Browsing by Author "Laar, A.K."

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ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: A mixed method study
(BioMed Central Ltd., 2016) Ankomah, A.; Ganle, J.K.; Lartey, M.Y.; Kwara, A.; Nortey, P.A.; Okyerefo, M.P.K.; Laar, A.K.
Background: Timely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce HIV transmission risk, HIV-related morbidity and mortality. However, there is evidence that in addition to limited supply of antiretrovirals (ARVs) and linkage to ART in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available. In Ghana, limited research evidence exists regarding the barriers HIV+ persons already linked to ART face. This paper explores ART access-related barriers that HIV+ persons linked to care in southern Ghana face. Methods: A mixed method study design, involving a cross-sectional survey and qualitative in-depth interviews, was conducted to collect data from four healthcare providers and a total of 540 adult HIV+ persons receiving ART at four treatment centres in Ghana. We used univariate analysis to generate descriptive tabulations for key variables from the survey. Data from qualitative in-depth interviews were thematically analysed. Results from the survey and in-depth interviews were brought together to illuminate the challenges of the HIV+ persons. Results: All (100%) the HIV+ persons interviewed were ARV-exposed and linked to ART. Reasons for taking ARVs ranged from beliefs that they will suppress the HIV virus, desire to maintain good health and prolong life, and desire to prevent infection in unborn children, desire both to avoid death and to become good therapeutic citizens (abide by doctors' advice). Despite this, more than half of the study participants (63.3%) reported seven major factors as barriers hindering access to ART. These were high financial costs associated with accessing and receiving ART (26%), delays associated with receiving care from treatment centres (24%), shortage of drugs and other commodities (23%), stigma (8.8%), fear of side effects of taking ARVs (7.9%), job insecurity arising from regular leave of absence to receive ART (5.3%), and long distance to treatment centres (4.9%). Conclusions: The results in this study suggest that efforts to provide and scale-up ART to all HIV+ persons must be accompanied by interventions that address structural and individual level access barriers.
ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study.
(The Open Access Publisher, 2016) Ankomah, A.; Kuumuori Ganle, J.; Lartey, M.A.; Kwara, A.; Nortey, P.A.; Okyerefo, M.P.K.; Laar, A.K.
Background Timely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce HIV transmission risk, HIV-related morbidity and mortality. However, there is evidence that in addition to limited supply of antiretrovirals (ARVs) and linkage to ART in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available. In Ghana, limited research evidence exists regarding the barriers HIV+ persons already linked to ART face. This paper explores ART access–related barriers that HIV+ persons linked to care in southern Ghana face. Methods A mixed method study design, involving a cross-sectional survey and qualitative in-depth interviews, was conducted to collect data from four healthcare providers and a total of 540 adult HIV+ persons receiving ART at four treatment centres in Ghana. We used univariate analysis to generate descriptive tabulations for key variables from the survey. Data from qualitative in-depth interviews were thematically analysed. Results from the survey and in-depth interviews were brought together to illuminate the challenges of the HIV+ persons. Results All (100%) the HIV+ persons interviewed were ARV-exposed and linked to ART. Reasons for taking ARVs ranged from beliefs that they will suppress the HIV virus, desire to maintain good health and prolong life, and desire to prevent infection in unborn children, desire both to avoid death and to become good therapeutic citizens (abide by doctors’ advice). Despite this, more than half of the study participants (63.3%) reported seven major factors as barriers hindering access to ART. These were high financial costs associated with accessing and receiving ART (26%), delays associated with receiving care from treatment centres (24%), shortage of drugs and other commodities (23%), stigma (8.8%), fear of side effects of taking ARVs (7.9%), job insecurity arising from regular leave of absence to receive ART (5.3%), and long distance to treatment centres (4.9%). Conclusions The results in this study suggest that efforts to provide and scale-up ART to all HIV+ persons must be accompanied by interventions that address structural and individual level access barriers.
Barriers and facilitators to the implementation of a community-based hypertension improvement project in Ghana: a qualitative study of ComHIP
(BMC Health Services Research, 2020-01-30) Laar, A.K.; Adler, A.J.; Kotoh, A.M.; Legido-Quigley, H.; Perel, P.; Lamptey, P.; Lange, I.L.
