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CHAPTER 6 !l!SQJ.SSI ON AND RECOMMENDATIONS 6.1: THE DISCUSSION The ma j or objecti ves o f this prospective study w- r-e to, (1 ) d e scribe the health s t a t us of wo men in t he ir e a rly p uerperal period in the Kumas ! d i s tric t, ( 2) ident ify tho major causes of morbidit y and the determinants a nd (J ) prov i de i nfor mation for us e in i mpr oving postpartum c a r e i n the region. I n this section the relevance o f the stud y find ings will be discussed. The results obtained in th i s s tudy wi ll a lso be com pa red. to fi nd i ng s af other studies and t he Ll mI t a ti l o ns h ighlighted . The study sample included a consecuti ve s ample of wome n who delivered during a three week t ime period Cit the xom t c xnckye Teaching hospital . This samp l e is repres en tativo of the women who arrive from horne a nd deliver at this health centre. Because this inst itution also handles about 60% of all deliveries i n the Kumasi district, this s a mp l e can be described as reasonably representative of the majorit y of women who deliver vaginally in t h i s district.
174 The s t ud y s a lllp l e . was made up mostly of wo men from low scc I o - e c c noafc backgrounds, reflecting basically the socio economic situation of the majority of women i n the region. An observation from t h e author's clinical e x p e r i e nc e s in KUllIll.si, i s t ha t there is the t endency for the more ind i g e nt women to delive r at t he SUbsidis e d government he a l t h centres while t he more we ll- to-do mother s see k the services of the more "ex pen s i ve" private materni t y homes . Ove r half ( 5 5 . 5\) of the wo me n were in their t we nt i e s , wi th less than a fifth of them being teenagers . Their parity distribution ranged from on e t o twelve births. with a mean of 2.8 b i r t hs. Over a t hird o f t he m were primipara (J9 . H:); grand-multipara formed a fifth of the sample. Thus i n terms of a ge and parity-related risk, this sample c a n be described as having a s izable prop ortion of high risk s Ub j e c t s . Indeed over three quarters (78 .4'l of study subjects were identified a s ha ving at least o ne pregnancy o r labour risk factor. comparing the a ge and pa rity risk rates obtained i n this s tU d y sam ple to the na t i ona l r ate s reported in 19 9 0 {24J, the p reva lence of these two risk f actor'i (that is age less than 20 or greater tha n 35 ye ars and par ity of more t ha n 4 b i r ths ) are muc h les s . Th e y a re about half the nationally reported rates of about 40 % for t he two f actors. Rumasi district is a n urban d i str i ct. Ur ban wo men in Gha na ha v e be t ter socio-economic status , be t t e r h ealth cere ,
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A PROSPECTIVE STUDY OF EARLY PUERPE
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dysuria (26%). Nearly 60% of the st
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on l y greatl y enri ch ed the s ub
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5.4 De t e r mi na nt s o f morbidi
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Ta ble 2 .1 1 Di ag nos es in t rea
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CHAPTER 1 IN T RODU CTI ON As mor e
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impair mater nal health [ 13 ] . Th
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Many African countries l ike Ghan a
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Sex ratio (M/F) (1 989) 0 . 98 Rura
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growt h r ate of 2 .5% [ 21] . I t
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Sex ratio (M as a % o f F) Crude bi
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hours in t he h o s p i t ll;l. Nor
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irths ( 19 ) . Although no communit
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It i s ob vious froID. the above in
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The need for adequate puerperal car
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for )0% and 20% respectivel y (33]
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The Za r i a s t ud y ( a}, also re
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embolism coul d be classified a s a
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serious h e alth consequences becau
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o ne known pat hoge n [54] _ Candid
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a de qua t e trr ea tinerrc fo r th
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3 6 Three of the 31 bacteriuric cas
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sinc e direct bladd er s ampling h
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developing world countries have i n
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Unlike t he developed world, breast
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i n t h e puerper ium will occur i
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ED; siotomy wou nd inf ection: I n
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4' The incidence o f deep vein thro
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percent in Bali, Indonesia [37]. Th
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Pos t p a r t um Anaemia: Anaemia i
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study situat ions and ma y be up t
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wome n with caesarean deliveries (-
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deficien t , 50% f o l a t e defici
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days {178, 179] . In a study of pre
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22,774 births s t udied were 6 .1%,
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ca r d i a c failure, a ssoc iated
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of the disease in zaria has been at
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Africa. and the incidence is still
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i ncreased occu rrenC:2 of psychiat
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African studies respectively h a d
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about the i r mari t a l s tat us,
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CHAP TE R 4 M!ill!Q.!2S 4 .1 : THE
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Bearing in mind t he fact t ha t th
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- Fre e medical consultation for ..
