Factors Influencing Supervised Delivery in the Asunafo North District in the Brong-Ahafo Region, Ghana.
For more than 20 million women each year, pregnancy and childbirth mean suffering, ill health or death. Recent estimates suggest that 515,000 women die annually of pregnancy related complications. This is in addition to the 3.9 million newborn and three million still born lives that are lost every year. It is estimated that 90% of maternal deaths could be avoided if adequate care was provided (including skilled attendant at birth). The objective of this study was to identify the factors for the low percentage of supervised delivery in the Asunafo North District. A cross-sectional study was done in all the three sub-districts of the Asunafo North District with a total population of 110,262. Structured questionnaires consisting of both open and close ended questions were administered on a sample of mothers who attended the child welfare clinic. A total of 90 mothers were selected by using systematic sampling method. Cross-tabulation and bivariate analyses were performed using statistical software known as SPSS 7.5. The results are presented in terms of correlation for the bivariate analysis and Chi-Square test for the cross-tabulation analysis. These analytical programmes were employed to establish the relative influence of the independent variables on the dependent variable; place of delivery. The interviews conducted among the mothers, health personnel and during the FGD revealed numerous reasons why women deliver at home in the Asunafo North District. Among the factors, the most prominent ones are quick child birth 30 0%, transportation difficulty 23.6%, financial difficulty 14.5%, long distance to the health facility 7.2%, high cost of transport 5.5%, inability to recognize labour signs 3.6% and ability to deliver without help 3.6°’o. The other factors contributed 2.0% each. In the study the most common factors mentioned as reasons for delivering with the TBA are; competency 17.3%, difficulty in getting transport 26.0%, quick childbirth 13.8%, low fees charged 5.2%, herbal treatment 5.2%, long distance to the health facility 5.2%, good care 5.2%, financial difficulty 3.4, high cost of transport 3.4%, and spiritual protection 3.4%. The other factors contributed 1.7% each. The prominent among the reasons why mothers delivered at the health facility were; ability to handle complications 53.1%, competency of health personnel 7.7%, ANC education 6.2%, no body to assist delivery at home 6.2%, prefer to deliver at health facility 4.7%, good medical treatment to baby 4.7%, primi-gravida 3.1% and good attitude of health workers 3.1%. The other factors contributed 1.6% each. None of the predisposing factors was statistically significant with the place of delivery. The enabling factor of income showed a significant difference with the place of delivery. All the restrictive factors of cost of hired transport, fees charged at the health facility, attitude of health workers, distance to the health facility, and waiting time except frequency of transport showed a statistically significant relationship with the place of delivery. It was recommended that the government, community and the household should collaborate in the improvement of’ road and transport in the district. Education, through antenatal and community durbars should also be intensified.
A thesis submitted to the Department of Community Health, College of Health Sciences in partial fulfilment of the requirements for the degree of Master of Science, 2005