Health worker’s knowledge on adolescent health, services provision and challenges in Kumbungu District, Ghana:: An observational study

Adolescents are persons between 10 and 19 years of age. In Ghana, about 23% of the total population are adolescents. They often experience a higher risk of sexual and reproductive health problems. Health worker’s knowledge on adolescent health, services provision and challenges are critical. Thus, this study explored health worker’s knowledge on adolescent health, services provision and challenges in Kumbungu District, Ghana. A purposive sampling technique was used to select eight key informants from five sub-districts. The sample was determined based on pragmatic considerations such as limited availability of participants. The interviews were transcribed and data analyzed using thematic analysis. The study was conducted between June and September 2017. All participants had heard of adolescent health. They said adolescent health covers teenagers between 10 and 19 years of age, their sexual lifestyle, teenage pregnancy, family planning, sexually transmitted infections, counselling services, personal hygiene and general curative care. The participants rated their knowledge as low due to inadequate training. The health services include family planning, counselling, nutrition education, menstrual hygiene and curative care due to the type of health facility, capacity, resources and demands of the adolescents. Challenges health workers face include low knowledge, inadequate staff, lack of separate rooms to ensure privacy/confidentially, language barriers and inadequate logistics. In conclusion, the participant’s knowledge on adolescent health was low, while some challenges were experienced. Thus, health workers should be trained on adolescent health in the district and there is the need for more resources to improve availability and variety of services

Clinical learning environment of nursing and midwifery students in Ghana.

BACKGROUND: Data on student experience of the clinical learning environment in Ghana are scarce. We therefore aimed to assess students' evaluation of the clinical learning environment and the factors that influence their learning experience. METHODS: This was a cross-sectional survey of 225 undergraduate nursing and midwifery students. We used the Clinical Learning Environment and Supervision + Nurse Teacher (CLES +T) evaluation scale to assess students' experience of their clinical placement. The association between student demographic characteristics and clinical placement experience was determined using t-test or ANOVA. RESULTS: Most of the sampled students were Nurses (67%) and in the third year of training (81%). More students received supervision from a nurse (57%) during clinical placement and team supervision (67%) was the most common during clinical placement. Nursing students were more likely to rate their clinical experience better than midwifery students (p=0.002). Students who had increased contact with private supervisors were also more likely to rate their experience higher (p=0.002). Clinical experience was also rated higher by students who received successful supervision compared to those who had unsuccessful or team supervision (p=0.001). CONCLUSION: Team supervision is high in health facilities where students undertake clinical placement in Ghana. Frequent contact with private supervisor and successful supervision are associated with better rating of clinical experience among Ghanaian undergraduate nursing and midwifery students

Mapping evidence on knowledge of breast cancer screening and its uptake among women in Ghana: a scoping review

Introduction: Female breast cancer is currently the most commonly diagnosed cancer globally with an estimated 2.3 million new cases in 2020. Due to its rising frequency and high mortality rate in both high- and low-income countries, breast cancer has become a global public health issue. This review sought to map literature to present evidence on knowledge of breast cancer screening and its uptake among women in Ghana. Methods: Five databases (PubMed, CINAHL, PsycINFO, Web of Science, and EMBASE) were searched to identify relevant published studies between January 2012 and August 2021 on knowledge of breast cancer screening and its uptake among women. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and the six-stage model by Arksey and O’Malley were used to select and report findings. Results: Of the 65 articles retrieved, 14 records were included for synthesis. The review revealed varied knowledge levels and practices of breast cancer screening among women across a few regions in Ghana. The knowledge level of women on breast cancer screening was high, especially in breast cancer screening practice. Breast cancer screening practice among women was observed to be low and the most identified barriers were lack of technique to practice breast self-examination, having no breast problem, lack of awareness of breast cancer screening, and not having breast cancer risk. The results further showed that good knowledge of breast cancer screening, higher educational level, increasing age, physician recommendation, and household monthly income were enabling factors for breast cancer screening uptake. Conclusion: This review showed varied discrepancies in breast cancer screening uptake across the regions in Ghana. Despite the benefits of breast cancer screening, the utilization of the screening methods across the regions is very low due to some varied barriers from the different regions. To increase the uptake of breast cancer screening, health workers could employ various strategies such as community education and sensitization on the importance of breast cancer screening

The Prevalence and Risk Factors of Hepatitis B Virus Infection Among Dwellers in A Peri-Urban District of Ghana: A Cross-Sectional Study

