Department of Population, Family and Reproductive Health

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    Assessment Of Quality Of Healthcare Among The Elderly Patients Utilising The Korle-Bu Teaching Hospital, Accra
    (2019-12) Wuaku, D.A.
    Background: The elderly tend to have a disproportionately high need for utilisation of healthcare services because they exhibit multiple disorders, have limited regenerative abilities, and are prone to diseases, syndromes, and sicknesses. These elderly persons are relatively regular consumers of the Out Patient Department’s care. The seeming lack of provision of suitable and quality healthcare services to the elderly is emerging as one of the main impediments of this era. The fundamental requirement to increase utilisation for the elderly persons is to improve the quality of healthcare services delivered in hospitals. Objective: The study sought to assess the quality of healthcare services among the elderly patients utilising the Korle-Bu Teaching Hospital, Accra. Methods: The study was a descriptive cross-sectional survey using a sequential explanatory mixed methods approach. In the quantitative study, questionnaires were used to elicit information from three hundred and sixty-one (361) elderly persons. Purposive sampling was used to select elderly persons from the seven Out-Patient Departments in the Korle-Bu Teaching Hospital in Accra. Simple random sampling [lottery method] was used to select the elderly persons in the inclusion criteria. The quantitative data was analysed by the use of chi-square test to determine the relationship between the socio-demographic characteristics of the elderly and the variables measuring utilisation of healthcare services (cost, accessibility, health personnel attitude, physical support, information and waiting time). In addition, Ordinal Logistic Regression was used to determine the relationship between the predisposing, enabling and need factors of the elderly and each of the variables measuring utilisation of healthcare services. Furthermore, one-way analysis of variance and Generalised Linear Model were used to examine the socio-demographic characteristics and quality of healthcare. In the qualitative study, purposive sampling method and then convenience sampling method were used to select seventy-six (76) elderly persons from the seven selected Out- Patient Departments. Qualitative study was conducted to obtain an in-depth understanding of the quality of healthcare services by the elderly patients utilising the Korle-Bu Teaching Hospital. Thematic content analysis was used to analyse the data. The interview transcripts were read to identify emerging themes and sub-themes, and were exported into Nvivo version 11 software for data organisation. Quantitative Results: The study showed that, the elderly persons who were accompanied to the health facility were 1.86 times more likely (OR=1.86, 95% CI; 1.13-3.08) to rate accessibility of healthcare services on a higher scale than the elderly persons who visited the hospital by themselves (p=0.016). The elderly who were beneficiaries of NHI were 0.42 times less likely (OR=0.42, 95% CI; 0.18-0.97) to rate accessibility of healthcare services on a higher scale compared with the elderly who were non-beneficiaries (p=0.042). The elderly persons with secondary school education and above were 0.53 times less likely (OR=0.53, 95% CI; 0.34-0.84) to rate cost on utilisation of healthcare services on a higher scale compared with the elderly persons with pre-secondary education (p=0.006). Adjusting for other factors, the elderly persons with multiple chronic conditions were 1.56 times more likely to rate cost on a higher scale compared with the elderly with one chronic condition (OR=1.56, 95% CI=1.04-2.34) (P=0.03). Furthermore, the study reported that, there was a decreasing trend in the rating of quality of healthcare services with increasing number of chronic conditions (p=0.042). The results indicated that both female and male elderly persons regarded quality of healthcare to be the same (p=0.808). Qualitative Findings: The elderly persons described the waiting time as long and stressful. They developed swollen feet and bodily pains due to the long waiting time. They clarified that the diagnostic investigation, medication and consultation fees were expensive, leading to postponement of their subsequent visits and deterioration of their health. Additionally, the elderly persons specified that they woke up very early to report timely at the Out-Patient Departments by means of ‘drop in’ taxi that was very costly. Furthermore, at the Out-Patient Department, they faced cumbersome procedures before seeing the doctors. With respect to the quality of healthcare provided at the hospital, feedback from the health personnel was reported harshly, and they provided negligible physical assistance. The elderly described the seats at the waiting rooms as being very low and uncomfortable. Nevertheless, the elderly persons described the health personnel as skillful and knowledgeable. Unexpectedly, the elderly were satisfied with the healthcare services at the Korle-Bu Teaching Hospital. For the elderly participants, satisfaction meant improvement in their health. Conclusion: Cost was a determining factor in utilising healthcare by the elderly patients. The health personnel were described as being skillful and knowledgeable in providing healthcare. The improvements in the general health of the elderly made them satisfied with healthcare services. Recommendations: The study recommends that policy makers should include elderly persons from age 60 years to 69 years in the National Health Insurance exemption policy to enable the majority of them to utilise the healthcare services. Additionally, there is the need to review visits to the healthcare units to schedule time appointments to reduce the long and stressful waiting time. .
