Browsing by Author "Amoakoh-Coleman, M."

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Assessing the Effect of mHealth Interventions in Improving Maternal and Neonatal Care in Low- and Middle-Income Countries: A Systematic Review
(Public Library of Science, 2016) Sondaal, S.F.; Browne, J.L.; Amoakoh-Coleman, M.; Borgstein, A.; Miltenburg, A.S.; Verwijs, M.; Klipstein-Grobusch, K.
CONCLUSION: mHealth interventions may be effective solutions to improve maternal and neonatal service utilization. Further studies assessing mHealth's impact on maternal and neonatal outcomes are recommended. The emerging trend of strong experimental research designs with randomized controlled trials, combined with feasibility research, government involvement and integration of mHealth interventions into the healthcare system is encouraging and can pave the way to improved decision making on best practice implementation of mHealth interventions.INTRODUCTION: Maternal and neonatal mortality remains high in many low- and middle-income countries (LMIC). Availability and use of mobile phones is increasing rapidly with 90% of persons in developing countries having a mobile-cellular subscription. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This systematic review assessed the effect of mHealth interventions that support pregnant women during the antenatal, birth and postnatal period in LMIC.METHODS: The review was registered with Prospero (CRD42014010292). Six databases were searched from June 2014-April 2015, accompanied by grey literature search using pre-defined search terms linked to pregnant women in LMIC and mHealth. Quality of articles was assessed with an adapted Cochrane Risk of Bias Tool. Because of heterogeneity in outcomes, settings and study designs a narrative synthesis of quantitative results of intervention studies on maternal outcomes, neonatal outcomes, service utilization, and healthy pregnancy education was conducted. Qualitative and quantitative results were synthesized with a strengths, weaknesses, opportunities, and threats analysis.RESULTS: In total, 3777 articles were found, of which 27 studies were included: twelve intervention studies and fifteen descriptive studies. mHealth interventions targeted at pregnant women increased maternal and neonatal service utilization shown through increased antenatal care attendance, facility-service utilization, skilled attendance at birth, and vaccination rates. Few articles assessed the effect on maternal or neonatal health outcomes, with inconsistent results.
Attitudes towards abortion and decision-making capacity of pregnant adolescents: perspectives of medicine, midwifery and law students in Accra, Ghana
(The European Journal of Contraception & Reproductive Health Care, 2020-02-28) Amoakoh-Coleman, M.; Bain, L.E.; Tiendrebeogo, K-S.T.; Zweekhorst, M.B.M.; Buning, T.D-C.; Becquet, R.
Objectives: Because medical, midwifery and law students in Ghana constitute the next generation of health care and legal practitioners, this study aimed to evaluate their attitudes towards abortion and their perceptions of the decision-making capacity of pregnant adolescents. Methods: We conducted a cross-sectional survey among 340 medical, midwifery and law students. A pretested and validated questionnaire was used to collect relevant data on respondents’ sociodemographic characteristics, attitudes towards abortion and the perceived capacity and rationality of pregnant adolescents’ decisions. The v2 test of independency and Fischer’s exact test were used where appropriate. Results: We retained 331 completed questionnaires for analysis. Respondents’ mean age was 21.0 ± 2.9 years and the majority (95.5%) were of the Christian faith. Women made up 77.9% (n¼258) of the sample. Most students (70.1%) were strongly in favour of abortion if it was for health reasons. More than three-quarters (78.0%) of the students strongly disagreed on the use of abortion for the purposes of sex selection. Most respondents (89.0%) were not in favour of legislation to make abortion available on request for pregnant adolescents, with medical students expressing a more negative attitude compared with law and midwifery students (p<0.001). Over half of the midwifery students (52.6%) believed that adolescents should have full decision-making capacity regarding their pregnancy outcome, compared with law and medical students (p<0.001). Conclusion: Tensions between adolescent reproductive autonomy, the accepted culture of third party involvement (parents and partners), and the current abortion law may require keen reflection if an improvement in access to safe abortion services is envisioned.
Blood pressure patterns and body mass index status in pregnancy: An assessment among women reporting for antenatal care at the Korle-Bu Teaching hospital, Ghana
(PLoS ONE, 2017-12-06) Amoakoh-Coleman, M.; Ogum-Alangea, D.; Modey-Amoah, E.; Ntumy, M.Y.; Adanu, R.M.; Oppong, S.A.
