2013 ANNUAL REPRODUCTIVE AND CHILD HEALTH REPORT
ANNUAL REPORT RCH, GHS
2013 ANNUAL REPRODUCTIVE AND CHILD HEALTH REPORT ANNUAL REPORT
RCH, GHS
Contents Contents ........................................................................................................................................................... 1 PREFACE ........................................................................................................................................................... 3 EXECUTIVE SUMMARY ..................................................................................................................................... 4 CHAPTER ONE .................................................................................................................................................. 5 1. Introduction .................................................................................................................................................. 5 1.1. Reproductive Health ................................................................................................................................... 5 1.2. Components of Reproductive Health ......................................................................................................... 5 1.3. Reproductive Health Commodity Security ................................................................................................. 6 1.4. Child Health ................................................................................................................................................ 7 1.4.1.
Components of Child Health .................................................................................................... 7
1.4.2. The priorities of Child Health Care are: ................................................................................................... 8 1.5. Justification ............................................................................................................................................... 8 1.6. Organogram of the RCH Department within Family Health Division ...................................................... 10 1.7. Vision ........................................................................................................................................................ 10 1.8. Mission ...................................................................................................................................................... 10 1.8.1. Goals &Objectives ................................................................................................................................. 11 Key Indicators /Performance and Targets ...................................................................................................... 12 CHAPTER TWO ............................................................................................................................................... 15 2. Safe Motherhood Programme .................................................................................................................... 15 2.1.
Introduction ........................................................................................................................... 15
2.2 ACHIEVEMENTS ........................................................................................................................................ 15 2.2.1
Utilization of Antenatal Care Services .................................................................................... 15
2.2.2 Antenatal Service Delivery .................................................................................................................... 16 2.2.2.5
Adolescent Pregnancy ............................................................................................................ 20
2.2.2.8
Tetanus Toxoid Immunization ................................................................................................ 23
2.2.3
Delivery Care .......................................................................................................................... 24
2.2.4 Emergency Obstetric and Newborn Care (EmONC) .............................................................................. 29 2.3 Postnatal Care Services............................................................................................................................. 31 2.4 Other Essential Maternal Health Services ................................................................................................ 33 2.5 PMTCT Services ......................................................................................................................................... 35 TABLE 1: Health facilities providing MNCH/PMTCT/EID services by region .................................................. 35 2.6 Cervical Cancer Screening ....................................................................................................................... 38 2.7 Institutional Maternal Deaths .................................................................................................................. 38 1
2.8
Regional maternal deaths audited against maternal deaths recorded for 2013 ................... 40
2.9
CAUSES OF MATERNAL DEATHS ............................................................................................. 41
2.10 KEY ACTIVITIES FOR 2013 ...................................................................................................................... 42 CHAPTER THREE ............................................................................................................................................. 47 3 Family Planning Services ......................................................................................................................... 47 3.1 Goal 48 3.1.1
The Objectives ........................................................................................................................ 48
