Assessing the Health System Factors Affecting Maternal Mortality in the Central Region

Abstract

Background: In spite of various interventions, Ghana still struggles to reduce the maternal mortality ratio at a faster pace. Several studies have been conducted to identify the direct and indirect causes of maternal mortality. However, fewer studies have addressed the health system-related factors or challenges that contribute significantly to maternal mortality. The aim of this study was to analyze the health system challenges that contribute to maternal mortality in the central region of Ghana and identify ways to help reduce them. Based on the findings, make recommendations to improve maternal health. Methods: The study was conducted by reviewing maternal mortality audit reports of maternal deaths that occurred between 1st January 2019 to 31st December 2021. A total of 98 reports were reviewed, after which 14 stakeholders were interviewed using a semi structured questionnaire. Descriptive statistics and inferential statistics using a multinomial regression analysis were generated using STATA 16. Statistical significance was assumed at p<0.05. Results: Health system challenges contributed to as high as 87.25% of maternal mortalities over the period of study. The challenges were mainly delayed in the intervention (59.18%), lack of equipment and consumables (41.84%), lack of expertise inadequate knowledge and skills (37.76%), inadequate human resources (24.49%), Communication breakdown (22.45%) and transportation challenges (13.27%). None of the deaths were attributable to all the factors, however, 10 mortalities had more than 3 factors contributing with 23 deaths having 3 factors contributing. After a multinomial regression analysis, it was established that lack of expertise, inadequate knowledge and skills (p< 0.04), and inadequate human resources (p< 0.031) contributed significantly to mortalities in women who had cesarean sections. It was again established that a higher percentage of the mortalities in the lower levels of care were due to a lack of expertise. Conclusion: Health system challenges contributed significantly to maternal deaths in the Central Region. Strengthening the health system by improving the knowledge and skill of health workers, increasing the number of health workers especially experts in the field of maternal care will help to eliminate some of the identified challenges and improve the reduction rate of maternal mortality ratio in the Central Region of Ghana.