Factors associated with perinatal mortality among Referred Obstetric Emergencies in the Accra-Tema Metropolitan Areas, Ghana, 2017

Abstract

Introduction : perinatal mortality rate (PNMR) in developing countries, particularly Sub-Sahara Africa and Ghana is unacceptably high. Most perinatal mortalities (PNM) occur among women referred for obstetric complications (Khanam et al,2017). Maternity referral system challenges limit access to emergency obstetric care needed to prevent maternal and perinatal mortalities. Much studies have focused on access to Emergency Obstetric Care (EmOC) and its association with maternal health, but few have focused on foetal outcomes and the role of referral system gaps on perinatal health. This study thus sought to find factors associated with PNM among referred obstetric emergencies in the Accra and Tema Metropolitan Areas, Ghana. Methods : this study is descriptive cross-sectional study conducted at four secondary level health facilities within the Accra and Tema metropolitan areas. Data was collected by interviewing mothers referred as obstetric emergencies or their relations using an interviewer administered structured questionnaire, and via data abstraction using a data abstraction template. Data obtained from 240 respondents was entered into SPSS v22 and analysed using STATA version 14. Univariate analysis, simple logistic regression and multivariate logistic regressions were carried out to determine factors associated with PNM. Results : most of the respondents (38.3%) were referred on account of Pregnancy Induced Hypertension (PIH). About 17% % were referred for non-clinician reasons, most due to non-availability of a doctor/ midwife. Most referred clients were unaccompanied by a health worker (55.0%) and no prior notification was given the receiving facility (70.8%), although most came with referral letters (92.7%). Perinatal mortality rate was high (21.7%). On simple logistic regression, means of transport, accompanied by health worker (HW), marital status, number of Ante-natal care (ANC) attendance, birth weight, gestational age and antepartum haemorrhage were found to be significantly associated with PNM (p Conclusion : referral guideline adherence is poor. Prevalence of PNM among referred obstetric emergencies is high. Independent risk factors for PNM are APH, low ANC visit and accompanied by HW. There is the need for a review of the current referral guidelines by the Ministry of Health to help address current challenges. Clinicians must attend quickly and have a low thresh-hold for lifesaving interventions for referred emergencies with APH, accompanied by a HW and with poor ANC attendance record. Further research on referral systems and their role in determining perinatal outcomes are needed.