Table 2.
Multilevel logistic regression of individual and contextual factors associated with barriers to healthcare among women in Ghana (Fixed effects results)
| Variable | Permission | Money | Distance | Alone | At least one barrier |
|---|---|---|---|---|---|
| AOR [95%CI] | AOR [95%CI] | AOR [95%CI] | AOR [95%CI] | AOR [95%CI] | |
| Age | |||||
| 15–19 | Ref | Ref | Ref | Ref | Ref |
| 20–24 | 0.941 [0.70,1.27] | 1.00 [0.73,1.05] | 0.915 [0.75,1.12] | 0.613***[0.49,0.77] | 0.820*[0.68,0.98] |
| 25–29 | 0.7 [0.51,1.11] | 0.727** [0.58,0.91] | 0.823 [0.64,1.05] | 0.592***[0.45,0.78] | 0.67***[0.54,0.83] |
| 30–34 | 1.00 [0.56,1.33] | 0.90 [0.69,1.12] | 0.887 [0.67,1.17] | 0.614**[0.45,0.84] | 0.729*[0.57,0.93] |
| 35–39 | 0.939 [0.60,1.48] | 1.00 [0.65,1.09] | 0.877 [0.66,1.17] | 0.576**[0.41,0.80] | 0.716*[0.55,0.93] |
| 40–44 | 0.70 [0.42,1.13] | 0.863 [0.66,1.14] | 0.893 [0.66,1.21] | 0.547***[0.38,0.78] | 0.750*[0.57,0.99] |
| 45–49 | 1.00 [0.40,1.15] | 0.745*[0.56,0.99] | 0.805 [0.59,1.11] | 0.555** [0.39,0.80] | 0.65**[0.49,0.86] |
| Marital status | |||||
| Never married | Ref | Ref | Ref | Ref | Ref |
| Married | 0.70 [0.52,1.07] | 0.604***[0.49,0.74] | 0.854 [0.67,1.08] | 1.05 [0.80,1.38] | 0.71**[0.58,0.87] |
| Cohabitation | 1.055 [0.72,1.54] | 0.742** [0.60,0.92] | 0.866 [0.67,1.11] | 0.937 [0.70,1.25] | 0.882 [0.71,1.10] |
| Widowed | 0.738 [0.39,1.41] | 1.378 [0.97,1.96] | 0.976 [0.66,1.43] | 1.498 [0.97,2.32] | 1.469*[1.03,2.10] |
| Divorced | 1.0 [0.42,1.12] | 1.2 [0.91,1.53] | 0.996 [0.74,1.34] | 1.016 [0.71,1.45] | 1.116 [0.86,1.44] |
| Educational level | |||||
| No education | Ref | Ref | Ref | Ref | Ref |
| Primary | 1.1 [0.83,1.47] | 1.007 [0.86,1.19] | 0.914 [0.77,1.09] | 0.835 [0.68,1.03] | 0.903 [0.76,1.07] |
| Secondary | 1.00 [0.67,1.19] | 0.797**[0.68,0.93] | 0.908 [0.76,1.08] | 0.835 [0.68,1.03] | 0.75***[0.64,0.89] |
| Higher | 0.588 [0.31,1.11] | 0.477***[0.34,0.67] | 0.594**[0.40,0.88] | 0.662 [0.43,1.01] | 0.51***[0.37,0.69] |
| Ethnicity | |||||
| Akan | Ref | Ref | Ref | Ref | Ref |
| Ga Adangme/ewe | 1.00 [0.61,1.22] | 1.00 [0.86,1.27] | 1.238 [0.99,1.55] | 1.265 [0.99,1.61] | 1.202 [0.99,1.46] |
| Mole-dagbani | 1.072 [0.73,1.58] | 1.206 [0.96,1.52] | 1.135 [0.87,1.47] | 1.043 [0.78,1.40] | 1.082 [0.86,1.36] |
| Other | 1.128 [0.79,1.61] | 1.101 [0.89,1.37] | 0.903 [0.70,1.16] | 0.976 [0.74,1.29] | 1.057 [0.85,1.31] |
| Employment | |||||
| Not working | Ref | Ref | Ref | Ref | Ref |