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    Quality of Maternal Healthcare in Four Districts in Northern Region, Ghana
    (University of Ghana, 2019-07) Mumuni, V.S.
    Background: The quality of maternal healthcare women receive during pregnancy and delivery has attracted global attention. However, tools and empirical studies on quality of maternal healthcare women receive are lacking in many low-income settings including Ghana. Available literature shows that many of the current assessment tools are provider driven, focusing mainly on clinical care aspect of quality without considering clients' perspectives. This study aimed to fill these knowledge gaps by developing and validating an assessment tool and using same tool to assess the quality of maternal healthcare in selected districts in Northern Region of Ghana. Methods: An exploratory sequential mixed methods study design was used. This design was operationalised in three phases. The first phase was a qualitative exploration of clients' and providers' perspectives on quality of maternal healthcare. It comprised 6 focus group discussion sessions with 46 postnatal women and 39 in-depth interviews with postnatal women and 7 healthcare workers. The second phase of the design built on the first. This involved the development and validation of a quality of care assessment tool. Fifty-five (55) maternal and child health experts were purposively selected to assess quality of care domains that was proposed. The aim was to determine item's clarity and relevance on a 5-point Likert scale. The final phase involved administering the maternal healthcare quality assessment tool to a total of 520 randomly sampled postnatal women in a survey in four districts in the northern region (Tamale metropolis, Savelugu-Nanton municipality, Kumbungu and Sagnerigu districts) to assess quality of maternal healthcare they received during their most recent pregnancy. Thematic content analysis techniques were used to analyse qualitative data. Content Validity index (CVI), polychoric correlation co-efficient, and Item Response Theory (lRT) model were used, to assess suitability, correlation between items in each construct and reliability of the tool. Descriptive statistical analysis was done to describe important demographic and maternal health characteristics of survey respondents. To assess quality of maternal healthcare women received, mean quality of care scores were obtained for each domain by adding the mean scores for individual items and dividing the results by the number of items in each domain. Based on this mean score for each domain, the quality of care under each domain was then recategorized into three scales, where a mean score of 1.0 - 2.0 meant low quality; mean score of 2.1- 3.9 meant moderate quality; and mean score of 4-5 meant high quality. Percentage distribution tables were then constructed to show the proportion of respondents who rated the quality of care they received as either low, moderate or high. Findings: Results from the qualitative interviews identified a total of 13 domains of care and 57 indicators of maternal healthcare quality. These domains included proximity of health facilities to clients, availability of infrastructure and other amenities, availability of logistics including equipment and medicines and good environmental sanitation, quality of the human resource/workforce. non-discriminatory provision of maternal healthcare services, interpersonal relationship, privacy of clients, pain management, Safety, outcome of pregnancy and client's satisfaction with the care processes and outcomes. Results from the experts' evaluation of the appropriateness and validity of the 57- indicators identified from the qualitative research showed that all the items of the construct were rated above a content validity index (CVI) of 0.6, where 0.6 was the benchmark below which items would be rated as irrelevant/inappropriate. However, following modification and pretesting of the tool and further reliability testing of the items in the tool using item discrimination indices, only 47 indicators had acceptable item discrimination indices. These were, therefore, included in the final tool. Findings from the survey showed that overall, 72% of the respondents rated the quality of maternal healthcare they received as high, with 27% and 0.6% rating the quality of care as moderate and low respectively. The highest rated domain was the outcome domain with a mean score 4.26 ± 0.57. The proportion of women who rated the outcome domain as high was 91.15% while 8.08% and 0.77% of them rated it as moderate and low respectively. The least rated' domain was pain management, which had an average rating score of 3.14 ± 1.18, with 277(53.27%) of respondents rating it as high, 179(34.42%) rating it as moderate and 64(12.31%) rating as low. Conclusion: For any meaningful quality of maternal healthcare assessment to occur, there is need for including both women's and provider's perspectives. Although majority of women rated the overall quality of care, they received to be high, there is space for further improvement. There is the need for more attention to be paid to aspects of maternity care that were poorly rated by clients. In this regard, good inter-personal relationships with clients. better resourcing of health facilities and sustained collaboration between clients and healthcare providers is needed for enhancing the status of maternal healthcare in the region.
