Factors associated with stillbirth and assessment of maternal health awareness among residents of northern Ghana
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Date
2025
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Publisher
University of Namibia
Abstract
Globally, 14 stillbirths per 1,000 births occur annually. Most of these deaths occur in
Asia and sub-Saharan Africa. Ghana’s stillbirth rate ranges from 13 – 20 per 1,000
births. The northern zone is as high as 20 per 1,000 births. The Early Newborn Action
Plan aims at 12 per 1,000 births. This study sought to assess risk factors associated
with stillbirth and assess maternal health awareness in northern zone of Ghana to
develop a policy brief to inform strategies in reducing stillbirths. The study employed
a convergent mixed method of qualitative and quantitative approach (Case-Control
study, survey and grounded theory) among residents in the northern part of Ghana
from November 2021 – May 2023. Muti-stage sampling was used to select participants
for the survey, population proportionate to size was used for the case control, In-depth
interviews was based saturation and focus group discussions were based on availability
of respondents. Data was collected using a semi-structured questionnaire and
interview guide through focused group discussions, in-depth interviews, and records
review. Descriptive and analytic statistics were performed using Stata 16. Multivariate
logistic regression was used to calculate adjusted odds ratios (aOR) and 95%
confidence intervals (95%CI) for stillbirth. Qualitative data was analysed using the
thematic content analysis approach with Nvivo version 10. Risk factors for stillbirth
included being unmarried (aOR=9.78, 95%CI:16.48-57.98), family history of
stillbirth (aOR=2.63, 95%CI: 1.67-4.12), no patograph use (aOR=2.14,95%CI:1.45-
3.16), partner’s tobacco use (aOR=2.19,95%CI:1.16-4.16), Rhesus negative
(aOR=1.75,95%CI:1.12-2.73), sickle cell trait (aOR=2.29,95%CI:1.27-4.10), foetal
malpresentation (aOR=2.67,95%CI:1.33-5.35), eclampsia (aOR = 9.00,95%CI:2.91-
27.87) and premature rupture of membranes (aOR=2.64, 95%CI:1.17-5.95). Attending
>4 antenatal care visits (aOR=0.53, 95%CI:0.30-0.93) was protective. Overall,
22.89%(276/1206) of the women studied had good knowledge of maternal health,
47.60%(574/1206) of them had good attitude, and 89.55%(1080/1206) had good
practices towards maternal healthcare. Community members practiced both orthodox
and traditional remedies, perceived some stillbirths are caused by evil spirits.
Healthcare workers perceived their responsibilities included routine prenatal, antenatal
and postnatal care, with many facilities reporting incapacity of handling severe
maternal health conditions. In conclusion, risk factors for stillbirth in Northern Ghana
include being unmarried, family history of stillbirth, not using patograph, tobacco use,
rhesus negative, sickle cell trait, premature rupture of membrane, foetal
malpresentation and eclampsia. Knowledge and attitude on maternal health was poor
but practice was high. Maternal healthcare was influence by traditional beliefs with
mainly husbands having the right to decision making on maternal health seeking
behaviour. Healthcare workers incapacity of handling severe maternal health
conditions was identified. A policy brief has been developed to guide interventions by
Ghana Health Service with recommendations on improving healthcare capacity,
improving collaboration with traditional healers and empowering women to take up
their role before and during pregnancy
Description
A dissertation submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy in Public Health
Keywords
Stillbirth, Ghana, Maternal health, Risk actors, Namibia, University of Namibia