Pregnant Teenagers’ Perception And Access To Focused Ante Natal Care Services in a Ghanaian Government Hospital

This study was aimed at assessing the perception of pregnant teenagers of focused ante natal care (FANC) and their challenges in accessing care in Suntreso government hospital, Kumasi, Ghana. A cross sectional descriptive survey design was utilized whereby a purposive sampling technique was used to recruit 50 pregnant teenagers who met the inclusion criteria. A pre-tested structured questionnaire was employed to obtain information from the study participants after obtaining due consents. Obtained data were analyzed using SPSS version 21. Majority ended at the junior high school level 30(60%); 44(88%) not married; majority 40(80%) started attending FANC in their first trimester; 24(48%) were students; 22(44%) earned 6-10 Ghc a day and 20(40%) of them were responsible for their healthcare. Distance 18(36%) and finance 18(36%) influenced their decision to attend FANC. On the whole, only 22(44%) had good perception of interpersonal care, 18(36%) of staff efficiency, 25(50%) of comfort with care, 34(68%) of information they received, and 21(42%) of service environment. Those with strong family support, married and with higher income had good perception of ANC services. Stressful service environment 46(92%) and dissatisfaction with services rendered rated very high 30(60%) among the challenges faced by pregnant teenagers in accessing FANC services. Short waiting time 50(100%), availability of staff 50(100%) and good healthcare providers’ attitude 40(80%) were rated highest among the respondents’ opinion on measures to improve access to ANC services. The study recommended a user friendly healthcare environment through the provision of a separate space for pregnant teenagers and re-training of care providers with emphasis on care of teenagers among others

Collateral damage? Small-scale fisheries in the global fight against IUU fishing

© 2020 The Authors. Fish and Fisheries published by John Wiley & Sons Ltd Concern over illegal, unreported and unregulated (IUU) fishing has led to a number of policy, trade and surveillance measures. While much attention has been given to the impact of IUU regulation on industrial fleets, recognition of the distinct impacts on small-scale fisheries is conspicuously lacking from the policy and research debate. In this paper, we outline three ways in which the application of IUU discourse and regulation undermines small-scale fisheries. First, the mainstream construction of “illegal,” “unreported” and “unregulated” fishing, and also the categorical use of “IUU” in an all-inclusive sense, disregards the diversity, legitimacy and sustainability of small-scale fisheries practices and their governing systems. Second, we explore how the recent trade-related measures to counter IUU fishing mask and reinforce existing inequalities between different sectors and countries, creating an unfair burden on small-scale fisheries and countries who depend on them. Third, as IUU fishing is increasingly approached as “organized crime,” there is a risk of inappropriately targeting small-scale fisheries, at times violently. Reflecting on these three trends, we propose three strategies by which a more sensitive and ultimately more equitable incorporation of small-scale fisheries can be supported in the global fight against IUU fishing

Counting the cost of progressive aortic valve stenosis: an international observational clinical cohort study

Background: We sought, for the first time, to quantify the societal to healthcare burden associated with the entire spectrum of aortic stenosis (AS) - the most common cardiac valve disorder requiring clinical management.Methods: In this observational clinical cohort study with individual data linkage to all-cause mortality, we examined the distribution of progressive stenosis in the native aortic valves of 98,565 men and 99,357 women aged ≥65 years within a multicentre cohort across 24 sites internationally. Individuals were grouped according to their peak aortic valve velocity on last electrocardiogram investigation: 1.0–1.99 m/s (no AS/reference groups) and then 0.5 m/s increments up to ≥4.0 m/s (severe AS). Sex-specific premature mortality and years of life-lost (YLL) during 5-year follow-up were calculated, along with willingness-to-pay (WTP) to regain quality-adjusted life-years (QALYs) and healthcare costs associated with concurrent heart failure (HF).Results: Overall, 20,701 men (21.0%; 95% CI 20.8–21.3) and 18,576 women (18.7%; 95% CI 18.5–18.9) had AS at baseline. Five-year mortality in men and women with no AS was 38.6% and 36.8%, respectively. In both sexes, mortality rose from 46.8–49.0% to 59.5–65.7% in the least- to most-severe cases of AS. Premature mortality (53.5–59.1% in the no AS group) declined from 42.4–50.9% to 34.8–35.2% of all deaths. Per 1,000 individuals, AS in men and women was associated with 8 and 13 more premature deaths resulting in 36 and 62 more QALYs (societal cost of $AU1.54 and$AU2.68 million respectively) when compared to no AS. The additional 5-year cost of healthcare utilisation for the 25 and 35 more men and women with concurrent HF and AS was estimated to be $AU1.27 and$AU1.91 million, respectively.Conclusions: The presence of any degree of aortic valve stenosis is associated with higher levels of premature mortality coupled with excess healthcare costs that impose a heavy societal burden. These findings indicate the need for proactive and cost-effective strategies to promptly detect this common condition.Funding Acknowledgement: Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Edwards LifeSciences: Investigator-initiated grant

Investigation of current models of care for genetic heart disease in Australia: A national clinical audit

Background: This sub-study of the Australian Genomics Cardiovascular Genetic Disorders Flagship sought to conduct the first nation-wide audit in Australia to establish the current practices across cardiac genetics clinics. Method: An audit of records of patients with a suspected genetic heart disease (cardiomyopathy, primary arrhythmia, autosomal dominant congenital heart disease) who had a cardiac genetics consultation between 1st January 2016 and 31 July 2018 and were offered a diagnostic genetic test. Results: This audit included 536 records at multidisciplinary cardiac genetics clinics from 11 public tertiary hospitals across five Australian states. Most genetic consultations occurred in a clinic setting (90%), followed by inpatient (6%) and Telehealth (4%). Queensland had the highest proportion of Telehealth consultations (9% of state total). Sixty-six percent of patients had a clinical diagnosis of a cardiomyopathy, 28% a primary arrhythmia, and 0.7% congenital heart disease. The reason for diagnosis was most commonly as a result of investigations of symptoms (73%). Most patients were referred by a cardiologist (85%), followed by a general practitioner (9%) and most genetic tests were funded by the state Genetic Health Service (73%). Nationally, 29% of genetic tests identified a pathogenic or likely pathogenic gene variant; 32% of cardiomyopathies, 26% of primary arrhythmia syndromes, and 25% of congenital heart disease. Conclusion: We provide important information describing the current models of care for genetic heart diseases throughout Australia. These baseline data will inform the implementation and impact of whole genome sequencing in the Australian healthcare landscape