Impact of NHIS on Antenatal Care Attendance among Pregnant Women in Ghana: Results
Impact of NHIS on Antenatal Care Attendance among Pregnant Women in Ghana
PRESENTATION OF RESULTS
The main objective of the present study was to evaluate the impact of National Health Insurance on antenatal care attendance among pregnant women in Ghana. This chapter is concerned with the presentation and analysis of secondary data.
Table 1 below shows the frequency distribution of the study participants.
Table 1: Frequency Distribution of the study participants
Variables
|
Frequency
|
Percentage (%)
|
Age (mean ± SD)
|
28.70years ±6.81
| |
Parity (mean ± SD)
|
3.18 children ±2.13
| |
Income monthly (mean ± SD)
|
GHS 102.37 ± 656.75
| |
Education
| ||
None
|
941
|
36.37
|
Basic
|
1,361
|
52.61
|
Secondary
|
191
|
7.38
|
Tertiary
|
93
|
3.59
|
Missing
|
1
|
0.04
|
Area of Residence
| ||
Urban
|
871
|
33.67
|
Rural
|
1,716
|
66.33
|
Employment Status
| ||
Employed
|
2,336
|
90.30
|
Unemployed
|
251
|
9.70
|
Marital Status
| ||
Married
|
1,873
|
72.40
|
Consensus
|
473
|
18.28
|
Separate
|
28
|
1.08
|
Divorced
|
21
|
0.81
|
Widowed
|
11
|
0.43
|
Never married
|
181
|
7.00
|
Religion
| ||
No religion
|
102
|
3.94
|
Catholic
|
369
|
14.26
|
Protestant
|
1,356
|
52.42
|
Islam
|
617
|
23.85
|
Traditional
|
140
|
5.41
|
Missing
|
3
|
0.12
|
Ethnicity
| ||
Akan
|
875
|
33.82
|
Ga-Dangbe
|
127
|
4.91
|
Ewe
|
282
|
10.90
|
Guan
|
106
|
4.10
|
Gurma
|
225
|
8.70
|
Mole-Dagbani
|
724
|
27.99
|
Grusi
|
119
|
4.60
|
Others
|
99
|
3.83
|
Missing
|
30
|
1.16
|
Region
| ||
Western
|
388
|
15.00
|
Central
|
264
|
10.20
|
Greater
|
438
|
16.93
|
Volta
|
341
|
13.18
|
Eastern
|
449
|
17.36
|
Ashanti
|
444
|
17.16
|
Brong Ahafo
|
256
|
9.90
|
Northern
|
3
|
0.12
|
Upper East
|
2
|
0.08
|
Upper West
|
2
|
0.08
|
Total
|
2,587
|
100
|
Table 2: Proportion of Pregnant Women with Valid NHIS Card
Hold Valid NHIS Card
|
Frequency
|
Percent Frequency (%)
|
Yes
|
1,643
|
63.51
|
No
|
144
|
5.57
|
Missing
|
800
|
30.92
|
Total
|
2,587
|
100
|
Table 2 above shows the proportion of pregnant women with valid NHIS. 800 observations were missing. From Table 2, out of the 2,587 study participants, 1,643 of them indicated that they do hold a valid NHIS card, while 144 said they don't.
Table 3: Association of Antenatal Care Attendance (ANC) with National Health Insurance Scheme Enrollment and Socio-demographic/economic Factors
Predictors
|
ANC
| |||
No
n (%)
|
Yes
n (%)
|
Chi-square
|
p-value
| |
NHIS
|
11.56
|
0.001
| ||
No NHIS
|
20 (1.13)
|
122 (13.91)
| ||
NHIS
|
105 (5.94)
|
1,521 (86.03)
| ||
SOCIO-DEMO/ECONOMIC
| ||||
Age
|
259 (10.12)
|
2,301 (89.88)
|
8.41
|
0.038
|
Parity
|
232 (9.70)
|
2,159 (90.30)
|
17.64
|
0.224
|
Income
|
259 (10.12)
|
2,301 (89.88)
|
9.378
|
0.153
|
Education
|
23.96
|
0.000
| ||
None
|
125 (4.88)
|
806 (31.50)
| ||
Basic
|
118 (4.61)
|
