Factors Influencing the Timing of Maternal Mortality at the Greater Accra Regional Hospital, 2014-2018

Abstract

Background: Ghana grapples with high maternal mortality ratios in spite of interventions to accelerate the reduction of maternal mortality. A substantial number of studies have been done to determine the causes of maternal mortality at the national and institutional levels. In Ghana, fewer studies have addressed the factors associated with maternal deaths. Aim: The aim of the present study was to ascertain the demographic factors and obstetric factors associated with the timing of maternal deaths at the Greater Accra Regional Hospital. Methods: A retrospective study was conducted using data abstracted from hospital records spanning 1st January 2014 to 31st December 2018. A total of 216 records of maternal deaths were analyzed. Descriptive and inferential statistics were generated using STATA 15. Statistical significance was assumed at p<0.05. Results: A fluctuating trend was observed in institutional maternal mortality ratios recorded over the five-year period. Majority of deaths were due to direct causes such as hypertensive states of pregnancy, disorders of the placenta and haemorrhage. The single greatest cause of indirect maternal death was due to cardiovascular disease. In addition, most of these deaths occurred during the postpartum period followed by the intrapartum period. After applying Fischer’s exact test, marital status and recommended Antenatal care attendance were found to be associated with the timing of maternal deaths (p = 0.044)and (p=0.000) respectively. Further analysis with logistic regression after controlling for confounding variables showed that being married (AOR= 3.916, 1.401-10.944 ) and not attaining the recommended number of ANC visits (AOR.2.361, 1.177-4.736) were significantly associated with the timing of maternal mortality. Conclusion: Close monitoring of women in the intra-partum and post-partum periods might be critical to their survival. Hypertensive states as both direct and indirect causes of maternal mortality should be prioritized for healthcare interventions during pregnancy and postpartum.