title: A decomposition analysis of change in skilled birth attendants, 2003 to 2008, Ghana Demographic and Health Surveys.
abstract: BACKGROUND
  The single most critical intervention to improve maternal and neonatal survival is to ensure that a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for obstetric care in case of an emergency. This study aims to describe changes in percentage of skilled birth attendants in Ghana and to identify causes of the observed changes as well as the contribution of different categories of mother's characteristics to these changes.
  
  
  METHODS
  This study uses two successive nationally representative household surveys: the 2003 and 2008 Ghana Demographic and Health Surveys (GDHS). The two datasets have comparable information on household characteristics and skilled attendants at birth at the time of the survey. The 2003 GDHS database includes information on 6,251 households and 3639 live births in the five years preceding the survey, whereas the 2008 GDHS database had information on11, 778 households and 2909 live births in the five years preceding the survey. A decomposition approach was used to explain the observed change in percentage of skilled birth attendants. Random-effects generalized least square regression was used to explore the effect of changes in population structure in respect of the mother's characteristics on percentage of skilled birth attendants over the period.
  
  
  RESULTS
  Overall, the data showed absolute gain in the proportion of births attended by a health professional from 47.1% in 2003 to 58.7% in 2008, which represents 21.9% of gap closed to reach universal coverage. The increase in skilled birth attendants was found to be caused by changes in general health behaviour. The gain is regardless of the mother's characteristics. The structural change in the proportion of births in respect of birth order and mother's education had little effect on the change in percentage of skilled birth attendants.
  
  
  CONCLUSIONS
  Improvement in general health behaviour can potentially contribute to an accelerated increase in proportion of births attended by skilled personnel in Ghana.
authors.affiliation: Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana. sbosomprah@ug.edu.gh.
authors.forename: Samuel
authors.initials: S
authors.lastname: Bosomprah
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana. cecearyeetey@yahoo.co.uk.
authors.forename: Genevieve Cecelia
authors.initials: GC
authors.lastname: Aryeetey
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana. jnonvignon@ug.edu.gh.
authors.forename: Justice
authors.initials: J
authors.lastname: Nonvignon
authors.affiliation: School of Public Health, University of Ghana, Legon, Accra, Ghana. rmadanu@ug.edu.gh.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Adanu
mesh_terms: D000488:Allied Health Personnel / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric; D005869:Ghana; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D050498:Live Birth; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008428:Maternal Mortality; D008880:Midwifery / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care