1,228 (47.99)
| ||
Secondary
|
6 (0.23)
|
183 (7.15)
| ||
Tertiary
|
10 (0.39)
|
83 (3.24)
| ||
Area of Residence
|
7.097
|
0.008
| ||
Urban
|
68 (1.82)
|
794 (15.64)
| ||
Rural
|
191 (0.55)
|
1,507 (4.54)
| ||
Employment Status
|
0.0006
|
0.980
| ||
Employed
|
234 (9.14)
|
2,080 (81.25)
| ||
Unemployed
|
25 (0.98)
|
221 (8.63)
| ||
Marital Status
|
8.70
|
0.122
| ||
Married
|
175 (6.84)
|
1,684 (65.78)
| ||
Consensus
|
55 (2.15)
|
410 (16.02)
| ||
Separate
|
3 (0.12)
|
24 (0.94)
| ||
Divorced
|
5 (0.20)
|
16 (0.63)
| ||
Widowed
|
0 (0.00)
|
11 (0.43)
| ||
Never married
|
21 (0.82)
|
156 (6.09)
| ||
Religion
|
15.34
|
0.004
| ||
No religion
|
17 (0.66)
|
84 (3.29)
| ||
Catholic
|
26 (1.02)
|
338 (13.22)
| ||
Protestant
|
135 (5.28)
|
1,206 (47.16)
| ||
Islam
|
57 (2.23)
|
555 (21.71)
| ||
Traditional
|
23 (0.90)
|
116 (4.54)
| ||
Ethnicity
|
10.47
|
0.163
| ||
Akan
|
75 (2.96)
|
795 (31.42)
| ||
Ga-Dangbe
|
8 (0.32)
|
116 (4.58)
| ||
Ewe
|
36 (1.42)
|
244 (9.64)
| ||
Guan
|
7 (0.28)
|
96 (3.79)
| ||
Gurma
|
27 (1.07)
|
196 (7.75)
| ||
Mole-Dagbani
|
74 (2.92)
|
639 (25.26)
| ||
Grusi
|
15 (0.59)
|
104 (4.11)
| ||
Others
|
13 (0.51)
|
85 (3.36)
| ||
Region
|
2.076
|
0.990
| ||
Western
|
35 (1.37)
|
353 (13.79)
| ||
Central
|
25 (0.98)
|
236 (9.22)
| ||
Greater
|
48 (1.88)
|
386 (15.08)
| ||
Volta
|
37 (1.45)
|
299 (11.68)
| ||
Eastern
|
45 (1.76)
|
400 (15.63)
| ||
Ashanti
|
42 (1.64)
|
395 (15.43)
| ||
Brong Ahafo
|
27 (1.05)
|
227 (8.87)
| ||
Northern
|
0 (0.00)
|
1 (0.04)
| ||
Upper East
|
0 (0.00)
|
2 (0.08)
| ||
Upper West
|
0 (0.00)
|
2 (0.08)
| ||
P-values were based on Pearson Chi-Square for categorical variables and p-values in bold are significant (p < 0.05). (%) represent row percentage
Table 3 above shows the association of antenatal care attendance (ANC) with National Health Insurance Scheme enrollment and socio-demographic/economic factors. The dependent variable is antenatal care attendance whilst the predictors like age, parity and income are the independent variables. The predicting factors explored were NHIS and socio-demographic/economic factors such as age, parity, income, education, area of residence, employment status, marital status, religion, and ethnicity.
Table 4: Examining the effect of socio-demographic/economic factors on National Health Insurance Scheme enrollment using multivariable logistic regression analysis
NHIS Enrollment
| ||||||
Unadjusted effect
|
Adjusted effect
| |||||
Predictors
|
UOR (95% CI)
|
p-value
|
AOR (95% CI)
|
p-value
| ||
Age
|
0.98 (0.95-1.0)
|
<0.001 ***
|
1.01 (1.00-1.02)
|
0.034
| ||
Parity
|
1.03 (0.99-1.06)
|
0.107
|
0.99 (0.95-1.04)
|
0.686
| ||
Income
|
0.99 (0.99-1.00)
|
0.329
|
0.99 (0.99-1.00)
|
0.366
| ||
Education
| ||||||
None
|
ref
|
ref
| ||||
Basic
|
0.82 (0.70-0.95)
|
0.009**
|
1.10 (0.92-1.32)
|
0.301
| ||
Secondary
|
0.78 (0.63-0.97)
|
