Abstract
Early discharge after child delivery although indispensable, but maybe precluded by several factors. The effect of these factors on prolonged length of stay (LOS) after vaginal delivery has been sparsely investigated in Ghana. This limits understanding of potential leading indicators to inform intervention efforts and optimize health care delivery. This study examined factors associated with prolonged LOS after vaginal birth in two time-separated cohorts in Ghana. We analyzed data from Ghana's demographic and health surveys in 2007 and 2017. Our comparative analysis is based on subsamples in 2007 cohort (n = 2,486) and 2017 cohort (n = 8,065). A generalized estimating equation (GEE) with logistic regression was used to examine predictors of prolonged LOS after vaginal delivery. The cluster effect was accounted for using the exchangeable working correlation. The odds ratios (OR) and 95% confidence interval were reported. We found that 62.4% (1551) of the participants in 2007 had prolonged LOS after vaginal delivery, whereas the prevalence of LOS in the 2017 cohorts was 44.9% (3617). This constitutes a 17.5% decrease over the past decade investigated. Advanced maternal age (AOR = 1.24, 95% Cl 1.01-1.54), place of delivery (AOR = 1.18, 95% Cl 1.02-1.37), child's size below average (AOR = 1.14; 95% Cl 1.03-1.25), and problems suffered during/after delivery (AOR = 1.60; 95% Cl 1.43-1.80) were significantly associated with prolonged (≥ 24 hours) length of hospitalization after vaginal delivery in 2017. However, among variables that were available in 2007, only those who sought delivery assistance from non-health professionals (AOR = 1.89, 95% CI: 1.00-3.61) were significantly associated with prolonged LOS in the 2007 cohort. Our study provides suggestive evidence of a reduction in prolonged LOS between the two-time points. Despite the reduction observed, more intervention targeting the identified predictors of LOS is urgently needed to further reduce post-vaginal delivery hospital stay. Also, given that LOS is an important indicator of medical services use, an accurate understanding of its prevalence and associated predictors are useful in assessing the efficiency of hospital management practices and the quality of care of patients in Ghana.
Highlights
There is no consensus regarding the exact length of stay (LOS) after delivery, WHO recommends that, all women who gave birth through vaginal delivery should remain admitted in hospitals or health facilities for a minimum of 24 hours postpartum for observation [1]
In the ten years (2007–2017), we found that LOS after vaginal delivery has changed from most of the women having prolonged length of hospitalization in 2007 (62.4%) to the majority having a shorter length of hospitalization in 2017 (55.1%)
Our study provides suggestive evidence of a reduction in prolonged hospital LOS between the two-time points and shows that predictors of LOS may have changed over time
Summary
There is no consensus regarding the exact length of stay (LOS) after delivery, WHO recommends that, all women who gave birth through vaginal delivery should remain admitted in hospitals or health facilities for a minimum of 24 hours postpartum for observation [1]. This recommendation is to provide ample time for mothers and newborns, especially in low-income countries to be appropriately monitored by skilled birth attendants if a serious postpartum complication arises [1]. The WHO recommended extended hospital LOS in low-income countries, this perspective in highincome countries is almost the reverse given that prolonged hospital LOS has consequences for their health care systems. Regardless, the burden of prolonged LOS has been reported in both low and high-income countries [3, 5, 6], which include nosocomial infections for both infant and mother, dissatisfaction with health care services, sustainability of health care systems, stress, maternal sleeping disorders, and breastfeeding issues as well affects family ties [3, 5–7]
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