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growt h r ate of 2 .5% [ 21] . I t is divided into 18 administrative d istr icts, including Kumasi district, the l oca t i on of tl;ll present study . Geographically the region f a l l s predominant ly i n t he tropical deciduous forest zone wi t h a maxi mum monthly r ainfall level of 310 millilitres in June. It i s inhabited mostly by the Ashanti, who f orm the largest ethnic g roup vithin the Akan linguistic group, an d a f ew other migrant tribes. The Ashanti are a pe op l e wi th a rich cuIture and history , a nd are noted f or thei r legendary Golden Stoo l. Ruled by a powerful k i ng , the Asant eh ene, the Ashanti i n the past conquered many n e i ghbour i ng groups and c reated a powe r f ul kingdom. Like other Akans , they have a matrilinear system o f inheritance . This system of inheritance appears to grant women more political and economic rights than does the patrilineal system practised by t he other tribes [ 19 ] . In Ashanti cu l t ure, l ife ' s experiences are taken ve ry seriously. Events like death, ill -health and i nfertility are v iewed with suspicion. Pregnancy , labour and the puerperium are c onside r e d special miles t o ne s a nd are marked by s p e c i fic norms and practices aimed at protecting the h ealth of mot he r a nd child . For i n s t a nce , to mark a su ccessful outcome o f p regnancy, t he woman is expected to dress up in "wh LtiLsh" garments and rich j ewelle r y whenever she goes out.
Agriculture, trading, mining, and timber logging are the major i ndustries i n the region, and together with social service related jobs, are the major forms of employment . The region is considered one of the richest in the country in terms of na tural resources. Other socie-demographic and health indicators are follows [19 ,21 , 22 ): Population density per sq. km. 86 Urban to rural proportion 32: 68 I n f a nt mortality rate 70 per 1000 Maternal mortality r a t e
Page 5: A PROSPECTIVE STUDY OF EARLY PUERPE
Page 8 and 9: dysuria (26%). Nearly 60% of the st
Page 10 and 11: on l y greatl y enri ch ed the s ub
Page 12 and 13: 5.4 De t e r mi na nt s o f morbidi
Page 14 and 15: Ta ble 2 .1 1 Di ag nos es in t rea
Page 16 and 17: CHAPTER 1 IN T RODU CTI ON As mor e
Page 18 and 19: impair mater nal health [ 13 ] . Th
Page 20 and 21: Many African countries l ike Ghan a
Page 22 and 23: Sex ratio (M/F) (1 989) 0 . 98 Rura
Page 26 and 27: Sex ratio (M as a % o f F) Crude bi
Page 28 and 29: hours in t he h o s p i t ll;l. Nor
Page 30 and 31: irths ( 19 ) . Although no communit
Page 32 and 33: It i s ob vious froID. the above in
Page 34: The need for adequate puerperal car
Page 37 and 38: for )0% and 20% respectivel y (33]
Page 39 and 40: The Za r i a s t ud y ( a}, also re
Page 41 and 42: embolism coul d be classified a s a
Page 43: serious h e alth consequences becau
Page 47 and 48: o ne known pat hoge n [54] _ Candid
Page 49 and 50: a de qua t e trr ea tinerrc fo r th
Page 51 and 52: 3 6 Three of the 31 bacteriuric cas
Page 53 and 54: sinc e direct bladd er s ampling h
Page 56 and 57: developing world countries have i n
Page 58 and 59: Unlike t he developed world, breast
Page 60 and 61: i n t h e puerper ium will occur i
Page 62 and 63: ED; siotomy wou nd inf ection: I n
Page 64 and 65: 4' The incidence o f deep vein thro
Page 66 and 67: percent in Bali, Indonesia [37]. Th
Page 68 and 69: Pos t p a r t um Anaemia: Anaemia i
Page 70 and 71: study situat ions and ma y be up t
Page 72 and 73: wome n with caesarean deliveries (-
Page 74:
deficien t , 50% f o l a t e defici
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days {178, 179] . In a study of pre
Page 79 and 80:
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
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
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CHAPTER 6 !l!SQJ.SSI ON AND RECOMME
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175 higher ed ucation levels a nd l
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177 a bout half of t he women who h
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180 ranked t he i r health as satis
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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
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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
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3 . What i s the ex tent o f pos t
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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