Maternal obesity in pregnancy has been linked with increased risk of pregnancy induced hypertension (PIH). In some tertiary referral hospitals in Ghana, PIH is the leading cause of institutional maternal mortality. To evaluate blood pressure changes during pregnancy amongst different body mass index (BMI) groups and how this relates to the risk of developing PIH. Women who had a dating ultrasound before 20 weeks gestation and registering for antenatal care at the Korle-Bu Teaching Hospital in Accra, between February and December 2013 and met the inclusion criteria were recruited into a cohort study. BMI was assessed at baseline. Blood pressure measurements were taken at (±2) 24, 28 and 36 weeks. Primary outcome measure of interest during follow-up was a diagnosis of PIH at these points. BP changes during follow up at the three points were measured. Descriptive analysis of baseline factors was carried out and compared for the BMI groups. Relative risk (RR) of PIH was estimated at 95% confidence interval. Mean (SD) age for the 361 women was 30.9 (4.8) years. Incidence of PIH amongst the cohort was 10.5% (95% CI: 7.45% - 14.45%) and 40.4% and 33.0% of them were overweight Mean (SD) age for the 361 women was 30.9 (4.8) years. Incidence of PIH amongst the cohort was 10.5% (95% CI: 7.45% - 14.45%) and 40.4% and 33.0% of them were overweight Obese women have a significantly increased risk of PIH. Women should be screened at booking for obesity status. Antenatal protocols should have interventions for prevention or early detection of obesity and management of obesity to improve outcomes.
Client factors affect provider adherence to clinical guidelines during first antenatal care
(Public Library of Science, 2016) Amoakoh-Coleman, M.; Agyepong, I.A.; Zuithoff, N.P.A.; Kayode, G.A.; Grobbee, D.E.; Klipstein-Grobusch, K.; Ansah, E.K.
Background: The first antenatal clinic (ANC) visit helps to distinguish pregnant women who require standard care, from those with specific problems and so require special attention. There are protocols to guide care providers to provide optimal care to women during ANC. Our objectives were to determine the level of provider adherence to first antenatal visit guidelines in the Safe Motherhood Protocol (SMP), and assess patient factors that determine complete provider adherence. Methods: This cross-sectional study is part of a cohort study that recruited women who delivered in eleven health facilities and who had utilized antenatal care services during their pregnancy in the Greater Accra region of Ghana. A record review of the first antenatal visit of participants was carried out to assess the level of adherence to the SMP, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected using a questionnaire. Percentages of adherence levels and baseline characteristics were estimated and cluster-adjusted odds ratios (OR) calculated to identify determinants. Results: A total of 948 women who had delivered in eleven public facilities were recruited with a mean age (SD) of 28.2 (5.4) years. Overall, complete adherence to guidelines pertained to only 48.1% of pregnant women. Providers were significantly more likely to completely adhere to guidelines when caring for multiparous women [OR = 5.43 (1.69-17.44), p<0.01] but less likely to do so when attending to women with history of previous pregnancy complications [OR = 0.50 (0.33-0.75), p<0.01]. Conclusion: Complete provider adherence to first antenatal visit guidelines is low across different facility types in the Greater Accra region of Ghana and is determined by parity and history of previous pregnancy complication. Providers should be trained and supported to adhere to the guidelines during provision of care to all pregnant women.
Completeness and accuracy of data transfer of routine maternal health services data in the greater Accra region
(BioMed Central Ltd., 2015) Amoakoh-Coleman, M.; Kayode, G.A.; Brown-Davies, C.; Agyepong, I.A.; Grobbee, D.E; Klipstein-Grobusch, K.; Ansah, E.K.
Background: High quality routine health system data is essential for tracking progress towards attainment of the Millennium Development Goals 4 & 5. This study aimed to determine the completeness and accuracy of transfer of routine maternal health service data at health facility, district and regional levels of the Greater Accra Region of Ghana. Methods: A cross sectional study was conducted using secondary data comprised of routine health information data collected at facility level for the first quarter of 2012. Twelve health facilities were selected using a multistage sampling method. Data relating to antenatal care and delivery were assessed for completeness and accuracy of data transfer. Primary source data from health facility level (registers and record notebooks where health information data are initially entered), used as the reference data, were counted, collated, and compared with aggregate data on aggregate forms compiled from these sources by health facility staff. The primary source data was also compared with data in the district health information management system (DHIMS-II), a web-based data collation and reporting system. Percentage completeness and percentage error in data transfer were estimated. Results: Data for all 5,537 antenatal registrants and 3, 466 deliveries recorded into the primary source for the first quarter of 2012 were assessed. Completeness was best for age data, followed by data on parity and hemoglobin at registration. Mean completeness of the facility level aggregate data for the data sampled, was 94.3% (95% CI = 90.6% - 98.0%) and 100.0% respectively for the aggregate form and DHIMS-II database. Mean error in data transfer was 1.0% (95% CI = 0.8% - 1.2%). Percentage error comparing aggregate form data and DHIMS-II data respectively to the primary source data ranged from 0.0% to 4.9% respectively, while percentage error comparing the DHIMS-II data to aggregate form data, was generally very low or 0.0%. Conclusion: Routine maternal health services data in the Greater Accra region, available at the district level through the DHIMS-II system is complete when compared to facility level primary source data and reliable for use.
