Educational Research Vol. 1 (1), pp. 008-014, February, 2010 Available online at http://www.interesjournalsjournals.org/ER © 2010 International Research Journals Improving maternal health in Ghana: resource availability for safe delivery in Akatsi and Keta Districts of Volta Region Chuks J. Mba1* and Irene K. Aboh1 1*Regional Institute for Population Studies, University of Ghana, P.O. Box LG96, Legon, Ghana. Accepted 20 December, 2009 The thrust of the present study was to examine resources available for safe delivery in Akatsi and Keta Districts of Volta Region of Ghana with a view to highlighting the importance of improving maternal health in these districts in particular, and by extension in Ghana as a whole. Interviews were conducted from a sample size of 6,250 respondents within the reproductive age group of 15-49 years drawn from both districts in 2007. The results show that most of the women had only basic education and were generally petty traders, farmers and fishmongers. Only 39.2% of the women from Akatsi and 53.9% of their counterparts from Keta delivered in a hospital within 8 km from their places of residence, implying that a substantial proportion of the women from both districts traveled long distances to deliver their babies. Furthermore, delivery by traditional birth attendants (TBAs) and assisted delivery at home by relatives and friends were still common, while the road network in both districts was poor. About 25% of the women from both districts spent more than 1 hr to walk to a health facility, while those who patronized vehicular means of transport had to pass through rough roads (61.2% in Akatsi and 52.2% in Keta). The findings also suggest that 36.4% and 29.1% from Akatsi and Keta districts respectively needed extra care from their attendants or experienced some degree of delay at the health facility level. The Government of Ghana should therefore aim at increasing girls’ participation at all levels of the education system in the country, and rehabilitate roads or construct new ones to help the people transport emergency complications to the health facility on time to prevent deaths. Every pregnant woman should be assisted by a skilled birth attendant because maternal deaths from pregnancies and birth complications are avoidable if the women are attended to by skilled professionals in well-equipped health facilities. Key words: Childbirth, Ghana, health, maternal, mortality, pregnancy. INTRODUCTION Maternal death or maternal mortality (It is also called woman during or shortly after a pregnancy. In the "obstetrical death", and according to the World Health developing world as a whole, a woman has a 1 in 76 Organization, "A maternal death is defined as the death lifetime risk of maternal death, compared with a of a woman while pregnant or within 42 days of probability of just 1 in 8,000 for women in industrialized termination of pregnancy, irrespective of the duration and countries (World Health Organization et al, 2007). The site of the pregnancy, from any cause related to or evidence further suggests that a woman in sub-Saharan aggravated by the pregnancy or its management but not Africa has a 4.5% chance of dying from causes related to from accidental or incidental causes”) is the death of a pregnancy in her life. However, most of these deaths have been medically preventable for decades, because treatments to avoid such deaths have been well known since the 1950s (Nour, 2008; Rosenfield et al, 2007; *Corresponding author E-mail: [email protected] , Costello et al, 2006). [email protected]. Tel: (233 21) 500274, (233 21) 514574, As stated in the 2005 World Health Organization report (233 20) 8183860. Fax: (233 21) 500273. "Make Every Mother and Child Count", the major causes Mba and Aboh 009 of maternal death are: severe bleeding/hemorrhage every day, while the other government health facilities in (25%), infections (13%), unsafe abortions (13%), the district provided limited health services. Since for eclampsia (12%), obstructed labour (8%), other direct some women, labour generally begins in the night, a causes (8%), and indirect (Indirect causes include substantial proportion of them preferred to patronize malaria, anaemia, HIV/AIDS and cardiovascular disease, either private health facilities in the district (which rarely complicate pregnancy or are aggravated by it) causes provided information on maternal mortality) or hospitals (20%). Current evidence suggests that over 90% of located in the other districts that were very close to Akatsi maternal deaths occur in developing countries. Maternal District. This fact is buttressed by the fact that in the Mortality Ratio (MMR), which is the ratio of the number of present study respondents in Akatsi District reported maternal deaths per 100,000 live births, is used as a maternal deaths in their communities), while Keta District measure of the quality of a health care