3.2 Family planning methods currently available in Ghana: .......................................................................... 49 3.3 ACTIVITIES PLANNED FOR 2013 ................................................................................................................ 50 3.4 ACTIVITIES CARRIED OUT IN 2013 ............................................................................................................ 51 CHAPTER FOUR .............................................................................................................................................. 63 4 Child Health Programme ......................................................................................................................... 63 4.1 Programme Areas ..................................................................................................................................... 63 4.2 Key Activities Carried Out ......................................................................................................................... 63 4.3 Child Health Service Delivery .................................................................................................................... 66 Proportion of Children 0-‐59 months underweight ........................................................................................ 69 CHAPTER FIVE ................................................................................................................................................ 70 5 Adolescent Health and Development Programme .................................................................................. 70 5.1 Introduction .............................................................................................................................................. 70 5.2 Planned Activities For The Year 2013 ....................................................................................................... 70 5.3 Achievements For The Year 2013 ............................................................................................................. 71 5.4 Challenges ................................................................................................................................................. 75 5.5 ADHD Programme Plan For The Year 2014 .............................................................................................. 76 Adolescent Pregnancy ........................................................................................................................... 77 Adolescent Delivery ............................................................................................................................... 78 6 School Health Program ............................................................................................................................ 80 6.1 Introduction .............................................................................................................................................. 80 6.2 Objectives ................................................................................................................................................. 80 6.3 School Health Service Delivery ................................................................................................................. 81 CHAPTER SEVEN ............................................................................................................................................. 83 7 CHALLENGES AND WAY FORWARD ......................................................................................................... 83 7.1 Challenges for 2013 .................................................................................................................................. 83 7.2 Way Forward For 2013 ............................................................................................................................. 84
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PREFACE The year has been a very busy and a challenging one for the Reproductive and Child Health Department of the Family Health Division of the Ghana Health Service as staff had to work with inadequate resources, particularly financial and human resources for most part of the year. Nevertheless, the determined health staff of the department was able to achieve some successes. The gains though modest, went a long way to sustain the pragmatic strategies put in place to deliver health care services to the good people of Ghana. Congratulations to all staff of the Department for the zeal, dedication and hard work exhibited in rendering effective and quality health service to our people. It is my hope that the enthusiasm with which we all worked in the past years shall be extended to the years ahead. I want to use this forum to express gratitude to our gallant workers in the communities and facilities. I pray that the Gracious Lord grant to them peaceful rest, our departed colleagues who lost their lives in the course of their duty and those who retired. We salute them.
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EXECUTIVE SUMMARY The Reproductive and Child Department aims to provide services that will improve maternal, neonatal, child and adolescent health. The concept of Reproductive and Child Health brings a new dimension to family planning and maternal and child health programmes. The constellation of Reproductive Health services reflect the need to considerably broaden the range of services provided by most of the current RCH programmes to respond to the needs of individuals, couples and families. Antenatal care coverage decreased from 90.2% in 2012 to 90.1% in 2013. These registrations occurred in both public and private health facilities. The reduction in performance is due to the use of 4% instead of 3% for the projection of the expected pregnancies for the country since 3% resulted in a lower target resulting in over 100 percentage coverages for most of the health indicators. The consensus to use 4% instead of 3% was reached at the Senior Managers meeting held at Miklin Hotel, Accra on 3rd and 4th of April, 2014 with all regions and partners involved. The trend in supervised or skilled delivery has increased steadily over the past five years, reaching 54.7% this year; making it the highest institutional coverage ever recorded. Institutional maternal mortality ratio remained almost the same for years 2012 and 2013 with 152/100,000LBs and 154/100,000LBs respectively. The family planning acceptor rate decreased from 25.2% in 2012 to 24.7% in 2013. Couple Year of Protection increased from 2,012,807.3 in 2012 to 2,149,456.6 in 2013 with other sectors other than Ghana Health Service contributing 25.9% (555,819.3). Dr. Patrick K. Aboagye Deputy Director, RCH, Ghana Health Service
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CHAPTER ONE 1. Introduction Reproductive and Child Health Care is a constellation of preventive, curative, promotional and rehabilitative services for improving the health and well-‐being of the population, especially women and children. In line with the GHS Monitoring and Evaluation Plan (2010 – 2013), the reproductive and child health department priority actions are: •
