Perceptions, attitude and willingness of pregnant women towards Caesarean Section in the Nkwanta South Municipality, Ghana

Perceptions, attitude and willingness of pregnant women towards Caesarean Section in the Nkwanta South Municipality, Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perceptions, attitude and willingness of pregnant women towards Caesarean Section in the Nkwanta South Municipality, Ghana Jacob Tse Ahiagbede, Lydia Sarponmaa Asante, Ernest Osei, Patrick Bondzi Fynn, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6849052/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background A Caesarean section is typically necessitated when vaginal birth might endanger the mother or the unborn child. Although some women opt for caesarean sections, research has shown that others oppose it even in the face of an emergency. Much has not been known about why most pregnant women do not willingly opt of CS Objectives This study assessed pregnant women's perceptions, attitudes and willingness towards the caesarean section in the Nkwanta South Municipality. Method The study employed a mixed concurrent methods approach. For the quantitative aspect, an analytical cross-sectional study was conducted among women who reside in the Nkwanta South Municipality in the Oti region. A total of 422 pregnant women in four selected health facilities. Again, for the qualitative aspect of the study, 12 pregnant women were interviewed with after consent was given. Results A study surveyed 422 Christian pregnant women aged 20–29, revealing religion, ethnicity, cultural factors, and willingness to undergo Caesarean Section. Reasons for refusal included cost, fear, pain, dying, and educational level. Concerns included long recovery periods, poor perception, and worker safety. Conclusion This study in Nkwanta South Municipality found that while most pregnant women have a positive perception of Caesarean sections, they still express concerns about complications, pain, risk of death, and mockery. Education efforts have partially been effective, but there is still a gap in addressing specific fears and misconceptions. The study suggests that improving perceived behavioural control through education can positively impact attitudes. Caesarean section pregnant women perception attitude willingness Figures Figure 1 Figure 2 Figure 3 Introduction Caesarean section has become increasingly safe and tops the list of the most performed surgical procedures in obstetric practice globally [ 1 ]. With advances in medical practice, the procedure has contributed to improvements in maternal safety and neo-natal outcomes when indicated in conditions such as foetal distress, antepartum haemorrhage, previous Caesarean Section (CS), and obstructed labour, among others [ 2 ]. Caesarean section is now a recommended method even as an elective option for childbirth [ 3 ]. However, several people still hold strong negative cultural and religious perceptions regarding the procedure, despite its evidence-based safe techniques and improvements [ 4 ]. Compared to developed countries recording rates between 25% and 30%, Ghana’s national average caesarean section rate is estimated at 18.8% according to previous studies [ 5 ]. The underutilisation of CS has been shown to have a strong association with traditional beliefs and sociocultural norms [ 6 ]. As a result of these perceptions, women engage untrained and unskilled providers, only to report to the hospital when life-threatening maternal and/or neonatal complications within the period of labour. This study sought to gain insights into the perceptions, attitudes and determining factors that affect willingness to accept caesarean section by women in the Nkwanta South Municipality of Ghana. The study findings add to the body of knowledge of existing data on perceptions about CS in Ghana and serve as useful information for educating expectant parents on appropriate health-seeking behaviours in a bid to reduce neonatal and maternal mortality rates. Materials and Methods Study Area: This study was conducted in the Nkwanta South Municipality of the Oti Region, Ghana, focusing on pregnant women attending antenatal clinics at selected healthcare facilities within the district. Study Design: An explanatory sequential mixed-methods approach was employed, combining both quantitative and qualitative research methods. This approach allowed for a comprehensive understanding of the perceptions, attitudes, and acceptability of caesarean sections (CS) among pregnant women. For the quantitative aspect of the study, an analytic cross-sectional study design was used among 422 pregnant women in Nkwanta south. The pregnant women were randomly sampled into the study. Those who consented were included and data taken. Also, the study conveniently sampled 12 women who have experienced child birth before. Qualitative interviews were conducted among these women. The data was transcribed and analysed with qualitative software Study Population: The study population consisted of pregnant women who reported to the antenatal clinics of selected health facilities in the Nkwanta South Municipality. Inclusion criteria required participants to be mentally sound, not critically ill, and to have consented to participate in the study. Sampling Technique: A proportionate stratified sampling method was used to allocate respondents across the various healthcare facilities. This ensured a representative sample from each facility in the municipality. For the qualitative aspect, convenience sampling was used. Pregnant women who were available and met the inclusion criteria were interviewed. The sample for the quantitative component was determined using the Cochran formula, with an adjustment for a 10% non-response rate. Sample size Cochran’s formula for determining sample size was used to estimate the final sample size for tertiary students. The formulae is given as: $$\:\:\:\:n=\frac{{z}^{2}\raisebox{1ex}{$a$}\!\left/\:\!\raisebox{-1ex}{$2$}\right.\times\:p(1-p)}{{e}^{2}}$$ Where n = sample size, \(\:{z}^{2}\raisebox{1ex}{$a$}\!\left/\:\!\raisebox{-1ex}{$2$}\right.\) = Z score of 1.96 at 95% Confidence Interval (C.I), p= proportion or prevalence, \(\:{e}^{2}\) = margin of error 5% = 0.05, and non-response rate of 5% will be added. Based on this formula, the sample size required for each region was 384 and with a non-response rate of 10%, 38 participants were added to the sample size. The total sample size required in this study was 422 participant were for the quantitative component of the study and 12 pregnant women interviewed after consent was given. Data Collection Procedure: For the quantitative data collection, a structured questionnaire adapted from existing literature [ 7 ] was used. The questionnaire was translated into local languages to accommodate illiterate respondents. For the qualitative component, in-depth interviews were conducted with a purposively selected subgroup of pregnant women meeting the inclusion criteria. An interview guide with open-ended questions facilitated the discussions, which were conducted in the local language, audio-recorded with participants' consent, and later transcribed verbatim. Data Analysis: The quantitative data were analysed using Stata version 14.0, with descriptive statistics (frequencies and percentages) employed to summarize the data. Independent variables such as age, marital status, occupation, education, and others were analysed with the dependent variables of perception, attitude, and acceptability of CS. Binary logistic regression was used to identify predictors of CS acceptance. For the qualitative data, thematic analysis was applied to the transcribed interview data, allowing for the identification of key themes related to the perceptions and acceptability of CS, which provided deeper insights into the quantitative findings. Results Socio-demographic characteristics of the respondents. The study included 422 respondents with a mean age of 28.85 ± 5.87 completed the survey (Table 1). 49.5% of the respondents lived in rural communities. About 57% had less than senior high school level education. Most (71.7%) of the respondents were Christians. The majority (60.8%) of the respondents were married. Approximately 47.0% of the respondents travelled about 5 km to 8 km before reaching a health facility. Table 1 Demographic characteristics of the respondents (Quantitative) Variable Frequency (N = 422) Percentage (%) Age of participants Mean = 28.85 ± 5.87 Below 20 12 2.8 20–29 252 59.7 30–39 138 32.7 40 and above 20 4.8 Education level No formal education 75 17.8 Primary 94 22.2 JHS 70 16.6 SHS 97 23.0 Tertiary 86 20.40 Marital status Single (Never married) 89 21.1 Married 256 60.8 Cohabiting 50 11.9 Divorced 11 2.6 Widowed 15 3.6 Occupation Farmer 105 24.9 Trader 117 27.7 Public servant 115 27.2 Others* 13 3.1 Unemployed 72 17.1 Ethnicity Ewe 171 40.5 Akan 162 38.4 Guan 39 9.2 Others** 50 11.9 Religion Christian 302 71.7 Muslim 69 16.4 Traditionalist 50 11.9 Type of residence Rural 208 49.3 Peri-urban 160 37.9 Urban 54 12.8 Distance to health facility Less than 5km 131 31.0 5km-8km 198 47.0 More than 8km 93 22.0 Means of transport to health facility On foot 172 40.8 Motorbike/bicycle 99 23.5 Taxi 80 18.9 Private car 31 7.3 Bus 40 9.5 Again, the study also recruited 12 pregnant women for the qualitative aspect of the study. Of the 12 women interviewed, their mean age was 27.92. Their gestational age ranged from 12 to 40 weeks (Table 2 ). Table 2 Characteristics of interview participants participant ID Age Number of children Gestational period 1 26 4 23 weeks 2 34 3 34 weeks 3 24 2 40 weeks 4 32 