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    Socio-Cultural Practices Influencing Intrapartum and Postpartum Continuum of Care In the Asante Akim North District Ashanti Region
    (University of Ghana, 2019-07) Ansong, J.
    Background: The growing recognition of the critical importance of providing care to mothers and new-borns and the substantial gaps in coverage that exists have prompted a paradigm shift in responding to maternal and new-born health issues. Invariably, the health care that a mother receives during pregnancy, at the time of delivery, and soon after delivery is important for the survival and well-being of both the mother and her child. However, evidence suggests that maternal and neonatal deaths are accentuated by socio-cultural practices along the intrapartum and postpartum continuum of care and several studies have documented this across the globe. However, in Ghana, studies on the role socio-cultural practices play along intrapartum and postpartum continuum of care remains unexplored. This study, therefore, seeks to identify the gaps in the knowledge and practices along the intrapartum and postpartum continuum of care in the Asante Akim North District of Ashanti Region of Ghana. Methods: This was a descriptive cross-sectional study which employed mixed sequential qualitative and quantitative strategies. An initial explorative study using focus group discussions and in-depth interviews was done to explore community leaders. health managers and mothers' perceptions and experiences in relation to the influence of socio-cultural practices along the intrapartum and post postpartum continuum of care. NVivo II was used to analyze the qualitative data and the themes and sub-theme converted into a survey questionnaire. A multistage sampling technique was used to sample 439 mothers with infants (0-6 months) from four subdistricts, based on proportion to population. Quantitative data was analyzed using STATA 14. Multivariable logistic regression to determine associations between independent and dependent variables was done. Results: The study found that 65.1 % of women had adequate ANC 4+, 49. JO/o had skilled delivery, and 65.4% had received postnatal care at six weeks with only 28.5% having achieved complete continuum of care. Women who practiced confinement were 2.42 times (95% C\=0.4450-0.7789) more likely to discontinue care at ANC, 1.98 times (95%CI=O. I 891.0.4000) the relative risk of discontinuing at postnatal than those who did not practice confinement. Women who believed in bewitchment during pregnancy and postnatal period had relative risk of 2.22 (95% CI=0.3634-0.9234) discontinuing at ANC, 1.67 (95% CI=0.4712-0.9178) at delivery and 2.89 (95% CI=0.4381-0.8172) during postnatal. Again, women who did not receive home visits by health care workers during pregnancy had higher relative risk of discontinuing at ANC (RR-1.89, 95% Cl=O.2190-0.9182), delivery (RR-2.71, 95% CI=0.8791) and PNC (RR=1.78, 95% C\=0.6981-0.8132). Receiving education on ANC also reduced a woman' s relative risk of interruptions along the continuum. Out of 439 participants, only 208 (47.4%) were advised to deliver in the health facilities. Women who were not advised to have skilled delivery had higher relative risk of discontinuing at delivery (RR=2.91, 95% CI=0.4001-0.7211) and PNC (RR=2.88, 95% CI=0.4412· 0.7219). Women who also reported having experienced bad attitudes from health workers were more likely to discontinue at ANC, delivery and PNC. Local practices such as use of enema and use of squatting position were reasons attributed to accessing unskilled delivery. With respect to maternal illness, 241 (55.2%) and 196 (44.8%) sought health care from biomedical and non-biomedical facilities respectively. After delivery, 88 (20.0%) sought health services from traditional healers, a factor affecting neonatal health. The study further found that 281 (65.1%) neonates experienced ill health during the neonatal period. Difficulty in breathing, 98 (34.3) and fever, 78 (27.3%) were the two most reported condition during the neonatal period. Of the 286 who fell sick during neonatal period, 201 (70.3%) sought health care whilst 85 (29.7%) did not seek health care. Among those who sought health care, 125 (62.2%) used biomedical health facilities. Conclusion: The study concludes that socio-cultural practices are common in the study area and transcends the perinatal period. These socio-cultural practices are viewed as indispensable and closely related to people's worldview that illnesses during pregnancy, childbirth, neonatal and postnatal period have social and supernatural causes. This belief system favoured accessing health care from traditional healers. The good interpersonal relationship of TBAs, local beliefs and poor services at biomedical facilities pushed expectant mothers towards traditional care. Both neonatal and postnatal illnesses were believed to have both biomedical and social causes but with social causes given more prominence. Hence, health seeking behaviour was directed toward non-orthodox service outlets; thus affecting the continuum of care.
