Improving skilled supervised delivery in two hospitals in Ashanti Region, Ghana: the case of Kumasi South and Suntreso Hospitals

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Ghana has maternal mortality rate of 214/100,000 live births. However, it is the aim of every nation to reduce maternal mortality to its lowest ebb. It is therefore imperative that supervised delivery is put on its right pedestal so as to help avert problems related to deliveries. Ashanti Region has a reproductive health goal of maximizing the healthy life of mothers and children as well as the entire population. The main objective of the study was to identify the factors contributing to low skilled supervised deliveries at Kumasi South and Suntreso Sub-Metro Hospitals in Kumasi Metropolis. The study was carried out in Kumasi Metropolis in two sub metropolitan areas; Amanfrom in Bantama sub metropolitan area and Chirapatre in Asokwa sub metropolitan area were chosen. Suntreso Hospital in Bantama sub-metropolitan area catered for deliveries from Amafrom whilst Kumasi South Hospital catered for those from Chirapatre. A descriptive cross-sectional study was done. Mothers, midwives and managers were interviewed. Questionnaires were used for mothers with children aged between 0 - 6 months as well as midwives, while key informant interview guide was used for the managers which highlighted questions relating to attitude of midwives, opportunity for updates among others. A sample size of 200 mothers was chosen. In addition 14 midwives and 6 managers were selected from the 2 hospitals. Systematic random sampling was used in identifying the mothers while convenience sampling was used for the managers and midwives. Pretesting was done at Manhyia Hospital. Confidentiality was ensured. The results, showed that majority o ft he respondents were Ashanti’s (95%) with most respondents being Christians (91%). The highest age group was 25 - 29 years(35.5%). Most respondents were in monogamous marriages (66%) Majority were JSS/middle school leavers (50.5%) Respondents were mainly traders and majority had 2 children.(37%) Socio-cultural factors such as delivering without supervision was considered a sign of bravery in certain cultures but the client who knows outcome of delivery is unpredictable would certainly seek supervised care. Financial cost and distances were considered. High cost of care was a deterrent factor whilst proximity to health facilities and easy availability of transport were enabling factors. Majority (62%) of respondents felt regular ANC improved delivery outcome. As regards the preferred provider care during delivery, majority felt a ‘Nurse’ (Midwife) in the hospital was ideal (88.5%). Staff attitude influenced 61% of respondents in their decision to go to the health facility. Majority felt the b ills were acceptable once the outcome was good (77%) and were of the opinion that they were warmly handled (93%). Pain management was done through breathing through their mouth (57.6%), being given verbal assurance (41 .7%), walking around etc. Majority had oxytocin given during the third stage of labour. All midwives in the 2 Hospitals had been trained and used partograph to manage labour and detect obstructed labour. However, less than 50% of midwives had ever attended a mortality meeting within the last 12 months in spite of maternal deaths in their facilities. Patronage of skilled supervised delivery in the catchment areas of the 2 hospitals was high (i.e. KSH 73%; SH 77%), contrary to the views of managers of Suntreso and Kumasi South Hospitals. Midwives expressed the wish to attend more external workshops (outside workplace or Kumasi) in order to share experiences and learn from other colleagues. Since supervised delivery data from private health institutions and maternity homes are collected routinely by Public Health Nurses, Hospital Managers must ensure that data on supervise4 deliveries from their catchment areas when analysed should include data from all sources.
A thesis submitted to the School of Graduate Studies, Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirement for the degree of Master of Science in Health Services Planning and Management, 2004