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Examination : SUbjects wer e examin
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•• Lowe r genita l t ract i nte
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" c linica l assessment and lIlanaq
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sample cJ9scr ipt i on ; The charac
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Further mUltivariate logistic regre
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discharge s i n c e they were aa s
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104 ETHNIC ORIGINS: The majority of
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106 ap prenticeship- trained occupa
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YES 1l6'l\ FIG. 1.4 ANTENATAL CARE
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Labour e ve nts , c omplications a
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n . OTHER IMMEDI ATE COMPL.ICATIONS
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5 .2 : FOLLOW-UP AND MORBIDI'I'Y FI
Page 136: 5 .2 . 1 Comparinq clinic a t t e n
Page 140 and 141: 200 ,eo 100 FIG. 2.1 :HOW SUBJECTS
Page 142 and 143: FIG.2.3: THE DAY OF FEVER ONSET REP
Page 145: 13 . I n a l l 21 2 ( 59 . 1\> s Ub
Page 148 and 149: 133 sUbjects said they did. A wide
Page 151: 136 Diastolic blood pressure readin
Page 156 and 157: 141 OTHER PATHOLOGI CAL FI NDI NGS
Page 159 and 160: 144 FOLLOW-UP OUTCOMES: At the end
Page 161: 5. 3 : I NCI DENCE OF MORBI DITY 5
Page 165 and 166: 150 LOWER GENITAL TRACT I NFECTIO N
Page 167 and 168: 152 ACUTE URIN ARY TRACT I NFECTION
Page 169: 154 !i\!m.!!!Ari. : The occurrence
Page 172 and 173: 15 7 regr ession was performed, t o
Page 174 and 175: 15. The s tat i stically significan
Page 176 and 177: 161 s t atistically !li gnifica nt
Page 178 and 179: 16 3 t.o de t ermi ne t hose wi th
Page 180 and 181: 165 was 280 nr (SO ± 166 ml.) and
Page 182 and 183: 1 6 7 The results o f multiva riate
Page 184 and 185: 169 The s atur a t ed rnode I of th
Page 190 and 191: 175 higher ed ucation levels a nd l
Page 192: 177 a bout half of t he women who h
Page 195 and 196: 180 ranked t he i r health as satis
Page 197: 1 8 2 I nformal i nf ormat ion obta
Page 201: 1 8 6 bact eriur ia r ates often r-
Page 205 and 206: 190 lacerations or i ncisions which
Page 207 and 208: The non-infectiolIs morbid!ties : P
Page 209 and 210: 194 About 60 % of the su b j ec t.s
Page 212 and 213: 197 for preventing postpartum infec
Page 214 and 215: '" comparable to t h e high 57% rep
Page 216 and 217: 201 p ostpartum pe r Lcd and also f
Page 218 and 219: 203 bcv ev e r , a bou t 3 to 10 t
Page 220: 205 The ve ry small number of patie
Page 225 and 226: 210 i n f orm ation on t he ea rly
Page 227 and 228: 212 depend o n the type of mo r b i
Page 229: one d id not fUlly escape t he l i
Page 232 and 233: 3 . What i s the ex tent o f pos t
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2 21 38 . Kah n AR, Jahan FA ( 1 98
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225 85 . Ph ill i p s I , ' Ba s s
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22. 122. Thacker 58, Banta HD (1982
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232 17 1. Hype r tensive di s o rde
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234 191. Cox ML ( J.963) . Incidenc
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'" 223 . Pugb TF , J erat h BK, Sch
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APPENDIZ A MAP OF GHANA AND STUDY "
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STUDY FORM A: Pa g e 2. PREGNANCY/l
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STUD Y FORM B : Page 2 IF YES, Did
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STUDY FORM B: Page 5 Bima nual Pa l
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3) Gaped wound/Delayed wound healin
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APPENDI X F R.ESULTS OF MUTI VARI A
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APPENDI X r II THE PREDICTORS OF PO
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APPENDIX L DETERMINANTS or POSTPART
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