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    Predictors of Intrapartum Stillbirths in Singletons in Six Public Hospitals in the Greater Accra Region, Ghana
    (University of Ghana, 2019-07) Vanotoo, L.A.
    Introduction . Globally. 2.6 million stillbirths are recorded annually: 50% occur during labour (intrapartum). Ghana records 11,000 stillbirths annually and 40% occur during. labour. The Greater Accra Region records 2000 stillbirths annually: 40 % of them occur intrapartum. An understanding of the contributory factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. Objectives The objectives of this study were to identify contributors to intrapartum stillbirths; explore perceptions about stillbirth from women with experience of intrapartum stillbirth, document views of health professionals about causes and prevention of intrapartum stillbirths and develop a model to predict intrapartum stillbirths. Method This was a retrospective 2: I unmatched case-control study with a qualitative component. The study sample was all deliveries between 1st January to 31st December 2016 in six public hospitals in the Greater Accra Region. Cases were selected through census while controls were selected from the live births using systematic random sampling. Relevant information was retrieved from clinical records for both cases and controls. Thirteen (10%) women from the cases and 14 health workers were purposively selected for in-depth interviews. Bivariate and multi variable data analyses were used to determine association between the variables and intrapartum stillbirth. Qualitative data were analysed by themes using NVIVO II. The Area Under the Receiver Operating Characteristics Curve (AUROq and the Brier Score (BS) were used to identify factors to include in the model to predict intrapartum stillbirths. Approval for the study was obtained from the Ghana Health Service Ethics Review Committee. Results During the study period. there were 36,168 deliveries with 918 stillbirths; 362 (39%) occurred intrapartum. Through the census, 125 cases were identified, in addition, 250 controls and 27 participants were included in the study. Mean age of cases and controls were 28.8= 5.54 and 28.9 ± 6.05 years respectively. Mean gestational age was 36.5 ± 3.95 weeks for cases and 38.8 ± 2.69 weeks for controls; median birth weight was 2. 7kg.± 0.92 for cases and 3.1kg ± 0.65 for controls. The following maternal factors were associated with intrapartum stillbirths: pregnancy-induced hypertension (PIH) (aOR 3.70); antepartum haemorrhage (APH) (aOR, 3.28) and premature rupture of membranes (PROM) (aOR 3.36). The major fetal contributory factor was low gestational age (aOR. 0.86). Service delivery factors included lack of trained health staff, inadequate number of beds, theatre space. Non use of partograph to monitor women in labour and non-auditing of perinatal deaths. Fetal autopsy was not performed on stillbirths. The best model to predict intrapartum stillbirth was the model with combination of maternal (PHI. APH and PROM); fetal (low gestational age) and service delivery (mode of delivery and health provider who conducted the delivery) factors. Conclusions and recommendations Improved management of PIH, APH, PROM and preterm delivery will reduce intrapartum stillbirth. Hospitals should improve on monitoring of women during labour. Auditing of intrapartum stillbirths should be mandatory for all hospitals and Ghana Health Service (GHS) should include fetal autopsy in stillbirth auditing to identify other causes of fetal deaths. The best model to predict intrapartum stillbirth is a combination of maternal, fetal and health service delivery factors. Thus, interventions to reduce intrapartum stillbirth must combine maternal, fetal and service delivery factors to make them effective.
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    Determinants of Adherence and Treatment Outcomes Among Adolescents Living with HIV in Cameroon
    (University of Ghana, 2019-07) Bongfen, M.C.
