Maternal mortality in Ghana: a hospital‐based review

Lee, Qin Yi; Odoi, Alexander T.; Opare‐Addo, Henry S.; Dassah, Edward T.

doi:10.1111/j.1600-0412.2011.01249.x

Cited by 56 publications

(59 citation statements)

References 9 publications

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“…When the increase in complicated deliveries was accounted for, the clinical improvements were more impressive: a near 70% maternal mortality reduction over 5 years. Without the CQI program, maternal mortality at RRH could have been 1389 deaths per 100 000 deliveries, consistent with the MMRs of 957-1004 reported concurrently in other regional and teaching hospitals in Ghana [12,13]. Additionally, the correlation between maternal mortality and CQI implementation supports a role for process-oriented efforts to improve clinical performance.…”

Section: Discussionsupporting

confidence: 48%

Measuring the impact of a quality improvement collaboration to decrease maternal mortality in a Ghanaian regional hospital

Srofenyoh

Kassebaum

Owen

et al. 2016

Intl J Gynecology & Obste

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Objective: To evaluate the performance of a continuous quality improvement collaboration at Ridge Regional Hospital, Accra, Ghana, that aimed to halve maternal and neonatal deaths. Methods: In a quasi-experimental, pre-and post-intervention analysis, system deficiencies were analyzed and 97 improvement activities were implemented from January 2007 to December 2011. Data were collected on outcomes and implementation rates of improvement activities. Severity-adjustment models were used to calculate counterfactual mortality ratios. Regression analysis was used to determine the association between improvement activities, staffing, and maternal mortality. Results: Maternal mortality decreased by 22.4% between 2007 and 2011, from 496 to 385 per 100 000 deliveries, despite a 50% increase in deliveries and five-and three-fold increases in the proportion of pregnancies complicated by obstetric hemorrhage and hypertensive disorders of pregnancy, respectively. Case fatality rates for obstetric hemorrhage and hypertensive disorders of pregnancy decreased from 14.8% to 1.6% and 3.1% to 1.1%, respectively. The mean implementation score was 68% for the 97 improvement processes. Overall, 43 maternal deaths were prevented by the intervention; however, risk severity-adjustment models indicated that an even greater number of deaths was averted. Mortality reduction was correlated with 26 continuous quality improvement activities, and with the number of anesthesia nurses and labor midwives. Conclusion: The implementation of quality improvement activities was closely correlated with improved maternal mortality.

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Section: Discussionsupporting

confidence: 48%

Measuring the impact of a quality improvement collaboration to decrease maternal mortality in a Ghanaian regional hospital

Srofenyoh

Kassebaum

Owen

et al. 2016

Intl J Gynecology & Obste

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“…This is in line with other findings in Ghana, which indicated haemorrhage as a major cause of maternal mortality. 13,14 Considering the three delays identified by Thaddeous and Maine, as delay in seeking care, delay in reaching health facility and delay from the health facility, the finding of this study indicated the last two delays as prevalent in Accra, Ghana. 11 While delay in seeking for care remain a problem in many rural regions of Ghana, delay in reaching health facility and delay from the health facility remain the major problem in Accra.…”

Section: Discussionmentioning

confidence: 96%

Maternal mortality in Ghana: an exploration of partners’ perception about factors that contributed to their wife’s death

Adika¹,

Chutiyami

Hamina

et al. 2017

Int J Community Med Public Health

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Background: Many programmes were put in place internationally and locally to curtail the menace of maternal mortality, but little achievement has been made in certain parts of the world, particularly in sub-Saharan Africa. A number of literatures exist, which investigate into the predisposing factors of maternal mortality in Ghana, however, no published evidence as the time of conducting this study explore the perception of men with respect to maternal mortality. This study aims to explore the perceptions of men who have lost their wives about the factors that contributed to their wife’s death in Accra, Ghana.Methods: A qualitative phenomenological approach was adopted, using an in-depth semi-structured interview conducted via a phone call, which was recorded and transcribed. Ten men participated in the study. The data was analysed using narrative synthesis through identification of themes/sub-themes. Results: It was identified that physical, cultural and socio-economic factors were responsible for the death of men’s wives on the course of pregnancy. The major physical factors include direct causes of maternal mortality notably haemorrhage, delay in reaching health facility and delay from the health facility. The cultural factors mainly include seeking care from unskilled attendants and use of traditional preparations to aid delivery. Lastly, poor socio-economic status was blamed by majority of the participants, which impedes them from accessing quality care within shortest period of time. Conclusions: Men perceived factors predisposing to maternal mortality in Accra, Ghana were avoidable with quality health care services and improved access to the health facilities.

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“…Such a counterfactual would have led to an MMR similar to those observed in other referral hospitals in Ghana, which ranged from 913–1004 maternal deaths per 100,000 live births. [52, 53] Our study shows that RRH was able to achieve significantly lower CFRs than these other hospitals over the intervention period.…”

Section: Discussionmentioning

confidence: 68%

The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana

et al. 2017

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ObjectiveTo evaluate the cost-effectiveness of a quality improvement intervention aimed at reducing maternal and fetal mortality in Accra, Ghana.DesignQuasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis.MethodsData were collected on the cost and outcomes of a 5-year Kybele-Ghana Health Service Quality Improvement (QI) intervention conducted at Ridge Regional Hospital, a tertiary referral center in Accra, Ghana, focused on systems, personnel, and communication. Maternal deaths prevented were estimated comparing observed rates with counterfactual projections of maternal mortality and case-fatality rates for hypertensive disorders of pregnancy and obstetric hemorrhage. Stillbirths prevented were estimated based on counterfactual estimates of stillbirth rates. Cost-effectiveness was then calculated using estimated disability-adjusted life years averted and subjected to Monte Carlo and one-way sensitivity analyses to test the importance of assumptions inherent in the calculations.Main outcome measureIncremental Cost-effectiveness ratio (ICER), which represents the cost per disability-adjusted life-year (DALY) averted by the intervention compared to a model counterfactual.ResultsFrom 2007–2011, 39,234 deliveries were affected by the QI intervention implemented at Ridge Regional Hospital. The total budget for the program was $2,363,100. Based on program estimates, 236 (±5) maternal deaths and 129 (±13) intrapartum stillbirths were averted (14,876 DALYs), implying an ICER of $158 ($129-$195) USD. This value is well below the highly cost-effective threshold of $1268 USD. Sensitivity analysis considered DALY calculation methods, and yearly prevalence of risk factors and case fatality rates. In each of these analyses, the program remained highly cost-effective with an ICER ranging from $97-$218ConclusionQI interventions to reduce maternal and fetal mortality in low resource settings can be highly cost effective. Cost-effectiveness analysis is feasible and should regularly be conducted to encourage fiscal responsibility in the pursuit of improved maternal and child health.

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Maternal mortality in Ghana: a hospital‐based review

Cited by 56 publications

References 9 publications

Measuring the impact of a quality improvement collaboration to decrease maternal mortality in a Ghanaian regional hospital

Measuring the impact of a quality improvement collaboration to decrease maternal mortality in a Ghanaian regional hospital

Maternal mortality in Ghana: an exploration of partners’ perception about factors that contributed to their wife’s death

The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana

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