Completeness of obstetric referral letters/notes from subdistrict to district level in three rural districts in Greater Accra region of Ghana: an implementation research using mixed methods
(BMJ Open, 2019-09-13) Amoakoh-Coleman, M.; Ansah, E.; Klipstein-Grobusch, K.; Arhinful, D.
Objective To assess the completeness of obstetric referral letters/notes at the district level of healthcare. Design An implementation research within three districts in Greater Accra region using mixed methods. During baseline and intervention phases, referral processes for all obstetric referrals from lower level facilities seen at the district hospitals were documented including indications for referrals, availability and completeness of referral notes/forms. An assessment of before and after intervention availability and completeness of referral forms was carried out. Focus group discussions, nonparticipant observations and in-depth interviews with health workers and pregnant women were conducted for qualitative data. Setting Three (3) districts in the Greater Accra region of Ghana. Participants Pregnant women referred from lower levels of care to and seen at the district hospital, health workers within the three districts and pregnant women attending antenatal clinic in the district and their family members or spouses. Intervention An enhanced interfacility referral communication system consisting of training, provision of communication tools for facilities, formation of hospital referral teams and strengthening feedback mechanisms. Outcome Completeness of obstetric referral letters/notes. Results Proportion of obstetric referrals with referral notes improved from 27.2% to 44.3% from the baseline to intervention period. Mean completeness (95% CI) of all forms was 71.3% (64.1% to 78.5%) for the study period, improving from 70.7% (60.4% to 80.9%) to 71.9% (61.1% to 82.7%) from baseline to intervention periods. Health workers reported they do not always provide referral notes and that most referral notes are not completely filled due to various reasons. Conclusions Most obstetric referrals did not have referral notes. The few notes provided were not completely filled. Interventions such as training of health workers, regular review of referral processes and use of electronic records can help improve both the provision of and completeness of the referral notes.
Contextual risk factors for low birth weight: A multilevel analysis
(Public Library of Science, 2014) Kayode, G.A.; Amoakoh-Coleman, M.; Akua Agyepong, L.; Ansah, E.; Grobbee, D.E; Klipstein-Grobusch, K.
Background: Low birth weight (LBW) remains to be a leading cause of neonatal death and a major contributor to infant and under-five mortality. Its prevalence has not declined in the last decade in sub-Saharan Africa (SSA) and Asia. Some individual level factors have been identified as risk factors for LBW but knowledge is limited on contextual risk factors for LBW especially in SSA. Methods: Contextual risk factors for LBW in Ghana were identified by performing multivariable multilevel logistic regression analysis of 6,900 mothers dwelling in 412 communities that participated in the 2003 and 2008 Demographic and Health Surveys in Ghana. Results: Contextual-level factors were significantly associated with LBW: Being a rural dweller increased the likelihood of having a LBW infant by 43% (OR 1.43; 95% CI 1.01-2.01; P-value <0.05) while living in poverty-concentrated communities increased the risk of having a LBW infant twofold (OR 2.16; 95% CI 1.29-3.61; P-value <0.01). In neighbourhoods with a high coverage of safe water supply the odds of having a LBW infant reduced by 28% (OR 0.74; 95% CI 0.57-0.96; P-value <0.05). Conclusion: This study showed contextual risk factors to have independent effects on the prevalence of LBW infants. Being a rural dweller, living in a community with a high concentration of poverty and a low coverage of safe water supply were found to increase the prevalence of LBW infants. Implementing appropriate community-based intervention programmes will likely reduce the occurrence of LBW infants.
