Midwives' attitudes to women in labour in Ghana

id 21 is hodted by the Institute of Development Studies and supported by the UK Departmrnt for Insternational Development

Community perceptions and practices of treatment seeking for childhood pneumonia: a mixed methods study in a rural district, Ghana

Abstract Background The World Health Organization recommends community case management of malaria and pneumonia for reduction of under-five mortality in developing countries. Caregivers’ perception and understanding of the illness influences the care a sick child receives. Studies in Ghana and elsewhere have routinely shown adequate recognition of malaria by caregivers. Similarly, evidence from Asia and some African countries have shown adequate knowledge on pneumonia. However, in Ghana, little has been documented about community awareness, knowledge, perceptions and management of childhood pneumonia particularly in the Dangme West district. Therefore this formative study was conducted to determine community perceptions of pneumonia for the purpose of informing the design and implementation of context specific health communication strategies to promote early and appropriate care seeking behaviour for childhood pneumonia. Methods A mixed method approach was adopted. Data were obtained from structured interviews (N = 501) and eight focus group discussions made up of 56 caregivers of under-fives and eight community Key Informants. Descriptive and inference statistics were used for the quantitative data and grounded theory to guide the analysis of the qualitative data. Results Two-thirds of the respondents had never heard the name pneumonia. Most respondents did not know about the signs and symptoms of pneumonia. For the few who have heard about pneumonia, causes were largely attributed to coming into contact with cold temperature in various forms. Management practices mostly were self-treatment with home remedies and allopathic care. Conclusion The low awareness and inadequate recognition of pneumonia implies that affected children may not receive prompt and appropriate treatment as their caregivers may misdiagnose the illness. Adequate measures need to be taken to create the needed awareness to improve care seeking behaviour

An assessment of trends in the use of the IUD in Ghana

Use of the IUD in relation to other contraceptive methods is reported to have either stagnated or declined in a number of countries including Ghana. The overall aim of this study was to inform the Ghana Health Service, USAID, and other partners on future directions for contraceptive promotion and supply. The stagnating demand for the IUD as a family planning method can be attributed to several factors, including perceptions and rumors about the method. The study recommends: intensified marketing of the IUD through the Ghana Life Choices Program; IUD-focused training and creation of a critical mass of trained IUD providers; and a Ministry of Health review of the National Reproductive Health Service Protocols on who qualifies to insert the IUD, and clarification of the eligibility criteria with regard to nulliparous and HIV-infected clients. The study also identified a need to address issues related to cost

Treatment choices for fevers in children under-five years in a rural Ghanaian district

<p>Abstract</p> <p>Background</p> <p>Health care demand studies help to examine the behaviour of individuals and households during illnesses. Few of existing health care demand studies examine the choice of treatment services for childhood illnesses. Besides, in their analyses, many of the existing studies compare alternative treatment options to a single option, usually self-medication. This study aims at examining the factors that influence the choices that caregivers of children under-five years make regarding treatment of fevers due to malaria and pneumonia in a rural setting. The study also examines how the choice of alternative treatment options compare with each other.</p> <p>Methods</p> <p>The study uses data from a 2006 household socio-economic survey and health and demographic surveillance covering caregivers of 529 children under-five years of age in the Dangme West District and applies a multinomial probit technique to model the choice of treatment services for fevers in under-fives in rural Ghana. Four health care options are considered: self-medication, over-the-counter providers, public providers and private providers.</p> <p>Results</p> <p>The findings indicate that longer travel, waiting and treatment times encourage people to use self-medication and over-the-counter providers compared to public and private providers. Caregivers with health insurance coverage also use care from public providers compared to over-the-counter or private providers. Caregivers with higher incomes use public and private providers over self-medication while higher treatment charges and longer times at public facilities encourage caregivers to resort to private providers. Besides, caregivers of female under-fives use self-care while caregivers of male under-fives use public providers instead of self-care, implying gender disparity in the choice of treatment.</p> <p>Conclusions</p> <p>The results of this study imply that efforts at curbing under-five mortality due to malaria and pneumonia need to take into account care-seeking behaviour of caregivers of under-fives as well as implementation of strategies.</p

Where is the ‘C’ in antenatal care and postnatal care: A multi‐country survey of availability of antenatal and postnatal care in low‐ and middle‐income settings

Objective: Antenatal (ANC) and postnatal care (PNC) are logical entry points for prevention and treatment of pregnancy‐related illness and to reduce perinatal mortality. We developed signal functions and assessed availability of the essential components of care. Design: Cross‐sectional survey. Setting: Afghanistan, Chad, Ghana, Tanzania, Togo. Sample: Three hundred and twenty‐one healthcare facilities. Methods: Fifteen essential components or signal functions of ANC and PNC were identified. Healthcare facility assessment for availability of each component, human resources, equipment, drugs and consumables required to provide each component. Main outcome measure: Availability of ANC PNC components. Results: Across all countries, healthcare providers are available (median number per facility: 8; interquartile range [IQR] 3–17) with a ratio of 3:1 for secondary versus primary care. Significantly more women attend for ANC than PNC (1668 versus 300 per facility/year). None of the healthcare facilities was able to provide all 15 essential components of ANC and PNC. The majority (>75%) could provide five components: diagnosis and management of syphilis, vaccination to prevent tetanus, BMI assessment, gestational diabetes screening, monitoring newborn growth. In Sub‐Saharan countries, interventions for malaria and HIV (including prevention of mother to child transmission [PMTCT]) were available in 11.7–86.5% of facilities. Prevention and management of TB; assessment of pre‐ or post‐term birth, fetal wellbeing, detection of multiple pregnancy, abnormal lie and presentation; screening and support for mental health and domestic abuse were provided in <25% of facilities. Conclusions: Essential components of ANC and PNC are not in place. Focused attention on content is required if perinatal mortality and maternal morbidity during and after pregnancy are to be reduced

