Impact of urban slum residence on coverage of maternal, neonatal and child health service indicators in the Greater Accra Region of Ghana: an ecological time-series analysis, 2018-2021

Abstract

The Sustainable Development Goals (SDGs) 11 and 3 emphasize the need to eliminate slums, provide access to safe and affordable housing and basic services, and achieve universal coverage of maternal, neonatal, and child health (MNCH) services by 2030. Governments and development agencies have historically neglected the problems associated with living in urban slums across major capital cities in sub-Saharan Africa. Health policies and programs have tended to focus on people living in rural communities. This study assessed the trends and compared inequities in MNCH service utilization between slum and non-slum districts in the Greater Accra region of Ghana. The study analyzed data from 29 districts using monthly time-series data on MNCH service utilization between January 2018 and December 2021 obtained from the routine health management information system. Multivariable quantile regression models with robust standard errors were used to quantify the impact of urban slum residence on MNCH service utilization. We assessed the inequality of MNCH coverage indicators between slum and non-slum districts using the Gini Index with bootstrapped standard errors and the Generalized Lorenz curve. The rates of vaccination coverage and antenatal care (ANC) attendance have declined significantly in slum districts compared to the non-slum districts. However, skilled delivery and postnatal care were found to be higher in the urban slum areas compared to the non-urban slum areas. To achieve the target of the SDGs, the Government and other relevant stakeholders should prioritize the implementation of effective policies, programs, and interventions aimed at improving access to and utilization of ANC and immunization services among the urban slum dwellers.