The Tamale Teaching Hospital (TTH), located in the Northern Region of Ghana, stands as a crucial healthcare institution. Established on February 2, 1974, it initially served as the Tamale Regional Hospital before being upgraded to a teaching hospital in 2009. TTH plays a pivotal role in medical education, healthcare delivery, and community health initiatives in the region.
History and Mandate
The hospital was commissioned on 2nd February 1974. In 2005, the Northern Regional Coordinating Council partnered with the Ghana Health Service to upgrade the hospital to a teaching hospital. This upgrade made TTH the third teaching hospital in the country. The hospital became a Teaching hospital in 2002 to help train medical students of the University of Development Studies (UDS). TTH is affiliated with the University for Development Studies (UDS), playing a crucial role in training healthcare professionals. It collaborates with UDS to offer undergraduate and postgraduate programs in medicine, nursing, and nutrition.
The mandate of the hospital is set by Act 525 of the Ghana Health Service and Teaching Hospitals Act of 1996.
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Infrastructure and Capacity
The portion that has been developed is 122,000 m². In 2016, TTH expanded its facilities with the commissioning of Phase II, a €39 million project that added a 400-bed complex. The hospital is undergoing major rehabilitation (Phase I) and this phase has been completed resulting in a total bed capacity of 600. This development increased the hospital's total bed capacity to 800.
In 2012 the hospital received a donation of 335,000 Ghana cedis for the construction of an ultra-modern Neonatal Intensive Care Unit (NICU). The completed units as of July 2015 have facilities to serve forty neonates and their mothers.
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Partnerships and Collaborations
Temple University Hospital Department of Surgery has developed a partnership with Tamale Teaching Hospital in Northern Ghana. Temple Global Surgery offers support through research planning, collaboration and educational support. Tamale Teaching Hospital, under the direction of Professor Stephen Tabiri, provides a clinical rotation in global surgery for Temple surgical residents.
One of our most exciting and fruitful partnerships is with The Ghana Hernia Society. The Ghana Health Service has tasked The Ghana Hernia Society with training medical officers and surgeons in mesh hernia repair throughout Ghana. Temple Global Surgery has offered support and partnership in this mission through funding, collaboration, and research planning.
Dr. Jessica Beard and Professor Michael Ohene-Yeboah were awarded a research grant from the American Hernia Society and an innovation grant from the Johnson & Johnson Gen H Challenge to train medical officers in mesh repair and study outcomes and program impact of the Ghana Hernia Society’s activities.
Maternal Health and Mortality
Maternal mortality is a critical issue in Ghana, and TTH plays a significant role in addressing this challenge. There were 280 maternal deaths from 1st January 2006 to 31st December 2010. The maternal mortality ratio dropped from 1870 per 100,000 live births in 2006 to 493 per 100,000 live births in 2010, a fall of nearly 74%. Using 2008 as the baseline, maternal mortality ratio dropped from 842 per 100,000 live births in 2008 to 493 per 100,000 live births in 2010, a fall of 41.4%.
The main causes of 139 audited maternal deaths from 2008 to 2010 were sepsis (19.8%) hypertensive disorders(18.6%), haemorrhage (15.8%), unsafe abortion (11.5%), obstructed labour (5.7%), anaemia (8.7%), sickle cell disease (5.7%) and malaria (5.0%). The ages of the 139 audited maternal deaths ranged from 14-48 years; with mean age of 26.5±4.6years. Nearly 50% of the maternal deaths were aged 20-29 years and about 10% were 14-19 years.
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The decline in maternal mortality ratio seen at the Tamale Teaching Hospital over the period of the review may be due to increase in the number of nurses and doctors in the Department of Obstetrics and Gynaecology, free maternal health care, improvement in blood transfusion service, improvements in supplies of antibiotics, oxytoxics, intravenous fluids, antihypertensive drugs, anticonvulsants and availability of an intensive care unit where some critically ill patients were managed.
Factors Influencing Caesarean Section (CS) Rates
Advances in modern medicine have transformed childbirth, with three primary delivery methods: spontaneous vaginal birth, assisted vaginal birth, and Caesarean section (CS). Globally, CS rates have risen considerably since 1990, with notable increases in regions such as Eastern Asia and Northern Africa, while sub-Saharan Africa has experienced modest growth. The global CS rate currently stands at 21.1%, projected to rise to 28.5% by 2030.
In Ghana, CS rates vary from 14.6% to 26.9%, with higher rates in private compared to public facilities. Socio-demographic, economic, and obstetric factors significantly predict CS deliveries in Ghana, including maternal age, parity, education, wealth, gestational age, antenatal visits, birth weight, and previous pregnancy loss.
Study on Caesarean Section in Tamale Metropolis
A retrospective cross-sectional study was conducted among 318 postpartum mothers at the Tamale Teaching Hospital to understand the medical and non-medical reasons for CS among women and identify the socio-demographic and obstetric factors that influence CS in the Tamale Metropolis.
The study found that the prevalence of CS was 8.8%. The majority of respondents (63.5%) were below 30 years, and almost all respondents (95.3%) were enrolled in the National Health Insurance Scheme (NHIS). Most respondents (91.2%) had spontaneous vaginal delivery.
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Study Design and Methodology
The study was conducted at Tamale Teaching Hospital (TTH) in the Northern Region of Ghana. In this retrospective cross-sectional study, the birth records of all women who delivered live babies at TTH between October and December 2021 were reviewed.
