Introduction: The COVID-19 pandemic has significantly affected global health systems, particularly maternal healthcare. This study examines the effects of the pandemic on maternal mortality rates at Tamale Teaching Hospital (TTH) in Northern Ghana, a region with high maternal mortality rates. We conducted a retrospective analysis of hospital records from TTH, covering three periods: pre-COVID-19 (March 1, 2019 - February 28, 2020), COVID-19 (March 1, 2020 - February 28, 2021), and post-COVID-19 (March 1, 2021 - February 28, 2022). Maternal mortality ratios were calculated and compared across these periods to evaluate the pandemic’s impact on maternal health outcomes. Results: The pre-COVID-19 era recorded a Maternal Mortality Ratio (MMR) of 571 per 100,000 live births, while the COVID-19 era recorded an MMR of 591 per 100,000 live births, representing a 3.5% increase. The post-COVID-19 era recorded the highest maternal mortality ratio of 790 per 100,000 live births, which represented a percentage change of 33.67% from the COVID-19 era and a 38.36% increase from the pre-COVID-19 era. Hypertensive disorders in pregnancy were the leading cause of death in all three periods, with more than 70% of all cases of mortalities occurring in the Maternal Intensive Care Unit (MICU). Interpretation: The study highlights critical vulnerabilities in maternal health systems exacerbated by the COVID-19 pandemic in Northern Ghana. It underscores the urgent need for targeted interventions to strengthen healthcare infrastructure, enhance maternal health services, and integrate pandemic preparedness into ongoing maternal health policies. Conclusion: Addressing the adverse impact of the COVID-19 pandemic on maternal mortality requires a multifaceted approach. Immediate actions include bolstering healthcare resources, expanding telemedicine initiatives, and ensuring equitable access to maternal health services.
Cite this paper
Charadan, A. M. S. , Duuti, B. and Titigah, A. B. (2025). Effect of the COVID-19 Pandemic on Maternal Mortality: A Retrospective Study in a Tertiary Hospital in Northern Ghana. Open Access Library Journal, 12, e3363. doi: http://dx.doi.org/10.4236/oalib.1113363.
Mbachu, I.I., Udigwe, G.O., Okafor, C.I., Umeonunihu, O.S., Ezeama, C. and Eleje, G.U. (2013) The Pattern and Obstetric Outcome of Hypertensive Dis-orders of Pregnancy in Nnewi, Nigeria. Nigerian Journal of Medicine, 22, 117-122.
World Health Organization (2019) Trends in Ma-ternal Mortality 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization. https://www.unfpa.org/featured-publication/trends-maternal-mortality-2000-2017
Putra, M., Kesavan, M., Brackney, K., Hackney, D.N., Roosa, K.M. and Bajema, K.L. (2020) Forecasting the Impact of Coronavirus Disease during Delivery Hospitalization: An Aid for Resource Utilization. American Journal of Obstetrics & Gynecology MFM, 2, Article 100127. https://doi.org/10.1016/j.ajogmf.2020.100127
Roberton, T., Carter, E.D., Chou, V.B., Stegmuller, A.R., Jackson, B.D., Tam, Y., et al. (2020) Early Es-timates of the Indirect Effects of the COVID-19 Pandemic on Maternal and Child Mortality in Low-Income and Middle-Income Countries: A Modelling Study. The Lancet Global Health, 8, e901-e908. https://doi.org/10.1016/s2214-109x(20)30229-1
Ebeigbe, P.N. and Aziken, M.E. (2020) Early Onset Pregnancy-Induced Hypertension/Eclampsia in Benin City, Nigeria. Nigerian Journal of Clinical Practice, 13, 388-393.
Chen, L., Li, Q., Zheng, D., Jiang, H., Wei, Y., Zou, L., et al. (2020) Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China. New England Journal of Medicine, 382, e100. https://doi.org/10.1056/nejmc2009226
Collin, J., Byström, E., Carnahan, A. and Ahrne, M. (2020) Public Health Agency of Sweden’s Brief Report: Preg-nant and Postpartum Women with Severe Acute Respiratory Syndrome Coro-navirus 2 Infection in Intensive Care in Sweden. Acta Obstetricia et Gynecologica Scandinavica, 99, 819-822. https://doi.org/10.1111/aogs.13901
Ellington, S., Strid, P., Tong, V.T., Woodworth, K., Galang, R.R., Zambrano, L.D., et al. (2020) Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status—United States, January 22-June 7, 2020. Morbidity and Mortality Weekly Report, 69, 769-775. https://doi.org/10.15585/mmwr.mm6925a1
Goyal, M., Singh, P., Singh, K., Shekhar, S., Agrawal, N. and Misra, S. (2021) The Effect of the COVID‐19 Pandemic on Maternal Health Due to Delay in Seeking Health Care: Experience from a Tertiary Center. International Journal of Gynecology & Obstetrics, 152, 231-235. https://doi.org/10.1002/ijgo.13457
Chmielewska, B., Barratt, I., Townsend, R., Kalafat, E., van der Meulen, J., Gurol-Urganci, I., et al. (2021) Effects of the COVID-19 Pandemic on Maternal and Perinatal Outcomes: A Sys-tematic Review and Meta-Analysis. The Lancet Global Health, 9, e759-e772. https://doi.org/10.1016/s2214-109x(21)00079-6
Say, L., Chou, D., Gemmill, A., Tunçalp, ö., Moller, A.-B., Daniels, J., et al. (2014) Global Causes of Maternal Death: A WHO Systematic Analysis. The Lancet Global Health, 2, e323-e333. https://doi.org/10.1016/S2214-109X(14)70227-X
Kassebaum, N.J., Barber, R.M., Bhutta, Z.A., Dandona, L., Gething, P.W., Hay, S.I., et al. (2016) Global, Regional, and National Levels of Maternal Mortality, 1990-2015: A Sys-tematic Analysis for the Global Burden of Disease Study 2015. The Lancet, 388, 1775-1812. https://doi.org/10.1016/s0140-6736(16)31470-2
World Health Organization (2020) Pulse Survey on Continuity of Essential Health Ser-vices during the COVID-19 Pandemic. World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS_continuity-survey-2020.1
Kassebaum, N.J., Bertozzi-Villa, A. and Lozano, R. (2022) Maternal Mortality and COVID-19 in the United States: Disparities, Delays, and Missed Opportunities. JAMA Network Open, 5, e2216640. https://doi.org/10.1001/jamanetworkopen.2022.16640
Allotey, J., Fernandez, S., Bonet, M., Stallings, E., Yap, M., Kew, T., et al. (2020) Clinical Manifestations, Risk Factors, and Maternal and Perinatal Outcomes of Corona-virus Disease 2019 in Pregnancy: Living Systematic Review and Meta-Analysis. BMJ, 370, m3320. https://doi.org/10.1136/bmj.m3320
Villar, J., Ariff, S., Gunier, R.B., Thiruvengadam, R., Rauch, S., Kholin, A., et al. (2021) Maternal and Neonatal Morbidity and Mortality Among Pregnant Women with and with-out COVID-19 Infection: The INTERCOVID Multinational Cohort Study. Obstetri-cal & Gynecological Survey, 77, 80-82. https://doi.org/10.1097/01.ogx.0000816508.60579.d5
Gajbhiye, R.K., Modi, D.N., Mahale, S.D. and Sawant, M.S. (2021) Pregnancy Outcomes, New-born Complications and Maternal-Fetal Transmission of SARS-CoV-2 in Women with COVID-19: A Systematic Review of 441 Cases. Journal of Perinatal Medicine, 49, 290-307.
