Improving maternal health in urban low resource settings

Approximately 300.000 women die annually during pregnancy, childbirth or within 42 days after the delivery. Most of these deaths occur in women living in low- and middle-income countries (LMIC) in sub-Saharan African and South-East Asia, and could have been prevented with access to quality maternal health care.

The objective of this thesis is to explore strategies to improve maternal and perinatal outcomes in an urban sub-Saharan African middle-income country context. Most of the studies in this thesis were conducted in Accra in Ghana. This will be approached through the identification of the impact of specific risk factors on adverse pregnancy outcomes, specifically obesity, hypertensive disorders of pregnancy and HIV/AIDS. The second part of this thesis focuses on hypertensive disorders of pregnancy, which occur more frequently in urban settings, and explores the role of biomarkers for prediction in hypertensive disorders of pregnancy. The third part explores approaches to improve the quality of care, including the assessment of the quality of care in hospitals, the effect of maternal insurance on maternal health services utilization, task shifting of care in hospital settings, and an innovative strategy to prevent hypertensive disorders of pregnancy.