23 Nov 2015

Over the past several decades, Ghana has made some significant progress towards meeting the Millennium Development Goals (MDGs) on health, i.e. reducing child mortality by two-thirds (MDG4) and improving maternal health outcomes by three-quarters (MDG5) between 1990 and 2015.  Recent data indicates that child mortality rates for Ghana are estimated to have reduced from 111 per 1000 live births in 2003 to 80 per 1000 live births in 2008. However, it is generally known that Ghana is not on target to meet those two goals unless significant efforts are made to identify and scale up child survival measures known to stem infant deaths such as the WOTRO-funded project to Accelerate progress towards meeting MDG 4 and 5 in Ghana.  

Among the known links to infant deaths include low birth weight (LBW), which is associated with maternal factors during pregnancy. Antenatal care (ANC), which provides the opportunity to detect and address maternal factors associated with adverse birth outcomes, is documented to be high in Ghana in recent years.  However, one of the most vital issues rarely addressed in ANC services include screening for risk factors for depression during pregnancy, and postpartum depression that has the potential to influence infant survival subsequently.  Despite high ANC coverage in Ghana, many women nationwide (56%) still chooses to deliver at home and/or without skilled birth attendant (SBA) at a health facility.  Such a worrying trend on the limited health facility or SBA use for delivery in Ghana reduces the opportunity for the women to receive valuable maternal and infant screening that could detect early signs of infant distress or postpartum depression in mothers. 

 

In a recent study, it was shown that about two-thirds of new mothers with sick infants in Ghana are at a higher risk for depression.  Postpartum depression, which appears to be as common in Africa as it is in the West, is known to affect not only mothers but it also increase the health risks of the infants.  However, many people in Africa, including in Ghana generally attribute symptoms of depression to spirituality or personal issues rather than a psychiatric condition that can be treated.  In the Ghanaian society, issues of mental disorders are not discussed or well addressed, even within the maternal and child health setting, and this could be affecting the health, and for that matter, the survival of some newborns. 

It has been documented that mothers who are depressed are almost twice as likely to have infants that are low birth weight or children that are underweight, and experience stunted growth.  Low birth weight is known and documented to be a powerful and proximate predictor of infant mortality. Although birth weight is influenced by many factors, it is so strongly related to the infant’s well-being that it has become one of the prime indicators for population health.  In the 2002 document “A World Fit for Children,” United Nations member countries pledged to reduce the proportion of infants born with LBW by one-third by the end of 2010.  Meeting such reduction in LBW target in Ghana would require serious measures to address the confluence of maternal risk factors known to be associated with low birth weight.  These measures must include serious efforts by Ghana to address the mental health needs of women during pregnancy and postpartum. 

The World Health Organization estimates that about 10% of a country’s population would suffer from a psychiatric condition at any point in time.  Therefore, using Ghana’s most recent population census suggests that more than 2.4 million Ghanaians (about half of whom are women) may have some form of psychiatric condition.  The WHO estimated that about 650,000 Ghanaians (or about 3% of the population) may have a severe form of mental disorder.  Although Ghana passed a new Mental Health Act in 2012 (Act 846), which is an important step towards addressing the mental health needs of Ghanaians, it does not explicitly address the mental health needs of pregnant or postpartum women.  The Act stipulated in Section 64(1-4) how women with mental illness should be treated when in mental health facilities but it never specifically addressed the needs of pregnant and postpartum women who experience mental disorders.

In fact, it could be argued that some challenges may exist to address the perinatal mental health needs of women in Ghana.  Nonetheless, efforts must be made to make it a priority, especially since there is documented evidence linking perinatal mental disorders to poor birth outcomes such as low birth weight, which in turn increases infants’ chances of death significantly (UNICEF 2004). In other words, Ghana can also address its infant mortality issues by tackling perinatal depression among high risk women.  Doing so could contribute towards a more accelerated approach towards meeting the MDG 4 (and 5) in Ghana by the end of the target year.

From your experience, what hidden  maternal factors have hindered the achievement of MGD 4 and 5? We would love to hear from you!    

References: 

  1. Chang, S. C., O’Brien, K. O., Nathanson, M. S., Mancini, J., & Whitter, F. R. (2003). Characteristics and risk factors for adverse birth outcomes in pregnant black adolescents. The Journal of Pediatrics. 143, 250-257.
  2. World Health Organization (2008).  Low birthweight: Newborns. WHO-Statistical Information System (WHOSIS). Retrieved From http://www.who.int/whosis/indicators/compendium/2008/2bwn/en/index.html  (27 March, 2015).
  3. United Nations Children’s Fund and World Health Organization (2004).  Low Birthweight: Country, Regional and Global Estimates. UNICEF, New York.
  4. Ibrahim, A. et al (2014). Levels and Determinants of Low Birth Weight in Infants Delivered Under the National Health Insurance Scheme in Northern Ghana. Maternal and Child Health Journal. Doi 10.1007/s10995-014-1628-3
  5. United Nations (2002). A World Fit for Children. UN General Assembly Special Resolution Document # A/RES/S-27/2. New York, NY.
  6. Mills, S., Williams, J. E., Adjuik, M., & Hodgson, A. (2008).  Use of health professionals for delivery following the availability of free obstetric care in Northern Ghana.  Maternal and Child Health Journal, 12, 509-518.
  7. Gold, K. et al. (2013). Depression and risk factors for depression among mothers of sick infants in Kumasi, Ghana. International Journal of Gynaecology and Obstetrics; (120): 228-231.