title: Increased use of recommended maternal health care as a determinant of immunization and appropriate care for fever and diarrhoea in Ghana: an analysis pooling three demographic and health surveys.
abstract: OBJECTIVE
  Enhancing maternal and child health are key Millennium Development Goals (MDGs). This study examined whether increased utilization of recommended maternal health care (MHC), is associated with factors that improve children's health; specifically, complete immunization and appropriate care for fever and diarrhoea in Ghana.
  
  
  METHODS
  Data from the 1998, 2003, and 2008 Ghana Demographic and Health Surveys were pooled for a nationally representative sample of 6786 women aged 15-49 years who had a child in the previous 5 years. Children aged 12-23 months were considered fully immunized if they received all eight basic immunizations. Appropriate care for children under-five was receipt of medical treatment for fever or oral rehydration therapy for diarrhoea. The effect of recommended MHC utilization (characterized as poor, intermediate or best use) on immunization and appropriate care for fever and diarrhoea was determined through logistic regression with Andersen's Behavioural Model guiding co-variate selection.
  
  
  RESULTS
  Increased MHC utilization (reference: intermediate MHC use) increased the odds of immunization [poor use: odds ratio (OR) = 0.54, 95% confidence interval (CI): 0.42-0.69; best use: OR = 1.29, 95% CI: 1.01-1.67], as well as appropriate care for fever (poor use: OR = 0.55, 95% CI: 0.35-0.88; best use: OR = 1.72, 95% CI: 1.17-2.52) and diarrhoea (poor use: OR = 0.63, 95% CI: 0.43-0.93). Survey year and region also predicted each outcome. Other determinants of immunization were maternal education, ethnicity, religion, media exposure, wealth and birth weight. Determinants of appropriate care for fever included paternal education, media exposure and wealth, and for diarrhoea, child's age and birth weight.
  
  
  CONCLUSIONS
  This study proposes a linkage between MDGs; initiatives to improve maternal health through promoting increased use of recommended MHC may enhance children's health-related care. This could be useful for countries with limited resources in achieving MDGs, especially in sub-Saharan Africa where under-five mortality is the highest.
authors.affiliation: Department of Epidemiology and Biostatistics, nmcglynn@alumni.uwo.ca.
authors.forename: Natalie
authors.initials: N
authors.lastname: McGlynn
authors.affiliation: Department of Epidemiology and Biostatistics, Children's Health Research Institute.
authors.forename: Piotr
authors.initials: P
authors.lastname: Wilk
authors.affiliation: Department of Geography.
authors.forename: Isaac
authors.initials: I
authors.lastname: Luginaah
authors.affiliation: Department of Epidemiology and Biostatistics, Centre for Studies in Family Medicine and.
authors.forename: Bridget L
authors.initials: BL
authors.lastname: Ryan
authors.affiliation: Department of Epidemiology and Biostatistics, Centre for Studies in Family Medicine and Schulich Interfaculty Program of Public Health, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada.
authors.forename: Amardeep
authors.initials: A
authors.lastname: Thind
mesh_terms: D000293:Adolescent; D000328:Adult; D003967:Diarrhea / Q000188:drug therapy*; D005260:Female; D005334:Fever / Q000188:drug therapy*; D005869:Ghana; D006306:Health Surveys; D006801:Humans; D007114:Immunization; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011787:Quality of Health Care; D055815:Young Adult
keywords: Developing countries; diarrhoea; fever; immunization; maternal child health services