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3 . What i s the ex tent o f pos t pa r tum morbidity in wome n who deliver at home and what are the dete rmina nt s ? 2 17 I n conclusion , it is h op ed that the r e s ults of thi s study, a nd i t s rec ommendati on s , will c o ntribute to improving the he alth of a l l mothers i n Ghana, and a lso in othe r developing nations thus answering t o t he Sa fe Motherhood ca ll to action (9}.
REFERENCES 1. pr eve nt i ng the Tr agedy of Maternal Deaths. A report on t he I nte r na t iona l Safe Motherhood Conference. Nairob i, Ke nya, Feb . 1987 - prepared b y Ann sta r rs: WHO, UNFPA , WB. 2 . K.A . Harrison (1989) . Mat e r na l Mortality in Developing co untri es . Br J Obstet Gynaecol, 96; p 1-3 . 3. Mortality : Summary list of causes 19 86 . ( 19 88 ) Vi tal St a t istics, stat ist i c Can ad a (1 986) . Ministry of supply Services Vo l . J; p 24 Vi t a l a nd Healt h St atis t ics ( 199 0). Supplement t o the monthly viti'll s t atistic s report : Adva nc e r eports 1987 : Compilation of data on natalit y , mort ality, ma r r i ag e , d i v or c e and induc ed t e r mi nati on s of p r egna ncy. U. S . Dept . of Health a n d Huma n Se r v i c es, Ma r y l a nd . Se r ies 24 ; p 1-13 S. Gree nwo od AM , Greenwood 8M, Bradley AK, Wil liams tt , Shenton FC, Tulloch S, Byass P , Oldf ield FSJ (1987) . II prospective study o f t he outcome of pr e g nan c y in a rural area o f Gambia. Bull WHO: 65 ; 5 1 p 635 -64 J . 6. Dobb i e BK ( 1982) . An attempt t o estimate t he tru e rate of maternal mortality i n sixteent h to eighteenth cent ur i e s . Med Hi st : 26; p 79 -9 0. 7 . Hogberg U, Wall 5, Brostrom G (1 98 61 . The impac t of e a rly medical technology on lIIaterna l mo r t a lit y i n late 1 9t h Ce ntu ry Sweden. I nt J Gynecol Obs t e t ; 24; p 251 2 61. 8 . Ha r r ison KA, ( 19 8 5 ) . Child be a r i ng , health and s ocial prior i t ies : A survey o f 22 , 7 74 consecutive hospital b irt hs i n zaria, Northe r n Ni ge r i a . Dr J Obs tet Gynaecol [Supp l 5) : p 1- 119 . 9 . Mahler H, ( 198 7) . The saf e motherhood i nit iative: call t o action. Lance t : i ; (8534) : p 668 -670 . 10 . EI Kady AA, Sa leh s , Gadalla S , Fortney J , Bay oum i H. ( 19 8 9 ) . Obs t etr i c deaths in He nou l i a Gove rnorate Egypt. ae J Obs tet c yneecct r 96 ; p 9 - 1 4. 11. Rogo , KO, ( 1989) . Mortal ity in acute gyn a e co l ogy: A developing count r y prospe ctive. l nt J Gy ne c o l Obstetl 3 0 ; p 343 -347.
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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
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5 .2 . 1 Comparinq clinic a t t e n
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200 ,eo 100 FIG. 2.1 :HOW SUBJECTS
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FIG.2.3: THE DAY OF FEVER ONSET REP
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13 . I n a l l 21 2 ( 59 . 1\> s Ub
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133 sUbjects said they did. A wide
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136 Diastolic blood pressure readin
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141 OTHER PATHOLOGI CAL FI NDI NGS
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144 FOLLOW-UP OUTCOMES: At the end
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5. 3 : I NCI DENCE OF MORBI DITY 5
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150 LOWER GENITAL TRACT I NFECTIO N
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152 ACUTE URIN ARY TRACT I NFECTION
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154 !i\!m.!!!Ari. : The occurrence
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15 7 regr ession was performed, t o
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15. The s tat i stically significan
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161 s t atistically !li gnifica nt
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16 3 t.o de t ermi ne t hose wi th
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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 188 and 189: CHAPTER 6 !l!SQJ.SSI ON AND RECOMME
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 236: 2 21 38 . Kah n AR, Jahan FA ( 1 98
Page 240 and 241: 225 85 . Ph ill i p s I , ' Ba s s
Page 243 and 244: 22. 122. Thacker 58, Banta HD (1982
Page 247 and 248: 232 17 1. Hype r tensive di s o rde
Page 249 and 250: 234 191. Cox ML ( J.963) . Incidenc
Page 251: '" 223 . Pugb TF , J erat h BK, Sch
Page 254: APPENDIZ A MAP OF GHANA AND STUDY "
Page 257 and 258: STUDY FORM A: Pa g e 2. PREGNANCY/l
Page 259: STUD Y FORM B : Page 2 IF YES, Did
Page 262: STUDY FORM B: Page 5 Bima nual Pa l
Page 265 and 266: 3) Gaped wound/Delayed wound healin
Page 267 and 268: APPENDI X F R.ESULTS OF MUTI VARI A
Page 270: APPENDI X r II THE PREDICTORS OF PO
Page 273 and 274: APPENDIX L DETERMINANTS or POSTPART
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