Browsing by Author "Adu-Bonsaffoh, K."

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Alteration in maternal serum uric acid levels in pre eclampsia and associated perinatal outcomes: a cross-sectional study in Ghana
(Pan African Medical Journal, 2024) Adu-Bonsaffoh, K.; Kudaya, D.Q.; Fidelis, B.; Fondjo, L.A.; Ahenkorah, J
Introduction: pre-eclampsia (PE) is a multisystemic pregnancy-specific hypertensive disorder associated with significant adverse maternal and perinatal outcomes. Maternal serum uric acid level is hypothesized as a reliable marker for predicting the severity and adverse outcomes of pre eclampsia and facilitating clinical decisions. This study explored the association between maternal serum uric acid and adverse pregnancy outcomes in pre-eclampsia. Methods: a cross-sectional study involving women diagnosed with pre-eclampsia was conducted at Korle-Bu Teaching Hospital (KBTH), a tertiary hospital in Ghana. Descriptive analyses were performed and multivariable logistic regression model was used to explore the association between maternal serum uric acid levels and pregnancy outcomes using R software. Results: we included 100 women with pre eclampsia comprising 79% and 21% preterm and term pre-eclampsia respectively and with mean gestational age (GA) at diagnosis of 32.35±2.66 weeks and 35.96±1.94 weeks respectively. The mean maternal age of preterm and term pre eclampsia groups was 29.81±5.29 years and 29.46±5.78 years respectively. Hyperuricemia (serum uric acid >375 µmol/L) occurred in 61% of the pre-eclamptic women. The mean gestational age (in weeks) at diagnosis was significantly lower in the pre-eclamptic women with hyperuricemia compared with those with normal levels of uric acid (33.51±3.03 versus 34.80±2.71). There was a significant negative association (moderate correlation) between maternal serum uric acid levels and birth weight (R= -0.34, p < 0.001) in pre eclampsia; the statistical significance was limited to preterm only (Pearson R= -0.39, p-value <0.001) but not term pre-eclampsia. Hyperuricemia was significantly associated with low birth weight [aOR: 3.222 (95% CI: 1.098, 10.393)], caesarean section [aOR: 2.281 (95% CI: 1.084, 7.568)] and severe diastolic pressure at birth [aOR: 3.517 (95% CI: 1.123, 11.939)]. Conclusion: hyperuricemia in pre-eclampsia was significantly associated with both maternal (caesarean section and sever hypertension) and neonatal (low birth weight) adverse outcomes. Hyperuricemia seems clinically useful in predicting pregnancy outcomes, especially in preterm pre-eclampsia. Further longitudinal study is recommended in exploring the clinical significance of maternal uric acid levels and pregnancy outcomes in pre-eclampsia.
Assessment of maternal near-miss and quality of care in a hospital-based study in Accra, Ghana
(International Journal of Gynecology and Obstetrics, 2013-10) Tunçalp, O.; Hindin, M.J.; Adu-Bonsaffoh, K.; Adanu, R.M.
Objective To assess the baseline incidence of maternal near-miss, process indicators related to facility access, and quality of care at a tertiary care facility in urban Ghana. Methods A prospective observational study of all women delivering at the facility, including those with pregnancy-related complications, was conducted between October 2010 and March 2011. Quality of maternal health care was assessed via a newly developed WHO instrument based on near-miss criteria and criterion-based clinical audit methodology. Results Among 3438 women, 516 had potentially life-threatening conditions and 131 had severe maternal outcomes (94 near-miss cases and 37 maternal deaths). More than half (64.4%) of the women had been referred to the facility. The incidence of maternal near-miss was 28.6 cases per 1000 live births. Anemia contributed to most cases with a severe maternal outcome. More than half of all women with severe maternal outcomes developed organ dysfunction or died within the first 12 hours of hospital admission. Although preventive measures were prevalent, treatment-related indicators showed mixed results. Conclusion The WHO near-miss approach was found to represent a feasible strategy in low-resource countries. Improving referral systems, effective use of critical care, and evidence-based interventions can potentially reduce severe maternal outcomes. © 2013 International Federation of Gynecology and Obstetrics.
Causes, Survival Rates, and Short-Term Outcomes of Preterm Births In a Tertiary Hospital in A Low Resource Setting: An Observational Cohort Study
(Frontiers in Global Women’s Health, 2023) Mocking, M.; Adu-Bonsaffoh, K.; Osman, K.A; et al.
