Browsing by Author "Rominski, S."
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Item Analysis of nursing education in Ghana: Priorities for scaling-up the nursing workforce(2013-06-17) Bell, S. A.; Rominski, S.; Bam, V.; Donkor, E.; LoriIn this cross-sectional study, the strengths, challenges and current status of baccalaureate nursing education in Ghana were described using a descriptive design. The World Health Organization Global Standards for the Initial Education of Nurses and Midwives were used as the organizing framework, with baseline data on the status of nursing education from two state-funded universities in Ghana presented. A serious shortage of qualified faculty was identified, along with the need for significant upgrading to the existing infrastructure. Additionally, the number of qualified applicants far exceeds the available training slots. Faculty and infrastructure shortages are common issues in nursing education and workforce expansion; however, in low-resource countries, such as Ghana, these issues are compounded by high rates of preventable disease and injury. An understanding of the strengths and challenges of nursing education in Ghana can inform the development of strategies for nursing workforce expansion for other low-resource countries.Item Clean delivery practices in rural northern Ghana: A qualitative study of community and provider knowledge, attitudes, and beliefs systems(2012-06-15) Moyer, C.A.; Aborigo, R.A.; Logonia, G.; Affah, G.; Rominski, S.; Adongo, P.B.; Williams, J.; Hodgson, A.; Engmann, C.Abstract Background Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness. Methods In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0. Results 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or “red earth sand.” Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill. Conclusions This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the disconnect between healthcare providers and the community, and the critical role grandmothers play in ensuring clean delivery practices. Future interventions to address clean delivery and prevention of neonatal infections include educating healthcare providers about harmful traditional practices so they are specifically addressed, strengthening facilities, and incorporating influential community members such as grandmothers to ensure success.Item Clean delivery practices in rural northern Ghana: A qualitative study of community and provider knowledge, attitudes, and beliefs(2012-06) Moyer, C.A.; Aborigo, R.A.; Logonia, G.; Affah, G.; Rominski, S.; Adongo, P.B.; Engmann, C.Background: Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness.Methods: In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0.Results: 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or " red earth sand." Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill.Conclusions: This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the disconnect between healthcare providers and the community, and the critical role grandmothers play in ensuring clean delivery practices. Future interventions to address clean delivery and prevention of neonatal infections include educating healthcare providers about harmful traditional practices so they are specifically addressed, strengthening facilities, and incorporating influential community members such as grandmothers to ensure success. © 2012 Moyer et al.; licensee BioMed Central Ltd.Item Creating a charter of collaboration for international university partnerships: The elmina declaration for human resources for health(Academic Medicine, 2014-06) Anderson, F.; Donkor, P.; De Vries, R.; Appiah-Denkyira, E.; Dakpallah, G.F.; Rominski, S.; Hassinger, J.; Lou, A.; Kwansah, J.; Moyer, C.; Rana, G.K.; Lawson, A.; Ayettey, S.The potential of international academic partnerships to build global capacity is critical in efforts to improve health in poorer countries. Academic collaborations, however, are challenged by distance, communication issues, cultural differences, and historical context. The Collaborative Health Alliance for Reshaping Training, Education, and Research project (funded by the Bill and Melinda Gates Foundation and implemented through academic medicine and public health and governmental institutions in Michigan and Ghana) took a prospective approach to address these issues. The project had four objectives: to create a "charter for collaboration" (CFC), to improve data-driven policy making, to enhance health care provider education, and to increase research capacity. The goal of the CFC was to establish principles to guide the course of the technical work. All participants participated at an initial conference in Elmina, Ghana. Nine months later, the CFC had been revised and adopted. A qualitative investigation of the CFC's effects identified three themes: the CFC's unique value, the influence of the process of creating the CFC on patterns of communication, and the creation of a context for research and collaboration. Creating the CFC established a context in which implementing technical interventions became an opportunity for dialogue and developing a