3 27 weeks 5 26 0 28 weeks 6 27 3 36 weeks 7 27 1 12 weeks 8 29 0 12 weeks 9 35 3 34 weeks 10 26 4 28 weeks 11 24 2 23 weeks 12 25 5 32 weeks Perceptions, attitude and willingness of pregnant women towards Caesarean Section Attitude towards CS The results of this study indicates that 52.61% of respondents have a negative attitude toward Caesarean Section as shown in Fig. 1.0. This suggests that there may still be misconceptions, fears, or cultural beliefs that contribute to the reluctance toward CS, even though a significant proportion also view it positively. Perception towards Caesarean Section The findings indicate that more than half 57% of respondents have a positive perception toward CS as shown in Fig. 2.0. More than half of the respondents recognize the importance, benefits, or necessity of Caesarean Section in certain medical situations. Willingness of pregnant women to undertake Caesarean Section As shown in Fig. 3.0, the findings of the study revealed that majority (over two-thirds) 68.74% of respondents were not willing to undergo CS despite the potential medical necessity in certain situations. Perception of participants towards the caesarean section There were no significant differences between perception towards CS and several pregnant women’s characteristics except religion (X 2 = 14.80, P < 0.001) and means of transportation to health facilities (X 2 = 11.04, p < 0.05) (Table 3). Interviewees perceived that their religious beliefs taught them CS was not for them. “…y es, caesarean section is against the will of God concerning delivery, because Hebrew women deliver successfully before the midwife got to know” (Interviewee #7). “I think evil spirits and witchcraft are following me; that is why they want to operate on me (Interviewee #6). Association between attitude and participants’ characteristics All others except married women had relatively negative attitudes towards CS ( X 2 = 13.11, p < 0.01). In most categories, more women had negative attitudes towards CS. However, more than half of the married respondents (54%), 53% rural dwellers and 52% public servants had positive attitudes towards CS (Table 3 ). About 64% of respondents felt women who have undergone CS as weak women, 25% stated they feel sorry for women who must undergo CS whilst 7% felt it was God’s wish for such women to have CS ( Fig. 3 ). “ …not worth it because you can die during the process, or your stomach might get too huge (Interviewee #9). “ I am afraid …. and I would not like to do it because I heard that some of them are 50% chance, some either baby survive, or mother survive. … so, it will be very difficult for me to opt for caesarean section ” ( Interviewee #4 ) Willingness to accept CS Willingness to accept CS was associated with marital status, occupation, ethnicity, distance and means of transportation to health facilities. Except for women who owned vehicles and those who lived about 8km away from the health facilities, more women were unwilling to accept the procedure even when indicated in all categories. In all, almost 69% of women stated they were unwilling to undergo CS even when indicated ( Fig. 2 ). The reasons given for their unwillingness to have a CS included cost, fear of ridicule, belief that it is against God's will, fear of pain, and fear of dying ( Fig. 3 ) (Table 3). “I think there is a lot of risk like death, doctors leaving items in your abdomen and you cannot gain your strength back but for me, I put my hope on God almighty” (Interviewee #3). Predictors of perception, attitudes and willingness towards CS. As shown in Table 3 below, the crude model revealed a statistically significant association between occupation and pregnant women's perception of caesarean section where pregnant women who were public servants were three times more likely to have a good perception towards caesarean section as compared to pregnant women who were farmers. Religion also influenced pregnant women's perceptions of caesarean section where Muslim pregnant women were 8 percent less likely to have a good perception towards caesarean section as compared to Christian pregnant women. Also, pregnant women who were traditionalists were two times more likely to have a good perception towards caesarean section as compared to pregnant women. Pregnant women who used a taxi and bus as a means of transportation to the health facility were three times and six times respectively more likely to have a good perception towards caesarean section as compared to pregnant women who walked to the health facility. Logistic regression analysis on the influence of socio-demographic characteristics on the attitude of pregnant women towards caesarean section Table 4 shows the result of the simple and multiple logistic regression analysis performed on factors that influence the attitude of women towards CS. The results revealed women with tertiary level education to be 3.02 times more likely to have a more positive attitude towards CS relative to those with no formal education. (AOR = 3.02; CI = 1.06–8.61; p = 0.039). Public servants were found to be 1.91 times more likely to have a positive attitude towards CS though this association was not significant in the multiple regression model (AOR = 1.91; CI = 1.11–3.31; p = 0.020). Muslims and Traditionalists were also found to have negative attitudes towards CS as compared to Christians, AOR = 0.54; CI = 0.17–0.62; p = 0.022 and AOR = 0.35; CI = 1.34–2.14; p = 0.001 respectively. These associations were however not significant after controlling confounders. Moreover, participants who were residing in Peri-urban areas were found to be 0.43 times less likely to have a positive attitude towards CS relative to those living in urban areas. (AOR = 0.43; CI = 0.34–0.97; p = 0.020). The findings also revealed participants who must travel a minimum of 5km to 8km to a health facility have lower odds of a positive attitude towards CS (AOR = 0.57; CI = 0.21–0.87; p = 0.037). Further, participants who travelled by taxi and bus were 1.83 and 2.80 times more likely to have a positive attitude towards CS if indicated as compared to those who travelled on foot, AOR = 1.83; CI = 1.05–3.18; p = 0.032 and AOR = 2.80; CI = 1.29–6.08; p = 0.009 respectively. This association was not significant in the multiple regression test. Table 4 predictors of perception, attitude and willingness of women towards CS SCD of Respondent Perception of women Attitude of women Willingness OR (CI, P-value) OR (CI, P-value) OR (CI, P-value) OR (CI, P-value) OR (CI, P-value) OR (CI, P-value) Education No formal education Primary 0.79(0.43–1.45)0.438 0.91 (0.46–1.78) 0.89(0.48–1.64)0.717 1.30 (0.66–2.57) 1.25 (0.63–2.51) 1.43 (0.61–3.39) JHS 0.83(0.43–1.60)0.581 0.99 (0.6–2.13) 1.20(0.63–2.32)0.574 2.01 (0.93–4.34) 1.36 (0.65–2.85) 1.51 (0.56–4.11) SHS 1.27(0.69–2.35)0.439 1.23 (0.49–3.01) 0.92(0.50–1.69)0.790 1.70 (0.69–4.21) 1.48 (0.75–2.93) 1.98 (0.63–6.19) Tertiary 1.54(0.82–2.92)0.182 1.74 (0.60–5.07) 1.60(0.86–2.98)0.141 3.02 (1.06–8.61)* 2.03 (1.03–4.03)* 2.78 (0.76–10.23) Marital status Married Single 1.08(0.66–1.76) 1.19(0.67–2.09) 0.58(0.33-1.00)0.052 0.58 (0.33-1.00) 0.29 (0.15–0.55)** 0.32 (0.15–0.68)** Cohabiting 0.84(0.46–1.55) 0.95(0.46–1.95) 0.69(0.34–1.40)0.303 0.69 (0.34–1.40) 1.16 (0.62–2.18) 0.63 (0.28–1.41) Divorced 0.41(0.12–1.44) 0.40(0.10–1.59) 0.59(0.15–2.26)0.441 0.59 (0.15–2.26) 1.52 (0.45–5.14) 2.18 (0.51–9.31) Widowed 0.82(0.29–2.33) 0.90(0.29–2.83) 0.29(0.08–1.12)0.073 0.29 (0.08–1.12) 0.92 (0.30–2.76) 0.84 (0.22–3.26) Occupation Farmer Trader 1.06(0.63–1.80) 1.14 (0.62–2.08) 1.07(0.58–1.97)0.820 1.07 (0.58–1.97) 0.45 (0.24–0.83) ** 0.40 (0.19–0.86) * Public servant 1.91(1.11–3.31) 1.67 (0.66–4.23) 0.91(0.36–2.60)0.833 0.91(0.36–2.6) 0.75 (0.42–1.33) 0.38 (0.12–1.17) Others 1.06(0.33–3.37) 1.04 (0.25–4.34) 1.86(0.44–7.94)0.400 1.86 (0.44–7.94) 6.39 (1.65–24.69) ** 6.78 (1.16–39.77) * Unemployed 1.07(0.59–1.96) 1.34 (0.55–3.29) 0.80(0.33–1.92)0.615 0.80 (0.33–1.92) 1.48 (0.80–2.76) 0.46 (0.16–1.30) Ethnicity Ewe Akan 1.00(0.65–1.55) 1.16 (0.71–1.89) 1.20(0.75–1.95)0.434 1.20 (0.75–1.95) 0.79 (0.49–1.29) 0.74 (0.41–1.34) Guan 0.99(0.49–1.99) 1.67 (0.75–3.68) 1.02(0.46–2.26)0.950 1.02 (0.46–2.26) 2.4 (1.17–4.91)* 1.79 (0.76–4.19) Others 1.24(0.65–2.38) 3.13 (1.39–7.05) 1.29(0.59–2.80)0.514 1.29 (0.59–2.80) 1.89 (0.99–3.61) 0.87 (0.37–2.05) Religion Christian Muslim 0.54(0.32–0.92)* 0.47 (0.27–0.85)** 1.12(0.67–1.90)0.661 1.18 (0.21–0.87) 1.07 (0.61–1.89) 1.03 (0.51–2.12) Traditionalist 0.35(1.34–2.14)** 0.37 (0.18–0.75)** 1.20(0.66–2.18)0.541 1.72 (0.85–3.46) 2.09 (1.13–3.83)* 1.02 (0.49–2.14) Type of residence Urban Peri-urban 1.05(0.57- 1.96(0.95–4.06) 0.32(0.17–0.62)0.001 0.43 (0.21–0.87)* 1.62 (0.82–3.23) 1.19 (0.48–2.89) Rural 1.11(0.61–2.03) 1.95(0.94–4.04) 0.64(0.35–1.20)0.167 0.84 (0.41–1.71) 1.12 (0.62–2.39) 1.58 (0.63–3.97) Distance to health facility Less than 5km 5km-8km 0.97(0.62–1.52) 0.90 (0.53–1.55) 0.60(0.39–0.94)0.026 0.57 (0.34–0.97)* 3.22 (1.90–5.44)** 5.20 (2.67–10.12)** More than 8km 0.82(0.48–1.39) 0.58 (0.30–1.13) 0.74(0.43–1.25)0.259 0.66 (0.35–1.27) 1.56 (0.82–2.96) 3.11 (1.37–7.09)** Means of transport On foot - - - - - - Motorbike/bicycle 1.17(0.71–1.92) 1.31 (0.73–2.34) 0.99(0.60–1.62)0.955 1.01 (0.62–1.96) 0.83 (0.49–1.39) 0.50 (0.26–0.96)* Taxi 1.83(1.05–3.18)* 2.22 (1.56–4.25)* 0.86(0.50–1.46)0.570 1.01 (0.54–1.91) 0.30 0.15–0.59)** 0.24 (0.11–0.53)** Private car 0.87(0.41–1.88) 0.80 (0.33–1.97) 0.76(0.35–1.64)0.480 0.78 (0.32–1.94) 3.48 (1.54–7.85)** 2.00 (0.76–5.26) Bus 2.80(1.29–6.08)** 3.55 (1.45–8.70)** 0.95(0.48–1.89)0.879 1.01 (0.45–2.26) 0.04 (0.01–0.32)** 0.03 (0.00-0.25)** Discussion The study conducted in the Nkwanta South Municipality of the Oti Region in Ghana revealed that 57.2% of participants had a positive perception of caesarean sections (CS), with 78.9% considering it as safe as vaginal delivery. However, 41.2% expressed reluctance to undergo CS even when medically indicated, and factors such as education level and occupation significantly influenced these perceptions. Similar studies in Ghana have reported varying perceptions toward CS. For instance, a study in Cape Coast found that while 40% of women perceived CS as potentially fatal, 95.7% were willing to undergo the procedure if medically necessary. Additionally, 94% preferred vaginal delivery over CS as their primary mode of delivery.