Background: Globally, hypertension is a leading cause of cardiovascular disease and mortality, with the majority of deaths occurring in low- and middle-income countries. Because the burden of hypertension is increasing in low resource settings with restricted infrastructure, it is imperative that new models for hypertension care are realised. One such model is the Community-based Hypertension Improvement Project (ComHIP) which employs a community-based method of task-shifting for managing hypertension. This study is a qualitative analysis of the barriers and facilitators of the main components of ComHIP. Methods: We purposively selected 55 informants for semi-structured interviews or focus group discussions, which were carried out bythree trained local researchers in Krobo, Twi or English. Informants included patients enrolled in ComHIP, health care providers and Licensed Chemical Sellers trained by ComHIP, and Ghana Health Service employees. Data were analysed using a multi-step thematic analysis. Results: While results of the effectiveness of the intervention are pending, overall, patients and nurses reported positive experiences within ComHIP, and found that it helped enable them to manage their hypertension. Healthcare providers appreciated the additional training, but had some gaps in their knowledge. Ghana Health Service employees were cautiously optimistic about the programme, but expressed some worries about the sustainability of the programme. Many informants expressed concerns over the inability of community nurses and workers to dispense anti-hypertensives, due to legal restrictions. Conclusions: The WHO recommends task-sharing as a technique for managing chronic conditions such as hypertension in resource constrained settings. ComHIP presents an example of a task-sharing programme with a high level of acceptability to all participants. Going forward, we recommend greater levels of communication and dialogue to allow community-based health workers to be allowed to dispense anti-hypertensives.
Bioethics North and South: Creating a common ground
(Ethics, Medicine and Public Health, 2018-01) Miles, S.H.; Laar, A.K.
Bioethics as practiced in Europe, the United States, and Canada has a tenuous and tentative reach into the developing countries of Africa, South America, and Asia. This paper explores the problematic translation of bioethics between the Global North and South; and between resource rich and resource poor countries. As Alexander Capron put it in 2007, bioethics has a 10/90 problem, analogizing to the observation that medical research spends 90% of its resources on problems affecting 10% of the world's population. Today, UNESCO's bioethics website says bioethics focuses on “stem cell research, genetic testing, cloning, progress in the life sciences”. Any review of the most widely cited bioethics articles and journals finds that the writing is largely centered within an enclave of first world concerns. Stem cells and cloning are neither health care nor health science priorities of developing countries. The priorities of developing countries (i.e., those that would improve the health of populations or that refer to local diseases) are marginalized. Costly and/or impractical medical infrastructure is discussed or proposed. The first-world orientation of bioethics was perhaps somewhat practicable during a post-World War II stasis, but it is increasingly dysfunctional and even dangerous in the context of twenty-first century climate change, refugee movements, and disease vector migrations. A new global bioethics is urgently needed.
Birth Preparedness and Complication Readiness Among Expectant Mothers at the Ridge Regional Hospital, Accra
(University of Ghana, 2013-07) Agbodohu, D.; Laar, A.K.
Background: Avoidable maternal mortality remains a huge burden more especially in sub-Saharan Africa. Expectant mothers are faced with life-threatening complications which a birth preparedness and complication readiness plan helps to actively avoid. Awareness of danger signs of pregnancy helps an expectant mother to make timely decisions to avoid delays that brings about complications that could result in morbidity or mortality. Objective: The main objective of the study was to assess the knowledge and practices of birth preparedness and complication readiness among expectant mothers and specifically to determine the association between socio-demographic factors and birth preparedness and complication readiness. Method: A cross sectional design was employed with a sample size of 400 expectant mothers in their 3 rd trimester at the Ridge Regional Hospital. A simple random sampling of pregnant women visiting the RRH was done using the lottery method to select the participants. Analysis was done using SPSS version 16. Results: Though many of the mothers (77.3%) were aware of the fact that they may need blood during labour only 16.4% of mothers actually had blood in the blood bank and 31.6% said they had arranged for a blood donor. There was a significant relationship between level of preparedness (p-value = 0.008) and educational level, also with ANC attendance (p = 0.032). It was observed that almost two-thirds of the respondents knew some danger signs and gave one or two examples. Two-thirds did not know anything about Eclampsia or pregnancy induced hypertension. Almost all respondents (96%) had identified a close family member as a companion when in labour. Conclusion: The respondents’demontrated little knowledge on danger signs in pregnancy and many respondents did not know about birth preparedness especially in the area of blood donation. It is suggested that strategies be put in place for effective implementation of the policy on blood donation so that by the seventh month of pregnancy every expectant mother, irrespective of her haemoglobin level must have her blood ready in the blood bank to ensure complication readiness. It is recommended that the standard for focused antenatal care is fully implemented as this will improve upon one on one provision of information and health education on danger signs in pregnancy. In doing so, there will be a general increase on the level of birth preparedness and complication readiness.