    Background: Despite over three decades of HIV, its prevalence especially among adolescents remains a public health concern. In 2015, there were more than two million adolescents living with HIV, with a higher proportion coming from sub-Sahara Africa. In Cameroon, there are over 40,000 adolescents living with HIV and there are still concerns about the provision of care to them as adolescents are trapped between paediatric and adult services which are unable to address their specific needs. However, there are limited studies in Cameroon that have examined adherence to antiretroviral treatment and associated factors as well as treatment outcomes among adolescents. It is therefore essential to clearly understand the determinants of adherence of these adolescents and their treatment outcomes. Objectives: The main objective of the study was to assess the determinants of adherence to Anti-Retroviral Therapy and treatment outcomes among adolescents living with HIV in Cameroon. Methods: The study was an analytical cross-sectional Study with a record review component. A total of 460 respondents were recruited from nine health facilities. A systematic random sampling procedure was used to select the required participants. Pretested questionnaires were administered to participants to collect data. The main outcome of interest (adherence) was measured in two ways: self-report adherence, and medication possession ratio (MPR). Three treatment outcome measures that were assessed included viral load suppression, retention in treatment, and CD4 counts. Finally, health facility readiness towards care for adolescents on ARV was assessed using the John Snow Inc. (JSI) tool. Descriptive (frequencies and proportions) and inferential (chi square and multivariate logistic regression) statistical analyses methods were used to analyse the data. Statistical significance was set at p<0.05 at a 95% confidence level. Results: A total of 455 questionnaires were retained and this gave a response rate of 99%. The average age of the adolescents was 14.8years (SD= ±2.9years). There were more females (55%) than males (45%) in the study. A larger proportion of the respondents were on first line treatment (77%) and had been on treatment for an average of five years. Self report adherence was 83% while MPR was 73%. The difference in adherence between self report and the Medication Possession ratio was not statistically significant (p=0.97). Regarding the determinants of adherence, 12 out of 30 independent variables examined showed significant statistical association with adherence at the bivariate level. In multivariable logistic regression analyses however, only two variables significantly predicted adherence, namely experiencing side effects (AOR= 2.63; 95%CI=1.14, 6.09; p = 0.02) and internalized stigma (AOR=2.51; 95%CI =1.04, 6.04; P = 0.04). The major challenges to adherence were stigma (59%) and forgetfulness to take medications (59%) while sending reminder messages and having friendlier health providers were the main suggestions to help improve on adherence. In terms of treatment outcomes, 70% of the respondents had their viral load suppressed. The retention rates were observed to decrease over time: 88%, 72% and 58% at 6months, 12 months and 24 months respectively. All the selected facilities were shown to be ready to receive adolescents into treatment as 7 out of the 9 facilities were in stage 5 of the facility readiness assessment. Conclusion: The determinants of adherence among adolescents are more psychological than the physical characteristics that differentiate them. There is therefore a need for more individual-targeted counselling for adolescents and their guardians to improve adherence levels among adolescents on antiretroviral treatment.
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    Negative Early Reproductive Health Decisions and Associated Outcomes Among Women in the Northern Region of Ghana
    (University of Ghana, 2019-03) Iddrisu, M.R.
    Background: A growing body of demographic and sociological literature indicates that early life decisions and choices individuals make have important health consequences in later life Within reproductive health in particular, a number of studies suggest that early reproductive health decisions that women make have an impact on their reproductive health outcomes in later life. Despite this growing evidence, little understanding exists in Ghana about the relationship between negative early reproductive health decisions of women and later life reproductive health outcomes. Based on a life course perspective, this study aimed to examine the early reproductive health decisions of women and their associated reproductive health outcomes in the northern region of Ghana. Methods: A concurrent mixed methods retrospective study design was conducted to elicit information from married women within the ages of 15-49 years as well as other key informants. Systematic sampling was used to sample a total of 390 married women to take part in the survey. A combination of purposive and snowball sampling was used to select 40 key informants and a total of 130 women between ages 15- 49 with a minimum marriage experience of five years to take part in qualitative focus group discussions, in-depth interviews and key informant interviews. Quantitative data were collected through a face-face interview using structured questionnaires. Qualitative data were collected through focus group discussions, in-depth interviews and key informant interviews using unstructured topic/discussion guides. Descriptive statistical methods were used to describe important characteristics of survey respondents. Bivariate and multivariate logistic regression analyses were performed to examine association between early reproductive health decisions and reproductive health outcomes in later life. Confidence level and statistical significance were set at 95% and a p-value<0.05 respectively. Stata 13 version software was used in the analysis of the quantitative data. Qualitative interviews were audio-recorded, transcribed verbatim and analysed thematically with Nvivo 10 software. Results: Prevalence of early sex (first intercourse before age 16) was 58%, early marriage (union contracted before the age 18) was 30.0% and 80% of respondents did not consent to their marriage partner. About 42% of women have engaged in spousal communication on contraceptives. Also 24% experienced gender-based violence, 25% respondents' ever experienced unintended pregnancy and 44% experienced high fertility. The results from the qualitative study showed that persons who influence negative early Reproductive Health (RI-l) decisions of early sex, early marriage and consent of marriage partner were future partner, fathers of respondents and arranged marriages. Women who married before age 18 (early marriage) were also 3.27 times more likely to experience poor spousal communication relative to those who married between the age bracket of 26 - 36. Also women who had early sex and married early were significantly more likely to experience Gender Based Violence (GBV). The study further established a significant association between respondents experiencing early sex and GBV (p= 0.001). The odds of experiencing GBV were 2.65 times higher among women who first had sex before age 16 years (early sex) compared to those who first had sex between the ages of 16-25. Also of the respondents who had experienced unintended pregnancy, 72.5% (n=71) engaged in early sex (first intercourse before age 16). The odds of experiencing unintended pregnancy was 3.10 times higher among women who had sex before age 16 (early sex) compared to those who had sex between the ages of 16 to 25. Again, 39.8% (n=39) of the respondents who had unintended pregnancy married early. Also 81.6% (n=80) of the respondents who experienced unintended pregnancy did not consent to their marriage partner. Conclusion: The study found evidence linking negative early RH decisions of women to RH outcomes in the adult lives, suggesting that early RH choices affect later life reproductive health outcomes of respondents. These findings suggest that understanding women's current RH outcomes in the northern region requires looking closely at early life decisions which are likely to affect women later in life. Interventions in this direction can considerably improve women's health in the Northern region.
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    Community-Based Intervention to Prevent Domestic Violence against Women in the Reproductive Age in Northwestern Ethiopia: A Quasi-Experimental Implementation Research
    (University of Ghana, 2019-07) Demisie, A.S.
    Background: Violence against women is a devastating public health challenge and a pervasive human rights abuse. Worldwide, a third of women experience domestic violence from either intimate or non-intimate partner in their lifetime. In sub-Saharan Africa region, the prevalence of domestic violence against women is similar with the global picture (36.6%). In Ethiopia, domestic violence against women is a common phenomenon and forms part of women’s life experiences ranging from 19% to 78%. However, there is paucity of translation of existing evidence into community-based intervention, and piloting its implementation applicability and effectiveness in preventing domestic violence against women in Ethiopia. Objective: Assessed the implementation and outcome of a community-based intervention on the prevention of domestic violence against women and its associated factors in Awi Zone, Northwestern Ethiopia. Methods: A community-based quasi-experimental study was conducted using mixed methods to assess domestic violence against women in the Northwestern Ethiopia. Complex probability sampling design and purposive methods were used to recruit study participants for quantitative and qualitative study, respectively. Study participants were assigned into three groups; Intervention, Active comparator, and Control and given the intervention packages. The women in the intervention group received all the intervention packages. These consisted of stakeholder advocacy workshop, community mobilization, training of community agents, house-to-house women’s awareness-creation and participating partners. In the active comparator group, only partners’ participating component was not implemented. The control group were sustained on standard services. A sequential explanatory data collection method was applied for both pre and post intervention surveys. Gathered data were entered into EpiData software and exported into SPSS version 23.0 for analysis. Descriptive, Generalized Linear Models and Difference in Differences (DID) statistical analysis methods were carried out. Statistical associations were reported using adjusted prevalence ratio at 95% confidence interval (CI) and p-value less than 0.05. The qualitative data were transcribed, coded, and thematically analyzed using Nvivo 11. The study protocol was registered on trial registry platform (ClinicalTrials.gov: NCT03265626). Results: The level of domestic violence against women reduced from pre-intervention 48.3% to 40.1% at post-intervention survey. Women’s receptive attitudes towards justified wife-beating reduced from 69.9% to 59.0%. Likewise, women’s receptive attitudes towards inequitable gender-norms between wives and partners declined from 67.6% to 55.9%. In the DID analysis, women’s experience of sexual violence declined by 10% among women in the active comparator group than the control group (DID, -0.10; 95% CI: -0.19, -0.02). Women’s receptive attitude towards justified wife-beating reduced by 17% in the active comparator group compared to the control group (DID, -0.17; 95% CI: -0.26, -0.08). Likewise, women’s receptive attitude towards inequitable gender-norms reduced by 17% in the intervention as compared with the control group (DID, -0.17, 95% CI: -0.26, -0.08). Furthermore, budget constraints, lack of commitment, having community-traditional gender-norms, poor planning, lack of integration and inter-sectoral collaboration were barriers to existing policy implementation to prevent domestic violence against women. The existing community health extension program, women development ‘army’ group, existing policy