[ 9 ] In the Upper West Region, many women viewed CS as highly problematic, associating it with long-term health issues that could hinder their economic activities and childcare responsibilities. [ 13 ] In Nigeria, a study revealed that only 6.1% of pregnant women were willing to accept CS as a primary method of delivery, although 81% would agree to the procedure if it was necessary to save their lives or that of their babies. However, 12.1% would not accept CS under any circumstances. Factors such as low education levels and previous successful vaginal deliveries were associated with non-acceptance of CS. [ 11 ] Another study in Ghana's Upper West Region highlighted that most women perceived CS as highly problematic, viewing it as a long-term ailment that impedes their ability to engage in economic activities and care for their children. [ 13 ] These studies collectively indicate that while awareness of CS is generally high, preferences for vaginal delivery remain strong. Willingness to accept CS is often contingent upon medical necessity, with educational attainment and occupation playing significant roles in shaping perceptions. Misconceptions and cultural beliefs continue to influence attitudes toward CS, underscoring the need for targeted educational interventions to address these concerns. The findings from the Nkwanta South Municipality study, where 57.2% of participants held a positive perception of caesarean sections (CS), contrast with earlier research indicating predominantly negative perceptions. For instance, a study in Ghana's Upper West Region found that most women viewed CS as highly problematic, equating it to a long-term ailment that impedes their ability to engage in economic activities and care for their children.[ 13 ] The disparity between these studies may stem from differences in study populations, geographical or cultural contexts, and educational backgrounds. The higher level of positive perception in the Nkwanta South study could be attributed to increased awareness and education about CS. In contrast, negative perceptions in other studies may reflect stronger cultural or regional barriers and a lack of accurate information. For example, research has shown that lack of formal education, age less than 19 years, and unemployment are associated with poor maternal perception of CS. [ 8 ] Furthermore, the Nkwanta South study underscores the need for better alignment with policies and guidelines on maternal health that advocate for informed decision-making, address fears and misconceptions surrounding CS, and improve access to maternal healthcare services. This aligns with findings that maternal knowledge, attitudes, and perceptions towards CS are crucial, as positive perceptions can lead to effective adaptation to the maternal role, while negative perceptions can contribute to delayed presentation for emergency obstetric care.[ 10 ] The mixed-methods approach employed in the Nkwanta South Municipality study provided a comprehensive understanding of pregnant women's perceptions of caesarean sections (CS), combining quantitative data with qualitative insights to capture personal and cultural beliefs. This methodology aligns with best practices in health research, as it allows for a nuanced exploration of complex issues. [ 12 ] However, the study's limitations, such as potential response bias in self-reported data and a narrow geographic focus, may affect the generalizability of its findings. Similar constraints have been noted in other research, where regional disparities and sociodemographic factors influenced CS perceptions and acceptance. [ 11 ] To address misconceptions and fears surrounding CS, targeted educational and awareness campaigns are recommended. Effective interventions often leverage social or peer support, provide communication materials, encourage partner or family participation, and facilitate interactions with healthcare providers [ 13 ]. Collaborating with local leaders and religious organizations can also help bridge cultural barriers to CS acceptance. Future research should delve deeper into the socio-cultural and psychological factors influencing pregnant women's attitudes toward CS. Understanding the role of sociodemographic factors, such as education and occupation, is crucial for improving healthcare decision-making [ 9 ] Additionally, assessing the effectiveness of educational interventions in reducing fears and enhancing knowledge about CS is essential for developing strategies to improve maternal healthcare outcomes. In conclusion, addressing cultural, psychological, and educational barriers is vital for improving the acceptance and appropriate utilization of CS. While the Nkwanta South Municipality study indicates a generally positive perception of CS, persistent misconceptions and fears highlight the need for culturally sensitive education and community engagement to ensure better health outcomes for mothers and their babies. Conclusion Most of the participants of the study demonstrated a good perception towards CS. An overwhelming majority of the pregnant women viewed CS as safe as vaginal delivery. However, most of the participants indicated their concerns for CS some of which are doctors leaving items in their abdomen, death, pain and mockery from friends and family. Generally, there was a prevalence of negative attitudes towards CS among the participants. Ideas such as women who undergo CS are cursed, not women, abnormal, unfaithful to their husbands, and always undergo CS were circulated among the participants. Those who had tertiary-level education were more likely to have a good attitude towards CS compared to those with no formal education. The study recommends the following actions: incorporating education on Caesarean section (CS) in birth preparedness at health facilities, implementing or strengthening education and sensitisation programmes on CS for women of reproductive age, and promoting education about the risks of vaginal delivery and CS for pregnant women and their families. Declarations Ethical considerations The study sought ethical consideration approval from Ghana Health Service Ethical Review Committee (GHS-ERC), with REC number, GHS-ERC 029/11/22 Consent for publication Not applicable Conflict of interest statement The authors declare no competing interest. Data Availability The data that support the findings of this study are available from the corresponding author, JTA upon request. Consent for publication Not applicable Funding We did not receive any external funding or support for this work. The work was funded by the authors. Author contribution JTA conceptualized the study and wrote the introduction. LSA supervised and did proof reading for the write up. SY, PBF and KDA analyzed and wrote the results for the study. IT and EO wrote the discussion. KDA also review and yourself qualitative analysis with editing Acknowledgements The authors are grateful to all the study participants. References A. P. Betrán, J. Ye, A. B. Moller, J. Shang, A. M. 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Seidu et al. , “Not just numbers: Beyond counting caesarean deliveries to understanding their determinants in Ghana using a population-based cross-sectional study,” BMC Pregnancy Childbirth , vol. 20, no. 1, pp. 1–10, Feb. 2020, doi: 10.1186/S12884-020-2792-7/FIGURES/1. N. U. Ugwu and B. de Kok, “Socio-cultural factors, gender roles and religious ideologies contributing to Caesarian-section refusal in Nigeria,” Reprod. Health , vol. 12, no. 1, p. 70, 2015, doi: 10.1186/s12978-015-0050-7. A. Ashimi, T. Amole, and L. Aliyu, “Knowledge and attitude of pregnant women to the caesarean section in a semi-urban community in northwest Nigeria.,” J. West African Coll. Surg. , vol. 3, no. 2, pp. 46–61, Apr. 2013. Danso-Appiah, A., & Turpin, C. A. (2019). Maternal perceptions about caesarean section deliveries and their implications for uptake in the Central Region of Ghana. *BMC Pregnancy and Childbirth*, 19(1), 220 Dorkenoo, J. E., & Abor, P. A. (2021). Knowledge, Attitude and Perceptions of Pregnant Women towards Caesarean Section among Antenatal Clinic Attendants in Cape Coast, Ghana. *Research Journal of Health Sciences*, 9(3), 207-220. Adageba, R. K., & Danso, K. A. (2024). Acceptability of Caesarean Section among Pregnant Women in the Ashanti Region of Ghana. *Open Journal of Obstetrics and Gynecology*, 14(5), 723-733 Mboho, M., & Mboho, A. (2006). Perceptions and attitudes of pregnant women towards caesarean section in Nigeria. *Acta Obstetricia et Gynecologica Scandinavica*, 85(11), 1359-1361. Mboho, M., & Mboho, A. (2023). Educational interventions targeting pregnant women to optimize the acceptance of caesarean sections in Nigeria. *Journal of Health Education Research & Development*, 41(3), 345-358. Moyer, C. A., & Mustafa, A. (2016). Women's perceptions of caesarean sections in Ghana's Upper West Region. *Midwifery*, 40, 30-36. Table 3 Table 3 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table3.