8 research outputs found
Intention to deliver in a healthcare facility and healthcare facilityâbased delivery rates among women in Akwatia, Ghana
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135204/1/ijgo161.pd
Shifting norms: pregnant womenâs perspectives on skilled birth attendance and facilityâbased delivery in rural Ghana
Skilled birth attendance (SBA) and healthcare facility (HCF) delivery
are effective means of reducing maternal mortality. However, their
uptake remains low in many low-income countries. The present study
utilized semi-structured interviews with 85 pregnant women attending an
antenatal clinic in Akwatia, Ghana (May-July 2010) to better understand
the barriers to SBA and HCF delivery through the underrepresented
perspective of pregnant women. Interview transcripts were analyzed
using grounded theory methodology. Participants described community
support for and uptake of HCF delivery as increasing and becoming
normalized, but barriers remain: (1) maltreatment by midwives; (2) cost
associated with HCF delivery despite waived facility fees; (3) the need
for a support person for HCF delivery; (4) difficulties in
transportation; and (5) precipitous labor. Given the importance of
community in Ghanaian health care decision-making, increasing community
support for HCF delivery suggests progress toward increasing uptake of
SBA and HCF delivery, however important actionable barriers remain.Les services des accoucheuses qualifiés (SAQ) et des
établissements de santé (SES) sont des moyens efficaces de
réduire la mortalité maternelle. Cependant, leur acceptation
reste faible dans de nombreux pays Ă faible revenu. La
prĂ©sente Ă©tude sâest servie des entretiens
semi-structurés recueillis auprÚs des 85 femmes enceintes qui
fréquentaient un dispensaire prénatal à Akwatia, Ghana
(entre les mois de mai et juillet 2010) afin de mieux comprendre les
obstacles Ă la prestation des SAQ et SES Ă travers les
perspectives sous-représentées chez les femmes enceintes. Les
transcriptions des entrevues ont été analysées en
utilisant une méthodologie basée sur le « grounded
theory ». Les participants ont signalé que le soutien
communautaire pour lâaccouchement dans les SES et de
lâadoption des SES augmentent et se normalisent, mais que des
obstacles demeurent: (1) les mauvais traitements infligés par des
sages-femmes, (2) le coût associé à la prestation des
SES en dépit des frais d'établissement supprimés; (3) la
nĂ©cessitĂ© d'une personne de soutien pour lâaccouchement
dans les SES, (4) des difficultés de transport, et (5) du travail
précipité. Compte tenu de l'importance de la communauté
concernant la prise de décision en matiÚre de soins de
santé au Ghana la hausse du soutien communautaire pour
lâaccouchement dans les SES est une indication du progrĂšs
vers lâutilisation croissante de la prestation des SAQ et des SES
mais il reste toujours dâimportants obstacles rĂ©alisable
Intention to deliver in a healthcare facility and healthcare facility-based delivery rates among women in Akwatia, Ghana
Transmission of Cryptosporidium Species Among Human and Animal Local Contact Networks in Sub-Saharan Africa: A Multicountry Study
Abstract
Background
Cryptosporidiosis has been identified as one of the major causes of diarrhea and diarrhea-associated deaths in young children in sub-Saharan Africa. This study traces back Cryptosporidium-positive children to their human and animal contacts to identify transmission networks.
Methods
Stool samples were collected from children < 5 years of age with diarrhea in Gabon, Ghana, Madagascar, and Tanzania. Cryptosporidium-positive and -negative initial cases (ICs) were followed to the community, where stool samples from households, neighbors, and animal contacts were obtained. Samples were screened for Cryptosporidium species by immunochromatographic tests and by sequencing the 18S ribosomal RNA gene and further subtyped at the 60 kDa glycoprotein gene (gp60). Transmission clusters were identified and risk ratios (RRs) calculated.
Results
Among 1363 pediatric ICs, 184 (13%) were diagnosed with Cryptosporidium species. One hundred eight contact networks were sampled from Cryptosporidium-positive and 68 from negative ICs. Identical gp60 subtypes were detected among 2 or more contacts in 39 (36%) of the networks from positive ICs and in 1 contact (1%) from negative ICs. In comparison to Cryptosporidium-negative ICs, positive ICs had an increased risk of having Cryptosporidium-positive household members (RR, 3.6 [95% confidence interval {CI}, 1.7â7.5]) or positive neighboring children (RR, 2.9 [95% CI, 1.6â5.1]), but no increased risk of having positive animals (RR, 1.2 [95% CI, .8â1.9]) in their contact network.
Conclusions
Cryptosporidiosis in rural sub-Saharan Africa is characterized by infection clusters among human contacts, to which zoonotic transmission appears to contribute only marginally
Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis
BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways