Sumankuuro J, Domapielle M K, Derbile E K
Faculty of Public Policy and Governance, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana; Centre for Health Policy, School of Public Health, Faculty of Science, University of Witwatersrand, Johannesburg, South Africa; School of Community Health, Faculty of Science, Charles Sturt University, NSW, Australia; School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, South Africa.
Faculty of Public Policy and Governance, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana.
Public Health. 2022 Dec;213:34-46. doi: 10.1016/j.puhe.2022.09.010. Epub 2022 Nov 2.
Miscarriage remains a significant public health challenge in most low- and middle-income settings, including Ghana. We thus examined the sociodemographic and maternal characteristics associated with miscarriage in Ghana using the 2017 Maternal Health Survey dataset.
This was a cross-sectional quantitative study.
We quantitatively analysed Ghana Maternal and Health Survey dataset. Demographic and Health Survey (DHS) collected the data using survey techniques. Approximately 25,062 women within the active reproductive ages of 15-49 years were involved in the survey. We analysed the data using binary and multivariate logistic regression models at a 95% confidence level. The findings were reported using the World Health Organisation's Conceptual Social Determinants of Health framework.
We found that the prevalence of miscarriage was 15.6%. Education, religion and ethnicity were the most significant structural factors associated with miscarriage. We also found that women of all ages (20-49 years), starting antenatal care (ANC) in the fifth month of gestation, residing in rural area, having history of abortion (aOR = 0.622, 95% CI = 0.570-0.679, P < 0.001), and not using mobile phone during complications (adjusted odds ratio = 0.601, 95% confidence interval = 0.556-0.651, P < 0.001) were key intermediary determinants of miscarriage. The analysis found increased odds of miscarriage among women who had no mobile phone and could not access the same during obstetric complications.
The study concludes that country-policy frameworks on maternal and neonatal health care do not go far enough in providing specific solutions for preventing miscarriage. To reverse this trend, we recommend targeted ANC, including enhanced twenty-four-hour primary emergency obstetric care within 5 km, advocacy, and education as a lever to increasing utilisation of ANC, and removal of indirect financial barriers to maternal health care. We further recommend a qualitative research to understand some of the findings and explore the feasibility of promoting mobile phone technology to address maternal health problems, particularly obstetric care for women in hard-to-reach rural communities.
在包括加纳在内的大多数低收入和中等收入地区，流产仍然是一项重大的公共卫生挑战。因此，我们利用2017年孕产妇健康调查数据集，研究了加纳与流产相关的社会人口学和孕产妇特征。
这是一项横断面定量研究。
我们对加纳孕产妇和健康调查数据集进行了定量分析。人口与健康调查（DHS）采用调查技术收集数据。约25062名年龄在15至49岁之间的育龄妇女参与了此次调查。我们使用二元和多变量逻辑回归模型在95%的置信水平下分析数据。研究结果依据世界卫生组织的健康概念性社会决定因素框架进行报告。
我们发现流产患病率为15.6%。教育、宗教和种族是与流产相关的最显著的结构性因素。我们还发现，所有年龄段（20至49岁）、在妊娠第五个月开始产前护理（ANC）、居住在农村地区、有堕胎史（调整后比值比 = 0.622，95%置信区间 = 0.570 - 0.679，P < 0.001）以及在并发症期间未使用手机（调整后比值比 = 0.601，95%置信区间 = 0.556 - 0.651，P < 0.001）的女性是流产的关键中介决定因素。分析发现，没有手机且在产科并发症期间无法使用手机的女性流产几率增加。
该研究得出结论，国家关于孕产妇和新生儿保健的政策框架在提供预防流产的具体解决方案方面做得还不够。为扭转这一趋势，我们建议进行有针对性的产前护理，包括在5公里范围内加强24小时初级紧急产科护理、宣传和教育，以此作为提高产前护理利用率的手段，并消除孕产妇保健的间接经济障碍。我们还建议开展定性研究，以了解部分研究结果，并探索推广手机技术以解决孕产妇健康问题的可行性，特别是为难以到达的农村社区的妇女提供产科护理。