Hepatitis B virus (HBV) infection is a significant health issue affecting about 296 million people worldwide. The disease is of great public health concern in Ghana as the country is within the endemic region of HBV infection. This study sought to determine the prevalence of HBV infection and associated risk factors among dwellers in a peri-urban district of Ghana. This cross-sectional descriptive study was conducted in the Sunyani West District of the Bono Region of Ghana. Respondents aged ≥18 years were purposively recruited from the four major towns in the District with health centres. A questionnaire was used to collect data from participants, and a rapid diagnostic test for the sero-presence or otherwise of hepatitis B infection was conducted. A total of 992 respondents took part in the study, with the prevalence of HBV infection using HBsAg as a marker among all the study participants being 2.9% (male 4.0% (12/298), female 2.5% (17/694)). Females aged between 20-29 years had a comparatively higher prevalence of hepatitis B infection than their corresponding males. The intake of alcohol (RR=4.23; 95% CI:2.05-8.74, p <0.000), previously diagnosed of having a sexually transmitted disease (RR= 2.43; 95% CI: 1.03-5.71, p = .04) and having multiple sexual partners (RR= 2.27; 95% CI: 1.11-4.65, p = .02) were the significant risk factors for HBV infection among the study participants. The study showed a low prevalence of HBV infection in the Sunyani West District of Ghana using HBsAg as a serum marker to diagnose the infection. Keywords: Hepatitis, prevalence, risk factors, Sunyani Wes

Health insurance coverage among women of reproductive age in rural Ghana:policy and equity implications

Background: Globally, health insurance has been identified as a key component of healthcare financing. The implementation of health insurance policies in low and middle-income countries has led to a significant increase in access to healthcare services in these countries. This study assessed health insurance coverage and its associated factors among women of reproductive age living in rural Ghana.Methods: This study used a nationally representative data from the 2017/2018 Ghana Multiple Indicator Cluster Survey (GMICS) and included 7340 rural women aged 15–49 years. Bivariate and multivariable logistic regression models were developed to assess the association between the explanatory and the outcome variable. Statistical significance was considered at p = 0.05.Results: The overall prevalence of health insurance coverage among rural women in Ghana was 51.9%. Women with secondary (aOR = 1.72, 95% CI: 1.38–2.14) and higher education (aOR = 4.57, 95% CI: 2.66–7.84) were more likely to have health insurance coverage than those who had no formal education. Women who frequently listened to radio (aOR = 1.146, 95% CI: 1.01–1.30) were more likely to have health insurance coverage than those who did not. Women who had a child (aOR = 1.81, 95% CI: 1.50–2.17), two children (aOR = 1.59, 95% CI: 1.27–1.98), three children (aOR = 1.41, 95% CI: 1.10–1.80), and five children (aOR = 1.36, 95% CI: 1.03–1.79) were more likely to have health insurance coverage than those who had not given birth. Women who were pregnant (aOR = 3.52, 95% CI: 2.83–4.38) at the time of the survey, and women within the richest households (aOR = 3.89, 95% CI: 2.97–5.10) were more likely to have health insurance coverage compared to their other counterparts. Women in the Volta region (aOR = 1.36, 95% CI: 1.02–1.81), Brong Ahafo region (aOR = 2.82, 95% CI: 2.20–3.60), Northern region (aOR = 1.32, 95% CI: 1.02–1.70), Upper East region (aOR = 2.13, 95% CI: 1.63–2.80) and Upper West region (aOR = 1.56, 95% CI: 1.20–2.03) were more likely to have health insurance coverage than those in the Western region.Conclusion: Although more than half of women were covered by health insurance, a significant percentage of them were uninsured, highlighting the need for prompt policy actions to improve coverage levels for insurance. It was found that educational level, listening to radio, parity, pregnancy status, wealth quintile, and region of residence were factors associated with health insurance coverage. We recommend better targeting and prioritization of vulnerability in rural areas and initiate policies that improve literacy and community participation for insurance programs. Further studies to establish health policy measures and context specific barriers using experimental designs for health insurance enrolments are required.</p

Leveraging breast cancer screening to promote timely detection, diagnosis and treatment among women in sub-Saharan Africa: a scoping review protocol

Introduction Female breast cancer is now the most often diagnosed cancer in the world. Breast cancer screening aims to reduce mortalities related to cancer, and morbidity associated with advanced stages of the disease, through timely detection in asymptomatic women. This study aims to conduct a comprehensive assessment and evaluation of the evidence on the factors that influence the provision and uptake of breast cancer screening among women in sub-Saharan Africa (SSA). Methods and analysis PubMed, Web of Science, EMBASE and the Cumulative Index to Nursing and Allied Health Literature including Google Scholar will be searched to identify published studies on barriers and facilitators to breast cancer screening from January 2010 to 2021. Two reviewers will independently assess the quality of all the included studies using the Mixed Methods Appraisal Tool version 2018. We envisage that this review will adduce evidence on common barriers and facilitators to breast cancer screening in SSA. Identifying these barriers and facilitators will help guide the initialisation of effective interventions that will improve breast cancer screening uptake among women in SSA. This review will also guide future research in developing, implementing and evaluating appropriate interventions tailored toward increasing breast cancer screening uptake. Ethics and dissemination Ethics approval for this protocol is not required since it does not involve collecting data from human participants. The outcomes of this study will be published in a peer-reviewed journal.info:eu-repo/semantics/publishedVersio

Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review

Background Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. Methods We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)‘s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. Results Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. Conclusion This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities

Rural Ghanaian women's experience of seeking reproductive health care

Ghana, a low-income developing country in sub-Saharan Africa is experiencing low maternal health service utilization and high rates of maternal mortality, especially in the rural areas. The Talensi-Nabdam District is one of the poorest and most remote districts in Ghana. The reproductive health status of women in the most remote communities in this District is poor. Dialogue about women’s reproductive health care needs in Ghana have been influenced by health care authorities, professionals, researchers and experts’ perceptions. The purpose of this ethnographic research was to explore rural Ghanaian women’s experiences of seeking reproductive health care from their own perspectives. The study was based on data collected from participant observations, unstructured face-to-face interviews and focus group discussions. A total of 27 women of varying socio-demographic backgrounds participated in the study. Interviews were conducted at locations of the women’s choice and in women’s local dialect. Data were translated and transcribed verbatim, and analyzed thematically. Four major themes emerged from the findings: submitting to the voices of family, women’s experiences of receiving nursing care, the community of gossip, and gaining voice. The findings of this study have implications for nursing practice, education and nursing inquiry. Awareness of barriers that rural women encounter in meeting their reproductive health care needs among health care providers is important in facilitating positive health care seeking behaviours. Nurse educators should orient themselves to the challenges to meeting women’s health care needs, and include in culturally sensitive approaches in nursing education programs. Further research is needed to investigate strategies that will enhance women’s reproductive health care seeking behaviours in rural settings and to focus on women’s perspectives in particular. In addition, research is needed to examine nurses’ perspectives on factors that influence quality care delivery to address women’s reproductive health issues.Health and Social Development, Faculty of (Okanagan)Nursing, School of (Okanagan)Graduat

Ethnographic perspectives on rural women’s reproductive health decisions in Ghana : the cultural influences of gender relations, kinship and belief system

Ghana, one of the challenging contexts settings in sub-Saharan Africa, is a strong democratic nation and one of the area’s emerging economies, yet the country still faces poor maternal health with maternal mortality ratios at 350/100,000 live births. This statistic means that the country’s efforts to achieve Millennium Development Goal-5—the reduction of maternal mortality by 75 per cent by 2015—remains a mere dream. In this dissertation, I explore rural Ghanaian women’s perspectives on the influence of social structures—especially, kinship and gender relations, individual maternal practices, the social meaning of motherhood and cultural beliefs—on their reproductive health decisions and maternal health service utilization. Secondly, I explore rural midwives’ perspectives on providing services to women in Talensi-Nabdam district of the Upper East Region. Using ethnographic methods— participant observation, face-to- face interviews, focus groups, “deep hanging out”—I gathered data in six villages and four health clinics. Participants included 27 women of childbearing age as well as older women who provide traditional maternal health services to rural women and four midwives. My findings suggest that a complexity of socio-cultural structures and concepts, sustained gender-based violence and, an increased disproportionate gendered division of labour, affect women’s reproductive health decisions at the household level. At the level of the health care system and government, poor health care provider attitudes, over medicalization of reproduction, application of unrealistic, unsustainable and culturally inappropriate local and foreign policies, poor infrastructural development and weak social protection policies all impact women’s reproductive health decisions and access to care with profound negative implications for maternal wellbeing. I highlight not only typical issues, often taken-for-granted by many scientists, but also how these issues have extreme negative impacts on women’s wellbeing. This diverse perspective offers a better understanding of maternal health services provision and utilization that will challenge the status quo and prompt improvements in maternal health in Ghana and other Sub-Saharan African nations. I offer recommendations, as well as future research, for health care providers, policymakers, medical and nursing education and government in an effort to promote a better understanding of rural women’s reproductive health and general wellbeing.Graduate Studies, College of (Okanagan)Graduat

Modification and adaptation of the general self-efficacy scale to determine nursing students’ belief in their capability to care for older adults

It is necessary to determine nursing students’ self-efficacy to care for person's 60 + years to identify opportunities and challenges to support, facilitate effective learning and performance, and enhance confidence in providing care for older adults. However, we did not find a validated survey instrument to determine self-efficacy to care for older adults. This paper aimed to describe the modification of the General Self-efficacy scale to the General Self-efficacy to Care for Older scale appropriate for the Africa context. A cross-sectional study was conducted with second- and third-year nursing students from two public Nursing and Midwifery Training Colleges in the northern and southern sectors of Ghana. The 13-item General Self-Efficacy Scale was expanded by adding 17 items specific to providing nursing care for older adults in acute care settings. Cognitive interviews were conducted to ensure the items added were understood by participants. The 30-items were tested using Exploratory Factor analysis. The mean age of participants was 21 years (SD = 3.73). More than half (54%) of the participants were female. An exploratory factor analysis yielded a two-factor model. Four items were removed due to low factors and cross-loadings on both factors. The remaining 26 items had fourteen items that loaded on Factor one and 12 items that loaded on Factor two. The Cronbach Alpha coefficient for the revised 26-item scale was 0.85 indicating good internal consistency. The modified scale is appropriate to examine nursing students’ self-efficacy to care for older adults in the African context