A prospective study of early puerperal morbidity in Kumasi, Ghana

Abstract

The objectives of this study were to; (1) describe the incidences and determinants of early puerperal morbidities in women in Kumasi; and (2) provide information for use in improving the postpartum health care of these women. -- A cohort of 472 women from home, who had vaginal deliveries at the Komfo Anokye hospital in Kumasi, Ghana, were recruited and followed up during their early puerperal period. Morbidity was assessed through interview, physical examination and haemoglobin investigation. An overall 81% follow-up rate was obtained. Forty-eight percent of subjects scheduled for follow-up failed to attend the special clinic and had to be traced to their homes. -- The subjects were mostly from low socioeconomic levels. Their mean age and parity was 25.4 years and 2.8 deliveries respectively. While three-quarters of them (78.4%) had at least one identifiable pregnancy or labour risk factor (nearly 40% were anaemic at labour) they had relatively uneventful deliveries. -- Nine out of every ten women seen postpartum reported at least one health complaint. The most frequent symptoms were fever (28%), abdominal pain (64%), perineal soreness (31%) and dysuria (26%). Nearly 60% of the study women self-treated with potent medications ranging from analgesics to antibiotics. -- On assessment, 66.6% of the women discharged home routinely after delivery, were found to have at least one puerperal health complication requiring medical attention. In 46% of subjects morbidity was severe enough to warrant medical attention within 72 hours or less. The incidences of puerperal upper and lower genital tract infection in the study sample were 180 and 151 per 1000 deliveries respectively. Postpartum anaemia occurred in 35.1% of women. The incidences of postpartum hypertension, acute urinary tract infection, and mastitis were 88.2, 52.2 and 13.1 per 1000 respectively. -- The findings in this study suggest that high rates of puerperal complications occur in women in Kumasi who are discharged home in a "satisfactory" health condition within a few hours after delivery. Postpartum health care services should address this need. It is recommended that: (1) a routine early postpartum clinic be organised for all women discharged home within hours after delivery; (2) women receive health education about the hazards of self-medication, and (3) further attention be paid to identifying the determinants of the specific morbidities.