Please understand when I cry out in pain: women's accounts of maternity services during labour and delivery in Ghana

BACKGROUND: This study was undertaken to investigate women's accounts of interactions with health care providers during labour and delivery and to assess the implications for acceptability and utilisation of maternity services in Ghana. METHODS: Twenty-one individual in-depth interviews and two focus group discussions were conducted with women of reproductive age who had delivered in the past five years in the Greater Accra Region. The study investigated women's perceptions and experiences of care in terms of factors that influenced place of delivery, satisfaction with services, expectations of care and whether they would recommend services. RESULTS: One component of care which appeared to be of great importance to women was staff attitudes. This factor had considerable influence on acceptability and utilisation of services. Otherwise, a successful labour outcome and non-medical factors such as cost, perceived quality of care and proximity of services were important. Our findings indicate that women expect humane, professional and courteous treatment from health professionals and a reasonable standard of physical environment. Women will consciously change their place of delivery and recommendations to others if they experience degrading and unacceptable behaviour. CONCLUSION: The findings suggest that inter-personal aspects of care are key to women's expectations, which in turn govern satisfaction. Service improvements which address this aspect of care are likely to have an impact on health seeking behaviour and utilisation. Our findings suggest that user-views are important and warrant further investigation. The views of providers should also be investigated to identify channels by which service improvements, taking into account women's views, could be operationalised. We also recommend that interventions to improve delivery care should not only be directed to the health professional, but also to general health system improvements

Nutrient Release Pattern and Greenhouse-Grown Swiss Chard Response to Biochar Inoculated with Vermicast

A study was performed to assess nutrient release from biochar inoculated with solid vermicast (SVB), vermicast tea (VTB), deionized water (DWB), uninoculated biochar (Bioc), and Promix-BX (Pro-BX). The growth response of Swiss chard (Beta vulgaris subsp. vulgaris) cv. Rhubarb chard was also assessed. Comparatively, nutrients were released slowly from treatments SVB and VTB compared to the other treatments. The rate of nutrient release determined by total dissolved solids and electric conductivity from the Pro-BX was the highest. The trend for the plant growth components, total leaf surface area and leaf fresh weight at first harvest, was Pro-BX > Bioc > DWB = SVB > VTB. The only treatment that increased total leaf area and leaf fresh weight at the second harvest by approximately 1.02- and 1.88-fold was VTB. Leaf fresh weight was significantly reduced by approximately 0.33-fold for DWB, 0.28-fold for Bioc, and 0.70-fold for Pro-BX but was not altered by SVB at the second harvest as compared to the first harvest. A 2-dimensional principal component analysis (PCA) biplot confirmed that treatment Pro-BX increased plant growth components at the first harvest only. The locations of SVB and VTB on the PCA biplot confirmed their efficacies, which led to increases in the plant growth components at the second harvest. Overall, the VTB adsorbed more nutrients onto its surface that were slowly released to enhance the Swiss chard cv. Rhubarb chard plant growth at the second harvest. Further studies should consider microbial activities

Plant Growth and Nutritional Quality Attributes of Basella alba Applied with Variable Rates of Nitrogen Fertilizer at Different Planting Dates under Canadian Maritime Climatic Conditions

Nitrogen (N) fertilization at critical planting time is important to optimize productivity and reduce nitrate accumulation in edible portions of green leafy vegetable plants. A field experiment was performed to determine the effects of variations in N rate and planting time on plant growth, yield, and nutritional quality attributes of Basella alba under Atlantic maritime climatic conditions. The N rates were 0 (control), 40 (low), 80 (medium), and 120 kg ha−1 (high) at planting times 15 June–3 August (early season), 6 July–20 August (mid-season), and 4 August–8 September (late season). Plant height, number of branches, and stem girth were increased after 45 days after sowing in early and mid-season plantings, but leaf length decreased during the same time by 32.8% in the late planting. The average yield obtained in early, mid-, and late plantings were 171, 464, and 328 g plant−1, respectively. Low N gave the highest yield in early planting while medium N gave higher yields in mid- and late plantings. However, the medium N increased nitrate accumulation in B. alba by 7% compared to the high N rate. In general, there was no significant effect of N on B. alba total phenolic and total carotenoid contents. Overall, the highest yield was obtained during the warmest summer months of mid- and late plantings. Therefore, there is a potential to grow B. alba as a summer vegetable under Canadian Atlantic maritime conditions. However, it is recommended to reduce the rate of N fertilizer application during high-temperature conditions. Future studies are required to investigate phosphorus and potassium fertilization and nitrate accumulation in B. alba and potential health risks