births. Mothers who delivered outside a health facility experienced 1.85 times higher odds of exp... more births. Mothers who delivered outside a health facility experienced 1.85 times higher odds of experiencing neonatal deaths (adjusted odds ratio = 1.85; 95% confidence interval=1.33−2.58) than those who delivered in a health facility. CONCLUSIONS: Place of delivery is a significant predictor of neonatal mortality. Pregnant women need to be encouraged to deliver at health facilities and this should be done by intensifying education on where to deliver. Infrastructure, such as emergency transport, to facilitate health facility deliveries also requires urgent attention.
ObjectiveTo evaluate the effect of a continuum-of-care intervention package on adequate contacts ... more ObjectiveTo evaluate the effect of a continuum-of-care intervention package on adequate contacts of women and newborn with healthcare providers and their reception of high-quality care.DesignCluster randomised controlled trial.Setting32 subdistricts in 3 rural sites in Ghana.ParticipantsThe baseline survey involved 1480 women who delivered before the trial, and the follow-up survey involved 1490 women who received maternal and newborn care during the trial.InterventionsThe intervention package included training healthcare providers, using an educational and recording tool named ‘continuum-of-care card’, providing the first postnatal care (PNC) by retaining women and newborns at healthcare facility or home visit by healthcare providers.Outcome measuresAdequate contacts were defined as at least four contacts during pregnancy, delivery with assistance of skilled healthcare providers at a healthcare facility and three timely contacts within 6 weeks postpartum. High-quality care was defi...
IntroductionFacility interventions to improve quality of care around childbirth are known but nee... more IntroductionFacility interventions to improve quality of care around childbirth are known but need to be packaged, tested and institutionalised within health systems to impact on maternal and newborn outcomes.MethodsWe conducted cross-sectional assessments at baseline (2016) and after 18 months of provider-led implementation of UNICEF/WHO’s Every Mother Every Newborn Quality Improvement (EMEN-QI) standards (preceding the WHO Standards for improving quality of maternal and newborn care in health facilities). 19 hospitals and health centres (2.8M catchment population) in Bangladesh, Ghana and Tanzania were involved and 24 from adjoining districts served for ‘comparison’. We interviewed 43 facility managers and 818 providers, observed 1516 client–provider interactions, reviewed 12 020 records and exit-interviewed 1826 newly delivered women. We computed a 39-criteria institutionalisation score combining clinical, patient rights and cross-cutting domains from EMEN-QI and used routine/Dis...
Background In low- and middle-income countries (LMICs), the continuum of care (CoC) for maternal,... more Background In low- and middle-income countries (LMICs), the continuum of care (CoC) for maternal, newborn, and child health (MNCH) is not always complete. This study aimed to evaluate the effectiveness of an integrated package of CoC interventions on the CoC completion, morbidity, and mortality outcomes of woman–child pairs in Ghana. Methods and findings This cluster-randomized controlled trial (ISRCTN: 90618993) was conducted at 3 Health and Demographic Surveillance System (HDSS) sites in Ghana. The primary outcome was CoC completion by a woman–child pair, defined as receiving antenatal care (ANC) 4 times or more, delivery assistance from a skilled birth attendant (SBA), and postnatal care (PNC) 3 times or more. Other outcomes were the morbidity and mortality of women and children. Women received a package of interventions and routine services at health facilities (October 2014 to December 2015). The package comprised providing a CoC card for women, CoC orientation for health worke...
<br>The database is saved as .dta (Stata 13 or above) format.The dataset contains the poole... more <br>The database is saved as .dta (Stata 13 or above) format.The dataset contains the pooled data from the baseline survey (conducted from July 1 to September 30, 2014) and the follow-up survey (conducted from October 1 to December 31, 2015). The dataset is .dta (Stata 13 or later) format.<br>
Generally, the question posed by the authors is scientifically well defined, the methods appropri... more Generally, the question posed by the authors is scientifically well defined, the methods appropriate and results supported be the data. However, there are minor essential revisions that should done; the entire manuscript also need to be proof red to make minor grammatical and typographical correction to enable the reading public better appreciate the results/findings of the paper.
Background Improving maternal and newborn health remains one of the most critical public health c... more Background Improving maternal and newborn health remains one of the most critical public health challenges, particularly in low-and lower-middle-income countries. To overcome this challenge, interventions to improve the continuum of care based on real-world settings need to be provided. The Ghana Ensure Mothers and Babies Regular Access to Care (EMBRACE) Implementation Research Team conducted a unique intervention program involving over 21 000 women to improve the continuum of care, thereby demonstrating an intervention program's effectiveness in a real-world setting. This study evaluates the implementation process of the EMBRACE intervention program based on the RE-AIM framework. Methods A cluster-randomized controlled trial was conducted in 32 sub-district-based clusters in Ghana. Interventions comprised of four components, and to evaluate the implementation process, we conducted baseline and endline questionnaire surveys for women who gave birth and lived in the study site. The key informant interviews of health workers and intervention monitoring were conducted at the health facilities in the intervention area. The data were analyzed using 34 components of the RE-AIM framework and classified under five general criteria (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Results In total, 1480 and 1490 women participated in the baseline and endline questionnaire survey, respectively. In the intervention area, 83.8% of women participated (reach). The completion rate of the continuum of care increased from 7.5% to 47.1%. Newborns who had danger signs immediately after birth decreased after the intervention (relative risk = 0.82, 95% confidence interval = 0.68-0.99) (effectiveness). In the intervention area,
The Lancet Regional Health - Western Pacific, 2020
Background: Quality care is essential for improving maternal and newborn health. Low-and middlein... more Background: Quality care is essential for improving maternal and newborn health. Low-and middleincome Pacific Island nations face challenges in delivering quality maternal and newborn care. The aim of this review was to identify all published studies of interventions which sought to improve the quality of maternal and newborn care in Pacific low-and middle-income countries. Methods: A scoping review framework was used. Databases and grey literature were searched for studies published between January 20 0 0 and July 2019 which described actions to improve the quality of maternal and newborn care in Pacific low-and middle-income countries. Interventions were categorised using a four-level health system framework and the WHO quality of maternal and newborn care standards. An expert advisory group of Pacific Islander clinicians and researchers provided guidance throughout the review process. Results: 2010 citations were identified and 32 studies included. Most interventions focused on the clinical service or organisational level, such as healthcare worker training, audit processes and improvements to infrastructure. Few addressed patient experiences or system-wide improvements. Enablers to improving quality care included community engagement, collaborative partnerships, adequate staff education and training and alignment with local priorities. Conclusions: There are several quality improvement initiatives in low-and middle-income Pacific Island nations, most at the point of health service delivery. To effectively strengthen quality maternal and newborn care in this region, effort s must broaden to improve health system leadership, deliver sustaining education programs and encompass learnings from women and their communities.
Background: Skilled birth delivery has increased up to nearly 74% in Ghana, but its quality has b... more Background: Skilled birth delivery has increased up to nearly 74% in Ghana, but its quality has been questioned over the years. As understanding women's satisfaction could be important to improving service quality, this study aimed to determine what factors were associated with women's overall satisfaction with delivery services quantitatively and qualitatively in rural Ghanaian health facilities. Results: This cross-sectional, mixed methods study used an explanatory sequential design across three Ghana Health Service research areas in 2013. Participants were women who had delivered in the preceding 2 years. Two-stage random sampling was used to recruit women for the quantitative survey. Relationships between women's socio-demographic characteristics and their overall satisfaction with health facility delivery services were examined using univariate and multiple logistic regression analyses. For qualitative analyses, women who completed the quantitative survey were purposively selected to participate in focus group discussions. Data from the focus group discussions were analyzed based on predefined and emerging themes. Overall, 1130 women were included in the quantitative analyses and 136 women participated in 15 focus group discussions. Women's mean age was 29 years. Nearly all women (94%) were satisfied with the overall services received during delivery. Women with middle level/junior high school education [adjusted odds ratio (AOR) = 0.50, 95% confidence interval (CI) = (0.26-0.98)] were less likely to be satisfied with overall delivery services compared to women with no education. Qualitatively, women were not satisfied with the unconventional demands, negative attitude, and unavailability of healthcare workers, as well as the long wait time. Conclusions: Although most women were satisfied with the overall service they received during delivery, they were not satisfied with specific aspects of the health services; therefore, higher quality service delivery is necessary to improve women's satisfaction. Additional sensitivity training and a reduction in work hours may also improve the experience of clients.
Improving maternal health is a global challenge. In Ghana, maternal morbidity and mortality rates... more Improving maternal health is a global challenge. In Ghana, maternal morbidity and mortality rates remain high, particularly in rural areas. Antenatal care (ANC) attendance is known to improve maternal health. However, few studies have updated current knowledge regarding determinants of ANC attendance. This study examined factors associated with ANC attendance in predominantly rural Ghana. We conducted a cross-sectional study at three sites (i.e. Navrongo, Kintampo, and Dodowa) in Ghana between August and September 2013. We selected 1500 women who had delivered within the two years preceding the survey (500 from each site) using two-stage random sampling. Data concerning 1497 women's sociodemographic characteristics and antenatal care attendance were collected and analyzed, and factors associated with attending ANC at least four times were identified using logistic regression analysis. Of the 1497 participants, 86% reported attending ANC at least four times, which was positively ...
Background: How does the gap in preferences between married couples affect their happiness after ... more Background: How does the gap in preferences between married couples affect their happiness after childbirth? Are couples that share similar preferences happier? In recent years, gender, marriage, and happiness have been considered to be key issues in public health research. Although much research has examined the happiness status of married couples, practically no study has explored the gender gap in relation to happiness and the preferences of married couples after childbirth. Therefore, our study was conducted to assess the association between the preference gap and the happiness status among married couples in the afterbirth period. Methods: We conducted a field experiment in rural communities in the Brong-Ahafo region of Ghana. Participants were 80 married couples who had experienced childbirth within 2 years prior to the survey. As preference indicators, we measured trust, reciprocity, altruism, and risk lovingness through an economic experiment. Then, we assessed how, for a couple, the gap between these preferences affected their happiness. Results: Wives' happiness was positively associated with the absolute value of the gap in risk lovingness between a couple (OR = 4.83, p = 0.08), while husbands' happiness was negatively associated with the gap in trust (OR = −3.58, p = 0.04) or altruism (OR = −3.33, p = 0.02). Within a couple, wives felt greater happiness than their husbands if there was a wider gap in trust (OR = 6.22, p = 0.01), reciprocity (OR = 2.80, p = 0.01), or risk lovingness (OR = 3.81, p = 0.07). Conclusions: The gender gaps in the preference indicators were found to be closely associated with the happiness levels between married couples after childbirth. For the further improvement of maternal and child health, we must consider the gender gaps between couples in relation to happiness and preferences.
Background: Health worker shortage in rural areas is one of the biggest problems of the health se... more Background: Health worker shortage in rural areas is one of the biggest problems of the health sector in Ghana and many developing countries. This may be due to fewer incentives and support systems available to attract and retain health workers at the rural level. This study explored the willingness of community health officers (CHOs) to accept and hold rural and community job postings in Ghana. Methods: A discrete choice experiment was used to estimate the motivation and incentive preferences of CHOs in Ghana. All CHOs working in three Health and Demographic Surveillance System sites in Ghana, 200 in total, were interviewed between December 2012 and January 2013. Respondents were asked to choose from choice sets of job preferences. Four mixed logit models were used for the estimation. The first model considered (a) only the main effect. The other models included interaction terms for (b) gender, (c) number of children under 5 in the household, and (d) years worked at the same community. Moreover, a choice probability simulation was performed. Results: Mixed logit analyses of the data project a shorter time frame before study leave as the most important motivation for most CHOs (β 2.03; 95 % CI 1.69 to 2.36). This is also confirmed by the largest simulated choice probability (29.1 %). The interaction effect of the number of children was significant for education allowance for children (β 0.58; 95 % CI 0.24 to 0.93), salary increase (β 0.35; 95 % CI 0.03 to 0.67), and housing provision (β 0.16; 95 % CI −0.02 to 0.60). Male CHOs had a high affinity for early opportunity to go on study leave (β 0.78; 95 % CI −0. 06 to 1.62). CHOs who had worked at the same place for a long time greatly valued salary increase (β 0.28; 95 % CI 0.09 to 0.47). Conclusions: To reduce health worker shortage in rural settings, policymakers could provide "needs-specific" motivational packages. They should include career development opportunities such as shorter period of work before study leave and financial policy in the form of salary increase to recruit and retain them.
Background Maternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan ... more Background Maternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan African countries. Both maternal and neonatal health outcomes improve when skilled personnel provide delivery services within health facilities. Determinants of delivery location are crucial to promoting health facility deliveries, but little research has been done on this issue in Ghana. This study explored factors influencing delivery location in predominantly rural communities in Ghana. Methods Data were collected from 1,500 women aged 15-49 years with live or stillbirths that occurred between January 2011 and April 2013. This was done within the three sites operating Health and Demographic Surveillance Systems, i.e., the Dodowa (Greater Accra Region), Kintampo (Brong Ahafo Region), and Navrongo (Upper-East Region) Health Research Centers in Ghana. Multivariable logistic regression was used to identify the determinants of delivery location, controlling for covariates that were statistically significant in univariable regression models.
