Browsing by Author "Engmann, C.M."
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Item Grandmothers as gatekeepers? The role of grandmothers in influencing health-seeking for mothers and newborns in rural northern Ghana.(Global Public Health, 2015-10) Gupta, M.L.; Aborigo, R.A.; Adongo, P.B.; Rominski, S.; Hodgson, A.; Engmann, C.M.; Moyer, C.A.Previous research suggests that care-seeking in rural northern Ghana is often governed by a woman's husband or compound head. This study was designed to explore the role grandmothers (typically a woman's mother-in-law) play in influencing maternal and newborn healthcare decisions. In-depth interviews were conducted with 35 mothers of newborns, 8 traditional birth attendants and local healers, 16 community leaders and 13 healthcare practitioners. An additional 18 focus groups were conducted with stakeholders such as household heads, compound leaders and grandmothers. In this region, grandmothers play many roles. They may act as primary support providers to pregnant mothers, care for newborns following delivery, preserve cultural traditions and serve as repositories of knowledge on local medicine. Grandmothers may also serve as gatekeepers for health-seeking behaviour, especially with regard to their daughters and daughters-in-law. This research also sheds light on the potential gap between health education campaigns that target mothers as autonomous decision-makers, and the reality of a more collectivist community structure in which mothers rarely make such decisions without the support of other community members.Item Intention to deliver in a healthcare facility and healthcare facility-based delivery rates among women in Akwatia, Ghana.(International Journal of Gynecology and Obstetrics, 2011-05) Crissman, H.P.; Crespo, K.; Nimako, D.; Domena, J.; Engmann, C.M.; Adanu, R.M.; Moyer, C.A.No abstractItem "it's up to the woman's people": How social factors influence facility-based delivery in Rural Northern Ghana(Maternal and Child Health Journal, 2014-01) Moyer, C.A.; Adongo, P.B.; Aborigo, R.A.; Hodgson, A.; Engmann, C.M.; Devries, R.To explore the impact of social factors on place of delivery in northern Ghana. We conducted 72 in-depth interviews and 18 focus group discussions in the Upper East Region of northern Ghana among women with newborns, grandmothers, household heads, compound heads, community leaders, traditional birth attendants, traditional healers, and formally trained healthcare providers. We audiotaped, transcribed, and analyzed interactions using NVivo 9.0. Social norms appear to be shifting in favor of facility delivery, and several respondents indicated that facility delivery confers prestige. Community members disagreed about whether women needed permission from their husbands, mother-in-laws, or compound heads to deliver in a facility, but all agreed that women rely upon their social networks for the economic and logistical support to get to a facility. Socioeconomic status also plays an important role alone and as a mediator of other social factors. Several "meta themes" permeate the data: (1) This region of Ghana is undergoing a pronounced transition from traditional to contemporary birth-related practices; (2) Power hierarchies within the community are extremely important factors in women's delivery experiences ("someone must give the order"); and (3) This community shares a widespread sense of responsibility for healthy birth outcomes for both mothers and their babies. Social factors influence women's delivery experiences in rural northern Ghana, and future research and programmatic efforts need to include community members such as husbands, mother-in-laws, compound heads, soothsayers, and traditional healers if they are to be maximally effective in improving women's birth outcomes. © 2013 Springer Science+Business Media New York.Item Neonatal near-misses in Ghana: a prospective, observational, multi-center study(BMC Pediatrics, 2019-12-23) Oppong, S.A.; Bakari, A.; Bell, A.J.; Bockarie, Y.; Wobil, P.; Plange-Rhule, G.; Goka, B.Q.; Engmann, C.M.; Adanu, R.M.; Moyer, C.A.Background: For every newborn who dies within the first month, as many as eight more suffer life-threatening complications but survive (termed ‘neonatal near-misses’ (NNM)). However, there is no universally agreed-upon definition or assessment tool for NNM. This study sought to describe the development of the Neonatal Near-Miss Assessment Tool (NNMAT) for low-resource settings, as well as findings when implemented in Ghana. Methods: This prospective, observational study was conducted at two tertiary care hospitals in southern Ghana from April – July 2015. Newborns with evidence of complications and those admitted to the NICUs were screened for inclusion using the NNMAT. Incidence of suspected NNM at enrollment and confirmed near-miss (surviving to 28 days) was determined and compared against institutional neonatal mortality rates. Suspected NNM cases were compared with newborns not classified as a suspected near-miss, and all were followed to 28 days to determine odds of survival. Confirmed near-misses were those identified as suspected near-misses at enrollment who survived to 28 days. The main outcome measures were incidence of NNM, NNM:mortality ratio, and factors associated with NNM classification. Results: Out of 394 newborns with complications, 341 (86.5%) were initially classified as suspected near-misses at enrollment using the NNMAT, with 53 (13.4%) being classified as a non-near-miss. At 28-day follow-up, 68 (17%) had died, 52 (13%) were classified as a non-near-miss, and 274 were considered confirmed near-misses. Those newborns with complications who were classified as suspected near-misses using the NNMAT at enrollment had 12 times the odds of dying before 28 days than those classified as non-near-misses. While most confirmed near-misses qualified as NNM via intervention-based criteria, nearly two-thirds qualified based on two or more of the four NNMAT categories. When disaggregated, the most predictive elements of the NNMAT were gestational age < 33 weeks, neurologic dysfunction, respiratory dysfunction, and hemoglobin < 10 gd/dl. The ratio of near-misses to deaths was 0.55: 1, yet this varied across the study sites. Conclusions: This research suggests that the NNMAT is an effective tool for assessing neonatal near-misses in lowresource settings. We believe this approach has significant systems-level, continuous quality improvement, clinical and policy-level implications.Item The relationship between facility-based delivery and maternal and neonatal mortality in Sub-Saharan Africa(International Journal of Gynecology and Obstetrics, 2013-06) Moyer, C.A.; Adanu, R.M.; Engmann, C.M.Item 'They treat you like you are not a human being': Maltreatment during labour and delivery in rural northern Ghana(2014) Moyer, C.A.; Adongo, P.B.; Aborigo, R.A.; Hodgson, A.; Engmann, C.M.To explore community and health-care provider attitudes towards maltreatment during delivery in rural northern Ghana, and compare findings against The White Ribbon Alliance's seven fundamental rights of childbearing women. Design: a cross-sectional qualitative study using in-depth interviews and focus groups. Setting: the Kassena-Nankana District of rural northern Ghana between July and October 2010. Participants: 128 community members, including mothers with newborn infants, grandmothers, household heads, compound heads, traditional healers, traditional birth attendants, and community leaders, as well as 13 formally trained health-care providers. Measurements and findings: 7 focus groups and 43 individual interviews were conducted with community members, and 13 individual interviews were conducted with health-care providers. All interviews were transcribed verbatim and entered into NVivo 9.0 for analysis. Despite the majority of respondents reporting positive experiences, unprompted, maltreatment was brought up in 6 of 7 community focus groups, 14 of 43 community interviews, and 8 of 13 interviews with health-care providers. Respondents reported physical abuse, verbal abuse, neglect, and discrimination. One additional category of maltreatment identified was denial of traditional practices. Key conclusions: maltreatment was spontaneously described by all types of interview respondents in this community, suggesting that the problem is not uncommon and may dissuade some women from seeking facility delivery. Implications for practice: provider outreach in rural northern Ghana is necessary to address and correct the problem, ensuring that all women who arrive at a facility receive timely, professional, non-judgmental, high-quality delivery care. © 2013 Elsevier Ltd.