FOR RAY WRITTER

METHODSandDATACOLLECTION.docx

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METHODS (NATURE OF STUDY)

Profile of Accra Metropolitan Area

Study Area (Accra Metropolitan Area).

Study design: Unmatched case control study using primary and secondary data from patient Hospital records, next of kin (of cases), and controls selected from Ridge Regional and 37 Military hospitals.

Study Population/Inclusion Criteria

The population is all pregnant women who delivered in health facilities in the Accra Metropolitan Area in 2016.

Cases would be Maternal death that occurred in hospitals in (the Osu Klottey Sub Metro of) Accra Metropolitan Area in 2016.

Controls would be mothers who delivered at the Ridge Regional and 37 Military hospitals in 2016 that were alive at the end of the puerperal periods.

Exclusion Criteria

Maternal deaths outside Osu Klottey Sub Metro and mothers who delivered at health facilities in Accra Metro in 2016 but not at Ridge Regional or 37 Military hospitals and were alive at the end of the puerperal period.

Sampling Methods

Cases would be purposively selected from maternal death in the Osu Klottey Sub Metro of the Accra Metropolitan Area in 2016. Cases are defined as obstetric cases that died or declared dead upon arrival, or after admission (including those who died before the fetus was delivered). Controls would be randomly selected from mothers who delivered at Ridge and 37 Military hospital in 2016 and are alive at the end of puerperal period using simple random sampling.

Sampling Frame: The second post-natal attendants register in both hospitals would be used for control selections.

Sample Size Calculation

The sample size was calculated using EPI INFO STAT CALC. Version 7. Sample size of 189 (63 cases and 126 controls) was determined using 95% confidence interval , power of 80 percent, ratio of 2 control to a case, minimum odds ratio of 2.6.

Data Collection Technique and Tools

Medical records (folders) of all cases from 1st January 2016 to 31st December 2016 would be retrieved from the health facilities and reviewed. Consented next of kins of all cases would be interviewed using structured questionnaire. Medical records of consented and randomly selected controls from the participating hospitals would be retrieved and reviewed. The controls would also be interviewed using structured questionnaire. Health personnel who played significant roles in the management of a case or control would also be interviewed using structured questionnaire.

Data Quality Control

Pre-Testing of questionnaire

Questionnaires (9) would be pre-tested in the Korle Bu Teaching hospital. This would offer an opportunity for coding open ended questions based on the responses received.

Training of Research Assistants

Three research assistants would be recruited and trained to ensure the right information are ascertained from medical records and respondents.

Data Analysis

Data would be entered into EPI INFO 7. Stata/MP 3.0 would be used to describe, cross tabulate and determine association of socio-demographic and service delivery factors with maternal mortality.

Ethical Clearance

Ethical approval would be obtained from the Ghana Health Service review committee, Greater Accra Division. Written informed consent would be obtained from the participating Health Institution and participants. The objectives of the study would be explained and informed consent obtained from them before each interview and medical record review. Data obtained would be confidentially kept and used on for the purpose of the research.

Dissemination of Research Findings

The results will provide information which could inform policy to reduce Maternal Mortality in health institutions in Accra. The findings would be disseminated through institutional and regional workshop, policy brief and publication in scientific journal.