Is there a safe limit of delay for emergency caesarean section in Ghana? Results of analysis of early perinatal outcome

Objective: To determine the limits of delaying caesarean section in a busy obstetric unit in a developing country setting that is not associated with neonatal survival.Methods: Retrospective cohort study of emergency cesarean sections. Indications were sub-divided into imminent threat and no imminent threat to fetal wellbeing. The primary outcomes was a composite measure of adverse perinatal outcome including stillbirth, 5-minute Apgar score < 7 and neonatal intensive care unit admission. Effect of decision-to-delivery interval on perinatal outcomes was evaluated using Kaplan-Meier survival analysis.Results: 495 women met inclusion criteria (142 ‘imminent threat’ group, 353 ‘no imminent threat’ group). The median decision-to-delivery interval was significantly shorter in the ‘imminent threat’ group (2.25 [95% CI 1.38 - 5.83] versus 3.42 [95% CI 1.83 - 5.85] hours, p <0.001). Only 1.7% and 12.7% sections were performed within 30 minutes and 1 hour, respectively. Risk of the composite outcome was significantly higher in the ‘imminent threat group (46.5% versus 31.2%, RR=1.49 [95% CI 1.18 – 1.89],  p=0.001). A 95% probability of ‘live intact’ survival occurred at 1hr and 2hrs respectively, for the imminent threat and the no imminent threat groupsConclusion: Increasing decision-to-delivery interval is associated with higher risk of adverse perinatal outcomes, but a 95% live intact survival can be achieved if the delivery occurs within 2 hours.Key words: Limits of delay, caesarean section, Ghana, perinatal outcom

Sexually transmitted infections and health seeking behaviour among Ghanaian women in Accra

The study was to measure the prevalence of sexually transmitted infection (STI) symptoms among women in Accra, Ghana, to identify characteristics that predispose to STI symptoms and to identify factors that influence health-seeking behaviour of women with STI symptoms. Data were collected by trained interviewers through questionnaire interviews of 3183 women. Data analysis was restricted to 1329 women with complete data. Only 19% of our study group had STI symptoms. Only 35% of the women with STI symptoms received care. Having high wealth index, being older and having no history of condom use were protective factors for experiencing STI symptoms. Seeking care was associated with increased by high wealth index and the presence of an offensive vaginal odour. Income level on its own did not affect health seeking behavior. Wealth index is the most significant determinant of a woman having STI symptoms and seeking care in Accra (Afr J Reprod Health 2008; 12[3]:151-158)

Clinic visits and cervical cancer screening in Accra

Objective: To determine the factors that increase the chances of a woman in Accra having a Pap smear and whether women who have recently visited clinics have higher chances of having had Pap smears.Design: A cross-sectional studyMethods: A representative sample of women in Accra, Ghana was interviewed and the clinical and demographic factors influencing cervical cancer screening was assessed.Results: Out of 1193 women with complete data, only 25 (2.1%) had ever had a Pap smear performed though 171 (14.3%) had their last outpatient clinic visit for either a gynaecological consultation or a regular checkup. Simple logistic regression showed that a high educational level, high socioeconomic status and a history over the past month of postmenopausal or intermenstrual bleeding significantly increased the odds of ever having a pap smear. Neither monthly income nor lastclinic visit for a gynaecological consultation or regular check up increased the odds of having a pap smear. Multiple logistic regression showed that a high educational level and experiencing postmenopausal or intermenstrualbleeding were the most important determinants of ever having a Pap smear.Conclusion: While we wait for a national program for cervical cancer screening, there is a need for clinicians to put more individual effort into ensuring that asymptomatic women are screened for cervical cancer

Utilization of Obstetric Services in Ghana between 1999 and 2003

Analysis of the 2003 Ghana Demographic and Health Survey shows that even though over 90% of pregnant women attend antenatal care in health institutions, only 43% deliver in the health institutions. The quality of antenatal care received is also lower than is expected for standard obstetric care. The national caesarean section rate of 3.7% reflects inadequate obstetric coverage. There is a need for continued education of health workers to improve the quality of antenatal care. The Ghanaian health system needs to consider how to improve obstetric coverage by skilled attendants and to study the reasons for inadequate use of delivery services in order to be able to achieve the target for maternal health set in the Millennium Development Goals (Afr. J. Reprod. Health 2010; 14[3]: 153-158).Key words: Obstetric services, antenatal care, delivery care, skilled attendants, safe motherhood

