Effect of a community-based primary healthcare program on adverse
pregnancy outcomes in Northern Ghana
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.