Background: Prematurity is the most important cause of death among children under the age of five years. Globally, most preterm births occur in Sub-Saharan Africa. Subsequent prematurity leads to significant neonatal morbidity, mortality and longterm disabilities. This study aimed to determine the causes, survival rates and outcomes of preterm births up to six weeks of corrected age in Ghana. Materials and methods: An observational prospective cohort study of infants born preterm was conducted in a tertiary hospital in Accra, Ghana from August 2019 to March 2020. Inclusion was performed within 48 h after birth of surviving infants; multiple pregnancies and stillbirths were excluded. Causes of preterm birth were categorized as spontaneous (including preterm pre-labour rupture of membranes) or provider-initiated (medically indicated birth based on maternal or fetal indications). Survival rates and adverse outcomes were assessed at six weeks of corrected age. Recruitment and follow-up were suspended due to the COVID-19 outbreak. Descriptive statistics and differences between determinants were calculated using Chi-squared tests or Kruskal-Wallis test. Results: Of the 758 preterm deliveries, 654 (86.3%) infants were born alive. 179 were enrolled in the cohort and were analyzed. Nine (5%) were extremely preterm [gestational age (GA) < 28 weeks], 40 (22%) very preterm (GA 28–31 weeks), and 130 (73%) moderate to late preterm (GA 32–37 weeks) births. Most deliveries (n = 116, 65%) were provider-initiated, often due to hypertensive disorders in pregnancy (n = 79, 44.1%). Sixty-two infants were followed-up out of which fifty-two survived, presenting a survival rate of 84% (n = 52/62) at six weeks corrected age in this group. Most infants (90%, n = 47/52) experienced complications, predominantly consisted of NICU admission (92%) and interval illnesses (21%) including jaundice and sepsis. Conclusions: The incidence of adverse outcomes associated with preterm birth in a tertiary facility with NICU capacity is high. Larger longitudinal studies are needed for an in-depth understanding of the causes and longer-term outcomes of preterm birth, and to identify effective strategies to improve outcomes in resource constrained settings.
Determinants and outcomes of preterm births at a tertiary hospital in Ghana
(Placenta, 2019-04) Adu-Bonsaffoh, K.; Gyamfi-Bannerman, C.; Oppong, S.A.; Seffah, J.D.
Introduction Preterm birth remains an important clinical challenge with significant short and long-term complications although its burden in the developing world is not adequately explored. This study determines the incidence, specific determinants and outcomes of preterm birth at a teaching hospital in Ghana. Methods Retrospective review of singleton births at Korle-Bu Teaching Hospital (KBTH) in Ghana between 1st January to 31st December, 2015. Results Preterm birth (PTB) occurred in 1478 (18.9%) out of 7801 single deliveries with etiological distribution of 879 (59.5%) spontaneous and 599 (40.5%) provider-initiated phenotypes. Gestational age categorization (WHO classification) of the preterm births included 68 (4.6%), 235 (15.9%) and 1175 (79.5%) below 28, between 28-31 and 32–36 weeks respectively. Adverse perinatal outcomes (low birth weight, perinatal deaths and poor Apgar scores) but not adverse maternal outcomes (cesarean and maternal deaths) were significantly higher in preterm compared to term births. Major factors associated with PTB include advanced maternal age (>35 years), poor antenatal care, hypertensive disorders and preterm premature rupture of membranes (PPROM) whiles obesity was protective. There were 156 stillbirths (105.6 per1000 births) comprising 93 macerated (62.9 per 1000 births) and 63 fresh stillbirths (42.6 per 1000 births), and perinatal mortality rate of 119.8 per 1000 births. Discussion Preterm birth is highly prevalent with significant adverse outcomes among singleton gestations at KBTH in Ghana, with disproportionately higher spontaneous etiology compared to provider-initiated phenotype. A paradigm shift in clinical management of preterm births/prematurity is urgently required with proactively dedicated multidisciplinary team and involvement of the global community.
Development of measures for assessing mistreatment of women during facility-based childbirth based on labour observations
(BMJ GLOBAL HEALTH, 2021) Berger, B.O.; Strobino, D.M.; Mehrtash, H.; Bohren, M.A.; Adu-Bonsaffoh, K.; Leslie, H.H.; Irinyenikan, T.A.; Maung, T.M.; Balde, M.D.; Tunçalp, O.