Potential pathogens in the lower genital tract at manual vacuum aspiration for incomplete abortion in Korle Bu teaching hospital, Ghana

Objectives: To determine the carriage rates of potential pathogens in the lower genital tract and factors associated with colonization among women with incomplete abortion. Design: A cross-sectional study. Setting: The Manual Vacuum Aspiration room of the Korle-Bu Teaching Hospital, Accra, Ghana. Subjects: Two hundred women undergoing Manual Vacuum Aspiration at the Korle- Bu Teaching Hospital. Methods: Eligible patients were screened for the presence of organisms in the lower genital tract by microscopy and culture of high vaginal and endocervical swabs. Results: Nearly two-thirds of the patients (64.2%) had potential pathogens in the lower genital tract. Bacterial vaginosis alone was present in 47% and a combination of bacterial vaginosis and Candida albicans was present in 17.2%. Residence in an urban slum showed a significant association with the presence of potential pathogens (Odds ratio 2.6; p-value 0.04). Conclusion: Organisms responsible for bacterial vaginosis were the most frequently isolated potential pathogens in the cervical canal of patients with incomplete abortion at the Korle-Bu Teaching Hospital. Management of these patients should therefore include antibiotic prophylaxis against bacterial vaginosis. East African Medical Journal Vol.81(8) 2004: 398-40

DRIVERS OF ANAEMIA REDUCTION AMONG WOMEN OF REPRODUCTIVE AGE IN THE EASTERN AND UPPER WEST REGIONS OF GHANA: A SECONDARY DATA ANALYSIS OF THE GHANA DEMOGRAPHIC AND HEALTH SURVEYS

Anaemia among women of reproductive age (WRA) increases the risk of pregnancy-related morbidity, mortality, and poor pregnancy outcomes. Globally, there is growing interest to reduce anaemia among WRA. In Ghana, anaemia among WRA declined at the national level between 2008 (59%) and 2014 (42%). There were also important declines at the sub-national level. The Eastern region (in the south) and Upper West region (in the north) provide an interesting opportunity to understand the decline. Identifying the drivers of anaemia reduction among WRA in Ghana provides important implementation science evidence for designing effective interventions. This current study examined the drivers of reduced anaemia prevalence in women of reproductive age using data from the Ghana Demographic and Health Surveys for 2008 and 2014. Anaemia was diagnosed as haemoglobin<12.0g/dl. Data were summarized using proportions and 95% confidence intervals. A weighted binary logistic-based multivariate decomposition technique was used to identify the potential drivers of anaemia across surveys for 2003, 2008 and 2014. Sensitivity analysis was carried out to test the robustness of the results of the decomposition analysis using haemoglobin concentration. The results of the decomposition analysis were presented as endowment and coefficient effects. Statistical analysis was carried out using Stata version 15. There was an improvement in access to water and sanitation, health services, family planning, and health insurance across surveys. Drivers of anaemia reduction over time at the national level included wealth index and maternal age, education, use of hormonal contraception and body mass index (BMI). In the Eastern region, the drivers of change were household wealth index, maternal age, hormonal contraceptive use and BMI. The drivers of change in the Upper West region, were household access to water, maternal education and BMI. The findings suggest that multi-level interventions are needed across sectors to further reduce anaemia among WRA

Contraceptive use by women in Accra, Ghana: results from the 2003 Accra women’s health survey

The study was to determine the predictors of use of modern contraception among women in Accra, Ghana. Data were collected by trained interviewers using questionnaires. Complete data for 2199 women were analysed using Stata 8.2. The study showed that educational status was the most significant predictor of contraceptive use. Women with no formal education had a 48% reduction in the odds of having ever used contraception and a 66% reduction in the odds of currently using contraception. Regular use of health facilities did not affect contraceptive use. Female education should continue to be a priority of the Ghanaian government. Education about family planning and the effects of having large families should be integrated into the school curriculum. Ghanaian health workers need to be active in promoting the use of modern contraceptive methods (Afr J Reprod Health 2009; 13[1]:123-133)