Implement the MDG Acceleration Framework Country Action Plan for improved maternal and newborn care
•
implement the Child Health Policy and Strategy
•
implement Adolescent Health Policy and Strategy
1.1. Reproductive Health Reproductive health is “a state of complete physical, mental and social well-‐being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and to its functions and processes” (ICPD). 1.2. Components of Reproductive Health The components of Reproductive Health are: •
Maternal and Newborn Health Services o Nutrition counseling and iron/folic acid supplementation o Intermittent preventive treatment of malaria o Tetanus immunization o Prevention of mother-‐to-‐child transmission of HIV o Early detection and management of complications o Counseling on birth preparedness and complication readiness o Labour and Delivery Care, including essential newborn care o Postnatal Care 5
•
Family Planning Services
•
Other Essential Services
ü Prevention and management of unsafe abortion and post-‐abortion care ü Prevention and management of reproductive tract infections, including STIs ü Management of cancers of the reproductive system, including cervical, breast, testicular and prostatic cancers ü Prevention and management of harmful traditional practices that affect the Reproductive Health of men and women ü Information and counseling on human sexuality, responsible sexual behavior, responsible parenthood and pre-‐conception care ü Gender-‐based violence and reproductive health 1.3. Reproductive Health Commodity Security The effective coverage of reproductive health services is premised on reproductive health commodity security. Certain commodities are needed in the right quantities and stored under optimal conditions to ensure effective coverage of quality family planning and maternal health services. Commodities needed for the effective coverage of family planning services include contraceptive pills, injectable, implants, intra-‐uterine contraceptive devices and condoms. Within the safe motherhood programme, quality uterotonics (e.g. oxytocin and ergometrine) are needed for the control of excessive bleeding immediately following childbirth. The management of complications such as pre-‐eclampsia and eclampsia is dependent on the use of quality medicines such as magnesium sulphate, among others. There is also the need for equipment such as the manual vacuum aspirator for the provision of other essential reproductive health services such as prevention and management of unsafe abortion and post-‐abortion care. The provision of adequate quantities of the commodities needs to be complemented with a comprehensive programme of capacity-‐ building to ensure safe delivery of reproductive health services.
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1.4. Child Health The Child Health Programme constitutes all health activities aimed at promoting and maintaining the optimal growth and development of children from birth to 18 years. For programmatic purposes it has been subdivided into three groups: Children under 5 years (Birth – 5 years) School age children (5 – 15 years) Adolescent (10 – 19 years) 1.4.1. Components of Child Health The components of the Child Health programme include: •
Child Welfare Services: §
§
Promotion of exclusive breastfeeding for the first six months of life
Timely introduction of appropriate complementary feeding at 6 months with continued breastfeeding till 24 months or more
§
Vitamin A supplementation
§
Immunization
§
Growth promotion and nutrition rehabilitation,
§
Curative care for minor ailments and injuries.
•
School Health Services:
§
Screening and examination of school children and food vendors
§
Immunization
§
Health education on current public health issues
§
Management of minor ailments and injuries
§
Maintenance of a hygienic school environment
§
Referrals
•
Adolescent Health and Development:
7
§
It covers pre-‐adolescents (5-‐9 years) and young (people (10-‐24 years)
§
Identification and management of common health problems affecting adolescents
§
Provision of adolescent focused services including counseling, Information and Education
§
Communication (IE&C) and Reproductive Health in general 1.4.2. The priorities of Child Health Care are:
§
Neonatal health
§
Prevention and management of nutritional problems among children
§
Prevention and control of infectious diseases
§
Clinical care of the sick and injured child
§
Adolescent health
§
School health
1.5. Justification Women and children are the most vulnerable group and form 58.3% of the population (2010 Census). Morbidity and mortality among this group account for a major proportion of all ill-‐health and deaths in Ghana. Most of these illnesses and deaths are preventable. While women are significant contributors to the nation’s development efforts, children are a nation’s important resource. Their needs are a national priority. Reproductive and Child Health (RCH) are crucial components of general health. Reproductive health affects everybody. It reflects health in childhood and sets the stage for health even beyond the reproductive years for both women and men. Reproductive and Child Health affect, and are affected by the broader context of peoples’ lives, their economic circumstances, education, employment, living conditions, family environment, social and gender relationships and the traditional and legal structures within which they live. Therefore Reproductive and Child Health mean more than bio-‐medical interventions. They involve a greater awareness of health by individuals so that they can promote and protect their own health. 8
Reproductive rights embrace certain human rights:
• The right of couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to do so. • The right to attain the highest standard of sexual and reproductive health. • The right to make decisions free of discrimination, coercion and violence. According to the United Nations Convention on the Rights of the Child, children have the right to enjoy the highest attainable standard of health. They have the right to access facilities for the treatment of illnesses. The concept of Reproductive and Child Health brings a new dimension to family planning and maternal and child health programmes. The constellation of Reproductive Health services reflect the need to considerably broaden the range of services provided by most of the current RCH programmes to respond to the needs of individuals, couples and families. Involvement of key partners is crucial for the success of Reproductive and Child health programmes.
