{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:56:49Z","timestamp":1785250609748,"version":"3.55.0"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Globally, the COVID-19 pandemic significantly impacted the provision of maternal health services, especially facility-based delivery. However, there is little evidence on the proportion of women who delivered at the health facility in various locations and the factors that influenced women\u2019s decision-making in choosing a place of delivery during and amid the COVID-19 restrictions. Therefore, this study assessed the prevalence and factors associated with health facility delivery during the COVID-19 pandemic in the Tamale Metropolis of Ghana.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      An analytical cross-sectional study design was conducted. A multistage sampling technique was used in selecting the study communities. At the individual level, random sampling technique was applied, and 461 women were recruited from 21\n                      <jats:sup>st<\/jats:sup>\n                      February 2021\u201321\n                      <jats:sup>st<\/jats:sup>\n                      March 2021. Using a questionnaire, a face-to-face approach was used to conduct the interviews. The questionnaire included questions on socio-demographic characteristics, place of childbirth and factors that led to the choice of delivery place. Using Statistical Package for Social Sciences version 25, descriptive and binary logistic regression analysis were conducted.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The results revealed that 64.0% of the women delivered in health facilities during the pandemic. Health facility delivery was more likely to occur among women with higher educational status (AOR: 5.2; 95% CI: 1.40\u201319.40), married women (AOR:6.3; 95% C.I:1.10\u201335.80), active National Health Insurance Scheme holders during delivery (AOR: 13.8; 95% C.I: 4.60\u201341.90), women who received education on birth preparedness and complication readiness (AOR: 7.6; 95% C.I:3.30\u201317.50) and women with underlying conditions before pregnancy (AOR:3.3; 95% C.I:1.20\u20139.20). There were reduced odds of health facility delivery among women with a history of home delivery (AOR:0.2; 95% C.I:0.10\u20130.50), when the mother-in-law decides on the place of delivery (AOR:0.1; 95% C.I:0.03\u20130.50), longer distance to the place of delivery (AOR:0.3; 95% C.I:0.01\u20131.00) and when women perceived COVID-19 as a barrier to facility delivery (AOR:0.1; 95% C.I:0.03\u20130.20).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings show that health facility delivery declined during COVID-19. Factors that affected health facility delivery were educational status, marriage, having an active National Health Insurance Scheme, education on birth preparedness and complication readiness, underlying conditions before pregnancy, history of home delivery, mother-in-law decision on place of delivery, distance to place of delivery and perceiving COVID-19 as a barrier to facility delivery. These contributed to low facility delivery. Thus, maternal health services need to be brought to the doorsteps of communities, including proper implementation of the Focused Antenatal Care and community-based pregnancy school programmes, especially during future pandemics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0344205","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T17:24:13Z","timestamp":1773077053000},"page":"e0344205","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence and associated factors of health facility delivery during COVID-19 in the Tamale Metropolis of Ghana: Analytical cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"given":"Obed Kwaku","family":"Duah Asumadu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert Abotisem","family":"Abiiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce Aputere","family":"Ndago","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0012-3097","authenticated-orcid":true,"given":"David Abatanie","family":"Kanligi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0167-5512","authenticated-orcid":true,"given":"Martin Nyaaba","family":"Adokiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"pone.0344205.ref001","doi-asserted-by":"crossref","unstructured":"Jebril N. World Health Organization declared a pandemic public health menace: a systematic review of the coronavirus disease 2019 \u201cCOVID-19\u201d. Available at SSRN 3566298. 