Slow progress has been made in achieving the Millennium Development Goals 4 and 5 in Ghana. Ensur... more Slow progress has been made in achieving the Millennium Development Goals 4 and 5 in Ghana. Ensuring continuum of care (at least four antenatal visits; skilled birth attendance; postnatal care within 48 hours, at two weeks, and six weeks) for mother and newborn is crucial in helping Ghana achieve these goals and beyond. This study examined the levels and factors associated with continuum of care (CoC) completion among Ghanaian women aged 15-49. A retrospective cross-sectional survey was conducted among women who experienced live births between January 2011 and April 2013 in three regions of Ghana. In a two-stage random sampling method, 1,500 women with infants were selected and interviewed about maternal and newborn service usage in line with CoC. Multiple logistic regression models were used to assess factors associated with CoC completion. Only 8.0% had CoC completion; the greatest gap and contributor to the low CoC was detected between delivery and postnatal care within 48 hours ...
Objectives: Assess the quality of health data compiled by community health workers (CHWs) by comp... more Objectives: Assess the quality of health data compiled by community health workers (CHWs) by comparing district data summarized from data aggregated by CHWs during routine operation to data aggregated by independent researchers. Methods: Compared summary reports aggregated from patient data by CHWs (site report) to summary reports compiled by data audit experts using the same raw data (validated report). Completeness and accuracy of data from site reports, including number of antenatal care visits, postnatal follow-up visits, immunizations, and malaria cases were compared to that of independently validated reports. Predictors of data quality such as community health worker, community, and system characteristics were included in the analysis using binary logistic regression. Results: All sites provided site reports to the district health management teams, but there were significant errors in the data aggregated by CHWs. Some variables were over-reported in site reports whereas others...
Objectives: To measure the knowledge and competence of community health workers (CHWs) in perform... more Objectives: To measure the knowledge and competence of community health workers (CHWs) in performing their duties. Methods: This is a cross sectional survey study of about 150 CHWs (aged ≥19) working in 4 districts (2 intervention and 2 control) of Northern Ghana. All 4 districts have Community Health Planning Service (CHPS) compounds which provide health services at the community level. Knowledge and skills of CHWs were ascertained at the CHPS level on specific functions including postnatal and infant care, antenatal care, growth monitoring, safe delivery, postnatal care, kangaroo mother care, and education on neonatal health and survival. Univariate and multivariate analysis are carried out to compare knowledge and skills in intervention district vs control districts. Results: Community health workers (CHWs) have adequate knowledge and skills in the performance of most of their duties, but nearly all CHWs said they required urgent training in some areas (e.g. safe delivery, neonat...
Background: The advent of affordable and accessible antiretroviral (ARV) therapy HIV patients has... more Background: The advent of affordable and accessible antiretroviral (ARV) therapy HIV patients has led to the implementation of many ARV programs in many countries. This has necessitated the need to assess adherence level among ARV-users, in order to make recommendations to inform policy. Objective: To assess the challenges and opportunities for ARV adherence among ARV-users in Bolgatanga Regional Hospital of Ghana. Methods: A cross sectional survey involving clients on ART, Health providers and Non-Governmental Organisations (NGOs). Purposive systematic sampling was used selected 20 ARV-users, 9 different categories of service providers, and 2 international NGOs providing care and support to PLWH. Data was collected through administered questionnaire, observation and review of existing documents to ascertain ARV adherence in 2010. Results: Adherence level among ARV-users in Bolgatanga hospital was 90%; provider assessment through pill counts and appointments showed 95% adherence. Ch...
Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recentl... more Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; ...
We assess depression rates and investigate whether depression among HIV-infected adults receiving... more We assess depression rates and investigate whether depression among HIV-infected adults receiving antiretroviral treatment (ART) is associated with social support and HIV coping strategies in rural South Africa (SA). The study took place in a decentralised public-sector ART programme in a poor, rural area of KwaZulu-Natal, SA, with high-HIV prevalence and high-ART coverage. The 12-item General Health Questionnaire (GHQ12), validated in this setting, was used to assess depression in 272 adults recently initiated on ART. Estimates of depression prevalence ranged from 33% to 38%, depending on the method used to score the GHQ12. Instrumental social support (providing tangible factors for support, such as financial assistance, material goods or services), but not emotional social support (expressing feelings, such as empathy, love, trust or acceptance, to support a person), was significantly associated with lower likelihood of depression [adjusted odds ratio (aOR) = 0.65, 95% confidence interval (CI) 0.52-0.81, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001], when controlling for sex, age, marital status, education, household wealth and CD4 cell count. In addition, using &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;avoidance of people&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; as a strategy to cope with HIV was associated with an almost three times higher odds of depression (aOR = 2.79, CI: 1.34-5.82, P = 0.006), whereas none of the other five coping strategies we assessed was significantly associated with depression. In addition to antidepressant drug treatment, interventions enhancing instrumental social support and behavioural therapy replacing withdrawal behaviours with active HIV coping strategies may be effective in reducing the burden of depression among patients on ART.
births. Mothers who delivered outside a health facility experienced 1.85 times higher odds of exp... more births. Mothers who delivered outside a health facility experienced 1.85 times higher odds of experiencing neonatal deaths (adjusted odds ratio = 1.85; 95% confidence interval=1.33−2.58) than those who delivered in a health facility. CONCLUSIONS: Place of delivery is a significant predictor of neonatal mortality. Pregnant women need to be encouraged to deliver at health facilities and this should be done by intensifying education on where to deliver. Infrastructure, such as emergency transport, to facilitate health facility deliveries also requires urgent attention.