Corporate Governance in South Africa”, In: Corporate Governance, edited by Alexander N. Kostyuk, Udo C. Braendle and Rodofo Apreda
(Virtus Interpress, pp.227-237, 2007) Kyereboah-Coleman, A; Amoakoh-Coleman, M.
A critical review of intervention and policy effects on the health of older people in sub-Saharan Africa
(Social Science & Medicine, 2020-02-27) Amoakoh-Coleman, M.; Lloyd-Sherlock, P.
This paper provides a critical review of publications containing information about specific health effects on older adults of interventions and policies in sub-Saharan Africa. Interventions and policies fell into the following categories: testing or treating HIV, the provision of pensions, screening for non-communicable diseases (NCDs), health service financing and interventions related to visual conditions. The review finds that the relevant literature is very limited relative to the size of older populations in the region. Conditions of particular relevance to older adults, such as NCDs, are under-represented and most studies treat older people as a single category, typically including all adults aged 50 and over. The paper concludes that evidence about the health effects of interventions and policies on the region's rapidly growing older populations remains minimal, and that this both reflects and reinforces a bias against older people in health policy.
Diabetes self-management education interventions and self-management in low resource settings; a mixed methods study
(PLOS ONE, 2023) Lamptey, R.; Amoakoh-Coleman, M.; Djobala, B.; Grobbee, D.E.; Adjei, G.O.; Klipstein-Grobusch, K.
Introduction Diabetes is largely a self-managed disease; thus, care outcomes are closely linked to self management behaviours. Structured self-management education (DSME) interventions are, however, largely unavailable in Africa. Aim We sought to characterise DSME interventions in two urban low-resource primary settings; and to explore diabetes self-management knowledge and behaviours, of persons living with diabetes (PLD). Research design and methods A convergent parallel mixed-methods study was conducted between January and February 2021 in Accra, Ghana. The sampling methods used for selecting participants were total enu meration, consecutive sampling, purposive and judgemental sampling. Multivariable regres sion models were used to study the association between diabetes self-management knowledge and behaviours. We employed inductive content analysis of informants’ experi ences and context, to complement the quantitative findings. Results In total, 425 PLD (70.1% (n = 298) females, mean age 58 years (SD 12), with a mean blood glucose of 9.4 mmol/l (SD 6.4)) participated in the quantitative study. Two managers, five professionals, two diabetes experts and 16 PLD participated in in-depth interviews. Finally, 24 PLD were involved in four focus group discussions. The median diabetes self-manage ment knowledge score was 40% ((IQR 20–60). For every one unit increase in diabetes self management knowledge, there were corresponding increases in the diet (5%;[95% CI: 2%- 9%, p<0.05]), exercise (5%; [95% CI:2%-8%, p<0.05]) and glucose monitoring (4%;[95% CI:2%-5%, p<0.05]) domains of the diabetes self-care activities scale respectively. The DSME interventions studied, were unstructured and limited by resources. Financial con straints, conflicting messages, beliefs, and stigma were the themes underpinning self-man agement behaviour. Conclusions The DSME interventions studied were under-resourced, and unstructured. Diabetes self management knowledge though limited, was associated with self-management behaviour. DSME interventions in low resource settings should be culturally tailored and should incor porate sessions on mitigating financial constraints. Future studies should focus on creating structured DSME interventions suited to resource-constrained settings.
The effect of anmHealth clinical decision-making support systemon neonatal mortality in a low resource setting: A cluster-randomized controlled trial
(EClinicalMedicine, 2018-03-28) Amoakoh-Coleman, M.; Amoakoh, H.B.; Klipstein-Grobusch, K.; Agyepong, I.A.; Zuithoff, N.P.A.; Kayode, G.A.; Sarpong, C.; Reitsma, J.B.; Grobbee, D.E.; Ansah, E.K.