Introduction Mistreatment of women during childbirth is increasingly recognised as a significant issue globally. Research and programmatic efforts targeting this phenomenon have been limited by a lack of validated measurement tools. This study aimed to develop a set of concise, valid and reliable multidimensional measures for mistreatment using labour observations applicable across multiple settings. Methods Data from continuous labour observations of 1974 women in Nigeria (n=407), Ghana (n=912) and Guinea (n=655) were used from the cross-sectional WHO’s multicountry study ‘How women are treated during facility-based childbirth’ (2016–2018). Exploratory factor analysis was conducted to develop a scale measuring interpersonal abuse. Two indexes were developed through a modified Organisation for Economic Co-operation and Development approach for generating composite indexes. Measures were evaluated for performance, validity and internal reliability. Results Three mistreatment measures were developed: a 7-item Interpersonal Abuse Scale, a 3-item Exams & Procedures Index and a 12-item Unsupportive Birth Environment Index. Factor analysis results showed a consistent unidimensional factor structure for the Interpersonal Abuse Scale in all three countries based on factor loadings and interitem correlations, indicating good structural construct validity. The scale had a reliability coefficient of 0.71 in Nigeria and approached 0.60 in Ghana and Guinea. Low correlations (Spearman correlation range: −0.06–0.19; p≥0.05) between mistreatment measures supported our decision to develop three separate measures. Predictive criterion validation yielded mixed results across countries. Both items within measures and measure scores were internally consistent across countries; each item co-occurred with other items in a measure, and scores consistently distinguished between ‘high’ and ‘low’ mistreatment levels. Conclusion The set of concise, comprehensive multidimensional measures of mistreatment can be used in future research and quality improvement initiatives targeting mistreatment to quantify burden, identify risk factors and determine its impact on health and well-being outcomes. Further validation and reliability testing of the measures in other contexts is needed.
Effects of factor v Leiden polymorphism on the pathogenesis and outcomes of preeclampsia
(BMC Medical Genetics, 2019-11-27) Ababio, G.K.; Adu-Bonsaffoh, K.; Abindau, E.; Narh, G.; Tetteh, D.; Botchway, F.; Morvey, D.; Neequaye, J.; Quaye, I.K.
Background: Factor V Leiden polymorphism is a well-recognized genetic factor in the etiology of preeclampsia. Considering that Ghana is recording high incidence of preeclampsia, we examined if factor V Leiden is a contributory factor to its development and pregnancy outcomes. Methods: STROBE consensus checklist was adopted to recruit eighty-one (81) consenting subjects after ethical clearance. Subjects were followed up till delivery to obtain outcomes of PE. Routine blood chemistry and proteinuria were done on all samples. Factor V Leiden was characterized by polymerase chain reaction and restriction fragment length polymorphism (RFLP). The data was captured as protected health information (PHI) and analyzed with SPSS version 22. Results: Overall allelic frequencies found in FVL exon 10 were 0.67 and 0.33 for G and A alleles respectively. The FVL mutation was more in PE and hypertensive patients. Increased white blood cells, increased uric acid and a three – fold increment of AST / ALT ratio was observed in PE cases when stratified by FVL exons (exon 8 and 10). Significant differences were also observed between FVL and age, systolic blood pressure (SBP), diastolic blood pressure (DBP), liver enzymes, white blood cells (wbc), hemoglobin levels. Conclusion: FVL mutation allele frequency was 0.33, a first report. The mutation was associated with increased uric acid, liver enzymes and blood cell indices suggestive of acute inflammation.
Erratum: Maternal deaths attributable to hypertensive disorders in a tertiary hospital in Ghana (International Journal of Gynecology and Obstetrics (2013) 123 (110-113))
(International Journal of Gynecology and Obstetrics, 2013-11) Adu-Bonsaffoh, K.; Oppong, S.A.; Binlinla, G.; Obed, S.A.
Objective To determine the contribution of hypertensive disorders of pregnancy to maternal deaths at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. Methods The retrospective descriptive study conducted at KBTH during 2010–2011 involved a comprehensive review of all maternal deaths attributable to hypertensive disorders. Results There were 21 385 deliveries, 21 742 live births, and 199 maternal deaths, resulting in a maternal mortality ratio of 915.3 per 100 000 live births. In total, 63 (31.7%) maternal deaths were attributable to hypertensive disorders with a case fatality rate of 3.9%. The incidence of hypertensive disorders of pregnancy was 7.6%. Hypertensive disorders were the most common direct cause of maternal death followed by obstetric hemorrhage (26.6%), unsafe abortion (11.1%), and puerperal sepsis (3.5%). Most (38.1%) hypertension-related maternal deaths occurred within 24 hours of admission and the majority (79.4%) had been referred. Eclampsia was the leading immediate cause of hypertension-related death (23.8%), followed by acute renal failure (20.6%), intracerebral hemorrhage (15.9%), and pulmonary edema (12.7%). Conclusion Hypertensive diseases are the leading cause of maternal death at KBTH, having overtaken obstetric hemorrhage, with eclampsia, acute renal failure, intracerebral hemorrhage, and pulmonary edema representing the major immediate causes of hypertension-related maternal death.
Histopathological lesions and exposure to Plasmodium falciparum infections in the placenta increases the risk of preeclampsia among pregnant women
(Scientific Reports, 2020-05-19) Obiri, D.; Erskine, I.J.; Oduro, D.; Kusi, K.A.; Amponsah, J.; Gyan, B.A.; Adu-Bonsaffoh, K.; Ofori, M.F.
