TY - JOUR
T1 - Impact of Urban Slum Residence on Coverage of Maternal, Neonatal, and Child Health Service Indicators in the Greater Accra Region of Ghana
T2 - an Ecological Time-Series Analysis, 2018–2021
AU - Dwomoh, Duah
AU - Iddi, Samuel
AU - Afagbedzi, Seth Kwaku
AU - Tejedor-Garavito, Natalia
AU - Dotse-Gborgbortsi, Winfred
AU - Wright, Jim
AU - Tatem, Andrew J.
AU - Nilsen, Kristine
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023
Y1 - 2023
N2 - Among other focus areas, the global Sustainable Development Goals (SDGs) 3 and 11 seek to advance progress toward universal coverage of maternal, neonatal, and child health (MNCH) services and access to safe and affordable housing and basic services by 2030. Governments and development agencies have historically neglected the health and well-being associated with living in urban slums across major capital cities in sub-Saharan Africa since health policies and programs have tended to focus on people living in rural communities. This study assessed the trends and compared inequities in MNCH service utilization between slum and non-slum districts in the Greater Accra region of Ghana. It analyzed information from 29 districts using monthly time-series Health Management Information System (HMIS) data on MNCH service utilization between January 2018 and December 2021. Multivariable quantile regression models with robust standard errors were used to quantify the impact of urban slum residence on MNCH service utilization. We assessed the inequality of MNCH coverage indicators between slum and non-slum districts using the Gini index with bootstrapped standard errors and the generalized Lorenz curve. The results indicate that rates of vaccination coverage and antenatal care (ANC) attendance have declined significantly in slum districts compared to those in non-slum districts. However, skilled birth delivery and postnatal care (PNC) were found to be higher in urban slum areas compared to those in non-urban slum areas. To help achieve the SDGs’ targets, it is important for the government of Ghana and other relevant stakeholders to prioritize the implementation of effective policies, programs, and interventions that will improve access to and utilization of ANC and immunization services among urban slum dwellers.
AB - Among other focus areas, the global Sustainable Development Goals (SDGs) 3 and 11 seek to advance progress toward universal coverage of maternal, neonatal, and child health (MNCH) services and access to safe and affordable housing and basic services by 2030. Governments and development agencies have historically neglected the health and well-being associated with living in urban slums across major capital cities in sub-Saharan Africa since health policies and programs have tended to focus on people living in rural communities. This study assessed the trends and compared inequities in MNCH service utilization between slum and non-slum districts in the Greater Accra region of Ghana. It analyzed information from 29 districts using monthly time-series Health Management Information System (HMIS) data on MNCH service utilization between January 2018 and December 2021. Multivariable quantile regression models with robust standard errors were used to quantify the impact of urban slum residence on MNCH service utilization. We assessed the inequality of MNCH coverage indicators between slum and non-slum districts using the Gini index with bootstrapped standard errors and the generalized Lorenz curve. The results indicate that rates of vaccination coverage and antenatal care (ANC) attendance have declined significantly in slum districts compared to those in non-slum districts. However, skilled birth delivery and postnatal care (PNC) were found to be higher in urban slum areas compared to those in non-urban slum areas. To help achieve the SDGs’ targets, it is important for the government of Ghana and other relevant stakeholders to prioritize the implementation of effective policies, programs, and interventions that will improve access to and utilization of ANC and immunization services among urban slum dwellers.
KW - Ecological time series
KW - Maternal neonatal and child health outcomes
KW - Urban slum
UR - http://www.scopus.com/inward/record.url?scp=85176800517&partnerID=8YFLogxK
U2 - 10.1007/s11524-023-00812-0
DO - 10.1007/s11524-023-00812-0
M3 - Article
AN - SCOPUS:85176800517
SN - 1099-3460
JO - Journal of Urban Health
JF - Journal of Urban Health
ER -