‘Ghost’ stories: sociocultural factors influencing tuberculosis treatment adherence in Ghana

Background: Non-adherence to treatment is a major problem in tuberculosis (TB) control and leads to adverse outcomes and increased morbidity and mortality. Aim: To explore the experiences of TB patients taking anti-TB drugs in Ghana to improve treatment adherence and prevent TB. Method: Ten semi-structured interviews were conducted. Participants were asked about their experience of taking anti-TB drugs and factors that affect treatment adherence. These were transcribed and analysed using inductive content analysis. Participants were chosen through purposive sampling. Findings: Three main themes emerged from the data: family support, stigma, beliefs and misconception. Subthemes included emotional support, financial difficulty and myth. Conclusion: Patients who have family support, who are ‘policed’ and reminded to take their drugs at home are likely to adhere to treatment. Traditional beliefs and social stigma can affect medication adherence adversely

Tuberculosis treatment adherence in Ghana: patients’ perspectives of barriers and enablers to treatment

Tuberculosis (TB) treatment continues to be a daunting task in most low and middle- income countries due to cultural beliefs held by people and inadequate information about the importance of treatment adherence in the community. This study explored the patient-related factors influencing tuberculosis treatment adherence, with a focus on patient-related factors affecting such treatment adherence. Using a semi-structured interview guide, 10 participants (Five males, five females) were engaged in in-depth individual interviews. Miles and Huberman’s (1994) content analysis approach was used to analyse data. Three main themes emerged from the synthesised data: Knowledge on TB and its treatment, challenges associated with TB treatment and motivating factors to adherence. Patients’ belief about the cause of TB such as spiritual forces, poor knowledge about treatment duration and consequences of defaulting, and the side effect of drugs especially when taken with little or no food were found to be critical factors that negatively impacted treatment adherence. The desire to attain one’s ‘normal self’, making up mind to complete treatment and recognition of symptom improvement following the commencement of treatment supported adherence to TB treatment. Continuous education on TB and counselling during treatment are vital interventions that need sustained integration in TB prevention and adherence programmes. Maintaining continuous multi-level support for clients living with TB is critical for TB prevention and control, and adherence to full treatment course

Reconceptualizing Geriatric Care in a Sub-Saharan African Context

Population ageing is very fast catching up worldwide and with a resultant rise in demands for health services and medical costs. This is because older adults are typically more vulnerable to falls and chronic diseases. It is estimated that by 2025, 57% of the world’s population aged 80 years or older will be living in less developed regions. By 2050, there is an estimated increase of more than 70%. Although, Africa, on average, has the lowest life expectancy in the world, in virtually every country, the section of people aged 60 years and over is developing faster than any other age group, because of both longer life expectancy and declining fertility rates. Older adults have recommended that nurses should receive some training for improving their behaviour and attitude. Older adults and their significant health needs are different from that of an adult or a child and should be considered to meet SDG Goal 8: “ensuring equitable access to, and utilisation of, health and long-term care services …”. Their intense use of health services puts older adults at greater risk of receiving fragmented or poor-quality care. The sheer number of people entering older ages is bound to challenge national structures, particularly health systems. This chapter seeks to review the literature on geriatric health care by specialists

Postpartum fertility behaviours and contraceptive use among women in rural Ghana

Abstract Background Although most women would want to wait for more than two years before having another baby, their fertility behaviours during the first year following birth may decrease or increase the length of the birth interval. The objectives of this study were to: assess how protected postpartum women in the Mfantseman municipal were against pregnancy, based on their patterns of amenorrhoea and sexual abstinence; determine the timing of postpartum contraception in relation to amenorrhoea and sexual abstinence; and determine the predictors of postpartum contraceptive use. Methods This was a prospective study carried out in the Mfantseman Municipality of the Central region of Ghana. Out of 1914 women attending antenatal clinic in the municipal within the study period, 1350 agreed to be part of the study to ascertain their postpartum fertility and contraceptive behaviours a year following delivery. These women were traced to their communities using telephone and house numbers provided and only 1003 of the women were finally traced and interviewed. The women were asked about their breastfeeding behaviour, postpartum sexual abstinence, duration of amenorrhoea and postpartum contraceptive use. Results The mean age of the respondents was 29.9 ± 6.5 years; adolescents constituted the least proportion (3.3%) of the women. More than half (54.1%) of the women had Middle, Junior secondary school or Junior high school education. Most (43.3%) of the women were married by means of traditional rites and more than half (51.4%) of them were petty traders. The mean durations of breastfeeding, amenorrhoea and sexual abstinence were 6.6 ± 2.8 months, 7.8 ± 3.8 months and 4.4 ± 3.1 months respectively, whilst mean time of first contraceptive uptake was 3.5 ± 2.7 months postpartum. The time to first use of modern contraceptive method during the postpartum period indicates that about 50% of the women had started use of modern contraceptive methods by 2.7 months postpartum, and occured 0.6 and 3.6 months before sexual relations and resumption of menses respectively. Occupation (likelihood ratio p = 0.013), area of residence (likelihood ratio p = 0.004), mode of delivery (likelihood ratio p < 0.001), breastfeeding (p = 0.024), period since delivery (p < 0.001), preferred number of children (p < 0.001) and parity (p < 0.001) were found to be predictors of postpartum contraceptive use. Conclusion Postpartum women in the Mfantseman municipal who did not use contraceptives or delayed in the use of contraceptives after birth were least likely to be protected against pregnancy in the post partum period, whilst those who adopted postpartum family planning were likely to be better protected because they were likely to adopt it within the first three months after birth and before the onset of sexual relations and first menses. The predictors of postpartum contraceptive use were breastfeeding pattern, occupation, parity, preferred number of children, period since delivery, place of residence and mode of delivery

