum stillbirths (70 of 95) occurred during intrapartum operative deliveries. The increased prevalence of older maternal age and obstetric risk factors were not associated with the variation in intrapartum stillbirth rates among the time periods. The prevalence of term intrapartum stillbirth was higher for individuals who gave birth in maternity units with fewer than 3000 annual births (adjusted odds ratio, 1.67; 95% CI, 1.07-2.61) than for those who gave birth in units with 3000 or more annual births.Conclusions and relevanceFindings of this study suggest that, despite increases in maternal and obstetric risk factors, term intrapartum stillbirth rates substantially decreased during the study period. Reasons for this decrease may be due to improvements in intrapartum care.
| S-EPMC10534268 | biostudies-literature
Project description:BackgroundMaternal mortality is high in Ghana, averaging 310 maternal deaths per 100,000 live births in 2017. This is partly due to inadequate postnatal care especially among rural communities. Ghana can avert the high maternal deaths if women meet the World Health Organisation's recommended early postnatal care check-up. Despite the association between geographical location and postnatal care utilisation, no study has been done on determinants of postnatal care among rural residents in Ghana. Therefore, this study determined the prevalence and correlates of postnatal care utilization among women in rural Ghana.MethodsThe study utilised women's file of the 2014 Ghana Demographic and Health Survey (GDHS). Following descriptive computation of the prevalence, binary logistic regression was fitted to assess correlates of postnatal care at 95% confidence interval. The results were presented in adjusted odds ratio (AOR). Any AOR less than 1 was interpreted as reduced likelihood of PNC attendance whilst AOR above 1 depicted otherwise. All analyses were done using Stata version 14.0.ResultsThe study revealed that 74% of the rural women had postnatal care. At the inferential level, women residing in Savanna zone had higher odds of postnatal care compared to those in the Coastal zone [AOR = 1.80, CI = 1.023-3.159], just as among the Guan women as compared to the Akan [AOR = 7.15, CI = 1.602-31.935]. Women who were working were more probable to utilise postnatal care compared to those not working [AOR = 1.45, CI = 1.015-2.060]. Those who considered distance as unproblematic were more likely to utilise postnatal care compared to those who considered distance as problematic [AOR = 1.63, CI = 1.239-2.145].ConclusionsThe study showed that ethnicity, ecological zone, occupation and distance to health facility predict postnatal care utilisation among rural residents of Ghana. The study points to the need for government to increase maternal healthcare facilities in rural settings in order to reduce the distance covered by women in seeking postnatal care.
| S-EPMC7791732 | biostudies-literature
Project description:BACKGROUND:Non-communicable diseases (NCDs) remain a global burden and is projected to increase due to aging, rapid urbanization and unhealthy lifestyles. The study was conducted to determine the prevalence of hypertension and diabetes in rural districts in the Ashanti region of Ghana and to determine factors that influence utilization of health care services. SETTING:Offinso North, Amansie West, Ahafo Ano South, and Asante Akim South. METHODS:A population based prospective cross-sectional study comprising of adults aged 18 years and above was carried out from January 2016 to March 2016. A multistage sampling method was employed to select four rural districts in the Ashanti region of Ghana. A structured questionnaire was used to collect primary data from respondents. RESULTS:A total of 684 participants were recruited in the study. The prevalence of hypertension and diabetes was found to be 16.23% and 5.41% respectively. The prevalence of diabetes and hypertension comorbidity was 1.61%. The public hospital was the most preferred choice of facility (52.56%) for patients with NCDs.Educational level significantly decreased the likelihood of seeking healthcare in OTCMS and Health Centre to Hospitals (RRR = 0.1, 95% CI = 0.011-0.917, p = 0.042) and (RRR = 0.4, 95% CI = 0.198-0.679, p = 0.001) respectively. CONCLUSION:The prevalence of self -reported hypertension and diabetes observed in this study was relatively lower for hypertension and higher for diabetes as compared to other studies in Ghana. The public hospital is the most preferred choice of health facilities for patients with hypertension and diabetes in the rural districts.
| S-EPMC7433304 | biostudies-literature
Project description:BACKGROUND:Approximately 800 women die of pregnancy-related complications every day. Over half of these deaths occur in sub-Saharan Africa (SSA). Most maternal deaths can be prevented with high quality maternal health services. It is well established that use of maternal health services vary by place of residence and socioeconomic status (SES), but few studies have examined the determinants of quality of maternal health services in SSA. The purpose of this study is to examine the determinants of antenatal care (ANC) quality in Ghana-focusing on the role of place of residence and SES (education and wealth). The analysis also examines the interactions of these variables and the mediating role of ANC timing, frequency, facility type, and provider type. METHODS:The data are from the Ghana Maternal Health Survey (N = 4,868). Analytic techniques include multilevel linear regression with mediation and moderation analysis. RESULTS:Urban residence and higher SES are positively associated with higher ANC quality, but the urban effect is completely explained by sociodemographic factors. Specifically, about half of the urban effect is explained by education and wealth alone, with other variables accounting for the remainder. The effects of education are conditional on wealth and are strongest for poor women. Starting ANC visits early and attending the recommended four visits as well as receiving ANC from a higher level facility and from a skilled provider are associated with higher quality ANC. These factors partially explain the SES differentials. IMPLICATIONS:Ghanaian women experience significant disparities in quality of ANC, with poor illiterate women receiving the worst care. Targeted efforts to increase quality of ANC may significantly reduce maternal health disparities in Ghana and SSA. A particularly crucial step is to improve ANC quality in the lower level health facilities, where the most vulnerable women are more likely to seek ANC.