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6849052","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":474791508,"identity":"ed903b05-1cbc-48f0-bc1a-a34a438fb5c8","order_by":0,"name":"Jacob Tse Ahiagbede","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYBACxgYGNoYEBgg6kFABFGJmbiBaC+ODB2dAWhjxawECNhAB0sJs+LANagw+wNzA/OzBg5raPH725GMSifNqo/nbgVp+VGzD4zA2c4OEY8eLJXuepUkkbjueO+MwYwNjz5nb+PxiJpHAdixxw40cM6CWY7kNQC3MjG34tLB/k0j4dyxx/438bxKJc47lzieshQdoeFtN4gaJHGaDxIaa3A0EtTTzlEkk9h0oljjzzPBBwrEDuRuBWg7i84the/s2yR/f6vL425MfHPxRU5c77/zhgw9+VODR0gymDsP4EMYBnOqBQB5C1cH4dbgUjoJRMApGwQgGAFu3Y1rH5KCiAAAAAElFTkSuQmCC","orcid":"","institution":"School of Public Health and Allied Sciences, Catholic University of Ghana, Sunyani, Ghana","correspondingAuthor":true,"prefix":"","firstName":"Jacob","middleName":"Tse","lastName":"Ahiagbede","suffix":""},{"id":474791513,"identity":"2aad9ca9-4750-4ae8-ba78-8f2a73d6bdf0","order_by":1,"name":"Lydia Sarponmaa Asante","email":"","orcid":"","institution":"Catholic University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Lydia","middleName":"Sarponmaa","lastName":"Asante","suffix":""},{"id":474791514,"identity":"97de879f-2404-48f0-bd5c-66bdd6c7da0e","order_by":2,"name":"Ernest Osei","email":"","orcid":"","institution":"School of Public Health and Allied Sciences, Catholic University of Ghana, Sunyani, Ghana","correspondingAuthor":false,"prefix":"","firstName":"Ernest","middleName":"","lastName":"Osei","suffix":""},{"id":474791517,"identity":"11e23733-26fb-4373-9624-9db11db19b88","order_by":3,"name":"Patrick Bondzi Fynn","email":"","orcid":"","institution":"Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development","correspondingAuthor":false,"prefix":"","firstName":"Patrick","middleName":"Bondzi","lastName":"Fynn","suffix":""},{"id":474791518,"identity":"354293ef-d3ff-4b21-80f6-6b4ec73409d8","order_by":4,"name":"Solomon Yabila","email":"","orcid":"","institution":"University of Ghana, Regional Institute for Population Studies","correspondingAuthor":false,"prefix":"","firstName":"Solomon","middleName":"","lastName":"Yabila","suffix":""},{"id":474791519,"identity":"c739166e-e08f-449b-9667-e9d8e8057097","order_by":5,"name":"Kwabla Daniel Ahiagbede","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Kwabla","middleName":"Daniel","lastName":"Ahiagbede","suffix":""},{"id":474791520,"identity":"9d9ac5f6-ae4c-42a4-8d30-837b185aa547","order_by":6,"name":"Isaac Tetteh","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Isaac","middleName":"","lastName":"Tetteh","suffix":""}],"badges":[],"createdAt":"2025-06-08 19:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6849052/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6849052/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85279682,"identity":"647e72f7-111c-4eba-bd49-01a2d3304aa9","added_by":"auto","created_at":"2025-06-24 07:56:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55488,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eattitude of pregnant women towards CS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6849052/v1/f1b6c64f21dcbd748c9ef081.png"},{"id":85279931,"identity":"6a2a084e-92e0-4f8f-a881-8c2e9e055ab8","added_by":"auto","created_at":"2025-06-24 08:04:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":48368,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePerception towards\u003c/strong\u003e \u003cstrong\u003eCaesarean Section\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6849052/v1/c2becc7f26c9db4a345f8e6d.png"},{"id":85279683,"identity":"ee8bc57f-41c1-46a2-a7ba-ade6736a5319","added_by":"auto","created_at":"2025-06-24 07:56:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":10701,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eWillingness of pregnant women to undertake Caesarean Section\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6849052/v1/ecbec626f01bc21211a9b854.png"},{"id":104805275,"identity":"7bb94329-e91e-458e-a142-04f9e0653183","added_by":"auto","created_at":"2026-03-17 11:27:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1747638,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6849052/v1/3b1df6fb-cb14-47a9-8cee-470884661bd1.pdf"},{"id":85278636,"identity":"ecbcefba-604e-436a-95e7-093e9fab7041","added_by":"auto","created_at":"2025-06-24 07:48:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23162,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-6849052/v1/563ccfd14f3521226a020846.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perceptions, attitude and willingness of pregnant women towards Caesarean Section in the Nkwanta South Municipality, Ghana","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCaesarean section has become increasingly safe and tops the list of the most performed surgical procedures in obstetric practice globally [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. With advances in medical practice, the procedure has contributed to improvements in maternal safety and neo-natal outcomes when indicated in conditions such as foetal distress, antepartum haemorrhage, previous Caesarean Section (CS), and obstructed labour, among others [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Caesarean section is now a recommended method even as an elective option for childbirth [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, several people still hold strong negative cultural and religious perceptions regarding the procedure, despite its evidence-based safe techniques and improvements [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Compared to developed countries recording rates between 25% and 30%, Ghana\u0026rsquo;s national average caesarean section rate is estimated at 18.8% according to previous studies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The underutilisation of CS has been shown to have a strong association with traditional beliefs and sociocultural norms [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. As a result of these perceptions, women engage untrained and unskilled providers, only to report to the hospital when life-threatening maternal and/or neonatal complications within the period of labour. This study sought to gain insights into the perceptions, attitudes and determining factors that affect willingness to accept caesarean section by women in the Nkwanta South Municipality of Ghana. The study findings add to the body of knowledge of existing data on perceptions about CS in Ghana and serve as useful information for educating expectant parents on appropriate health-seeking behaviours in a bid to reduce neonatal and maternal mortality rates.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area:\u003c/h2\u003e \u003cp\u003eThis study was conducted in the Nkwanta South Municipality of the Oti Region, Ghana, focusing on pregnant women attending antenatal clinics at selected healthcare facilities within the district.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design:\u003c/h3\u003e\n\u003cp\u003eAn explanatory sequential mixed-methods approach was employed, combining both quantitative and qualitative research methods. This approach allowed for a comprehensive understanding of the perceptions, attitudes, and acceptability of caesarean sections (CS) among pregnant women. For the quantitative aspect of the study, an analytic cross-sectional study design was used among 422 pregnant women in Nkwanta south. The pregnant women were randomly sampled into the study. Those who consented were included and data taken. Also, the study conveniently sampled 12 women who have experienced child birth before. Qualitative interviews were conducted among these women. The data was transcribed and analysed with qualitative software\u003c/p\u003e\n\u003ch3\u003eStudy Population:\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of pregnant women who reported to the antenatal clinics of selected health facilities in the Nkwanta South Municipality. Inclusion criteria required participants to be mentally sound, not critically ill, and to have consented to participate in the study.\u003c/p\u003e\n\u003ch3\u003eSampling Technique:\u003c/h3\u003e\n\u003cp\u003eA proportionate stratified sampling method was used to allocate respondents across the various healthcare facilities. This ensured a representative sample from each facility in the municipality. For the qualitative aspect, convenience sampling was used. Pregnant women who were available and met the inclusion criteria were interviewed. The sample for the quantitative component was determined using the Cochran formula, with an adjustment for a 10% non-response rate.\u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eCochran\u0026rsquo;s formula for determining sample size was used to estimate the final sample size for tertiary students. The formulae is given as:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\:\\:\\:n=\\frac{{z}^{2}\\raisebox{1ex}{$a$}\\!\\left/\\:\\!\\raisebox{-1ex}{$2$}\\right.\\times\\:p(1-p)}{{e}^{2}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhere n\u0026thinsp;=\u0026thinsp;sample size, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{z}^{2}\\raisebox{1ex}{$a$}\\!\\left/\\:\\!\\raisebox{-1ex}{$2$}\\right.\\)\u003c/span\u003e\u003c/span\u003e = Z score of 1.96 at 95% Confidence Interval (C.I), p= proportion or prevalence, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{e}^{2}\\)\u003c/span\u003e\u003c/span\u003e= margin of error 5% = 0.05, and non-response rate of 5% will be added.