Tuberculosis treatment adherence in Ghana: patients’ perspectives of barriers and enablers to treatment

Tuberculosis (TB) treatment continues to be a daunting task in most low and middle- income countries due to cultural beliefs held by people and inadequate information about the importance of treatment adherence in the community. This study explored the patient-related factors influencing tuberculosis treatment adherence, with a focus on patient-related factors affecting such treatment adherence. Using a semi-structured interview guide, 10 participants (Five males, five females) were engaged in in-depth individual interviews. Miles and Huberman’s (1994) content analysis approach was used to analyse data. Three main themes emerged from the synthesised data: Knowledge on TB and its treatment, challenges associated with TB treatment and motivating factors to adherence. Patients’ belief about the cause of TB such as spiritual forces, poor knowledge about treatment duration and consequences of defaulting, and the side effect of drugs especially when taken with little or no food were found to be critical factors that negatively impacted treatment adherence. The desire to attain one’s ‘normal self’, making up mind to complete treatment and recognition of symptom improvement following the commencement of treatment supported adherence to TB treatment. Continuous education on TB and counselling during treatment are vital interventions that need sustained integration in TB prevention and adherence programmes. Maintaining continuous multi-level support for clients living with TB is critical for TB prevention and control, and adherence to full treatment course

Is the bereavement grief intensity of survivors linked with their perception of death quality?

Background: Some people experience exceptionally severe bereavement grief, and this level of post-death grief could potentially be the result of a low quality dying process. Aims: A pilot study was conducted to determine if a relationship exists between perceived death quality and bereavement grief intensity. Methods: A questionnaire was developed and posted online for data on bereavement grief intensity, perceived death quality, and decedent and bereaved person characteristics. Data from 151 Canadian volunteers were analysed using bi-variate and multiple linear regression tests. Findings: Half had high levels of grief, and over half rated the death as more bad than good. Perceived death quality and post-death grief intensity were close to being negatively correlated. Conclusion: These findings indicate research is needed to explore possible connections between bereavement grief and the survivor's perceptions of whether a good or bad death took place. In the meantime, it is important for palliative care nurses to think of the quality of the dying process as being potentially very impactful on the people who will be left to grieve that death

A Bayesian Spatio-Temporal Analysis of Malaria in the Greater Accra Region of Ghana from 2015 to 2019

The Greater Accra Region is the smallest of the 16 administrative regions in Ghana. It is highly populated and characterized by tropical climatic conditions. Although efforts towards malaria control in Ghana have had positive impacts, malaria remains in the top five diseases reported at healthcare facilities within the Greater Accra Region. To further accelerate progress, analysis of regionally generated data is needed to inform control and management measures at this level. This study aimed to examine the climatic drivers of malaria transmission in the Greater Accra Region and identify inter-district variation in malaria burden. Monthly malaria cases for the Greater Accra Region were obtained from the Ghanaian District Health Information and Management System. Malaria cases were decomposed using seasonal-trend decomposition, based on locally weighted regression to analyze seasonality. A negative binomial regression model with a conditional autoregressive prior structure was used to quantify associations between climatic variables and malaria risk and spatial dependence. Posterior parameters were estimated using Bayesian Markov chain Monte Carlo simulation with Gibbs sampling. A total of 1,105,370 malaria cases were recorded in the region from 2015 to 2019. The overall malaria incidence for the region was approximately 47 per 1000 population. Malaria transmission was highly seasonal with an irregular inter-annual pattern. Monthly malaria case incidence was found to decrease by 2.3% (95% credible interval: 0.7-4.2%) for each 1 °C increase in monthly minimum temperature. Only five districts located in the south-central part of the region had a malaria incidence rate lower than the regional average at &gt;95% probability level. The distribution of malaria cases was heterogeneous, seasonal, and significantly associated with climatic variables. Targeted malaria control and prevention in high-risk districts at the appropriate time points could result in a significant reduction in malaria transmission in the Greater Accra Region.</p