Pathways Utilized for Antenatal Health Seeking Among Women in the Ga East District, Ghana

Background: Ghana’s maternal mortality ratio has been declining over the last two decades but at a rather slow pace. Poor access to effective maternity care is identified as one of the key challenges of maternity care. The current study mapped out the pathways to pregnancy care seeking among urban-dwelling adult women in a peri-urban district located in the Greater Accra region of Ghana.Methods: A total of 300 women who had a live birth in the last 12 months participated in a communitybased survey. They answered questions on care seeking behavior related to their last pregnancy. A multivariate Logistic regression model was used to identify factors associated with multiple care seeking behavior.Results: Almost all women in the survey (98%) reported accessing skilled antenatal care (ANC) from a biomedical provider, although 35% begun ANC later than the first trimester. About 45% of women simultaneously utilized both ANC and alternative care providers (ACP) including traditional birth attendants, herbalists, and spiritualists. A complex pathway to antenatal care seeking behavior involving shuttling between providers was observed. Controlling for household wealth, household size, and age, seeking care from multiple providers concurrently was associated with residence in Kwabenya sub-district OR=2.13 (95% CI: 1.28, 3.55) and previous abortion OR=2.08 (95% CI: 1.11, 3.91)Conclusions: Urban-dwelling women in Ga East District seek antenatal care concurrently from multiple sources. Health system interventions must seek ways to integrate alternative care providers into the existing biomedical health care system.Keywords: multiple care seeking, pregnancy, pathway, alternative care, antenata

Trends in the prevalence of female genital muti-lation and its effect on delivery outcomes in the kassena-nankana district of northern Ghana

Rational: Female genital mutilation (FGM) is prevalent in northern Ghana, as the practice is seen as a passage rite to women adulthood and thus undertaken just before marriage. Objectives: We determined the changes in trend of FGM in deliveries at the Navrongo War Memo-rial hospital, and compared the outcomes and FGM status.Design: Retrospective extraction and analysis of delivery data at the hospital from 1st January 1996 to 31st December 2003. Results: Of the 5071 deliveries, about 29% (1466/5071) were associated with FGM. The high-est prevalence (95% CI) of 61.5% (50.9, 71.2) was in women aged 40 years and above, and the lowest of 14.4% (11.7, 17.0) was in women below 20 years. The all-age prevalence of FGM showed a significant decline (p-value for linear trend < 0.01) from 35.2% in 1996 to 21.1% in 2003. About 6% (89/1466) of mothers with FGM had stillbirths compared with about 3% (123/3605) of mothers without FGM. Again FGM was associated with 8.2% (120/1466) caesarean section rate compared with 6.7% (241/3605) in mothers without FGM. Mean birth weight and frequency of low birth weights were not significantly associated with FGM status. Conclusion: Although there is a high rate of FGM among mothers in the district and is associated with a higher proportion of stillbirths and caesar-ean sections, practice has shown a significant de-cline in the district in recent years due to the pre-vailing campaigns and intervention studies. There is therefore the need to sustain the ongoing inter-vention efforts

“I don’t know anything about their Culture”: The Disconnect between Allopathic and Traditional Maternity Care Providers in Rural Northern Ghana

The provision of maternal and neonatal health care in rural northern Ghana is pluralistic, consisting of traditional and allopathic providers. Although  women often use these providers interchangeably, important differences exist. This study explored the differences in approaches to maternal and neonatal care provision by these two different types of providers. This  research was part of the Stillbirth and Neonatal Death Study (SANDS),  conducted in northern Ghana in 2010. Trained field staff of the Navrongo Health Research Centre conducted in-depth interviews with 13 allopathic and 8 traditional providers. Interviews were audio-recorded, transcribed, and analyzed using in vivo coding and discussion amongst the research team. Three overarching themes resulted: 1) many allopathic providers were isolated from the culture of the communities in which they practiced, while traditional providers were much more aware of the local cultural  beliefs and practices. 2) Allopathic and traditional healthcare providers have different frameworks for understanding health and disease, with  allopathic providers relying heavily on their biomedical knowledge, and traditional providers drawing on their knowledge of natural remedies. 3) All providers agreed that education directed at pregnant women, providers (both allopathic and traditional), and the community at large is needed to improve maternal and neonatal outcomes. Our findings suggest that, among other things, programmatic efforts need to be placed on the cultural education of allopathic providers. (Afr J Reprod Health 2014; 18[2]: 36-45).Keywords: Allopathic medicine, traditional medicine, maternal health, delivery care, cultur

