DECLARATION

We, the under listed students do hereby declare that, apart from references made to works done in

relation to this subject area which have been duly acknowledged, this work was independently

done by us under supervision. We further declare that this work has not been submitted for the

award of any certificate in diploma nursing in this university or elsewhere.

STUDENTS

AMONOO PATRICIA ………………..

………………

INDEX Number- Signature Date

Certified by:

OWUSU BOAKYEWAA SALOMEY …………..

……………

INDEX Number- Signature

Date

Certified by:

OSEI DUFIE COMFORT ………………..

…………………

INDEX Number- Signature

Date

Certified by:

MRS. ROSE KONADU BOAFO …………….. ……………

i
(Supervisor) Signature Date

MR. SAMUEL ANSU FRIMPONG ……………………..

…………………

(Principal) Signature Date

ABSTRACT

Maternal mortality is a critical area of concern globally, despite the availability of accessible

preventive measures. The role of sociodemographic and service delivery factors in maternal

mortality in the Goaso Municipality of Ghana are important to examine. As part of the United

Nations (UN) Millennium Campaign, the UN implemented 8 Millennium Development Goals

(MDGs); maternal mortality reduction by 75% between 1990 and 2015 was among the

fundamental MDGs to be achieved by 2015. The purpose of this case-control study was to use

secondary data to assess the relationships between sociodemographic variables, service delivery

factors, and maternal mortality among 200 women of reproductive age (15-45 years) living in the

Goaso Municipality in Ghana. These study results provide support for the significant effects of

sociodemographic and service delivery factors on maternal mortality and survivorship in the

Greater Accra metropolitan area in Ghana. The results of this study could enhance educational and

outreach programs designed to lower maternal mortality rate. Further research needs to be done to

advance knowledge and practice in health delivery services and public health education with

respect to the importance of sociodemographic and service delivery characteristics.

ii
 LIST OF ACRONYMS

AA: Antenatal Attendance

ANC: Antenatal Care

MDG: Millennium Development Goals

GHS: Ghana Health Service

HIV: Human Immunodeficiency Virus

MMR: Maternal Mortality Ratio

MMRate: Maternal Mortality Rate

PA: Post Natal Attendance

SHP: Skilled Health Personnel

WHO: World Health Organization

NMTC: Nursing and Midwifery Training College

UNICEF: United Nations International Children’s Emergency Fund

UNFPA: United Nations Population Fund

iii
 ACKNOWLEDGEMENT

We wish to thank the almighty God who made a way for this study opportunity. His love for us is

renewed every day.

We would also like to thank our supervisor Mrs.Rose Konadu Boafo for his guidance and support

throughout the dissertation writing. His constructive criticism and time spent to go through the

work with me during every session made us the envy of our friends. God richly bless you Madam.

We really acknowledge the entire staff of the NMTC, Goaso for their time and contribution to this

study.

We would also like to thank our dear parents and all our friends who supported and encouraged us

throughout the study period. Also, we would like to acknowledge the Mothers of Goaso

Government Hospital for their cooperation during the data collection. God richly bless you all and

may He meet you at your point of need.

Our final appreciation goes to the authors whose works we gained valuable knowledge and to our

course mates for their encouragement and advices offered during the course of the study. God

richly bless you all.

iv
 CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Maternal death is defined as “the death of a woman while pregnant or within 42 days of termination

of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or

aggravated by the pregnancy or its management but not from accidental or incidental causes’’

(UNICEF, 2013). Though the causes and risk factors for maternal death are known and preventable,

it is a major health problem concentrated in resource-poor regions of the world, including Ghana

(Menéndez et al., 2018). The reduction of maternal deaths is a key international development goal;

therefore, health policy and interventions targeted at significantly reducing should be evidence based

(Khan, Wojdyla, Say, Imezoglu, & Van Look, 2016).

As part of the United Nations’ (UN) Millennium Campaign, the UN implemented eight Millennium

Development Goals (MDGs). Maternal mortality reduction was among the fundamental MDGs to be

achieved by 2015 (World Health Organization [WHO], 2015). It is a crucial factor when assessing

the progress made toward reducing the maternal and morbidity rates among maternal mothers. The

fifth MDG was aimed at improving maternal health and reducing maternal mortality ratio (MMR) by

75% from 1990 to 2015 (Mills, 2011; World Health Organization, UNICEF, UNFPA, The World

Bank, and the UNP Division, 2014). Although considerable progress has been made worldwide with

the number of maternal deaths halved in the past 20 years (with an MMR of 210 per 100,000 live

births in 2010), many countries in sub-Saharan Africa failed to attain the MDG by 2015.

1
The region had an MMR of 500 maternal deaths per 100,000 live births in 2010 and is composed of

36 of the 40 countries with the world’s highest MMR (WHO, 2012a). This has made the region a

dangerous place to give birth even though leadership are sure of what to do to stop the deaths that

occurs during childbirth. Prevention of childbirth complications can be achieved by having an

accessible place for family planning, hiring more skilled midwifery, and having accessible obstetrics

care (Osotimehin, 2012).

Results from my research can support the promotion of positive social change by helping health

professionals identify sociodemographic and service delivery factors that can be targeted to prevent

or reduce maternal mortality in the Accra metropolitan area of Ghana. These study findings may also

help prevent complications and improve service delivery to maternal mothers. Similarly, there is a

need to investigate and inform policymakers to work toward the UN’s Sustainable Development

Goal (SDG) Goal 5, which is to achieve gender equality and empower all women and girls. Maternal

mortality affects women worldwide; however, countries in the sub-Saharan Africa region have the

highest prevalence of maternity-related deaths (Alkema et al., 2016).

2
1.2 Problem Statement

Although considerable progress has been made worldwide with the number of maternal deaths

halved in the past 20 years (with an MMR of 210 per 100,000 live births in 2010), many countries in

sub-Saharan Africa failed to attain the MDG by 2015. The region had an MMR of 500 maternal

deaths per 100,000 live births in 2010, and is composed of 36 of the 40 countries with the world’s

highest MMR (WHO, 2012a). This has made the region a dangerous place to give birth even though

people are sure of what to do to put an end to deaths occupancies during childbirth. This can be done

by having accessible place for family planning, hiring more skilled midwifery and having obstetrics

care that is accessible to the pregnant women to help prevent complication with childbirth

(Osotimehin, 2012).

Ghana has a documented Maternal Mortality Ratio (MMR) of 350 per 100,000 live births for the

year 2012 (Mahama, 2013). However, the district of Osu Klottey submetro of the Accra metropolitan

area in its report recorded 428 maternal deaths per 100,000 live births at the end of 2012. This is a

39% increase on the 309 per 100,000 live births recorded in 2011. According to Addo and Gudu

(2017), the Accra metropolitan area, and urban and commercial metropolis in the Greater Accra

region, has seen collaborative implementation of health policies and programs geared towards

reducing maternal mortality for the past three years. Urban populations are mostly assumed to have

access to better quality health care systems than their rural counterparts (Addo & Gudu, 2017).

However, urban health systems in many low-income countries (LICs) and middleincome countries

(MIC) have weak to nonexistent public health structures (Coast et al., 2012). They also lack uniform

implementation strategies and inadequate infrastructure to improve population health (Coast et al.,

2012). Even though Ghana, in collaboration with its development partners, has implemented

interventions to reduce maternal mortality to achieve the UN MDG 5 Targets, institutional maternal

3
mortality was very high in Osu Klottey sub metro for 2016 with the majority (80%) of maternal

deaths being among individuals who did not attend antenatal clinic (Mahama, 2013). Studies have

indicated a lack of access to obstetrics care due to the lack of health care facilities, poor

transportation system and greater distances between client home and health facilities (Kaye,

Mirembe, Aziga, & Namulema 2003).

Although the causes of maternal deaths are well established, knowledge on effective health care

management has not been translated into significant outcomes (Coast et al., 2012). Observations at

health care institutions in the Accra Metro area show that service delivery factors such as prenatal

care coverage, and the presence of a skilled attendant at delivery, may play a significant role in the

mortality rate and therefore needs to be investigated to inform policy decisions if the Sustainable

Development Goal be met. The causes of maternal deaths in Ghana follow the trends of the

developing country with hemorrhage, hypertensive disorders, abortion-related complications, and

septicemia leading, in that order (Mensah et al., 2011). In this research study, we examined the

association between sociodemographic and service delivery factors and maternal mortality.

Socioeconomic factors have been identified to have a connection with maternal mortality as it helps

determine risk factors which can be associated with the life of the mothers before and after delivery

(Owusu & Oteng-Ababio, 2015). Income determines the health status of maternal mothers in the

country (Gelaye, Rondon, Araya, & Williams, 2016). To ensure that maternal mothers have a safe

environment during and after birth, adequate income must be available within the family to access

adequate health care. In the Northern and Central regions of Africa, the government formulated

policies exempting women from paying for health care services in the region in the year 2003 to

increase the number of those who could access health care institutions. Similarly, these policies were

4
enacted with a view of ensuring that maternal mothers receive specialized care in the time of

emergencies to reduce mortality rates.

1.3 General objective

The main objective of the study was to explore the factors that contribute to increase maternal

mortality rate in Goaso Municipal Hospital

1.4 Specific objectives

Specifically, the study aimed to:

1. Determine the incidence of the specific morbidities most commonly leading to maternal

death.

2. Investigate which factors influence the risk of maternal death and how these might be

addressed to prevent death.

3. Assess the factors that contributes to maternal mortality.

1.5 Operational definition of terms

Maternal: relating to a mother, especially during pregnancy or after childbirth.

Mortality Rate: The measure of the frequency of occurrence of death in a defined population.

5
 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

About 830 women die each day from complications that result from childbirth and preventable

causes of pregnancy, despite the 44% reduction in rate of maternal deaths since 1990. This,

according to the United Nations Population Fund, is approximately one woman for every two

minutes and 20 or 30 women face severe or long-lasting complications (UNFPA, 2017). This chapter

reviews literature in accordance with the model to be employed and the general working title.

2.1 Global Perspective

Between 1990 and 2010, maternal deaths has declined globally by approximately 50%, and the

regular yearly maternal death reduction rate has increased by more than two folds in the past decade.

This, notwithstanding, maternal death remains high in underdeveloped nations, especially in the

outskirt and less accessible areas. A mother’s death compromises nutrition and general child care

and these children mostly do not avail themselves of routine health care in order to enjoy some

interventions such as vaccination. This consequence is even worse in disadvantaged communities

(Susana et al., 2015).

In 2010, Hogan and Foreman measured the sensitivities and the patterns of maternal deaths for 181

countries in the article, “Maternal mortality for 181 countries, 1980-2008: a systematic analysis of

progress towards Millennium Development Goal 5.” The Authors created 2651 record of

observations of maternal deaths involving 181 countries for 1990 through 2008, using verbal autopsy

studies, vital registration data, censuses, and surveys. The researchers employed vigorous

investigative procedures to produce maternal death estimates and Maternal Mortality Ratio (MMR)

throughout the study period (1980 to 2008). In furtherance, they verified the sensitivity of the data

6
to model requirement and showed the out-of-sample explorative soundness of the procedures. They

argue that there were 342,900 maternal deaths globally in 2008, a decline from 1980’s 526; 300

maternal deaths. This resulted in a worldwide decrease in MMR from 422 in 1980 to 320 in 1990

and eventually, 251 out of 100,000 live births in 2008. They observed that, without HIV, 281,500

maternal deaths would be recorded globally in 2008. In concluding, the researchers intimated that

only 23 countries were on path to realizing the Millennium Development Goal objective of 75%

decrease in maternal deaths by the year 2015, and that these nations, China, Egypt, Ecuador and

Bolivia had been attaining enhanced headway.

A research was conducted in four States of Northern Nigeria to project maternal mortality level

using the ‘Sisterhood method.’ In all, 3; 080 participants reported 7; 731 maternal sisters of which

593 were reported dead and 298 of those dead were maternal-related. To the Authors, this matched

to a lifetime danger of maternal death of 9% and maternal mortality ratio (MMR) of 1271 maternal

deaths out of 100000 live births. The Authors further argue that the “Sisterhood method” for

estimating MMR, in situations where the sample size is very large, is the perfect approach in such

settings because it requires fewer participants than vital registration and cohort studies. However,

they agree that projections from this method should be considered as orders of magnitude instead of

specific ratios since they can have varied confidence intervals, and that projections from this

technique are fairly exact and the degrees of accuracy may be low as a result of the retroactive form

of the data and absence of proof of the information given. The four States considered for the study

were selected based on the fact that they had generally poor maternal and child health pointers.

Henry and co. reported that antenatal care services were present in some selected health care

facilities in the four States and that per the Nigerian Demographic and Health Survey of 2008 in

Northern Region, 59:1% of expectant mothers in the five years before the survey had no antenatal

7
care, and of those enjoying antenatal service, only 37% enjoyed these services from a trained health

care provider (Henry, Sally, Findley, & Godwin, 2012).

A study conducted by the Ghana Statistical Service suggests that 12 percent of all pregnancies that

happened within the ten years preceding the research failed to result in a live birth. Again, the

research stated that approximately one out of every four pregnancies to women between the ages of

15 and 19, was lost early through induced or spontaneous abortion. The study further reported that

early miscarriages were particularly high among women of these ages and that two out of five

pregnancies to women in this age group resulting in early miscarriage (Ghana Statistical Service and

Macro International, 1998).

The primary contributory factors of maternal deaths for women of all ages are obstetric related;

hemorrhage as the major global contributing factor of maternal death (27%), followed by

hypertensive disorders (4%) and Sepsis having 10%. Other factors include abortion (8%) and

embolism (3%). Some Authors further observed significant regional differences for the percentage

each factor contributes to total maternal deaths (Neal et al., 2016).

