A 6-Year (2004-2009) Review of Maternal Mortality at the Eastern Regional Hospital, Koforidua, Ghana

doi:10.1053/j.semperi.2011.09.015

Seminars in Perinatology

Volume 36, Issue 1, February 2012, Pages 79-83

https://doi.org/10.1053/j.semperi.2011.09.015 Get rights and content

A 6-year (2004-2009) review of maternal deaths is presented to establish particular trends at the eastern regional hospital (1 of 10 regional hospitals in Ghana). There were a total of 191 maternal deaths over the period, with a total of 19,965 live births, giving a maternal mortality ratio of 957 per 100,000 live births. The main causes of maternal deaths were postpartum hemorrhage (22.5%), abortion-related causes (19.3%), hypertensive disorders in pregnancy (17.8%), and puerperal sepsis (8.9%). The study revealed that the highest number of deaths was recorded in the period following termination of pregnancy (abortion or delivery). Timely referral of patients to this hospital could help reduce preventable maternal deaths.

Section snippets

Materials and Methods

To improve the accuracy of estimates in this study, maternal deaths were extracted from multiple sources and compared with each other. Discrepancies were investigated and relevant corrections were made.

Data were initially extracted from the obstetrics and gynaecology ward admission and discharge record book. This was then compared with the labor ward admission and discharge book and the theater record book. Minutes of maternal death audit meetings were reviewed, and events preceding maternal

Results

There were a total of 191 maternal deaths and 19,965 live births, giving an overall maternal mortality ratio of 957 per 100,000 live births (Table 1). This is approximately 1 maternal death for every 100 live births. The maternal mortality ratios on average show a decreasing trend over the period (Fig. 1). The highest ratio was recorded in 2005 (1389 deaths per 100,000 live births), and the lowest was recorded in 2008 (489 deaths per 100,000 live births). It is suspected that some maternal

Discussion

Of the 707 maternal deaths recorded in the eastern region from 2004 to 2009,⁴ 191 occurred in the regional hospital. More than 1 in 4 maternal deaths in the region thus occurred in this hospital. Ghana maternal health survey 2007 (household survey) found 457 maternal deaths occurred per 100,000 live births in Ghana.⁵ UN agencies report 2008 (based on statistical models) estimate that on average, 350 maternal deaths occurred per 100,000 live births in Ghana.¹ The very high maternal mortality

Recommendations

Reducing maternal deaths in this hospital primarily requires a serious commitment to improved maternity care from all care deliverers within the region, especially doctors and midwives. Adequate staffing is paramount to achieving this.

There is an urgent need to review the data collection and storage system. Dedicated record clerks attached to the department of obstetrics and gynaecology will help improve the quality of data collected.

Looking at the top 5 causes of maternal deaths in this

Conclusions

A maternal death in KRH will most probably occur after termination of pregnancy, and the patient is likely to die within 24 hours on admission. Developing case management protocols to involve active participation of skilled personnel from the point of admission could help salvage 1 or 2 maternal deaths.

Acknowledgments

The author thanks all the midwives of the obstetrics and gynaecology unit of the hospital whose untiring efforts have ensured that the requisite data were collected and compiled into the regular midwifery returns. Notable among them are 2 principal nursing officers, Mary Affrah and Rosina Asantewa, without whom the midwifery returns could not have been completed. A very special gratitude is owed to Dr Kwame Anim Boamah (Head, Department of Obstetrics and Gynaecology, Koforidua Regional Hospital

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The Confidential Enquiry into Maternal Death in South Africa found that embolism was responsible for 2.0%, 1.9%, and 1.4% of deaths in 1999–2001, 2002–2004, and 2005–2007, respectively.13 Other reports from Africa implicate embolism in a similar proportion of deaths.14–16 In contrast, a systematic review of maternal deaths performed by the World Health Organization implicated embolism in 14.9% of maternal deaths in developed countries,1 and the United Kingdom’s Confidential Enquiries into Maternal Death found that from 2003 to 2005 thromboembolism caused 31.1% of deaths directly related to pregnancy.4
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These midwifery students are aware of the large negative impact unsafe abortion has on Ghanaian women. Complications from unsafe abortion have repeatedly been shown to be a large contributor to maternal mortality in Ghana and hospital admissions [29,30]. An almost universal agreement with this by these participants underscores that this knowledge is widespread.
Even in countries where the abortion law is technically liberal, the full application of the law has been delayed due to resistance on the part of providers to offer services. Ghana has a liberal law, allowing abortions for a wide range of indications. The current study sought to investigate factors associated with midwifery students’ reported likelihood to provide abortion services.
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However, Ghana will fall short of the national Millennium Development Goal target of 185 maternal deaths/100 000 live births by 2015.2 Combined data from three large referral and teaching hospitals has identified 895 maternal deaths/100 000 live births, a ratio nearly double the corresponding national average.3–5 This represents significant disparity between regional and teaching facilities and other institutions.
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Au Ghana, les établissements de recours régionaux reçoivent, de par leur nature, un nombre disproportionné de cas obstétricaux et néonataux exposés à des risques élevés; par conséquent, ces établissements comptent des taux de mortalité plus élevés que la moyenne nationale. Les volumes élevés et la complexité des cas font en sorte que ces établissements ont à faire face à des défis cliniques, opérationnels et de direction particuliers. Dans de telles situations, l'amélioration des issues nécessite la mise en œuvre d'une approche intégrée visant à renforcer le système dans sa globalité.
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Our higher levels of mortality for tuberculosis in 2010 suggest that tuberculosis should remain a major priority. Deaths due to maternal causes have been reported in various studies86,87 in the peer-reviewed scientific literature and UN reports.88 These studies, however, focused on the maternal mortality ratio.
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