26 research outputs found

    The effectiveness of intrapartum ultrasonography in assessing cervical dilatation, head station and position: A systematic review and meta-analysis

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    The objective of this review was to assess the effectiveness of intrapartum ultrasonography in measuring cervical dilatation, head station and position. Electronic literature searches were carried out of MEDLINE, CINAHL, and Web of Knowledge, plus manual reference list checks of all relevant articles. All published prospective studies comparing intrapartum ultrasonography with digital VE in the determination of cervical dilatation, head station and position were then evaluated for the success rate and level of agreement between ultrasonography and digital VE. Ultrasonography had higher success rate than digital VE in the determination of fetal head position, with a statistically significant difference in the first stage of labour. Second, although the successful determination of cervical dilatation was in favour of digital VE, the difference was not statistically significant. In addition, there was high agreement between ultrasound and digital VE findings on cervical dilatation. Lastly, a significant but moderate correlation between digital VE and ultrasound methods was found in the assessment of fetal head station. However, no meta-analysis could be done for the fetal head station due to the methodological differences between ultrasound anatomical landmarks and that of digital VE. The findings suggest that ultrasonography is superior to digital VE in the assessment of fetal head position, but has moderate correlation with digital VE in the assessment of head station. It also showed high agreement with digital VE in the assessment of cervical dilatation with no statistically significant difference in terms of success rate

    Difficulty with mobility among the aged in Ghana: Evidence from Wave 2 of the World Health Organization’s Study on Global Ageing and Adult Health

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    Background Globally, the population is rapidly ageing, stemming from a recent decline in mortality, and an increase in life expectancy. About 727 million people globally were aged ≄65 in 2020, and 1 in 6 people will be ≄65 years by 2050. About 7% of Ghana’s population was over 60 years in 2010, and projected to be 12% by 2050. However, the aged are confronted with degenerative conditions that translate into difficulty with mobility. The study was conducted to investigate the difficulty with mobility among the aged in Ghana. Methods The study utilised a cross-sectional dataset of the 2014/2015 (wave 2) Study on Global Ageing and Adult Health and included 1,856 participants aged ≄50 years. The survey command was applied to adjust for sampling biases and the design of the study. At 5% alpha level, a chi-square test of independence was conducted to determine the association between dependent and independent variables. At 95% confidence interval and 5% alpha level, three-level multilevel logistic regression models were performed. The fixed-effects were presented in odds ratio and the random effects were presented using the Intra-Class Correlation. All analysis were performed using STATA statistical software version 16.0. Results Out of the 1,856 participants, 40.3% had difficulty with mobility. Additionally, age (80 and above) [AOR = 3.05, 95%CI = 1.78–5.22], self-reported poor/bad health status [AOR = 2.39, 95%CI = 1.35–4.23], having severe/extreme difficulty performing household activities [AOR = 25.12, 95%CI = 11.49–44.91], experienced severe/extreme bodily pains [AOR = 4.56, 95%CI = 2.16–9.64], severe/extreme sleep problems [AOR = 4.15, 95%CI = 1.68–10.29], and participants with difficulty with sight/vision [AOR = 1.56, 95%CI = 1.16–2.10] had higher odds of difficulty with mobility. Conclusion The aged in Ghana had relatively higher prevalence (40.3%) of difficulty with mobility which is influenced by demographics, health status, and degeneration associated with ageing. This highlights the need to provide social support and strengthen social capital for the aged in Ghana, especially those with difficulty with vision, experiencing bodily pains and had poor health status. Additionally, the Government and stakeholders should provide assistive devices for the aged and geriatric care including recreational fields and care homes to address the health and physical needs of the aged in Ghana

    Survival trends among people living with human immunodeficiency virus on antiretroviral treatment in two rural districts in Ghana

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    Background The human immunodeficiency virus (HIV) has caused a lot of havoc since the early 1970s, affecting 37.6 million people worldwide. The 90-90-90 treatment policy was adopted in Ghana in 2015 with the overall aim to end new infections by 2030, and to improve the life expectancy of HIV seropositive individuals. With the scale-up of Highly Active Antiretroviral Therapy, the lifespan of People Living with HIV (PLWH) on antiretrovirals (ARVs) is expected to improve. In rural districts in Ghana, little is known about the survival probabilities of PLWH on ARVs. Hence, this study was conducted to estimate the survival trends of PLWH on ARVs. Methods A retrospective evaluation of data gathered across ARV centres within Tatale and Zabzugu districts in Ghana from 2016 to 2020 among PLWH on ARVs. A total of 261 participants were recruited for the study. The data was analyzed using STATA software version 16.0. Lifetable analysis and Kaplan-Meier graph were used to assess the survival probabilities. “Stptime” per 1000 person-years and the competing risk regression were used to evaluate mortality rates and risk. Results The cumulative survival probability was 0.8847 (95% CI: 0.8334–0.9209). The overall mortality rate was 51.89 (95% CI: 36.89–72.97) per 1000 person-years. WHO stage III and IV [AHR: 4.25 (95%CI: 1.6–9.71) p = 0.001] as well as age group (50+ years) [AHR: 5.02 (95% CI: 1.78–14.13) p = 0.002] were associated with mortality. Conclusion Survival probabilities were high among the population of PLWH in Tatale and Zabzugu with declining mortality rates. Clinicians should provide critical attention and care to patients at HIV WHO stages III and IV and intensify HIV screening at all entry points since early diagnosis is associated with high survival probabilities