\u003c/p\u003e \u003cp\u003e Based on this formula, the sample size required for each region was 384 and with a non-response rate of 10%, 38 participants were added to the sample size. The total\u003c/p\u003e \u003cp\u003esample size required in this study was 422 participant were for the quantitative component of the study and 12 pregnant women interviewed after consent was given.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Procedure:\u003c/h2\u003e \u003cp\u003eFor the quantitative data collection, a structured questionnaire adapted from existing literature [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] was used. The questionnaire was translated into local languages to accommodate illiterate respondents. For the qualitative component, in-depth interviews were conducted with a purposively selected subgroup of pregnant women meeting the inclusion criteria. An interview guide with open-ended questions facilitated the discussions, which were conducted in the local language, audio-recorded with participants' consent, and later transcribed verbatim.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis:\u003c/h2\u003e \u003cp\u003eThe quantitative data were analysed using Stata version 14.0, with descriptive statistics (frequencies and percentages) employed to summarize the data. Independent variables such as age, marital status, occupation, education, and others were analysed with the dependent variables of perception, attitude, and acceptability of CS. Binary logistic regression was used to identify predictors of CS acceptance. For the qualitative data, thematic analysis was applied to the transcribed interview data, allowing for the identification of key themes related to the perceptions and acceptability of CS, which provided deeper insights into the quantitative findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics of the respondents.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 422 respondents with a mean age of 28.85 ± 5.87 completed the survey (Table\u0026nbsp;1). 49.5% of the respondents lived in rural communities. About 57% had less than senior high school level education. Most (71.7%) of the respondents were Christians. The majority (60.8%) of the respondents were married. Approximately 47.0% of the respondents travelled about 5 km to 8 km before reaching a health facility.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDemographic characteristics of the respondents (Quantitative)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency (N = 422)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of participants\u003c/strong\u003e Mean = 28.85 ± 5.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBelow 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20–29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30–39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle (Never married)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCohabiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrader\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEwe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAkan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGuan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraditionalist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistance to health facility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than 5km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5km-8km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMore than 8km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeans of transport to health facility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOn foot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMotorbike/bicycle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTaxi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate car\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAgain, the study also recruited 12 pregnant women for the qualitative aspect of the study. Of the 12 women interviewed, their mean age was 27.92. Their gestational age ranged from 12 to 40 weeks (Table\u0026nbsp;2\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCharacteristics of interview participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eparticipant ID\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of children\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGestational period\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003ePerceptions, attitude and willingness of pregnant women towards Caesarean Section\u003c/h2\u003e\n \u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003eAttitude towards CS\u003c/h2\u003e\n \u003cp\u003eThe results of this study indicates that 52.61% of respondents have a negative attitude toward Caesarean Section as shown in Fig.\u0026nbsp;1.0. This suggests that there may still be misconceptions, fears, or cultural beliefs that contribute to the reluctance toward CS, even though a significant proportion also view it positively.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003e\u003cstrong\u003ePerception towards Caesarean Section\u003c/strong\u003e\u003c/h2\u003e\n \u003cp\u003eThe findings indicate that more than half 57% of respondents have a positive perception toward CS as shown in Fig.\u0026nbsp;2.0. More than half of the respondents recognize the importance, benefits, or necessity of Caesarean Section in certain medical situations.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003eWillingness of pregnant women to undertake Caesarean Section\u003c/h2\u003e\n \u003cp\u003eAs shown in Fig.\u0026nbsp;3.0, the findings of the study revealed that majority (over two-thirds) 68.74% of respondents were not willing to undergo CS despite the potential medical necessity in certain situations.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003ePerception of participants towards the caesarean section\u003c/h2\u003e\n \u003cp\u003eThere were no significant differences between perception towards CS and several pregnant women’s characteristics except religion (X\u003csup\u003e2\u003c/sup\u003e = 14.80, P \u0026lt; 0.001) and means of transportation to health facilities (X\u003csup\u003e2\u003c/sup\u003e = 11.04, p \u0026lt; 0.05) (Table\u0026nbsp;3). Interviewees perceived that their religious beliefs taught them CS was not for them.\u003c/p\u003e\n \u003cp\u003e“…y\u003cem\u003ees, caesarean section is against the will of God concerning delivery, because Hebrew women deliver successfully before the midwife got to know” (Interviewee #7).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e“I think evil spirits and witchcraft are following me; that is why they want to operate on me (Interviewee #6).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003eAssociation between attitude and participants’ characteristics\u003c/h2\u003e\n \u003cp\u003eAll others except married women had relatively negative attitudes towards CS (\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e = 13.11, p \u0026lt; 0.01). In most categories, more women had negative attitudes towards CS. However, more than half of the married respondents (54%), 53% rural dwellers and 52% public servants had positive attitudes towards CS (Table\u0026nbsp;3\u003cstrong\u003e).\u003c/strong\u003e About 64% of respondents felt women who have undergone CS as weak women, 25% stated they feel sorry for women who must undergo CS whilst 7% felt it was God’s wish for such women to have CS (\u003cstrong\u003eFig.\u0026nbsp;3\u003c/strong\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e“\u003c/strong\u003e \u003cem\u003e…not worth it because you can die during the process, or your stomach might get too huge (Interviewee #9).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e“\u003cem\u003eI am afraid …. and I would not like to do it because I heard that some of them are 50% chance, some either baby survive, or mother survive.\u003c/em\u003e… \u003cem\u003eso, it will be very difficult for me to opt for caesarean section\u003c/em\u003e” (\u003cem\u003eInterviewee #4\u003c/em\u003e)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\"\u003e\n \u003ch2\u003eWillingness to accept CS\u003c/h2\u003e\n \u003cp\u003eWillingness to accept CS was associated with marital status, occupation, ethnicity, distance and means of transportation to health facilities. Except for women who owned vehicles and those who lived about 8km away from the health facilities, more women were unwilling to accept the procedure even when indicated in all categories. In all, almost 69% of women stated they were unwilling to undergo CS even when indicated (\u003cstrong\u003eFig.\u0026nbsp;2\u003c/strong\u003e). The reasons given for their unwillingness to have a CS included cost, fear of ridicule, belief that it is against God's will, fear of pain, and fear of dying (\u003cstrong\u003eFig.\u0026nbsp;3\u003c/strong\u003e)\u003c/p\u003e\n \u003cp\u003e(Table\u0026nbsp;3).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e“I think there is a lot of risk like death, doctors leaving items in your abdomen and you cannot gain your strength back but for me, I put my hope on God almighty” (Interviewee #3).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePredictors of perception, attitudes and willingness towards CS.