ObjectiveTo evaluate the effect of a continuum-of-care intervention package on adequate contacts ... more ObjectiveTo evaluate the effect of a continuum-of-care intervention package on adequate contacts of women and newborn with healthcare providers and their reception of high-quality care.DesignCluster randomised controlled trial.Setting32 subdistricts in 3 rural sites in Ghana.ParticipantsThe baseline survey involved 1480 women who delivered before the trial, and the follow-up survey involved 1490 women who received maternal and newborn care during the trial.InterventionsThe intervention package included training healthcare providers, using an educational and recording tool named ‘continuum-of-care card’, providing the first postnatal care (PNC) by retaining women and newborns at healthcare facility or home visit by healthcare providers.Outcome measuresAdequate contacts were defined as at least four contacts during pregnancy, delivery with assistance of skilled healthcare providers at a healthcare facility and three timely contacts within 6 weeks postpartum. High-quality care was defi...
IntroductionFacility interventions to improve quality of care around childbirth are known but nee... more IntroductionFacility interventions to improve quality of care around childbirth are known but need to be packaged, tested and institutionalised within health systems to impact on maternal and newborn outcomes.MethodsWe conducted cross-sectional assessments at baseline (2016) and after 18 months of provider-led implementation of UNICEF/WHO’s Every Mother Every Newborn Quality Improvement (EMEN-QI) standards (preceding the WHO Standards for improving quality of maternal and newborn care in health facilities). 19 hospitals and health centres (2.8M catchment population) in Bangladesh, Ghana and Tanzania were involved and 24 from adjoining districts served for ‘comparison’. We interviewed 43 facility managers and 818 providers, observed 1516 client–provider interactions, reviewed 12 020 records and exit-interviewed 1826 newly delivered women. We computed a 39-criteria institutionalisation score combining clinical, patient rights and cross-cutting domains from EMEN-QI and used routine/Dis...
Background In low- and middle-income countries (LMICs), the continuum of care (CoC) for maternal,... more Background In low- and middle-income countries (LMICs), the continuum of care (CoC) for maternal, newborn, and child health (MNCH) is not always complete. This study aimed to evaluate the effectiveness of an integrated package of CoC interventions on the CoC completion, morbidity, and mortality outcomes of woman–child pairs in Ghana. Methods and findings This cluster-randomized controlled trial (ISRCTN: 90618993) was conducted at 3 Health and Demographic Surveillance System (HDSS) sites in Ghana. The primary outcome was CoC completion by a woman–child pair, defined as receiving antenatal care (ANC) 4 times or more, delivery assistance from a skilled birth attendant (SBA), and postnatal care (PNC) 3 times or more. Other outcomes were the morbidity and mortality of women and children. Women received a package of interventions and routine services at health facilities (October 2014 to December 2015). The package comprised providing a CoC card for women, CoC orientation for health worke...
<br>The database is saved as .dta (Stata 13 or above) format.The dataset contains the poole... more <br>The database is saved as .dta (Stata 13 or above) format.The dataset contains the pooled data from the baseline survey (conducted from July 1 to September 30, 2014) and the follow-up survey (conducted from October 1 to December 31, 2015). The dataset is .dta (Stata 13 or later) format.<br>
Generally, the question posed by the authors is scientifically well defined, the methods appropri... more Generally, the question posed by the authors is scientifically well defined, the methods appropriate and results supported be the data. However, there are minor essential revisions that should done; the entire manuscript also need to be proof red to make minor grammatical and typographical correction to enable the reading public better appreciate the results/findings of the paper.
