Maternal Mortality Audit, a tool to identify the causes of maternal mortality with communities’ perspective, a case study of Nsawam-Adoagyiri Municipality

ABSTRACT

As the world gradually enters the last stage of MDGs target, concerns are raised with countries lacking the achievement of MDGs 5 on maternal mortality. In the 2010 Ghana Population and Housing Census, it is indicated that 33,347 women died in the last 12 months preceding the census. Out of the number, 3,026 are recorded as pregnancy-related deaths (i.e. died during pregnancy, delivery or within 42 days of the termination of a pregnancy - GSS, 2012). Since the development of the MDG 5, considerable progress has been made by some countries whiles others remain stagnated. However, challenge still remains on measurement of maternal mortality, including number of deaths, their causes and circumstances in low-income countries. One of the best strategies and cost effective way of addressing maternal mortality is the use of maternal audit tool to identify the root cause of maternal mortality.

This study therefore aimed at identifying the main causes of maternal mortality in the Nsawam-Adoagyiri District and how maternal death audit together with community assessment brings out these causes. Moreover, the study also reviewed the various approaches adopted by the district in addressing the causes of maternal mortality. The study used both quantitative and qualitative analyses in drawing conclusions on findings from the field. Both primary and secondary data were collected for analysis. The study used both simple random and purposive sampling technique to sample community members, institutions including Health Directorate, Nsawam Hospital, and some health facilities in the district. A total of 125 community women were interviewed at the community. Additionally, two FGDs were conducted for 10 community members (five in each community) and 8 health staff interviewed.

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The study observed that maternal mortality data was only available for district hospital. The health directorate had no record of community-level maternal death. However, with a follow up to the community, it was observed that three maternal deaths had occurred at the community level. For the period under review in this research, seven facility-based maternal deaths were recorded with 20020 live births. This comes to confirm the challenges that come with analysing maternal death trends in the country. The recorded seven maternal deaths give an institutional maternal mortality rate of 35 deaths per 100000 live births for the period under the review.

The study established a positive relationship between maternal audit and causes of maternal death. Through the various maternal audits conducted by the district health directorate, it was observed that the leading direct causes of maternal mortality are eclampsia, haemorrhage and obstructed labour. The indirect cause of maternal mortality was identified to be anaemia. It is therefore important to note that any strategy that addresses maternal mortality should consider providing comprehensive education on maternal care including nutrition. To ascertain the causes of maternal mortality a maternal audit team is established to collect data on three different contributing factors: technical, managerial and others (not limited to socio-cultural factors). Strategies adopted to curb any further cause of maternal mortality include emergency community transport system, community awareness campaigns and community outreach health care delivery.

The study therefore recommends that the Nsawam-Adoagyiri Health Directorate through the Public Health Unit should strengthen its structures on the ground to be able to report all maternal death cases in the community. Additionally, the audit process should include community members and deceased’s relatives to help establish the socio-cultural causes of maternal death.