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAs shown in Table 3 below, the crude model revealed a statistically significant association between occupation and pregnant women's perception of caesarean section where pregnant women who were public servants were three times more likely to have a good perception towards caesarean section as compared to pregnant women who were farmers. Religion also influenced pregnant women's perceptions of caesarean section where Muslim pregnant women were 8 percent less likely to have a good perception towards caesarean section as compared to Christian pregnant women. Also, pregnant women who were traditionalists were two times more likely to have a good perception towards caesarean section as compared to pregnant women. Pregnant women who used a taxi and bus as a means of transportation to the health facility were three times and six times respectively more likely to have a good perception towards caesarean section as compared to pregnant women who walked to the health facility.\u003c/p\u003e\n \u003cdiv\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eLogistic regression analysis on the influence of socio-demographic characteristics on the attitude of pregnant women towards caesarean section\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTable\u0026nbsp;4 shows the result of the simple and multiple logistic regression analysis performed on factors that influence the attitude of women towards CS. The results revealed women with tertiary level education to be 3.02 times more likely to have a more positive attitude towards CS relative to those with no formal education. (AOR = 3.02; CI = 1.06–8.61; p = 0.039). Public servants were found to be 1.91 times more likely to have a positive attitude towards CS though this association was not significant in the multiple regression model (AOR = 1.91; CI = 1.11–3.31; p = 0.020). Muslims and Traditionalists were also found to have negative attitudes towards CS as compared to Christians, AOR = 0.54; CI = 0.17–0.62; p = 0.022 and AOR = 0.35; CI = 1.34–2.14; p = 0.001 respectively. These associations were however not significant after controlling confounders. Moreover, participants who were residing in Peri-urban areas were found to be 0.43 times less likely to have a positive attitude towards CS relative to those living in urban areas. (AOR = 0.43; CI = 0.34–0.97; p = 0.020). The findings also revealed participants who must travel a minimum of 5km to 8km to a health facility have lower odds of a positive attitude towards CS (AOR = 0.57; CI = 0.21–0.87; p = 0.037). Further, participants who travelled by taxi and bus were 1.83 and 2.80 times more likely to have a positive attitude towards CS if indicated as compared to those who travelled on foot, AOR = 1.83; CI = 1.05–3.18; p = 0.032 and AOR = 2.80; CI = 1.29–6.08; p = 0.009 respectively. This association was not significant in the multiple regression test.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003epredictors of perception, attitude and willingness of women towards CS\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSCD of Respondent\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePerception of women\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAttitude of women\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eWillingness\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (CI, P-value)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (CI, P-value)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (CI, P-value)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (CI, P-value)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (CI, P-value)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (CI, P-value)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.79(0.43–1.45)0.438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91 (0.46–1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.89(0.48–1.64)0.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.30 (0.66–2.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.25 (0.63–2.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.43 (0.61–3.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83(0.43–1.60)0.581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99 (0.6–2.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.20(0.63–2.32)0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.01 (0.93–4.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.36 (0.65–2.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.51 (0.56–4.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27(0.69–2.35)0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.23 (0.49–3.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92(0.50–1.69)0.790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.70 (0.69–4.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.48 (0.75–2.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.98 (0.63–6.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.54(0.82–2.92)0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.74 (0.60–5.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.60(0.86–2.98)0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.02 (1.06–8.61)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.03 (1.03–4.03)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.78 (0.76–10.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.08(0.66–1.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.19(0.67–2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58(0.33-1.00)0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58 (0.33-1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.29 (0.15–0.55)**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.32 (0.15–0.68)**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCohabiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.84(0.46–1.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.95(0.46–1.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69(0.34–1.40)0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69 (0.34–1.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.16 (0.62–2.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.63 (0.28–1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41(0.12–1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.40(0.10–1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59(0.15–2.26)0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59 (0.15–2.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.52 (0.45–5.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.18 (0.51–9.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.82(0.29–2.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.90(0.29–2.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.29(0.08–1.12)0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.29 (0.08–1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92 (0.30–2.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.84 (0.22–3.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrader\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.06(0.63–1.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.14 (0.62–2.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07(0.58–1.97)0.820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07 (0.58–1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45 (0.24–0.83) \u003cstrong\u003e**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.40 (0.19–0.86) \u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.91(1.11–3.31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.67 (0.66–4.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91(0.36–2.60)0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91(0.36–2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75 (0.42–1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.38 (0.12–1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.06(0.33–3.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.04 (0.25–4.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.86(0.44–7.94)0.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.86 (0.44–7.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.39 (1.65–24.69) **\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.78 (1.16–39.77) *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07(0.59–1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.34 (0.55–3.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.80(0.33–1.92)0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.80 (0.33–1.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.48 (0.80–2.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46 (0.16–1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEwe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAkan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00(0.65–1.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.16 (0.71–1.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.20(0.75–1.95)0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.20 (0.75–1.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.79 (0.49–1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.74 (0.41–1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGuan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99(0.49–1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.67 (0.75–3.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02(0.46–2.26)0.950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02 (0.46–2.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.4 (1.17–4.91)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.79 (0.76–4.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.24(0.65–2.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.13 (1.39–7.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.29(0.59–2.80)0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.29 (0.59–2.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.89 (0.99–3.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.87 (0.37–2.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.54(0.32–0.92)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.47 (0.27–0.85)**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.12(0.67–1.90)0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.18 (0.21–0.