| Managerial | 0.90 [0.51,1.56] | 0.855 [0.63,1.16] | 1.073 [0.76,1.51] | 0.953 [0.66,1.39] | 0.921 [0.70,1.21] |
| Clerical /sales | 1.00 [0.60,1.01] | 0.859* [0.74,1.00] | 0.911 [0.77,1.08] | 0.755** [0.62,0.91] | 0.855*[0.74,0.99] |
| Agricultural | 0.81 [0.61,1.08] | 1.00 [0.99,1.41] | 1.217* [1.01,1.47] | 0.959 [0.77,1.19] | 1.242*[1.04,1.49] |
| Services | 0.325* [0.11,0.92] | 0.769 [0.51,1.17] | 0.854 [0.52,1.41] | 0.421* [0.21,0.86] | 0.690 [0.46,1.03] |
| Manual | 0.686* [0.49,0.96] | 0.90 [0.78,1.13] | 0.954 [0.78,1.17] | 0.773* [0.61,0.98] | 0.967 [0.81,1.16] |
| Religion | |||||
| Christianity | Ref | Ref | Ref | Ref | Ref |
| Islam | 0.813 [0.60,1.11] | 0.825* [0.69,0.99] | 0.709** [0.58,0.87] | 0.772* [0.61,0.98] | 0.835 [0.70,1.00] |
| Traditionalist | 2.054** [1.26,3.35] | 1.00 [0.91,1.92] | 1.033 [0.72,1.47] | 1.363 [0.93,1.99] | 1.382 [0.92,2.07] |
| No religion | 0.8 [0.48,1.48] | 1.092 [0.81,1.47] | 0.612** [0.44,0.84] | 0.861 [0.59,1.25] | 0.903 [0.67,1.23] |
| Parity | |||||
| 0 | Ref | Ref | Ref | Ref | Ref |
| 1 to 3 | 0.905 [0.65,1.26] | 1.431***[1.18,1.73] | 0.996 [0.81,1.23] | 0.755* [0.59,0.96] | 1.108 [0.92,1.33] |
| 4 or more | 1.1 [0.69,1.61] | 1.846***[1.46,2.34] | 1.131 [0.87,1.47] | 0.787 [0.58,1.06] | 1.334*[1.06,1.68] |
| Health insurance subscription | |||||
| No | – | Ref | Ref | Ref | Ref |
| Yes | – | 0.542***[0.49,0.61] | 0.880* [0.78,0.99] | – | 0.59***[0.53,0.66] |
| Frequency of listening to radio | |||||
| Not at all | Ref | Ref | Ref | Ref | Ref |
| Less than once a week | 1.162 [0.89,1.51] | 1.00 [0.77,1.06] | 0.927 [0.79,1.10] | 0.881 [0.73,1.06] | 0.878 [0.75,1.03] |
| At least once a week | 1.047 [0.81,1.36] | 0.749***[0.65,0.87] | 0.873 [0.74,1.02] | 0.793*[0.66,0.95] | 0.77***[0.66,0.90] |
| Frequency of reading newspaper | |||||
| Not at all | – | Ref | Ref | Ref | |
| Less than once a week | – | 1.00 [0.76,1.11] | 0.911 [0.74,1.13] | – | 0.936 [0.78,1.12] |
| At least once a week | – | 0.914 [0.74,1.13] | 0.98 [0.77,1.25] | – | 0.971 [0.79,1.19] |
| Frequency of watching television | |||||
| Not at all | Ref | Ref | Ref | Ref | Ref |
| Less than once a week | 1.383* [1.06,1.80] | 0.830* [0.71,0.97] | 0.822* [0.69,0.97] | 1.125 [0.92,1.37] | 0.846*[0.72,0.99] |
| At least once a week | 1.00 [0.80,1.38] | 0.699***[0.60,0.81] | 0.796** [0.68,0.94] | 1.132 [0.93,1.37] | 0.75***[0.64,0.87] |
| Household and community level factors | |||||
| Sex of head of household | |||||
| Male | – | – | Ref | Ref | Ref |
| Female | – | – | 0.915 [0.80,1.05] | 0.97 [0.83,1.14] | 1.061 [0.94,1.20] |