Preeclampsia (PE) is a placental disorder with different phenotypic presentations. In malaria-endemic regions, high incidence of PE is reported, with debilitating foeto-maternal effects, particularly among primigravid women. However, the relationship between placental pathology and Plasmodium falciparum infection in the placenta with PE is underexplored. Placentas from 134 pregnant women were examined after delivery for pathological lesions and placental malaria (PM). They comprised of 69 women without PE (non-PE group) and 65 women diagnosed with PE (PE group). The presence of placental pathology increased the risk of PE, with particular reference to syncytial knots. Placental malaria was 64 (48.1%) and 21 (15.8%) respectively for active and past infections and these proportions were significantly higher in the PE group compared to the non-PE group. Further multivariate analyses showed placental pathology (adjusted (aOR) 3.0, 95% CI = 1.2–7.5), active PM (aOR 6.7, 95% CI = 2.3–19.1), past PM (aOR 12.4, 95% CI = 3.0–51.0) and primigravidity (aOR 6.6, 95% CI 2.4–18.2) to be associated with PE. Our findings suggest that placental histological changes and PM are independent risk factors for PE particularly in primigravida. These findings might improve the management of PE in malaria-endemic regions.
How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys
(The Lancet Journal, 2019-10-08) Maya, E.; Bohren, M.A.; Mehrtash, H.; Fawole, B.; Maung, T.M.; Balde, M.D.; Thwin, S.S.; Aderoba, A.K.; Vogel, J.P.; Irinyenikan, T.A.; Adeyanju, A.O.; Mon, N.O.; Adu-Bonsaffoh, K.; Landoulsi, S.; Guure, C.; Adanu, R.; Diallo, B.A.; Gülmezoglu, A.M.; Soumah, A.M.; Sall, A.O.; Tunçalp, O.
Background Women across the world are mistreated during childbirth. We aimed to develop and implement evidenceinformed, validated tools to measure mistreatment during childbirth, and report results from a cross-sectional study in four low-income and middle-income countries. Methods We prospectively recruited women aged at least 15 years in twelve health facilities (three per country) in Ghana, Guinea, Myanmar, and Nigeria between Sept 19, 2016, and Jan 18, 2018. Continuous observations of labour and childbirth were done from admission up to 2 h post partum. Surveys were administered by interviewers in the community to women up to 8 weeks post partum. Labour observations were not done in Myanmar. Data were collected on sociodemographics, obstetric history, and experiences of mistreatment. Findings 2016 labour observations and 2672 surveys were done. 838 (41·6%) of 2016 observed women and 945 (35·4%) of 2672 surveyed women experienced physical or verbal abuse, or stigma or discrimination. Physical and verbal abuse peaked 30 min before birth until 15 min after birth (observation). Many women did not consent for episiotomy (observation: 190 [75·1%] of 253; survey: 295 [56·1%] of 526) or caesarean section (observation: 35 [13·4%] of 261; survey: 52 [10·8%] of 483), despite receiving these procedures. 133 (5·0%) of 2672 women or their babies were detained in the facility because they were unable to pay the bill (survey). Younger age (15–19 years) and lack of education were the primary determinants of mistreatment (survey). For example, younger women with no education (odds ratio [OR] 3·6, 95% CI 1·6–8·0) and younger women with some education (OR 1·6, 1·1–2·3) were more likely to experience verbal abuse, compared with older women (≥30 years), adjusting for marital status and parity. Interpretation More than a third of women experienced mistreatment and were particularly vulnerable around the time of birth. Women who were younger and less educated were most at risk, suggesting inequalities in how women are treated during childbirth. Understanding drivers and structural dimensions of mistreatment, including gender and social inequalities, is essential to ensure that interventions adequately account for the broader context.
How women are treated during facility-based childbirth: development and validation of measurement tools in four countries – phase 1 formative research study protocol
(Reproductive Health, 2015-07) Vogel, J.P.; Bohren, M.A.; Tunçalp, O.; Oladapo, O.T.; Adanu, R.M.; Baldé, M.D.; Maung, T.M.; Fawole, B.; Adu-Bonsaffoh, K.; Dako-Gyeke, P.; Maya, E.T.; Camara, M.C.; Diallo, A.B.; Diallo, S.; Wai, K.T.; Myint, T.; Olutayo, L.; Titiloye, M.; Alu, F.; Idris, H.; Gülmezoglu, M.A.