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07 (0.61–1.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03 (0.51–2.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraditionalist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35(1.34–2.14)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.37 (0.18–0.75)**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.20(0.66–2.18)0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.72 (0.85–3.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.09 (1.13–3.83)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02 (0.49–2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePeri-urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.05(0.57-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.96(0.95–4.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.32(0.17–0.62)0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.43 (0.21–0.87)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.62 (0.82–3.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.19 (0.48–2.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.11(0.61–2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.95(0.94–4.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64(0.35–1.20)0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.84 (0.41–1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.12 (0.62–2.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.58 (0.63–3.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistance to health facility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than 5km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5km-8km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97(0.62–1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.90 (0.53–1.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60(0.39–0.94)0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57 (0.34–0.97)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.22 (1.90–5.44)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.20 (2.67–10.12)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMore than 8km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.82(0.48–1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58 (0.30–1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.74(0.43–1.25)0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66 (0.35–1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.56 (0.82–2.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.11 (1.37–7.09)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"8\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeans of transport\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOn foot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMotorbike/bicycle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.17(0.71–1.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.31 (0.73–2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99(0.60–1.62)0.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.01 (0.62–1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83 (0.49–1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.50 (0.26–0.96)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTaxi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.83(1.05–3.18)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.22 (1.56–4.25)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86(0.50–1.46)0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.01 (0.54–1.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.30 0.15–0.59)**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.24 (0.11–0.53)**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate car\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.87(0.41–1.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.80 (0.33–1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76(0.35–1.64)0.480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78 (0.32–1.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.48 (1.54–7.85)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.00 (0.76–5.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.80(1.29–6.08)**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.55 (1.45–8.70)**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.95(0.48–1.89)0.879\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.01 (0.45–2.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04 (0.01–0.32)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03 (0.00-0.25)**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e The study conducted in the Nkwanta South Municipality of the Oti Region in Ghana revealed that 57.2% of participants had a positive perception of caesarean sections (CS), with 78.9% considering it as safe as vaginal delivery. However, 41.2% expressed reluctance to undergo CS even when medically indicated, and factors such as education level and occupation significantly influenced these perceptions.\u003c/p\u003e \u003cp\u003eSimilar studies in Ghana have reported varying perceptions toward CS. For instance, a study in Cape Coast found that while 40% of women perceived CS as potentially fatal, 95.7% were willing to undergo the procedure if medically necessary. Additionally, 94% preferred vaginal delivery over CS as their primary mode of delivery.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] In the Upper West Region, many women viewed CS as highly problematic, associating it with long-term health issues that could hinder their economic activities and childcare responsibilities. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn Nigeria, a study revealed that only 6.1% of pregnant women were willing to accept CS as a primary method of delivery, although 81% would agree to the procedure if it was necessary to save their lives or that of their babies. However, 12.1% would not accept CS under any circumstances. Factors such as low education levels and previous successful vaginal deliveries were associated with non-acceptance of CS. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAnother study in Ghana's Upper West Region highlighted that most women perceived CS as highly problematic, viewing it as a long-term ailment that impedes their ability to engage in economic activities and care for their children. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThese studies collectively indicate that while awareness of CS is generally high, preferences for vaginal delivery remain strong. Willingness to accept CS is often contingent upon medical necessity, with educational attainment and occupation playing significant roles in shaping perceptions. Misconceptions and cultural beliefs continue to influence attitudes toward CS, underscoring the need for targeted educational interventions to address these concerns.\u003c/p\u003e \u003cp\u003e The findings from the Nkwanta South Municipality study, where 57.2% of participants held a positive perception of caesarean sections (CS), contrast with earlier research indicating predominantly negative perceptions. For instance, a study in Ghana's Upper West Region found that most women viewed CS as highly problematic, equating it to a long-term ailment that impedes their ability to engage in economic activities and care for their children.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe disparity between these studies may stem from differences in study populations, geographical or cultural contexts, and educational backgrounds. The higher level of positive perception in the Nkwanta South study could be attributed to increased awareness and education about CS. In contrast, negative perceptions in other studies may reflect stronger cultural or regional barriers and a lack of accurate information. For example, research has shown that lack of formal education, age less than 19 years, and unemployment are associated with poor maternal perception of CS. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e Furthermore, the Nkwanta South study underscores the need for better alignment with policies and guidelines on maternal health that advocate for informed decision-making, address fears and misconceptions surrounding CS, and improve access to maternal healthcare services. This aligns with findings that maternal knowledge, attitudes, and perceptions towards CS are crucial, as positive perceptions can lead to effective adaptation to the maternal role, while negative perceptions can contribute to delayed presentation for emergency obstetric care.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e The mixed-methods approach employed in the Nkwanta South Municipality study provided a comprehensive understanding of pregnant women's perceptions of caesarean sections (CS), combining quantitative data with qualitative insights to capture personal and cultural beliefs. This methodology aligns with best practices in health research, as it allows for a nuanced exploration of complex issues. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHowever, the study's limitations, such as potential response bias in self-reported data and a narrow geographic focus, may affect the generalizability of its findings. Similar constraints have been noted in other research, where regional disparities and sociodemographic factors influenced CS perceptions and acceptance. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTo address misconceptions and fears surrounding CS, targeted educational and awareness campaigns are recommended. Effective interventions often leverage social or peer support, provide communication materials, encourage partner or family participation, and facilitate interactions with healthcare providers [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Collaborating with local leaders and religious organizations can also help bridge cultural barriers to CS acceptance.