A REVIEW OF THE PREVENTION OF MATERNAL MORTALITY PROGRAMME IN EJISU - JUABEN DISTRICT

ABSTRACT

The issue of maternal mortality continues to plague many developing countries including Ghana. To address this problem the Prevention of Maternal Mortality (PMM) programme was established in two districts in Ghana by a team of both local and foreign researchers in 1989. They constituted themselves into two teams in Accra and Kumasi. However actual work on the field by the Kumasi team in the Ejisu-Juaben district where they concentrated their activities was started in 1993 and ended in 1997 when the programme became a local entity and part of the Regional Prevention of Maternal Mortality programme. There has since been no evaluation of this programme. Their approach was through the establishment of both facility-based and community-based interventions. These facilities were aimed at catering for the critically ill pregnant woman and specifically addressed obstetric bleeding. The intervention site was the Juaben health centre, which was upgraded to a district hospital. A theatre and a blood bank were provided and nurses trained in life-saving skills. The community programmes put in place included the setting up of a community fund to cater for these women. Bicycles were also provided to be used to call vehicles to transport obstetric emergencies to the hospital for care. This study therefore set out to review the Prevention of Maternal Mortality Programme in the Ejisu-Juaben district with special emphasis on obstetric emergencies. The specific objectives were: 1. To describe the emergency obstetric care activities of the Prevention of Maternal Mortality programme in the district in the management of obstetric haemorrhage. 2. To study the trend of activities at the intervention site using hospital records from the theatre, maternity ward and the blood bank. 3. To describe the knowledge, attitudes and practices of the adult population (especially women in the reproductive age-group, household heads and other opinion leaders) to the emergency obstetric care services in the district 4. To undertake a confidential enquiry into five maternal deaths in the community and identify factors surrounding these deaths. The findings of the study showed that the facility based interventions put in place have been sustained, however there still remains aspects of the facility based interventions such as staffing and training that still need to be addressed. The impact of the programme has also been limited to the subdistrict where the intervention site is located and a few areas of adjacent sub-districts. The communitybased interventions are almost non-existent in all the communities surveyed. The knowledge of respondents from the communities and health providers about the availability and utilisation of the prevention of maternal mortality was also inadequate. From the study factors found to be associated with survival of obstetric emergencies in the Ejisu- Juaben district include geographic accessibility of health facilities, financial accessibility of health facilities, practices of health seeking behaviour of the people, knowledge of emergency obstetric cases, knowledge of the appropriate place to go for help, knowledge of the availability of a functioning blood bank, knowledge of the availability of drugs and the competence of health staff at handling emergency obstetric cases. These are important areas of the prevention of the maternal mortality programme, which need to be addressed in order that the programme would have the desired impact.