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Question:

You will write a 10-page proposal paper in current AMA format that focuses on the design of a primary health program to meet the maternal and child primary health care needs of a hypothetical village in an underdeveloped country in either sub-Sahara Africa, Southeast Asia, or Latin America (student’s choice).

The Village I want to work on:

The rural village I choose is Savelugu in the northern region of Ghana. It has a population of 38,074 as of 20121. It’s the capital of the Savelugu-Nanton district. Savelugu, like every town or nation in Africa and sub-Sahara Africa to be precise has high maternal mortality and even though it is located in the northern region which has seen decline2 in maternal mortality, the rate is still high.

I have attached my references with a little gist of their content. I will also attach PDF files of all the references. Thank you.

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Reference1. Adomako J, Asare G, Anderson F, et al. Community­based surveillance of maternal deaths in rural Ghana. Bulletin Of The World Health Organization [serial online]. February 2016;94(2):86­91 6p. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed April 9, 2016.In most low income or developing countries, there isn’t a set system ofrecording the number of deaths and births in rural areas especially. The onlyrecords of such information with be the ones the hospital provided and this mightbe just a little fraction of the exact amount considering there isn’t any set systemto account for mothers who died in their homes before, during or after childbirth.Without the proper or accurate account of such information, the neededintervention to reduce maternal death might not be produce or the interventionmight not reach the right audience. This research was tailored to fix or help fixthat by going to the people to find out if the number of deaths reported in thatregion matches the real number of death from pregnancy and childbirth relatedissues.2. Asamoah B, Moussa K, Stafström M, Musinguzi G. Distribution of causes of maternal mortality among different socio­demographic groups in Ghana; a descriptive study. BMCPublic Health [serial online]. January 2011;11(1):159­168. Available from: Academic Search Complete, Ipswich, MA. Accessed April 9, 2016.Educational level, age and social status such as being married or single or being wealthy or poor affects the health of pregnancy or pregnant women across the world and has been shown to play a part or contribute to maternal mortality.In this study, it was found out the infections during pregnancy is more common inthe younger than older women who were pregnant. Also it was found out the married women are more likely to die from hemorrhage than their single counterparts. Also single women are more like to due from abortions than their married counterparts. All these are essential in preparing the right interventions toprevent these causes of mortality among pregnant women. 3. Banchani E, Tenkorang E. Implementation challenges of maternal health care in Ghana: the case of health care providers in the Tamale Metropolis. BMC Health Services Research [serial online]. January 2014;14(1):1­19. Available from: Academic Search Complete, Ipswich, MA. Accessed April 9, 2016Mothers do not only die at home, a reasonable number of them die in healthcare facilities indicating that the problem could be with the women or with also the healthcare facility or the care they receive. This study was tailored to findout what was wrong on the care and facility side of the story. Insufficient or improper training was among the top cause of the maternal mortality. Increase work load for the midwifes which can lead to fatigue was also identified as a problem. Lack access to or proper equipment and risk of infection also lead to increase in mortality. 4. GUMANGA S, KOLBILA D, GANDAU B, MUNKAILA A, MALECHI H, KYEI­ABOAGYE K. TRENDS IN MATERNAL MORTALITY IN TAMALE TEACHING HOSPITAL, GHANA. Ghana Medical Journal [serial online]. September 2011;45(3):105­110. Available from: Academic Search Complete, Ipswich, MA. Accessed April 9, 2016While parts of Ghana are experiencing increase in maternal mortality, parts are also seeing decrease which is good and much can be learnt from theses areas. In this research conducted by Gumanga et al, it was noted that maternal mortality decreased from 2008 to 2010 and even though the rate is still unacceptable, it is an improvement. It was still observed however that the leading cause of mortality in the tamale teaching hospital where the research was conducted was sepsis.5. Hong R, Banta J, Kamau J. Effect of maternal HIV infection on child survival in Ghana. Journal Of Community Health [serial online]. February 2007;32(1):21­36 16p. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed April 9, 2016.HIV is a worldly pandemic that has caused or is causing more harm than most diseases the world has experienced. The fate of children born to HIV mothers in low or third world countries is very shaky. The mothers usually die leaving these children with a guardian who is likely a grandparent and taking care of other grand children and this can lead to a chain of unfavorable life circumstances and conditions that a detriment to the proper growth of these children. Most of these children die from lack of proper nutrition or from the AIDS if they acquired it in vitro.6. London S. Ghana's R3M Program Is Associated with Greater Provision of Safe Abortions. International Perspectives On Sexual & Reproductive Health [serial online]. December 2015;41(4):223. Available from: Academic Search Complete, Ipswich, MA. Accessed April 9, 2016.From other researches above, it has been noted that abortion is one of the causes of maternal mortality especially among the single or non­married women. Safer abortion techniques and procedures during and after abortions has been shown to save lives. In this study it was observed that caregivers who were properly trainedhad more confidence and their procedures where less likely to result in death as compared to those who weren’t trained.7. Mills S, Williams J, Wak G, Hodgson A. Maternal mortality decline in the Kassena­Nankana district of Northern Ghana. Maternal & Child Health Journal [serial online]. September 2008;12(5):577­585 9p. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed April 9, 2016.In Ghana and most low income countries, the only records of maternal mortality are the ones the hospital provide and this might be just a little fraction ofthe exact amount considering there isn’t any set system to account for mothers who died in their homes before, during or after childbirth. This can be seen in the different statistics reported by the WHO, UNICEF and UNFPA.Without the proper or accurate account of such information, the needed intervention to reduce maternal death might not be produce or the intervention might not reach the right audience.8. Moyer C, Aborigo R, Kaselitz E, Gupta M, Oduro A, Williams J. PREventing Maternal And Neonatal Deaths (PREMAND): a study protocol for examining social and cultural factors contributing to infant and maternal deaths and near­misses in rural northern Ghana. Reproductive Health [serial online]. March 9, 2016;13:1­13 13p. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed April 10, 2016.Other factors independent of the nosocomial factors can affect maternal and child mortality in Ghana. Social and cultural factors can also affect maternal mortality in Ghana. In some cultures, traditional medicines and concoctions are the main source of treatments for conditions such as infections after delivery. Also culturally accepted way of life such as asking permission from husbands family orother elderly members of the society contribute to this high maternal mortality seen in Ghana.9. Nanang M, Atabila A. Factors predicting home delivery among women in Bosomtwe­Atwima­Kwanwoma district of Ghana: A case control study. International Journal Of Medicine & Public Health [serial online]. July 2014;4(3):287­291. Available from: Academic Search Complete, Ipswich, MA. Accessed April 9, 2016.Maternal age of 31 years or more was associated with non­hospital or at home deliveries than those younger. It was also observed that those with formal or someformal education were more likely to deliver in the hospital or healthcare settings than those who were not. And looking at the age above, mothers who are younger than 31 years are more likely to have some level of formal education than those who are older due to the introduction of the girl child education campaign.10. Zakariah A, Alexander S, van Roosmalen J, Buekens P, Kwawukume E, Frimpong P. Reproductive age mortality survey (RAMOS) in Accra, Ghana. Reproductive Health [serial online]. January 2009;6:1­6. Available from: Academic Search Complete, Ipswich, MA. Accessed April 9, 2016.In this study as with other studies, observed low or underreporting of maternal deaths even in the capital city of Accra. This goes to show that the system of surveillance and data collection in maternal health and healthcare in general is inadequate. The research proposed that until a better system is in place, surveys done in the various places where maternal mortality seems to be high is a better if not the best alternative to account for these deaths.
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