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oai:repository.unam.edu.na:11070/41572025-10-04T22:01:04Zcom_11070_3438com_11070_3321com_11070_3307col_11070_1209

Mitonga, Kambwebwe Honore Frimpong, Joseph Asamoah 2025-10-02T08:11:51Z 2025-10-02T08:11:51Z 2025 http://hdl.handle.net/11070/4157 A dissertation submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy in Public Health 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 en University of Namibia Stillbirth Ghana Maternal health Risk actors Namibia University of Namibia Factors associated with stillbirth and assessment of maternal health awareness among residents of northern Ghana Thesisopen.access