frameworks, government’s political willingness, presence of school-based gender clubs and development partners were some of the enabling conditions for ensuring the sustainable implementation of domestic violence prevention programs in the study area. Conclusions: The community-based piloted intervention was effective in preventing domestic violence, receptive attitudes towards justified wife-beating and inequity-norms. However, the prevalence of the different forms of domestic VAW were still high. Both women’s receptive attitude towards justified wife-beating and inequitable gender-norms were interlinked factors associated with persistently high domestic violence against women. The community’s receptive attitude is also exhibited by local politicians and or implementers. Community-based intervention was found to be effective, feasible and applicable in reducing domestic violence and its receptive attitudes. The implementation of existing policies to prevent domestic violence against women was poor due to lack of inter-sectoral collaboration, poor integration and stakeholders having competing priorities among others. It is suggested that programs focus on intersectoral collaboration and service integration with existing programs to sustain and synergize domestic violence prevention intervention.
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    Factors of Rapid Repeat Pregnancy and Its Consequences on Depression among Adolescents in the Greater Accra Region, Ghana.
    (University Of Ghana, 2018-07) Amuasi, S.A.
    Rapid repeat pregnancy (RRP) is defined as pregnancy onset within 24 months of the previous pregnancy outcome. RRP has been identified to result from different situations and as such might create different risks to the individual. Several studies have shown an association between RRP and mental health issues such as anxiety, emotional stress, depression, aggression and poorer education attainment. There is a pint-size consensus as to which risk factors are the very key predictors of RRP and whether the outcome (RRP) may lead to depression. This study seeks to identify the main risk factors that could lead to RRP and its consequences on depression among adolescents. METHODS: A mixed method approach (quantitative and qualitative) was used for this study which was conducted in 12 public health facilities in the Greater Accra Region. An unmatched case-control study design was used for the study. The cases were adolescent girls aged between 15 and 19 years who have had more than one pregnancy within two years. Controls were adolescent girls aged between 15 and 19 years who have had one pregnancy which either ended an abortion or delivery with more than twenty-four months spacing. The sample size for the quantitative method was n= 417 with 209 controls and 208 cases. Both the qualitative and quantitative components were hospital-based. Six FGDs were conducted among the control group in six of the selected hospitals and involved a total of forty-six adolescents. Eleven In-depth Interviews (IDI) were also held with every eligible adolescent who had experienced RRP (case) in six of the twelve health facilities selected for the research. STATA 15 MP (StataCorp, College Station, TX, USA) was used to analyze the quantitative aspect of the work. Univariate, bivariate and multivariate logistic regression analyses were conducted with p-value of <0.05 considered as significant. Composite score analysis was used in estimating the level of depression among the participants using Beck’s Depression Inventory scale. The qualitative data were audio recorded, translated into English and transcribed verbatim. Thematic content analysis was adopted for the analysis. Data triangulation was done to support the quantitative data using the qualitative data. RESULTS: There were two outcome variables in the study. The first one was the risk factors for RRP and the second was the effect of RRP on depression. Risk factors for RRP: The median ages at menarche between cases and controls were 12 and 13 years respectively and it was observed that most of the girls who experienced menarche at age 12 years and below were involved in early sexual activity (age at first sexual intercourse) than those who did not. It was also revealed in the study that the number of times a pregnant adolescent visits the hospital for ANC had some form of influence on the risk of RRP. The peers of the adolescents were the main source of information on issues of sex among the cases as compared with the control group. Transactional sex was more common among the cases than the controls. In a univariate analysis variables that showed significance as risk factors for RRP were planning of last pregnancy, history of miscarriage, married or living with partner, parental care, and at least 4 ANC visits. All these variables were significantly associated with odds of RRP. There was an evidence that the odds of RRP for the adolescents who have ever had a miscarriage was about eight times more than that among those who have never had a miscarriage (aOR=7.92; 95%CL: 3.18-19.71; p<0.0001). Effect of RRP on depression: The risk of being depressed among cases were 19% higher than the control group (crude RR=1.19; 95%Cl=0.99 to 1.43; p=0.070). After adjusting for the confounding variables, this increased significantly to 36% higher risk of being depressed (adjusted RR=1.36; 95%Cl=1.11 to 1.67; p=0.003) suggesting an evidence of association between RRP and depression. CONCLUSION: This research has identified the main risk factors of RRP to be, age at menarche, marital status, parental care and support, number of times of ANC visits, sex education and transactional sex. Again the study has investigated the extent to which having subsequent birth in less than 24 months (Rapid Repeat Pregnancy) could adversely affect psychological state of an adolescent mother. The results from this study could provide an insight into designing targeted interventions by policy makers and other stakeholders. Key words: Rapid Repeat Pregnancy, depression, unmatched case-control, mixed method, Antenatal visits transactional sex, menarche, cases, controls.