Background: MHealth interventions promise to bridge gaps in clinical care but documentation of their effectiveness is limited. We evaluated the utilization and effect of an mhealth clinical decision-making support intervention that aimed to improve neonatal mortality in Ghana by providing access to emergency neonatal protocols for frontline health workers. Methods: In the Eastern Region of Ghana, sixteen districtswere randomized into two study arms (8 intervention and 8 control clusters) in a cluster-randomized controlled trial. Institutional neonatal mortality data were extracted from the District Health Information System-2 during an 18-month intervention period. We performed an intention-to-treat analysis and estimated the effect of the intervention on institutional neonatalmortality (primary outcomemeasure) using grouped binomial logistic regression with a random intercept per cluster. This trial is registered at ClinicalTrials.gov (NCT02468310) and Pan African Clinical Trials Registry (PACTR20151200109073). Findings: There were 65,831 institutional deliveries and 348 institutional neonatal deaths during the study period. Overall, 47∙3% of deliveries and 56∙9% of neonatal deaths occurred in the intervention arm. During the intervention period, neonatal deaths increased from 4∙5 to 6∙4 deaths and, from3∙9 to 4∙3 deaths per 1000 deliveries in the intervention armand control arm respectively. The odds of neonatal deathwas 2⋅09 (95% CI (1∙00;4∙38); p=0∙051) times higher in the intervention arm compared to the control arm (adjusted odds ratio). The correlation between the number of protocol requests and the number of deliveries per intervention cluster was 0∙71 (p = 0∙05). Interpretation: The higher risk of institutional neonatal death observed in intervention clustersmay be due to problems with birth and death registration, unmeasured and unadjusted confounding, and unintended use of the intervention. The findings underpin the need for careful and rigorous evaluation of mHealth intervention implementation and effects.
Gestational diabetes mellitus among women attending prenatal care at Korle-Bu Teaching Hospital, Accra, Ghana
(International Journal of Gynecology and Obstetrics, 2015-08) Oppong, S.A.; Ntumy, M.Y.; Amoakoh-Coleman, M.; Ogum-Alangea, D.; Modey-Amoah, E.
Objective To determine the burden of gestational diabetes mellitus (GDM) among pregnant women in Accra, Ghana. Methods The present cross-sectional study enrolled women at 20-24 weeks of pregnancy attending their first prenatal clinic at Korle-Bu Teaching Hospital, Accra, between March and November 2013. Participants underwent a 2-hour, 75-g oral glucose tolerance test between 24 and 28 weeks. The odds of GDM among different body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) groupings were calculated in a multiple logistic regression model. Results Among 399 women screened, 37 (9.3%) had GDM. Compared with women with a BMI in the normal range (18.50-24.99), obese women (BMI > 30.0) had an increased risk of GDM (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.08-8.20; P = 0.034]; overweight women (BMI 25.00-29.99) had a slightly elevated risk (OR 1.20, 95% CI 0.41-3.55; P = 0.742). Maternal age, parity, education, employment status, place of residence, and previous pregnancy complications did not affect the risk of GDM. Conclusion GDM was found in 10% of pregnant women in Accra. Women who were obese by 20-24 weeks of pregnancy had a significantly increased risk of GDM. © 2015 International Federation of Gynecology and Obstetrics.
Impact of antenatal care on severe maternal and neonatal outcomes in pregnancies complicated by preeclampsia and eclampsia in Ghana
(Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2023) Beyuo, T.K; Oppong, S.A.; Amoakoh-Coleman, M.; et al.
Objectives: To explore how specific measures of antenatal care utilization are associated with outcomes in pregnancies complicated by preeclampsia and eclampsia in Ghana. Study Design: Participants were adult pregnant women with preeclampsia or eclampsia at a tertiary hospital in Ghana. Antenatal care utilization measures included timing of first visit, total visits, facility and provider type, and referral status. Antenatal visits were characterized by former and current World Health Organization rec ommendations, and by gestational age-based adequacy. Main Outcome Measures: Composites of maternal complications and poor neonatal outcomes. Multivariate logistic regressions identified associations with antenatal care factors. Results: Among 1176 participants, median number of antenatal visits was 5.0 (IQR 3.0–7.0), with 72.9% attending ≥4 visits, 19.4% attending ≥8 visits, and 54.9% attending adequate visits adjusted for gestational age. Care was most frequently provided in a government polyclinic (n = 522, 47.2%) and by a midwife (n = 704, 65.1%). Odds of the composite maternal complications were lower in women receiving antenatal care at a tertiary hospital (aOR 0.47, p = 0.01). Odds of poor neonatal outcomes were lower in women receiving antenatal care at a tertiary hospital (aOR 0.56, p < 0.001), by a specialist Obstetrician/Gynecologist (aOR 0.58, p < 0.001), and who attended ≥8 visits (aOR 0.67, p = 0.04). Referred women had twice the odds of a maternal complication (aOR 2.12, p = 0.007) and poor neonatal outcome (aOR 1.68, p = 0.002). Conclusions: Fewer complications are seen after receiving antenatal care at tertiary facilities. Attending ≥8 visits reduced poor neonatal outcomes, but didn’t impact maternal complications. Quality, not just quantity, of antenatal care is essential.