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1.6. Organogram of the RCH Department within Family Health Division
REPRODUCTIVE AND CHILD HEALTH
REPRODUCT IVE HEALTH
CHILD HEALTH
Other reproductive health and sexual health concern Prevention and management of STIs/HIV/AIDS Cancers of the reproductive tracts Addressing harmful traditional practices and GBV Concerns about menopause/male climacteric
Safe Motherhood Family Planning Prevention and Management of unsafe abortion Adolescent Health & Development
Under fives Neonatal Health Post neonatal health Postnatal health Child (1-4yrs) Breastfeeding Promotion IMNCI School Health
1.7. Vision To contribute to improvement in the health and quality of life of persons of reproductive age and beyond as well as children by providing high quality reproductive and child health services. 1.8. Mission The mission of the Reproductive and Child Health (RCH) Department is to contribute to improvement in the health and quality of life of persons of reproductive age and beyond as well as children (including adolescents).
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1.8.1. Goals &Objectives 1. To improve the health of women in general and especially, to reduce maternal morbidity and mortality and to contribute to reducing infant and child morbidity and mortality. 2. To assist couples and individuals of all ages to achieve their reproductive goals and improve their general reproductive health. 3. To provide individuals and communities (including adolescents) with information and equip them with life skills needed to adopt and maintain healthy behavior and optimal. 4. To plan and coordinate health activities aimed at promoting and maintaining healthy pregnancies and deliveries and optimal growth of children from birth to 18 years. 5. To improve awareness and knowledge on reproductive and child health issues.
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Key Indicators /Performance and Targets Table 1: Safe motherhood performance and targets PERIOD
2010
INDICATOR
2011
2012
2013
2014
TARG
PERFOR
TARGE
PERFOR
TARGE
PERFO
TARGE
PERFO
TARGE
ET
MANCE
T
MANCE
T
RMAN
T
RMAN
T
CE
CE
SAFE MOTHERHOOD 1. Antenatal Care
98%
92.6%
91%
98.2%
98.5%
92.2%
100%
90.1%
100%
2. At least 4 Visits
85%
74.3%
74.6%
75.2%
80%
77%
80%
72.6%
80%
3. Hb< 11.0g/dl at
20%
25.8%
20%
33.1%
20%
30.9%
20%
31%
20%
-‐
24.9%
34.3%
10%
25.5%
10%
28%
10%
50%
44.6%
50.3%
49.4%
55.6%
54.0%
80%
54.7%
60%
60%
55.2%
60%
58.6
65%
58.02% 90%
83.4%
90%
5%
8.1%
5%
8.7%
5%
8.5%
5%
8.3%
5%
8. Still Birth Rate
1.5%
2%
1.9%
1.9%
1.8%
2%
1.8%
1.8%
1.5%
9. Postnatal Care
65%
59.6%
65%
65.3%
78%
62.7%
90%
64.1%
70%
10. Maternal
1.50/
1.66/100
1.50/10 1.95/10
1.0/100 1.52/10 1.0/100 1.54/1
1.0/100
Mortality Ratio
1000
0
00
00
0
00
0
000
0
80%
77.5%
78%
76%
80%
76.9%
100%
71.5%
100%
12. CYP Short
1,000
1,098,12
1,100,0
817,722. 1,300,0
1,544,6
2,000,0
1,485,
2,000,0
Term Method
,000
9.4
00
6
95.6
00
634.9
00
Coverage
registration 4. Hb< 11.0g/dl at 36 weeks** 5.Supervised Delivery 6.TotalDelivery(inc luding Trained TBA) 7. Low Birth Weight Rate
Coverage
(Institutional) 11. TT2+ Immunization
00
12
13. CYP Long
350,0
326,455.
