Implementation challenges of maternal health care in Ghana: the case of health care providers in the Tamale Metropolis

Background: Achieving the Millennium Development Goal (MDG) of improving maternal health has become a focus in recent times for the majority of countries in sub-Saharan Africa. Ghana’s maternal mortality is still high indicating that there are challenges in the provision of quality maternal health care at the facility level. This study examined the implementation challenges of maternal health care services in the Tamale Metropolis of Ghana. Methods: Purposive sampling was used to select study participants and qualitative strategies, including in-depth interviews, focus group discussions and review of documents employed for data collection. The study participants included midwives (24) and health managers (4) at the facility level. Results: The study revealed inadequate in-service training, limited knowledge of health policies by midwives, increased workload, risks of infection, low motivation, inadequate labour wards, problems with transportation, and difficulties in following the procurement act, among others as some of the challenges confronting the successful implementation of the MDGs targeting maternal and child health in the Tamale Metropolis. Conclusions: Implementation of maternal health interventions should take into consideration the environment or the context under which the interventions are implemented by health care providers to ensure they are successful. The study recommends involving midwives in the health policy development process to secure their support and commitment towards successful implementation of maternal health interventions

Child and Young Adult Headed Households in the Context of the AIDS Epidemic in Zimbabwe, 1988-2006

The emergence of Child-Headed Households (CHH) and Young Adult Households (YAH) has largely been taken as an indicator of the erosion of the traditional safety nets in sub-Saharan countries and a direct consequence of the increasing number of orphans in the region. However, the initial evidence presented so far suggests that the process of formation of CHH and YAH is more complex than it appears to be. Using the four available waves of the Zimbabwe Demographic and Health Surveys (1988, 1994, 1999, and 2005/2006) we find that the proportion of households with no adults have remained stable in the last years, although the number of orphans have increased significantly. In fact, a large number of children living in CHH are non-orphans, which suggests that this kind of living arrangements is not always a direct consequence of parental death. Moreover, our analysis show that children living in CHH and YAH are less likely to have unmet basic needs than children in households headed by working-age adults and other vulnerable households

Academic and Personal-Social Adjustment Challenges of University of Cape Coast Freshmen

This study was carried out to investigate the common adjustment challenges freshmen in the University of Cape Coast experience during their first year in school, and the coping strategies they used in response to the adjustment challenges. A mixed model research design was used in carrying out the study. A sample of 355 students made up of 235 males and 120 females was selected through purposive and proportional stratified random sampling techniques. Adapted forms of the Student Adaptation to College Questionnaire (SACQ) developed by Baker and Siryk (1999) and the Ways of Coping Questionnaire (WCQ) developed by Folkman and Lazarus (1988) were used along with a semi-structured interview. Quantitative data was analysed descriptively while qualitative data was analysed thematically. The study found that freshmen in the University of Cape Coast encountered adjustment challenges such as difficulty handling the academic pressure and lack of involvement in social activities. In terms of coping, most respondents adopted Planful Problem Solving strategies which involved planning, concentrating and taking action to resolve issues. It was recommended that university authorities make the timetable of freshmen more flexible to enable them cope with the academic pressure. Keywords: Adjustment, Challenges, Coping, Strategies DOI: 10.7176/JEP/11-18-07 Publication date:June 30th 202

Motivations for food prohibitions during pregnancy and their enforcement mechanisms in a rural Ghanaian district

© 2015 Arzoaquoi et al. Background: Food taboos are known from virtually all human societies and pregnant women have often been targeted. We qualitatively assessed food taboos during pregnancy, its motivating factors, and enforcement mechanisms in the Upper Manya Krobo district of Ghana. Methods: This was an exploratory cross sectional study using qualitative focus group discussions (FGDs). Sixteen FGDs were conducted. Participants were purposively selected using the maximum variation sampling technique. Tape recorded FGDs were transcribed verbatim and analyzed using Malterudian systematic text condensation technique. Results: All the participants were aware of the existence of food prohibitions and beliefs targeting pregnant women in Upper Manya Krobo. The study identified snails, rats, hot foods, and animal lungs as tabooed during pregnancy. Adherence motivators included expectation of safe and timely delivery, avoidance of "monkey babies" (deformed babies); respect for ancestors, parents, and community elders. Enforcement mechanisms identified included constant reminders by parents, family members and significant others. Stigmatization and community sanctions are deployed sparingly. Conclusions: Food taboos and traditional beliefs targeting pregnant women exist in Upper Manya Krobo. Pregnant women are forbidden from eating snails, rats, snakes, hot foods and animal lungs. To a large extent, socio-cultural, and to a lesser, health concerns motivate the practice

The effects of individual and community-level factors on maternal health outcomes in Ghana

Background Utilization of maternal health care services is key to reducing the number of perinatal deaths and post-natal complications in sub-Saharan Africa. With a few exceptions, many studies that examine the use of maternal health services in sub-Saharan Africa have focused largely on individual-level explanations and have ignored the importance of contextual and community-level explanations. In Ghana, progress has been made in reducing maternal mortality ratio from 740/100,000 in the late 1990s to 319/100,000 in 2015 but these rates are still high. Our study focuses on impact of individual and community level-factors on maternal outcomes with the hope that it will inform public policy in Ghana. This approach highlights latent or unacknowledged aspects of fragility within health systems designed to improve maternal health and opportunities for improving uptake of services. Methods and findings Using the 2014 Ghana Demographic and Health Survey, we examined the effects of individual and community-level factors on antenatal care, facility-based delivery, and post-natal care. Multilevel logistic regression models were used to examine the effects of individual and community-level factors on the outcome variables. Our analysis revealed that overall utilization of antenatal, facility-based delivery and post-natal care was substantial across the board; however, both individual and community-level factors were significant predictors of these maternal health outcomes. Wealthier and better educated women were more likely to use antenatal services and facility-based delivery; in contrast poor and uneducated women were more likely to use antenatal and postnatal care but not facility-based delivery. Additionally, use of National Health Insurance Scheme was statistically associated with the utilization of maternal health services. Conclusions The findings point to areas where services can be better tailored to meet community-specific needs. Policy makers must consider factors such as educational levels and economic security at both individual and community-levels that shape women’s preferences and uptake of maternal health care in Ghana

The Emerald International Handbook of Feminist Perspectives on Women’s Acts of Violence

Over the past twenty years, interest in women’s violence has grown as an area of academic research and teaching across disciplines such as criminology, sociology, history, international relations, public health and film and literary studies. This handbook makes a timely contribution by acting as a comprehensive introduction to a wide range of international, interdisciplinary scholarship which applies feminist perspectives to the phenomenon of women’s violence. Violence is enabled and enacted by individuals, organisations and states with interconnections between these different levels (Collins, 1998, 2017). We adopt this multilevel understanding of violence in the handbook, bringing together contributions on interpersonal and intimate violence by women, women’s violence as agents of institutions, and women’s political violence as state and non-state actors. The handbook is international in scope with contributions from scholars across countries in the Global South and North. Women’s acts of violence are rarer than men’s and frequently perceived as more shocking. Violence by women is regularly sensationalised and stigmatised, especially in media discourses. This sensationalisation and stigmatisation relies on and reproduces misogynistic tropes about violent women as ‘evil’, ‘unnatural’ and masculinised. The chapters in this handbook are written from a feminist perspective and eschew or deconstruct stereotypical portrayals in favour of more considered and complex analyses of the violence women enact and the relevance of their social and political positioning, as well as cultural understandings of womanhood and how these inform understandings of and responses to this violence. Previous literature has emphasised that women’s violence is frequently understood as deviant and transgressive, violating norms of ideal femininity. Such ideas are explored throughout the handbook in contributions which consider, for instance, the vilification and monsterisation of women who kill. These chapters tease out the ways in which violent women are profiled as unnatural and abject. The handbook therefore retains a focus on scholarship which considers the ‘abnormality’ of violent women while also including contributions which demonstrate that women’s violent acts can be normalised and made invisible, for example when perpetrated during a professional role. Adding further nuance, various chapters address how, due to marginalisation across axes of race and class, certain women are not always presumed to be non-violent or perceived through norms of ideal femininity. The handbook explores how these assumptions can lead to overcriminalisation and harsh treatment within the criminal justice system. The significance of women’s intersectional identities is a consistent theme throughout the handbook. Running through the chapters too is the seemingly intractable problem of agency – including the obstacles to fully assigning agency to violent women as well as the frequently unwanted consequences when they are considered to have acted with agency and are punished more harshly. Throughout the handbook, authors grapple with questions of women’s volitional capacity, considering difficult questions of how far we should consider the contexts in which women commit violence, which include structural oppression, domestic- and gender-based violence, and cultural norms. The contributions reveal the necessity of abandoning a binary view of victim-perpetrator, agency/non-agency and evolving a more complex framework in which to gauge questions of intention and deliberation. The handbook is divided into eight sections: historical perspectives; understanding women’s acts of violence; women as perpetrators of interpersonal and intimate violence; power and women’s violence; women and non-state political violence; cultural interpretations of violent women; fictional representations of violent women; and violent women and girls in the criminal justice system. The rest of this introductory chapter outlines the handbook’s structure and summarises each contribution

The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the global burden of disease study 2013

Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disabilityadjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for illdefined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made