2020.","DOI":"10.2139\/ssrn.3566298"},{"key":"pone.0344205.ref002","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ijsu.2020.02.034","article-title":"World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19)","volume":"76","author":"C Sohrabi","year":"2020","journal-title":"Int J Surg"},{"key":"pone.0344205.ref003","article-title":"China coronavirus: WHO declares international emergency as death toll exceeds 200","volume":"368","author":"E Mahase","year":"2020","journal-title":"BMJ"},{"issue":"8","key":"pone.0344205.ref004","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.healthpol.2021.05.016","article-title":"A comparative study of public health and social measures of COVID-19 advocated in different countries","volume":"125","author":"D Wang","year":"2021","journal-title":"Health Policy"},{"issue":"10230","key":"pone.0344205.ref005","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/S0140-6736(20)30681-4","article-title":"Mass gathering events and reducing further global spread of COVID-19: a political and public health dilemma","volume":"395","author":"B McCloskey","year":"2020","journal-title":"Lancet"},{"issue":"4","key":"pone.0344205.ref006","article-title":"Pregnancy outcomes before and during COVID-19 pandemic in Tamale Metropolis, Ghana: A retrospective cohort study","volume":"19","author":"ODK Asumadu","year":"2024","journal-title":"PLoS One"},{"key":"pone.0344205.ref007","doi-asserted-by":"crossref","first-page":"38","DOI":"10.4314\/gmj.v55i2s.6","article-title":"Overview of preparedness and response to COVID-19 in Ghana","volume":"55","author":"B Sarkodie","year":"2021","journal-title":"Ghana Med J"},{"key":"pone.0344205.ref008","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.ejogrb.2021.06.020","article-title":"Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-1) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections in pregnancy - An overview","volume":"263","author":"IA Babarinsa","year":"2021","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"pone.0344205.ref009","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s12879-016-1437-y","article-title":"Impact of Middle East Respiratory Syndrome coronavirus (MERS-CoV) on pregnancy and perinatal outcome","volume":"16","author":"H Alserehi","year":"2016","journal-title":"BMC Infect Dis"},{"issue":"12","key":"pone.0344205.ref010","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1093\/infdis\/jiu068","article-title":"Stillbirth during infection with Middle East respiratory syndrome coronavirus","volume":"209","author":"DC Payne","year":"2014","journal-title":"J Infect Dis"},{"key":"pone.0344205.ref011","unstructured":"Anokwuru RA, Mulaudzi FM. Lived experiences of antenatal services utilization among pregnant women during COVID-19 pandemic. 2022."},{"key":"pone.0344205.ref012","unstructured":"Burger R, Day C, Deghaye N, Nkonki L, Rensburg R, Smith A, et al. Examining the unintended consequences of the COVID-19 pandemic on public sector health facility visits: the first 150 days. Cramsurvey org https:\/\/cramsurveyorg\/wp-content\/uploads\/2020\/12\/16-Examining-the-unintendedconsequences-of-the-COVID-19-pandemic-on-public-sector-health-facility-visits-The-first-150-days-2.pdf. 2020."},{"issue":"1","key":"pone.0344205.ref013","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s12978-021-01198-5","article-title":"COVID-19 in Ghana: challenges and countermeasures for maternal health service delivery in public health facilities","volume":"18","author":"F Agbozo","year":"2021","journal-title":"Reprod Health"},{"issue":"4","key":"pone.0344205.ref014","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1002\/jid.3627","article-title":"Impact of Covid\u201019 on Maternal Health Seeking in Ghana","volume":"34","author":"PO Asuming","year":"2022","journal-title":"Journal of international development"},{"issue":"6","key":"pone.0344205.ref015","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1038\/s41591-021-01381-y","article-title":"Health 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Pandemic: Review","volume":"9","author":"M Tuczy\u0144ska","year":"2021","journal-title":"Front Public Health"},{"issue":"3","key":"pone.0344205.ref019","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.3390\/ijerph19031749","article-title":"Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review","volume":"19","author":"G Pujolar","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0344205.ref020","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1186\/s12978-022-01446-2","article-title":"Accessing Antenatal Care (ANC) services during the COVID-19 first wave: insights into decision-making in rural India","volume":"19","author":"S Bankar","year":"2022","journal-title":"Reproductive Health"},{"issue":"10","key":"pone.0344205.ref021","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2022-009594","article-title":"Impact