| Wealth | |||||
| Poorest | Ref | Ref | Ref | Ref | Ref |
| Poorer | 1.1 [0.83,1.58] | 1.005 [0.83,1.22] | 1.008 [0.82,1.23] | 1.113 [0.88,1.41] | 1.071 [0.88,1.31] |
| Middle | 1.00 [0.72,1.60] | 0.863 [0.69,1.09] | 1.031 [0.80,1.32] | 1.171 [0.87,1.57] | 0.944 [0.75,1.19] |
| Richer | 0.758 [0.47,1.21] | 0.650** [0.50,0.85] | 1.016 [0.76,1.36] | 0.958 [0.68,1.35] | 0.71**[0.54,0.92] |
| Richest | 0.7 [0.40,1.14] | 0.399***[0.29,0.54] | 0.764 [0.54,1.08] | 0.781 [0.53,1.15] | 0.47***[0.35,0.63] |
| Neighbourhood socio-economic status | |||||
| Low | Ref | Ref | Ref | Ref | Ref |
| Medium | 0.812 [0.52,1.27] | 1.00 [0.59,1.13] | 1.101 [0.75,1.61] | 0.837 [0.58,1.21] | 0.851 [0.61,1.19] |
| High | 1.041 [0.55,1.97] | 0.87 [0.54,1.39] | 2.042** [1.20,3.49] | 1.416 [0.83,2.40] | 1.054 [0.65,1.71] |
| Residence | |||||
| Urban | Ref | Ref | Ref | Ref | [1.00,1.00] |
| Rural | 1.00 [0.57,1.42] | 0.948 [0.68,1.32] | 1.415 [0.97,2.07] | 1.024 [0.70,1.49] | 0.998 [0.71,1.40] |
| Religion | |||||
| Western | Ref | Ref | Ref | Ref | [1.00,1.00] |
| Central | 0.605 [0.35,1.04] | 1.00 [0.68,1.59] | 0.922 [0.56,1.50] | 1.962** [1.19,3.24] | 0.95 [0.62,1.45] |
| Greater Accra | 1.00 [0.37,1.18] | 0.888 [0.57,1.37] | 0.833 [0.50,1.39] | 2.463***[1.47,4.11] | 0.93 [0.60,1.44] |
| Volta | 0.249***[0.12,0.51] | 2.732***[1.73,4.32] | 1.214 [0.72,2.04] | 1.772* [1.03,3.05] | 2.20**[1.38,3.53] |
| Eastern | 1.146 [0.68,1.92] | 1.661* [1.09,2.52] | 2.135** [1.33,3.43] | 2.707***[1.65,4.43] | 1.70*[1.11,2.61] |
| Ashanti | 0.951 [0.57,1.58] | 2.041***[1.35,3.08] | 1.585 [0.99,2.54] | 3.008***[1.85,4.88] | 1.75**[1.15,2.67] |
| Brong Ahafo | 0.608 [0.35,1.04] | 1.0 [0.49,1.15] | 0.878 [0.54,1.44] | 1.956** [1.18,3.23] | 0.776 [0.50,1.19] |
| Northern | 0.90 [0.46,1.66] | 2.127** [1.28,3.52] | 2.282** [1.29,4.03] | 4.740***[2.67,8.43] | 2.19**[1.30,3.67] |
| Upper East | 0.384**[0.19,0.77] | 0.9 [0.53,1.46] | 0.510* [0.28,0.92] | 1.00 [0.54,1.85] | 0.770 [0.46,1.29] |
| Upper West | 1.666 [0.89,3.13] | 2.578***[1.55,4.29] | 2.672***[1.50,4.75] | 1.56 [0.86,2.85] | 2.22**[1.32,3.74] |
| N | 9370 | 9370 | 9370 | 9370 | 9370 |
Exponentiated coefficients; 95% confidence intervals in brackets
Ref Reference
Model I is the null model, a baseline model without any determinant variable
Model II = individual level variables
Model III = contextual level variables
Model IV is the final model adjusted for individual and contextual level variables
* p < 0.05, ** p < 0.01, *** p < 0.001