Variables
- Outcome variable: Caesarean delivery.
- Dependent variable: Obstetric characteristics such as type of birth, gravidity, parity, gestational age, number of pregnancies in the last five years, previous history of low birth weight (LBW), abortion, stillbirth, and any obstetric complications.
- Additional predictors included family history of hypertension and the use of long-lasting insecticidal nets (LLINs).
Maternal conditions, including Hepatitis B, pre-eclampsia, hypertension during antenatal care, haemoglobin levels at registration and 36 weeks, sickling status, HIV status, malaria infection during pregnancy, syphilis infection during pregnancy, and hypertension prior to pregnancy, were documented and monitored throughout the course of antenatal care.
Inclusion and Exclusion Criteria
The study included birth records of mothers who delivered live babies after the gestational age of viability (≥ 28 weeks) at Tamale Teaching Hospital between October and December 2021. Mothers who underwent laparotomy for extra-uterine pregnancy and those who had non-live births following caesarean section were excluded from this study.
Data Extraction and Sample Size
A pretested data extraction sheet was used to obtain information on maternal demographics, obstetric history, ANC attendance, delivery details, and neonatal outcomes. During the study period, a total of 598 live births were recorded. However, 36 records were excluded due to laparotomies for extra-uterine pregnancies and incomplete birth records. As a result, 318 cases were included in the final analysis, representing approximately 56.2% of all live births during the study period.
Data Analysis
Descriptive statistics were used to calculate frequencies and percentages were reported for categorical variables. For continuous variables, means and standard deviations were determined. Principal component analysis (PCA) was used on the relevant socioeconomic indicator variables that contributed to a combined socioeconomic status score factor of more than 10%. Univariate logistic regression analysis was used to identify associations between variables and Caesarean section (Model I), followed by a stepwise multivariate logistic regression model (Model II) that considered variables that were significant in the univariate logistic regression.
Ethical Considerations
Ethical approval for this study was obtained from the Department of Research and Development, Tamale Teaching Hospital. Informed consent was obtained from the respondents before conducting the interviews. The data obtained from the study was kept confidential, and personal information was anonymised during the data collection, analysis, and dissemination of findings.
Socio-Demographic Characteristics
Most respondents (63.5%) were under 30 years. Over 60% (n = 203/318) of the respondents had formal education, while 58.2%(n = 185/318) reported that their husbands had formal education. The majority were employed (n = 269/318, 84.6%), whereas most husbands were not civil servants (n = 276/318, 86.8%). Most lived in urban areas (n = 211/318, 67.2%). Almost all respondents (n = 303/318, 95.3%) were enrolled in the NHIS. The majority (n = 197/318, 62%) were classified as having a low wealth index.
| Characteristic | Number (n) | Percentage (%) |
|---|---|---|
| Age | ||
| Under 30 years | 202 | 63.5 |
| Formal Education | 203 | 63.8 |
| Husbands with Formal Education | 185 | 58.2 |
| Employed | 269 | 84.6 |
| Husbands not Civil Servants | 276 | 86.8 |
| Urban Dwellers | 211 | 67.2 |
| Enrolled in NHIS | 303 | 95.3 |
| Low Wealth Index | 197 | 62.0 |
Obstetric Characteristics
The majority (n = 305/318, 95.9%) had singleton births. Most pregnancies (n = 259/318, 81.5%) were term. Vaginal delivery was much more common (n = 290/318, 91.2%). One-third (n = 116/318, 36.48%) had delayed initiation of antenatal care. Two-thirds (n = 215/318, 67.61%) had fewer than the recommended four antenatal care (ANC) visits.
| Characteristic | Number (n) | Percentage (%) |
|---|---|---|
| Singleton Births | 305 | 95.9 |
| Term Pregnancies | 259 | 81.5 |
| Vaginal Delivery | 290 | 91.2 |
| Delayed ANC Initiation | 116 | 36.5 |
| Fewer than 4 ANC Visits | 215 | 67.6 |
Maternal Conditions
A total of 2.5% (n = 8/318) of the respondents were Hepatitis B positive. Approximately a quarter (n = 76/318, 23.9%) tested positive for H. pylori infection. Anaemia at the first ANC registration was also high at 38.4% (n = 122/318), and 2.2% (n = 7/318) had sickle cell trait.
| Condition | Number (n) | Percentage (%) |
|---|---|---|
| Hepatitis B Positive | 8 | 2.5 |
| H. Pylori Infection | 76 | 23.9 |
| Anaemia at ANC Registration | 122 | 38.4 |
| Sickle Cell Trait | 7 | 2.2 |
Challenges and Corruption Allegations
The Tamale Teaching Hospital (TTH) has faced numerous challenges, including allegations of corruption, procurement violations, and mismanagement. Reports have highlighted issues such as drug supply contracts awarded without proper oversight, missing equipment, and unofficial fees charged to patients. These issues have led to public distrust and calls for systemic reforms.
To address these challenges, recommendations include independent audits, transparent procurement systems, whistleblower protections, merit-based leadership appointments, and strengthened community engagement.
Accreditation and Recognition
The Tamale Teaching Hospital has been accredited by several reputable organizations, including the Medical and Dental Council of Ghana, National Health Insurance Authority, and the Ghana College of Physicians and Surgeons. It also holds full accreditation from the Medical and Dental Council of Ghana for the training of house officers or interns.
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