valentineghanem-bit/anc-fertility-ghana-inequities

Spatial ML and longitudinal analysis of ANC access and fertility inequities in Ghana 1988-2022 # Temporal and Spatial Dynamics of Antenatal Care Coverage and Fertility Inequities in Ghana: A Subnational Ecological Study Using Ghana Demographic and Health Surveys **Author:** Valentine Golden Ghanem | Ghana COCOBOD Cocoa Clinic, Accra, Ghana **ORCID:** 0009-0002-8332-0220 **Affiliation:** Ghana COCOBOD Cocoa Clinic, Accra, Ghana **Reporting standard:** STROBE **Date:** April 2026 **Status:** Manuscript in preparation --- ## 1. Abstract A 34-year (1988–2022) longitudinal spatial analysis of skilled antenatal care (ANC) coverage and total fertility rate (TFR) across all 16 Ghana administrative regions, using nine survey waves. The study introduces the **Care Efficiency Index** (CEI = ANC% / TFR) as an exploratory composite indicator to expose persistent regional inequities obscured by national coverage convergence. Spatial autocorrelation analysis shows ANC–TFR decoupling by 2022, with the Northern Belt remaining a persistent high-TFR spatial cluster. --- ## 2. Research Question & Aims - **Primary:** Characterise the 34-year (1988–2022) temporal and spatial dynamics of skilled ANC coverage and fertility across harmonized Ghana DHS regional analytic units. - **Secondary:** (a) Quantify subnational inequities using the Care Efficiency Index (CEI); (b) detect ANC–TFR spatial decoupling using global and local Moran's I; (c) identify an exploratory TFR inflection via Random Forest partial dependence; (d) stratify regions into policy priority zones. --- ## 3. Methods Summary | Method | Tool | Purpose | |--------|------|---------| | Gini coefficient decomposition | scipy | ANC inequality over time | | Global Moran's I (KNN k=4) | esda / libpysal | ANC and TFR spatial autocorrelation | | LISA (Rook contiguity) | esda | Local cluster detection | | Random Forest (n=200) | scikit-learn | ANC prediction and partial dependence | | Decision Tree (CART) | scikit-learn | Interpretable benchmark comparator | | Care Efficiency Index (CEI) | Custom (ANC% / TFR) | Novel …