Kwame Adu-Bonsaffoh

Assessment of maternal near-miss and quality of care in a hospital-based study in Accra, Ghana

To assess the baseline incidence of maternal near‐miss, process indicators related to facility access, and quality of care at a tertiary care facility in urban Ghana.

How women are treated during facility-based childbirth: development and validation of measurement tools in four countries – phase 1 formative research study protocol

BackgroundEvery woman has the right to dignified, respectful care during childbirth. Recent evidence has demonstrated that globally many women experience mistreatment during labour and childbirth in health facilities, which can pose a significant barrier to women attending facilities for delivery and can contribute to poor birth experiences and adverse outcomes for women and newborns. However there is no clear consensus on how mistreatment of women during childbirth in facilities is defined and measured. We propose using a two-phased, mixed-methods study design in four countries to address these research gaps. This protocol describes the Phase 1 qualitative research activities.Methods/DesignWe will employ qualitative research methodologies among women, healthcare providers and administrators in the facility catchment areas of two health facilities in each country: Ghana, Guinea, Myanmar and Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) will be conducted among women of reproductive age (15–49 years) to explore their perceptions and experiences of facility-based childbirth care, focused on how they were treated by healthcare workers and perceived factors affecting how they were treated. IDIs will also be conducted with healthcare providers of different cadres (e.g.: nurses, midwives, medical officers, specialist obstetricians) and facility administrators working in the selected facilities to explore healthcare providers’ perceptions and experiences of facility-based childbirth care and how staff are treated, colleagues and supervisors. Audio recordings will be transcribed and translated to English. Textual data will be analysed using a thematic framework approach and will consist of two levels of analysis: (1) conduct of local analysis workshops with the research assistants in each country; and (2) line-by-line coding to develop a thematic framework and coding scheme.DiscussionThis study serves several roles. It will provide an in-depth understanding of how women are treated during childbirth in four countries and perceived factors associated with this mistreatment. It will also provide data on where and how an intervention could be developed to reduce mistreatment and promote respectful care. The findings from this study will contribute to the development of tools to measure the prevalence of mistreatment of women during facility-based childbirth.

Measuring Coverage in MNCH: Validating Women’s Self-Report of Emergency Cesarean Sections in Ghana and the Dominican Republic

Background Cesarean section is the only surgery for which we have nearly global population-based data. However, few surveys provide additional data related to cesarean sections. Given weaknesses in many health information systems, health planners in developing countries will likely rely on nationally representative surveys for the foreseeable future. The objective is to validate self-reported data on the emergency status of cesarean sections among women delivering in teaching hospitals in the capitals of two contrasting countries: Accra, Ghana and Santo Domingo, Dominican Republic (DR). Methods and Findings This study compares hospital-based data, considered the reference standard, against women’s self-report for two definitions of emergency cesarean section based on the timing of the decision to operate and the timing of the cesarean section relative to onset of labor. Hospital data were abstracted from individual medical records, and hospital discharge interviews were conducted with women who had undergone cesarean section in two hospitals. The study assessed sensitivity, specificity, and positive predictive value of responses to questions regarding emergency versus non-emergency cesarean section and estimated the percent of emergency cesarean sections that would be obtained from a survey, given the observed prevalence, sensitivity, and specificity from this study. Hospital data were matched with exit interviews for 659 women delivered via cesarean section for Ghana and 1,531 for the Dominican Republic. In Ghana and the Dominican Republic, sensitivity and specificity for emergency cesarean section defined by decision time were 79% and 82%, and 50% and 80%, respectively. The validity of emergency cesarean defined by operation time showed less favorable results than decision time in Ghana and slightly more favorable results in the Dominican Republic. Conclusions Questions used in this study to identify emergency cesarean section are promising but insufficient to promote for inclusion in international survey questionnaires. Additional studies which confirm the accuracy of key facility-based indicators in advance of data collection and which use a longer recall period are warranted.

Maternal deaths attributable to hypertensive disorders in a tertiary hospital in Ghana.

To determine the contribution of hypertensive disorders of pregnancy to maternal deaths at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana.

