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

Pilot implementation of community health advocacy teams to improve the effectiveness of long-lasting insecticide net distribution through both campaigns and continuous channels in Ghana: a qualitative study of opportunities and barriers to implementation

IntroductionIn Ghana, the National Malaria Elimination Programme (NMEP) distributes long-lasting insecticide net (LLIN) to households for free through the periodic point mass distribution (PMD) campaign and continuous distribution to populations most vulnerable to malaria. It is known that the existence of effective and functional community-based groups could influence positive behaviours regarding health interventions promoted through health campaigns. However, there is no evidence of functional community-based groups that aim to improve the effectiveness of LLIN distribution campaigns by transitioning into primary healthcare delivery. This study aimed to explore the opportunities and barriers to the pilot implementation of co-created community health advocacy teams (CHATs) to improve the effectiveness of LLIN distribution through both campaigns and continuous channels in Ghana.MethodsA qualitative research approach was used among 43 CHAT members across six communities in the Eastern and Volta regions of Ghana. The CHAT constitutes significant community actors whose roles are centred on key elements of community/social mobilisation and capacity building, all nested in social and behaviour change communication (SBCC) strategies. The CHATs were pilot implemented in all study communities for 4 months after which we identified opportunities and barriers during implementation. CHAT members participated in six focus group discussions which were audio recorded, transcribed verbatim, and analysed thematically using the NVivo 13.ResultsCHATs were instrumental in sensitising community members through SBCC strategies. Moreover, there were changes in the behaviour of community members who were receptive towards and participated in CHAT activities. Community members were accurately informed about malaria (e.g., causes and preventive measures). However, the CHAT experienced barriers during implementation, including a lack of financial support to aid in transportation, organisation of meetings, and outreach activities. Additionally, the level of participation by CHAT members in activities and the medium of communication among members were key areas of concern.ConclusionThe CHATs would be instrumental in promoting LLINs' use during and after PMD campaigns through community outreaches. It is therefore necessary to provide resources to support their operations and a good network to address communication barriers. Finally, continuous capacity strengthening of CHAT members by the NMCP is important

Social factors influencing child health in Ghana

Objectives Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals’ target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal. Methods ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review. Results Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices. Conclusions Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother’s health knowledge is emphasised

Social problems and social work in Ghana: Implications for sustainable development

Social Work practice is a helping profession that provides services aimed at assisting societies work better for their people. It is designed to support people burdened with varying degrees of social problems to function better within society. Meaningful and sustainable development cannot take place in societies afflicted with a host of social problems which receive no meaningful interventions. Ghana is beset with a myriad of social problems that call for professional social work interventions. Using Social work education and practice as a backdrop, this article highlights some of the key and emerging social problems in Ghana. It examines the constraints and unique challenges that the profession face in its efforts to help people develop their full potential and improve their lives. Furthermore, the authors discuss social work education and practice interventions that would bring about social change and help people, especially the poor and the marginalized, to appropriately play their part in society. This article concludes with highlights on the implications of social problems and social work interventions for sustainable development in Ghanaian society

Factors Influencing Prevention and Control of Malaria among Pregnant Women Resident in Urban Slums, Southern Ghana

Throughout Africa and particularly in Ghana, there are concerns about malaria infection during pregnancy. This study aimed to investigate factors that influence malaria prevention and control practices among pregnant women residing in Chorkor and Korle-Gonno in Accra, Ghana. One hundred and twenty pregnant women between ages 18-49 were randomly recruited during antenatal sessions at a maternity facility in Accra, as participants for the study. An interviewer-administered questionnaire was used to collect data, which were analysed using SPSS version16.0. It was found that in Chorkor and Korle-Gonno, 57.4% and 42.6% participants respectively reported having been infected with malaria during their current pregnancy. There was no significant relationship between religious beliefs of participants and their malaria prevention and control practices (X2 = 0.28, P = .53). However, there was a significant relationship between malaria prevention and control practices of participants and their income earning (X2 = 53.94, P = .00) and employment (X2 = 61.76, P = .00) statuses. With the exception of ethnicity (X2 = 35.62, P =.22), other socio-cultural conditions had a significant relationship with malaria prevention and control practices of the participants. The findings suggest the need to consider and integrate factors, such as poverty and poor living conditions in malaria prevention and control strategies. Keywords: Ghana, Malaria prevention and control practices, pregnant women, slums

Mobile phone-based interactive voice response as a tool for improving access to healthcare in remote areas in Ghana - an evaluation of user experiences

Brinkel J, May J, Krumkamp R, et al. Mobile phone-based interactive voice response as a tool for improving access to healthcare in remote areas in Ghana - an evaluation of user experiences. TROPICAL MEDICINE & INTERNATIONAL HEALTH. 2017;22(5):622-630.OBJECTIVES To investigate and determine the factors that enhanced or constituted barriers to the acceptance of an mHealth system which was piloted in Asante-Akim North District of Ghana to support healthcare of children. METHODS Four semi-structured focus group discussions were conducted with a total of 37 mothers. Participants were selected from a study population of mothers who subscribed to a pilot mHealth system which used an interactive voice response (IVR) for its operations. Data were evaluated using qualitative content analysis methods. In addition, a short quantitative questionnaire assessed system's usability (SUS). RESULTS Results revealed 10 categories of factors that facilitated user acceptance of the IVR system including quality-of-care experience, health education and empowerment of women. The eight categories of factors identified as barriers to user acceptance included the lack of human interaction, lack of update and training on the electronic advices provided and lack of social integration of the system into the community. The usability (SUS median: 79.3; range: 65-97.5) of the system was rated acceptable. CONCLUSIONS The principles of the tested mHealth system could be of interest during infectious disease outbreaks, such as Ebola or Lassa fever, when there might be a special need for disease-specific health information within populations