A Policy Brief on Adopting the Somali Camel for Enhanced Profitability and Pastoral Resilience in Northern Kenya

Persistent drought and high temperatures in Isiolo and Marsabit counties of northern Kenya repeatedly devastate livestock herds particularly cattle making the pastoralists less resilient, more vulnerable to climate change and poor. To address this challenge, an IGAD funded project promoted adoption of Somali camel breed, trained farmers on improved management and also estimated potential profitability of rearing the camel. Through the project, trainers were trained and facilitated to train 240 peri-urban Somali camel producers in Isiolo and Marsabit on breeding, health, routine husbandry and marketing. Impact study documenting positive stories of change was conducted at the end. Producers who hitherto made zero money from their camels were making KES. 42,000 a month from sale of 20 litres of milk daily from only 5 milking camels; producers had adopted a new grazing management strategy that ensured daily access of the camel milk market and conservation of grazing areas around settlements; motor bikes had been adopted as means delivering milk to collection centers thus creating jobs for the youth; the beneficiary producers were spending more money on production inputs. In terms of policy, the county governments of Isiolo and Marsabit need to appreciate the huge business potential in Somali camel rearing and the magnitude of positive change that can be brought about by capacity training of producers on improved camel management technologies and agree to allocate more funds in support of livestock production extension services

Health impact assessment for promoting sustainable development: the HIA4SD project

Health is central to sustainable development, and thus a cross-cutting issue of the SustainableDevelopment Goal (SDG) 2030 agenda. Natural resource extraction projects in Africa haveconsiderable potential to impact on health-related targets of the SDGs. This paper introducesthe rationale and organization of the HIA4SD Project; a 6-year research for development (r4d)project that aims to inform and facilitate a policy dialogue at the national and internationallevel on whether current regulatory approaches to impact assessment in Africa promotesustainable development, placing emphasis on SDG3Good Health and Well-being. TheHIA4SD Project has a focus on large-scale natural resource extraction projects and is imple-mented in four African countries, namely Burkina Faso, Ghana, Mozambique and Tanzania

Revolutionizing the public health workforce: a policy brief in retrospect of the world congress on public health Rome 2020

Background: The COVID-19 pandemic dramatically illustrates the consequences of inadequate prioritization of the Public Health Workforce (PHW). This Policy Brief introduces a Call for Action following the plenary session entitled "Revolutionising the Public Health Workforce (PHW) as Agents of Change" as part of the 2020 World Congress on Public Health.Policy Options and Recommendations: In order to revolutionize the PHW, five long-term key approaches are proposed: 1. Transforming public health competencies through transdisciplinary education and inter-professional training; 2. Revolutionizing educational systems by shifting the public health paradigm; 3. Linking public health education and work opportunities; 4. Overcoming the paradoxical shortage and overproduction of graduates and 5. Developing adaptable, multisectoral agents of change.Conclusion: Public health education of the future requires a paradigm shift towards a holistic understanding of public health, characterized by transdisciplinary education, inter-professional training and a closer integration of academia, health services, and communities

Venture funding for science-based African health innovation

<p>Abstract</p> <p>Background</p> <p>While venture funding has been applied to biotechnology and health in high-income countries, it is still nascent in these fields in developing countries, and particularly in Africa. Yet the need for implementing innovative solutions to health challenges is greatest in Africa, with its enormous burden of communicable disease. Issues such as risk, investment opportunities, return on investment requirements, and quantifying health impact are critical in assessing venture capital’s potential for supporting health innovation. This paper uses lessons learned from five venture capital firms from Kenya, South Africa, China, India, and the US to suggest design principles for African health venture funds.</p> <p>Discussion</p> <p>The case study method was used to explore relevant funds, and lessons for the African context. The health venture funds in this study included publicly-owned organizations, corporations, social enterprises, and subsidiaries of foreign venture firms. The size and type of investments varied widely. The primary investor in four funds was the International Finance Corporation. Three of the funds aimed primarily for financial returns, one aimed primarily for social and health returns, and one had mixed aims. Lessons learned include the importance of measuring and supporting both social and financial returns; the need to engage both upstream capital such as government risk-funding and downstream capital from the private sector; and the existence of many challenges including difficulty of raising capital, low human resource capacity, regulatory barriers, and risky business environments. Based on these lessons, design principles for appropriate venture funding are suggested.</p> <p>Summary</p> <p>Based on the cases studied and relevant experiences elsewhere, there is a case for venture funding as one support mechanism for science-based African health innovation, with opportunities for risk-tolerant investors to make financial as well as social returns. Such funds should be structured to overcome the challenges identified, be sustainable in the long run, attract for-profit private sector funds, and have measurable and significant health impact. If this is done, the proposed venture approach may have complementary benefits to existing initiatives and encourage local scientific and economic development while tapping new sources of funding.</p