Background Every woman has the right to dignified, respectful care during childbirth. Recent evidence has demonstrated that globally many women experience mistreatment during labour and childbirth in health facilities, which can pose a significant barrier to women attending facilities for delivery and can contribute to poor birth experiences and adverse outcomes for women and newborns. However there is no clear consensus on how mistreatment of women during childbirth in facilities is defined and measured. We propose using a two-phased, mixed-methods study design in four countries to address these research gaps. This protocol describes the Phase 1 qualitative research activities.Methods/Design We will employ qualitative research methodologies among women, healthcare providers and administrators in the facility catchment areas of two health facilities in each country: Ghana, Guinea, Myanmar and Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) will be conducted among women of reproductive age (15–49 years) to explore their perceptions and experiences of facility-based childbirth care, focused on how they were treated by healthcare workers and perceived factors affecting how they were treated. IDIs will also be conducted with healthcare providers of different cadres (e.g.: nurses, midwives, medical officers, specialist obstetricians) and facility administrators working in the selected facilities to explore healthcare providers’ perceptions and experiences of facility-based childbirth care and how staff are treated, colleagues and supervisors. Audio recordings will be transcribed and translated to English. Textual data will be analysed using a thematic framework approach and will consist of two levels of analysis: (1) conduct of local analysis workshops with the research assistants in each country; and (2) line-by-line coding to develop a thematic framework and coding scheme.Discussion This study serves several roles. It will provide an in-depth understanding of how women are treated during childbirth in four countries and perceived factors associated with this mistreatment. It will also provide data on where and how an intervention could be developed to reduce mistreatment and promote respectful care. The findings from this study will contribute to the development of tools to measure the prevalence of mistreatment of women during facility-based childbirth.
Listening to women's voices: The quality of care of women experiencing severe maternal morbidity, in Accra, Ghana.
(PLoS ONE, 2012-08-31) Tunçalp, Ö.; Hindin, J.M.; Adu-Bonsaffoh, K.; Adanu, R.
Background: Women who survive severe obstetric complications can provide insight into risk factors and potential strategies for prevention of maternal morbidity as well as maternal mortality. We interviewed 32 women, in an urban facility in Ghana, who had experienced severe morbidity defined using a standardized WHO near-miss definition and identification criteria. Women provided personal accounts of their experiences of severe maternal morbidity and perceptions of the care they received. Methods and Findings: The study took place in a referral facility in urban Accra, and semi-structured interviews were conducted with women who had either a maternal near miss (n = 17) or a potentially life-threatening complication (n = 15). The most common themes surrounding the traumatic delivery were the fear of dying and concern over the potential (or actual) loss of the baby. For many women, the loss of a baby negatively influenced how they viewed and coped with this experience. Women's perceptions of the quality of the care highlighted several key factors such as the importance of information, good communication and attitudes, and availability of human (i.e., more doctors) and physical resources (i.e., more beds, water) at the facility. Conclusions: Our results suggest that experiences of women with severe maternal morbidity may inform different aspects of quality improvement in the facilities, which in turn have a positive impact on future health seeking behavior, service utilization and reduction in maternal morbidity and mortality. © 2012 Tunçalp et al.
Maternal outcomes of hypertensive disorders in pregnancy at Korle Bu Teaching Hospital, Ghana
(International Journal of Gynecology and Obstetrics, 2014-12) Adu-Bonsaffoh, K.; Obed, S.A.; Seffah, J.D.
Objective To determine maternal outcomes of hypertensive disorders in pregnancy at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana.Methods A cross-sectional study was conducted between January 1 and February 28, 2013. All women delivering at KBTH whose pregnancies were complicated by hypertensive disorders were identified. A structured questionnaire was administered, and the women were followed up on a daily basis until discharge from hospital. Medical records were also reviewed to identify any complications of hypertensive disorders.Results A total of 368 women were analyzed. Of 10 maternal deaths, 3 (30.0%) were due to hypertensive disorders in pregnancy, and specifically pre-eclampsia. Overall, 168 (45.7%) women with hypertensive disorders in pregnancy delivered by cesarean, 16 (4.3%) had placental abruption, 11 (3.0%) had pulmonary edema, 3 (0.8%) had HELLP syndrome, 2 (0.5%) had acute renal failure, 3 (0.8%) had an intracerebral hemorrhage or cerebrovascular accident, 21 (5.7%) were admitted to the intensive care unit, 7 (1.9%) had disseminated intravascular coagulation, and 58 (15.8%) had eclampsia. Cesarean delivery, admission to intensive care unit, and eclampsia were significantly more common in women with pre-eclampsia than in those with other hypertensive disorders.Conclusion Hypertensive disorders in pregnancy are associated with high incidences of adverse maternal outcomes in Ghana, with significantly increased frequencies in women with pre-eclampsia. © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Measuring Coverage in MNCH: Validating Women's Self-Report of Emergency Cesarean Sections in Ghana and the Dominican Republic
(Public Library of Science, 2013) TunÃ§alp, Ã.; Stanton, C.; Castro, A.; Adanu, R.; Heymann, M.; Adu-Bonsaffoh, K.; Lattof, S.R.; Blanc, A.; Langer, A.