of the COVID-19 pandemic on access to and utilisation of services for sexual and reproductive health: a scoping review","volume":"7","author":"H VanBenschoten","year":"2022","journal-title":"BMJ Glob Health"},{"issue":"2","key":"pone.0344205.ref022","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1177\/1368430220984248","article-title":"Gender inequalities during COVID-19","volume":"24","author":"AN Fisher","year":"2021","journal-title":"Group Processes & Intergroup Relations"},{"issue":"2","key":"pone.0344205.ref023","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1111\/1475-5890.12232","article-title":"COVID-19 and Inequalities","volume":"41","author":"R Blundell","year":"2020","journal-title":"Fisc Stud"},{"issue":"3","key":"pone.0344205.ref024","doi-asserted-by":"crossref","first-page":"77","DOI":"10.5502\/ijw.v10i3.1305","article-title":"COVID-19, gender inequality, and the responsibility of the state","volume":"10","author":"N Fortier","year":"2020","journal-title":"Intnl J Wellbeing"},{"key":"pone.0344205.ref025","first-page":"161","article-title":"The gendered impacts of COVID-19: Lessons and reflections","volume-title":"SAGE Publications Sage CA","author":"I Mooi-Reci","year":"2021"},{"issue":"9","key":"pone.0344205.ref026","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1007\/s10995-015-1720-3","article-title":"An Exploration of Decision-Making Processes on Infant Delivery Site from the Perspective of Pregnant Women, New Mothers, and Their Families in Northern Karnataka, India","volume":"19","author":"AK Blanchard","year":"2015","journal-title":"Matern Child Health J"},{"issue":"2","key":"pone.0344205.ref027","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.wombi.2013.11.003","article-title":"Socially disadvantaged women\u2019s views of barriers to feeling safe to engage in decision-making in maternity care","volume":"27","author":"L Ebert","year":"2014","journal-title":"Women Birth"},{"issue":"12","key":"pone.0344205.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0261316","article-title":"Why do women attend antenatal care but give birth at home? a qualitative study in a rural Ghanaian District","volume":"16","author":"KA Alatinga","year":"2021","journal-title":"PLoS One"},{"key":"pone.0344205.ref029","article-title":"Factors influencing quality of maternal care in Ghana","volume":"32","author":"J Afful","year":"2017","journal-title":"Health Education"},{"key":"pone.0344205.ref030","author":"EK Ameyaw","year":"2021"},{"key":"pone.0344205.ref031","unstructured":"Family Health Division. Annual Report 2016 Ghana Health Service, Accra. 2017."},{"key":"pone.0344205.ref032","unstructured":"Family Health Division. Annual Report 2014 Ghana Health Service, Accra. 2015."},{"key":"pone.0344205.ref033","unstructured":"Ghana Statistical Service. Ghana Demographic Health and Health Survey, 2014."},{"key":"pone.0344205.ref034","unstructured":"Family Health Division. Annual Report 2019 Ghana Health Service, Accra. 2020."},{"key":"pone.0344205.ref035","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-019-7253-8","article-title":"Factors determining choice of place of delivery: analytical cross-sectional study of mothers in Akordet town, Eritrea","volume":"19","author":"NK Gebregziabher","year":"2019","journal-title":"BMC Public Health"},{"key":"pone.0344205.ref036","unstructured":"Ministry of Health. Health sector annual programme of work. Holistic Assessment Report. Ghana, 2021."},{"issue":"1","key":"pone.0344205.ref037","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1186\/s12889-024-17912-4","article-title":"Economic and social determinants of health care utilization during the first wave of COVID-19 pandemic among adults in Ghana: a population-based cross-sectional study","volume":"24","author":"MA Ayanore","year":"2024","journal-title":"BMC Public Health"},{"key":"pone.0344205.ref038","doi-asserted-by":"crossref","DOI":"10.1016\/j.chest.2020.03.012","article-title":"Cross-Sectional Studies: Strengths, Weaknesses, and Recommendations","volume":"158","author":"X Wang","year":"2020","journal-title":"Chest"},{"key":"pone.0344205.ref039","unstructured":"Ghana Statistical Service. Population and Housing Census: Population of Regions and Districts. Ghana Statistical Service. 2021."