Background Improving maternal and newborn health remains one of the most critical public health c... more Background Improving maternal and newborn health remains one of the most critical public health challenges, particularly in low-and lower-middle-income countries. To overcome this challenge, interventions to improve the continuum of care based on real-world settings need to be provided. The Ghana Ensure Mothers and Babies Regular Access to Care (EMBRACE) Implementation Research Team conducted a unique intervention program involving over 21 000 women to improve the continuum of care, thereby demonstrating an intervention program's effectiveness in a real-world setting. This study evaluates the implementation process of the EMBRACE intervention program based on the RE-AIM framework. Methods A cluster-randomized controlled trial was conducted in 32 sub-district-based clusters in Ghana. Interventions comprised of four components, and to evaluate the implementation process, we conducted baseline and endline questionnaire surveys for women who gave birth and lived in the study site. The key informant interviews of health workers and intervention monitoring were conducted at the health facilities in the intervention area. The data were analyzed using 34 components of the RE-AIM framework and classified under five general criteria (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Results In total, 1480 and 1490 women participated in the baseline and endline questionnaire survey, respectively. In the intervention area, 83.8% of women participated (reach). The completion rate of the continuum of care increased from 7.5% to 47.1%. Newborns who had danger signs immediately after birth decreased after the intervention (relative risk = 0.82, 95% confidence interval = 0.68-0.99) (effectiveness). In the intervention area,
The Lancet Regional Health - Western Pacific, 2020
Background: Quality care is essential for improving maternal and newborn health. Low-and middlein... more Background: Quality care is essential for improving maternal and newborn health. Low-and middleincome Pacific Island nations face challenges in delivering quality maternal and newborn care. The aim of this review was to identify all published studies of interventions which sought to improve the quality of maternal and newborn care in Pacific low-and middle-income countries. Methods: A scoping review framework was used. Databases and grey literature were searched for studies published between January 20 0 0 and July 2019 which described actions to improve the quality of maternal and newborn care in Pacific low-and middle-income countries. Interventions were categorised using a four-level health system framework and the WHO quality of maternal and newborn care standards. An expert advisory group of Pacific Islander clinicians and researchers provided guidance throughout the review process. Results: 2010 citations were identified and 32 studies included. Most interventions focused on the clinical service or organisational level, such as healthcare worker training, audit processes and improvements to infrastructure. Few addressed patient experiences or system-wide improvements. Enablers to improving quality care included community engagement, collaborative partnerships, adequate staff education and training and alignment with local priorities. Conclusions: There are several quality improvement initiatives in low-and middle-income Pacific Island nations, most at the point of health service delivery. To effectively strengthen quality maternal and newborn care in this region, effort s must broaden to improve health system leadership, deliver sustaining education programs and encompass learnings from women and their communities.
Background: Skilled birth delivery has increased up to nearly 74% in Ghana, but its quality has b... more Background: Skilled birth delivery has increased up to nearly 74% in Ghana, but its quality has been questioned over the years. As understanding women's satisfaction could be important to improving service quality, this study aimed to determine what factors were associated with women's overall satisfaction with delivery services quantitatively and qualitatively in rural Ghanaian health facilities. Results: This cross-sectional, mixed methods study used an explanatory sequential design across three Ghana Health Service research areas in 2013. Participants were women who had delivered in the preceding 2 years. Two-stage random sampling was used to recruit women for the quantitative survey. Relationships between women's socio-demographic characteristics and their overall satisfaction with health facility delivery services were examined using univariate and multiple logistic regression analyses. For qualitative analyses, women who completed the quantitative survey were purposively selected to participate in focus group discussions. Data from the focus group discussions were analyzed based on predefined and emerging themes. Overall, 1130 women were included in the quantitative analyses and 136 women participated in 15 focus group discussions. Women's mean age was 29 years. Nearly all women (94%) were satisfied with the overall services received during delivery. Women with middle level/junior high school education [adjusted odds ratio (AOR) = 0.50, 95% confidence interval (CI) = (0.26-0.98)] were less likely to be satisfied with overall delivery services compared to women with no education. Qualitatively, women were not satisfied with the unconventional demands, negative attitude, and unavailability of healthcare workers, as well as the long wait time. Conclusions: Although most women were satisfied with the overall service they received during delivery, they were not satisfied with specific aspects of the health services; therefore, higher quality service delivery is necessary to improve women's satisfaction. Additional sensitivity training and a reduction in work hours may also improve the experience of clients.
Improving maternal health is a global challenge. In Ghana, maternal morbidity and mortality rates... more Improving maternal health is a global challenge. In Ghana, maternal morbidity and mortality rates remain high, particularly in rural areas. Antenatal care (ANC) attendance is known to improve maternal health. However, few studies have updated current knowledge regarding determinants of ANC attendance. This study examined factors associated with ANC attendance in predominantly rural Ghana. We conducted a cross-sectional study at three sites (i.e. Navrongo, Kintampo, and Dodowa) in Ghana between August and September 2013. We selected 1500 women who had delivered within the two years preceding the survey (500 from each site) using two-stage random sampling. Data concerning 1497 women's sociodemographic characteristics and antenatal care attendance were collected and analyzed, and factors associated with attending ANC at least four times were identified using logistic regression analysis. Of the 1497 participants, 86% reported attending ANC at least four times, which was positively ...
