title: Home birth without skilled attendants despite millennium villages project intervention in Ghana: insight from a survey of women's perceptions of skilled obstetric care.
abstract: BACKGROUND
  Skilled birth attendance from a trained health professional during labour and delivery can prevent up to 75% of maternal deaths. However, in low- and middle-income rural communities, lack of basic medical infrastructure and limited number of skilled birth attendants are significant barriers to timely obstetric care. Through analysis of self-reported data, this study aimed to assess the effect of an intervention addressing barriers in access to skilled obstetric care and identified factors associated with the use of unskilled birth attendants during delivery in a rural district of Ghana.
  
  
  METHODS
  A cross-sectional survey was conducted from June to August 2012 in the Amansie West District of Ghana among women of reproductive age. Multi-stage, random, and population proportional techniques were used to sample 50 communities and 400 women for data collection. Weighted multivariate logistic regression analysis was used to identify factors associated with place of delivery.
  
  
  RESULTS
  A total of 391 mothers had attended an antenatal care clinic at least once for their most recent birth; 42.3% of them had unskilled deliveries. Reasons reported for the use of unskilled birth attendants during delivery were: insults from health workers (23.5%), unavailability of transport (21.9%), and confidence in traditional birth attendants (17.9%); only 7.4% reported to have had sudden labour. Other factors associated with the use of unskilled birth attendants during delivery included: lack of partner involvement aOR = 0.03 (95% CI; 0.01, 0.06), lack of birth preparedness aOR = 0.05 (95% CI; 0.02, 0.13) and lack of knowledge of the benefits of skilled delivery aOR = 0.37 (95% CI; 0.11, 1.20).
  
  
  CONCLUSIONS
  This study demonstrated the importance of provider-client relationship and cultural sensitivity in the efforts to improve skilled obstetric care uptake among rural women in Ghana.
authors.affiliation: School of Public Health, Department of Population, Family and Reproductive Health, Kwame Nkrumah University Science and Technology, PMB, Kumasi, Ghana. emmanngh@gmail.com.
authors.forename: Emmanuel Kweku
authors.initials: EK
authors.lastname: Nakua
authors.affiliation: School of Public Health, Department of Population, Family and Reproductive Health, Kwame Nkrumah University Science and Technology, PMB, Kumasi, Ghana. justicese1@yahoo.com.|Sekyere-Kumawu Health Directorate, Box 40, Kumasi, Ghana. justicese1@yahoo.com.
authors.forename: Justice Thomas
authors.initials: JT
authors.lastname: Sevugu
authors.affiliation: Department of Nursing, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. vmdzomeku@gmail.com.
authors.forename: Veronica Millicent
authors.initials: VM
authors.lastname: Dzomeku
authors.affiliation: School of Public Health, Department of Population, Family and Reproductive Health, Kwame Nkrumah University Science and Technology, PMB, Kumasi, Ghana. easmono@yahoo.com.
authors.forename: Easmon
authors.initials: E
authors.lastname: Otupiri
authors.affiliation: Henry Ford Health System, Department of Public Health Sciences, Detroit, MI, USA. hlipkov1@hfhs.org.
authors.forename: Heather R
authors.initials: HR
authors.lastname: Lipkovich
authors.affiliation: School of Public Health, Department of International and Global Health, KNUST, Kumasi, Ghana. owusudabo@yahoo.com.|Kumasi Collaborative Center for Tropical Research, Kumasi, Ghana. owusudabo@yahoo.com.
authors.forename: Ellis
authors.initials: E
authors.lastname: Owusu-Dabo
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D054521:Cultural Competency; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005869:Ghana; D006268:Health Facilities / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D008880:Midwifery / Q000706:statistics & numerical data*; D011295:Prenatal Care / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D015397:Program Evaluation; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014186:Transportation; D035502:Trust; D055815:Young Adult