A comparative study on the availability of modern contraceptives in public and private health facilities in a peri-urban community in Ghana
( Reproductive Health, 2015-08) Adjei, K.K.; Laar, A.K.; Narh, C.T.; Abdulai, M.A.; Newton, S.; Owusu-Agyei, S.; Adjei, S.
Background Sub-Saharan Africa reports low use of family planning methods and high unmet need. Availability of these methods is one of the major barriers to contraceptive use in the region. This study determined the availability of modern contraceptives and perceived factors affecting this in health facilities in the Ga East municipality of Ghana. Methods This was a cross-sectional study involving quantitative and qualitative techniques. Data was obtained from 51 randomly selected health facilities using a checklist. Relationships between certain attributes of the facilities and availability of each category of contraceptive identified was tested using univariate and and multiple logistic regression techniques. The qualitative data was obtained by conducting in-depth interviews with the managers of the facilities and then analysed according to emerging themes. Results The study gave an indication that there was a low availability of long acting reversible contraceptives (LARC) such as implants (14 %) and IUDs (14 %) in the health facilities. Male condoms (78 %) and combined oral contraceptives (82 %) were the most available At the bivariate level, emergency contraceptives were less likely to be found in public health facilities (OR = 0.11, p = 0.05). Facility managers cited ‘profit’ and ‘preference’ as some of the reasons for availability of their contraceptives. Conclusion Availability of modern contraceptives differ according to the type and brand of contraceptive. There is however a low availability of LARC methods in all the health facilities. Factors such as ‘profit’ accounted for the low availability of this method. (PDF) A comparative study on the availability of modern contraceptives in public and private health facilities in a peri-urban community in Ghana. Available from: https://www.researchgate.net/publication/280737701_A_comparative_study_on_the_availability_of_modern_contraceptives_in_public_and_private_health_facilities_in_a_peri-urban_community_in_Ghana [accessed Sep 12 2018].
Conference on ‘Nutrition dynamics in Africa: opportunities and challenges for meeting the sustainable development goals’
(Proceedings of the Nutrition Society, 2017) Laar, A.K.; Aryeetey, R.N.O.; Mpereh, M.; Zotor, F.B.
