Social and Cultural Norms of Abortion Seeking in Ghana.

Ghanaian women are dying from complications resulting from unsafe abortions. This is despite a law referred to one of the most liberal in sub-Saharan Africa and a policy and regulatory situation that closely mirrors what international agencies call for to eliminate the complications from unsafe abortion. This study sought to answer the question, if safe abortions are available to Ghanaian women legally, why do so many continue to self-induce unsafely? While agencies such as the World Health Organization conclude that women resort to self-induction only if they are not able to access safe services, the women I interviewed suggested a different situation. Ghanaian women are engaging in transactional sexual relationship and are not using contraception. When pregnancies result, these women chose to self-induce not because they could not access a facility-based option but rather on the advice from their social networks. They know of friends who have been treated badly by healthcare providers or they themselves have been treated badly; they are shamed for their promiscuity and for falling pregnant. Some providers have told them that abortions are not available legally in facilities. Women know of others who have successfully self-induced an abortion using Misoprostol, a drug which is widely and inexpensively available in Ghana. It is for these reasons that Ghanaian women choose to self-induce and only seek care for complications. To engage women with the formal healthcare system, major investment into improving the quality of care patients receive is absolutely necessary. Investing in peer education, using these social networks to communicate positive messages about contraception and how to access safe abortion services, are potential interventions to reduce unsafe abortion. When individuals receive poor quality care, they are less likely to seek care in the future, and their entire social networks are likewise unlikely to come for care, relying instead on this system only in case complications arise.PhDHealth Services Organization and PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/113421/1/sarahrom_1.pd

Quality of family planning counseling among women attending prenatal care at a hospital in Addis Ababa, Ethiopia

ObjectiveTo assess the quality of family planning counseling among women attending a prenatal clinic in Addis Ababa, Ethiopia.MethodsIn a descriptive cross‐sectional study conducted between February and April, 2015, at the prenatal care clinic of Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, pregnant women in their third trimester were interviewed about their experience of family planning counseling. Data were collected via a questionnaire. Logistic regression was used to assess predictors of satisfaction with the counseling service.ResultsDuring the study period, 400 women were interviewed. Only 139 women (34.8%) were counseled about family planning. Among those counseled, 126 (90.6%) decided to use a contraceptive method after delivery and 46 (36.7%) decided to use an injectable contraceptive. Women were more likely to report high satisfaction when their provider asked about their partner’s attitude toward contraceptive methods (adjusted odds ratio 6.6; P<0.001), and when asked about their concerns and worries regarding family planning methods (adjusted odds ratio 5.1; P<0.001).ConclusionVery few women were counseled about contraception during prenatal care. Asking about a partner’s attitude toward contraceptives and discussing women’s fears or worries about contraceptives should be considered during family planning counseling to improve satisfaction and quality of care.Despite a hospital policy of universal counseling, only 35% of women attending prenatal care were counseled about family planning methods.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136375/1/ijgo12110.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136375/2/ijgo12110_am.pd

Factors that influence midwifery students in Ghana when deciding where to practice: a discrete choice experiment

Abstract Background Mal-distribution of the health workforce with a strong bias for urban living is a major constraint to expanding midwifery services in Ghana. According to the UN Millennium Development Goals (MDG) report, the high risk of dying in pregnancy or childbirth continues in Africa. Maternal death is currently estimated at 350 per 100,000, partially a reflection of the low rates of professional support during birth. Many women in rural areas of Ghana give birth alone or with a non-skilled attendant. Midwives are key healthcare providers in achieving the MDGs, specifically in reducing maternal mortality by three-quarters and reducing by two-thirds the under 5 child mortality rate by 2015. Methods This quantitative research study used a computerized structured survey containing a discrete choice experiment (DCE) to quantify the importance of different incentives and policies to encourage service to deprived, rural and remote areas by upper-year midwifery students following graduation. Using a hierarchical Bayes procedure we estimated individual and mean utility parameters for two hundred and ninety eight third year midwifery students from two of the largest midwifery training schools in Ghana. Results Midwifery students in our sample identified: 1) study leave after two years of rural service; 2) an advanced work environment with reliable electricity, appropriate technology and a constant drug supply; and 3) superior housing (2 bedroom, 1 bathroom, kitchen, living room, not shared) as the top three motivating factors to accept a rural posting. Conclusion Addressing the motivating factors for rural postings among midwifery students who are about to graduate and enter the workforce could significantly contribute to the current mal-distribution of the health workforce.http://deepblue.lib.umich.edu/bitstream/2027.42/112340/1/12909_2012_Article_752.pd

Discontinuation of long‐acting reversible contraception versus short‐term hormonal methods in urban Ghana: A pilot longitudinal study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144677/1/ijgo12518.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144677/2/ijgo12518_am.pd

The implementation of the South African Triage Score (SATS) in an urban teaching hospital, Ghana