0.027*
|
1.19 (0.87-1.64)
|
0.260
| ||
Tertiary
|
0.70 (0.52-0.94)
|
0.018*
|
1.12 (0.73-1.70)
|
0.613
| ||
Area of Residence
| ||||||
Urban
|
ref
|
ref
| ||||
Rural
|
1.29 (1.04-1.62)
|
0.024*
|
1.16 (0.96-1.47)
|
0.230
| ||
Employment Status
| ||||||
Employed
|
Ref
|
ref
| ||||
Unemployed
|
1.01(0.89-1.15)
|
0.873
|
1.24 (0.96-1.61)
|
0.093
| ||
Marital Status
| ||||||
Married
|
ref
|
ref
| ||||
Consensus
|
1.03 (0.81-1.31)
|
0.785
|
1.18 (0.92-1.53)
|
0.232
| ||
Separate
|
0.81 (0.57-1.15)
|
0.241
|
0.88 (0.64-1.29)
|
0.526
| ||
Divorced
|
1.03 (0.76-1.39)
|
0.876
|
1.12 (0.82-1.53)
|
0.485
| ||
Widowed
|
1.01 (0.68-1.51)
|
0.945
|
0.94 (0.63-1.38)
|
0.736
| ||
Never married
|
0.80 (0.72-0.92)
|
0.001**
|
0.76 (0.55-1.06)
|
0.105
| ||
Ethnicity
| ||||||
Akan
|
ref
|
ref
| ||||
Ga-Dangbe
|
0.87 (0.58-1.31)
|
0.501
|
0.80 (0.49-1.32)
|
0.389
| ||
Ewe
|
1.11 (0.85-1.43)
|
0.442
|
0.78 (0.55-1.10)
|
0.151
| ||
Guan
|
1.41 90.98-2.02)
|
0.065
|
1.11 (0.70-1.73)
|
0.663
| ||
Gurma
|
1.41 (0.98-2.02)
|
0.191
|
1.04 (0.67-1.62)
|
0.857
| ||
Mole-Dagbani
|
1.47 (1.15-1.890
|
0.002**
|
1.08 (0.76-1.53)
|
0.674
| ||
Grusi
|
2.08 (1.47-2.93)
|
<0.001***
|
1.17 (0.74-1.86)
|
0.494
| ||
Others
|
1.50 (1.07-2.11)
|
0.020*
|
1.24 (0.80-1.92)
|
0.329
| ||
Region
| ||||||
Western
|
ref
|
ref
| ||||
Central
|
2.56 (1.45-4.54)
|
0.001**
|
2.39 (1.34-4.25)
|
0.003
| ||
Greater
|
1.38 (0.79-2.43)
|
0.260
|
1.55 (0.86- 2.790
|
0.142
| ||
Volta
|
2.26 (1.42-3.61)
|
0.001**
|
2.70 (1.55- 4.71)
|
<0.001***
| ||
Eastern
|
1.89 (1.12-3.61)
|
0.017*
|
1.96 (1.16- 3.31)
|
0.012*
| ||
Ashanti
|
1.16 (0.73-1.83)
|
0.528
|
1.19 (0.75- 1.88)
|
0.466
| ||
Brong Ahafo
|
1.96 (1.24-3.10)
|
0.004**
|
1.69 (1.07-2.680
|
0.025
| ||
Northern
|
1.98 91.26-3.12)
|
0.003**
|
1.73 (1.02- 2.94)
|
0.044
| ||
Upper East
|
3.73 (2.32-5.99)
|
<0.001***
|
3.39 (1.93-5.97)
|
<0.001***
| ||
Upper West
|
3.51 (2.13-5.79)
|
<0.001***
|
3.27 (1.82- 5.88)
|
<0.001***
| ||
Religion
| ||||||
No religion
|
ref
|
ref
| ||||
Catholic
|
1.16 (0.77-1.73)
|
0.480
|
0.88 (0.56- 1.38)
|
0.581
| ||
Protestant
|
0.87 (0.60-1.27)
|
0.477
|
0.80 (0.52- 1.22)
|
0.310
| ||
Islam
|
1.12 (0.74-1.69)
|
0.605
|
0.83 (0.52- 1.34)
|
0.456
| ||
Traditional
|
1.77 (1.08-2.89)
|
0.023*
|
0.95 (0.57- 1.59)
|
0.854
| ||
ref: the reference category, UOR: Unadjusted odds ratio, AOR: adjusted odds ratio from the multivariable logistic regression model, CI: confidence interval
Table 4 above examines the effect of socio-demographic/economic factors on National Health Insurance Scheme enrollment using multivariable logistic regression analysis. The dependent or outcome variable for this analysis was NHIS enrollment and the independent variables are the predictors found in the rows.
Table 5: Assessing the Effect of NHIS and other Predictors on Antenatal care attendance among pregnant women in Ghana.