350,00
372,865. 420,00
468,11
600,00
663,82 600,00
Term Method
00
3
0
1
0
1.7
0
1.7
0
14. Family
35%
34.7%
35.6%
28.1
38%
25.2%
38%
24.7%
38%
Planning Acceptor rate Child Health Table 2: Child Health Performance and Targets PERIOD
2010
INDICATOR
2011
TARGE
PERFOR TARG
PERFO
T
MANCE ET
RMAN
2012
2013
TARGET PERFOR TARG
2014
PERFOR
TAR
MANCE ET
MANCE GET
46%
46%
CE 15.Exclusive
70%
63%
70%
63%
65%
Breastfeeding
70%
(MICS)
70%
(MICS)
Rate 6 months 16. No. of Baby Friendly
350
324
350
324
100%
95.4%
100% 98.2%
350
461
500
461
500
99%
98.1%
100%
96.9%
100
Health Facilities 17.% of mother/baby pair breastfeeding
%
exclusively at discharge 18. EPI (PENTA-‐3)
95%
83.4%
95%
19. Growth Monitoring
90%
111.9% 90%
0-‐11 months
86.9%
95%
90.7%
116.1
90%
95%
84.7%
95%
117.7% 90%
112.7%
90%
%
20. Average # of visits
9
4.7
9
5.2
9
5.4
9
4.9
50%
42.2%
50%
41.2%
50%
42.4%
50%
41.8%
50%
6
6.2
7
6.7
7
4.2
7
7.6
8
20%
15.2%
20%
15%
20%
15.3%
20%
13.7%
20%
0-‐11 months 21. Growth Monitoring 12-‐23 months 22. Average # of visit 12-‐23 months 23. Growth Monitoring
13
24-‐59 months 24. Average no. of visits
8
6.5
8
7
8
7.2
8
7.8
8
2%
11.4%
2%
9.6%
2%
3%
2%
3.8%
2%
4%
15%
4%
12.3%
4%
4%
4%
4.9%
4%
3%
14.9%
3%
11.3%
3%
3.5%
3%
4.1%
3%
70%
60.8%
70%
75.8%
80%
85.4%
90%
175.4%
90%
25%
30.4%
35%
25.5%
35%
70.7%
75%
101%
75%
0%
0.3%
0%
0.4%
0%
0.3%
0%
0.3%
0.2%
10%
12.2%
10%
12.9%
10%
12.7%
10%
12.0%
10%
24-‐59 months 25. % Malnourished children 0-‐11 months 26. % Malnourished children 12-‐23 months 27. % Malnourished children 24-‐59 months 28. % Enrolled children physically examined 29. % Schools received 3+ health education Talks 31. % Adolescent Pregnancy (10-‐14 yrs.)/ ANC registrants 32. % Adolescent Pregnancy (15-‐19yrs) /ANC registrants
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CHAPTER TWO 2. Safe Motherhood Programme 2.1. Introduction Adequate care during pregnancy is important for the health of the mother and the optimal development of the baby. Antenatal care is the health care and education given during pregnancy. This period clearly presents opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-‐being and that of their unborn babies. Some of these interventions include fetal growth monitoring, vaccination with tetanus toxoid, intermittent preventive treatment for malaria, iron-‐folate supplementation as well as routine screening tests for protein and sugar in urine and haemoglobin level check among others. The recommended strategy for providing antenatal care services is the Focused Antenatal Care (FANC) rather than the traditional strategy. The traditional antenatal care strategy uses a risk approach to classify which women are more likely to experience complications and assumes that more visits mean better outcomes for mother and baby, whiles focused antenatal care is geared towards promoting individualized, client centered and comprehensive services. It also means that service providers focus on assessment and actions needed to make prompt decisions and provide quality care tailored to meet each woman’s need as an individual. An effective antenatal care system links the mother and her family with the formal health system, increases the chance of using a skilled attendant at birth and contributes to good health throughout life cycle. Inadequate care during this time breaks a critical link in the continuum of care.
