Self-medication practices of pregnant women attending antenatal clinic in northern Ghana: An analytical cross-sectional study

In Ghana, despite the dangers that self-medication poses to maternal and fetal health, there has been limited examination of self-medication among pregnant women. This study examines the practice of self-medication among pregnant women in Wa Municipality, Ghana. An analytical cross-sectional survey of 367 pregnant women was conducted in three health facilities. The prevalence of self-medication practice was 74.1%. The majority (68.4%) of pregnant women obtained unprescribed medicines from chemical shops; others utilized leftover drugs from previous hospital visits (15.8%) or herbal medications (9.9%), while others took unprescribed drugs from relatives or friends (5.9%). Analgesics (76.1%), antibiotics (24.6%), and antimalarials (16.2%) were the most frequently self-medicated drugs. The most common illnesses or symptoms for which pregnant women self-medicated were headaches (34.2%), back pain (33.1%), waist pain (32.7%), lower abdominal pain (20.6%), and malaria (16.2%). After adjusting for potential confounders, easy access to medication without prescription (AOR= 8.4), illness perceived as minor (AOR=4.1), availability of health facilities (AOR=4.2), and frequent lack of medicines at health facilities (AOR=1.7) were significantly associated with self-medication. Enforcing legislation to prevent the stocking and sale of certain analgesics and antibiotics, increasing service points, and improving service quality at antenatal clinics, outpatient departments and pharmacies could reduce self-medication.   Au Ghana, malgré les dangers que l'automédication fait peser sur la santé maternelle et foetale, l'examen de l'automédication chez les femmes enceintes a été limité. Cette étude examine la pratique de l'automédication chez les femmes enceintes de la municipalité de Wa, au Ghana. Une enquête transversale analytique auprès de 367 femmes enceintes a été menée dans trois formations sanitaires. La prévalence de la pratique de l'automédication était de 74,1 %. La majorité (68,4 %) des femmes enceintes ont obtenu des médicaments sans ordonnance dans les magasins de produits chimiques ; d'autres utilisaient des restes de médicaments provenant de visites antérieures à l'hôpital (15,8 %) ou des médicaments à base de plantes (9,9 %), tandis que d'autres prenaient des médicaments non prescrits de parents ou d'amis (5,9 %). Les antalgiques (76,1 %), les antibiotiques (24,6 %) et les antipaludiques (16,2 %) étaient les médicaments les plus fréquemment auto-médiqués. Les maladies ou symptômes les plus courants pour lesquels les femmes enceintes s'automédicament étaient les maux de tête (34,2 %), les maux de dos (33,1 %), les douleurs à la taille (32,7 %), les douleurs abdominales basses (20,6 %) et le paludisme (16,2 %). Après ajustement pour les facteurs de confusion potentiels, accès facile aux médicaments sans ordonnance (AOR = 8,4), maladie perçue comme mineure (AOR = 4,1), disponibilité des établissements de santé (AOR = 4,2) et manque fréquent de médicaments dans les établissements de santé (AOR = 1,7) étaient significativement associés à l'automédication. L'application de la législation pour empêcher le stockage et la vente de certains analgésiques et antibiotiques, l'augmentation des points de service et l'amélioration de la qualité des services dans les cliniques prénatales, les services de consultation externe et les pharmacies pourraient réduire l'automédicatio

Acceptability and feasibility of introducing strengthened school-based sexual and reproductive health information and services in Accra, Ghana

An initial study conducted by Population Council under the Strengthening Evidence for Programming on Unintended Pregnancies (STEP UP) project in 2012 assessed the knowledge and reproductive health needs of adolescents living in selected slums in Brong Ahafo and Greater Accra regions with the view of informing an improvement in adolescent sexual health (ASRH) programming in Ghana. The study concludes that stakeholders generally believed there was the need for enhanced adolescent sexual and reproductive health services in school as the present system of delivering these services were not sufficiently addressing ASRH needs. The use of trained psychologists and health workers was perceived as feasible and acceptable in the Ghanaian context, provided mechanisms are institutionalized to address the financial and other logistical considerations in its implementation. Stakeholders furthermore believed it was important to consider a dedicated curriculum to specifically address the population and family life education needs of adolescents; however, comprehensive stakeholder engagement would be required to determine content and implementation strategies

