Determinants of All-Cause Maternal Mortality in Ghana: A Multivariate Decomposition Analysis of 2007 and 2017 Ghana Maternal Health Surveys

Abstract

Background Maternal mortality has seen a significant decline in Ghana over last decade. Stakeholders and government continue to invest in strategic policies aimed to further decrease the ratio of maternal mortality. To achieve the desired results, interventions must be tailored toward specific factors in order to further strengthen the remedy to this health menace. Even though, there has been a decline over the years, international target and standards yet to be achieved. Method Analysis of data from the 2007 and 2017 Ghana Maternal Health Survey was done to determine prevalence of maternal mortality from these separate surveys. Analysis of the separate and combined data from the surveys was performed to ascertain the factors that influenced maternal mortality in 2007 and 2017. To be able to determine the effect of decline in the distribution and the actual effect size which contributed to the outcome, a multivariate decomposition analysis was employed to arrive at endowment and coefficient that explained factors that contributed or otherwise to the decline in maternal mortality over the period. Results Prevalence of maternal mortality was estimated in 2007 to 9.15% (95% CI: 7.99 – 10.46). The outcome declined in 2017 to 1.51. With a percentage point decrease of 7.64%, the prevalence for the combined data for 2007 and 2017 was estimated to be 4.03% (95% CI: 3.65 – 4.45). The changes (decline) in prevalence among all the variables considered in this study were significant with p-values <0.001. The actual effect size of variables such as place of residence (urban), low parity (0-2), middle/JHS education and women who attempted abortion added to the decline (negative) of maternal mortality over 2007 and 2017. Conclusion Provision of quality maternal healthcare in rural settings of Ghana should be improved to make maternal healthcare services readily available in rural areas to further reduce the prevalence of maternal mortality among women living in rural communities in Ghana. Education levels of women were identified to be associated with maternal mortality. Keywords: Maternal Mortality, Factors, Multivariate Decomposition, Ghana, Maternal Health Survey, 2007, 2017