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CHAP TE R 4 M!ill!Q.!2S 4 .1 : THE STU DY DESIGN The de s i gn was basically that of a prospective cohort study i n which a cohort of presumably well pregnant women from home, 'Who delivered their i nf ant s v aginally at the xomr c Anokye Teaching Hospital (KATH) l a bou r ward, were followed up i n their early puerperium, by i nt e r v i e w a nd physical examination t o determine the occurrences of morbi dity such as anaemia, puerperal sepsis, e tc. . 4 • 2 : S TU DY OBJECTIVES 1 . To determine the incidence of puerperal morbidity , pa rticularly i nfections and a naemia , i n a cohort af women deliv e r i ng in Kumasi, Ghana . 2. To determine the ex tent to which c er t a i n 50 c10 - demographic features, pregnancy a nd labour experiences i nflue nc e the occurrence of morbidity in these women. 3. To provide information fo r uoe in improving the post partum health care of women i n Kumasi and the country.
4 .3: STUDY PLANNIN G AND THE CONS I DERATIONS Because the planning stages o f this stud y wer e done in St . J ohn ' s , Newfoundland , Canada, a c on s i de rable dista nce from the study area, in:p ortant methodological c onsiderations h ad to be made . Two aspects of the study design, judged a s mos t affected by these limitations, were the devel opme nt of t h e q uestionnaires (the measuring i ns t r ument ) [ or us e i n t he study , and t he time interval for achieving the desi red study goals. s trategies adopted to minimise the e ffects of these l i mitations are as follows : Ins t rum ent dev e lopment: Ti me and f i na nc ial co ns t r a i nt s prevented the organisation o t: a p i l ot survey ne eded to refine study questionnaires. Samp les of t h e s e questionnaires were forwarded t o a number of individuals involved i n maternity care i n the As ha nt i region , Ghana , for comments and review based on their patient e xpe r i e nc e s . opini o ns were als o s imilarly sough'.: f rom a practising Obstetrician a nd Gynaecologist i n Kumasi and i n St . John's on t he mor e tec h nica l aspec t s of mor bidity asseaseent; i n t he Kumas i setting . Time for mor bidity as s e s s ment: A on e week period f rom t he 7t h to 14th pos t pa r t um days was chosen as t he best time f or patient follow up . This time i nterval was chosen because i t
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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
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
Page 77 and 78: days {178, 179] . In a study of pre
Page 79 and 80: 22,774 births s t udied were 6 .1%,
Page 81 and 82: ca r d i a c failure, a ssoc iated
Page 84 and 85: of the disease in zaria has been at
Page 86 and 87: Africa. and the incidence is still
Page 88 and 89: i ncreased occu rrenC:2 of psychiat
Page 90 and 91: African studies respectively h a d
Page 92 and 93: about the i r mari t a l s tat us,
Page 97 and 98: Bearing in mind t he fact t ha t th
Page 99 and 100: - Fre e medical consultation for ..
Page 102 and 103: Examination : SUbjects wer e examin
Page 105: •• Lowe r genita l t ract i nte
Page 108 and 109: " c linica l assessment and lIlanaq
Page 110 and 111: sample cJ9scr ipt i on ; The charac
Page 112: Further mUltivariate logistic regre
Page 116 and 117: discharge s i n c e they were aa s
Page 119 and 120: 104 ETHNIC ORIGINS: The majority of
Page 121: 106 ap prenticeship- trained occupa
Page 124: YES 1l6'l\ FIG. 1.4 ANTENATAL CARE
Page 129 and 130: Labour e ve nts , c omplications a
Page 131 and 132: n . OTHER IMMEDI ATE COMPL.ICATIONS
Page 133: 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
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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
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1 6 7 The results o f multiva riate
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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
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1 8 6 bact eriur ia r ates often r-
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190 lacerations or i ncisions which
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The non-infectiolIs morbid!ties : P
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194 About 60 % of the su b j ec t.s
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197 for preventing postpartum infec
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'" comparable to t h e high 57% rep
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201 p ostpartum pe r Lcd and also f
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203 bcv ev e r , a bou t 3 to 10 t
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205 The ve ry small number of patie
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210 i n f orm ation on t he ea rly
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212 depend o n the type of mo r b i
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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
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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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