2.2 ACHIEVEMENTS 2.2.1 Utilization of Antenatal Care Services A single antenatal visit is not a good indicator of the quality of care. Additional indicators may include the number of visits (at least four per pregnancy are recommended) and the
15
timing of the first visit. The indicators used to assess utilization of antenatal services in the health facilities include: Proportion accessing antenatal services (Antenatal coverage) The number making adequate visits ( proportion making at least 4 visits) Gestational age at first visit Utilization of available services
2.2.2 Antenatal Service Delivery Antenatal Coverage Antenatal care coverage is an indicator of access and utilization of care during pregnancy. It measures the proportion of women who receive care at least once during pregnancy within a given year. Antenatal coverage decreased from 98.2% in 2011 to 92.2% in 2012 and further decreased to 90% in 2013. The consistent decrease in antenatal care coverage needs to be investigated for necessary measures to be put in place to reverse the trend.
Figure1: Trend of Antenatal Care Coverage In the year under review, Northern and Western regions recorded 113.6% and 103.2% coverages in ANC respectively. Volta and Ashanti regions recorded the lowest ANC coverages of 783 and 81.9% respectively. All the other regions recorded above 82%. Only two regions achieved the national target of 100%.
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% ANC Coverage by Region 160
140 120 100 80
60 40 20 0
AS
BAR
CR
ER
GAR
NR
UER
UWR
VR
WR
NAT
2011
84.3
110.6
107.7
93.9
91.7
135
91.6
86.2
88.7
98.6
98.2
2012
82.3
100.4
97.7
86.9
88.7
112
88.1
84.4
81.8
101.1
92.2
2013
81.9
95.5
89.3
82.1
86.9
113.6
83.3
87.7
78.3
103.2
90
Figure 2: Trend of Antenatal Care Coverage by Region Proportion of pregnant women making at least 4 visits It is expected that pregnant women attend at least four antenatal care visits for women with uncomplicated pregnancies. This is in line with the National Reproductive Health Policy which also recommended a minimum of four visits per client, with the first visit in the first trimester; ideally before 12 weeks but not later than 16 weeks in order for the mother to benefit from the full range of life-‐saving interventions offered at the antenatal clinics such as IPTP.o The proportion of clients who made at least four visits within the year under review was 72.6%. This is a decrease of 4.4% compared to year 2012 (77.0%), the national target of 80% was not achieved.
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Figure 3: Proportion of Pregnant Women Making At Least 4 Visits Average Visit by Regions The average visit is the average of the total antenatal attendance made by each pregnant woman registered over a period of time. During the year under review (2013), the national average antenatal visit decreased slightly from 4.1 in 2012 to 4.0. Upper East Region recorded the highest average antenatal visit of 5.1 whilst Northern Region recorded the least of 3.3 respectively.
Percentage Antenatal 4+ Visit by Region 120 100
80 60 40
20 0
AS
BAR
CR
ER
GAR
NR
UER
UWR
VR
WR
2011
82.2
61.2
80
68.2
108.8
51.2
92.1
68.2
74
60.9
2012
85.1
66.4
88.2
74
92.2
58.3
94.5
63.9
74.3
66.3
2013
93.4
64
76.6
67.1
74.6
57.1
87.5
70
67.7
63.8
Figure 4: Average ANC visits by Region Gestational Age at Registration Early booking at antenatal clinic helps to establish the correct gestational age and enables early identification of problems for prompt management. This enables women to get the information they need during pregnancy. Hence the first ANC visit should be as early as possible in pregnancy, preferably in the first trimester. The last visit should be at around 37 weeks or near the expected date of delivery to ensure that appropriate advice and care have been provided to the woman to prevent and manage problems. In 2013, 45.1% of pregnant women in Ghana attended antenatal clinic within their first trimester of pregnancy and 13.1% in their third trimester. Though over 50% of women reported for antenatal service in their second and third trimesters in Ghana for the year under review, the trend since 2009 shows a consistent reduction in third trimester 18
registrants whilst first trimester registrants keep increasing. This development is encouraging and regions need to sustain this progress through health promotional activities to further widen the gap between first and third trimester registration of pregnancies.