Maternal death is defined by the World Health Organization as “the death of a woman while

pregnant or within 42 days of termination of pregnancy, regardless of the length and location of the

pregnancy, from any cause linked to or worsened by the pregnancy or its management but not from

accidental or incidental causes”.

8
2.2 The Medical explanatory model

A number of studies have proven the following as the most frequent clinical factors of maternal

deaths and lasting morbidity during pregnancy and delivery.

2.2.1 Postpartum Hemorrhage (PPH)

PPH is currently reported as the principal cause of maternal death. For instance, in the United States,

PPH account for approximately 11:4% of maternal deaths. In developing countries such as Ghana,

lack of experienced caregivers who might be able to effectively handle PPH if it occurs, and lack of

blood transfusion services have been cited as major contributions of unfavorable outcomes of PPH.

Postpartum Hemorrhage is simply explained as blood loss of more than 500ml following vaginal

delivery or more than 1000ml following Cesarean delivery. If these blood loss occurs within 24hours

of delivery, it is called primary PPH, otherwise, secondary PPH.

Out of 634 pregnancy-related deaths that happened between 2004 and 2008 at Korle-Bu Teaching

Hospital, 21:8% was as a result of Postpartum Hemorrhage (Der et al., 2013).

2.2.2 Hypertensive disorders

This is one of the obstetric emergencies that are difficult to prevent or manage. It is a major factor of

maternal death in Africa. In a retroactive descriptive study conducted at the Korle-Bu Teaching

Hospital (KBTH) in Accra, the Authors reported that 63 out of 199 maternal deaths that happened

between 2010-2011 were attributable to hypertensive disorders (Adu-Bonsaffoh, Oppong, Binlinia &

Obed, 2013). Hypertensive disorders normally progresses to eclampsia characterized by severe renal

failure, intracerebral hemorrhage, pulmonary edema and death.

9
2.2.3 Anemia

According to the Ghana Demographic Health survey, the number of pregnant women with anemia

climbed from 65 percent in 2003 to 70 percent in 2008. The report further stated that at least 9000

expectant mothers in Ghana would lose their lives by 2020 if the high levels of anemia among

pregnant women were not put to check (Ghana Demographic Health Survey). Malaria is the

principal cause of anemia in Ghana.

2.2.4 Sepsis

Unnoticed or poorly handled maternal infections can result in Sepsis, death or disability on the part

of the mother and a corresponding greater possibility of premature neonatal infection and other

adverse consequences (WHO, 2017). Sepsis normally occurs when the amniotic sac raptures way

before delivery occurs, when the vaginal examinations are too common or when obstructed labour

happens. Long term consequences of puerperal sepsis include pelvic inflammatory diseases,

secondary infertility and in rare cases, maternal tetanus (Senah, 2003).

2.2.5 Obstructed Labour

This is mostly caused by cephalo-pelvic disproportion- a mismatch between the fetal head and the

mother’s pelvic brim. This therefore impairs the smooth passage of the baby. In severe cases, it

could lead to fistulation, whereby urine and faecal matter have access to the reproductive system.

The number of maternal deaths due to obstructed labour or labour dystocia varies between 4% and

70% of all maternal deaths, accounting to maternal mortality ratio of 410 per 100,000

live births (Neilson, Lavender, Quenby & Wray, 2003).

10
2.2.6 Abortion

In a study conducted in Benin, Ivory Coast and Senegal, “4116 women were admitted for obstetrical

complications during the first trimester of pregnancy. 1525 (37%) were admitted for complications

of induced abortion, 1834 (45%) for complications of spontaneous abortion, 651 (16%) for ectopic

pregnancy and 106 (3%) for molar pregnancies. A total of 42 of these 4116 women died, 37 (88%)

of these deaths resulted from complications of induced abortion” (New Englang Journal of Medicine

[NEJM], 2002). This supports past studies findings that complications of induced abortion is the

major contributory factor of death in the first trimester of pregnancy. According to the Ghana

Demographic and Health Survey (Ghana Statistical Service and Macro International, 1998) 12

percent of all pregnancies that happened before the study failed to result in a live birth. Moreover,

the study stated that approximately one out of four pregnancies to women aged between 15 and 19

years was lost early due to spontaneous or induced abortion. It was observed further that early

miscarriages were particularly high among women aged between 15 and 19 with about two out of

five pregnancies to women in this age group resulting in early miscarriage. Abortion is usually

characterized by severe bleeding, lower abdominal pains, and passage of fetal and placental tissue.

