Risk factors for Caesarean sections in Ghana: evidence from the Ghana Maternal Health Survey

2020 ◽  
pp. 1-18
Author(s):  
Emmanuel Banchani ◽  
Eric Y. Tenkorang
Keyword(s):  
Risk Factors ◽  
Maternal Health ◽  
Caesarean Section ◽  
Health Survey ◽  
Elective Caesarean Section ◽  
Sub Saharan Africa ◽  
Maternal Complications ◽  
Obstructed Labour ◽  
Sub Saharan ◽  
Using Data

Abstract A Caesarean section can be a life-saving intervention in case of pregnancy complications or difficult labour. The prevalence of Caesarean section continues to increase, especially in sub-Saharan Africa, yet the reasons for this remain largely unexplored. This study investigated risk factors contributing to the decision to perform Caesarean sections in Ghana using data from 8645 women aged 15–49 years from the 2017 Ghana Maternal Health Survey. The data were analysed by applying complementary log-log and logit models. The majority of Ghanaian women (about 87%) reported preferring vaginal delivery to Caesarean section. Of those who had undergone a Caesarean section for their most recent birth, about 55% had an elective rather than an emergency section. Women with labour complications (prolonged/obstructed labour) were significantly more likely to have a Caesarean section (OR=4.09, 95% CI=3.10–5.41). Furthermore, women with maternal complications, particularly prolonged/obstructed labour, were less likely to have an elective Caesarean section than those who had no such complications (OR=0.25, 95% CI=0.14–0.46). Compared with poorer women, wealthy women were significantly more likely to have an elective Caesarean section (OR=1.84, 95% CI=1.08–3.14). The findings suggest that beyond maternal complications, women’s socioeconomic and demographic characteristics are important risk factors for undergoing a Caesarean section in Ghana.

EFFECTS OF COUPLES' CHARACTERISTICS ON CONTRACEPTIVE USE IN SUB-SAHARAN AFRICA: THE GHANAIAN EXAMPLE

1997 ◽  
Vol 29 (1) ◽  
pp. 33-49 ◽  
Author(s):  
YAW OHENEBA-SAKYI ◽  
BAFFOUR K. TAKYI
Keyword(s):  
Family Planning ◽  
Health Survey ◽  
Contraceptive Use ◽  
Sub Saharan Africa ◽  
Men And Women ◽  
Socioeconomic Characteristics ◽  
Sub Saharan ◽  
Using Data ◽  
The Impact

Using data from the 1988 Ghana Demographic and Health Survey, this study examines couples' demographic and socioeconomic characteristics in the context of their attitudes towards family planning, and the impact of these factors on the use of contraceptives. The characteristics of the husbands and their influence on wives' behaviour illustrate the role of intra-household relations between men and women and their effect on fertility-related behaviour in patriarchal African societies.

scholarly journals Predictors of neonatal mortality in Ghana: evidence from 2017 Ghana Maternal Health Survey

2021 ◽  
Author(s):  
Emmanuel Ayire Adongo ◽  
John Kuumuori Ganle
Keyword(s):  
Logistic Regression ◽  
Maternal Health ◽  
Neonatal Mortality ◽  
Health Survey ◽  
Neonatal Period ◽  
Multivariate Logistic Regression Analysis ◽  
Population Level ◽  
Sub Saharan Africa ◽  
Maternal Characteristics ◽  
Sub Saharan

Abstract Background Neonatal mortality contributes about 45% of under-5 mortality globally; 35% in Sub-Saharan Africa; and over 50% of under-5 deaths in Ghana. Though there are existing studies on the determinants of neonatal mortality in Sub-Saharan Africa, limited population level analysis has been done in Ghana to understand the factors affecting neonatal mortality. Objectives The objective of the study was to examine the predictors of neonatal mortality in Ghana. Method Data from the 2017 Ghana Maternal Health Survey (GMHS) were analysed. The data used in the analysis included only responses from women who delivered live babies in the five years preceding the 2017 GMHS and the children lived for at least 28 days. A total of 10,624 respondents were included in the study after data cleaning. Descriptive statistical techniques (frequency and percentage distribution) were used to describe important background characteristics of the women included in the study. Pearson’s Chi-squares (χ2) test was used to assess association between the outcome (neonatal death) and independent variables. Multivariate logistic regression analysis was done to estimate odds ratios and control for potential confounders. Confidence level was held at 95%, and a p< 0.05 was considered statistically significant. All the data analysis was done using STATA 15. Results The prevalence of neonatal mortality was 1.8% i.e. 18 per 1000 live births. Three factors predicted neonatal mortality: ANC attendance, sex of baby, and baby being put on mother’s chest immediately after birth. Women with at least one ANC visit were less likely to experience neonatal mortality as compared to women with no ANC visit prior to delivery (AOR=0.11; CI=0.02-0.56, p=0.01). Baby girls were less likely (COR=0.68; CI=0.48-0.20; p=0.03) to die during the neonatal period as compared to boys and this did not change when potential confounders were controlled for in a multiple logistic regression model (AOR=0.68, CI=0.47-0.98; p=0.04). The odds of a baby dying within the neonatal period when a baby was not put on the mother’s chest immediately after birth were 2.5 times higher than those who were put on their mother’s chest immediately after birth (COR=2.46; CI=1.66-3.65, p=0.00). Conclusion Community level and sociodemographic factors were not significant predictors of neonatal mortality in this study. Rather, neonatal, and maternal characteristics did. Education on the importance of timely and adequate antenatal care should be intensified. Also, targeted social and behaviour change communication emphasizing the importance of immediate skin-to-skin kangaroo mother care to prevent neonatal hypothermia and promote successful breastfeeding should intensified.

scholarly journals Prevalence and Outcome of Obstructed Labour at a Tertiary Institution

2021 ◽  
Vol 04 (09) ◽  
Author(s):  
Elizabeth Nionzima ◽  
Keyword(s):  
Caesarean Section ◽  
Neonatal Intensive Care ◽  
Mode Of Delivery ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Sub Saharan Africa ◽  
Tertiary Institution ◽  
Obstructed Labour ◽  
Sub Saharan ◽  
Prolonged Hospital

Obstructed labour is a common preventable causes of both maternal and perinatal morbidity and mortality in developing countries affecting 3-6% labouring women globally and accounts for an estimated 8% of maternal deaths in Sub-Saharan Africa and South Asia. Objective: To determine the prevalence and outcome of obstructed labour in the Gynaecology and Obstetrics Department at a tertiary hospital in Northern Uganda. Method: This was a retrospective chart review of pregnant women admitted in labour and delivered by caesarean section from 1st January 2016 to 31st December 2017 at a Lira Regional Referral Hospital, a tertiary institution in Lango Sub region. Data was analysed using Statistical Package for Social Sciences version 16.0. Results: A total of 808 medical charts of mothers with obstructed labour were retrieved, evaluated and included in this review out of 12,189 deliveries during the study period, giving a prevalence of 6.6%. Majority (77%; 622/808) mothers admitted with diagnosis of obstructed were referred in from peripheral facilities. Over half (53.4%) of the women were in the age group of 20 to 29 years. Over 53%, were prime gravidae and were twice more likely to undergo C/S due to obstructed labour than multigravidas (OR 1.8; 95% CI 1.5-2.2). Only 49.2% had documented cause of obstructed labour, with Cephalo-pelvic disproportion being most common (17.5%), malposition/mal-presentation (14.6%), and macrosomia (3.6%). Partograph was used in only 46.6% (374) women who had obstructed labour. The commonest maternal complication observed were Sepsis (11%), PPH (5.2%), uterine rupture (4%) and burst abdomen (3%) which led to prolonged hospital stay and loss of fertility to some. Mode of delivery in the 808 reviewed charts was caesarean section, 90.3% of babies were born alive, while 8.5% (69) were born dead, (1.2%) had early neonatal, and 40.2% were referred Paediatric Neonatal Intensive Care Unit (NICU) because of low APGAR score. Conclusion: The prevalence of obstructed labour among women delivered by Caesarean section was high compared to the global average. Majority of the women were referrals from the peripheral health centres and associated with life threatening complications and even death. Young age and prime gravida is associated with obstructed labour and high caesarean section rates. The obstruction in multigravida could be due to secondary cephalo-pelvic disproportion as majority of the babies were in normal range weight. Low use of Partograph to monitor labour was evident among women who had obstructed.

scholarly journals Sub-Saharan African Women’s Views and Experiences of Risk Factors for Obstetric Fistula: A Qualitative Systematic Review

2021 ◽  
Author(s):  
Lydia Babatunde Bulndi ◽  
Deborah Ireson ◽  
Esther Adama ◽  
Sara Bayes
Keyword(s):  
Risk Factors ◽  
Obstetric Fistula ◽  
Evidence Synthesis ◽  
Cultural Beliefs ◽  
Sub Saharan Africa ◽  
Birth Canal ◽  
Obstructed Labour ◽  
Sub Saharan ◽  
Safe Childbirth ◽  
Women’S Views

Abstract Background: Obstetric fistula, also known as vesico vagina fistula (VVF), is a hole between the birth canal and the bladder or rectum caused by prolonged, obstructed labour. VVF may cause sufferers to experience chronic urinary and/or faecal incontinence, and the burden of continuing foul odour. Obstetric fistula is primarily caused by prolonged obstructed labour, which is brought about by a range of causes. Recently, it has been proposed that women’s groups and fistula survivors should suggest interventions to reduce or resolve the incidence of VVF. Objective: The objective of this review was to summarise what is reported about women’s own views and experiences of the risk factors underlying the causes of obstetric fistula. Methods: A systematic approach outlined in the Joanna Briggs institute Manual for Evidence synthesis was followed for this review, articles published within the last 11 years from 2011 to 2021 were selected against several criteria and critically appraised using JBI Critical Appraisal checklist for qualitative studies. Results: Nine studies were retained for inclusion in this review, the data were then synthesised into five themes: (1) Cultural beliefs and practices impeding safe childbirth, (2) Lack of woman’s autonomy in choices of place to birth safely, (3) Lack of accessibility and social support to safe childbirth, (4) Inexperienced birth attendants and, (5) Delayed emergency maternal care (childbirth).Conclusions. This review highlights the complexity of risk factors predisposing women to the known causes of obstetric fistula. It also illuminates the absence of women’s voices in the identification of solutions to these risks. Women are most directly affected by VVF. Therefore, their knowledge, views and experience should be considered in the development and implementation of strategies to address the issue. Exploring women’s views on this issue would enable the identification of gaps in maternity care provision, which would be of interest to community and health service leaders as well as policy makers in Sub-Saharan Africa.

scholarly journals HIV and cardiovascular disease in sub-Saharan Africa: Demographic and Health Survey data for 4 countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Leonard E. Egede ◽  
Rebekah J. Walker ◽  
Patricia Monroe ◽  
Joni S. Williams ◽  
Jennifer A. Campbell ◽  
...  
Keyword(s):  
South Africa ◽  
Cardiovascular Disease ◽  
Health Survey ◽  
Survey Design ◽  
Logistic Models ◽  
Population Data ◽  
Demographic And Health Survey ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
The Relationship

Abstract Background Investigate the relationship between two common cardiovascular diseases and HIV in adults living in sub-Saharan Africa using population data provided through the Demographic and Health Survey. Methods Data for four sub-Saharan countries were used. All adults asked questions regarding diagnosis of HIV, diabetes, and hypertension were included in the sample totaling 5356 in Lesotho, 3294 in Namibia, 9917 in Senegal, and 1051 in South Africa. Logistic models were run for each country separately, with self-reported diabetes as the first outcome and self-reported hypertension as the second outcome and HIV status as the primary independent variable. Models were adjusted for age, gender, rural/urban residence and BMI. Complex survey design allowed weighting to the population. Results Prevalence of self-reported diabetes ranged from 3.8% in Namibia to 0.5% in Senegal. Prevalence of self-reported hypertension ranged from 22.9% in Namibia to 0.6% in Senegal. In unadjusted models, individuals with HIV in Lesotho were 2 times more likely to have self-reported diabetes (OR = 2.01, 95% CI 1.08–3.73), however the relationship lost significance after adjustment. Individuals with HIV were less likely to have self-reported diabetes after adjustment in Namibia (OR = 0.29, 95% CI 0.12–0.72) and less likely to have self-reported hypertension after adjustment in Lesotho (OR = 0.63, 95% CI 0.47–0.83). Relationships were not significant for Senegal or South Africa. Discussion HIV did not serve as a risk factor for self-reported cardiovascular disease in sub-Saharan Africa during the years included in this study. However, given the growing prevalence of diabetes and hypertension in the region, and the high prevalence of undiagnosed cardiovascular disease, it will be important to continue to track and monitor cardiovascular disease at the population level and in individuals with and without HIV. Conclusions The odds of self-reported diabetes in individuals with HIV was high in Lesotho and low in Namibia, while the odds of self-reported hypertension in individuals with HIV was low across all 4 countries included in this study. Programs are needed to target individuals that need to manage multiple diseases at once and should consider increasing access to cardiovascular disease management programs for older adults, individuals with high BMI, women, and those living in urban settings.

scholarly journals Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case–control study

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Paraskevi Stylianou-Riga ◽  
Theodora Boutsikou ◽  
Panayiotis Kouis ◽  
Paraskevi Kinni ◽  
Marina Krokou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Caesarean Section ◽  
Distress Syndrome ◽  
Elective Caesarean Section ◽  
Case Control ◽  
Male Gender ◽  
Term Neonates ◽  
Systemic Hypotension ◽  
Neonatal Respiratory Distress

Abstract Background Neonatal respiratory distress syndrome (NRDS) is strongly associated with premature birth, but it can also affect term neonates. Unlike the extent of research in preterm neonates, risk factors associated with incidence and severity of NRDS in term neonates are not well studied. In this study, we examined the association of maternal and neonatal risk factors with the incidence and severity of NRDS in term neonates admitted to Neonatal Intensive Care Unit (NICU) in Cyprus. Methods In a prospective, case-control design we recruited term neonates with NRDS and non-NRDS admitted to the NICU of Archbishop Makarios III hospital, the only neonatal tertiary centre in Cyprus, between April 2017–October 2018. Clinical data were obtained from patients’ files. We used univariate and multivariate logistic and linear regression models to analyse binary and continuous outcomes respectively. Results During the 18-month study period, 134 term neonates admitted to NICU were recruited, 55 (41%) with NRDS diagnosis and 79 with non-NRDS as controls. In multivariate adjusted analysis, male gender (OR: 4.35, 95% CI: 1.03–18.39, p = 0.045) and elective caesarean section (OR: 11.92, 95% CI: 1.80–78.95, p = 0.01) were identified as independent predictors of NRDS. Among neonates with NRDS, early-onset infection tended to be associated with increased administration of surfactant (β:0.75, 95% CI: − 0.02-1.52, p = 0.055). Incidence of pulmonary hypertension or systemic hypotension were associated with longer duration of parenteral nutrition (pulmonary hypertension: 11Vs 5 days, p < 0.001, systemic hypotension: 7 Vs 4 days, p = 0.01) and higher rate of blood transfusion (pulmonary hypertension: 100% Vs 67%, p = 0.045, systemic hypotension: 85% Vs 55%, p = 0.013). Conclusions This study highlights the role of elective caesarean section and male gender as independent risk factors for NRDS in term neonates. Certain therapeutic interventions are associated with complications during the course of disease. These findings can inform the development of evidence-based recommendations for improved perinatal care.

scholarly journals Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hafte Kahsay Kebede ◽  
Lillian Mwanri ◽  
Paul Ward ◽  
Hailay Abrha Gesesew
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Care Services ◽  
Validity Assessment ◽  
Sub Saharan ◽  
Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

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