Trend in Percentage 1st and 3rd Trimester Registrants 60 40 20
38.4
40.3
43.1
44.2
45.1
17.1
16.2
15.3
14
13.1
2009
2010
2011
2012
2013
0
1st Trimester
3rd Trimester
Figure 5: Trend in 1st and 3rdTrimester Registrant Age and Parity at Registration Routine data for the year under review revealed that 12.3% of registrants were adolescents, This however represents a slight decrease of 1% when compared to that of 2012 (13.3%) but the national target (10%) was not met. Nine (9) out of the ten Regions recorded adolescent pregnancies which were higher than the national target (10%). The region reporting the lowest adolescent pregnancies in the year under review is Greater Accra with 7.1% whilst Upper East and Volta Regions recorded the highest with 15.5% respectively. The increase in adolescent pregnancies in the two regions need further investigation.
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2.2.2.5 Adolescent Pregnancy
Figure 6: Trend in Adolescent Pregnancy
Figure7: Adolescent Pregnancy by Region Women Aged 35 Years and Above The proportion of women aged 35 years and above of registered pregnancies increased slightly from 12.2% in 2012 to 12.3% in 2013. During the year under review, Western Region recorded the lowest number of pregnant women who were 35 years and above (22%) whilst Greater Accra Region registered the highest (28.8%), this far exceeded the national target (12.2%). 20
Percentage ANC Registrants 35years and above 12.8
12.8
13
2009
2010
2011
12.2
12.3
12
8
4
0 2012
2013
Figure 8: Trend in ANC Registrants 35yrs and above
ANC Registrants Above 35 Years By Regions
40 30
23.2
28.8
25.3
24.2
22.1
BA
CR
ER
22.1
22.2
26
23.9
22
20 10 0 ASH
GAR
NR
2012
2013
UER
UWR
VR
WR
Figure 9: Trend in ANC registrants above 35years by region Women who had five or more children visiting health facilities for antenatal care in Ghana for the period 2013 were 10.3%. The lowest reported was in Greater Accra with 4.5% below the national coverage (10.3%) whilst Northern and Upper West Regions recorded the highest with 15.9 and 14.5% respectively which far exceeded the national coverage (10.3%). 21
Figure 10: Trend in ANC Registrants with Parity 5+
Trends in ANC Registrants with Parity 5 By Region 18 16 14 12 10 8 6 4 2 0
ASH
BAR
CR
ER
GAR
NR
UER
UWR
VR
WR
NAT
2011
11.5
15
10.5
9.3
4.7
16.1
11.3
16.4
11.8
11.4
11.2
2012
10.3
13.1
11.1
8.9
4.8
15.9
10.7
15.8
11.2
11.3
10.7
2013
9.7
12.4
10.5
8.2
4.5
15.9
9.6
14.5
11
11.3
10.3
Figure 11: Trends in ANC Registrants with Parity 5 Anaemia in Pregnancy During pregnancy, haemoglobin level checked at registration and at 36 weeks of gestation is an important activity to ensure that anaemia is detected for timely management. This is
22
because haemorrhage during the antenatal and post-‐partum periods has been found to be a major direct cause of maternal deaths in the country. Coverage of haemoglobin level of pregnant women checked at registration for the year under review was 82.7% in the country which is 1.3% lower than the coverage for 2012 (84%). Of the 82.7% pregnant women whose HB were checked at registration, 31% were anaemic (HB level < 11.0gper dl). Out of the 35.3% of pregnant women checked at 36 weeks gestation, 28% were anaemic. Analysis by regions indicated that Eastern and Western Regions recorded the lowest proportion of pregnant women with HB
