title: Trends in maternal mortality: a 13-year hospital-based study in rural Ghana.
abstract: OBJECTIVE
  To measure the impact of the Safe Motherhood Initiative (SMI) on hospital-based maternal mortality since its start in 1987.
  
  
  METHODS
  Retrospective analysis of all 229 maternal deaths in a district hospital in rural Ghana, between 1 January 1987 and 1 January 2000. Main outcome measures were maternal mortality ratio and relative contribution of causes of maternal deaths to overall maternal mortality. Chi-square test was used to assess differences in proportions, and relative risks with confidence intervals were calculated.
  
  
  RESULTS
  The overall maternal mortality ratio of 1077/100,000 live births did not change significantly during the study period. However, the relative contributions of sepsis, hemorrhage, obstructed labor, anemia/sickle cell disease and (pre-) eclampsia diminished, while abortion complications increased significantly.
  
  
  CONCLUSIONS
  The Safe Motherhood Initiative in the study area has contributed to the reduction of maternal mortality due to causes against which interventions were directed. Abortion complications as cause of maternal mortality need to be included in interventions and research.
authors.affiliation: Holy Family Hospital, Berekum, Region, Brong Ahafo, Ghana.
authors.forename: Diederike W
authors.initials: DW
authors.lastname: Geelhoed
authors.forename: Lucia E
authors.initials: LE
authors.lastname: Visser
authors.forename: Kofi
authors.initials: K
authors.lastname: Asare
authors.forename: Jules H
authors.initials: JH
authors.lastname: Schagen van Leeuwen
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000028:Abortion, Induced / Q000401:mortality; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006470:Hemorrhage / Q000401:mortality; D006761:Hospitals; D006801:Humans; D008428:Maternal Mortality / Q000639:trends*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D018805:Sepsis / Q000401:mortality