system. Sierra had 177 maternal deaths per 100,000 live births. Leone has the highest maternal death rate at 2,000, and For a framework for safe motherhood promotion, the Afghanistan has the second highest maternal death rate present study attempts to identify the contributing factors at 1900 maternal deaths per 100,000 live births. In fact, responsible for high maternal mortality in Akatsi and Keta African countries are the worst hit as, for example, the Districts of the Volta region of Ghana on the basis of following countries all in sub-Sahararan Africa have MMR available data. at or in excess of 1,000: Malawi (1,800), Angola (1,700), Without baseline information, the region will not be able Niger (1,600), Tanzania (1,500), Rwanda (1,400), Mali to effectively plan, implement and evaluate programmes (1,200), Somalia, Zimbabwe, Chad, Central African concerning maternal health. If the Safe Motherhood Republic, Guinea Bissau (1,100 each), Mozambique, Initiative is to succeed in the Volta Region, some Burkina Faso, Burundi, and Mauritania (1,000 each). empirical information on the specific delayed factors Ghana currently has maternal mortality estimated at 451 contributing to maternal mortality should be known and deaths per 100,000 live births (Ghana Statistical Service since no specific study has been done in this direction, et al, 2009a), while lowest rates of MMR can be found the present study is appropriate and timely. generally in countries of the West (such as Iceland at 0 Current programmes devoted much of their efforts to per 100,000 and Austria at 4 per 100,000). emergency preparedness and to the provision of Since the launch of the Safe Motherhood Initiative in emergency obstetric care (EmOC). An increasing number 1987, the goal of reducing maternal mortality has been of such programmes are based on the three delayed reiterated at many global conferences. At the Millennium models, which are a framework that explain the social Summit in 2000, for example, the United Nations Member factors responsible for maternal death (UNFPA, 2002). In States issued the Millennium Development Goals most instances women who die in childbirth experienced (MDGs) that call for a three-fourths reduction in maternal at least one of the following three delays: (i) delay in mortality rates by the year 2015. Similarly, two major deciding to seek care for an obstetric complication (This international conferences, the 1994 Cairo International may be due to several reasons, including late recognition Conference on Population and Development (ICPD) and that there is a problem, fear of the hospital or of the cost the 1995 Beijing Fourth World Conference on Women that will be incurred there, or the lack of an available echoed the concerns of the Nairobi Conference in 1987 decision maker); (ii) delay in reaching the health facility on safe motherhood initiatives which urged immediate (This is usually caused by transport difficulties as many global action. villages have poor road network and very limited According to a newly released national study, one in transportation options); and (iii) delay in obtaining care at five deaths among Ghanaian women aged 15 to 29 is the health facility (This delay is occasioned by waiting so due to complications of pregnancy and childbirth (Ghana many hours at the referral centre because of poor Statistical Service et al, 2009a). Nationwide, Ghana’s staffing, prepayment policies, or difficulties in obtaining maternal mortality ratio is estimated at 451 deaths per blood supplies, equipment or going to an operating 100,000 live births in the seven years preceding the theatre). survey, about 40 times the maternal mortality ratio in the Any of these delays can lead to the death of the United States. From the annual reports of the Volta expectant woman. The death of a woman in childbirth is a Region, MMR was 256/100,000, 262/100,000, tragedy, an unnecessary and wasteful event that carries 256/100,000 and 200/100,000, respectively for 2003, with it a huge burden of grief and pain. Pregnancy is not 2004, 2005 and 2006 years. These reports indicate a disease and pregnancy related morbidity and mortality further that by 2006 Akatsi District recorded no maternal are preventable (Begum et al, 2003). As noted deaths (That Akatsi District recorded no deaths does not previously, reducing the maternal mortality by three in any way imply that there were no maternal deaths in quarters between 1990 and 2015 is a specific part of the district. The district as at the time of this study had Goal 5 -Improving Maternal Health - of the eight only one health centre that was being considered for a Millennium Development Goals. district hospital (unlike Keta District that had two In the light of the foregoing, the study aims to examine hospitals).This facility was closed to public after 6.00 pm the women’s accessibility to health institutions, and iden- 010 Educ.Res.