DETERMINANTS OF PERINATAL MORTALITY: A CASE CONTROL STUDY IN THE TEMA METROPOLIS IN THE GREATER ACCRA REGION OF GHANA

ABSTRACT

Introduction: More than five million newborns are stillborn or die within the first 7 days of life each year globally. In Ghana prematurity, low birth weight, multiple births, birth complications and first order pregnancies are known to be major determinants of perinatal deaths. However it is unclear what the major contributors to perinatal mortality in the Tema Metropolis are. This study was conducted to assess the determinants of perinatal mortality in the Tema Metropolis in the Greater Accra region of Ghana. Methods: A 1:2 unmatched case-control study design was used. Cases were all stillbirths and neonatal deaths within seven days after delivery in Tema General Hospital from February 2017 to June 2017. Control group were those newborns delivered in Tema General Hospital during the same period, who survived the perinatal period. Structured questionnaires were used to collect data. Data analysis was done with STATA version 13. Results: The factors significantly associated with reduced odds of perinatal mortality were early antenatal booking (odds ratio (OR) = 0.06), higher number of antenatal visits (OR = 0.28), uptake of at least the third dose of the routine Sulfadoxine-Pyrimethamine (IPT3) (OR = 0.21) and sleeping under Insecticide Treated Net (ITN) (OR = 0.10). Those associated with higher odds of perinatal mortality were; presence of an obstetric complication (OR = 13.66), presence of maternal infection (OR = 3.14), a baby being male (OR = 5.08), preterm delivery (OR = 2.58), low birthweight (OR = 4.29) and baby requiring aggressive resuscitation (OR = 20.71, 95% CI: 1.56-273.95, p = 0.021). Conclusion: Early entry to antenatal care, higher number of antenatal visits, uptake of IPT3 and sleeping under ITN may protect against perinatal mortality in the Tema Metropolis. Obstetric complications, maternal infections, a baby being male, preterm delivery, low birthweight and baby requiring aggressive resuscitation may increase risk of perinatal mortality. There is the need for education and campaigns in the Tema metropolisto help improve high levels of antenatal attendance, use of ITN and IPT3 uptake for pregnant women.