mutually beneficial partnership. To increase the likelihood that research results would be translated into policy reforms, the CFC made explicit the opportunities, potential problems, and institutional barriers to be overcome. The process of creating a CFC and the resulting document define a new standard in academic and governmental partnerships.Item Factors that influence midwifery students in Ghana when deciding where to practice: a discrete choice experiment(2013-05-04) Ageyi-Baffour, P.; Rominski, S.; Nakua, E.; Gyakobo, M.; Lori, J.R.Abstract Background Mal-distribution of the health workforce with a strong bias for urban living is a major constraint to expanding midwifery services in Ghana. According to the UN Millennium Development Goals (MDG) report, the high risk of dying in pregnancy or childbirth continues in Africa. Maternal death is currently estimated at 350 per 100,000, partially a reflection of the low rates of professional support during birth. Many women in rural areas of Ghana give birth alone or with a non-skilled attendant. Midwives are key healthcare providers in achieving the MDGs, specifically in reducing maternal mortality by three-quarters and reducing by two-thirds the under 5 child mortality rate by 2015. Methods This quantitative research study used a computerized structured survey containing a discrete choice experiment (DCE) to quantify the importance of different incentives and policies to encourage service to deprived, rural and remote areas by upper-year midwifery students following graduation. Using a hierarchical Bayes procedure we estimated individual and mean utility parameters for two hundred and ninety eight third year midwifery students from two of the largest midwifery training schools in Ghana. Results Midwifery students in our sample identified: 1) study leave after two years of rural service; 2) an advanced work environment with reliable electricity, appropriate technology and a constant drug supply; and 3) superior housing (2 bedroom, 1 bathroom, kitchen, living room, not shared) as the top three motivating factors to accept a rural posting. Conclusion Addressing the motivating factors for rural postings among midwifery students who are about to graduate and enter the workforce could significantly contribute to the current mal-distribution of the health workforce.Item Factors that influence midwifery students in Ghana when deciding where to practice: A discrete choice experiment(BMC Medical Education, 2013-05) Ageyi-Baffour, P.; Rominski, S.; Nakua, E.; Gyakobo, M.; Lori, J.R.Background: Mal-distribution of the health workforce with a strong bias for urban living is a major constraint to expanding midwifery services in Ghana. According to the UN Millennium Development Goals (MDG) report, the high risk of dying in pregnancy or childbirth continues in Africa. Maternal death is currently estimated at 350 per 100,000, partially a reflection of the low rates of professional support during birth. Many women in rural areas of Ghana give birth alone or with a non-skilled attendant. Midwives are key healthcare providers in achieving the MDGs, specifically in reducing maternal mortality by three-quarters and reducing by two-thirds the under 5 child mortality rate by 2015. Methods: This quantitative research study used a computerized structured survey containing a discrete choice experiment (DCE) to quantify the importance of different incentives and policies to encourage service to deprived, rural and remote areas by upper-year midwifery students following graduation. Using a hierarchical Bayes procedure we estimated individual and mean utility parameters for two hundred and ninety eight third year midwifery students from two of the largest midwifery training schools in Ghana. Results: Midwifery students in our sample identified: 1) study leave after two years of rural service; 2) an advanced work environment with reliable electricity, appropriate technology and a constant drug supply; and 3) superior housing (2 bedroom, 1 bathroom, kitchen, living room, not shared) as the top three motivating factors to accept a rural posting. Conclusion: Addressing the motivating factors for rural postings among midwifery students who are about to graduate and enter the workforce could significantly contribute to the current mal-distribution of the health workforce. © 2013 Ageyi-Baffour et al.; licensee BioMed Central Ltd.