IntroductionTriage is the process of sorting patients based on the level of acuity to ensure the most severely injured and ill patients receive timely care before their condition worsens. The South African Triage Scale (SATS) was developed out of a need for an accurate and objective measure of urgency based on physiological parameters and clinical discriminators that is easily implemented in low resource settings. SATS was introduced in the emergency center (EC) of Komfo Anokye Teaching Hospital (KATH) in January 2010. This study seeks to evaluate the accurate use of the SATS by nurses at KATH.MethodsThis cross-sectional study was conducted in the EC at KATH in Kumasi, Ghana. Patients 12years and over with complete triage information were included in this study. Each component of SATS was calculated (i.e. for heart rate of 41–50, a score of 1 was given) and summed. This score was compared to the original triage score. When scores did not equate, the entire triage record was reviewed by an emergency physician and an advanced practice emergency nurse separately to determine if the triage was appropriate. These reviews were compared and consensus reached.Results52 of 903 adult patients (5.8%) were judged to have been mis-triaged by expert review; 49 under-triaged (sent to a zone that corresponded to a lower acuity level than they should have been, based on their vital signs) and 3 over-triaged. Of the 49 patients who were under-triaged, 34 were under-triaged by one category and 7 by two categories.ConclusionUnder-triage is a concern to patient care and safety, and while the under-triage rate of 5.7% in this sample falls within the 5–10% range considered unavoidable by the American College of Surgeons Committee on Trauma, concentrated efforts to regularly train triage nurses to ensure no patients are under-triaged have been undertaken. Overall though, SATS has been implemented successfully in the EC at KATH by triage nurses

The Perceived Impact of Prior Research Experience in Global Health on Residency Choice and Career Decisions among US Interns

http://deepblue.lib.umich.edu/bitstream/2027.42/94436/1/the_perceived_impact_of_prior_research_experience_in_global_health_on_residency_choice_and_career_decisions_among_US_interns.pd

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

Maternity waiting homes and traditional midwives in rural Liberia

ObjectiveMaternity waiting homes (MWHs) can reduce maternal morbidity and mortality by increasing access to skilled birth attendants (SBAs). The present analysis was conducted to determine whether MWHs increase the use of SBAs at rural primary health clinics in Liberia; to determine whether traditional midwives (TMs) are able to work with SBAs as a team and to describe the perceptions of TMs as they engage with SBAs; and to determine whether MWHs decrease maternal and child morbidity and mortality.MethodsThe present analysis was conducted halfway through a large cohort study in which 5 Liberian communities received the intervention (establishment of an MWH) and 5 Liberian communities did not (control group). Focus groups were conducted to examine the views of TMs on their integration into health teams.ResultsCommunities with MWHs experienced a significant increase in team births from baseline to post‐intervention (10.8% versus 95.2%, P < 0.001), with greater TM engagement. Lower rates of maternal and perinatal death were reported from communities with MWHs.ConclusionThe reduction in morbidity and mortality indicates that the establishment of MWHs is an effective strategy to increase the use of SBAs, improve the collaboration between SBAs and TMs, and improve maternal and neonatal health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135181/1/ijgo114.pd

A case series study on the effect of Ebola on facility-based deliveries in rural Liberia

Abstract Background As communities’ fears of Ebola virus disease (EVD) in West Africa exacerbate and their trust in healthcare providers diminishes, EVD has the potential to reverse the recent progress made in promoting facility-based delivery. Using retrospective data from a study focused on maternal and newborn health, this analysis examined the influence of EVD on the use of facility-based maternity care in Bong Country, Liberia, which shares a boarder with Sierra Leone - near the epicenter of the outbreak. Methods Using a case series design, retrospective data from logbooks were collected at 12 study sites in one county. These data were then analyzed to determine women’s use of facility-based maternity care between January 2012 and October 2014. The primary outcome was the number of facility-based deliveries over time. The first suspected case of EVD in Bong County was reported on June 30, 2014. Heat maps were generated and the number of deliveries was normalized to the average number of deliveries during the full 12 months before the EVD outbreak (March 2013 – February 2014). Results Prior to the EVD outbreak, facility-based deliveries steadily increased in Bong County reaching an all-time high of over 500 per month at study sites in the first half of 2014 – indicating Liberia was making inroads in normalizing institutional maternal healthcare. However, as reports of EVD escalated, facility-based deliveries decreased to a low of 113 in August 2014. Conclusion Ebola virus disease has negatively impacted the use of facility-based maternity services, placing childbearing women at increased risk for morbidity and death.http://deepblue.lib.umich.edu/bitstream/2027.42/114384/1/12884_2015_Article_694.pd

Infant nutrition in the first seven days of life in rural northern Ghana

BackgroundGood nutrition is essential for increasing survival rates of infants. This study explored infant feeding practices in a resource-poor setting and assessed implications for future interventions focused on improving newborn health.MethodsThe study took place in the Kassena-Nankana District of the Upper East Region of northern Ghana. In-depth interviews were conducted with 35 women with newborn infants, 8 traditional birth attendants and local healers, and 16 community leaders. An additional 18 focus group discussions were conducted with household heads, compound heads and grandmothers. All interviews and discussions were audio taped, transcribed verbatim and analyzed using NVivo 9.0.ResultsCommunity members are knowledgeable about the importance of breastfeeding, and most women with newborn infants do attempt to breastfeed. However, data suggest that traditional practices related to breastfeeding and infant nutrition continue, despite knowledge of clinical guidelines. Such traditional practices include feeding newborn infants water, gripe water, local herbs, or traditionally meaningful foods such as water mixed with the flour of guinea corn (yara’na). In this region in Ghana, there are significant cultural traditions associated with breastfeeding. For example, colostrum from first-time mothers is often tested for bitterness by putting ants in it – a process that leads to a delay in initiating breastfeeding. Our data also indicate that grandmothers – typically the mother-in-laws – wield enormous power in these communities, and their desires significantly influence breastfeeding initiation, exclusivity, and maintenance.ConclusionPrelacteal feeding is still common in rural Ghana despite demonstrating high knowledge of appropriate feeding practices. Future interventions that focus on grandmothers and religious leaders are likely to prove valuable in changing community attitudes, beliefs, and practices with regard to infant nutrition