2.3 Socio-Cultural Context

Some cultural practices in Ghana contribute immensely to maternal mortality. Key among them is

Betrothing. In the Northern part of Ghana, girls are betrothed as early as seven years. These girls are

compelled to move into their potential husbands homes in their early teen ages. Because these

children don’t have well developed pelvic to contain pregnancies, most of them die during labour,

especially when there is no timely medical intervention. Another contributing factor is taboos. In

some Ghanaian societies, pregnant women are prohibited from taking certain foods, with the believe

11
that such foods would negatively affect their babies. Darko (1992) observed that, among the

Akwapims, expectant mothers were not allowed to buy tomatoes, pepper, okro, and garden eggs

from the market. It is believed that pregnant women who violate this order would have their children

infected with acute rashes and eventually suffer some degree of disability. This practice could

obviously lead to malnutrition, thereby affecting the growth and the development of the baby, as

well as the health conditions of the expectant mother.

2.4 Role of Antenatal and Postnatal care in Maternal Mortality

Antenatal and Postnatal care are factors that contribute greatly to maternal mortality. Unfortunately

little attention is attached to them in developing countries such as Ghana. A study conducted at N.

Wadia Maternity Hospital in India between 1929 and 1988 showed a decline in Maternal Mortality

Ratio (MMR) from 1920 during 1929-1939 period to 82 per 100000 live births in 1980- 1988.

According to the Researchers this progress in reduction of maternal death over decades was due to

several factors such as an effective postnatal, intranatal and antenatal service. It was observed further

that direct obstetric death also reduced from 670 to 41 per 100000 live births. These figures,

according to researchers, indicate utilization when health care facilities are free of charge and

available within the shortest possible distance from one’s residence (Pandit, 1992).

A similar research titled “importance of Antenatal care in reduction of maternal morbidity and

mortality,” was conducted in Pakistan, a developing country with a population of over 140 million

and a high maternal mortality ratio of 340 per 100000 live births in 2002. The major causes of

maternal mortality in Pakistan, like other developing countries remain hemorrhage(21%),

eclampsia(18:6%), Sepsis(13:3%), abortion(11%), obstructed labour(8:7%) and others(27:4%). The

researchers argue that effective antenatal service, its delivery and accessibility can generally prevent

all the above factors that need urgent obstetrical care. They argue further that antenatal attendance

12
play a key role in creating confidence among the stake holders. In furtherance, they observed that in

underdeveloped countries only 65% women enjoy antenatal service as compared to 97% in

developed countries (Inam & Khan, 2002).

13
 CHAPTER THREE

MATERIAL AND METHODS

3.0 Introduction

This chapter describes the method used for this research. It constitutes research design, research

settings, target population, sampling method, data gathering tool, data collecting procedure, validity

and reliability, pre-testing, data analysis and ethical consideration.

3.1 Study Setting and population

Burns and Grove (2011) noted that the study setting is the location where the study took place. The

research was conducted at Goaso Government Hospital. The hospital forms part of the Goaso, Ahafo

Region. Established in 1999, the hospital is 1.2km away from the capital with a hospital bed capacity

of population of one thousand (1,000) patients (as at 2020).

Goaso is a cosmopolitan community and the capital of Asunafo North District. A district in Ahafo

Region of Ghana and has a double rainfall pattern with annual rainfall ranging between 125mm and

175mm. The peak season is between April and July and the minor season is in September-October.

According to the 2010 Population Census the population of the municipality was is 126,364 persons

(Ghana Statistical Service, 2010). The educational system of Goaso is encouraging. The community

is endowed with seven (7) primary schools, five (5) junior high schools, two senior high schools that

is Ahafoman Senior High Technical School and Ken Hammer Senior High School. Most of the

inhabitants are engaged in farming activities and also petty trading. The community is also endowed

with a hospital, Goaso Government Hospital where the study was conducted. The study population

composed of nurses in the Hospital. This group was chosen because of their proximity. The inclusive

criteria included all nurses enrolled in the hospital.

14
Familiarization visits was made by the researchers to the Goaso Government Hospital prior to the

data collection.

3.2 Study Design

This study was a quantitative, descriptive cross-sectional study. This design was adopted in order for

the phenomenon of interest to be investigated as a snap shot of the actual situation that exists on the

ground. The design also allowed for the selected variables to be measured at a single time. It was an

institution-based study.

3.3 Sampling Method/ Sample Size

Simple random sampling was used to ensure that every member of the population had equal chance

of participating in the study to avoid biases associated with non -probability sampling. A sample size

of 200 mothers were selected by inviting them to answer the questionnaires.

