Maternal and perinatal mortality in Ghana

Project team: Sabine Gabrysch, Robin Nesbitt, Terhi Lohela, Anja Schoeps

External collaborators: Betty Kirkwood, Seth Owusu-Agyei, Alexander Manu, Eunice Okyere, Seeba Amengo-Etego, Chris Grundy, Karen Edmond, Lisa Hurt, Oona Campbell, Linda Vesel und Seyi Soremekun

Funding: Postdoctoral fellowship of the Baden-Württemberg Foundation and Postdoctoral fellowship of the Daimler und Benz Foundation (Sabine Gabrysch)
Completion grant, Graduate Academy Excellence Initiative, University of Heidelberg (Robin Nesbitt)

This study uses data collected over five years from 4-weekly household surveillance of all women of reproductive age in seven predominantly rural districts in the Brong Ahafo region of Ghana. This surveillance system was established for the ObaapaVitA cluster-randomised controlled trial on the effect of Vitamin A supplementation on maternal mortality, and extended for the Newhints cluster-randomised controlled trial on the impact of home visits by community volunteers on neonatal mortality, both conducted in collaboration between Kintampo Health Research Centre and the London School of Hygiene & Tropical Medicine.

To complement these sociodemographic, service use and mortality data, this study additionally collected data on all health facilities in the surveillance area, in particular on staffing and services provided for pregnant women and newborn babies, including routine antenatal, delivery and postpartum care, as well as emergency obstetric and newborn care. The facility data has been linked to individual demographic data using geographic coordinates.

The aim of this study is to better understand the role of distance to and quality of care on facility use, and on maternal and perinatal mortality in a typical Sub-Saharan setting, in order to inform current strategies to reduce maternal and child mortality.

Publications:

Gabrysch S, Nesbitt RC, Schoeps A, Hurt L, Soremekun S, Edmond K, Manu A, Lohela TJ, Danso S, Tomlin K, Kirkwood B, Campbell OMR. (2019): Does facility birth reduce maternal and perinatal mortality? A secondary analysis of two RCTs including 119,244 pregnancies in Brong Ahafo, Ghana. The Lancet Global Health, 7(8): e1074–87; https://doi.org/10.1016/S2214-109X(19)30165-2

Nesbitt RC, Lohela TJ, Soremekun S, Vesel L, Manu A, Okyere E, Grundy C, Amenga-Etego S, Owusu-Agyei S, Kirkwood B, Gabrysch S. (2016): The influence of distance and quality of care on place of delivery in rural Ghana. Scientific Reports, 6, 30291; doi:10.1038/srep30291.

Lohela TJ, Nesbitt RC, Manu A, Vesel L, Okyere E, Kirkwood B, Gabrysch S. (2016): Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana. BMJ Open,  16:105; 6:e010963. doi:10.1136/bmjopen-2015-010963.

Nesbitt RC, Gabrysch S, Laub A, Soremekun S, Manu A, Kirkwood BR, Amenga-Etego S, Wiru K, Höfle B, Grundy C. (2014): Methods to measure potential spatial access to delivery care in low- and middle-income countries: a case study in rural Ghana. International Journal of Health Geographics, 13:25.

Nesbitt RC, Lohela TJ, Manu A, Vesel L, Okyere E, Edmond K, Owusu-Agyei S, Kirkwood B, Gabrysch S (2013): Quality along the continuum: A health facility assessment of intrapartum and postnatal care in Ghana. PLoS One, 8(11): e81089. doi:10.1371/journal.pone.0081089.