    Developing excellence in biostatistics leadership, training and science in Africa: How the Sub-Saharan Africa Consortium for Advanced Biostatistics (SSACAB) training unites expertise to deliver excellence

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    The increase in health research in sub-Saharan Africa (SSA) has generated large amounts of data and led to a high demand for biostatisticians to analyse these data locally and quickly.  Donor-funded initiatives exist to address the dearth in statistical capacity, but few initiatives have been led by African institutions. The Sub-Saharan African Consortium for Advanced Biostatistics (SSACAB) aims to improve biostatistical capacity in Africa according to the needs identified by African institutions, through (collaborative) masters and doctoral training in biostatistics. We describe the SSACAB Consortium, which comprises 11 universities and four research institutions- supported by four European universities. SSACAB builds on existing resources to strengthen biostatistics for health research with a focus on supporting biostatisticians to become research leaders; building a critical mass of biostatisticians, and networking institutions and biostatisticians across SSA.  In 2015 only four institutions had established Masters programmes in biostatistics and SSACAB supported the remaining institutions to develop Masters programmes. In 2019 the University of the Witwatersrand became the first African institution to gain Royal Statistical Society accreditation for a Biostatistics MSc programme. A total of 150 fellows have been awarded scholarships to date of which 123 are Masters fellowships (41 female) of which with 58 have already graduated. Graduates have been employed in African academic (19) and research (15) institutions and 10 have enrolled for PhD studies. A total of 27 (10 female) PhD fellowships have been awarded; 4 of them are due to graduate by 2020. To date, SSACAB Masters and PhD students have published 17 and 31 peer-reviewed articles, respectively. SSACAB has also facilitated well-attended conferences, face-to-face and online short courses. Pooling the limited biostatistics resources in SSA, and combining with co-funding from external partners is an effective strategy for the development and teaching of advanced biostatistics methods, supervision and mentoring of PhD candidates

    Home birth without skilled attendants despite millennium villages project intervention in Ghana: insight from a survey of women’s perceptions of skilled obstetric care

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    BACKGROUND: Skilled birth attendance from a trained health professional during labour and delivery can prevent up to 75 % of maternal deaths. However, in low- and middle-income rural communities, lack of basic medical infrastructure and limited number of skilled birth attendants are significant barriers to timely obstetric care. Through analysis of self-reported data, this study aimed to assess the effect of an intervention addressing barriers in access to skilled obstetric care and identified factors associated with the use of unskilled birth attendants during delivery in a rural district of Ghana. METHODS: A cross-sectional survey was conducted from June to August 2012 in the Amansie West District of Ghana among women of reproductive age. Multi-stage, random, and population proportional techniques were used to sample 50 communities and 400 women for data collection. Weighted multivariate logistic regression analysis was used to identify factors associated with place of delivery. RESULTS: A total of 391 mothers had attended an antenatal care clinic at least once for their most recent birth; 42.3 % of them had unskilled deliveries. Reasons reported for the use of unskilled birth attendants during delivery were: insults from health workers (23.5 %), unavailability of transport (21.9 %), and confidence in traditional birth attendants (17.9 %); only 7.4 % reported to have had sudden labour. Other factors associated with the use of unskilled birth attendants during delivery included: lack of partner involvement aOR = 0.03 (95 % CI; 0.01, 0.06), lack of birth preparedness aOR = 0.05 (95 % CI; 0.02, 0.13) and lack of knowledge of the benefits of skilled delivery aOR = 0.37 (95 % CI; 0.11, 1.20). CONCLUSIONS: This study demonstrated the importance of provider-client relationship and cultural sensitivity in the efforts to improve skilled obstetric care uptake among rural women in Ghana

    Prevalence, treatment outcomes and determinants of TB–HIV coinfection: a 10-year retrospective review of TB registry in Kwabre East Municipality of Ghana

