The what’s, where’s and why’s of miscarriage: evidence from the 2017 Ghana Maternal Health Survey

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Study Justification:
– Miscarriage is a significant public health challenge in low- and middle-income settings, including Ghana.
– Understanding the sociodemographic and maternal characteristics associated with miscarriage can help inform interventions and policies to prevent miscarriage and improve maternal health.
Study Highlights:
– The study used data from the 2017 Ghana Maternal Health Survey to examine the factors associated with miscarriage.
– The prevalence of miscarriage in Ghana was found to be 15.6%.
– Education, religion, and ethnicity were identified as significant structural factors associated with miscarriage.
– Key intermediary determinants of miscarriage included women of all ages (20-49 years), starting antenatal care (ANC) in the fifth month of gestation, residing in rural areas, having a history of abortion, and not using a mobile phone during complications.
– Women who had no mobile phone and could not access one during obstetric complications had increased odds of miscarriage.
Study Recommendations:
– Country-policy frameworks on maternal and neonatal health care should provide specific solutions for preventing miscarriage.
– Targeted ANC should be implemented, including enhanced twenty-four-hour primary emergency obstetric care within 5 km.
– Advocacy and education should be used to increase the utilization of ANC.
– Indirect financial barriers to maternal health care should be removed.
– Qualitative research should be conducted to further understand the findings and explore the feasibility of promoting mobile phone technology to address maternal health problems, especially in hard-to-reach rural communities.
Key Role Players:
– Ministry of Health
– Ghana Health Service
– Non-governmental organizations (NGOs) working in maternal health
– Community health workers
– Health facility staff
– Researchers and academics in the field of maternal health
Cost Items for Planning Recommendations:
– Training and capacity building for health workers
– Infrastructure development for primary emergency obstetric care
– Advocacy and education campaigns
– Research funding for qualitative research
– Mobile phone technology implementation and support in rural communities

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a cross-sectional quantitative study using a large dataset, which provides a solid foundation. The study utilized binary and multivariate logistic regression models at a 95% confidence level. However, the evidence is limited to associations and does not establish causation. To improve the strength of the evidence, future research could consider longitudinal studies to establish temporal relationships and explore potential causal mechanisms. Additionally, conducting qualitative research to gain a deeper understanding of the findings and exploring the feasibility of implementing mobile phone technology in rural communities would provide valuable insights.

Objectives: Miscarriage remains a significant public health challenge in most low- and middle-income settings, including Ghana. We thus examined the sociodemographic and maternal characteristics associated with miscarriage in Ghana using the 2017 Maternal Health Survey dataset. Study design: This was a cross-sectional quantitative study. Methods: We quantitatively analysed Ghana Maternal and Health Survey dataset. Demographic and Health Survey (DHS) collected the data using survey techniques. Approximately 25,062 women within the active reproductive ages of 15–49 years were involved in the survey. We analysed the data using binary and multivariate logistic regression models at a 95% confidence level. The findings were reported using the World Health Organisation’s Conceptual Social Determinants of Health framework. Results: We found that the prevalence of miscarriage was 15.6%. Education, religion and ethnicity were the most significant structural factors associated with miscarriage. We also found that women of all ages (20–49 years), starting antenatal care (ANC) in the fifth month of gestation, residing in rural area, having history of abortion (aOR = 0.622, 95% CI = 0.570–0.679, P < 0.001), and not using mobile phone during complications (adjusted odds ratio = 0.601, 95% confidence interval = 0.556–0.651, P < 0.001) were key intermediary determinants of miscarriage. The analysis found increased odds of miscarriage among women who had no mobile phone and could not access the same during obstetric complications. Conclusions: The study concludes that country-policy frameworks on maternal and neonatal health care do not go far enough in providing specific solutions for preventing miscarriage. To reverse this trend, we recommend targeted ANC, including enhanced twenty-four-hour primary emergency obstetric care within 5 km, advocacy, and education as a lever to increasing utilisation of ANC, and removal of indirect financial barriers to maternal health care. We further recommend a qualitative research to understand some of the findings and explore the feasibility of promoting mobile phone technology to address maternal health problems, particularly obstetric care for women in hard-to-reach rural communities.

Innovations for the recommendations mentioned in the study are as follows:

1. Targeted Antenatal Care (ANC): One innovation could be the implementation of mobile ANC clinics that travel to remote areas, bringing comprehensive care directly to pregnant women who may have difficulty accessing healthcare facilities. This approach can help overcome geographical barriers and ensure timely initiation of ANC.

2. Enhanced Emergency Obstetric Care: An innovation could be the establishment of telemedicine networks that connect healthcare providers in remote areas with specialists in urban centers. This way, healthcare providers in remote areas can receive real-time guidance and support during emergency obstetric situations, improving the quality of care and reducing the risk of complications.

3. Advocacy and Education: Innovative approaches to advocacy and education could include the use of social media campaigns, community radio programs, and interactive mobile phone applications to disseminate information about maternal health and the importance of ANC. These platforms can engage and educate a wide range of audiences, including community members, healthcare providers, and policymakers.