Individual and community determinants of neonatal mortality in Ghana: a multilevel analysis
(2014-05-12) Kayode, G.A.; Ansah, E.; Agyepong, I.A.; Amoakoh-Coleman, M.; Grobbee, D.E.; Klipstein-Grobusch, K.
Abstract Background Neonatal mortality is a global challenge; identification of individual and community determinants associated with it are important for targeted interventions. However in most low and middle income countries (LMICs) including Ghana this problem has not been adequately investigated as the impact of contextual factors remains undetermined despite their significant influence on under-five mortality and morbidity. Methods Based on a modified conceptual framework for child survival, hierarchical modelling was deployed to examine about 6,900 women, aged 15 – 49 years (level 1), nested within 412 communities (level 2) in Ghana by analysing combined data of the 2003 and 2008 Ghana Demographic and Health Survey. The aim was to identify individual (maternal, paternal, neonatal, antenatal, delivery and postnatal) and community (socioeconomic disadvantage communities) determinants associated with neonatal mortality. Results The results showed both individual and community characteristics to be associated with neonatal mortality. Infants of multiple-gestation [OR 5.30; P-value < 0.001; 95% CI 2.81 – 10.00], neonates with inadequate birth spacing [OR 3.47; P-value < 0.01; 95% CI 1.60 – 7.57] and low birth weight [OR 2.01; P-value < 0.01; 95% CI 1.23 – 3.30] had a lower chance of surviving the neonatal period. Similarly, infants of grand multiparous mothers [OR 2.59; P-value < 0.05; 95% CI 1.03 – 6.49] and non-breastfed infants [OR 142.31; P-value < 0.001; 95% CI 80.19 – 252.54] were more likely to die during neonatal life, whereas adequate utilization of antenatal, delivery and postnatal health services [OR 0.25; P-value < 0.001; 95% CI 0.13 – 0.46] reduced the likelihood of neonatal mortality. Dwelling in a neighbourhood with high socioeconomic deprivation was associated with increased neonatal mortality [OR 3.38; P-value < 0.01; 95% CI 1.42 – 8.04]. Conclusion Both individual and community characteristics show a marked impact on neonatal survival. Implementation of community-based interventions addressing basic education, poverty alleviation, women empowerment and infrastructural development and an increased focus on the continuum-of-care approach in healthcare service will improve neonatal survival.
Individual and community determinants of neonatal mortality in Ghana: A multilevel analysis
(BMC Pregnancy and Childbirth, 2014) Kayode, G.A.; Ansah, E.; Agyepong, I.A.; Amoakoh-Coleman, M.; Grobbee, D.E.; Klipstein-Grobusch, K.
Neonatal mortality is a global challenge; identification of individual and community determinants associated with it are important for targeted interventions. However in most low and middle income countries (LMICs) including Ghana this problem has not been adequately investigated as the impact of contextual factors remains undetermined despite their significant influence on under-five mortality and morbidity.Methods: Based on a modified conceptual framework for child survival, hierarchical modelling was deployed to examine about 6,900 women, aged 15 - 49 years (level 1), nested within 412 communities (level 2) in Ghana by analysing combined data of the 2003 and 2008 Ghana Demographic and Health Survey. The aim was to identify individual (maternal, paternal, neonatal, antenatal, delivery and postnatal) and community (socioeconomic disadvantage communities) determinants associated with neonatal mortality.Results: The results showed both individual and community characteristics to be associated with neonatal mortality. Infants of multiple-gestation [OR 5.30; P-value < 0.001; 95% CI 2.81 - 10.00], neonates with inadequate birth spacing [OR 3.47; P-value < 0.01; 95% CI 1.60 - 7.57] and low birth weight [OR 2.01; P-value < 0.01; 95% CI 1.23 - 3.30] had a lower chance of surviving the neonatal period. Similarly, infants of grand multiparous mothers [OR 2.59; P-value < 0.05; 95% CI 1.03 - 6.49] and non-breastfed infants [OR 142.31; P-value < 0.001; 95% CI 80.19 - 252.54] were more likely to die during neonatal life, whereas adequate utilization of antenatal, delivery and postnatal health services [OR 0.25; P-value < 0.001; 95% CI 0.13 - 0.46] reduced the likelihood of neonatal mortality. Dwelling in a neighbourhood with high socioeconomic deprivation was associated with increased neonatal mortality [OR 3.38; P-value < 0.01; 95% CI 1.42 - 8.04].Conclusion: Both individual and community characteristics show a marked impact on neonatal survival. Implementation of community-based interventions addressing basic education, poverty alleviation, women empowerment and infrastructural development and an increased focus on the continuum-of-care approach in healthcare service will improve neonatal survival. © 2014 Kayode et al.; licensee BioMed Central Ltd.
