Prevalence and factors associated with low medication adherence among Type 2 Diabetic patients attending a diabetic clinic at the Tema general hospital, Ghana

Introduction: Poor adherence to diabetes medication has been linked to poor glycemic control, increased cost, morbidity, and mortality rates. This study assessed factors influencing adherence to medication regimens among outpatients with type 2 diabetes mellitus (T2DM) patients at a diabetes clinic, Tema General Hospital, Ghana. Methods: This was a cross-sectional study using quantitative methods. A culturally tailored semi-structured questionnaire and the Morisky Medication Adherence Scale (MMAS-8) were used to evaluate the levels of adherence to T2DM medications. Chi-square test and logistic regression were used to assess the association between exposure variables and medication adherence. Results: A total of 206 T2DM patients aged 24 to 90 years, mean age=59.1(±1) years were interviewed. The majority were female (82.5%) and married (56.8%). The prevalence of low adherence to T2DM medication was 47.6% (95%CI: 0.41-0.55). Respondents who were on herbal medication (AOR: 5.99; 95%CI= (0.21–71.65)) had the lowest adherence compared to those on insulin followed by Insulin +OHA (AOR; 95%CI=3.15(0.79-12.53)) and OHA medication (AOR: 1.24; 95%CI (0.42-3.68)). Among those who reported side effects from medication, the odds of low adherence was 2.9 times compared to those who did not report any (AOR;95%CI=2.91(1.16-7.29)). Those who reported that their pill burden affected the continued usage of medication had 8.3 times the odds of low adherence compared to those who did not (AOR; 95%CI=8.25 (2.95-23.08)). Irregular visits to the health facility (AOR; 95%CI=6.71(2.35-19.16)) and the provision of information on the disease condition by the health provider (AOR; 95%CI= 1.14 (0.15-8.75)) significantly influenced adherence to the medication regimen. Conclusion: The prevalence of low adherence to the T2DM medication regimen was influenced by current medication intake, experiencing side effects from medication, pill burden, irregular visits to the health facility, and adequacy of information provided by health providers on the disease condition. National level interventions are needed to intensify health education on diabetes management

Prevalence and risk factors of intimate partner violence among women in four districts of the central region of Ghana: Baseline findings from a cluster randomised controlled trial.

Intimate partner violence (IPV) is a significant global public health problem. Understanding risk factors is crucial for developing prevention programmes. Yet, little evidence exists on population-based prevalence and risk factors for IPV in West Africa. Our objective was to measure both lifetime and past year prevalence of IPV and to determine factors associated with past year physical or sexual IPV experience. This population-based survey involved 2000 randomly selected women aged 18 to 49 years living in 40 localities within four districts of the Central Region of Ghana. Questionnaires were interviewer-administered from February to May 2016. Respondents were currently or ever-partnered, and resident in study area ≥12months preceding the survey. Data collected included: socio-demographics; sexual behavior; mental health and substance use; employment status; 12-month and lifetime experience of violence; household food insecurity; gender norms/attitudes; partner characteristics and childhood trauma. Logistic regression modelling was used to determine factors associated with sexual or physical IPV, adjusting for age and survey design. About 34% of respondents had experienced IPV in the past year, with 21.4% reporting sexual and or physical forms. Past year experience of emotional and economic IPV were 24.6% and 7.4% respectively. Senior high school education or higher was protective of IPV (AOR = 0.51[0.30-0.86]). Depression (AOR = 1.06[1.04-1.08], disability (AOR = 2.30[1.57-3.35]), witnessing abuse of mother (AOR = 2.1.98[1.44-2.72]), experience of childhood sexual abuse (AOR = 1.46[1.07-1.99]), having had multiple sexual partners in past year (AOR = 2.60[1.49-4.53]), control by male partner (AOR = 1.03[1.00-1.06]), male partner alcohol use in past year (AOR = 2.65[2.12-3.31]) and male partner infidelity (AOR = 2.31[1.72-3.09]) were significantly associated with increased odds of past year physical or sexual IPV experience. Male perpetrated IPV remains a significant public health issue in Ghana. Evidence-based interventions targeting women's mental health, disabilities, exposure to violence in childhood, risky sexual behavior and unequal power in relationships will be critical in reducing IPV in this setting

'Small small quarrels bring about happiness or love in the relationships': Exploring community perceptions and gendered norms contributing to male perpetrated intimate partner violence in the Central Region of Ghana.

