Transcript E.Y. Kwawukume - National

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
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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
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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.
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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.
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Year Total deliveries Live births
births%
2002
2003
2004
2005
2006
2007
2008
11,798
10,528
11,099
11,175
7,229
7,378
10,310
11,122
9,901
10, 392
10, 443
7,624
6,993
9,785
Still Births
676
627
707
732
395
385
525
SB/Live
5.7
6.3
6.8
7.0
5.2
5.5
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
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Year
1984-1994
1995-2002
2003-2008
Rate
734.4
777.2
884.2
Causes
1984-1994. 20052008
 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
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Year
Rates
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1991
99.1
1992
99.8
2008
80.7
The perinatal mortality rate showed 18.4%
decrease as compared to the year 1991.
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Causes
Prematurity
Birth Asphyxia
Bacteria Sepsis
Number
145
121
6
Causes
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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
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Staff
Number % Population Ratio
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Nurses
women
Doctors
women
14,297
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1 to 1,000
2,334
0.02
1 to 5,000
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There is a geographical there are regional
variation from the North to the South
Year enrolled
graduated
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No
Year graduated
1999
83
2000
89
2001
90
2002
89
2003
111
An average of 88 doctors
since 1999.
No
2005
77
2006
87
2007
83
2008
88
2009
105
is produced annually
Year
No. Obstetricians
 2006
3
 2007
 2008
2
No. Pediatricians
6
1
1
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Year Obst Pedia Anes Family Med
2007
7
2008
9
5
7
7
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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.
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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.
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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.
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Due to physical distance,
Poor road networks,
Inadequate ambulance services.
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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.
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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
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inadequate number of midwives,
lack of functioning theatres
frequent shortages of blood and blood
products as against a high annual delivery
rate.
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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.
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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.
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Efforts must be made to decongest the
hospitals
Polyclinics should be fully functional
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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
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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.
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Maternal mortality is a Human Rights issue
and should be recognized as such
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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