Social protection (SP) has been demonstrated as an effective tool against poverty and severe hunger. In Ghana, SP interventions have been employed to address vulnerability to poverty since 1965. Nevertheless, its potential for enhancing nutrition has hardly been explored. To harness the cross-sectoral benefits of scaling up nutrition-sensitive actions in Ghana, the The National Development Planning Commission requested an assessment of nutrition linkages across existing SP policies and programmes. The present paper presents gaps and opportunities for improving the nutrition-sensitivity of existing SP programming in Ghana. The evidence draws heavily on desk review of available published and grey literature. The data show that SP provides an entry point for mainstreaming nutrition into other programmes. However, designing and coupling SP programmes with nutrition programmes remains a challenge in Ghana. Local SP interventions are predominantly designed as standalone services and therefore are implemented independently of each other. To increase synergy between SP and nutrition, including nutrition as an explicit objective of SP policies/strategies is recommended
Determinants of Obesity among Basic School Pupils in the Ga-East Municipality
(University of Ghana, 2014-07) Alangea, D.O.; Adanu, R.M.K.; Aryeetey, R.; Laar, A.K.; University of Ghana, College of Health Sciences , School of Public Health , Department of Community Health; University of Ghana, College of Health Sciences , School of Public Health , Department of Community Health
Background: Overweight and obesity among children is a major public health concern globally. Childhood obesity is likely to persist into adulthood. Little is known about the prevalence and determinants of overweight and obesity among school-age children in Ghana. Knowing the determinants of overweight/obesity among basic school pupils is important for obesity intervention design. Objective: To determine overweight and obesity prevalence and its risk factors among basic school pupils in the Ga-East Municipality of Ghana. Methods: A cross-sectional study involving 24 private and public basic schools in the Ga-East Municipality; 487 pupils aged 9 - 15 years and 340 parents. Data collection involved interviews with pupils, parents and head teachers, a school environmental scan and an audit of school feeding and physical activity facilities. Dietary data was collected using a one-time 24 – hour meal recall and a 7–day Food Frequency assessment. Body weight and height of pupils and their parents were measured. Physical activity level of pupils was determined using the physical activity questionnaire for children. Associations between home and school food environments and child BMI and overweight status were tested using linear and logistic regressions respectively. Results: Total overweight prevalence among basic school pupils in the Ga-East Municipality was 17.7%; 8% were obese. Overweight prevalence among parents was 59.2%. Frequency of beverage consumption (p<0.01), least physical activity level (p<0.01) and being in the middle household wealth tertile (p=0.03) significantly predicted higher child BMI after controlling for parental BMI, age, sex, and calories consumed. None of the schools assessed had a written policy on eating at school and physical activity of pupils. Over 77% of all pupil purchases made during break time were from within the school compound. Foods associated with obesity formed 46.6% of all purchases. Schools which highly promoted healthier food options had over 5 times increased odds of child overweight [AOR=5.55; 95% CI = 1.430 – 21.511, p=0.013] than schools that least promoted. Schools‘ exerting moderate control over the food options available to pupils compared to those who had least control had 84.3% reduced odds of having overweight pupils. Parental use of snacks and sweetened drinks as reward from the least to the moderate category was associated with reduced odds of child overweight (AOR = 0.282, 95% CI = 0.105 – 0.759, p<0.05). High provision of a supporting environment for physical activity (open spaces, sports field) in a school was associated with an 80.2% reduced likelihood of pupils being overweight compared to the least provision. Conclusions: The school and home environments have significant influences on child weight status beyond the individual child behavioural and background factors. The school environment offers an opportunity to reach a large child population and changes made to improve physical activity and access to healthy food can have positive impacts on child weight status.
Factors associated with suboptimal intake of some important nutrients among HIV-positive pregnant adolescents from two Ghanaian districts
(Journal of the Ghana Science Association, 2009) Laar, A.K.; Ampofo, W.K.; Tuakli, J.M.; Wonodi, C.; Asante, R.K.; Quakyi, I.A.
This study determined the daily intakes of some important nutrients and factors associated with the suboptimal intakes of these nutrients among young HIV-positive (HIV+) pregnant women from two Ghanaian districts. Eighty-jive of such women after informed consent were recruited from three hospitals and were interviewed using a structured questionnaire. Dietary intake was quantified using the 24-hour recall technique. Total intake, calculated based on dietary recall, and adequacy of intake, calculated based on intake levels compared to the RDA, were assessed. Factors potentially associated with intake were tested using the Mann Whitney U test. The median daily intakes of the nutrients of interest were as follows: Protein (63.1 g), Vitamin C (106 mg), Zinc (11.7 mg), Iron (22.2 mg), and Selenium (1.4 micrograms). The prevalence of inadequacy of these nutrients were: Vitamin C (35.3%), Protein (39.7%), Iron (72.9%), Selenium (97.6%), and Zinc (100%). HIV + women with nausea, vomiting, and oral lesions had significantly lower intakes of Protein, Iron and Zinc (p < 0.05). Inadequacy of dietary intake is very prevalent among this group of pregnant women particularly among those with nausea, vomiting, and oral lesions. These conditions could be significant contributors to the burden of nutrient deficiencies among women infected with HIV in this setting. Since deficiencies of these nutrients during pregnancy could lead to adverse pregnancy outcomes, emphasis on the dietary sources of these nutrients such as fish, peas, nuts, kontomire, whole grain cereals, seafood, onions, milk, garlic, alfalfa, mushrooms, and banana should be made during antenatal counseling.
