The use of emergency contraception among female senior high students in the Ho municipality of the Volta Region, Ghana

Background: Emergency contraception (EC) is one option for preventing unplanned pregnancy when it is available and properly used. Unsafe abortions are responsible for nearly one third of maternal deaths in sub-Saharan Africa and about quarter of unsafe abortions are among teenagers.Methods: A quantitative descriptive cross-sectional study. Data was collected using a pretested questionnaire. 260 senior high students were selected using a systematic sampling method in the Volta Region, Ghana. Data were cleaned and entered into SPSS version 22 and analysed into descriptive statistics.Results: Respondents acquired awareness about EC from friends (36.9%), family members (5.6%) and the mass media (41.6%). The required time for EC to be taken were stated as immediately after sex (57.9%), 24 hours after sex (1.2%) and (30.6%) did not know. 28.4% of participants indicated they would not use EC in the future as their faith was against it, 18.0% believed EC is ineffective and 24.9% consider it dangerous to their health. Reasons for use of EC included condom slipped (35.7%), inability to be on daily pill (33.7%), forced unprotected sex (8.2%) and miscalculation of the safe menstrual period (22.4%). There was a significant relationship between age and history of use of EC (p=0.000, c2=8.128, n=260).Conclusions: Strengthening education in Senior High Schools on sexual and reproductive health, with special emphasis on emergency contraceptives as a pregnancy preventive procedure will remain imperative to reducing the canker of maternal mortality attributed to adolescent abortions while improving understanding of the appropriate use of EC

Knowledge of pregnant women on the factors that influence anaemia in pregnancy in a rural farming district of the Western Region of Ghana

Background: The presence of anaemia in pregnancy is one of the serious public health concerns across the globe especially in developing countries like Ghana. This study assessed pregnant women's knowledge on factors influencing aneamia in pregnancy in a low-income district of Ghana.Methods: A quantitative descriptive cross-sectional study. Data was collected using a pretested questionnaire. 112 pregnant women seeking antenatal care were recruited using systematic sampling technique in the Wassa East district of Ghana. Data were cleaned and entered into SPSS version 22 and analysed into descriptive statistics.Results: Majority of participants; 72.3% did not know the causes of anaemia in pregnancy. Pregnant women (27.7%) indicated nutritional deficiency as a common cause of anaemia; 18.7% of them could identify appropriately at least one sign of anaemia in pregnancy with 28% asserting that pregnancy-related anaemia can affect labour, despite 72% indicating that anaemia could cause maternal mortality. The reasons for irregular ANC attendance included; perceived non importance of ANC (18.8%), financial difficulties (17.9%), health facility inaccessibility (18.8%) and time constraints (44.5%). There was a strong association between knowledge level on the cause of anaemia in pregnancy and the educational level of pregnant women (p=0.005 chi square = 50.289).Conclusions: Lack of knowledge on the importance of antenatal care and financial constraints were among the reasons leading to a surge in anaemia amongst pregnant women in the district. Health providers should incorporate services which enable pregnant women to access valuable information on anaemia prevention in pregnancy

Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea

Summary: Background: A dose of 30 mg/kg of azithromycin is recommended for treatment of yaws, a disease targeted for global eradication. Treatment with 20 mg/kg of azithromycin is recommended for the elimination of trachoma as a public health problem. In some settings, these diseases are co-endemic. We aimed to determine the efficacy of 20 mg/kg of azithromycin compared with 30 mg/kg azithromycin for the treatment of active and latent yaws. Methods: We did a non-inferiority, open-label, randomised controlled trial in children aged 6–15 years who were recruited from schools in Ghana and schools and the community in Papua New Guinea. Participants were enrolled based on the presence of a clinical lesion that was consistent with infectious primary or secondary yaws and a positive rapid diagnostic test for treponemal and non-treponemal antibodies. Participants were randomly assigned (1:1) to receive either standard-dose (30 mg/kg) or low-dose (20 mg/kg) azithromycin by a computer-generated random number sequence. Health-care workers assessing clinical outcomes in the field were not blinded to the patient's treatment, but investigators involved in statistical or laboratory analyses and the participants were blinded to treatment group. We followed up participants at 4 weeks and 6 months. The primary outcome was cure at 6 months, defined as lesion healing at 4 weeks in patients with active yaws and at least a four-fold decrease in rapid plasma reagin titre from baseline to 6 months in patients with active and latent yaws. Active yaws was defined as a skin lesion that was positive for Treponema pallidum ssp pertenue in PCR testing. We used a non-inferiority margin of 10%. This trial was registered with ClinicalTrials.gov, number NCT02344628. Findings: Between June 12, 2015, and July 2, 2016, 583 (65·1%) of 895 children screened were enrolled; 292 patients were assigned a low dose of azithromycin and 291 patients were assigned a standard dose of azithromycin. 191 participants had active yaws and 392 had presumed latent yaws. Complete follow-up to 6 months was available for 157 (82·2%) of 191 patients with active yaws. In cases of active yaws, cure was achieved in 61 (80·3%) of 76 patients in the low-dose group and in 68 (84·0%) of 81 patients in the standard-dose group (difference 3·7%; 95% CI −8·4 to 15·7%; this result did not meet the non-inferiority criterion). There were no serious adverse events reported in response to treatment in either group. The most commonly reported adverse event at 4 weeks was gastrointestinal upset, with eight (2·7%) participants in each group reporting this symptom. Interpretation: In this study, low-dose azithromycin did not meet the prespecified non-inferiority margin compared with standard-dose azithromycin in achieving clinical and serological cure in PCR-confirmed active yaws. Only a single participant (with presumed latent yaws) had definitive serological failure. This work suggests that 20 mg/kg of azithromycin is probably effective against yaws, but further data are needed. Funding: Coalition for Operational Research on Neglected Tropical Diseases

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways