Rural and Urban Differences in NHIS enrollment Among women 15-49 years: Analyses 2008-2022 Ghana Demographic and Health Survey

Objective This study examined the predictors of NHIS enrollment among women 15–49 years in Ghana, using the Ghana Demographic and Health Survey (GDHS) from 2008 to 2022. It also evaluates the association between place of residence and NHIS enrollment while recognizing key elements impelling neonatal mortality rates over time. Design: A cross-sectional study utilising secondary data from the GDHS conducted 2008, 2014, and 2022. Statistical analyses were performed using STATA version 17, with univariate, bivariate, and trend analysis applied to assess NHIS enrollment. Setting: The study is based on nationwide representative survey data from Ghana, shelling all 16 regions. The GDHS datasets provide understandings into maternal and child health, including maternal health and NHIS enrollments. Results The odds of NHIS registration increased from 2008 to 2022, indicating improved enrollment over time. Rural residence and proximity to health facilities were associated with lower registration odds, but these associations were not significant. Age, marital status, and education were significant factors, with women aged 30–39 showing the highest odds of registration. Married women had 53% higher odds of registration, and those with higher education were more likely to enroll. Wealthier women also had higher registration odds, highlighting the socio-economic factors influencing NHIS uptake. Conclusion Sociodemographic factors such as wealth, marital status, and education significantly influenced NHIS registration. Despite some associations being statistically insignificant, the findings stress the importance of addressing socio-economic disparities and optimizing NHIS services to improve coverage in Ghana.