title: Use of a spatial scan statistic to identify clusters of births occurring outside Ghanaian health facilities for targeted intervention.
abstract: OBJECTIVE
  To identify and evaluate clusters of births that occurred outside health facilities in Ghana for targeted intervention.
  
  
  METHODS
  A retrospective study was conducted using a convenience sample of live births registered in Ghanaian health facilities from January 1 to December 31, 2014. Data were extracted from the district health information system. A spatial scan statistic was used to investigate clusters of home births through a discrete Poisson probability model. Scanning with a circular spatial window was conducted only for clusters with high rates of such deliveries. The district was used as the geographic unit of analysis. The likelihood P value was estimated using Monte Carlo simulations.
  
  
  RESULTS
  Ten statistically significant clusters with a high rate of home birth were identified. The relative risks ranged from 1.43 ("least likely" cluster; P=0.001) to 1.95 ("most likely" cluster; P=0.001). The relative risks of the top five "most likely" clusters ranged from 1.68 to 1.95; these clusters were located in Ashanti, Brong Ahafo, and the Western, Eastern, and Greater regions of Accra.
  
  
  CONCLUSIONS
  Health facility records, geospatial techniques, and geographic information systems provided locally relevant information to assist policy makers in delivering targeted interventions to small geographic areas.
authors.affiliation: Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana. Electronic address: sbosomprah@ug.edu.gh.
authors.forename: Samuel
authors.initials: S
authors.lastname: Bosomprah
authors.affiliation: Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Winfred
authors.initials: W
authors.lastname: Dotse-Gborgbortsi
authors.affiliation: Family Health Division, Ghana Health Service, Accra, Ghana.
authors.forename: Patrick
authors.initials: P
authors.lastname: Aboagye
authors.affiliation: Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Matthews
mesh_terms: D016000:Cluster Analysis; D005260:Female; D040362:Geographic Information Systems; D005869:Ghana; D006268:Health Facilities; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk
keywords: Circular spatial window; Clusters; District health information system; Geographic information system; Home births; Spatial scan statistic