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    Objective To assess the prevalence, treatment outcomes and determinants of tuberculosis (TB)–HIV coinfection in Ghana.Study design A retrospective review of TB case register for Kwabre East Municipality was conducted for the period 2010–2020 to identify TB–HIV coinfections.Setting 462 patients with TB from four sub-municipal treatment centres were included in the study.Primary outcome measure A logistic regression model was used to investigate the relationship between clinico-demographic factors (age, sex, type of patient, disease classification, treatment category and sputum smear microscopy) and TB–HIV coinfection.Results Of the 462 individual TB cases found in the TB register from 2010 to 2020, 286 (61.9%) were screened for HIV and the results showed that 18% had TB–HIV coinfection. TB–HIV coinfection was highest in 2015 with a prevalence of 40% among all registered TB cases. The likelihood of TB–HIV coinfection was highest among patients with TB aged 40–49 years (AOR=3.99, CI=1.3, 12.7). Those who tested negative for TB at the end of their treatment period had lower odds of HIV coinfection (AOR=0.27, CI=0.10, 0.72).Conclusion Nearly one out of every five (18%) patients with TB in the municipality were found to be coinfected with HIV. TB–HIV coinfection was significantly associated with patients' age and their TB treatment outcomes. Urgent interventions are needed to address these risk factors to promote optimal health for patients with TB in the municipality

    Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care

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    Introduction: the incidence of emergency conditions is increasing worldwide, particularly in low- and middle-income countries (LMICs). However, triage and emergency care training has not been prioritized in LMICs. We aimed to assess the reliability and validity of the South African Triage Scale (SATS) when used by providers not specifically trained in SATS, as well as to compare triage capabilities between senior medical students and senior house officers to examine the effectiveness of our curriculum for house officer training with regards to triage. Methods: sixty each of senior medical students and senior house officers who had not undergone specific triage or SATS training were asked to triage 25 previously validated emergency vignettes using the SATS. Estimates of reliability and validity were calculated. Additionally, over- and under-triage, as well as triage performance between the medical students and house officers was assessed against a reference standard. Results: fifty-nine senior medical students (98% response rate) and 43 senior house officers (72% response rate) completed the survey (84% response rate overall). A total of 2,550 triage assignments were included in the analysis (59 medical student and 43 house officer triage assignments for 25 vignettes each; 1,475 and 1,075 triage assignments, respectively). Inter-rater reliability was moderate (quadratically weighted Îș 0.59 and 0.60 for medical students and house officers, respectively). Triage using SATS performed by these groups had low sensitivity (medical students: 54%, 95% CI 49–59; house officers: 55%, 95% CI 48–60) and moderate specificity (medical students: 84%, 95% CI 82 - 89; house officers: 84%, 95% CI 82 - 97). Both groups under-triaged most ‘emergency’ level vignette patients (i.e. SATS Red; 80 and 82% for medical students and house officers, respectively). There was no difference between the groups for any metric. Conclusion: although the SATS has proven utility in a number of different settings in LMICs, its success relies on its use by trained providers. Given the large and growing burden of emergency conditions, training current and future emergency care providers in triage is imperative.The Pan African Medical Journal. 2016;2

    Exploring midwives' understanding of respectful maternal care in Kumasi, Ghana: Qualitative inquiry.

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    BackgroundVarious aspects of disrespect and abusive maternity care have received scholarly attention because of frequent reports of the phenomenon in most healthcare facilities globally, especially in low- and middle-income countries. Experiences of disrespect and abuse during childbirth may dissuade women from returning for facility-based postpartum services, for antenatal care, and delivery for future pregnancies and births. Midwives' knowledge of respectful maternity care is critical in designing any interventive measures to address the menace of disrespect and abuse in maternity care. However, the perspectives of skilled providers on respectful maternal care have not been extensively studied. Therefore, the present study sought to explore the views of midwives on respectful maternity care at a teaching hospital in Kumasi, Ghana.MethodsWe employed an exploratory descriptive qualitative research design using an interpretative approach. Data were generated through individual in-depth interviews of fifteen midwives, which were audio-recorded and transcribed verbatim. Open Code 4.03 was used to manage and analyse the data.FindingsThe midwives demonstrated some degree of awareness of respectful maternity care that comprised of the following components: non-abusive care, consented care, confidential care, non-violation of childbearing women's basic human rights, and non-discriminatory care. However, midwives' support for disrespectful and abusive practices such as hitting, pinching, and implicitly blaming childbearing women for mistreatment suggests that midwives awareness of respectful maternity care is disconnected from its practice.ConclusionIn view of these findings, we recommend frequent in-service training for midwives and the institutionalization of regular supervision of intrapartum care services in the healthcare facility
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