Understanding the Continuum of Maternal Morbidity in Accra, Ghana

The objective was to determine the levels of maternal morbidity from no complications to near miss and describe factors associated with different levels of morbidity. We conducted an observational study of all women delivering at a tertiary hospital in Accra, Ghana between October 2010 and March 2011. We examined the factors associated with the continuum of maternal outcomes in terms of severity using multinomial logistic regression. Data were extracted from women’s maternal care files with the main outcome measures of no complications, non-life threatening complications, potentially life-threatening conditions (PLTC), and near miss as defined by World Health Organization. Our study includes 1,586 women with no complications, 1,205 women with non-life threatening complications, 516 women with PLTC, and 94 near-miss cases. All of the factors associated with PLTC and near-miss cases were similar. None of the socio-demographic variables remained significant in the multivariate analysis comparing different levels of severe morbidity with no complications. Women with no complications shared similar characteristics with women who experienced non-life threatening complications. As compared to women who had no complications, women who had severe morbidity were significantly more likely to have had no antenatal care. Our results underline the concept that morbidity is a continuum and indicate that if the underlying causes of poor maternal health outcomes are addressed, it is likely that changes such as better access to antenatal care will improve health outcomes across the continuum of morbidity. However, by only monitoring near-miss cases and mortality, we underestimate the impact on women who will live with non-life threatening, yet serious maternal morbidities.

Nitric oxide dysregulation in the pathogenesis of preeclampsia among Ghanaian women

Background Preeclampsia (PE) is still a disease of theories as the exact cause remains uncertain. Widespread vascular endothelial cell dysfunction is thought to mediate the generalized vasospasm and hypertension characteristic of PE. Altered nitric oxide (NO) production has been associated with the endothelial dysfunction in the pathogenesis of PE but conflicting results have emerged from previous studies. Objectives To determine maternal serum levels of NO, a biomarker of endothelial function, in nonpregnant, normal pregnant, and preeclamptic women. Materials and methods This was a cross-sectional case–control study of 277 women comprising 75 nonpregnant, 102 normal pregnant, and 100 preeclamptic women conducted at the Korle Bu Teaching Hospital between April and June 2011. About 5 mL of venous blood was obtained from the participants for the various investigations after meeting the inclusion criteria and signing to a written consent. Serum levels of NO were determined by Griess reaction. The data obtained were analyzed with SPSS version 20. Results The study showed significantly elevated serum levels of NO in preeclamptic women (82.45±50.31 μM) compared with normal pregnant (33.12±17.81 μM) and nonpregnant (16.92±11.41 μM) women with P<0.001. The alteration in maternal serum NO levels was significantly more profound in early-onset (severe) PE (119.63±45.860 μM) compared to that of late-onset (mild) disease (62.44±40.44 μM) with P<0.001, indicating a more severe vascular endothelial cell dysfunction in the early-onset disease. Conclusion This study has determined a profound NO upregulation in PE evidenced by significant elevation of NO metabolite levels compared to normal pregnancy. This might be due to deranged endothelial function with dysregulated production of NO to restore the persistent hypertension characteristic of PE.

Self - Control Tasks Depend on Glucose Levels in Students

Background: Burgeoning evidences have correlated self-control to desirable outcomes. A recent work found in literature has indicated that self-control relied on glucose; but there is no such data in Ghana. Hence, a replicative study is needed to investigate this further and this was the focus of the current study. Aim: The purpose was to determine the association between blood glucose levels and self – control score in medical students under exams condition. Method: The convenience sample consisted of 105 first year medical students of the University of Ghana Medical School (UGMS). These students’ were interviewed using a structured questionnaire for demographic, self –control information and clinical information after ethical clearance and informed consent. Three mL venous blood samples were obtained for determination of blood sugar levels before mini students’ exams and 10 minutes after students’ interim assessment. The data obtained was entered into an excel spread sheet (Microsoft company, USA) and analyzed using SPSS version 18. Results: Self-control schedule (SCS) formed a unique pattern with blood glucose levels. However, there was no relationship between gender and SCS [chi-square (2df)=0.120, p=0.942]; but with the introduction of interim assessment as the stressor, SCS in females increased with increased exams score. Conclusion: Self-control task could possibly depend on glucose.

Impaired renal function and increased urinary isoprostane excretion in Ghanaian women with pre-eclampsia

