MATERNAL HEALTH PROJECT
IN NKORANZA

The care of mothers and babies in Nkoranza district of Brong Ahafo region, Ghana has been greatly improved by an integrated safe motherhood project started by MaterCare International, in partnership with the Catholic Diocesan Health Committee, Sunyani, mid-West Ghana. Nkoranza district is mainly a farming area of about 150 rural settlements, producing mostly maize, yam, cassava, beans, groundnut and rice. Its centre is the small town of Nkoranza. The total population is approximately 144,000 with an estimated 36,000 living within an eight-kilometre radius of the hospital. Mothers in Nkoranza district have the choice of attending St. Theresa's Hospital for care during childbirth, a small but busy district general hospital that offers maternity services, or one of ten rural health centres staffed by nurse-midwives. The reality of maternity care for Nkoranza mothers is that many choose the traditional birth attendants (TBAs), local village women who are dedicated to their work, but who have little or no training. Sixty-five per cent of births in the rural areas are conducted by traditional birth attendants (TBAs), in the village.

The major reasons for lack of professional care for the mothers are poverty, lack of knowledge, cultural beliefs and values and difficulties in accessing the health services especially at night. Travel in Nkoranza is difficult due to poor roads, isolation and unreliable public transport. Transportation, generally by taxi, motor bike or tractor, is particularly difficult during the rainy season. Therefore if a mother develops problems during pregnancy or birth there is delay in transferring her to hospital in emergency. Medical and midwifery staff have told us that women were arriving at the hospital in critical condition and lives were lost due to delays in transportation from the villages. There are no telephones or other direct methods of communication between the villages, rural health centres and the district hospital in cases of emergency.

Another major factor in maternal deaths in developing countries is lack of blood transfusions to treat haemorrhage during childbirth.

The safe motherhood project was developed to address these threats to the health of mothers and their babies while recognizing and respecting local resources and practices. The project includes an emergency obstetric transport service (EOTS), continuing education sessions for rural nurse-midwives, training and supervision of all traditional birth attendants (TBAs) in the project area and development of a blood bank dedicated to mothers in childbirth and their babies. The emergency obstetric transport service, a Range Rover ambulance suitable for travel over rough roads, is central to the safe motherhood program. The ambulance was purchased and equipped with essential emergency obstetric supplies, and solar powered radios were installed in the rural maternity centres to enable the midwives communicate with the hospital and ambulance service. The radios were linked to the base radio in the labour and delivery ward at St. Theresa's Hospital which had access to the ambulance and driver.

Before the ambulance service was started, the TBAs were taught to use a pictograph, a set of drawings of major complications of birth. The pictograph helped the TBAs to recognise women at risk of birth complications and women who developed complications during pregnancy and labour. The importance of referring the women to the nearest health centre or the hospital was emphasised. They were also informed about the availability of the emergency transport service and how they could access it through the nearest rural health centre. The rural midwives attended orientation sessions on the use of the service, were instructed in the use of the radio system and were provided with a manual outlining the protocols for the use of the service. The midwives also received a workshop to update their emergency obstetric skills. If the ambulance was required, the midwife radioed the labour ward for advice and the doctor or midwife on call dispatched the ambulance if necessary.

The equipment in the blood transfusion laboratory at St. Theresa's Hospital was updated and a blood collection system developed.

In the 15 months, since the inception of the service 364 mothers and two babies have been transferred by ambulance to the hospital with complications of pregnancy, labour, or following birth. Happily, in most cases the births were normal and mothers and babies were healthy. However, over 30% of the mothers transferred required medical interventions that, if delayed, could have had serious consequences for the mother and/or baby,

Another activity carried out in the district during 2002 was a study to find a safe, effective method of preventing haemorrhage in mothers after birth, especially in isolated villages where help is not readily available. This study showed that there is an inexpensive, effective medication to prevent or control haemorrhage in mothers after birth under the conditions of the district hospital. The next step is to find out if it can work in the villages when used by the traditional birth attendants.

There have been many other improvements in the care of the mothers of Nkoranza district. The on-going supervision of the TBAs and their involvement in the district health system has had many benefits. Referrals of mothers from the TBAs to the health centre and/or the hospital have increased from 76 referrals in 1997-98, the year prior to the project, to 272 referrals in 2000, and 296 in 2002 ensuring professional help for mothers with childbirth problems. Access to medical advice through the radio link to the hospital has been greatly appreciated by the rural midwives.

Several young midwifery, medical and nursing students from Canada and elsewhere have benefited from having clinical field experience in international women's health through participation in the activities of the project.
© 2008 MaterCare International, All Rights Reserved
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