4. Removal of Financial Barriers: An innovation could be the implementation of mobile money transfer systems that provide financial support directly to pregnant women for transportation costs and other out-of-pocket expenses. This approach can reduce the financial burden associated with accessing maternal health services and ensure that women can afford to seek care when needed.

5. Qualitative Research: An innovative approach to qualitative research could involve the use of participatory methods, such as community-based focus group discussions and storytelling sessions, to gather insights from women in hard-to-reach rural communities. This approach can empower women to share their experiences and perspectives, ensuring that interventions are tailored to their specific needs.

6. Mobile Phone Technology: Innovations in mobile phone technology could include the development of mobile applications that provide personalized ANC reminders, educational content, and teleconsultation services. These applications can be designed to be user-friendly and accessible even in low-resource settings, improving access to maternal health information and services for women in remote areas.

By implementing these innovations, Ghana can enhance access to maternal health services, reduce the prevalence of miscarriage, and improve the overall well-being of pregnant women.
AI Innovations Description
The recommendation to improve access to maternal health based on the study is as follows:

1. Targeted Antenatal Care (ANC): Implementing targeted ANC programs that specifically address the needs of pregnant women can help reduce the prevalence of miscarriage. These programs should focus on providing comprehensive care, including early initiation of ANC, regular check-ups, and appropriate management of complications.

2. Enhanced Emergency Obstetric Care: Establishing twenty-four-hour primary emergency obstetric care facilities within a 5 km radius can ensure timely access to emergency services for pregnant women. This can help prevent complications and reduce the risk of miscarriage.

3. Advocacy and Education: Increasing awareness about the importance of maternal health and the risks associated with miscarriage is crucial. Advocacy campaigns can help educate communities, healthcare providers, and policymakers about the need for improved access to maternal health services.

4. Removal of Financial Barriers: Indirect financial barriers, such as transportation costs and out-of-pocket expenses, can hinder access to maternal health care. Removing these barriers by providing financial support or implementing health insurance schemes can make maternal health services more accessible to all women.

5. Qualitative Research: Conducting qualitative research can provide deeper insights into the factors influencing miscarriage and access to maternal health care. This research can help identify specific challenges faced by women in hard-to-reach rural communities and inform the development of targeted interventions.

6. Mobile Phone Technology: Exploring the feasibility of promoting mobile phone technology to address maternal health problems, particularly obstetric care, is recommended. Mobile phones can be used to provide information, reminders, and teleconsultations, improving access to healthcare services for women in remote areas.

Implementing these recommendations can contribute to improving access to maternal health services and reducing the prevalence of miscarriage in Ghana.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Targeted Antenatal Care (ANC): Implement a targeted ANC program in a selected region or community in Ghana. This program should include early initiation of ANC, regular check-ups, and appropriate management of complications. Collect data on the number of pregnant women accessing ANC services before and after the implementation of the program. Compare the prevalence of miscarriage among women who received targeted ANC with those who did not. Analyze the data using statistical methods to determine the impact of targeted ANC on reducing miscarriage rates.

2. Enhanced Emergency Obstetric Care: Establish twenty-four-hour primary emergency obstetric care facilities within a 5 km radius in a specific area. Monitor the utilization of emergency obstetric care services by pregnant women in that area before and after the establishment of the facilities. Compare the rates of complications and miscarriage among women who had access to emergency obstetric care with those who did not. Analyze the data to assess the impact of enhanced emergency obstetric care on reducing miscarriage rates.

3. Advocacy and Education: Conduct advocacy campaigns and educational programs in a selected community or region to increase awareness about maternal health and the risks of miscarriage. Collect data on knowledge and awareness levels before and after the campaigns. Survey the community to assess changes in attitudes and behaviors related to maternal health. Analyze the data to determine the impact of advocacy and education on improving access to maternal health services and reducing miscarriage rates.

4. Removal of Financial Barriers: Implement a financial support program or health insurance scheme in a specific area to remove indirect financial barriers to maternal health care. Monitor the utilization of maternal health services by pregnant women in that area before and after the implementation of the program. Compare the rates of miscarriage among women who received financial support or had access to health insurance with those who did not. Analyze the data to assess the impact of removing financial barriers on reducing miscarriage rates.

5. Qualitative Research: Conduct qualitative research in hard-to-reach rural communities to understand the factors influencing miscarriage and access to maternal health care. Conduct interviews and focus group discussions with women and healthcare providers to gather insights and experiences. Analyze the qualitative data to identify specific challenges faced by women in accessing maternal health services. Use the findings to inform the development of targeted interventions and assess their potential impact on improving access to maternal health care and reducing miscarriage rates.

6. Mobile Phone Technology: Explore the feasibility of promoting mobile phone technology for maternal health care in a selected area. Implement a pilot program that utilizes mobile phones to provide information, reminders, and teleconsultations for pregnant women. Monitor the utilization of mobile phone services by pregnant women and collect data on their access to maternal health care and rates of miscarriage. Analyze the data to assess the impact of mobile phone technology on improving access to maternal health services and reducing miscarriage rates.

By implementing these methodologies, researchers can gather data and analyze the impact of the recommendations on improving access to maternal health and reducing miscarriage rates in Ghana.

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