3.4 Data Collection Tools

Structured questionnaire was adopted for the study. The questionnaire also had open and closed

ended questions and they captured all the research questions.

It offered the respondents an alternative reply from which they choose and also allowed them to

respond in their own words.

3.5 Data Collection Techniques

Data was collected from 200 mothers in the Goaso Government Hospital. Data entry and editing

were however be done simultaneously. First the authorities of the institution were informed and after

consulting the authorities and given the permission, the target mothers were informed and invited to

answer the questionnaire. The questionnaire was administered personally by the researchers.

15
3.6 Data Analysis Techniques

Data collected was analyzed using SPSS version 22 and presented using pie, bar, line chart and

percentage table to make it graphical and picturesque. Descriptive statistics was used for this study.

Similarities were identified and compared to the existing literature and conclusions were drawn.

3.7 Ethical Consideration

Ethical approval was obtained from the authorities of the hospital with the aims and data collection

procedure explained to them to gain their consent. Participation will be voluntary and only those

who give their consent was included in the study. To maintain confidentiality, names of all

correspondents will be withheld and remained anonymous. The need for the study was explained to

all participants to get informed consent from them.

3.8 Limitations of the Study

The study will be limited to only females of Goaso Government Hospital, due to financial

constraints and insufficient time in relation to the short academic calendar of the semester; the study

cannot cover all the mothers of the Goaso Hospital.

16
 CHAPTER FOUR

RESULTS AND DISCUSSION

4.0 Introduction

This section presents the results of the study in tables and charts. The results are presented in

accordance with the order of the study objectives.

4.1 Demographic Characteristics of Respondents

As part of the general background information of the respondents, the study provided a tabular

presentation as seen in Table 1 below. The demographic characteristics entailed the age group,

marital status, educational level, ethnic group as well as the religion of the respondents

Table 1: Demographic Characteristics of Respondents

Age group of Respondents Number of Respondents Percentage (%)

Age group (years)

15-22 11 5.5
23-30 34 17.0
31-38 89 44.5
39 and above 66 33.0

Total 200 100

Table 1: Respondents age group

Table 2 above shows that 11 (5.5%) of respondents are aged between 15 and 22, 34 (17.0%) of them

are between 23 and 30, and 89 (44.5%) of the respondents are between the ages 31 and 38 and

66(33.0%) of them are 39 and above.

17
Table 2: Respondents’ Educational level (Expectant mother)

Marital status Number of respondents Percentage (%)

No Education 9 4.5

Primary Level 76 38.0

Secondary Level 81 40.5

Tertiary Level 34 17.0

Total 200 100

Table 3 above shows that 9 respondents representing 5.5% had no education, 76 respondents

representing 38.0% had primary level of education, 81 respondents representing 40.5% had

secondary level education and 34 respondent representing 17.0% had tertiary education.

Table 3: Respondents’ Religious background

Marital status Number of respondents Percentage (%)

Christianity 115 57.5

Islam 85 29.0

Total 200 100

Table 4 above shows that 115 respondents representing 57.5% are Christians and 85 respondents of

representing 29.0% are Muslims.

Number of antenatal visit Frequency Percentage (%)

18
 No antenatal visit 47 23.5
1-3 visits 68 34.0
4&more visits 70 35.0
Don’t know 15 7.5

Total 200 100

Table 4: Respondents’ Antenatal Visit

Table 4 above shows that 47 respondents representing 23.5% did not visit antenatal clinic, 68

respondents representing 34.0% visited the antenatal clinic thus (1-3 visits), 70 respondents

representing 35.0% visited the ANC for more than 4 times and 15 respondent representing 7.5%

don’t know whether they visited the ANC or not.

Received ANC as
at last pregnancy Frequency Percentage (%)
Yes 183 91.5
No
17 8.5
Source of initial care/ admission
Health facilities 113 56.5
TBA’s 58 29.0
Home 20 10.0
Mission Houses
9 4.5
Period of maternal death
Post-partum
123 61.5
Labour/delivery
36 18.0
3rd trimester ANC
15 7.5
2nd trimester ANC
14 7.0
1st trimester ANC

19
 12 6.0
Table 5: Obstetrics/ Gynecological History of the women died

In Table 5, 183 respondents, 91.5percent, reported that they received ANC as at last pregnancy.

Most (56.5%) respondents reported to have visited the health facilities for their initial care, 29.0

percent visited the TBA’s for initial care/admission, 10.0 and 4.5 percent were at home and mission

houses respectively for initial care. Also, majority (61.5) percent died during their post-partum stage,

18.0% during labour, and 7.5% during their 3rd trimester, 7.0% during the 2nd trimester and 6.0%

during 1st trimester.

4.2.1 Major causes of Maternal Mortality

The five leading or major or direct causes of maternal mortality in Goaso Government Hospital are

shown in Fig.1below. Haemorrhage accounts for 49.0% of causes, while pre-eclampsia or eclampsia

accounts for 30.0% of deaths. Others causes include septicaemia, ruptured uterus, and complications

of unsafe abortions (each accounting for 21.0% of causes).

Major causes of Maternal Mortality Fig.3

Prolong obstructed labour
5%
Complication of Abortion
12%

Sepsis
3%

Haemorrhage
Ecclampsias/ 49%
Preeclampsia
30%

Haemorrhage Ecclampsias Sepsis Complication of Abortion Prolong obstructed labour

20
Table 6: Contributory factors/ non-medical causes of maternal and perinatal deaths

Contributing factors Frequency Percentage (%)

Manpower shortage 94 47.0
Lack of transport/ ambulance
34 17.0
Delay in seeking care
17 8.5
Delay in referrals
20 10.0
Poverty
10 5.0
Lack of medications/equipment’s/blood
6 3.0
Failure to recognize danger sign
12 6.0
Inadequate power supply
7 3.5

The leading contributory factors or non-medical causes of Maternal and Perinatal Deaths as shown

in Table 6 above, and these include inadequate manpower (47.0%), delay in seeking help(8.5%),

lack of essential equipment/medications/blood(3.0%), lack of ambulance/transportation(17.0%),

delay in referrals most especially of high risk pregnant women(10.0%), poverty/lack of money

(5.0%) and lack of awareness of danger signs by care givers(6.0%).

21
 CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATION

5.0 Introduction

The study sought to assess the factors contributing to increased maternal mortality rate in Goaso

Government Hospital. Specifically, the study was guided by three objectives. This chapter captures

the summary of findings that were made from the study. It goes on to provide conclusions made

from the study and thereafter give recommendations to various stakeholders in the institution based

on the findings. The chapter ends by giving suggestions for further research.

5.1 Discussion

5.1.1 Delay in seeking health care

A combination of factors contributed to the first delay, which lead the pregnant women not to seek

prompt treatment from a health facility with capacity to manage pregnancy and delivery-related

complications. Some mothers did nothing in this situation, while others sought treatment from TBAs

(as the first place to seek care which is in accordance with a study from Gambia or Village Health

Workers (VHWs), while other purchased medicine from the pharmacy or sought treatment by

spiritual healers. Obstetric emergency among the studied cases, occurred mostly during the

intrapartum or immediately postpartum. In this study 19 of the women delivered at home increasing

the risk of maternal mortality from delays.

Traditional birth attendants played a major role in this study as health service providers. Delay in

referral from a TBA to a health facility with emergency obstetric care and skilled birth attendants

can result in a high risk of maternal death. For example, the six cases in this study where sepsis was

either direct or underlining cause of death, were all delivered at home assisted by a TBA. It has been

22
shown in other studies that sepsis usually follows hemorrhage in maternal deaths and previous

studies have shown that facility-based delivery can reduce the risk of maternal death. It has also been

shown in a study of maternal near miss cases in Brazil, that delay in accessing emergency obstetric

care increases the severity of the complications.

5.1.2 Socioeconomic factors

a) Poverty: Poverty is strongly linked to maternal mortality1. Poverty: Poverty is strongly

linked to maternal mortality. Women living in poverty often lack access to quality healthcare

services, including skilled birth attendance, emergency obstetric care, and prenatal and

postnatal care. They may also face barriers in reaching healthcare facilities1. Poverty:

Poverty is strongly linked to maternal mortality. Women living in poverty often have limited

access to proper healthcare and are more likely to experience malnutrition and inadequate

prenatal care, leading to higher rates of complications during pregnancy and childbirth.

Montagu, D., Yamin, A., Griffiths, P., Akseer, N., & Amouzou, A. (2018).

b) Lack of education: Women with lower education levels are more likely to have a higher

maternal mortality rate. Limited education can contribute to a lack of awareness about

reproductive health, limited decision-making power, and poor understanding of the

importance of seeking timely and appropriate healthcare during pregnancy and childbirth.

Jain, A. K., & Winfrey, W. (2017).

c) Inadequate healthcare infrastructure: Limited access to quality healthcare facilities,

especially in rural and remote areas, can contribute to the increased maternal mortality rate.

Lack of skilled healthcare professionals, emergency obstetric services, and poor

transportation infrastructure can result in delays in receiving necessary care during pregnancy

and childbirth. World Bank. (2020).

