title: Perinatal mortality among infants born during health user-fees (Cash & Carry) and the national health insurance scheme (NHIS) eras in Ghana: a cross-sectional study.
abstract: This research determined the rates of perinatal mortality among infants delivered under Ghana's national health insurance scheme (NHIS) compared to infants delivered under the previous "Cash and Carry" system in Northern Region, especially as the country takes stock of its progress toward meeting the Millennium Development Goals (MDG) 4 and 5.
  
  
  
  The labor and maternity wards delivery records of infants delivered before and after the implementation of the NHIS in Northern Region were examined. Records of available daily deliveries during the two health systems were extracted. Fisher's exact tests of non-random association were used to examine the bivariate association between categorical independent variables and perinatal mortality.
  
  
  
  On average, 8% of infants delivered during the health user-fee (Cash & Carry) died compared to about 4% infant deaths during the NHIS delivery fee exemption period in Northern Region, Ghana. There were no remarkable difference in the rate of infant deaths among mothers in almost all age categories in both the Cash and Carry and the NHIS periods except in mothers age 35 years and older. Infants born to multiparous mothers were significantly more likely to die than those born to first time mothers. There were more twin deaths during the Cash and Carry system (p = 0.001) compared to the NHIS system. Deliveries by caesarean section increased from an average of 14% in the "Cash and Carry" era to an average of 20% in the NHIS era.
  
  
  
  The overall rate of perinatal mortality declined by half (50%) in infants born during the NHIS era compared to the Cash and Carry era. However, caesarean deliveries increased during the NHIS era. These findings suggest that pregnant women in the Northern Region of Ghana were able to access the opportunity to utilize the NHIS for antenatal visits and possibly utilized skilled care at delivery at no cost or very minimal cost to them, which therefore improved Ghana's progress towards meeting the MDG 4, (reducing under-five deaths by two-thirds).
authors.affiliation: School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Abdallah
authors.initials: A
authors.lastname: Ibrahim
authors.affiliation: School of Public Health, University of Ghana, Accra, Ghana. emaya@ug.edu.gh.
authors.forename: Ernest T
authors.initials: ET
authors.lastname: Maya
authors.affiliation: School of Nursing, University of Ghana, Accra, Ghana.
authors.forename: Ernestina
authors.initials: E
authors.lastname: Donkor
authors.affiliation: Ghana Health Service, Dodowa Health Research Center, Dodowa, Ghana.
authors.forename: Irene A
authors.initials: IA
authors.lastname: Agyepong
authors.affiliation: School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Adanu
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000191:economics*; D005249:Fees and Charges; D005260:Female; D005869:Ghana; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007231:Infant, Newborn; D009313:National Health Programs / Q000706:statistics & numerical data*; D054238:Perinatal Mortality / Q000639:trends*; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics*
keywords: Cash and Carry; NHIS; Northern Region; Perinatal mortality; Tamale Teaching Hospital