Factors Associated With Perinatal Mortality Among Referred Obstetric Emergencies In The Accra And Tema Metropolitan Areas, Ghana

Abstract

Background Perinatal mortality rate (PNMR)in developing countries, particularly sub-saharan Africa and Ghana is unacceptably high. Most perinatal mortalities (PNM) occur among women referred for obstetric complication. Maternity referral system (MRS) challenges limit access to emergency obstetric care (EmOC) needed to prevent maternal and perinatal mortalities. Despite the importance of MRSs, they have been understudies and under researched. This study thus sought to find factors associated with PNM among referred obstetric emergencies in the Accra and Tema Metropolitan Areas, Ghana. Methods This research was a descriptive cross-sectional study conducted at four secondary level health facilities within the two metropolitan areas. Data was collected by interviewing mothers referred to these hospitals on account of obstetric emergencies or their caregivers with multiple data verification procedures. The data collection tool used was a structured questionnaire. Data was obtained from 240 respondents, entered into SPSS v22 and analysed using STATA version 14. Univariate analysis, simple logistic regression and multivariate logistic regressions were carried out to determine factors associated with PNM. Results Most of the respondents (38.3%) were referred on account of Pregnancy Induced Hypertension (PIH). About 17% % were referred for non-clinician reasons, most due to non-availability of a doctor/ midwife. Most referred clients were unaccompanied by a health worker (55.0%) and no prior notification was given to the receiving facility (70.8%), although most came with referral letters (92.7%). Perinatal mortality rate was high (21.7%). On simple logistic regression, means of transport, accompanied by health worker (HW), marital status, number of Ante-natal care (ANC) attendance, birth weight, gestational age and antepartum haemorrhage were found to be significantly associated with PNM (p<0.05). On multivariate logistic analysis, the following independently reduce the odds of PNM: not accompanied by HW (AOR=0.32; 95% CI; 0.12-0.85), ANC visits of four or more times (AOR=0.11; 95%CI; 0.04-0.28) and not referred on account of antepartum haemorrhage (APH) (AOR=0.12; 95% CI; 0.05-0.32). Conclusion Referral guideline adherence is poor. Prevalence of PNM among referred obstetric emergencies is high. APH, low ANC visit and accompanied by HW increase the odds of PNM. There is the need for a review of the current referral guidelines by the Ministry of Health to help address current challenges. Clinicians must attend quickly and have a low thresh-hold for lifesaving interventions for referred emergencies with APH, accompanied by a HW and with poor ANC attendance record. Further research on referral systems and their role in determining perinatal outcomes are needed.