Background: Cesarean section is the only surgery for which we have nearly global population-based data. However, few surveys provide additional data related to cesarean sections. Given weaknesses in many health information systems, health planners in developing countries will likely rely on nationally representative surveys for the foreseeable future. The objective is to validate self-reported data on the emergency status of cesarean sections among women delivering in teaching hospitals in the capitals of two contrasting countries: Accra, Ghana and Santo Domingo, Dominican Republic (DR). Methods and Findings: This study compares hospital-based data, considered the reference standard, against women's self-report for two definitions of emergency cesarean section based on the timing of the decision to operate and the timing of the cesarean section relative to onset of labor. Hospital data were abstracted from individual medical records, and hospital discharge interviews were conducted with women who had undergone cesarean section in two hospitals. The study assessed sensitivity, specificity, and positive predictive value of responses to questions regarding emergency versus non-emergency cesarean section and estimated the percent of emergency cesarean sections that would be obtained from a survey, given the observed prevalence, sensitivity, and specificity from this study. Hospital data were matched with exit interviews for 659 women delivered via cesarean section for Ghana and 1,531 for the Dominican Republic. In Ghana and the Dominican Republic, sensitivity and specificity for emergency cesarean section defined by decision time were 79% and 82%, and 50% and 80%, respectively. The validity of emergency cesarean defined by operation time showed less favorable results than decision time in Ghana and slightly more favorable results in the Dominican Republic. Conclusions: Questions used in this study to identify emergency cesarean section are promising but insufficient to promote for inclusion in international survey questionnaires. Additional studies which confirm the accuracy of key facility-based indicators in advance of data collection and which use a longer recall period are warranted. Â© 2013 TunÃ§alp et al.
Mistreatment of women during childbirth and postpartum depression: secondary analysis of WHO community survey across four countries
(BMJ Glob Health, 2023) Guure, C.; Aviisah, P.A.; Adu-Bonsaffoh, K.; Mehrtash, H.; et al.
Background Postpartum depression (PPD) is a leading cause of disability globally with estimated prevalence of approximately 20% in low-income and middle-income countries. This study aims to determine the prevalence and factors associated with PPD following mistreatment during facility-based childbirth. Method This secondary analysis used data from the community survey of postpartum women in Ghana, Guinea, Myanmar and Nigeria for the WHO study, ‘How women are treated during facility-based childbirth’. PPD was defined using the Patient Health Questionnaire (PHQ-9) tool. Inferential analyses were done using the generalised ordered partial proportional odds model. Results Of the 2672women, 39.0% (n=1041) developed PPD. 42.2% and 5.2% of mistreated women developed minimal/mild PPD and moderate/severe PPD, respectively. 43.0% and 50.6% of women who experienced verbal abuse and stigma/discrimination, respectively developed minimal/mild PPD. 46.3% of women who experienced physical abuse developed minimal/mild PPD while 7.6% of women who experienced stigma/discrimination developed moderate/severe PPD. In the adjusted model, women who were physically abused, verbally abused and stigma/ discrimination compared with those who were not were more likely to experience any form of PPD ((OR: 1.57 (95% CI 1.19 to 2.06)), (OR: 1.42 (95% CI 1.18 to 1.69)) and (OR: 1.69 (95% CI 1.03 to 2.78))), respectively. Being single and having higher education were associated with reduced odds of experiencing PPD. Conclusion PPD was significantly prevalent among women who experienced mistreatment during childbirth. Women who were single, and had higher education had lower odds of PPD. Countries should implement women centred policies and programmes to reduce mistreatment of women and improve women’s postnatal experiences.
Navigating with logics: Care for women with hypertensive disorders of pregnancy in a tertiary hospital in Ghana
(Social Science & Medicine, 2021) Vestering, A.; Kok, B.C.D.; Browne, J.L.; Adu-Bonsaffoh, K.
This paper explores how care for women with hypertensive disorders of pregnancy (HDP) is practiced in a tertiary hospital in Ghana. Partly in response to the persistently high maternal and neonatal mortality rates in Low- and Middle-income countries, efforts to improve quality of maternity care have increased. Quality improvement initiatives are shaped by the underlying conceptualisation of quality of care, often driven by global (WHO) standards and protocols. However, there are tensions between global standards of care and local clients’ and providers’ understandings of care practices and quality of care. Implementation of standards is further complicated by structural and organisational restrictions that influence providers’ possibilities and priorities. Based on ethnographic fieldwork, we explore how clinical guidelines and professionals’ and patients’ perspectives converge and, more importantly, diverge. We illuminate local, situated care practices and show how professionals creatively deal with tensions that arise on the ground. In this middle-income setting, caring for women with HDP involves tinkering and navigating in contexts of uncertainty, scarcity, varying responsibilities and conflicting interests. We unravelled a complex web of, at times, contradictory logics, from which various forms of care arise and in which different notions of good care co-exist. While practitioners navigated through and with these varying logics of care, the logic of survival permeated all practices. This study provides important initial insights into how professionals might implement and innovatively adapt the latest quality of maternity care guidelines which seek to marry clinical standards and patients’ needs, preferences and experiences.
