Mistreatment of Women in Health Facilities by Midwives during Childbirth in Ghana: Prevalence and Associated Factors

Studies have shown that many women worldwide experience mistreatment during pregnancy and childbirth. However, there are few quantitative estimates of the prevalence of mistreatment of women during facility-based childbirth in many developing countries including Ghana. Based on a cross-sectional retrospective survey of 253 randomly selected women who gave birth between November 2017 and April 2018 in a second-tier referral hospital in Ghana, this study examines mistreatment of women by midwives during childbirth and associated factors. Bivariate and logistic regression analyses were performed at 95% confidence level and p < 0.05. Results show that 83% of women were mistreated. Manifestations of mistreatments included detention for non-payment of bills (43.1%), non-confidential care (39.5%), abandonment (30.8%), verbal abuse (25.3%), discrimination (21.3%), physical abuse (14.2%) and non-consented care (13.3%). Factors that significantly independently predicted mistreatment after potential confounders were controlled for were being HIV positive (aOR: 0.11; 95% CI = 0.022–0.608; p = 0.011), being attended by a midwife rather than an obstetrician/gyneacologist (aOR: 0.07; 95% CI = 0.018–0.279; p < 0.01), and a woman’s husband earning lower monthly income. There is need for interventions to train midwives and other maternity care service providers in patient-centered care and interpersonal communication so as to minimize mistreatment of women during childbirth

NGOs and the Promotion of the Sexual and Reproductive Rights of Girls and Young Women with Disabilities in Zimbabwe

This case study investigates strategies used by the NGO Leonard Cheshire Disability Zimbabwe (LCDZ) to promote the SRHRs of girls and young women with disabilities in Zimbabwe. The findings show that LCDZ employed a combination of six strategies. These are: (1) building practical knowledge on SRHRs; (2) increasing community awareness and sensitivity; (3) providing SRHRs-related education; (4) enhancing access to justice and related services for survivors of sexual violence; (5) delivering assistive devices; and (6) promoting the livelihoods and economic empowerment. LCDZ made use of multi-stakeholder partnerships to implement these strategies, leveraging complementary skills and experience in the promotion of SRHRs. In each of these strategies, girls and young women with disabilities are the target group, with other stakeholders brought together to support them

Ghanaian women's knowledge on whether malaria treatment is covered by the national health insurance: a multilevel regression analysis of national data

Background: To obviate malaria and other healthcare costs and enhance healthcare utilization, the government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2005. Nonetheless, there is dearth of empirical evidence on Ghanaian women's knowledge about whether malaria treatment is covered by the NHIS or not. The current study, therefore, investigated factors associated with knowledge of malaria treatment with the NHIS among women aged 15-49 in Ghana. Methods: The study is a secondary analysis of data from women respondents in the 2014 Ghana Demographic and Health Survey. A total of 2,560 women participated in this study. Descriptive computation of the weighted proportion of women who knew that malaria is covered by NHIS was conducted at 95% confidence interval (CI). A multilevel logistic regression analyses was carried out with Stata's MLwinN package version 3.05. We declared significance at 5% alpha. Findings from the models were reported as adjusted odds ratios (aOR) and credible intervals (CrIs). Results: In all, 81.0% of Ghanaian women included in the study knew that NHIS covers malaria treatment. Women aged 45-49 had higher odds of knowing that NHIS covers malaria relative to those aged 15-19 age category [aOR=1.5;95%crl=1.2-2.1]. Women with higher education (post-secondary) had higher odds of knowing that NHIS covers malaria treatment compared with women who had no formal education [aOR=1.6;95%Crl=1.2-2.0]. Richest women were more likely to know that NHIS covers malaria treatment compared to the poorest women [aOR=1.3;95%Crl=1.2-1.7]. Women who had subscribed to the NHIS were more likely to report that NHIS covers malaria treatment [aOR=1.5;95%Crl=1.2-1.8]. The study revealed that the variance in the tendency for a woman to be aware that NHIS covers malaria treatment is attributable to 10.8% community level factors. Conclusion: This study has shown that individual, community and regional level factors affect women's knowledge on whether NHIS covers malaria treatment or not. As knowledge that malaria treatment is covered by NHIS may increase use of malaria prevention and treatment services in health facilities, we recommend that the Ghana Health Service intensifies community level education and awareness creation efforts, targeted at women among whom awareness levels are currently low

Male_Involvement_Maternal_health_Ghana

Male involvement in maternal healthcare dat

Free but not accessible to all: free maternity care, access, equity of access, and barriers to accessing and using skilled maternal and newborns healthcare services in Ghana