Old age and depression in Ghana: assessing and addressing diagnosis and treatment gaps
(GLOBAL HEALTH ACTION, 2019-11-04) Amoakoh-Coleman, M.; Lloyd-Sherlock, P.; Agrawal, S.; Adom, S.; Adjetey-Sorsey, E.; Rocco, I.; Minicuci, N.
Background: There is limited evidence about the prevalence of depression among older people in sub-Saharan Africa, about access to treatment or the potential efficacy of community- based interventions. Objective: Using nationally representative data from the WHO SAGE survey, we examine the prevalence of and factors associated with depression among people aged 50 and over in Ghana. Compare self-reported diagnosis and a symptom algorithm to assess treatment gaps and factors associated with the size of gap. Assess the feasibility of a small community-based intervention specifically for older people. Method: Prevalence and treatment data were taken from the WHO SAGE 2007 survey in Ghana, including 4,725 people aged 50 or over. Outcomes of interest were self-reported depression and diagnosis of depression derived from a symptom-based algorithm. The data were subjected to bivariate and multivariate analysis. In parallel, a pilot intervention was conducted with 35 older people, which included screening by a trained psychiatrist and follow-up group sessions of psychotherapy. Results: The symptomatic algorithm reported an overall rate of 9.2 per cent for the study population, with associations with female sex and older age. The treatment gap for these cases was found to be 83.0 per cent. The implementation of the pilot study was perceived as effective and replicable by stakeholders and there was some evidence of enhanced outcomes for people with mild depression. Conclusions: Large numbers of older people in Ghana experience depression, but very few have access to treatment. There is an urgent need to develop and validate community-based services for older people experiencing this condition.
Predictors of skilled attendance at delivery among antenatal clinic attendants in Ghana: A cross-sectional study of population data
(BMJ Open, 2015-05) Amoakoh-Coleman, M.; Ansah, E.K.; Agyepong, I.A.; Grobbee, D.E.; Kayode, G.A.; Klipstein-Grobusch, K.
Objective: To identify demographic, maternal and community predictors of skilled attendance at delivery among women who attend antenatal clinic at least once during their pregnancy in Ghana. Design: A cross-sectional study using the 2008 Ghana Demographic and Health Survey (DHS) data. We used frequencies for descriptive analysis, χ2 test for associations and logistic regression to identify significant predictors. Predictive models were built with estimation of area under the receiver operating characteristic curves (AUC). Setting: Ghana. Participants: A total of 2041 women who had a live birth in the 5 years preceding the survey, and attended an antenatal clinic having a skilled provider, at least once, during the pregnancy. Outcome: Skilled attendance at delivery. Results: Overall, 60.5% (1235/2041) of women in our study sample reported skilled attendance at delivery. Significant positive associations existed between skilled attendance at delivery and the variables such as maternal educational level, wealth status class, ever use of contraception, previous pregnancy complications and health insurance coverage (p<0.001). Significant predictors of skilled attendance were wealth status class, residency, previous delivery complication, health insurance coverage and religion in a model with AUC (95% CI) of 0.85 (0.83 to 0.88). Conclusions: Women less likely to have skilled attendance at delivery can be identified during antenatal care by using data on wealth status class, health insurance coverage, residence, history of previous birth complications and religion, and targeted with interventions to improve skilled attendance at delivery. © 2015, BMJ Publishing Group. All rights reserved.
Prognostic models for adverse pregnancy outcomes in low-income and middle-income countries: a systematic review
(BMJ Global Health, 2019-10-05) Amoakoh-Coleman, M.; Heestermans, T.; Payne, B.; Kayode, G.A.; Schuit, E.; Rijken, M.J.; Klipstein-Grobusch, K.; Bloemenkamp, K.; Grobbee, D.E.; Browne, J.L.
