Abstract
BackgroundThis research determined the rates of perinatal mortality among infants delivered under Ghana’s national health insurance scheme (NHIS) compared to infants delivered under the previous “Cash and Carry” system in Northern Region, especially as the country takes stock of its progress toward meeting the Millennium Development Goals (MDG) 4 and 5.MethodsThe labor and maternity wards delivery records of infants delivered before and after the implementation of the NHIS in Northern Region were examined. Records of available daily deliveries during the two health systems were extracted. Fisher’s exact tests of non-random association were used to examine the bivariate association between categorical independent variables and perinatal mortality.ResultsOn average, 8% of infants delivered during the health user-fee (Cash & Carry) died compared to about 4% infant deaths during the NHIS delivery fee exemption period in Northern Region, Ghana. There were no remarkable difference in the rate of infant deaths among mothers in almost all age categories in both the Cash and Carry and the NHIS periods except in mothers age 35 years and older. Infants born to multiparous mothers were significantly more likely to die than those born to first time mothers. There were more twin deaths during the Cash and Carry system (p = 0.001) compared to the NHIS system. Deliveries by caesarean section increased from an average of 14% in the “Cash and Carry” era to an average of 20% in the NHIS era.ConclusionThe overall rate of perinatal mortality declined by half (50%) in infants born during the NHIS era compared to the Cash and Carry era. However, caesarean deliveries increased during the NHIS era. These findings suggest that pregnant women in the Northern Region of Ghana were able to access the opportunity to utilize the NHIS for antenatal visits and possibly utilized skilled care at delivery at no cost or very minimal cost to them, which therefore improved Ghana’s progress towards meeting the MDG 4, (reducing under-five deaths by two-thirds).
Highlights
This research determined the rates of perinatal mortality among infants delivered under Ghana’s national health insurance scheme (NHIS) compared to infants delivered under the previous “Cash and Carry” system in Northern Region, especially as the country takes stock of its progress toward meeting the Millennium Development Goals (MDG) 4 and 5
As observed in this study, overall perinatal mortality rates among infants born during the Cash and Carry era in 2000–2003 declined by 50% when the NHIS delivery fee exemption program was in effect in 2008–2011
Perinatal mortality was observed to have declined in mothers age 35 or older, those with three or more prior birth experiences and mothers with a postpartum blood loss of 250 ml or higher during the NHIS period compared to Cash and Carry era at this tertiary hospital
Summary
This research determined the rates of perinatal mortality among infants delivered under Ghana’s national health insurance scheme (NHIS) compared to infants delivered under the previous “Cash and Carry” system in Northern Region, especially as the country takes stock of its progress toward meeting the Millennium Development Goals (MDG) 4 and 5. Almost all (98%) of these perinatal deaths occur in low -middle income countries (LMIC) including Sub-Saharan Africa [1, 2]. As a LMIC in sub-Saharan Africa, Ghana has had its fair share of these mortalities, especially in parts of the country where there are challenges with access to supervised delivery. Recent data indicates that infant and neonatal mortality rates for Ghana are estimated to be 53 and 32 per 1000 live births respectively with regional variations [4]. The Northern Region has infant and neonatal mortality rates of 66 and 39 per 1000 live births respectively which are all higher than the national average [4]
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