Publication: Maternal Mortality Decline in the Kassena-Nankana District of Northern Ghana
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Published
2008
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1092-7875 (Print)
1092-7875 (Linking)
Date
2012-03-30
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OBJECTIVE: In the absence of an adequate vital registration system in Ghana, the Navrongo demographic surveillance system (NDSS) established in 1993 presents a viable alternative to monitor, in a poor rural district, the UN Millennium Development Goal on maternal health (MDG) of reducing maternal mortality by 75% between 1990 and 2015. METHODS: Of the 518 women aged 12-49 years identified in the NDSS database to have died in the Kassena-Nankana district in the period January 2002-December 2004, spouses or family members completed verbal autopsy interviews for 516 female deaths. RESULT: Of the 516 female deaths, 45 were identified as maternal deaths. 71% of the maternal deaths were attributed to direct maternal causes while 29% were due to indirect maternal causes. Abortion-related deaths were the most frequent cause of maternal deaths. The maternal mortality ratio for the period 2002-2004 was 373 maternal deaths per 100,000 live births indicating a 40% reduction of maternal mortality from the 1995-1996 level of 637 maternal deaths per 100,000 live births. However, the health-facility based maternal mortality ratio in the district (which excludes maternal deaths outside health facilities) was 141 maternal deaths per 100,000 live births for the period 2002-2004. CONCLUSION: This district may be on track to achieve the MDG on maternal health. Ultimately, strengthening vital registration systems to provide timely information to policymakers should supersede the other methods of measuring maternal mortality.
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Publication Use of Health Professionals for Delivery Following the Availability of Free Obstetric Care in Northern Ghana(2008)OBJECTIVES: To assess the factors associated with the use of health professionals for delivery following the implementation of a free obstetric care policy in the poorest regions of Ghana. METHODS: All 4,070 women identified in the Navrongo demographic surveillance system with pregnancy outcomes in the Kassena-Nankana district between January 1 and December 31, 2004 were eligible for the study. Three thousand four hundred and thirty three women completed interviews on socio-demographic and pregnancy related factors. Information on 259 communities including travel distance to the nearest health facility was also obtained. Multilevel logistic regression analyses were conducted. RESULTS: ninety eight percent of women received antenatal care but only 38% delivered with the assistance of health professionals. In a multilevel logistic model, physical access factors {such as availability of public transport, odds ratio (OR) = 1.50 (1.15-1.94), travel distance to the district hospital [for 20+ km, OR = 0.31 (0.23-0.43)] as well as community perception of access to the nearest health facility [for highest quintile, OR = 4.44 (2.88-6.84)]} showed statistically significant associations with use of health professionals at last delivery. Women who knew that delivery care was free of charge were 4.6 times more likely to use health professionals. Higher parity was strongly negatively associated with use of health professionals [OR = 0.37 (0.29-0.48) for parity > or = 4 compared to parity 0-1]. However, community perception of quality of care was not associated with use of health professionals for delivery. CONCLUSION: Physical access factors remain strong determinants of use of professional delivery care in rural northern Ghana.Publication Maternal and Child Survival : Findings from Five Countries Experience in Addressing Maternal and Child Health Challenges(World Bank, Washington, DC, 2014-05)Considerable progress has been made towards the achievement of the Millennium Development Goals (MDGs) since 1990. Although advances in improving MDG 4 and MDG 5a (reducing child and maternal mortality, respectively) have been made, progress is some countries have been insufficient. While some countries have made substantial gains, others have not. This paper is part of a larger study that aims to address this gap in knowledge. The paper discusses the findings from qualitative case studies of five countries that are either on track to meet MDGs 4 and 5a by 2015 or have made significant progress to this end (Bolivia, China, Egypt, Malawi and Nepal). Although they have different socio-economic characteristics, all have made significant advancements due to a strong commitment to improving maternal and child health. To do this, strong political commitment, through policies backed by financial and programmatic support, was critical. In addition, focusing on the most vulnerable populations helped increase access to and use of services. Empowering women and families through education, employment, and poverty reduction programs have led to better health outcomes. These countries still face challenges, however, in terms of the evolving health system, and changes at the economic, social and political levels. Future qualitative and quantitative analyses on the returns of health investments, the political context and institutional arrangements at the country level could help deepen the understanding of the ways in which various countries, with their unique conditions, can improve MCH.Publication Maternal Health, Child Health and Nutrition in Lao PDR : Evidence from a Household Survey in Six Central and Southern Provinces(Washington, DC, 2013-06)Despite being on-track on the child- and maternal-health Millennium Development Goals (MDGs), Lao PDR continues to have some of the worst maternal and child health (MCH) and nutrition outcome indicators, both globally as well as in the East Asia and Pacific (EAP) region. This report presents results from a household, village, and facility survey on Maternal and Child Health (MCH) and nutrition in mostly rural areas of six central and southern provinces of Lao People's Democratic Republic (PDR). The information in this report localizes MCH and nutrition-related information that are typical for sampled catchment areas of selected health centers in six central and southern provinces of the country. In addition, the report summarizes data on service availability and readiness of health centers in terms of their ability to provide key MCH & nutrition-related services. The results from this survey thus shed light on what it would take to attain the health-related MDGs. In order to improve the level and equity of maternal and child health indicators, interventions would need to address numerous demand-side barriers, including physical access barriers, financial barriers, and cultural, linguistic, and educational barriers.Publication Why Are Adult Women Missing? Son Preference and Maternal Survival in India(World Bank, Washington, DC, 2014-03)This paper is the first to show that excess mortality among adult women can be partly explained by strong preference for male children, the same cultural norm widely known to cause excess mortality before birth or at young ages. Using pooled individual-level data for India, the paper compares the age structure and anemia status of women by the sex of their first-born and uncovers several new findings. First, the share of living women with a first-born girl is a decreasing function of the women's age at the time of the survey. Second, while there are no systematic differences at the time of birth, women with a first-born girl are significantly more likely to develop anemia when young (under the age of 30) and these differences disappear for older women. Moreover, among those in the older age group, they appear to be significantly better off in terms of various predetermined characteristics. These findings are consistent with a selection effect in which maternal and adult mortality is higher for women with first-born girls, especially the poor and uneducated with limited access to health care and prenatal sex diagnostic technologies. To ensure the desired sex composition of children, these women resort to a fertility behavior medically known to increase their risk of death. The observed sex ratios for first births imply that 2.2-8.4 percent of women with first-born girls are 'missing' because of son preference between the ages of 30 and 49.Publication An Assessment of LAC's Vital Statistics System : The Foundation of Maternal and Infant Mortality Monitoring(World Bank, Washington, DC, 2008-05)Vital records, the registration of births, deaths, marriages and divorces, and the vital statistics derived from these records serve two important purposes. Firstly, vital records are legal documents, but the focus of this review, is the role of vital records to create demographic and epidemiological statistics that are used in monitoring trends and developing health policies and programs. Vital statistics are classic public goods, and the World Bank is keenly interested in assisting countries in the Latin America region to strengthen their vital statistics systems. This assessment reviews the status and evolution of vital statistics systems in Latin America and makes recommendations for improving their coverage, quality, and timeliness. The strongest systems in the region on the measures of coverage, quality and timeliness are found in Argentina, Chile, Costa Rica, and Uruguay. This review found that countries in Latin America are well ahead of many other regions in the world in developing their vital registration systems. Yet challenges remain before these systems can support results-oriented health programs. Concerted efforts to improve these systems are likely to generate large payoffs in terms of supporting better public policies. Vital statistics should very soon replace surveys in Latin America as the most important primary source of information about births and deaths given their potential to more effectively guide policymaking and monitor results related to the maternal and infant health Millennium Development Goals (MDGs).
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