Abstract
BackgroundThe burden of maternal mortality in sub-Saharan Africa is enormous. In Ghana the maternal mortality ratio was 350 per 100,000 live births in 2010. Skilled birth attendance has been shown to reduce maternal deaths and disabilities, yet in 2010 only 68% of mothers in Ghana gave birth with skilled birth attendants. In 2005, the Ghana Health Service piloted an enhancement of its Community-Based Health Planning and Services (CHPS) program, training Community Health Officers (CHOs) as midwives, to address the gap in skilled attendance in rural Upper East Region (UER). The study determined the extent to which CHO-midwives skilled delivery program achieved its desired outcomes in UER among birthing women.MethodsWe conducted a cross-sectional household survey with women who had ever given birth in the three years prior to the survey. We employed a two stage sampling techniques: In the first stage we proportionally selected enumeration areas, and the second stage involved random selection of households. In each household, where there is more than one woman with a child within the age limit, we interviewed the woman with the youngest child. We collected data on awareness of the program, use of the services and factors that are associated with skilled attendants at birth.ResultsA total of 407 households/women were interviewed. Eighty three percent of respondents knew that CHO-midwives provided delivery services in CHPS zones. Seventy nine percent of the deliveries were with skilled attendants; and over half of these skilled births (42% of total) were by CHO-midwives. Multivariate analyses showed that women of the Nankana ethnic group and those with uneducated husbands were less likely to access skilled attendants at birth in rural settings.ConclusionsThe implementation of the CHO-midwife program in UER appeared to have contributed to expanded skilled delivery care access and utilization for rural women. However, women of the Nankana ethnic group and uneducated men must be targeted with health education to improve women utilizing skilled delivery services in rural communities of the region.
Highlights
The burden of maternal mortality in sub-Saharan Africa is enormous
Background characteristics A total of 407 women were interviewed yielding a response rate 100%: 165 women were from Bongo, and 121 women each from the Kassena-Nankana East (KNE) and Kassena-Nankana West (KNW)
The findings revealed that majority of women have had skilled delivery three years prior to this study in Community-Based Health Planning and Services (CHPS) zones where there was a Community Health Officers (CHOs)-midwife and many of the women preferred to be supervised by skilled attendants during birth in future
Summary
The burden of maternal mortality in sub-Saharan Africa is enormous. In Ghana the maternal mortality ratio was 350 per 100,000 live births in 2010. Skilled birth attendance has been shown to reduce maternal deaths and disabilities, yet in 2010 only 68% of mothers in Ghana gave birth with skilled birth attendants. The study determined the extent to which CHO-midwives skilled delivery program achieved its desired outcomes in UER among birthing women. Ghana has a high maternal mortality ratio (MM Ratio) of 350 maternal deaths per 100,000 live births [2]. Access to and quality skilled attendants at birth and emergency obstetric care [5] has been shown to be effective in reducing maternal mortality [4]. In Ghana, two-thirds of women deliver with the assistance of skilled attendants, but skilled delivery is higher in urban (88%) than in rural areas (54%) [8]. The level of skilled delivery in the rural areas of UER (67%) is similar to that of urban areas in Ghana [8]
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