Maternal mortality at the Korle Bu Teaching Hospital, Accra, Ghana: A five-year review

Maternal death is a major global health issue with the highest impact in low-income countries. Despite some modest decline in the maternal mortality rates in Ghana since the 1990’s, this has been below expectation. The aim of this study was to describe the trends and contributory factors to maternal mortality at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. We performed a retrospective chart review of all maternal deaths at KBTH from 2015 to 2019. Data were analyzed using SPSS version 23. A p-value of <0.05 was considered statistically significant. Over the period, there were 45,676 live births, 276 maternal deaths and a maternal mortality ratio of 604/100,000 live births (95% CI: 590/100,000 - 739/100,000). The leading causes of maternal death were hypertensive disorders (37.3%), hemorrhage (20.6%), Sickle cell disease (8.3%), sepsis (8.3%), and pulmonary embolism (8.0%). Significant factors associated with maternal mortalities at the KBTH were: women with no formal education [AOR 3.23 (CI: 1.73 - 7.61)], women who had less than four antenatal visits [AOR 1.93(CI: 1.23-3.03)], and emergency cesarean section [AOR 3.87(CI: 2.51-5.98)]. Hypertensive disorders remain the commonest cause of the high maternal mortality at KBTH. Formal education and improvement in antenatal visits may help prevent these deaths. La mortalité maternelle est un problème de santé mondial majeur ayant le plus grand impact dans les pays à faible revenu.Malgré une légère baisse du taux de mortalité maternelle au Ghana depuis les années 1990, cela a été au-dessous des attentes. Le but de cette étude était de décrire les tendances et les facteurs qui contribuent à la mortalité maternelle à l’Hôpital Universitaire de Korle Bu (KBTH), Accra Ghana. Nous avons effectué un examen rétrospectif des dossiers concernant les décès maternels à KBTH de 2015 à 2019. Les données ont analysé à l’aide de SPSS version 23. Une valeur p de <0,05 était considérée comme statistiquement significatif. Sur la période, il y a eu 45 676 naissances, 276 décès maternels et un taux de mortalité maternelle de 604/100 000 naissances (IC à 95% : 590/100 000 – 739/100 000). Les causes principales des décès maternels étaient les troubles hypertensifs (37,3%), les hémorragies (20,6%), la drépanocytose (8,3%) la septicémie (8,3%) et l’embolie pulmonaire (8,0%). Les facteurs importants associés aux mortalités maternelles à KBTH étaient : les femmes sans éducation formelle [AOR 3,23 (IC : 1,73-7,61)], les femmes qui ont eu moins de quatre visites prénatales [AOR 1.93 (IC : 1,23-3,03)] et l’urgence césarienne [AOR 3,87(IC : 2,51- 5,98)]. Les troubles hypertensifs restent la cause le plus fréquente de la mortalité maternelle à KBTH. Une éducation formelle et une amélioration des visites prénatales peuvent aider à éviter ces décès

Data_Sheet_1_International collaborative research, systems leadership and education: reflections from academic biomedical researchers in Africa.docx

ScopeAcademic biomedical researchers and educators in African countries navigate complex local, national, and international systems to conduct grant-funded research. To secure funding, collaboration with researchers from high-income countries is often necessary. Existing literature highlights that these global health initiatives are commonly fraught with unequal power dynamics and lead by the foreign partners. Despite these inequalities, African faculty can benefit from these collaborations, fostering the development of their labs and careers. This study delves into reflections on lived experiences from academic biomedical researchers in Africa to better understand the impact of foreign collaborations.MethodsWe designed a qualitative study using the Interpretative Phenomenological Analysis (IPA) method and used Self-determination and Complex Systems Leadership theories to frame this study. Ten academic biomedical researchers in Africa consented to join this study. The participants submitted a four-week series of reflective journals through an online data management platform. Subsequently, IPA methods were employed to analyze the collected journals.ResultsParticipants’ reflections yielded six thematic key findings, encompassing their experiences in international collaborative research. The findings included: foreign dominance within the international macrosystem; resource challenges in their local microsystems; mesosystem dependency from collaborations; scholarly identity within research relationships; collaborative leadership; and the impact of the foreign perspective. From these findings, three implications were drawn suggesting that participants were (1) motivated by scholarly identity found in collaborations; (2) depended on collaborations that were colonialist but beneficial; and (3) created change through leadership at the microsystem level.ImplicationsForeign collaborators and funders in global health education and research should critically consider how implications of this study relate to their collaborative work. Based on our analysis, recommendations for foreign collaborators and funders include prioritizing local leadership and perspectives in education initiatives and research grants; reviewing and leveraging collective leadership; engaging in bidirectional training, and mentoring opportunities; participating in power assessments; and removing publication barriers for researchers in Africa (and low-and middle-income countries). Insights from this study could impact global health research and education in multiple ways including new initiatives in mentorship and training in international collaborations along with increased awareness and correction of colonialism within these collaborations.</p