Determinants of maternal health service utilisation among refugee women in Krisan and Ampain camps, Ghana: a cross-sectional analysis.

Abstract

Background: Maternal healthcare utilization among refugee populations remains a major public health concern due to intersecting social, structural, and health system barriers. Guided by Andersen's Healthcare Utilization Theory (1995), this study examined the determinants of antenatal care, skilled delivery, and postnatal care among refugee women in Ghana.

Methods: A cross-sectional analytical study was conducted among 410 refugee women aged 15-49 years residing in the Krisan and Ampain refugee camps in the Western Region of Ghana. Eligible women who had experienced a pregnancy within the preceding two years were recruited using a census approach. Data were collected using a structured interviewer-administered questionnaire. Because the prevalence of ANC attendance (≥4 visits) was low, Firth's penalized likelihood logistic regression was used to examine factors associated with ANC utilization. For skilled delivery and PNC utilization, conventional multivariable logistic regression was used. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was assessed at p < 0.05. Camp location was included as a fixed effect in all models. Multilevel modeling was not employed as only two camps were included, which is insufficient for reliable random effects estimation.

Results: The majority of refugee women attended fewer than four ANC visits (93.9%), while 72.4% delivered with skilled birth attendants and only 31.0% received postnatal care. ANC utilization was significantly higher among women residing in Krisan Camp (AOR = 9.54; 95% CI: 1.68-54.30) and those receiving transport support (AOR = 4.31; 95% CI: 1.12-16.58). Income was not significantly associated with ANC attendance, with women earning GHS 100-499 (AOR = 0.06; 95% CI: 0.00-1.00) and ≥ GHS 500 (AOR = 0.03; 95% CI: 0.00-1.05) having lower odds of ANC attendance. Trustful social networks were paradoxically associated with lower ANC utilization (AOR = 0.32; 95% CI: 0.11-0.96). Skilled delivery was associated with education, with secondary or higher education linked to lower odds (AOR = 0.56; 95% CI: 0.31-0.99), while media exposure showed a marginal positive effect. Postnatl utilization was higher among Muslim women (AOR = 2.02; 95% CI: 1.15-3.55) and lower among married women (AOR = 0.62; 95% CI: 0.39-0.98).

Conclusions: Maternal healthcare utilization among refugee women in Ghana is influenced by complex interactions between social support, access-related factors, and individual characteristics. Interventions that strengthen social networks, improve transport and service accessibility, and address contextual barriers within refugee camps are critical to improving maternal health outcomes.