| S-EPMC4335004 | biostudies-literature
Project description:OBJECTIVES:To identify groups of municipal employees between the ages of 20 and 34 years with distinct utilisation trajectories of primary care services provided by occupational health service (OHS), measured as the annual number of OHS visits, and to identify demographic and socioeconomic risk factors that distinguish employees in the high utilisation trajectory group(s). METHODS:The present study is a retrospective register-based cohort study. All municipal employees of the City of Helsinki, Finland, aged 20-34 in the Helsinki Health Study, recruited from 2004 to 2013, with follow-up data for 4 years were included in the study (n=9762). The outcome measure was group-based trajectories of OHS utilisation, identified with a group-based trajectory analysis. The demographic and socioeconomic variables used to predict the outcome were age, first language, educational level and occupational class. The analyses were stratified by gender. RESULTS:A large proportion of the young employees do not use OHS. Trajectory groups of 'No visits' (50%), 'Low/increasing' (18%), 'Low/decreasing' (22%) and 'High/recurrent' (10%) use were identified. We found occupational class differences in OHS utilisation patterns showing that lower occupational classes had a higher propensity for 'High/recurrent' OHS utilisation for both genders. CONCLUSIONS:Preventive measures should be targeted particularly to the trajectory groups of 'Low/increasing' and 'High/recurrent' in order to intervene early. In addition, OHS utilisation should be closely monitored among the two lowest occupational classes. More research with longitudinal OHS data is needed.
| S-EPMC6887011 | biostudies-literature
Project description:Living in deprived neighbourhoods may have biological consequences, but few studies have assessed this empirically. We examined the association between neighbourhood deprivation and allostatic load, a biological marker of wear and tear, taking into account individual's socioeconomic position. We analysed data from three cohort studies (CoLaus-Switzerland; EPIPorto-Portugal; Whitehall II-UK) comprising 16,364 participants. We defined allostatic load using ten biomarkers of dysregulated metabolic, cardiovascular, and inflammatory systems (body mass index; waist circumference; total, high and low density lipoprotein cholesterol; triglycerides; glucose; systolic and diastolic blood pressure; C-reactive protein). Mixed Poisson regression models were fitted to examine associations with neighbourhood deprivation (in quintiles, Q1-least deprived as reference). After adjustment for confounding variables, participants living in the most deprived quintile had 1.13 times higher allostatic load than those living in the least deprived quintile (Relative Risk, RR, for Q2 RR = 1.06, 95% CI 1.03-1.09; Q3 = 1.06, 1.03-1.10; Q4 = 1.09, 1.06-1.12; Q5 = 1.13, 1.09-1.16). This association was partially modified by individual's socioeconomic position, such that the relative risk was higher in participants with low socioeconomic position (Q5 vs Q1 1.16, 1.11-1.22) than those with high socioeconomic position (Q5 vs Q1 1.07, 1.01-1.13). Neighbourhood deprivation is associated with biological wear and tear, suggesting that neighbourhood-level interventions may yield health gains.
| S-EPMC6584573 | biostudies-literature
Project description:To describe trends in mental health service use of youth by immigration status and characteristics.Population-based longitudinal cohort study from 1996 to 2012 using linked health and administrative datasets.Ontario, Canada.Youth 10-24 years, living in Ontario, Canada.The main exposure was immigration status (recent immigrants vs long-term residents). Secondary exposures were region of origin and refugee status.Mental health hospitalisations, emergency department (ED) visits and outpatient visits within consecutive 3-year time periods. Poisson regression models estimated rate ratios (RR).Over 2.5?million person years per period were included. Rates of recent immigrant mental health service utilisation were at least 40% lower than long-term residents (p<0.0001).Mental health hospitalisation and ED visit rates increased in long-term residents (hospitalisations, RR 1.09 (95% CI 1.08 to 1.09); ED visits, RR 1.15 (1.14 to 1.15)) and recent immigrants (hospitalisations RR 1.05 (1.03 to 1.07); ED visits, RR 1.08 (1.05 to 1.11)). Mental health outpatient visit rates increased in long-term residents (RR 1.03 (1.03 to 1.03)) but declined in recent immigrant (RR 0.94 (0.93 to 0.95)). Comparable divergent trends in acute care and outpatient service use were observed among refugees and across most regions of origin. Recent immigrant acute care use was driven by longer-term refugees (hospitalisations RR 1.12 (1.03 to 1.21); ED visits RR 1.11 (1.02 to 1.20)).Mental health service utilisation was lower among recent immigrants than long-term residents. While acute care use is increasing at a faster rate among long-term residents than recent immigrants, the decrease in outpatient mental health visits in immigrants highlights a potential emerging disparity in access to preventative care.
