Socio-Cultural Practices Influencing Intrapartum and Postpartum Continuum of Care In the Asante Akim North District Ashanti Region

Abstract

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.