Nitric oxide dysregulation in the pathogenesis of preeclampsia among Ghanaian women
(Dove Press Journal: Integrated Blood Pressure Control, 2015-02-19) Adu-Bonsaffoh, K.; Antwi, D.A.; Amenyi, S.O.; Gyan, B.
Background: Preeclampsia (PE) is still a disease of theories as the exact cause remains uncertain. Widespread vascular endothelial cell dysfunction is thought to mediate the generalized vasospasm and hypertension characteristic of PE. Altered nitric oxide (NO) production has been associated with the endothelial dysfunction in the pathogenesis of PE but conflicting results have emerged from previous studies. Objectives: To determine maternal serum levels of NO, a biomarker of endothelial function, in nonpregnant, normal pregnant, and preeclamptic women. Materials and methods: This was a cross-sectional case–control study of 277 women comprising 75 nonpregnant, 102 normal pregnant, and 100 preeclamptic women conducted at the Korle Bu Teaching Hospital between April and June 2011. About 5 mL of venous blood was obtained from the participants for the various investigations after meeting the inclusion criteria and signing to a written consent. Serum levels of NO were determined by Griess reaction. The data obtained were analyzed with SPSS version 20. Results: The study showed significantly elevated serum levels of NO in preeclamptic women (82.45±50.31 μM) compared with normal pregnant (33.12±17.81 μM) and nonpregnant (16.92±11.41 μM) women with P,0.001. The alteration in maternal serum NO levels was significantly more profound in early-onset (severe) PE (119.63±45.860 μM) compared to that of late-onset (mild) disease (62.44±40.44 μM) with P0.001, indicating a more severe vascular endothelial cell dysfunction in the early-onset disease. Conclusion: This study has determined a profound NO upregulation in PE evidenced by significant elevation of NO metabolite levels compared to normal pregnancy. This might be due to deranged endothelial function with dysregulated production of NO to restore the persistent hypertension characteristic of PE.
Preferred mode of childbirth among women attending antenatal clinic at a tertiary hospital in Ghana: a cross-sectional study
(2022) Adu-Bonsaffoh, K.; Tamma, E.; Seffah, J.
Abstract Background: The preference for mode of childbirth by women is emerging as a global subject of interest to many researchers, especially with the steady increase in caesarean section (CS) rates with some countries exceeding the world health organization (WHO) recommended rate. This study explored the preferences of mode of childbirth and associated factors among pregnant women in Ghana. Methods: A cross-sectional study was conducted among pregnant women at tertiary hospital in Ghana. Descriptive analysis and multivariate logistic regression were performed. Results: Among the 415 pregnant women included, 357(86.0%) and 58(14.0%) preferred vaginal delivery and CS respectively. Majority (26%) attributed their preference for vaginal delivery to its being the natural way of childbirth. The most common reason why women preferred to deliver by CS was mainly influenced by medical indication such as doctors’ remarks. Significant determinants influencing preference for CS were previous childbirth [aOR:0.21, 95%CI (0.05, 0.91)], previous caesarean [aOR:20.08, 95%CI (7.73, 52.19)] and urban settlement [aOR:2.51, 95%CI (1.01, 6.29)] Conclusion: There was a clear preference for vaginal birth by pregnant women although a significant proportion preferred caesarean birth. Integration of women’s preferred mode of childbirth into the clinical decision with appropriate counselling is recommended to improve women’s pregnancy and childbirth experiences.
Prevalence of gestational diabetes mellitus and associated factors among women receiving antenatal care at a tertiary hospital in South-Western Uganda
(Pan African Medical Journal, 2023) Kahimakazi, I.; Tornes, Y.F.; Adu-Bonsaffoh, K.; et al.