Knowledge and Perception of Pupils on Health and Environmental Risk of Open Defaecation: A case Study in the First Cycle Schools in Eastern and Volta Regions of Ghana

Open defaecation remains major public and environmental health concerns and has attracted global attention in recent time. This study explores the knowledge and perception of pupils on health and environmental risk of open defaecation. Self-reported data were collected from 400 school pupils using questionnaires, focus group discussions and in-depth interview. Results of the study shows high knowledge level (89.8%) among the pupils. Pupils’ knowledge of environmental risks was fairly high (52%). Knowledge of health risks was, however, low among greater number (53%) of the pupils. Open defaecation shows statistical significant association with health risk (ᵡ2 =65.062, p=0.002), environmental risk (ᵡ2 = 44.961, p=0.006) and pupils level of perception of environmental risk (ᵡ2 = 36.887, p=0.045). The Ministry of Education must introduce courses into the school curriculum to help pupils acquire adequate knowledge on health and environmental consequences of open defaecation.  Keywords: Knowledge, perception, health & environmental risks, open defaecation, first cycle school pupils, Eastern, Volta, Ghana

Acceptability and implementation challenges of smartphone-based training of community health nurses for visual inspection with acetic acid in Ghana : mHealth and cervical cancer screening

Unidad de excelencia María de Maeztu MdM-2015-0552Objective To explore acceptability and feasibility of smartphone-based training of low-level to mid-level health professionals in cervical cancer screening using visual inspection with acetic acid (VIA)/cervicography. Design In 2015, we applied a qualitative descriptive approach and conducted semi-structured interviews and focus groups to assess the perceptions and experiences of community health nurses (CHNs) (n=15) who performed smartphone-based VIA, patients undergoing VIA/cryotherapy (n=21) and nurse supervisor and the expert reviewer (n=2). Setting Community health centres (CHCs) in Accra, Ghana. Results The 3-month smartphone-based training and mentorship was perceived as an important and essential complementary process to further develop diagnostic and management competencies. Cervical imaging provided peer-to-peer learning opportunities, and helped better communicate the procedure to and gain trust of patients, provide targeted education, improve adherence and implement quality control. None of the patients had prior screening; they overwhelmingly accepted smartphone-based VIA, expressing no significant privacy issues. Neither group cited significant barriers to performing or receiving VIA at CHCs, the incorporation of smartphone imaging and mentorship via text messaging. CHNs were able to leverage their existing community relationships to address a lack of knowledge and misperceptions. Patients largely expressed decision-making autonomy regarding screening. Negative views and stigma were present but not significantly limiting, and the majority felt that screening strategies were acceptable and effective. Conclusions Our findings suggest the overall acceptability of this approach from the perspectives of all stakeholders with important promises for smartphone-based VIA implementation. Larger-scale health services research could further provide important lessons for addressing this burden in low-income and middle-income countries

Global governance for improved human, animal, and planetary health : the essential role of schools and programs of public health

Since March 2021, the world’s leaders have expressed a desire to “build back better,” reflecting a desire to see an enhanced post-pandemic world and the need to improve and protect health by being better prepared to respond to future pandemics. On March 30, 2021, 25 of the world’s leaders signed an accord calling for a new pandemic preparedness treaty. There is great complexity in achieving an international health treaty. The Independent Panel for Pandemic Preparedness and Response, appointed by the World Health Organization (WHO), reported on May 14, 2021. They called for better funding for WHO, a Global Council for Health threats to work collaboratively with the WHO, and the delivery of the global vaccine program. They called for “21st century health data surveillance” and transparency in data sharing across countries. The Rome Declaration of the Global Health Summit of the G20, called for better preparedness, for support to low- and middle-income countries and for better global financing and governance for public health and health care. The Carbis Bay Declarations of the G7 governments set out proposals for a better planet, economy, and health. The European Union has set out plans to strengthen its capabilities through a Health Emergency Responsiveness Agency (HERA). The vision for HERA may be an example of how other supra-national, continental, or WHO regional health response agencies could be organized and resourced. A Special Session of the World Health Assembly which took place in November 2021 has agreed to set up an Intergovernmental negotiating body to move forward the process of establishing a new Global Pandemic Preparedness Treaty

Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide-treated net use in Ghana