Family planning, abortion and HIV in Ghanaian print media: a 15-month content analysis of National Ghanaian Newspaper
(African Journal of Reproductive Health, 2010) Laar, A.K.
This study assessed coverage of reproductive health (RH) issues – family planning (FP), abortion, and HIV— in the Ghanaian Daily Graphic newspaper. Using the composite week sampling technique, the researcher analyzed the contents of 62 editions of the paper. Prominence was measured using various attributes, and differences in mean coverage over time were assessed using analysis of variance. This review shows that coverage of RH issues was extraordinarily poor, less than 1 percent each for FP, abortion, and HIV. RH news that was covered was given little prominence. These findings support the popular impression that the Daily Graphic does not give priority to reproductive health issues in its coverage. RH advocates need to develop innovative means of integrating RH content into existing media outlets.
Food availability, accessibility and dietary practices during the COVID-19 pandemic: a multi-country survey
(Cambridge University Press, 2021) Jafri, A.; Mathe, N.; Aglago, E.K.; Konyole, S.O.; Ouedraogo, M.; Audain, K.; Zongo, U.; Laar, A.K.; Johnson, J.; Sanou, D.
Objective: To investigate the perceived effects of the coronavirus disease (COVID-19) pandemic lockdown measures on food availability, accessibility, dietary practices and strategies used by participants to cope with these measures. Design: We conducted a cross-sectional multi-country online survey between May and July 2020. We used a study-specific questionnaire mainly based on the adap tation of questions to assess food security and coping strategies from the World Food Programme’s ‘Emergency Food Security Assessment’ and ‘The Coping Strategy Index’. Setting: The questionnaire was hosted online using Google Forms and shared using social media platforms. Participants: A total of 1075 adult participants from eighty-two countries com pleted the questionnaire. Results: As a prelude to COVID-19 lockdowns, 62·7 % of the participants reported to have stockpiled food, mainly cereals (59·5 % of the respondents) and legumes (48·8 %). An increase in the prices of staples, such as cereals and legumes, was widely reported. Price increases have been identified as an obstacle to food acquisition by 32·7 % of participants. Participants reported having lesser variety (50·4 %), quality (30·2 %) and quantity (39·2 %) of foods, with disparities across regions. Vulnerable groups were reported to be facing some struggle to acquire adequate food, especially people with chronic diseases (20·2 %), the elderly (17·3 %) and children (14·5 %). To cope with the situation, participants mostly relied on less preferred foods (49 %), reduced portion sizes (30 %) and/or reduced the number of meals (25·7 %). Conclusions: The COVID-19 pandemic negatively impacted food accessibility and availability, altered dietary practices and worsened the food insecurity situation, particularly in the most fragile regions.
Food elimination, food substitution, and nutrient supplementation among ARV-exposed HIV-positive persons in southern Ghana
(Journal of health, population, and nutrition, 2018-12) Laar, A.K.; Lartey, M.Y.; Ankomah, A.; Okyerefo, M.P.K.; Ampah, E.A.; Letsa, D.P.; Nortey, P.A.; Kwara, A.
Background Optimal nutrition is a determinant of health in all persons. In persons living with HIV (PLHIV), nutrition is particularly important. Various factors, including dietary practices, play a role in guaranteeing nutritional health. Objectives We investigated multiple non-prescription drugs use among HIV-positive persons receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. This paper, however, focuses on nutrient supplement use, food elimination, and food substitution practices by the PLHIV. Methods Using quantitative and qualitative methods, we collected data from 540 HIV-positive persons at the health facility level. This paper focuses on only the quantitative data. Individual study participants were selected using a systematic random sampling procedure. Participants were interviewed after informed consent. We used univariate analysis to generate descriptive tabulations for key variables. Multivariable logistic regression modeling identified predictors of three practices (nutrient supplementation, food elimination, and food substitution). P value less than 0.05 or 95% confidence intervals facilitated determination of statistical significance. All analyses were performed using IBM SPSS Statistics for Windows, version 20.0. Results The use of nutrient supplements was a popular practice; 72% of the PLHIV used various kinds. The primary motive for the practice was to boost appetite and to gain weight. A little over 20% of the participants reportedly eliminated certain foods and beverages, while 17% introduced new foods since their initial HIV diagnosis. All the three practices were largely driven by the quest for improved health status. We determined predictors of nutrient supplementation to be ART clinic location and having an ART adherence monitor. Having an ART adherence monitor was significantly associated with reduced odds of nutrient supplementation (AOR = 0.34; 95% CI 0.12–0.95). The only predictor for food elimination was education level (AOR = 0.29; 95% CI 0.30–0.92); predictors of food substitution were ART clinic location (AOR = 0.11; 95% CI 0.02–0.69) and anemia (defined as hemoglobin concentration less than 11.0 g/dl) (AOR = 0.21; 95% CI 0.12–0.85). Conclusions The practice of supplementation is popular among this group of PLHIV. Food elimination and substitution are practiced, albeit in moderation. The predictors identified may prove helpful in provider-client encounters as well as local HIV programming.
Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders
(BMC Health Services Research, 2019-10-15) Laar, A.K.; Adler, A.J.; Kotoh, A.M.; Legido-Quigley, H.; Lange, I.L.; Perel, P.; Lamptey, P.
Background: Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognized as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. Methods: A total of 55 informants – comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policymakers – were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after giving informed consent. Results: Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, and the benefits, as well as drawbacks, of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers – increasing providers’ knowledge on hypertension and patients’ awareness of same- there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence and the phenomenon of medical pluralism in Ghana were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and similarly designed programmes. Conclusions: This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.
HIV-seropositivity is not important in childbearing decision-making among HIV-positive Ghanaian women receiving antiretroviral therapy
(AIDS Care Psychological and Socio-medical Aspects of AIDS/HIV, 2015-02) Laar, A.K.; Taylor, A.E.; Akasoe, B.A.
Women in their reproductive years make up about 50% of all HIV-positive persons globally. These women, just as their HIV-negative counterparts, wield the right to procreate. However, HIV infection and lack of appropriate information on reproductive options may negatively impact women's procreative decision-making. This study assessed fertility intentions of HIV-positive women receiving antiretroviral therapy (ART) in southern Ghana. Quantitative methods were used to collect data from HIV-positive women receiving ART at four treatment centers. HIV-positive aged 18–49 years, and receiving ART were selected using systematic random sampling technique. Three hundred eighteen women were interviewed after informed consent. We used univariate analysis to generate descriptive tabulations for key variables. Bivariate analysis and logistic regression modeling respectively produced unadjusted and adjusted associations between background attributes of respondents and their childbearing decision-making. All analyses were performed using IBM SPSS Statistics for Windows, Version 20.0. Irrespective of age, reproductive history, and duration of HIV diagnosis, 46% of the women were desirous of procreating. The bivariate level analysis shows that women in their late reproductive ages (30–39 years) had the strongest desire to procreate (p < 0.001). After controlling for a number of covariates, primiparous and secundiparious women were about twice as likely to desire children (aOR = 2.553; 95% CI 1.480–4.401), and so were women aged 30–39 years (aOR = 2.149; 95% CI 1.202–3.843). Of 54% women who do not wish to procreate, achievement of desired family size (64.3%) was more popular a reason than fear of vertical transmission of HIV (7.5%), poor health status (5%), and pregnancy-related complications (1.6%).
Housing, psychosocial and adherence counseling among HIV+ persons in Ghana
(Health Promotion International, 2019-04) Tenkorang, E.Y.; Owusu, A.Y.; Laar, A.K.; Yeboah, E.H.
As part of providing comprehensive HIV/AIDS services, the Ghana National AIDS Control Programme (NACP) and Ministry of Health recommend that Persons Living with HIV/AIDS (PLWHAs) receive psychosocial support and follow-up visits that ensure medical and drug adherence assistance. The successful implementation of these support services requires patients to have stable and quality housing, yet studies that examine associations between housing, psychosocial support, and adherence counseling among PLWHAs in Ghana and sub-Saharan Africa are limited. Data were collected from 605 PLWHAs attending check-up and receiving Anti-Retroviral Therapy (ART) from both Atua Government Hospital and St. Martin's de Porres Hospital, located in the Manya Krobo district. Results show significant relationships between housing and access to psychosocial counseling and support. Specifically, respondents with stable homes and quality housing were significantly more likely to receive psychosocial counseling and support, compared to those without stable and quality housing. It is important for policy makers to consider housing as an important element of psychosocial counseling and care.
Infant feeding choices and experiences of HIV-positive mothers from two Ghanaian districts
(Journal of AIDS and HIV Research, 2009) Laar, A.K.; Ampofo, W.; Tuakli, J.M.; Quakyi, I.A.
Documentation of the feeding choices and experiences of HIV-positive mothers is needed to improve infant feeding counselling. The feeding behaviour and experiences of mothers receiving infant feeding counselling at two Ghanaian districts were explored. A postpartum survey involving 128 HIV-positive mothers, and in-depth interviews involving a purposively selected sample of 10 HIV-positive mothers were conducted. Exclusive breastfeeding rate was 62%. About six percent of the infants were given breast milk and infant formula, while 33% received breast milk and other feeds. Perceived stigma of formula feeding (odds ratio [OR] 7.50; p < 0.05), and perceived cost of infant formula (OR 0.37; p < 0.05) were significantly associated with exclusive breastfeeding for three months. In our multiple regression analysis, perceived stigma of formula feeding (OR 15.62; p < 0.05), and perceived cost of infant formula (OR 4.60; p < 0.05) were significantly associated with exclusive breastfeeding. Social pressure to mixfeed, local norms and “the baby friendly hospital initiative” also influenced infant feeding implementation efforts of mothers. Mothers face various barriers in implementing their feeding intentions. Policy makers and service providers in these districts need to address these issues in order to improve feeding practice.
Infant feeding choices and experiences of HIV-positive mothers from two Ghanaian districts
(Journal of AIDS and HIV Research, 2009) Laar, A.K.; Ampofo, W.; Tuakli, J.M.; Quakyi, I.A.
Documentation of the feeding choices and experiences of HIV-positive mothers is needed to improve infant feeding counseling. The feeding behavior and experiences of mothers receiving infant feeding counseling at two Ghanaian districts were explored. A postpartum survey involving 128 HIV-positive mothers, and in-depth interviews involving a purposively selected sample of 10 HIV-positive mothers were conducted. Exclusive breastfeeding rate was 62%. About six percent of the infants were given breast milk and infant formula, while 33% received breast milk and other feeds. Perceived stigma of formula feeding (odds ratio [OR] 7.50; p < 0.05), and perceived cost of infant formula (OR 0.37; p < 0.05) were significantly associated with exclusive breastfeeding for three months. In our multiple regression analysis, perceived stigma of formula feeding (OR 15.62; p < 0.05), and perceived cost of infant formula (OR 4.60; p < 0.05) were significantly associated with exclusive breastfeeding. Social pressure to mixfeed, local norms and “the baby friendly hospital initiative” also influenced infant feeding implementation efforts of mothers. Mothers face various barriers in implementing their feeding intentions. Policy makers and service providers in these districts need to address these issues in order to improve feeding practice.
Institutional Approaches to Research Integrity in Ghana
(Science and Engineering Ethics, 2020) Laar, A.K.; Redman, B.K.; Ferguson, K.; Caplan, A.