Background: How does the gap in preferences between married couples affect their happiness after ... more Background: How does the gap in preferences between married couples affect their happiness after childbirth? Are couples that share similar preferences happier? In recent years, gender, marriage, and happiness have been considered to be key issues in public health research. Although much research has examined the happiness status of married couples, practically no study has explored the gender gap in relation to happiness and the preferences of married couples after childbirth. Therefore, our study was conducted to assess the association between the preference gap and the happiness status among married couples in the afterbirth period. Methods: We conducted a field experiment in rural communities in the Brong-Ahafo region of Ghana. Participants were 80 married couples who had experienced childbirth within 2 years prior to the survey. As preference indicators, we measured trust, reciprocity, altruism, and risk lovingness through an economic experiment. Then, we assessed how, for a couple, the gap between these preferences affected their happiness. Results: Wives' happiness was positively associated with the absolute value of the gap in risk lovingness between a couple (OR = 4.83, p = 0.08), while husbands' happiness was negatively associated with the gap in trust (OR = −3.58, p = 0.04) or altruism (OR = −3.33, p = 0.02). Within a couple, wives felt greater happiness than their husbands if there was a wider gap in trust (OR = 6.22, p = 0.01), reciprocity (OR = 2.80, p = 0.01), or risk lovingness (OR = 3.81, p = 0.07). Conclusions: The gender gaps in the preference indicators were found to be closely associated with the happiness levels between married couples after childbirth. For the further improvement of maternal and child health, we must consider the gender gaps between couples in relation to happiness and preferences.
Background: Health worker shortage in rural areas is one of the biggest problems of the health se... more Background: Health worker shortage in rural areas is one of the biggest problems of the health sector in Ghana and many developing countries. This may be due to fewer incentives and support systems available to attract and retain health workers at the rural level. This study explored the willingness of community health officers (CHOs) to accept and hold rural and community job postings in Ghana. Methods: A discrete choice experiment was used to estimate the motivation and incentive preferences of CHOs in Ghana. All CHOs working in three Health and Demographic Surveillance System sites in Ghana, 200 in total, were interviewed between December 2012 and January 2013. Respondents were asked to choose from choice sets of job preferences. Four mixed logit models were used for the estimation. The first model considered (a) only the main effect. The other models included interaction terms for (b) gender, (c) number of children under 5 in the household, and (d) years worked at the same community. Moreover, a choice probability simulation was performed. Results: Mixed logit analyses of the data project a shorter time frame before study leave as the most important motivation for most CHOs (β 2.03; 95 % CI 1.69 to 2.36). This is also confirmed by the largest simulated choice probability (29.1 %). The interaction effect of the number of children was significant for education allowance for children (β 0.58; 95 % CI 0.24 to 0.93), salary increase (β 0.35; 95 % CI 0.03 to 0.67), and housing provision (β 0.16; 95 % CI −0.02 to 0.60). Male CHOs had a high affinity for early opportunity to go on study leave (β 0.78; 95 % CI −0. 06 to 1.62). CHOs who had worked at the same place for a long time greatly valued salary increase (β 0.28; 95 % CI 0.09 to 0.47). Conclusions: To reduce health worker shortage in rural settings, policymakers could provide "needs-specific" motivational packages. They should include career development opportunities such as shorter period of work before study leave and financial policy in the form of salary increase to recruit and retain them.
Background Maternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan ... more Background Maternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan African countries. Both maternal and neonatal health outcomes improve when skilled personnel provide delivery services within health facilities. Determinants of delivery location are crucial to promoting health facility deliveries, but little research has been done on this issue in Ghana. This study explored factors influencing delivery location in predominantly rural communities in Ghana. Methods Data were collected from 1,500 women aged 15-49 years with live or stillbirths that occurred between January 2011 and April 2013. This was done within the three sites operating Health and Demographic Surveillance Systems, i.e., the Dodowa (Greater Accra Region), Kintampo (Brong Ahafo Region), and Navrongo (Upper-East Region) Health Research Centers in Ghana. Multivariable logistic regression was used to identify the determinants of delivery location, controlling for covariates that were statistically significant in univariable regression models.
