Factors Associated With Maternal Complications among Women Who Delivered at the Presbyterian Hospital, Agogo

Abstract

Introduction: Many women die as a result of pregnancy and delivery-related complications and most of these deaths occur in sub-Saharan Africa as a result of preventable circumstances. It is believed that factors such as maternal age, parity, gravida, ANC attendance, decision to seek health care at the onset of complication and the availability of prompt care are associated with maternal complications. Literature suggests that the quality of care for maternal complications is woefully inadequate especially in lower-income settings thereby worsening the complications which could either result in near misses or maternal mortalities. Treating maternal complications is also a major cost to women and their households since treatment sometimes exceed their disposable income. This impoverishes most of them and results in a high rate of absconders and abandonment of mothers at the health facilities by their families. The aim of the study was to determine the proportion of women that developed complications during delivery and the factors contributing to maternal complications. The study also sought to determine the perception of care and cost to patients for treating maternal complications at the Presbyterian Hospital, Agogo. Methods: A cross-sectional study was conducted at the Presbyterian Hospital, Agogo from June 01- June 30, 2019, where the delivery register was reviewed to identify socio-demographic and obstetric factors of women who delivered in 2018. In-depth interviews were also conducted with women on admission and health professionals at the obstetrics/gynaecological department to obtain information on the perception of care and direct cost of maternal health services. For quantitative data obtained, the univariate analysis of categorical variables was presented in frequencies and proportions. Multiple logistic regression analysis was used to determine the association between independent variables and maternal complication. Logistic regression was done to determine individual factors associated with maternal complications. Qualitative data was analysed under broad themes in line with the research objectives; perception of maternal care and cost of treating maternal complications. Results: From this study, it was found that 57 (16.8%) of the 340 women who delivered at the hospital developed one form of maternal complications. One maternal death and 4 stillbirths were identified. Maternal Mortality Ratio of 298 deaths per 100,000 live births and Maternal Complication of 169 cases per 1,000 live births were recorded in the study. The most diagnosed maternal complication was postpartum haemorrhage with 17 (29.8%) cases. Risk factors of maternal complication were caesarean section in current pregnancy [aOR 95CI:0.07 - 0.3134] and multiple births [aOR 95CI:1.16 - 27.34]. Hepatitis ‘B’ was found to be the leading known medical condition among mothers in the study. Patients who delivered at the hospital perceived quality of care to be high but complained about the cost involved in treating maternal complications especially when they had registered with the National Health Insurance Scheme. Conclusion: Factors associated with maternal complications are multiple births and delivery via caesarean section. Even though patients perceived the quality of care to be good in terms of promptness of care and good interpersonal relationship, the cost of accessing maternal care in health facilities poses a challenge. Policy makers should be put in place to make maternal care financially accessible especially for mothers with low socioeconomic status.