\u003c/p\u003e \u003cp\u003eFuture research should delve deeper into the socio-cultural and psychological factors influencing pregnant women's attitudes toward CS. Understanding the role of sociodemographic factors, such as education and occupation, is crucial for improving healthcare decision-making [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Additionally, assessing the effectiveness of educational interventions in reducing fears and enhancing knowledge about CS is essential for developing strategies to improve maternal healthcare outcomes.\u003c/p\u003e \u003cp\u003eIn conclusion, addressing cultural, psychological, and educational barriers is vital for improving the acceptance and appropriate utilization of CS. While the Nkwanta South Municipality study indicates a generally positive perception of CS, persistent misconceptions and fears highlight the need for culturally sensitive education and community engagement to ensure better health outcomes for mothers and their babies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMost of the participants of the study demonstrated a good perception towards CS. An overwhelming majority of the pregnant women viewed CS as safe as vaginal delivery. However, most of the participants indicated their concerns for CS some of which are doctors leaving items in their abdomen, death, pain and mockery from friends and family. Generally, there was a prevalence of negative attitudes towards CS among the participants. Ideas such as women who undergo CS are cursed, not women, abnormal, unfaithful to their husbands, and always undergo CS were circulated among the participants. Those who had tertiary-level education were more likely to have a good attitude towards CS compared to those with no formal education. The study recommends the following actions: incorporating education on Caesarean section (CS) in birth preparedness at health facilities, implementing or strengthening education and sensitisation programmes on CS for women of reproductive age, and promoting education about the risks of vaginal delivery and CS for pregnant women and their families.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study sought ethical consideration approval from Ghana Health Service Ethical Review Committee (GHS-ERC), with REC number, \u003cstrong\u003eGHS-ERC 029/11/22\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConflict of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author, JTA upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe did not receive any external funding or support for this work. The work was funded by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJTA conceptualized the study and wrote the introduction. LSA supervised and did proof reading for the write up. SY, PBF and KDA analyzed and wrote the results for the study. IT and EO wrote the discussion. KDA also review and yourself qualitative analysis with editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors are grateful to all the study participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eA. P. Betr\u0026aacute;n, J. Ye, A. B. Moller, J. Shang, A. M. G\u0026uuml;lmesoglu, and M. R. Torloni, \u0026ldquo;The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014,\u0026rdquo; \u003cem\u003ePLoS One\u003c/em\u003e, vol. 11, no. 2, Feb. 2016, doi: 10.1371/JOURNAL.PONE.0148343.\u003c/li\u003e\n\u003cli\u003eNIHR, \u0026ldquo;Balance of long-term benefits and risks of caesarean delivery explained,\u0026rdquo; Dec. 2018, doi: 10.3310/SIGNAL-000601.\u003c/li\u003e\n\u003cli\u003eI. Mylonas and K. Friese, \u0026ldquo;Indications for and Risks of Elective Caesarean Section,\u0026rdquo; \u003cem\u003eDtsch. Arstebl. Int.\u003c/em\u003e, vol. 112, no. 29\u0026ndash;30, pp. 489\u0026ndash;495, Jul. 2015, doi: 10.3238/ARSTEBL.2015.0489.\u003c/li\u003e\n\u003cli\u003eK. D. Konlan, R. M. Amoah, and J. A. Abdulai, \u0026ldquo;Factors associated with the preference of caesarean section among parturient women in Africa: a systematic synthesis,\u0026rdquo; \u003cem\u003eJ. Glob. Heal. Sci.\u003c/em\u003e, vol. 4, no. 2, pp. 1\u0026ndash;14, 2022, doi: 10.35500/jghs.2022.4.e20.\u003c/li\u003e\n\u003cli\u003eA. A. Seidu \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Not just numbers: Beyond counting caesarean deliveries to understanding their determinants in Ghana using a population-based cross-sectional study,\u0026rdquo; \u003cem\u003eBMC Pregnancy Childbirth\u003c/em\u003e, vol. 20, no. 1, pp. 1\u0026ndash;10, Feb. 2020, doi: 10.1186/S12884-020-2792-7/FIGURES/1.\u003c/li\u003e\n\u003cli\u003eN. U. Ugwu and B. de Kok, \u0026ldquo;Socio-cultural factors, gender roles and religious ideologies contributing to Caesarian-section refusal in Nigeria,\u0026rdquo; \u003cem\u003eReprod. Health\u003c/em\u003e, vol. 12, no. 1, p. 70, 2015, doi: 10.1186/s12978-015-0050-7.\u003c/li\u003e\n\u003cli\u003eA. Ashimi, T. Amole, and L. Aliyu, \u0026ldquo;Knowledge and attitude of pregnant women to the caesarean section in a semi-urban community in northwest Nigeria.,\u0026rdquo; \u003cem\u003eJ. West African Coll. Surg.\u003c/em\u003e, vol. 3, no. 2, pp. 46\u0026ndash;61, Apr. 2013.\u003c/li\u003e\n\u003cli\u003eDanso-Appiah, A., \u0026amp; Turpin, C. A. (2019). Maternal perceptions about caesarean section deliveries and their implications for uptake in the Central Region of Ghana. *BMC Pregnancy and Childbirth*, 19(1), 220\u003c/li\u003e\n\u003cli\u003eDorkenoo, J. E., \u0026amp; Abor, P. A. (2021). Knowledge, Attitude and Perceptions of Pregnant Women towards Caesarean Section among Antenatal Clinic Attendants in Cape Coast, Ghana. *Research Journal of Health Sciences*, 9(3), 207-220.\u003c/li\u003e\n\u003cli\u003eAdageba, R. K., \u0026amp; Danso, K. A. (2024). Acceptability of Caesarean Section among Pregnant Women in the Ashanti Region of Ghana. *Open Journal of Obstetrics and Gynecology*, 14(5), 723-733\u003c/li\u003e\n\u003cli\u003eMboho, M., \u0026amp; Mboho, A. (2006). Perceptions and attitudes of pregnant women towards caesarean section in Nigeria. *Acta Obstetricia et Gynecologica Scandinavica*, 85(11), 1359-1361. \u003c/li\u003e\n\u003cli\u003eMboho, M., \u0026amp; Mboho, A. (2023). Educational interventions targeting pregnant women to optimize the acceptance of caesarean sections in Nigeria. *Journal of Health Education Research \u0026amp; Development*, 41(3), 345-358. \u003c/li\u003e\n\u003cli\u003eMoyer, C. A., \u0026amp; Mustafa, A. (2016). Women\u0026apos;s perceptions of caesarean sections in Ghana\u0026apos;s Upper West Region. *Midwifery*, 40, 30-36.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 3","content":"\u003cp\u003eTable 3 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Caesarean section, pregnant women, perception, attitude, willingness","lastPublishedDoi":"10.21203/rs.3.rs-6849052/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6849052/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eA Caesarean section is typically necessitated when vaginal birth might endanger the mother or the unborn child. Although some women opt for caesarean sections, research has shown that others oppose it even in the face of an emergency. Much has not been known about why most pregnant women do not willingly opt of CS\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study assessed pregnant women's perceptions, attitudes and willingness towards the caesarean section in the Nkwanta South Municipality.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThe study employed a mixed concurrent methods approach. For the quantitative aspect, an analytical cross-sectional study was conducted among women who reside in the Nkwanta South Municipality in the Oti region. A total of 422 pregnant women in four selected health facilities. Again, for the qualitative aspect of the study, 12 pregnant women were interviewed with after consent was given.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA study surveyed 422 Christian pregnant women aged 20\u0026ndash;29, revealing religion, ethnicity, cultural factors, and willingness to undergo Caesarean Section. Reasons for refusal included cost, fear, pain, dying, and educational level. Concerns included long recovery periods, poor perception, and worker safety.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study in Nkwanta South Municipality found that while most pregnant women have a positive perception of Caesarean sections, they still express concerns about complications, pain, risk of death, and mockery. Education efforts have partially been effective, but there is still a gap in addressing specific fears and misconceptions. The study suggests that improving perceived behavioural control through education can positively impact attitudes.\u003c/p\u003e","manuscriptTitle":"Perceptions, attitude and willingness of pregnant women towards Caesarean Section in the Nkwanta South Municipality, Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-24 07:47:56","doi":"10.21203/rs.3.rs-6849052/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"053674ce-725f-403f-ae3c-774a24cf5707","owner":[],"postedDate":"June 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-17T11:26:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-24 07:47:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6849052","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6849052","identity":"rs-6849052","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}