Factors Associated with Maternal Mortality in Greater Accra Ghana 2016

/in /by

Biology homework help
Prospectus
Factors Associated with Maternal Mortality in Greater Accra Ghana 2016;
Case-Control Study


Prospectus: Factors associated with Maternal Mortality in greater Accra Ghana 2016;

Case-control Study

Problem Statement

Maternal death is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes’’ (Menendez et al., 2008, p. 2). Though the causes and risk factors for maternal death are known and preventable, it is a major health problem concentrated in resource-poor regions of the world (Menendez et al., 2008) including Ghana. The reduction of maternal deaths is a key international development goal, therefore health policy and interventions targeted at significantly reducing it should be evidence-based (Khan et al., 2006).

Ghana documented a Maternal Mortality Ratio (MMR) of 350 per 100,000 live births for the year 2012 (Mahama, 2013), however some districts for example Osu Klottey sub metro of the Accra Metropolitan area in its report recorded 428 maternal deaths per 100,000 live births at the end of 2012. This is a 39 percent increment on the 309 per 100,000 live births recorded in 2011. According to Addo and Gudu (2017), the Accra Metropolitan Area, an urban and commercial metropolis in the Greater Accra region has seen collaborative implementation of health policies and programs geared towards reducing maternal mortality over the past three years. Urban populations are mostly assumed to have access to more quality health care systems than their rural counterparts (Addo & Gudu, 2017). However, urban health systems in many low income countries (LIC) and lower middle income countries (MIC) have weak to non-existent public health structures (Coast et al., 2012). They also lack uniform implementation strategies and inadequate infrastructure to improve population health (Coast et al., 2012). Even though Ghana in collaboration with its development partners has implemented interventions to reduce maternal mortality to achieve the United Nations’ Millenium Development Goal (MDG 5) targets, institutional maternal mortality was very high in Osu Klottey Sub Metro for 2016 with the majority (80%) of maternal deaths being among individuals who were antenatal clinic non attendants (Mahama, 2013). Studies have shown lack of access to obstetrics care due to the lack of health facilities, poor transportation system and greater distances between client home and health facilities (Kaye et al., 2003).

Although the causes of maternal deaths are well established, knowledge on effective management of conditions has not translated into significantly improved outcomes (Coast et al., 2012). Observations at health institutions in the Accra Metro area show that service delivery factors such as prenatal care coverage and the presence of a skilled attendant at delivery may play a significant role in the mortalities and therefore needs to be investigated to inform policy decisions if the Sustainable Development Goal (SDG) goal 5 is to be met. The causes of maternal deaths in Ghana follow the trends of the developing country with haemorrhage, hypertensive disorders, abortion related complications, and septicemia leading in that order (Mensah et al., 2011) . In this research study, I will examine the association between sociodemographic and service delivery factors and maternal mortality.

Purpose

The purpose of this study is to examine the socio-demographic and service delivery factors associated with maternal mortality in the Accra Metropolitan Area of Ghana. The maternal mortality rates are not the same in every region and therefore there is a need to investigate whether there are factors that are exclusive to some geographic areas.

Significance

Since Ghana did not achieve its Millennium Development Goal 5 (MDG 5) target, there has been renewed effort to achieve the Sustainable Development Goals on maternal death reduction, yet very little research has been done on the factors for which intervention would yield the most impact. As Accra Metro is a high urbanized setting characterized by rural urban migration, with so much pressure on relatively few health facilities (Report 2016), policy makers need more information on the major risk factors in this setting to guide decision making and resource allocation. The information gathered could inform the Metro and Regional Health Directorate on other policy interventions to help reduce maternal death in the Metro area. The positive social change implication that could result is to improve the quality of institutional antenatal, intra-partum, and post-partum service delivery in the Metropolis and add to the body of knowledge to reduce maternal death in Ghana.

Background

Selected papers and works relating to factors associated with maternal mortality and how to improve outcomes in West Africa particularly Ghana are described below:

1. Menendez et al. (2008) presented the causes and risk factors of maternal deaths as a major health problem in resource-poor regions of the world.

2. Addo and Gudu (2017) set out the various factors that are associated with the utilization of skilled service delivery among women that live in the rural part of northern Ghana.

