Department of Population, Family and Reproductive Health

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    Socio-Cultural Practices Influencing Intrapartum and Postpartum Continuum of Care In the Asante Akim North District Ashanti Region
    (University of Ghana, 2019-07) Ansong, J.
    Background: The growing recognition of the critical importance of providing care to mothers and new-borns and the substantial gaps in coverage that exists have prompted a paradigm shift in responding to maternal and new-born health issues. Invariably, the health care that a mother receives during pregnancy, at the time of delivery, and soon after delivery is important for the survival and well-being of both the mother and her child. However, evidence suggests that maternal and neonatal deaths are accentuated by socio-cultural practices along the intrapartum and postpartum continuum of care and several studies have documented this across the globe. However, in Ghana, studies on the role socio-cultural practices play along intrapartum and postpartum continuum of care remains unexplored. This study, therefore, seeks to identify the gaps in the knowledge and practices along the intrapartum and postpartum continuum of care in the Asante Akim North District of Ashanti Region of Ghana. Methods: This was a descriptive cross-sectional study which employed mixed sequential qualitative and quantitative strategies. An initial explorative study using focus group discussions and in-depth interviews was done to explore community leaders. health managers and mothers' perceptions and experiences in relation to the influence of socio-cultural practices along the intrapartum and post postpartum continuum of care. NVivo II was used to analyze the qualitative data and the themes and sub-theme converted into a survey questionnaire. A multistage sampling technique was used to sample 439 mothers with infants (0-6 months) from four subdistricts, based on proportion to population. Quantitative data was analyzed using STATA 14. Multivariable logistic regression to determine associations between independent and dependent variables was done. Results: The study found that 65.1 % of women had adequate ANC 4+, 49. JO/o had skilled delivery, and 65.4% had received postnatal care at six weeks with only 28.5% having achieved complete continuum of care. Women who practiced confinement were 2.42 times (95% C\=0.4450-0.7789) more likely to discontinue care at ANC, 1.98 times (95%CI=O. I 891.0.4000) the relative risk of discontinuing at postnatal than those who did not practice confinement. Women who believed in bewitchment during pregnancy and postnatal period had relative risk of 2.22 (95% CI=0.3634-0.9234) discontinuing at ANC, 1.67 (95% CI=0.4712-0.9178) at delivery and 2.89 (95% CI=0.4381-0.8172) during postnatal. Again, women who did not receive home visits by health care workers during pregnancy had higher relative risk of discontinuing at ANC (RR-1.89, 95% Cl=O.2190-0.9182), delivery (RR-2.71, 95% CI=0.8791) and PNC (RR=1.78, 95% C\=0.6981-0.8132). Receiving education on ANC also reduced a woman' s relative risk of interruptions along the continuum. Out of 439 participants, only 208 (47.4%) were advised to deliver in the health facilities. Women who were not advised to have skilled delivery had higher relative risk of discontinuing at delivery (RR=2.91, 95% CI=0.4001-0.7211) and PNC (RR=2.88, 95% CI=0.4412· 0.7219). Women who also reported having experienced bad attitudes from health workers were more likely to discontinue at ANC, delivery and PNC. Local practices such as use of enema and use of squatting position were reasons attributed to accessing unskilled delivery. With respect to maternal illness, 241 (55.2%) and 196 (44.8%) sought health care from biomedical and non-biomedical facilities respectively. After delivery, 88 (20.0%) sought health services from traditional healers, a factor affecting neonatal health. The study further found that 281 (65.1%) neonates experienced ill health during the neonatal period. Difficulty in breathing, 98 (34.3) and fever, 78 (27.3%) were the two most reported condition during the neonatal period. Of the 286 who fell sick during neonatal period, 201 (70.3%) sought health care whilst 85 (29.7%) did not seek health care. Among those who sought health care, 125 (62.2%) used biomedical health facilities. Conclusion: The study concludes that socio-cultural practices are common in the study area and transcends the perinatal period. These socio-cultural practices are viewed as indispensable and closely related to people's worldview that illnesses during pregnancy, childbirth, neonatal and postnatal period have social and supernatural causes. This belief system favoured accessing health care from traditional healers. The good interpersonal relationship of TBAs, local beliefs and poor services at biomedical facilities pushed expectant mothers towards traditional care. Both neonatal and postnatal illnesses were believed to have both biomedical and social causes but with social causes given more prominence. Hence, health seeking behaviour was directed toward non-orthodox service outlets; thus affecting the continuum of care.
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    Predictors of Intrapartum Stillbirths in Singletons in Six Public Hospitals in the Greater Accra Region, Ghana
    (University of Ghana, 2019-07) Vanotoo, L.A.