Background The cause of pre-eclampsia remains largely unknown, but oxidative stress (an imbalance favoring oxidant over antioxidant forces) has been implicated in contributing to the clinical symptoms of hypertension and proteinuria. Assessment of oxidative stress in pre-eclampsia using urinary isoprostane has produced conflicting results, and it is likely that renal function may affect isoprostane excretion. The aim of this study was to determine the role of oxidative stress in the pathophysiology of pre-eclampsia and to assess the effect of renal function on isoprostane excretion in pre-eclampsia in the Ghanaian population. Methods This was a case-controlled study, comprising 103 pre-eclamptic women and 107 normal pregnant controls and conducted at the Korle-Bu Teaching Hospital between December 2006 and May 2007. The study participants were enrolled in the study after meeting the inclusion criteria and signing their written informed consent. Oxidative stress was determined by measuring urinary excretion of isoprostane and total antioxidant capacity using an enzyme-linked immunosorbent assay technique. Renal function was assessed by calculating the estimated glomerular filtration rate using the Modification of Diet in Renal Disease formula. Results The pre-eclampsia group had significantly (P = 0.0006) higher urinary isoprostane excretion (2.81 ± 0.14 ng/mg creatinine) than the control group (2.01 ± 0.18 ng/mg creatinine) and a significantly (P = 0.0008) lower total antioxidant power (1.68 ± 0.05 mM) than the control group (1.89 ± 0.04 mM). Urinary isoprostane excretion showed a positive correlation with both mean arterial pressure (r = 0.261) and microalbuminuria (r = 0.510) in the pre-eclampsia cases. The pre-eclampsia group had a significantly lower estimated glomerular filtration rate than the control group (P < 0.001), indicating more renal impairment. Conclusion The increased urinary excretion of isoprostanes and decreased total antioxidant power in the in pre-eclampsia group suggest increased production of oxidants and depletion and/or reduction of maternal antioxidants. Increased oxidative stress may be important in the pathophysiology of pre-eclampsia by contributing to endothelial dysfunction, proteinuria, and hypertension.

PREVALENCE OF HYPERTENSIVE DISORDERS IN PREGNANCY AT KORLE-BU TEACHING HOSPITAL IN GHANA

Background: The true burden of Hypertensive Disorders in Pregnancy (HDP) has been difficult to determine with significant accuracy globally as a result of considerable inconsistencies regarding their prevalence due to lack of definite terminologies and classification Objective: To determine the current prevalence and relative contribution of the various categories of HDP to the burden of maternal hypertension at Korle Bu Teaching Hospital (KBTH) using the recent globally acknowledged consensus classification by the International Society for the Study of Hypertension in Pregnancy (ISSHP). Methods: A cross sectional study conducted between January and February 2013 at the KBTH in Accra, Ghana. Results: There were a total of 398 women with HDP among 1856 deliveries during the study period resulting in prevalence of 21.4%. The proportions of the various types of HDP include 184 (50.0%), 140 (38.0%), 23 (6.3%) and 21 (5.7%) representing gestational hypertension, preeclampsia, chronic hypertension and superimposed preeclampsia respectively. Eclampsia occurred in 58 (15.8%) women. The prevalence of gestational hypertension, preeclampsia chronic hypertension, chronic hypertension with superimposed preeclampsia with respect to the total singleton deliveries were 10.4%, 7.9%, 1.3% and 1.2% respectively. Parity-specific prevalence of HDP showed an increasing trend with the lowest and highest relative proportions occurring in women who had parity of one and 5 or more respectively. Age-specific prevalence showed a steep decline after maternal age of 19 years followed by a general rise after 25 years with highest rate occurring after maternal age of 35 years. Conclusion: There is a significant burden of HDP in the Ghanaian population as evidenced by a high prevalence of 21.4% at the largest tertiary hospital in the country. Gestational hypertension represented the largest proportion followed by preeclampsia, chronic hypertension and superimposed preeclampsia on chronic hypertension. Parity-specific prevalence was highest among women with grand multiparity whereas age-specific prevalence was highest after maternal age of 35 years. *Corresponding Author: Kwame Adu-Bonsaffoh, Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital PO Box KB783, Korle Bu, Accra, Ghana, Tel: +2332244295763; E-mail: bonsaffoh@yahoo.com Citation: Adu-Bonsaffoh, K., et al. Prevalence of Hypertensive Disorders in Pregnancy at Korle-Bu Teaching Hospital in Ghana. (2017) J Gynecol Neonatal Biol 3(1): 16. J Gynecol Neonatal Biol | Volume 3: Issue 1 www.ommegaonline.org

W407 VALIDATING WOMEN'S SELF-REPORT OF EMERGENCY CESAREAN DELIVERY IN GHANA AND THE DOMINICAN REPUBLIC

W407 VALIDATING WOMEN’S SELF-REPORT OF EMERGENCY CESAREAN DELIVERY IN GHANA AND THE DOMINICAN REPUBLIC O. Tuncalp, C. Stanton, A. Castro, R. Adanu, M. Heymann, K. Adu-Bonsaffoh, S.R. Lattof, A. Langer. Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Washington, DC, United States; Harvard School of Public Health, Boston, MA, United States; School of Public Health, University of Ghana, Accra, Ghana; University of Ghana Medical School, College of Health Sciences, Accra, Ghana