},{"issue":"1","key":"pone.0344205.ref040","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1186\/s12978-018-0579-3","article-title":"Knowledge and practice of exclusive breastfeeding among mothers in the tamale metropolis of Ghana","volume":"15","author":"RN Nukpezah","year":"2018","journal-title":"Reprod Health"},{"key":"pone.0344205.ref041","unstructured":"MyJoyOnline. No new Covid-19 cases in Northern Region in 3 weeks.: MyJoyOnline; ["},{"issue":"14","key":"pone.0344205.ref042","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1002\/(SICI)1097-0258(19980730)17:14<1551::AID-SIM868>3.0.CO;2-E","article-title":"Self-designing clinical trials","volume":"17","author":"LD Fisher","year":"1998","journal-title":"Stat Med"},{"issue":"1","key":"pone.0344205.ref043","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1186\/s12889-018-5695-z","article-title":"Health facility delivery in sub-Saharan Africa: successes, challenges, and implications for the 2030 development agenda","volume":"18","author":"HV Doctor","year":"2018","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0344205.ref044","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s10754-020-09288-w","article-title":"National health insurance and the choice of delivery facility among expectant mothers in Ghana","volume":"21","author":"R Agbanyo","year":"2021","journal-title":"Int J Health Econ Manag"},{"key":"pone.0344205.ref045","author":"S Gabrysch","year":"2010"},{"issue":"1","key":"pone.0344205.ref046","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s41043-018-0153-1","article-title":"Health facility or home delivery? Factors influencing the choice of delivery place among mothers living in rural communities of Eritrea","volume":"37","author":"MM Kifle","year":"2018","journal-title":"J Health Popul Nutr"},{"issue":"5","key":"pone.0344205.ref047","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0060957","article-title":"Birth preparedness and its effect on place of delivery and post-natal check-ups in Nepal","volume":"8","author":"D Nawal","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"pone.0344205.ref048","doi-asserted-by":"crossref","first-page":"17","DOI":"10.2307\/3583341","article-title":"Gate-keeping and women\u2019s health seeking behaviour in Navrongo, northern Ghana","volume":"7","author":"P Ngom","year":"2003","journal-title":"Afr J Reprod Health"},{"issue":"10","key":"pone.0344205.ref049","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1111\/j.1553-2712.2011.01185.x","article-title":"Logistic regression: a brief primer","volume":"18","author":"JC Stoltzfus","year":"2011","journal-title":"Acad Emerg Med"},{"issue":"12","key":"pone.0344205.ref050","article-title":"Effect of Covid-19 on maternal and child health services utilization in Ghana. Evidence from the National Health Insurance Scheme (NHIS)","volume":"19","author":"YN Opoku-Boateng","year":"2024","journal-title":"PLoS One"},{"key":"pone.0344205.ref051","doi-asserted-by":"crossref","first-page":"7203980","DOI":"10.1155\/2016\/7203980","article-title":"What Influences Where They Give Birth? 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WHO recommendation on antenatal care contact schedules. The WHO Reproductive Health Library. 2018:1\u20137."},{"key":"pone.0344205.ref057","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1186\/s12884-015-0652-7","article-title":"Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study","volume":"15","author":"C Sialubanje","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"issue":"6","key":"pone.0344205.ref058","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1093\/her\/cyu057","article-title":"Personal and environmental predictors of the intention to use maternal healthcare services in Kalomo, Zambia","volume":"29","author":"C Sialubanje","year":"2014","journal-title":"Health Educ Res"},{"key":"pone.0344205.ref059","doi-asserted-by":"crossref","first-page":"749","DOI":"10.2147\/IJWH.S140366","article-title":"Distance from health facility and mothers\u2019 perception of quality related to skilled delivery service utilization in northern Ethiopia","volume":"9","author":"G Fisseha","year":"2017","journal-title":"Int J Womens Health"},{"issue":"1","key":"pone.0344205.ref060","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1186\/s12884-023-06038-x","article-title":"\u201cIt is not by choice that I gave birth at home\u201d: the social determinants of home births during COVID-19 in peri-urban and urban Kenya, a qualitative study","volume":"23","author":"M Sudhinaraset","year":"2023","journal-title":"BMC Pregnancy Childbirth"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0344205","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T17:24:24Z","timestamp":1773077064000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0344205"}},"subtitle":[],"editor":[{"given":"Mabel Kamweli","family":"Aworh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":60,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0344205","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]}}}