Health impact assessment and health equity in sub-Saharan Africa : a scoping review

Background:Naturalresourceextractionprojectscanhavepositivebutalsonegativeeffectsonthehealthofaffectedcommunities, governed by demographic, economic, environmental, physical and social changes. Negative effectsoftenprevailandthesemightwidenexistinghealthinequities.Healthimpactassessment(HIA)isadecision-supporttool that aims at maximizing benefits and minimizing negative impacts on people's health. A core value of HIA isequity; yet, little is known about health equity in the frame of HIA, particularly in sub-Saharan Africa.Methodology:Weconducteda scopingreview todetermine whetherand towhat extent HIAin sub-Saharan Africaaddresses health equity. We included peer-reviewed publications and guidelines pertaining to HIA, environmentalimpact assessment (EIA) and social impact assessment (SIA). Health equity was investigated by identifying (i) howhealth considerations were addressed and (ii) whether health was stratified by subgroups of the community.Results:Out of 1′640 raw hits, we identified 62 articles (16 HIA, 36 EIA, one SIA and nine integrated assess-ments),32ofwhichspecificallyaddressedhealth.While20articlesfocusedonaspecifichealthtopic,12articlesusedamorecomprehensiveapproachtoaddresshealth.In15articlestherewerespecificsubgroupanalyses(e.g.mothers, children or marginalized groups) as a measure of health equity. Another 12 papers referred to thecommunity in a more general way (e.g. affected). Without exception, health was an integral part of the nineincluded guidelines. HIA guidelines addressed health systematically through environmental health areas, riskassessment matrix or key performance indicators.Conclusions:We found evidence that previously conducted HIA in sub-Saharan Africa and current guidelinesaddresshealthequity.However,thereisaneedtostratifycommunitysubgroupsmoresystematicallyinordertodeterminehealthdifferentialsbetter.FutureHIAshouldconsidercommunityheterogeneityinanefforttoreducehealth inequities by "leaving no one behind", as suggested by the Sustainable Development Goal

Understanding and retention of the informed consent process among parents in rural northern Ghana

<p>Abstract</p> <p>Background</p> <p>The individual informed consent model remains critical to the ethical conduct and regulation of research involving human beings. Parental informed consent process in a rural setting of northern Ghana was studied to describe comprehension and retention among parents as part of the evaluation of the existing informed consent process.</p> <p>Methods</p> <p>The study involved 270 female parents who gave consent for their children to participate in a prospective cohort study that evaluated immune correlates of protection against childhood malaria in northern Ghana. A semi-structured interview with questions based on the informed consent themes was administered. Parents were interviewed on their comprehension and retention of the process and also on ways to improve upon the existing process.</p> <p>Results</p> <p>The average parental age was 33.3 years (range 18–62), married women constituted a majority (91.9%), Christians (71.9%), farmers (62.2%) and those with no formal education (53.7%). Only 3% had ever taken part in a research and 54% had at least one relation ever participate in a research. About 90% of parents knew their children were involved in a research study that was not related to medical care, and 66% said the study procedures were thoroughly explained to them. Approximately, 70% recalled the study involved direct benefits compared with 20% for direct risks. The majority (95%) understood study participation was completely voluntary but only 21% recalled they could withdraw from the study without giving reasons. Younger parents had more consistent comprehension than older ones. Maternal reasons for allowing their children to take part in the research were free medical care (36.5%), better medical care (18.8%), general benefits (29.4%), contribution to research in the area (8.8%) and benefit to the community (1.8%). Parental suggestions for improving the consent process included devoting more time for explanations (46.9%), use of the local languages (15.9%) and obtaining consent at home (10.3%).</p> <p>Conclusion</p> <p>Significant but varied comprehension of the informed consent process exists among parents who participate in research activities in northern Ghana and it appears the existing practices are fairly effective in informing research participants in the study area.</p