Research misconduct (RM) remains an important problem in health research despite decades of local, national, regional, and international efforts to eliminate it. The ultimate goal of every health research project, irrespective of setting, is to produce trustworthy findings to address local as well as global health issues. To be able to lead or participate meaningfully in international research collaborations, individual and institutional capacities for research integrity (RI) are paramount. Accordingly, this paper concerns itself not only with individuals’ research skills but also with institutional and national policies and governance. Such policies and governance provide an ethical scaffold for the production of knowledge and structure incentives. This paper’s operational definition of research therefore draws from the Institute of Medicine’s articulation of health research as an inquiry that aims to produce knowledge about the structure, processes, or effects of personal health services; and from an existing health systems framework. The paper reviews the research regulatory environment and the ethics apparatus in Ghana and describes a project jointly undertaken by Ghanaian researchers in collaboration with New York University to assess the perceived adequacy of current institutional practices, opportunities, and incentives for promoting RI.
Is it a rights violation or lack of knowledge about options? An examination of HIV counselors views on whether women infected with HIV should procreate
(Pan African Medical Journal, 2013-02) Laar, A.K.
Prior to the widespread availability of antiretroviral therapy (ART), the desire to conceive among HIV-positive women was discouraged due to a high perinatal transmission risk [1]. The recent advancement in HIV therapy has transformed the conceptualization of the infection. In particular, highly effective prevention strategies have led to a near elimination of the pediatric HIV epidemic in the United States and Europe [2, 3]. “Virtual elimination”of pediatric HIV infection is a now touted as a near-term target [4], and the proportion of HIV-positive individuals who desire to exercise their fundamental right to reproduction is increasing. With this reality, experts currently advise that health professionals to approach the HIV-positive client as a person with rights just as any other individual [5, 6]. As to whether the Ghanaian healthcare provider is abreast of the fact that HIV-positive persons have reproductive rightsmotivated the investigation from which this commentary metamorphosed. I examine in this short communication how knowledgeablea group of Ghanaian healthcare workers are on the subject of HIV and reproductive rights. A survey of nurse counselors (32) and medical officers (3) providing counseling and testing services to HIV-positive clients in two Ghanaian districts was completed. Figure 1 depicts the results obtained. The study uncovers two main perspectives. On the one hand, there was an overwhelmingly high level of approbation by the providers on HIV-positive women's right to reproduction (94.3%), on the other providers demonstrated a disappointingly high level of ignorance regarding the various reproductive options available to women infected with HIV in Ghana. It is worthy of note that Articles 1 and 16 of the Universal Declarations of Human Rights recognize the reproductive rights of all humans. (“All human beings are born free and equal in dignity and rights...”)...(“men and women of full age, without any limitation, have the right to marry and to found a family...”) [7].Women infected with the AIDS virus clearly fall within this scope.Only about 10% of theproviders were aware of some reproductive options for HIV-positive women. A quarter would advise HIV-positive women to have unprotected intercourse as an option to conceive. Some of the providers openly expressed their inability to give qualified and relevant advice to HIV-positive women on the options tabled for discussion. There are no specific policies with regard to reproductive rights and options for HIV persons accessing services in Ghanaian hospitals. Other constraints mentioned were lack of resources and knowledge upgrade refresher trainings.In a related study in Tanzania, Leshabari et al. revealed a high level of stress, frustration, and acknowledgment of incompetence by the nurse-counselors [8].
Malaria-HIV co-infection: Adverse perinatal outcomes
(VDM, 2010) Laar, A.K.
This paper aims at examining the factors which influence the demand for health care services in selected Regions of Ghana. We use cross-sectional data covering 300 households in Ghana, and adopt a multinomial probit model with four health care options: self-care, drug stores, clinics, and hospitals with self-care as the base comparison group. Beside the relevant demographic, socio-economic, location, and facility-specific variables, we consider gender bias in households’ utilization of health care services. We find that married people tend to prefer care at drug stores, clinics, or hospitals to self-care. Also, urban dwellers tend to have easier access to drug stores compared to rural dwellers. Male-headed households tend to prefer self-care to any of the formal care options. We also find that, interestingly, households with more female children tend to use self-care compared to care at drug stores or hospitals while those with more adult males prefer to use drug stores during illness. This finding implies that policies aimed at promoting gender equity in health care need to consider not only the gender of the decision maker, but also the gender of individual household members.