Trend, client profile and surgical features of vasectomy in Ghana.

OBJECTIVE: To examine the socio-demographic and reproductive characteristics of vasectomy acceptors and surgical features of vasectomy in Ghana. METHODS: Retrospective review of 271 vasectomies performed between 1 January 2000 and 31 December 2009 in three healthcare facilities. RESULTS: Less than 0.5% of family planning clients opt for vasectomy in Ghana; acceptors are both professional and semi-skilled workers. The mean age of vasectomy acceptors was 40.7 years, and their mean number of children four. All clients had two children or more; there was a trend towards a greater number of children with increasing age (p trend <0.001) or a lower educational level of the clients (p trend =0.01). Most clients obtained their information on vasectomy through the media and healthcare workers. Nearly all vasectomies were performed under local anaesthesia using the no-scalpel technique. The operating time of gynaecologists was significantly shorter than that of urologists (median operating time 10 minutes vs. 25 minutes; p <0.001). The reported vasectomy failure rate was about 1%. CONCLUSIONS: The prevalence of vasectomy is low in Ghana. The factors influencing utilisation of male sterilisation services must be identified in order to improve uptake of this method of contraception in the country.

Reproductive age mortality survey (RAMOS) in Accra, Ghana.

BACKGROUND: Maternal mortality remains a severe problem in many parts of the world, despite efforts to reach MDG 5. In addition, underreporting is an issue especially in low income countries. Our objective has been to identify the magnitude of maternal deaths and the degree of underreporting of these deaths in Accra Metropolis in Ghana during a one year period. METHODS: A Reproductive Age Mortality survey (RAMOS) was carried out in the Accra Metropolis for the period 1st January 2002-31st December 2002. We reviewed records of female deaths aged 10-50 years in the Metropolis for the whole year 2002 using multiple sources. Maternal deaths identified through the review were compared with the officially reported maternal deaths for the same period. RESULTS: At the end of the study, a total of 179 maternal deaths out of 9,248 female deaths between the ages of 10-50 years were identified. One hundred and one (N = 101) of these were reported, giving an underreporting rate of 44%. The 179 cases consisted of 146 (81.6%) direct maternal deaths and 32 (17.9%) indirect maternal deaths and 1 (0.6%) non maternal death. The most frequent causes of direct maternal deaths were obstetric haemorrhage (57; 32%), pregnancies with abortive outcome (37; 20.8%), (pre) eclampsia (26; 14.6%) and puerperal sepsis (13; 7.3%). The most frequent indirect cause was sickle cell crisis in pregnancy (13; 7.3%). CONCLUSION: A Reproductive Age Mortality Survey is an effective method that could be used to update data on maternal mortality in Ghana while efforts are made to improve on maternal death audits in the health facilities. Strengthening the existing community based volunteers to report deaths that take place at home and the civil registration systems of births and deaths is also highly recommended.