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 Infant nutrition in the first seven days of life in rural northern Ghana(2012-08-02) Aborigo, R.A.; Moyer, C.A.; Rominski, S.; Adongo, P.; Williams, J.; Logonia, G.; Affah, G.; Hodgson, A.; Engmann, C.Abstract Background Good nutrition is essential for increasing survival rates of infants. This study explored infant feeding practices in a resource-poor setting and assessed implications for future interventions focused on improving newborn health. Methods The study took place in the Kassena-Nankana District of the Upper East Region of northern Ghana. In-depth interviews were conducted with 35 women with newborn infants, 8 traditional birth attendants and local healers, and 16 community leaders. An additional 18 focus group discussions were conducted with household heads, compound heads and grandmothers. All interviews and discussions were audio taped, transcribed verbatim and analyzed using NVivo 9.0. Results Community members are knowledgeable about the importance of breastfeeding, and most women with newborn infants do attempt to breastfeed. However, data suggest that traditional practices related to breastfeeding and infant nutrition continue, despite knowledge of clinical guidelines. Such traditional practices include feeding newborn infants water, gripe water, local herbs, or traditionally meaningful foods such as water mixed with the flour of guinea corn (yara’na). In this region in Ghana, there are significant cultural traditions associated with breastfeeding. For example, colostrum from first-time mothers is often tested for bitterness by putting ants in it – a process that leads to a delay in initiating breastfeeding. Our data also indicate that grandmothers – typically the mother-in-laws – wield enormous power in these communities, and their desires significantly influence breastfeeding initiation, exclusivity, and maintenance. Conclusion Prelacteal feeding is still common in rural Ghana despite demonstrating high knowledge of appropriate feeding practices. Future interventions that focus on grandmothers and religious leaders are likely to prove valuable in changing community attitudes, beliefs, and practices with regard to infant nutrition.Item Infant nutrition in the first seven days of life in rural northern Ghana(2012-08-02) Aborigo, R.A.; Moyer, C.A.; Rominski, S.; Adongo, P.; Williams, J.; Logonia, G.; Engmann, C.Background: Good nutrition is essential for increasing survival rates of infants. This study explored infant feeding practices in a resource-poor setting and assessed implications for future interventions focused on improving newborn health.Methods: The study took place in the Kassena-Nankana District of the Upper East Region of northern Ghana. In-depth interviews were conducted with 35 women with newborn infants, 8 traditional birth attendants and local healers, and 16 community leaders. An additional 18 focus group discussions were conducted with household heads, compound heads and grandmothers. All interviews and discussions were audio taped, transcribed verbatim and analyzed using NVivo 9.0.Results: Community members are knowledgeable about the importance of breastfeeding, and most women with newborn infants do attempt to breastfeed. However, data suggest that traditional practices related to breastfeeding and infant nutrition continue, despite knowledge of clinical guidelines. Such traditional practices include feeding newborn infants water, gripe water, local herbs, or traditionally meaningful foods such as water mixed with the flour of guinea corn (yara'na). In this region in Ghana, there are significant cultural traditions associated with breastfeeding. For example, colostrum from first-time mothers is often tested for bitterness by putting ants in it - a process that leads to a delay in initiating breastfeeding. Our data also indicate that grandmothers - typically the mother-in-laws - wield enormous power in these communities, and their desires significantly influence breastfeeding initiation, exclusivity, and maintenance.Conclusion: Prelacteal feeding is still common in rural Ghana despite demonstrating high knowledge of appropriate feeding practices. Future interventions that focus on grandmothers and religious leaders are likely to prove valuable in changing community attitudes, beliefs, and practices with regard to infant nutrition. © 2012 Aborigo et al.; licensee BioMed Central Ltd.Item A Low-Cost Method for Performing a Curriculum Gap-Analysis in Developing Countries: Medical School Competencies in Ghana(Teaching and Learning in Medicine, 2012-07) Rominski, S.; Donkor, P.A.; Lawson, A.; Danso, K.; Stern, D.Background: In this study, we undertook a comparison of the international, national, and local curricula of Ghanaian medical schools in order to identify any gaps. Purpose: To identify gaps in the Ghanaian medical school curriculum. Methods: The Ministry of Health and the two major sites for medical education in Ghana (UGMS, KNUST) participated using the only internationally accepted and validated set of outcome standards for medical education, the Global Minimum Essential Requirements. The competencies were reviewed by two U.S. consultants (DS, SR) and then edited, revised, and validated by individuals who are deeply involved in medical education in Ghana. Results: The KNUST team validated 6 gaps in their curriculum, and the team from UGMS identified 5. The standards were found by the U.S.-based consultants and validated by the Ghanaian team to have 6 gaps, many of which overlapped with those found in the Ghanaian medical school curricula. Conclusions: This analysis is a first step to determining physician training competency and an inexpensive method for identifying agreed-upon gaps in the current national requirements and local curriculum. © 2012 Copyright Taylor and Francis Group, LLC.