Limited and inequitable access to skilled maternal and newborn healthcare has been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. To address the problem of access, the government of Ghana, in 2003, pioneered and is implementing a new maternal healthcare policy that provides free maternity care at the point of delivery in all public and mission health facilities to ensure increased and equitable access and use of skilled maternal and newborn healthcare services. The aim of this doctoral study is to explore how the introduction of the free maternal health policy in Ghana affects access, equity of access, and to investigate barriers to accessibility and utilization of skilled maternal and newborn health services. It does this using data from the Ghana Maternal Health Survey 2007, in combination with qualitative data generated from ethnographic-style in-depth interviews and focus group discussions that the author originally conducted with a total of 185 expectant and lactating mothers, and 20 healthcare providers and policy-makers in six communities in Ghana between November 2011 and June 2012. Survey data suggest that accessibility to, and utilization of skilled antenatal care, delivery in a health facility, delivery with a skilled birth attendant, as well as other post-natal care services have increased by an average of 8% since the introduction of the policy (i.e. between 2003 and 2007). However, both survey and qualitative data indicate that while the free maternity care policy in Ghana removes important financial barriers to access and use of life-saving maternal and newborn health services, most skilled care services remain underutilized, while inequities in skilled care services accessibility and utilization persist. Qualitative findings suggest that this is largely because not only is the provision of skilled maternal and newborn healthcare services in Ghana very limited and unequally available to the population, but also even where these services are available at no or minimal cost, and can be physically accessed, they can be unfriendly, culturally unacceptable, socially degrading or even abusive to women. These factors have combined to discourage a disproportionate number of expectant mothers from accessing and using skilled maternal and newborn health services although these services are free. This doctoral research argues for a move beyond free maternity care and stresses the importance of organizing and delivering services in ways that are medically appropriate, socially sensitive, and culturally responsive. The thesis also argues that the development of a diversity responsive maternal healthcare system would go a long way to first redress the health system and socio-cultural barriers to equitable access, and then promote increased and equitable access for different groups of women.</p

Predictors of neonatal mortality in Ghana: evidence from 2017 Ghana maternal health survey

Abstract Background Neonatal mortality contributes about 47% of child mortality globally and over 50% of under-5 deaths in Ghana. There is limited population level analysis done in Ghana on predictors of neonatal mortality. Objectives The objective of the study was to examine the predictors of neonatal mortality in Ghana. Method This study utilizes secondary data from the 2017 Ghana Maternal Health Survey (GMHS). The GMHS survey focuses on population and household characteristics, health, nutrition, and lifestyle with particular emphasis on topics that affect the lives of newborns and women, including mortality levels, fertility preferences and family planning methods. A total of 10,624 respondents were included in the study after data cleaning. Descriptive statistical techniques were used to describe important background characteristics of the women and Pearson’s Chi-squares (χ2) test used to assess association between the outcome (neonatal death) and independent variables. Multivariate logistic regression analysis was done to estimate odd ratios and potential confounders controlled. Confidence level was held at 95%, and a p < 0.05 was considered statistically significant. Data analysis was done using STATA 15. Results The prevalence of neonatal mortality was 18 per 1000 live births. ANC attendance, sex of baby, and skin-to-skin contact immediately after birth were predictors of neonatal mortality. Women with at least one ANC visit were less likely to experience neonatal mortality as compared to women with no ANC visit prior to delivery (AOR = 0.11; CI = 0.02–0.56, p = 0.01). Girls were less likely (AOR = 0.68; CI = 0.47–0.98; p = 0.03) to die during the neonatal period as compared to boys. Neonates who were not put skin-to-skin contact immediately after birth were 2.6 times more likely to die within the neonatal period than those who were put skin-to-skin contact immediately after birth (AOR = 2.59; CI = 1.75–3.83, p = 0.00). Conclusion Neonatal mortality remains a public health concern in Ghana, with an estimated rate of 18 deaths per 1,000 live births. Maternal and neonatal factors such as the sex of the newborn, the number of antenatal care visits, and skin-to-skin contact between the newborn and mother immediately after birth are the predictors of neonatal mortality in Ghana

Free but not accessible to all: free maternity care, access, equity of access, and barriers to accessing and using skilled maternal and newborns healthcare services in Ghana

