“Trends in Institutional Maternal Mortality and Stillbirths in Korle Bu Teaching Hospital, Pre and During The Mdg Implementation”

Abstract

The initiation of the Millennium Development Goals (MDGs), and particularly MDG 4 and 5, was a wake-up call for all nations of the world, especially developing countries, to take proactive measures to improve the health status of women and children. While few developing countries have made significant strides in achieving MDG 5, most countries are however off- track and its clear they may not be able to meet the target by 2015. This realization led to the MDG Acceleration Framework (MAF) initiative, aimed at speeding up efforts to meet the set target. (Ghana MDG Acceleration Framework Country Report, 2011). This study was carried out to analyze trends in institutional maternal mortality and stillbirths in Korle Bu Teaching Hospital, a tertiary institution over a period of 18years (1995 to 2013). This was to make it possible to analyze trends before and during the implementation of the MDG in order to determine the impact of the interventions, and explore factors (institutional inclusive) that explain the trends observed. A mixed methods approach was adopted, which involved; a retrospective review of hospital records on mortalities to analyze maternal deaths and stillbirths and their trend over the years. Qualitative data was also gathered through key informant interviews, as well as Focus Group Discussions to elicit views on maternal mortality and some institutional factors that may have contributed to it. Data was analyzed using Microsoft Excel, and Nvivo data management software. The results show that, the trend in maternal mortality in Korle Bu Teaching Hospital has remained high over the years and fluctuates from year to year. The reasons are that, the institution receives a lot of referrals from the peripheries, which is between 84%- 87% (KBTH Annual Obstetrics and Gynecology Biostatistics Department Report, 2014) mostly with bad obstetric complications. The leading causes of maternal death identified were hypertensive and hemorrhagic disorders. Some institutional factors such as inadequate number of midwives, lack of emergency preparedness and staff attitude were identified. The results also showed a steady rise in stillbirth rate during the preceding five years to the MDG implementation, while the trend during the implementation phase was fluctuating in nature, but mostly lower than the period before implementation. This study’s findings also revealed that, progress has been made at achieving MDG 5 in Ghana, though at a slow pace, but maternal mortality and stillbirth rates in KBTH remain very high. Achieving the MDGs remains a big hurdle to surmount by most countries, especially in sub Saharan Africa. There is therefore the need to examine the trends in maternal deaths and stillbirths, explore reasons that explain them, and reinforce strategies in place to control their impact. It is hoped that, the results of this study will contribute to decision making for the improvement of maternal health care in Korle Bu Teaching Hospital, and Ghana as a whole.