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EY Kwawukume

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									               E. Y Kwawukume
Professor and Chair, K.K. Bentsi-Enchill Chair,
  University of Ghana Medical School, College
  of Health Sciences, Dept of Obst and Gynae,
                     Korle Bu
   The main indices of quality obstetric and
    perinatal care in a given geographical location
    are maternal and perinatal mortality.
   WHO estimates that at least 1,600 women die
    every day associated with pregnancy and child
    birth.
   90% of these deaths occur in sub-Saharan Africa
    and Asia.
   Annual del KBTH is between 10,000 to 12,000
    women.
   About 36% of the pregnant women with
    complications reach the hospital in a moribund
    state
   40% or more of pregnant women may
    experience acute obstetric problems during
    pregnancy, child birth and puerperium.
   Of this number an estimated15% of the
    pregnant women develop life-threatening
    complications.
   Significant percentage of the maternal deaths
    is therefore due to emergency complications
    of pregnancy.
   This is a descriptive study.
   Data was collected from published articles
    including studies from 1984 to 1994 and
    1995 to 2002,
   records were retrieved from the depart of
    Obs/Gynae and Child Health, KBTH
   Ghana Statistical Service, Ministry of Health
    Human resource Division
   University of Ghana Medical School.

   Year Total deliveries Live births   Still Births   SB/Live
    births%

   2002     11,798          11,122          676           5.7
   2003     10,528           9,901          627           6.3
   2004     11,099          10, 392         707           6.8
   2005     11,175          10, 443         732           7.0
   2006      7,229           7,624          395           5.2
   2007      7,378           6,993          385           5.5
   2008     10,310           9,785          525           5.4
    Year   Live births   Maternal deaths    MMR

 2005        10,443              95           909
 2006          7,624             62           813
 2007          6,993             72
  1,029
 2008          9,785             77           786
 2005-2008       -                -             884
 MMR/100,000
Most of the cases are referrals from the district
   Year        Rate
   1984-1994   734.4
   1995-2002   777.2
   2003-2008   884.2
   Causes                      1984-1994. 2005-
  2008
 Hemorrhage                  17.7%       30.0%
 Hypertensive disorders     17.5%        25.8%
 Abortions                   13.5%       10.7%
 Genital infections         9.5%          3.5%
 Obstructed labour           5.5%          0.3%
 Others                       36.3%        29.4%
Causes of MM remain the same but there is
  significant increase in the major causes, ie hypert
  and haemorrage
     Year           Rates                 .
   1991            99.1
   1992           99.8
   2008           80.7
   The perinatal mortality rate showed 18.4%
    decrease as compared to the year 1991.
       Causes          Number
    Prematurity      145
   Birth Asphyxia    121
   Bacteria Sepsis     6
    Causes            year
                 1990 1992     1991/1902
    2008
   Prematurity 52.1% 55.3% 58.8%
    53.3%
   Birth asphyxia 26.7% 19.1% 23%
    44.4%
   Bacteria sepsis 11.6% 14.6% 13%
    2.2%
Languages                       Women     Men
 English/other languages    45.7%     62.9%
 English/one Ghanaian language 27.2% 41.6%
More than half of the population in Ghana is
  illiterate.
The literacy rate of women is lower than that of
  men.
   Sex             Number
 Women       11,816,192
 Men          11,600,326
 Total        23,416,518
The population of women and men is almost
  equal with the women having a slight edge
  over the men
   Staff     Number % Population Ratio          .

   Nurses     14,297      0.1       1 to 1,000
    women
   Doctors    2,334       0.02      1 to 5,000
    women

   There is a geographical there are regional
    variation from the North to the South
Year enrolled      No    Year graduated      No
 graduated

   1999              83       2005              77
   2000             89        2006              87
   2001             90        2007              83
   2002             89        2008              88
   2003             111       2009            105
   An average of 88 doctors   is produced annually
    since 1999.
Year   No. Obstetricians   No. Pediatricians
 2006      3                       6
 2007      -                       1
 2008      2                       1
   Year Obst Pedia Anes Family Med
   2007  -      -    -          7
   2008  9      5    7          7
   MMR of 884.2 per 100,000 live births and the
    perinatal mortality rate of 80.7 per1,000 births
    are high compared to that obtained in the
    developed countries.
   The causes of maternal and perinatal mortality
    have remained the same
   the major causes of maternal mortality,
    hemorrhage and hypertensive disorders of
    pregnancy, showed a significant percentage
    increase.
   These causes are emergency obstetric and
    perinatal conditions.
   More than half of the population of Ghana are
    illiterate .
   The illiterate population is less likely to lead a
    healthy life style.
   They are also less likely to make use of
    available health services.
   Clinical features of complications of
    pregnancy may not be recognized and as
    such may be misinterpreted and report late
    for treatment.
   Poverty is a high risk factor
   It is associated with illiteracy and impedes access
    to health care.
   The global economic situation is not in favor of
    the developing countries.
   This situation has been worsened by bad
    governance; bad developmental policies and
    corruption
   The majority of the population is therefore poor.
   When complications arise there may be no money
    to finance transportation and medical bills.
   The patient may not be taken to a health care
    facility.
   Due to physical distance,
   Poor road networks,
   Inadequate ambulance services.
   lack of medical supplies and equipment,
   non functioning theaters
   shortage of medical staff.
   From the study the ratio of a nurse to the
    women population is 1:1000
   doctor to the women population 1:5000.
   This is woefully inadequate leading to
    MM/PNM.
   Measures presently taken to address the
    situation are also woefully inadequate.
   On the average 88 doctors are trained
    annually from KBTH
   Much more worse is the number of Specialist
    doctors
   inadequate number of midwives,
   lack of functioning theatres
   frequent shortages of blood and blood
    products as against a high annual delivery
    rate.
   To increase the literacy rate at all the levels of
    education including informal education.
   To reach out to the populace on health issues
    both in English and the local languages.
   The transportation network should be
    improved.
   The National Ambulance Service should be
    resourced and expanded to reach a large
    number of communities.
   Helicopter services should be established to
    airlift emergency cases to health facilities.
   mobile phone services to compliment the services in
    the transport sector
   Governments to tackle the problems of corruption,
    show good governance and formulate policies when
    dealing with multinational coorperations in order to
    get better deals for their countries
   National Health Insurance Scheme to be encouraged.
   The challenges in the NHIS affecting the finances of
    the health providers should be quickly addressed.
   Health personnel should have continuous heath
    education including ethics. This is currently being
    done - Continuous Professional Development
    Programs for doctors.
   Efforts must be made to decongest the
    hospitals
   Polyclinics should be fully functional
   La polyclinic now a hospital.
   The burden on KBTH has reduced. Delivery from
    12,000 to 9,931 babies annually.
   Many standard Private hospitals are springing up
   Private organizations are helping government
    facilities eg MTN refurbishing KBTH labour ward
    and thaetres.
   Private institutions should train more health
    personnel
   They should be encouraged to grow to effectively
    supplement the efforts of government
   Major causes are Prematurity and asphyxia
   Supervised delivery should be encouraged
    Adequate ambu-bags in labour wards and
    NICU
   Availabilty of Maternal and neonatal
    ventilators
   Oxygen cylinders to be at all delivery units
   Management protocols should be established.
   Maternal mortality is a Human Rights issue
    and should be recognized as such
   Doctors and nurses- Are we doing enough!
    What about Hospital Administrators!
   What about Parliamentarians!-do you know
    the needs of pregnant women in your
    constituency?
   And our Ministers- are we visiting health
    institutions including maternity homes!
   What about ourselves who are hearing this
    presentation

								
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