Introduction: gestational diabetes mellitus is one of the major causes of morbidity and mortality among pregnant women worldwide. We aimed to determine the prevalence and factors associated with gestational diabetes mellitus among women attending the antenatal care clinic at a tertiary care hospital in south-western Uganda. Methods: this was a hospital-based cross-sectional study conducted among women at ≥24 weeks of amenorrhea, attending the antenatal care clinic at Mbarara Regional Referral Hospital between December 2020 and March 2021. We screened all women for gestational diabetes mellitus using the World Health Organization 2013 diagnostic criteria. We obtained socio-demographic, medical, and obstetric data. Multivariable logistic regression used to determine the factors independently associated with gestational diabetes mellitus. Results: we enrolled 343 pregnant women with a mean age of 27.3 (SD ±12.3) years. Of the 343 participants, 35 (10.2%) had gestational diabetes mellitus (GDM) (95% C.I: 7.4%–13.9%) and 7 (2%) had diabetes during pregnancy. The factors significantly associated with gestational diabetes mellitus were: previous history of foetal macrosomia in any of the previous pregnancies (aOR: 5.53, 95% C.I: 1.29- 23.65) and family history of diabetes mellitus in the first-degree relatives (aOR: 4.45, 95% C.I.: 1.48- 13.34). Conclusion: one in every ten pregnant women attending the antenatal care clinic at Mbarara Regional Referral Hospital is likely to have gestational diabetes mellitus in pregnancy. There is a need to strengthen routine testing for gestational diabetes mellitus among women attending the antenatal care clinic, especially pregnant women with a prior history of foetal macrosomia and a family history of diabetes mellitus in first-degree relatives.
Prevention and Screening for Cardiometabolic Disease Following Hypertensive Disorders in Pregnancy in Low-Resource Settings: A Systematic Review and Delphi Study
(Global Heart, 2023) Ishaku, S.M.; Adu-Bonsaffoh, K.; Housseine, N.; et al.
Hypertensive disorders in pregnancy (HDP) and cardiometabolic and kidney diseases are rising in low- and middle-income countries (LMICs). While HDP are risk factors for cardiometabolic and kidney diseases, cost-effective, scalable strategies for screening and prevention in women with a history of HDP are lacking. Existing guidelines and recommendations require adaptation to LMIC settings. This article aims to generate consensus-based recommendations for the prevention and screening of cardiometabolic and kidney diseases tailored for implementation in LMICs. We conducted a systematic review of guidelines and recommendations for prevention and screening strategies for cardiometabolic and chronic kidney diseases following HDP. We searched PubMed/Medline, Embase and Cochrane Library for relevant articles and guidelines published from 2010 to 2021 from both high-income countries (HICs) and LMICs. No other filters were applied. References of included articles were also assessed for eligibility. Findings were synthesized narratively. The summary of guiding recommendations was subjected to two rounds of Delphi consensus surveys with experts experienced in LMIC settings. Fifty-four articles and 9 guidelines were identified, of which 25 were included. Thirty-five clinical recommendations were synthesized from these and classified into six domains: identification of women with HDP (4 recommendations), timing of first counseling and provision of health education (2 recommendations), structure and care setting (12 recommendations), information and communication needs (5 recommendations), cardiometabolic biomarkers (8 recommendations) and biomarkers thresholds (4 recommendations). The Delphi panel reached consensus on 33 final recommendations. These recommendations for health workers in LMICs provide practical and scalable approaches for effective screening and prevention of cardiometabolic disease following HDP. Monitoring and evaluation of implementation of these recommendations provide opportunities for reducing the escalating burden of noncommunicable diseases in LMICs.
Understanding the Continuum of Maternal Morbidity in Accra, Ghana
(Springer Science+Business Media New York, 2013) Tunçalp, O.; Hindin, M.J.; Adu-Bonsaffoh, K.; Adanu, R.M.
The objective was to determine the levels of maternal morbidity from no complications to near miss and describe factors associated with different levels of morbidity. We conducted an observational study of all women delivering at a tertiary hospital in Accra, Ghana between October 2010 and March 2011. We examined the factors associated with the continuum of maternal outcomes in terms of severity using multinomial logistic regression. Data were extracted from women's maternal care files with the main outcome measures of no complications, non-life threatening complications, potentially life-threatening conditions (PLTC), and near miss as defined by World Health Organization. Our study includes 1,586 women with no complications, 1,205 women with non-life threatening complications, 516 women with PLTC, and 94 near-miss cases. All of the factors associated with PLTC and near-miss cases were similar. None of the socio-demographic variables remained significant in the multivariate analysis comparing different levels of severe morbidity with no complications. Women with no complications shared similar characteristics with women who experienced non-life threatening complications. As compared to women who had no complications, women who had severe morbidity were significantly more likely to have had no antenatal care. Our results underline the concept that morbidity is a continuum and indicate that if the underlying causes of poor maternal health outcomes are addressed, it is likely that changes such as better access to antenatal care will improve health outcomes across the continuum of morbidity. However, by only monitoring near-miss cases and mortality, we underestimate the impact on women who will live with non-life threatening, yet serious maternal morbidities.