KC, A., Gurung, R., Kinney, M.V., Sunny, A.K., Moinuddin, M., Basnet, O., et al. (2020) Effect of the COVID-19 Pandemic Response on In-trapartum Care, Stillbirth, and Neonatal Mortality Outcomes in Nepal: A Pro-spective Observational Study. The Lancet Global Health, 8, e1273-e1281. https://doi.org/10.1016/s2214-109x(20)30345-4
World Health Organ-ization (2019) Trends in Maternal Mortality: 1990 to 2008. Estimates Devel-oped by WHO, UNICEF, UNFPA, and the World Bank. Geneva, World Health Or-ganization. http://www.who.int/entity/reproductivehealth/publications/monitoring/MMR_technical_report.pdf
Riley, T., Sully, E., Ahmed, Z. and Biddlecom, A. (2020) Estimates of the Potential Impact of the COVID-19 Pandemic on Sexual and Reproductive Health in Low- and Middle-Income Countries. International Perspectives on Sexual and Reproductive Health, 46, 73-76. https://doi.org/10.1363/46e9020
UNFPA (2021) MHTF Annual Report: Strengthening Health System Resilience in the COVID-19 Era.
https://www.unfpa.org/publications/maternal-and-newborn-health-thematic
-fund-annual-report-2021?utm_source=chatgpt.com#:~:text=Publications
Idris, H., Duum, N.C.N, Adamu, U.G., Abdullateef, R.M. and Yabagi, I.A. (2020) Hypertensive Disorders in Pregnancy: Pattern and Obstetric Outcome in Bida, Nigeria. Nigerian Medical Journal, 61, 42-47. https://doi.org/10.4103/nmj.NMJ_29_18
World Health Organization (2023) Strategies toward Ending Pre-ventable Maternal Mortality (EPMM). World Health Organization. https://platform.who.int/docs/default-source/mca-documents/qoc/quality-of-care/strategies-toward-ending-preventable-maternal-mortality-%28epmm%29.pdf?sfvrsn=a31dedb6_4
Ministry of Health, Ghana (2020) Guidelines for Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition Services during the COVID-19 Pandemic. Ministry of Health, Ghana.
https://www.qualityofcarenetwork.org/sites/default/files/2021-
12/Ghana%20QoC_MNCH%20Bulletin%20%28July%202020-June%202021%29.pdf
Ameyaw, E.K., Yamoah, F.A., Agyei-Baffour, P., Boateng, D., Mensah, A.B. and Gyasi, R.M. (2021) Implications of COVID-19 for Maternal and Child Health Ser-vices in Northern Ghana: A Qualitative Exploratory Study. BMC Pregnancy Child-birth, 21, 1-9.
Oppong, J., et al. (2022) Impact of the COVID-19 Pandemic on Tuberculosis Detection and Care in Ghana. Journal of Public Health in Africa, 13, 238-245.
Ahmed, N.U., Maamri, A., Fa-lade, A.G., Ayede, A.I., Bhutta, A., Gambhir, A., Tagarro, A., Abdelmegeid, A., Ahmadi, A.R., Barros, A.J.D., Mekasha, A., et al. (2023) Global Research Priori-ties on COVID-19 for Maternal, Newborn, Child and Adolescent Health. Journal of Global Health, 11, e04071. https://doi.org/10.7189/jogh.11.04071
Asuming, P.O., Gaisie, D.A., Agula, C. and Bawah, A.A. (2022) Impact of COVID-19 on Maternal Health Seeking in Ghana. Journal of International Development, 34, 919-930. https://doi.org/10.1002/jid.3627
Alkema, L., Chou, D., Hogan, D., Zhang, S., Moller, A., Gemmill, A., et al. (2016) Global, Regional, and National Levels and Trends in Maternal Mortality between 1990 and 2015, with Scenario-Based Projections to 2030: A Systematic Analysis by the UN Maternal Mortality Estimation In-ter-Agency Group. The Lancet, 387, 462-474. https://doi.org/10.1016/s0140-6736(15)00838-7