    Introduction . Globally. 2.6 million stillbirths are recorded annually: 50% occur during labour (intrapartum). Ghana records 11,000 stillbirths annually and 40% occur during. labour. The Greater Accra Region records 2000 stillbirths annually: 40 % of them occur intrapartum. An understanding of the contributory factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. Objectives The objectives of this study were to identify contributors to intrapartum stillbirths; explore perceptions about stillbirth from women with experience of intrapartum stillbirth, document views of health professionals about causes and prevention of intrapartum stillbirths and develop a model to predict intrapartum stillbirths. Method This was a retrospective 2: I unmatched case-control study with a qualitative component. The study sample was all deliveries between 1st January to 31st December 2016 in six public hospitals in the Greater Accra Region. Cases were selected through census while controls were selected from the live births using systematic random sampling. Relevant information was retrieved from clinical records for both cases and controls. Thirteen (10%) women from the cases and 14 health workers were purposively selected for in-depth interviews. Bivariate and multi variable data analyses were used to determine association between the variables and intrapartum stillbirth. Qualitative data were analysed by themes using NVIVO II. The Area Under the Receiver Operating Characteristics Curve (AUROq and the Brier Score (BS) were used to identify factors to include in the model to predict intrapartum stillbirths. Approval for the study was obtained from the Ghana Health Service Ethics Review Committee. Results During the study period. there were 36,168 deliveries with 918 stillbirths; 362 (39%) occurred intrapartum. Through the census, 125 cases were identified, in addition, 250 controls and 27 participants were included in the study. Mean age of cases and controls were 28.8= 5.54 and 28.9 ± 6.05 years respectively. Mean gestational age was 36.5 ± 3.95 weeks for cases and 38.8 ± 2.69 weeks for controls; median birth weight was 2. 7kg.± 0.92 for cases and 3.1kg ± 0.65 for controls. The following maternal factors were associated with intrapartum stillbirths: pregnancy-induced hypertension (PIH) (aOR 3.70); antepartum haemorrhage (APH) (aOR, 3.28) and premature rupture of membranes (PROM) (aOR 3.36). The major fetal contributory factor was low gestational age (aOR. 0.86). Service delivery factors included lack of trained health staff, inadequate number of beds, theatre space. Non use of partograph to monitor women in labour and non-auditing of perinatal deaths. Fetal autopsy was not performed on stillbirths. The best model to predict intrapartum stillbirth was the model with combination of maternal (PHI. APH and PROM); fetal (low gestational age) and service delivery (mode of delivery and health provider who conducted the delivery) factors. Conclusions and recommendations Improved management of PIH, APH, PROM and preterm delivery will reduce intrapartum stillbirth. Hospitals should improve on monitoring of women during labour. Auditing of intrapartum stillbirths should be mandatory for all hospitals and Ghana Health Service (GHS) should include fetal autopsy in stillbirth auditing to identify other causes of fetal deaths. The best model to predict intrapartum stillbirth is a combination of maternal, fetal and health service delivery factors. Thus, interventions to reduce intrapartum stillbirth must combine maternal, fetal and service delivery factors to make them effective.
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    Assessment of the Implementation of the Home Visiting Strategy: A Case Study of Maternal and New Born Health Care in the Ga South Municipality of Ghana
    (University Of Ghana, 2017-07) Chandi, M.G.
    Background: Home visiting has been the pivot of both the Primary Health Care (PHC) and currently the CHPS concepts in the Ghana Health Service; yet there is little information on how the home visit strategy improves maternal and new born health. This study aimed at assessing the implementation of the home visiting strategy and its effect on maternal and newborn health care in the Ga South Municipality in Ghana. Methods: A cross sectional study employing mixed methods approach was carried out. Four hundred and fifty three women were interviewed using a structured questionnaire. Four methods (desk review, observation, Key Informant Interviews, and two Focus Group Discussions) were used in the qualitative aspect. The quantitative data was analysed in SPSS version 22 using descriptive statistics for the background characteristics. Chi Square test was used to determine the association between ANC 4+ visits, Post natal coverage and the home visit strategy on one hand; and on the other, infection prevention and exclusive breastfeeding and the home visiting strategy. Nvivo version 11 was used to analyse the qualitative study. Triangulation of data from the quantitative and qualitative studies was done resulting in a synthesised and synergized document. Results: About 51% of respondents had not seen home visit service providers in their communities. All the respondents agreed that the heavy workload of the Community Health Officers (CHOs) makes it difficult for them to conduct home visiting. The social network of clients influenced responsiveness to home visiting services. Fifty seven percent of respondents felt socio economic status of clients do influence home visiting services but there was not enough statistical evidence to conclude. Geographical access and availability of social amenities did not statistically influence home visiting services. The home visiting strategy is more beneficial to neonates than to pregnant women Conclusion: There are intervening factors that influence home visiting service delivery. Ensuring the availability and managing the workload of service providers could enhance home visiting services. The social networks of clients are valuable resources home visit service providers need to take advantage of.