ANC Attendances
| ||||
Unadjusted effect
|
Adjusted effect
| |||
Predictors
|
UOR [95% CI]
|
p-value
|
AOR ((95% CI)
|
p-value
|
NHIS
| ||||
No NHIS
|
ref
|
ref
| ||
NHIS
|
1.67 [1.02-2.72]
|
0.041
|
2.19 (1.31-3.67)
|
0.003**
|
Age
|
0.98 [0.96-1.01]
|
0.324
|
0.94 (0.89-0.98)
|
0.007**
|
Parity
|
0.97 [0.91.034]
|
0.323
|
1.22 (1.03-1.45)
|
0.022*
|
Income
|
0.99 [0.99-1.00]
|
0.778
|
0.99 (0.99-0.99)
|
0.016*
|
Education
| ||||
None
|
ref
|
ref
| ||
Basic
|
1.92 [1.32-2.80]
|
0.001**
|
1.14 (0.61-2.14)
|
0.682
|
Secondary
|
5.96 [2.12-16.76]
|
0.001**
|
6.87 (1.04-45.52)
|
0.046
|
Tertiary
|
1.55 [0.72- 3.33]
|
0.261
|
0.55 (0.19-1.61)
|
0.278
|
Area of Residence
| ||||
Urban
|
ref
|
ref
| ||
Rural
|
0.61[0.42-0 .42]
|
0.009
|
0.84 (0.43-1.62)
|
0.596
|
Religion
| ||||
No religion
|
ref
|
ref
| ||
Catholic
|
3.77 [1.67-8.51]
|
0.001**
|
2.65 (0.76-9.28)
|
0.128
|
Protestant
|
2.79 [1.43- 5.42]
|
0.002**
|
1.96 (0.64-6.02)
|
0.242
|
Islam
|
3.29 [1.63- 6.65]
|
0.001**
|
4.23 (1.36-13.17)
|
0.013*
|
Traditional
|
0.95 [0 .46- 1.99]
|
0.900
|
4.47 (0.79-25.20)
|
0.089
|
Marital Status
| ||||
Married
|
ref
|
ref
| ||
Consensus
|
0.61 [0.40- 0.94]
|
0.024
|
0.40 (1.98-0.82)
|
0.012
|
Separate
|
0.84 [0 .23- 3.07]
|
0.794
|
0.79 (0.99-6.39)
|
0.828
|
Divorced
|
0.34 [0.09- 1.30]
|
0.115
|
1.02 (0.93-11.30)
|
0.985
|
Widowed
|
1
| |||
Never married
|
0.67 [0.37-1.21]
|
0.182
|
5.83 (0.73-46.37)
|
0.095
|
Region
| ||||
Western
|
ref
|
ref
| ||
Central
|
1.24 [0 .43-3.63)]
|
0.690
|
2.54 (0.24-27.39)
|
0.442
|
Greater
|
2.12 [0.96- 4.68]
|
0.062
|
1.02 (0.27-3.85)
|
0.980
|
Volta
|
1.12 [0.53- 2.38]
|
0.759
|
0.43 (1.01-1.84)
|
0.257
|
Eastern
|
1.60 [0.74- 3.48]
|
0.234
|
0.71 (0.19-2.63)
|
0.609
|
Ashanti
|
1.16 [0.55- 2.45]
|
0.687
|
0.83 (0.25-2.72)
|
0.756
|
Brong Ahafo
|
1.55 [0.72- 3.36]
|
0.265
|
0.67 (0.22-2.02)
|
0.476
|
Northern
|
1.34 [0.67- 2.67]
|
0.405
|
0.61 (0.18-2.05)
|
0.425
|
Upper East
|
1.02 [0.46- 2.28]
|
0.965
|
0.83 (0.24-2.95)
|
0.776
|
Upper West
|
1.53 [0.68- 3.41]
|
0.303
|
0.84 (0.26-2.80)
|
0.781
|
Employment Status
| ||||
Employed
|
ref
|
ref
| ||
Unemployed
|
0 .96 [0.59- 1.57]
|
0.861
|
0.54 (0.21-1.43)
|
0.216
|
Ethnicity
| ||||
Akan
|
ref
|
ref
| ||
Ga-Dangbe
|
2.22 [0.96- 5.15]
|
0.062
|
2.12 (0.44-10.31)
|
0.352
|
Ewe
|
0.69 [0.42- 1.14]
|
0.145
|
0.73 (0.19-2.73)
|
0.637
|
Guan
|
1 .67 [0.72- 3.85]
|
0.232
|
0.59 (0.14-2.49)
|
0.472
|
Gurma
|
0.80 [0.44- 1.45]
|
0.456
|
0.23 (0.78-0.71)
|
0.010*
|
Mole-Dagbani
|
0.95 [0.60- 1.52]
|
0.837
|
0.24 (0.90-0.65)
|
0.005**
|
Grusi
|
0.56 [0 .26- 1.18]
|
0.127
|
0.16 (0.38-0.70)
|
0.015*
|
Others
|
0.72 [0.36- 1.42]
|
0.342
|
0.12 (0.32-0.42)
|
0.001**
|
ref: the reference category, AOR: adjusted odds ratio from the multivariable logistic regression model, CI: confidence interval. p<0.05, **p<0.01, ***p<0.001
Table 5 shows the output from a multivariable logistic regression analysis carried out to assess the effect of NHIS on antenatal care attendance among pregnant women in Ghana. From Table 5, it can be observed that the adjusted odds ratio for NHIS was found to be 2.19 (95 % CI: 1.31-3.67; p = 0.003).
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