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 d) Cultural and societal norms: Cultural norms and societal factors play a significant role in

maternal mortality rates. In some societies, women may have limited decision-making power

regarding their reproductive health, leading to delayed or inadequate care during pregnancy

and childbirth. Furthermore, harmful traditional practices such as child marriage, female

genital mutilation, and son preference can increase the risk of complications and maternal

mortality. Ahmed, S., Norton, M., Williams, E., Ahmed, M., & Shah, R. (2015).

5.2 Conclusion

We concluded that the majority of causes and contributory factors to reported maternal deaths are

preventable through combined safe motherhood strategies of focused antenatal care, prompt referral,

active management of labour and immediate post-partum period and access to family planning.

However, the pattern of the causes is gradually changing with deaths due to cephalo-pelvic

disproportion on the decline due to availability of caesarean section services. MPDSR provides a

platform for critical evidence of where the main problems lie. MPDSR also provides evidence-based

recommendations to maternal health stakeholders on strategies that could significantly reduce

maternal mortality. The implementation and institutionalization of MPDSR programs is on course in

Goaso Municipality. MPDSR is feasible and should be institutionalized in all cities in Ghana. A

commitment to act upon the findings of MPDSR is a key prerequisite for success.

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5.3 Recommendations

The following recommendations are made based on the findings of the study;

1. Improve emergency obstetric care by ensuring that there are enough personnel, logistics and

facilities to attend to women who are in labour, especially 12 hours prior to delivery and after

delivery. That is, skilled attendance at birth should be a number one priority for all pregnant

women in both urban and rural areas.

2. Encourage and ensure that a lot more women have access to and actually attend antenatal clinics.
This would allow for the preempting of pregnancy related complications and also ensure that

pregnant women engage in practices suitable for their condition throughout that period and

during delivery.

3. Embark upon massive education to reduce negative socio-cultural practices on maternal care.

25
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 QUESTIONNAIRE

This questionnaire is for academic research and designed to find out the factors that contribute to

increased maternal mortality rate at Goaso Government Hospital. Your responses will be treated

confidential and all information will be reported as aggregated data. Hence, you are not required to

write your name. There are no wrong or right answers. This is just to seek your opinion on the

subject. Kindly tick the appropriate spaces provided or write what you think in the open-ended

questions. The questionnaire will take approximately 30 minutes at most to be completed. We will

be grateful if you can answer all questions to the best of your ability. Thank you.

SECTION A: DEMOGRAPHIC DATA

1. Age (at last birthday) …………………………………

2. Marital status a. Single (never married) [ ] b. Married [ ] c. Living together [ ]

4. Religion: a. Christian [ ] b. Muslim [ ] c. Traditional [ ] d. Others [ ]

5. Have you ever attended school? Yes [ ] No [ ]

6. What is the highest level of school you attended?

a. Primary [ ]
b. Middle/JSS [ ]
c. Secondary or SSS [ ]
d. Tertiary [ ]

29
7. Are you Pregnant now?

a. Yes [ ]
b. No [ ]

8. How many months are you pregnant? [ ]

9. Is abortion legal in Ghana?

a. Yes [ ]
b. No [ ]

10. Under what condition is abortion legal in Ghana?

a. Rape [ ]
b. Incest [ ]
c. Life of mother in Danger [ ]
d. Fetal Abnormality [ ]

11. How many months was the fetus when you had the abortion? Specify [ ] don’t know [ ]

13. Have you ever had a miscarriage? (Tick all that apply)

a. Yes [ ]
b. No [ ]

14. What caused this miscarriage to happen (Tick all that apply).

a. Accident [ ]
b. Ate something [ ]
c. Spontaneous [ ]
d. Someone hurt me [ ]

15. Did you see anyone for antenatal care during pregnancy?

a. Yes. [ ]

30
 b. No. [ ]
c. Don’t know [ ]

16. If YES, who did you see?

a. Health personnel [ ]
b. Doctor [ ]
c. Nurse/Midwife [ ]
d. Traditional Birth Attendant

17. How many months of pregnancy were you when you first received antenatal care?

a. 1 week [ ]
b. 3 months [ ]
c. 4 moths[ ]
d. 5months [ ]
e. Don’t know [ ]

18. How many times did you receive antenatal care during pregnancy?

SPECIFY [ ] DON’T KNOW [ ]

19. Where did you give birth to?

a. Home [ ]
b. Government Hospital [ ]
c. Health Center [ ]
d. Polyclinic [ ]

20. Did you go to the place you were referred to or told to go for treatment?

a. Yes [ ]
b. No [ ]

21. Was your baby delivered through caesarian section?

a. Yes [ ]
b. No [ ]

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Thank you for participating!!!

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