Introduction Ninety-nine per cent of all maternal and neonatal deaths occur in low-income and middle-income countries (LMIC). Prognostic models can provide standardised risk assessment to guide clinical management and can be vital to reduce and prevent maternal and perinatal mortality and morbidity. This review provides a comprehensive summary of prognostic models for adverse maternal and perinatal outcomes developed and/or validated in LMIC. Methods A systematic search in four databases (PubMed/ Medline, EMBASE, Global Health Library and The Cochrane Library) was conducted from inception (1970) up to 2 May 2018. Risk of bias was assessed with the PROBAST tool and narratively summarised. Results 1741 articles were screened and 21 prognostic models identified. Seventeen models focused on maternal outcomes and four on perinatal outcomes, of which hypertensive disorders of pregnancy (n=9) and perinatal death including stillbirth (n=4) was most reported. Only one model was externally validated. Thirty different predictors were used to develop the models. Risk of bias varied across studies, with the item ‘quality of analysis’ performing the least. Conclusion Prognostic models can be easy to use, informative and low cost with great potential to improve maternal and neonatal health in LMIC settings. However, the number of prognostic models developed or validated in LMIC settings is low and mirrors the 10/90 gap in which only 10% of resources are dedicated to 90% of the global disease burden. External validation of existing models developed in both LMIC and high-income countries instead of developing new models should be encouraged.
Provider adherence to first antenatal care guidelines and risk of pregnancy complications in public sector facilities: A Ghanaian cohort study
(BioMed Central Ltd., 2016) Amoakoh-Coleman, M.; Klipstein-Grobusch, K.; Agyepong, I.A.; Kayode, G.A.; Grobbee, D.E.; Ansah, E.K.
Background: Guideline utilization aims at improvement in quality of care and better health outcomes. The objective of the current study was to determine the effect of provider complete adherence to the first antenatal care guidelines on the risk of maternal and neonatal complications in a low resource setting. Methods: Women delivering in 11 health facilities in the Greater Accra region of Ghana were recruited into a cohort study. Their first antenatal visit records were reviewed to assess providers' adherence to the guidelines, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected. Participants were followed up for 6 weeks post-partum to complete data collection on outcomes. The incidence of maternal and neonatal complications was estimated. The effects of complete adherence on risk of maternal and neonatal complications were estimated and expressed as relative risks (RRs) with their 95% confidence intervals (CI) adjusted for a potential clustering effect of health facilities. Results: Overall, 926 women were followed up to 6 weeks post-partum. Mean age (SD) of participants was 28.2 (5.4) years. Complete adherence to guidelines pertained to the care of 48.5% of women. Incidence of preterm deliveries, low birth weight, stillbirths and neonatal mortality were 5.3, 6.1, 0.4 and 1.4% respectively. Complete adherence to the guidelines decreased risk of any neonatal complication [0.72 (0.65-0.93); p = 0.01] and delivery complication [0.66 (0.44-0.99), p = 0.04]. Conclusion: Complete provider adherence to antenatal care guidelines at first antenatal visit influences delivery and neonatal outcomes. While there is the need to explore and understand explanatory mechanisms for these observations, programs that promote complete adherence to guidelines will improve the pregnancy outcomes.
Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana
(BioMed Central Ltd., 2016) Amoakoh-Coleman, M.; Agyepong, I.A.; Kayode, G.A.; Grobbee, D.E.; Klipstein-Grobusch, K.; Ansah, E.K.
Background: Lack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines. Methods: A cross-sectional analysis of the baseline data of a prospective cohort study on adherence to first antenatal care visit guidelines was carried out in 11 facilities in the Greater Accra Region of Ghana. Provider adherence was studied in relation to health facility resource availability such as antenatal workload for clinical staffs, routine antenatal drugs, laboratory testing, protocols, ambulance and equipment. Results: Eleven facilities comprising 6 hospitals (54.5 %), 4 polyclinics (36.4 %) and 1 health center were randomly sampled. Complete provider adherence to first antenatal guidelines for all the 946 participants was 48.1 % (95 % CI: 41.8-54.2 %), varying significantly amongst the types of facilities, with highest rate in the polyclinics. Average antenatal workload per month per clinical staff member was higher in polyclinics compared to the hospitals. All facility laboratories were able to conduct routine antenatal tests. Most routine antenatal drugs were available in all facilities except magnesium sulphate and sulphadoxine-pyrimethamine which were lacking in some. Antenatal service protocols and equipment were also available in all facilities. Conclusion: Although antenatal workload varies across different facility types in the Greater Accra region, other health facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities. These factors therefore do not adequately account for the low and varying proportions of complete adherence to guidelines across facility types. Providers should be continually engaged for a better understanding of the barriers to their adherence to these guidelines.