1. E. Y Kwawukume Professor and Chair, K.K. Bentsi-Enchill Chair, University of Ghana Medical School, College of Health Sciences, Dept of Obst and Gynae, Korle Bu

2.  The main indices of quality obstetric and perinatal care in a given geographical location are maternal and perinatal mortality.  WHO estimates that at least 1,600 women die every day associated with pregnancy and child birth.  90% of these deaths occur in sub-Saharan Africa and Asia.  Annual del KBTH is between 10,000 to 12,000 women.  About 36% of the pregnant women with complications reach the hospital in a moribund state

3.  40% or more of pregnant women may experience acute obstetric problems during pregnancy, child birth and puerperium.  Of this number an estimated15% of the pregnant women develop life-threatening complications.  Significant percentage of the maternal deaths is therefore due to emergency complications of pregnancy.

4.  This is a descriptive study.  Data was collected from published articles including studies from 1984 to 1994 and 1995 to 2002,  records were retrieved from the depart of Obs/Gynae and Child Health, KBTH  Ghana Statistical Service, Ministry of Health Human resource Division  University of Ghana Medical School.

5.   Year Total deliveries Live births Still Births SB/Live births%   2002 11,798 11,122 676 5.7  2003 10,528 9,901 627 6.3  2004 11,099 10, 392 707 6.8  2005 11,175 10, 443 732 7.0  2006 7,229 7,624 395 5.2  2007 7,378 6,993 385 5.5  2008 10,310 9,785 525 5.4

6. Year Live births Maternal deaths MMR  2005 10,443 95 909  2006 7,624 62 813  2007 6,993 72 1,029  2008 9,785 77 786  2005-2008 - - 884  MMR/100,000 Most of the cases are referrals from the district

7.  Year Rate  1984-1994 734.4  1995-2002 777.2  2003-2008 884.2

8. Causes 1984-1994. 2005- 2008  Hemorrhage 17.7% 30.0%  Hypertensive disorders 17.5% 25.8%  Abortions 13.5% 10.7%  Genital infections 9.5% 3.5%  Obstructed labour 5.5% 0.3%  Others 36.3% 29.4% Causes of MM remain the same but there is significant increase in the major causes, ie hypert and haemorrage

9. Year Rates.  1991 99.1  1992 99.8  2008 80.7  The perinatal mortality rate showed 18.4% decrease as compared to the year 1991.

10. Causes Number  Prematurity 145  Birth Asphyxia 121  Bacteria Sepsis 6

11. Causes year 1990 1992 1991/1902 2008  Prematurity 52.1% 55.3% 58.8% 53.3%  Birth asphyxia 26.7% 19.1% 23% 44.4%  Bacteria sepsis 11.6% 14.6% 13% 2.2%

12. Languages Women Men  English/other languages 45.7% 62.9%  English/one Ghanaian language 27.2% 41.6% More than half of the population in Ghana is illiterate. The literacy rate of women is lower than that of men.

13. Sex Number  Women 11,816,192  Men 11,600,326  Total 23,416,518 The population of women and men is almost equal with the women having a slight edge over the men

14.  Staff Number % Population Ratio.   Nurses 14,297 0.1 1 to 1,000 women  Doctors 2,334 0.02 1 to 5,000 women   There is a geographical there are regional variation from the North to the South

15. Year enrolled No Year graduated No graduated  1999 83 2005 77  2000 89 2006 87  2001 90 2007 83  2002 89 2008 88  2003 111 2009 105  An average of 88 doctors is produced annually since 1999.

16. Year No. Obstetricians No. Pediatricians  2006 3 6  2007 - 1  2008 2 1

17.  Year Obst Pedia Anes Family Med  2007 - - - 7  2008 9 5 7 7

18.  MMR of 884.2 per 100,000 live births and the perinatal mortality rate of 80.7 per1,000 births are high compared to that obtained in the developed countries.  The causes of maternal and perinatal mortality have remained the same  the major causes of maternal mortality, hemorrhage and hypertensive disorders of pregnancy, showed a significant percentage increase.  These causes are emergency obstetric and perinatal conditions.

19.  More than half of the population of Ghana are illiterate.  The illiterate population is less likely to lead a healthy life style.  They are also less likely to make use of available health services.  Clinical features of complications of pregnancy may not be recognized and as such may be misinterpreted and report late for treatment.

20.  Poverty is a high risk factor  It is associated with illiteracy and impedes access to health care.  The global economic situation is not in favor of the developing countries.  This situation has been worsened by bad governance; bad developmental policies and corruption  The majority of the population is therefore poor.  When complications arise there may be no money to finance transportation and medical bills.  The patient may not be taken to a health care facility.

21.  Due to physical distance,  Poor road networks,  Inadequate ambulance services.

22.  lack of medical supplies and equipment,  non functioning theaters  shortage of medical staff.  From the study the ratio of a nurse to the women population is 1:1000  doctor to the women population 1:5000.  This is woefully inadequate leading to MM/PNM.

23.  Measures presently taken to address the situation are also woefully inadequate.  On the average 88 doctors are trained annually from KBTH  Much more worse is the number of Specialist doctors

24.  inadequate number of midwives,  lack of functioning theatres  frequent shortages of blood and blood products as against a high annual delivery rate.

25.  To increase the literacy rate at all the levels of education including informal education.  To reach out to the populace on health issues both in English and the local languages.  The transportation network should be improved.  The National Ambulance Service should be resourced and expanded to reach a large number of communities.  Helicopter services should be established to airlift emergency cases to health facilities.

26.  mobile phone services to compliment the services in the transport sector  Governments to tackle the problems of corruption, show good governance and formulate policies when dealing with multinational coorperations in order to get better deals for their countries  National Health Insurance Scheme to be encouraged.  The challenges in the NHIS affecting the finances of the health providers should be quickly addressed.  Health personnel should have continuous heath education including ethics. This is currently being done - Continuous Professional Development Programs for doctors.

27.  Efforts must be made to decongest the hospitals  Polyclinics should be fully functional

28.  La polyclinic now a hospital.  The burden on KBTH has reduced. Delivery from 12,000 to 9,931 babies annually.  Many standard Private hospitals are springing up  Private organizations are helping government facilities eg MTN refurbishing KBTH labour ward and thaetres.  Private institutions should train more health personnel  They should be encouraged to grow to effectively supplement the efforts of government

29.  Major causes are Prematurity and asphyxia  Supervised delivery should be encouraged  Adequate ambu-bags in labour wards and NICU  Availabilty of Maternal and neonatal ventilators  Oxygen cylinders to be at all delivery units  Management protocols should be established.

30.  Maternal mortality is a Human Rights issue and should be recognized as such

31.  Doctors and nurses- Are we doing enough!  What about Hospital Administrators!  What about Parliamentarians!-do you know the needs of pregnant women in your constituency?  And our Ministers- are we visiting health institutions including maternity homes!  What about ourselves who are hearing this presentation