Mass and continuous distribution channels have significantly increased access to insecticide-treated nets (ITNs) in Ghana since 2000. Despite these gains, a large gap remains between ITN access and use.; A qualitative research study was carried out to explore the individual and contextual factors influencing ITN use among those with access in three sites in Ghana. Eighteen focus group discussions, and free listing and ranking activities were carried out with 174 participants; seven of those participants were selected for in-depth case study. Focus group discussions and case study interviews were audio-recorded, transcribed verbatim, and analysed thematically.; ITN use, as described by study participants, was not binary; it varied throughout the night, across seasons, and over time. Heat was the most commonly cited barrier to consistent ITN use and contributed to low reported ITN use during the dry season. Barriers to ITN use throughout the year included skin irritation; lack of airflow in the sleeping space; and, in some cases, a lack of information on the connection between the use of ITNs and malaria prevention. Falling ill or losing a loved one to malaria was the most powerful motivator for consistent ITN use. Participants also discussed developing a habit of ITN use and the economic benefit of prevention over treatment as facilitating factors. Participants reported gender differences in ITN use, noting that men were more likely than women and children to stay outdoors late at night and more likely to sleep outdoors without an ITN.; The study results suggest the greatest gains in ITN use among those with access could be made by promoting consistent use throughout the year among occasional and seasonal users. Opportunities for improving communication messages, such as increasing the time ITNs are aired before first use, as well as structural approaches to enhance the usability of ITNs in challenging contexts, such as promoting solutions for outdoor ITN use, were identified from this work. The information from this study can be used to inform social and behaviour change messaging and innovative approaches to closing the ITN use gap in Ghana

Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs

Abstract Background Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness. Methods In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0. Results 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or “red earth sand.” Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill. Conclusions This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the disconnect between healthcare providers and the community, and the critical role grandmothers play in ensuring clean delivery practices. Future interventions to address clean delivery and prevention of neonatal infections include educating healthcare providers about harmful traditional practices so they are specifically addressed, strengthening facilities, and incorporating influential community members such as grandmothers to ensure success.http://deepblue.lib.umich.edu/bitstream/2027.42/112409/1/12884_2011_Article_543.pd

“If you do vasectomy and come back here weak, I will divorce you”: a qualitative study of community perceptions about vasectomy in Southern Ghana

Background: Male involvement in contraceptive use is increasingly becoming a global reproductive health issue. Vasectomy is one of the two male modern contraceptive methods espoused by the National Family Planning Policy in Ghana. Despite these advocacies, there are reports of low patronage of this method in Ghana. This study adhering to RATS guidelines on qualitative research therefore explored the social and cultural factors that may be affecting the low vasectomy uptake in Southern Ghana. Methods: The study was conducted in Sefwi Bibiani-Ahwiaso Bekwai (SBAB) District and Komenda-Edina-Eguafo-Abrem (KEEA) Municipal area in the Western and Central regions of Ghana respectively. Twelve Focus Group Discussions were held with both male and female community members. In-depth interviews were also carried out with Community Health Officers (CHOs), Community Health Volunteers (CHVs) and health managers at both the district and regional levels. The discussions and interviews were recorded, transcribed verbatim and analysed using Nvivo 10. Results: The study revealed that vasectomy was perceived as an act against God, which was punishable either by death or answerable on judgement day. Vasectomy was also perceived to be a form of castration, which can make men weak and incapable, thereby unable to satisfy their wives sexually, leading to marital conflicts. Women were more concerned about the negative effects of vasectomy on men. Cafalgin and panacin which are locally manufactured analgesics were perceived to have contraceptive abilities and therefore used by men as an alternative to modern contraceptive methods. Conclusions: Stigma and the misconceptions in the community may be accounting for the low vasectomy uptake in Ghana despite several advocacy strategies. Women were highly influential in a man's decision on vasectomy. This calls for the need to increase health education to demystify the misconceptions about vasectomy. Vasectomy-related campaign messages should target both men and women

Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting...

Background: Rapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana. Methods: This research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones. Results: The findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban residents also requires a broader expertise and training of the CHOs. Conclusions: Access to improved urban health services remains a challenge. However, current policy guidelines for the implementation of a primary health model based on rural experiences and experimental design requires careful review and modifications to meet the needs of the urban settings