Slow progress has been made in achieving the Millennium Development Goals 4 and 5 in Ghana. Ensur... more Slow progress has been made in achieving the Millennium Development Goals 4 and 5 in Ghana. Ensuring continuum of care (at least four antenatal visits; skilled birth attendance; postnatal care within 48 hours, at two weeks, and six weeks) for mother and newborn is crucial in helping Ghana achieve these goals and beyond. This study examined the levels and factors associated with continuum of care (CoC) completion among Ghanaian women aged 15-49. A retrospective cross-sectional survey was conducted among women who experienced live births between January 2011 and April 2013 in three regions of Ghana. In a two-stage random sampling method, 1,500 women with infants were selected and interviewed about maternal and newborn service usage in line with CoC. Multiple logistic regression models were used to assess factors associated with CoC completion. Only 8.0% had CoC completion; the greatest gap and contributor to the low CoC was detected between delivery and postnatal care within 48 hours ...
Objectives: Assess the quality of health data compiled by community health workers (CHWs) by comp... more Objectives: Assess the quality of health data compiled by community health workers (CHWs) by comparing district data summarized from data aggregated by CHWs during routine operation to data aggregated by independent researchers. Methods: Compared summary reports aggregated from patient data by CHWs (site report) to summary reports compiled by data audit experts using the same raw data (validated report). Completeness and accuracy of data from site reports, including number of antenatal care visits, postnatal follow-up visits, immunizations, and malaria cases were compared to that of independently validated reports. Predictors of data quality such as community health worker, community, and system characteristics were included in the analysis using binary logistic regression. Results: All sites provided site reports to the district health management teams, but there were significant errors in the data aggregated by CHWs. Some variables were over-reported in site reports whereas others...
Objectives: To measure the knowledge and competence of community health workers (CHWs) in perform... more Objectives: To measure the knowledge and competence of community health workers (CHWs) in performing their duties. Methods: This is a cross sectional survey study of about 150 CHWs (aged ≥19) working in 4 districts (2 intervention and 2 control) of Northern Ghana. All 4 districts have Community Health Planning Service (CHPS) compounds which provide health services at the community level. Knowledge and skills of CHWs were ascertained at the CHPS level on specific functions including postnatal and infant care, antenatal care, growth monitoring, safe delivery, postnatal care, kangaroo mother care, and education on neonatal health and survival. Univariate and multivariate analysis are carried out to compare knowledge and skills in intervention district vs control districts. Results: Community health workers (CHWs) have adequate knowledge and skills in the performance of most of their duties, but nearly all CHWs said they required urgent training in some areas (e.g. safe delivery, neonat...
Background: The advent of affordable and accessible antiretroviral (ARV) therapy HIV patients has... more Background: The advent of affordable and accessible antiretroviral (ARV) therapy HIV patients has led to the implementation of many ARV programs in many countries. This has necessitated the need to assess adherence level among ARV-users, in order to make recommendations to inform policy. Objective: To assess the challenges and opportunities for ARV adherence among ARV-users in Bolgatanga Regional Hospital of Ghana. Methods: A cross sectional survey involving clients on ART, Health providers and Non-Governmental Organisations (NGOs). Purposive systematic sampling was used selected 20 ARV-users, 9 different categories of service providers, and 2 international NGOs providing care and support to PLWH. Data was collected through administered questionnaire, observation and review of existing documents to ascertain ARV adherence in 2010. Results: Adherence level among ARV-users in Bolgatanga hospital was 90%; provider assessment through pill counts and appointments showed 95% adherence. Ch...
Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recentl... more Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; ...
We assess depression rates and investigate whether depression among HIV-infected adults receiving... more We assess depression rates and investigate whether depression among HIV-infected adults receiving antiretroviral treatment (ART) is associated with social support and HIV coping strategies in rural South Africa (SA). The study took place in a decentralised public-sector ART programme in a poor, rural area of KwaZulu-Natal, SA, with high-HIV prevalence and high-ART coverage. The 12-item General Health Questionnaire (GHQ12), validated in this setting, was used to assess depression in 272 adults recently initiated on ART. Estimates of depression prevalence ranged from 33% to 38%, depending on the method used to score the GHQ12. Instrumental social support (providing tangible factors for support, such as financial assistance, material goods or services), but not emotional social support (expressing feelings, such as empathy, love, trust or acceptance, to support a person), was significantly associated with lower likelihood of depression [adjusted odds ratio (aOR) = 0.65, 95% confidence interval (CI) 0.52-0.81, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001], when controlling for sex, age, marital status, education, household wealth and CD4 cell count. In addition, using &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;avoidance of people&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; as a strategy to cope with HIV was associated with an almost three times higher odds of depression (aOR = 2.79, CI: 1.34-5.82, P = 0.006), whereas none of the other five coping strategies we assessed was significantly associated with depression. In addition to antidepressant drug treatment, interventions enhancing instrumental social support and behavioural therapy replacing withdrawal behaviours with active HIV coping strategies may be effective in reducing the burden of depression among patients on ART.
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