Unmet need for essential obstetric services in a rural district in northern Ghana: Complications of unsafe abortions remain a major cause of mortality

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Study Justification:
– The aim of this study was to evaluate the baseline data on antenatal services, deliveries, and maternal deaths in a rural district in northern Ghana.
– The study aimed to identify the major causes of maternal mortality and the factors contributing to the unmet need for essential obstetric services.
– The findings of this study would provide valuable information for the development of a program to improve maternal care in the district.
Study Highlights:
– The majority of women attended antenatal clinics during the second trimester, indicating a delay in seeking care.
– A significant number of women had low levels of hemoglobin, indicating a high prevalence of anemia.
– The prevalence of female genital cutting was 21.4%, highlighting the need for interventions to address this harmful practice.
– The rates of Caesarean section were low, with only one-third of women in need of the procedure able to access it.
– Complications of unsafe abortion and hemorrhage were identified as the leading causes of maternal death.
– A high proportion of maternal deaths occurred within 24 hours of arrival at the hospital, indicating late recourse to healthcare facilities.
Recommendations for Lay Reader and Policy Maker:
– Increase awareness and education on the importance of early antenatal care attendance.
– Improve access to essential obstetric services, including Caesarean sections, especially for women in need.
– Implement interventions to address the prevalence of female genital cutting.
– Strengthen emergency obstetric care services to effectively manage complications of unsafe abortion and hemorrhage.
– Promote community-level availability of essential obstetric services to reduce maternal mortality.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation.
– District Health Directorate: Oversees healthcare services at the district level.
– Healthcare Providers: Including doctors, nurses, midwives, and other healthcare professionals.
– Community Health Workers: Involved in community-level healthcare delivery.
– Non-Governmental Organizations (NGOs): Provide support and resources for maternal health programs.
Cost Items for Planning Recommendations:
– Infrastructure: Upgrading and equipping healthcare facilities to provide essential obstetric services.
– Training: Capacity building for healthcare providers to improve skills in emergency obstetric care.
– Supplies and Equipment: Provision of necessary medical supplies and equipment for safe deliveries and management of complications.
– Outreach Programs: Funding for community-level interventions and awareness campaigns.
– Monitoring and Evaluation: Resources for monitoring the implementation and impact of the recommended interventions.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides descriptive analyses of data extracted from hospital records, which gives insights into the state of obstetric services in a rural district in northern Ghana. The study identifies key issues such as late recourse to health facilities, complications of unsafe abortion, and unmet need for essential obstetric services. However, the evidence is limited to data from one district hospital and covers a specific time period. To improve the strength of the evidence, future studies could include data from multiple hospitals and cover a longer time span. Additionally, conducting qualitative research to gather more in-depth information from women and healthcare providers would provide a more comprehensive understanding of the challenges and potential solutions.

Aim: The aim of this study was to review 4 years of hospital data on antenatal services, deliveries and maternal deaths as the baseline evaluation for a programme to improve care. Methods: Descriptive analyses were made of data extracted from the monthly returns charts and clinical notes on all maternal deaths from January 2001 to December 2003 at the district hospital in the Kassena-Nankana district of rural northern Ghana. Results: The majority (56.6%) of women first attended an antenatal clinic during the second trimester, and about 70% had haemoglobin levels of <10 g/dl. A total of 3160 deliveries were recorded. The prevalence of female genital cutting was 21.4%. Hospital and population rates of Caesarean section were 9.1 and 1.8%, respectively. Only one-third of women in need of a Caesarean section were able to access this intervention. Twenty-four maternal deaths were recorded, giving a hospital maternal mortality ratio of 759 per 100 000 live births. Complications of unsafe abortion (29.1%) and haemorrhage (20.8%) were the leading causes of death. Seventy-one percent of deaths occurred in women living within 15 km of the district hospital, and 50% occurred within 24 h of arrival. Conclusion: Late recourse to the health facility and complications of unsafe abortion are major contributory factors to maternal mortality in this district. A high level of unmet need for essential obstetric services, including access to contraceptive services, exists in this district. Decentralizing the availability of essential obstetric services through health centres to community level is necessary to reduce maternal mortality in developing countries. © 2006 The Royal Institute of Public Health.

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Based on the information provided in the study, the following recommendations can be made to improve access to maternal health in the rural district in northern Ghana:

1. Decentralize the availability of essential obstetric services: Establish health centers at the community level to provide necessary care and interventions. This will bring maternal health services closer to the women in the district, making it easier for them to access antenatal care, deliveries, and emergency obstetric care.

2. Address late recourse to health facilities: Educate and raise awareness among women about the importance of seeking timely care during pregnancy and childbirth. This can be done through community outreach programs, health education sessions, and the involvement of community leaders.

3. Address complications of unsafe abortions: Provide access to safe and legal abortion services to reduce the number of unsafe abortions and associated complications. Additionally, comprehensive contraceptive services should be made available to address the unmet need for family planning and prevent unintended pregnancies.

4. Improve transportation infrastructure: Enhance transportation facilities in the district to ensure that women can reach health centers and hospitals in a timely manner during emergencies. This may involve improving road networks, providing ambulances, or implementing transportation schemes specifically for pregnant women.

5. Strengthen health system capacity: Train healthcare providers in the district to deliver quality maternal health services, including emergency obstetric care. This will ensure that health centers are equipped with skilled personnel who can handle complications and emergencies effectively.

6. Promote community involvement: Engage community members, including traditional birth attendants and community health workers, in promoting maternal health and encouraging women to seek care. This can be done through training programs, community dialogues, and the establishment of referral systems.

By implementing these recommendations, it is expected that access to maternal health services will improve, leading to a reduction in maternal mortality and better overall health outcomes for women in the rural district in northern Ghana.
AI Innovations Description
Based on the information provided, a recommendation to improve access to maternal health in the rural district in northern Ghana would be to decentralize the availability of essential obstetric services. This would involve bringing these services closer to the community level by establishing health centers that can provide necessary care and interventions.

By decentralizing the availability of essential obstetric services, women in the district would have easier access to antenatal care, deliveries, and emergency obstetric care. This would help address the issue of late recourse to health facilities, which has been identified as a major contributory factor to maternal mortality in the district.

Additionally, the recommendation emphasizes the need to address complications of unsafe abortion, which were found to be a leading cause of maternal death in the district. By providing access to safe and legal abortion services, as well as comprehensive contraceptive services, the unmet need for essential obstetric services can be reduced.

Overall, the recommendation to decentralize the availability of essential obstetric services through health centers at the community level aims to improve access to maternal health care, reduce maternal mortality, and address the specific challenges faced in the rural district in northern Ghana.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Baseline data collection: Gather data on the current state of maternal health in the rural district in northern Ghana, including information on antenatal care, deliveries, maternal deaths, complications of unsafe abortions, and access to essential obstetric services. This data can be obtained from health facilities, community surveys, and other relevant sources.

2. Define indicators: Identify key indicators that will be used to measure the impact of the recommendations. These may include maternal mortality ratio, access to antenatal care, access to emergency obstetric care, prevalence of complications of unsafe abortions, and contraceptive prevalence rate.

3. Intervention implementation: Implement the recommended interventions, such as decentralizing the availability of essential obstetric services by establishing health centers at the community level. This may involve training healthcare providers, improving infrastructure, and ensuring the availability of necessary equipment and supplies.

4. Data collection post-intervention: Collect data on the impact of the interventions after a specified period of time. This may involve conducting surveys, reviewing health facility records, and monitoring key indicators.

5. Data analysis: Analyze the collected data to assess the impact of the interventions on improving access to maternal health. Compare the post-intervention data with the baseline data to identify any changes or improvements.

6. Interpretation of results: Interpret the findings of the data analysis to determine the effectiveness of the interventions in improving access to maternal health. Assess whether the recommended interventions have led to a reduction in maternal mortality, increased access to antenatal care and emergency obstetric care, and a decrease in complications of unsafe abortions.

7. Recommendations and future actions: Based on the results and findings, make recommendations for further actions or interventions that may be needed to continue improving access to maternal health in the rural district. This may include scaling up successful interventions, addressing any remaining gaps or challenges, and ensuring sustainability of the implemented interventions.

By following this methodology, researchers and policymakers can assess the impact of the recommended interventions on improving access to maternal health in the rural district in northern Ghana and make informed decisions for future interventions.

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