Limited and inequitable access to skilled maternal and newborn healthcare has been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. To address the problem of access, the government of Ghana, in 2003, pioneered and is implementing a new maternal healthcare policy that provides free maternity care at the point of delivery in all public and mission health facilities to ensure increased and equitable access and use of skilled maternal and newborn healthcare services. The aim of this doctoral study is to explore how the introduction of the free maternal health policy in Ghana affects access, equity of access, and to investigate barriers to accessibility and utilization of skilled maternal and newborn health services. It does this using data from the Ghana Maternal Health Survey 2007, in combination with qualitative data generated from ethnographic-style in-depth interviews and focus group discussions that the author originally conducted with a total of 185 expectant and lactating mothers, and 20 healthcare providers and policy-makers in six communities in Ghana between November 2011 and June 2012. Survey data suggest that accessibility to, and utilization of skilled antenatal care, delivery in a health facility, delivery with a skilled birth attendant, as well as other post-natal care services have increased by an average of 8% since the introduction of the policy (i.e. between 2003 and 2007). However, both survey and qualitative data indicate that while the free maternity care policy in Ghana removes important financial barriers to access and use of life-saving maternal and newborn health services, most skilled care services remain underutilized, while inequities in skilled care services accessibility and utilization persist. Qualitative findings suggest that this is largely because not only is the provision of skilled maternal and newborn healthcare services in Ghana very limited and unequally available to the population, but also even where these services are available at no or minimal cost, and can be physically accessed, they can be unfriendly, culturally unacceptable, socially degrading or even abusive to women. These factors have combined to discourage a disproportionate number of expectant mothers from accessing and using skilled maternal and newborn health services although these services are free. This doctoral research argues for a move beyond free maternity care and stresses the importance of organizing and delivering services in ways that are medically appropriate, socially sensitive, and culturally responsive. The thesis also argues that the development of a diversity responsive maternal healthcare system would go a long way to first redress the health system and socio-cultural barriers to equitable access, and then promote increased and equitable access for different groups of women.This thesis is not currently available in ORA

Factors influencing the use of supervised delivery services in Garu-Tempane District, Ghana

Abstract Background There is evidence that supervised delivery has the potential to improve birth outcomes for both women and newborns. However, not all women especially in low-income settings like Ghana use supervised delivery services during childbirth. The purpose of this study was to estimate the prevalence of supervised delivery and determine factors that influence use of supervised delivery services in a local district of Ghana. Methods A retrospective cross-sectional survey of 322 randomly sampled postpartum women who delivered between January and December 2016 in the Garu-Tempane District was conducted. Structured questionnaires were used to collect data. Descriptive, binary and multivariate logistic regression analysis techniques were used to analyse data. Results Although antenatal care attendance among respondents was very high 291(90.4%), prevalence of supervised birth was only 219(68%). More than a quarter 103(32%) of the postpartum women delivered their babies at home without skilled birth attendants. After controlling for possible confounders in multivariable logistic regression analyses, factors that strongly independently predicted supervised delivery were religion (p < 0.01), distance to health facility (p < 0.05), making at least 4 antenatal care visits (p < 0.01), national health insurance scheme registration (p < 0.01), satisfaction with services received during antenatal care (p < 0.01), need partner’s approval before delivering in health facility (p < 0.01), woman’s thoughts that her religious beliefs prohibited health facility delivery(p < 0.01), and woman’s belief that there are norms in her community that did not support health facility delivery (p < 0.01). Conclusion There is need for targeted interventions, including community mobilization and health education, and male partner involvement to help generate local demand for, and uptake of, supervised delivery services. Improvement in the quality of services in health facilities, including ensuring respect and dignity for service users, would also be essential

Anaemia at antenatal care initiation and associated factors among pregnant women in West Gonja District, Ghana: a cross-sectional study

CITATION: Tibambuya, B. A. et al. 2019. Anaemia at antenatal care initiation and associated factors among pregnant women in West Gonja District, Ghana: a cross-sectional study. Pan African Medical Journal, 33. doi:10.11604/pamj.2019.33.325.17924The original publication is available at https://www.panafrican-med-journal.com/Introduction: anaemia in pregnancy remains a critical public health concern in many African settings; but its determinants are not clear. The purpose of this study was to assess anaemia at antenatal care initiation and associated factors among pregnant women in a local district of Ghana. Methods: a facility-based cross-sectional survey was conducted. A total of 378 pregnant women attending antenatal care at two health facilities were surveyed. Data on haemoglobin level, helminths and malaria infection status at first antenatal care registration were extracted from antenatal records booklets of each pregnant women. Questionnaires were then used to collect data on socio-demographic and dietary variables. Binary and multivariate logistic regression analyses were done to assess factors associated with anaemia. Results: the prevalence of anaemia was 56%, with mild anaemia being the highest form (31.0%). Anaemia prevalence was highest (73.2%) among respondents aged 15-19 years. Factors that significantly independently reduced the odds of anaemia in pregnancy after controlling for potential confounders were early (within first trimester) antenatal care initiation (AOR=5.01; 95% CI =1.41-17.76; p=0.013) and consumption of egg three or more times in a week (AOR=0.30; 95% CI=0.15-0.81; P=0.014). Conclusion: health facility and community-based preconception and conception care interventions must not only aim to educate women and community members about the importance of early ANC initiation, balanced diet, protein and iron-rich foods sources that may reduce anaemia, but must also engage community leaders and men to address food taboos and cultural prohibitions that negatively affect pregnant woman.https://panafrican-med-journal.com/content/article/33/325/full/Publisher’s versio