In this paper, we explore gender norms held by men and women that might contribute to male perpetration of intimate partner violence (IPV) in Ghana. This qualitative research was conducted at the pre-intervention stage of a cluster randomized controlled trial. Our intervention uses community-based action teams to change social norms on gender and violence. Focus group discussions and in-depth interviews were conducted within communities. We found that male perpetrated IPV is a common phenomenon within the study communities, yet it is complex and experienced differently depending on the context. A woman's non-compliance with gender norms provided context for the male partner to enforce societal conformity through IPV. Also, male partners' misbehavior (e.g. alcohol abuse) may exacerbate IPV. Whereas the former is socially acceptable, the latter may be contested. Victims may challenge/counteract IPV using varying tactics (e.g. threats), which were mainly directed toward male partners' immoral behavior. We conclude that there is a need to assess IPV with key considerations for female agency, as some victims may respond with violence. Moreover, some communities have the tendency to demonstrate more gender-equitable attitudes regarding male perpetration of IPV, as indicated by laws instituted by some traditional leaders to deter perpetrators. These are key learnings that can inform the design and delivery of various interventions that seek to address IPV

Prevalence and risk factors of physical or sexual intimate violence perpetration amongst men in four districts in the central region of Ghana: Baseline findings from a cluster randomised controlled trial

<div><p>Background</p><p>Evidence-based interventions are essential in the prevention of violence against women (VAW). An understanding of risk factors for male perpetration of VAW using population-based research is crucial for developing such interventions. This study is a baseline assessment of a two-arm unmatched cluster randomised controlled trial (C-RCT), set up to assess the impact of a Rural Response System (RRS) intervention for preventing violence against women and girls in Ghana. This study aims at assessing past year prevalence and risk factors for sexual or physical intimate partner violence (IPV) perpetration among men.</p><p>Methods</p><p>The population-based survey involved 2126 men aged 18 and above living in selected communities in 4 districts in the central region of Ghana. Logistic regression techniques were used to determine risk factors for sexual or physical IPV perpetration. All models adjusted for age of respondent and took into account the study design.</p><p>Results</p><p>Half of the men had perpetrated at least one form of violence against their intimate partners in their lifetime while 41% had perpetrated sexual or physical IPV. Majority (93%) of the men had been in relationships in the 12 months preceding the survey, and of these, 23% had perpetrated sexual or physical IPV. Childhood factors associated with sexual or physical IPV included witnessing abuse of mother (aOR:1.40(1.06–1.86)), and neglect (aOR:1.81(1.30–2.50)). Other major risk factors for IPV perpetration were: having multiple partners (aOR:1.76(1.36–2.26)), (involvement in transactional sex (aOR:1.76(1.36–2.26)), substance use (aOR:1.74(1.25–2.43)) and gender inequitable attitudes (aOR:0.94(0.91–0.97)).</p><p>Conclusion</p><p>Childhood violence experience and witnessing, risky behaviour (multiple partners, transactional sex, substance use) and gender inequitable attitudes are major risk factors for sexual or physical IPV perpetration. Perpetration of sexual or physical IPV tend to co-occur with non-partner violence and emotional IPV perpetration. Interventions targeting these factors are critical in reducing IPV.</p></div

Background characteristics of respondents (N = 2000).

<p>Background characteristics of respondents (N = 2000).</p

Prevalence of violence perpetration by men.

<p>Prevalence of violence perpetration by men.</p

Social and demographic characteristics of the sample of men interviewed in the 4 districts.

<p>Social and demographic characteristics of the sample of men interviewed in the 4 districts.</p

Multivariate analysis of factors associated with past year sexual or Physical IPV experience.

<p>Multivariate analysis of factors associated with past year sexual or Physical IPV experience.</p

Prevalence of IPV experience among ever partnered women aged 18–49 years.

<p>Prevalence of IPV experience among ever partnered women aged 18–49 years.</p

Bivariate analysis of factors associated with past year sexual or Physical IPV experience.

<p>Bivariate analysis of factors associated with past year sexual or Physical IPV experience.</p