Abstract
Background: Pregnancy complications and adverse birth outcomes
are among the major contributors to poor maternal and child health.
Mothers in remote communities are at higher risk of adverse birth
outcomes due to constraints in access to maternal healthcare services.
In Ghana, a community-based primary healthcare program called the Ghana
Essential Health Interventions Program (GEHIP) was implemented in a
rural region to help strengthen primary healthcare delivery and improve
maternal and child healthcare services delivery. This study assessed the
effect of this program on adverse birth outcomes.
Methods: Secondary household survey data from reproductive-aged
women from the GEHIP project were used in this analysis.
Difference-in-differences regression and logistic regression were used
to examine the effect of GEHIP on adverse birth outcomes and equity in
the distribution of adverse birth outcomes using household wealth index
and maternal educational attainment as equity measures. The analysis
involves the comparison of project baseline and end-line outcomes in
intervention and non-intervention districts.
Results: The
intervention had a significant effect in the reduction of adverse
pregnancy outcomes (DiD=-0.043; p-value=0.010). Although disadvantaged
groups experience larger reductions in adverse pregnancy outcomes,
controlling for covariates, there was no statistically significant
equity effect of GEHIP on adverse pregnancy outcomes using either the
household wealth index or maternal educational attainment as equity
measures.
Conclusion : GEHIP’s community-based healthcare program reduced
adverse birth outcomes but no effect on relative equity was established.
Factoring in approaches for targeting disadvantaged populations in the
implementation of community-based health programs is crucial to ensuring
equity in health outcomes.
Keywords: pregnancy outcome, community-based healthcare,
maternal health, equity