title: Factors Influencing Health Facility Delivery in Predominantly Rural Communities across the Three Ecological Zones in Ghana: A Cross-Sectional Study.
abstract: BACKGROUND
  Maternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan African countries. Both maternal and neonatal health outcomes improve when skilled personnel provide delivery services within health facilities. Determinants of delivery location are crucial to promoting health facility deliveries, but little research has been done on this issue in Ghana. This study explored factors influencing delivery location in predominantly rural communities in Ghana.
  
  
  METHODS
  Data were collected from 1,500 women aged 15-49 years with live or stillbirths that occurred between January 2011 and April 2013. This was done within the three sites operating Health and Demographic Surveillance Systems, i.e., the Dodowa (Greater Accra Region), Kintampo (Brong Ahafo Region), and Navrongo (Upper-East Region) Health Research Centers in Ghana. Multivariable logistic regression was used to identify the determinants of delivery location, controlling for covariates that were statistically significant in univariable regression models.
  
  
  RESULTS
  Of 1,497 women included in the analysis, 75.6% of them selected health facilities as their delivery location. After adjusting for confounders, the following factors were associated with health facility delivery across all three sites: healthcare provider's influence on deciding health facility delivery, (AOR = 13.47; 95% CI 5.96-30.48), place of residence (AOR = 4.49; 95% CI 1.14-17.68), possession of a valid health insurance card (AOR = 1.90; 95% CI 1.29-2.81), and socio-economic status measured by wealth quintiles (AOR = 2.83; 95% CI 1.43-5.60).
  
  
  CONCLUSIONS
  In addition to known factors such as place of residence, socio-economic status, and possession of valid health insurance, this study identified one more factor associated with health facility delivery: healthcare provider's influence. Ensuring care provider's counseling of clients could improve the uptake of health facility delivery in rural communities in Ghana.
authors.affiliation: Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana.
authors.forename: Yeetey Akpe Kwesi
authors.initials: YA
authors.lastname: Enuameh
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Tokyo, Japan.
authors.forename: Sumiyo
authors.initials: S
authors.lastname: Okawa
authors.affiliation: Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana.
authors.forename: Kwaku Poku
authors.initials: KP
authors.lastname: Asante
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Tokyo, Japan.
authors.forename: Kimiyo
authors.initials: K
authors.lastname: Kikuchi
authors.affiliation: Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mahama
authors.affiliation: Research and Development Division, Ghana Health Service, P. O. Box MB 190, Accra, Ghana.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Ansah
authors.affiliation: Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Tawiah
authors.affiliation: Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana.
authors.forename: Kwame
authors.initials: K
authors.lastname: Adjei
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shibanuma
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Tokyo, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Nanishi
authors.affiliation: Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana.
authors.forename: Francis
authors.initials: F
authors.lastname: Yeji
authors.affiliation: System Science Consultants, Tokyo, Japan.
authors.forename: Enoch Oti
authors.initials: EO
authors.lastname: Agyekum
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Tokyo, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Yasuoka
authors.affiliation: Dodowa Health Research Centre, P.O. Box DD1, Dodowa, Greater Accra, Ghana.
authors.forename: Margaret
authors.initials: M
authors.lastname: Gyapong
authors.affiliation: Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana.
authors.forename: Abraham Rexford
authors.initials: AR
authors.lastname: Oduro
authors.affiliation: Ghana Health Service Headquarters, Private Mail Bag, Ministries, Accra, Ghana.
authors.forename: Gloria
authors.initials: G
authors.lastname: Quansah Asare
authors.affiliation: Research and Development Division, Ghana Health Service, P. O. Box MB 190, Accra, Ghana.
authors.forename: Abraham
authors.initials: A
authors.lastname: Hodgson
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Tokyo, Japan.
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
authors.affiliation: Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana.
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008428:Maternal Mortality; D008875:Middle Aged; D054238:Perinatal Mortality; D012424:Rural Population