| S-EPMC6144399 | biostudies-other
Project description:This study aimed to examine the prevalence of dental service utilisation in Indonesia and its association with social determinants at individual and community levels. Cross-sectional data from the 2014 Indonesian Family Life Survey (IFLS-5) was analysed. Individual independent variables included age, sex, marital status, educational attainment, economic status, health insurance, dental pain, self-reported mouth ulcers, self-rated health status, unmet healthcare needs and smoking status, while community independent variables included cognitive, structural social capital and residential area. Multilevel logistic regressions were performed to explore the associations between independent variables at different levels and the outcome of dental service utilisation. Of the total sample of 16,860 adults aged 15 years or older in our study, around 86.4% never visited a dentist. Dental service utilisation was associated with older age, female, currently not married, higher education level and economic status, health insurance, dental pain, self-reported mouth ulcers, met healthcare needs, never smoking, living in urban areas and communities with high structural social capital. Both individual and broader social determinants influenced dental service utilisation in Indonesia. These factors should be considered in the formulation of oral health policies and programmes aiming to improve dental service utilisation in the country.
| S-EPMC7432444 | biostudies-literature
Project description:We sought to examine the short-term and long-term impacts of psychiatric hospitalisations among patients of Chinese and South Asian origin.Retrospective population-based cohort study using linked health administrative data.We examined all adult psychiatric inpatients discharged between 1 April 2006 and 31 March 2014 in Ontario, Canada, who were classified as Chinese, South Asian and all other ethnicities (ie, 'general population') using a validated algorithm. We identified 2552 Chinese, 2439 South Asian and 127?142 general population patients.We examined psychiatric severity measures at admission and discharge and performed multivariable logistic regression analyses to examine 30-day, 180-day and 365-day postdischarge service utilisation and outcomes, comparing each of the ethnic groups with the reference population, after adjustment for age, sex, income, education, marital status, immigration status, community size and discharge diagnosis.Despite presenting to hospital with greater illness severity, Asian psychiatric inpatients had shorter lengths of hospital stay and greater absolute improvements in mental health and functional status at discharge compared with other inpatients. After hospitalisation, Chinese patients were more likely to visit psychiatrists and South Asian patients were more likely to seek mental healthcare from general practitioners. They were also less likely to have a psychiatric readmission or die 1?year following hospitalisation (adjusted ORChinese=0.87; 95%?CI 0.79 to 0.97; adjusted ORSouth Asian=0.82, 95%?CI 0.73 to 0.91). Findings were consistent across genders, psychiatric diagnoses and immigrant groups.Once hospitalised, patients of Chinese and South Asian origin fared as well as or better than general population patients at discharge and following discharge, and had a positive trajectory of psychiatric service utilisation.
| S-EPMC5781058 | biostudies-literature
Project description:INTRODUCTION:Both excessive weight gain and weight loss are important risk factors in the older population. Neighborhood environment may play an important role in weight change, but neighborhood effects on weight gain and weight loss have not been studied separately. This study examined the associations between neighborhood socioeconomic deprivation and excessive weight gain and weight loss. METHODS:This analysis included 153,690 men and 105,179 women (aged 51-70 years). Baseline addresses were geocoded into geographic coordinates and linked to the 2000 U.S. Census at the Census tract level. Census variables were used to generate a socioeconomic deprivation index by principle component analysis. Excessive weight gain and loss were defined as gaining or losing >10% of baseline (1995-1996) body weight at follow-up (2004-2006). The analysis was performed in 2015. RESULTS:More severe neighborhood socioeconomic deprivation was associated with higher risks of both excessive weight gain and weight loss after adjusting for individual indicators of SES, disease conditions, and lifestyle factors (Quintile 5 vs Quintile 1: weight gain, OR=1.36, 95% CI=1.28, 1.45 for men and OR=1.20, 95% CI=1.13, 1.27 for women; weight loss, OR=1.09, 95%% CI=1.02, 1.17 for men and OR=1.23, 95% CI=1.14, 1.32 for women). The findings were fairly consistent across subpopulations with different demographics and lifestyle factors. CONCLUSIONS:Neighborhood socioeconomic deprivation predicts higher risk of excessive weight gain and weight loss.
| S-EPMC5438759 | biostudies-literature