3. Khan et al. (2006) demonstrated that reduction of maternal deaths is a key international development goal, therefore health policy and interventions targeted at significantly reducing it should be evidence-based.

4. Mahama (2013) reported that Ghana documented Maternal Mortality Ratio (MMR) of 350 per 100,000 live births for the year 2012.

5. The annual report at Accra Metropolitan area, Ghana (2016) documented 428 maternal deaths per 100,000 live births. This is a 39 percent increment on the 309 per 100,000 live births recorded in 2015.

6. Coast and McDaid (2012) reported that urban populations are mostly assumed to have improved access to health care as compared to their rural counterparts, however, urban health systems in many Low Income Countries and Lower Middle Income Countries have weak to non-existent public health structures and lack uniform implementation of strategies and necessary infrastructure.

7. Based on information from UNICEF and WHO, Blencowe (2012) indicated that the sub-Saharan African region had a Maternal Mortality Ratio of 500 deaths per 100,000 live births which is the highest in the world. This has made the region a dangerous place to give birth.

8. Osotimehin (2012) reported maternal death preventable interventions. These include improving access to voluntary family planning, investing in health workers with midwifery skills, and ensuring access to emergency obstetrics care when complications arise.

9. Mensah et al. (2011) described the causes of maternal deaths in Ghana. It followed the trends of causes in developing country, with haemorrhage, hypertensive disorders, abortion related complications, and septicemia leading in that order.

Framework

The theory of social capital is very broad and has found a place in public policy, public health, and more specifically in epidemiology. This theory is founded on several assertions. Chief among these assertions are that social relationships are a determinant of health (Begum, Aziz-un-Nisa, & Begum, 2003). The external environment and the daily social interactions and support systems play a pivotal role in an individual’s overall health. This theory is also founded on the premise that poor social capital is one of the leading causes of physical and mental distress (Krieger, 2011). To elaborate, a strong social connection has been shown to lead to improved all-cause mortality rates. Lack of social connection can have an adverse impact on health outcomes. Social epidemiologists are tasked with identifying the social aspects that affect the pattern of disease distribution and its mechanisms in a populace. Social relationships, social inequalities, and social capital are some of the most important concepts of social epidemiology. Krieger takes the position that social epidemiologists exploit indicators of ‘life chances’ such as occupation, skills and income which inform on social inequality. The underlying factors linked to social equality are the most important determinants of health. The knowledge, skills, and resources possessed by individuals are factors contributing to the social stratification and consequentially the health outcomes of a given population (Krieger, 2011). Research indicates a social gradient of health whereby most of the individuals with a lower socioeconomic position have been shown to have poor health (Krieger, 2011).

Social capital occurs at different levels. These include the macro-level (social, economic and political aspects of society), mesolevel (organizations and the neighborhood) and the individual context through social interactions. Many ecological studies conducted indicate a positive association between social capital and health outcomes (Mensah, Bentil, Adjepong, & Dolo, 2011). The concept of social inequality is of fundamental importance to epidemiology and health research since it is evident that social factors such as level of education and income levels impact access to health and the quality of health care services in a particular region. Epidemiologists can capitalize on this premise to establish health patterns in a given population informed by the socio-economic status of the persons residing there. Social support structures influence help-seeking behavior, adherence to medical treatment and use of health care services (Pearce, 1996). The theoretical aspects of social capital theory and factors behind them such as social inequalities, social capital, and social relationships will form an integral part of my research. This theory will serve as the framework to determine how and to what extent sociodemographic and service delivery factors can affect health care outcomes such as maternal mortality.

Research Questions

RQ1:

· Is there a significant association between sociodemographic factors (marital status, education, income, and health insurance) and maternal mortality in Greater Accra Ghana?

RQ2;

· Is there a significant association between service delivery factors (prenatal care, delivery location, and presence of a skilled attendant at delivery) and maternal mortality in Greater Accra Ghana?

RQ 3:

· Is there a significant difference in maternal survival rates between women in Greater Accra Ghana in terms of health insurance coverage, annual median income above GH¢30.00, education above the high school level, marital status, and location of infant birth?