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    A Study of Community Perceptions and Strategies to Improve Women’s Dietary Quality in Savelugu-Nanton District, Ghana
    (University Of Ghana, 2018-07) Sawudatu, Z.
    Background: The diets of women in reproductive age (WRA) are an important determinant of their health outcomes and quality of life especially in northern Ghana, where women’s diets remain persistently suboptimal. However, socio-cultural barriers, one of the multiple influences on WRA’s diets, are rarely addressed in existing interventions. This study identified the socio-cultural barriers to WRA achieving optimal diets, which, herein, represent beliefs, attitudes and actions that are derived from the existing native and emergent culture of the community and tested the feasibility of a community-based pilot intervention developed in consultation with the community to address these barriers. Methods: Socio-cultural barriers to women’s diets were identified and characterized through a qualitative study involving the exploration of the local food system, dietary knowledge, attitudes and practices at Yilkpene and Kpachilo. Data was collected through key informant interviews, focus group discussions, qualitative 24-hour dietary recalls with in-depth interviews and observations at the household and community levels. A 17-week attitudinal and behaviour change intervention was designed and implemented at Yilkpene in consultation with key community stakeholders. The first component, nutrition education, emphasized the importance of women’s diets and their reproductive health. The second component, advocacy, concerned empowering women to have more control over household food resources and modifying food taboos affecting women. Messages were delivered in the local language through participatory activities including community durbars, small group meetings, home-visits and food demonstration sessions. In the post-evaluation of the intervention, data was collected from 182 participants using the same tools used at baseline. The two sets of data were compared to assess the impact of the intervention at Yilkpene. Results: Study participants, all aged at least 15 years, were mostly WRA (73%), married Muslims (87.4%) without formal education whose source of livelihood was farming (84.1%) and had households with sizes ranging between 6 and 40. At baseline, gender and socio-cultural factors significantly influenced all aspects of the food system, limiting women’s access to quality foods. Animal-source food taboos, which are mostly gender-based and affect the quality of women’s diets, were identified. At endline, these practices did not change but members of Yilkpene community were sensitized about them. Prior to the intervention, the dietary knowledge and attitudes among members of both communities were sub-optimal; but, at endline, improved knowledge and attitudes were observed in both communities even though the scope of improvements was more in the intervention community. There were also less reported beliefs about plant-source food restrictions at Yilkpene compared to Kpachilo. At baseline, close to half (45%) of women in either community could not meet their minimum dietary diversity but diversity deficit declined at endline (25% at Yilkpene and 10% at Kpachilo). Conclusion: Attitudinal and behavioural change communication interventions on entrenched socio-cultural issues pertaining to women’s diets need more prolonged and sustained durations to enhance their scopes of feasibility. Ghana Health Service and individuals should organize similar interventions.
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    Contraceptive Discontinuation and Switching among Women in the Shai-Osudoku and Ningo Prampram Districts, Ghana
    (University Of Ghana, 2018-07) Modey, E.J.
    INTRODUCTION: The intended and continued use of contraceptives is critical for attaining individual reproductive health goals and the prevention of unintended births that may be subject to induced abortions. Women who eventually overcome barriers and adopt a contraceptive method, encounter challenges that result in discontinuation, switching, or method failure. The occurrence of discontinuation for reasons other than the desire to conceive or switching to less effective methods, places women at an increased risk of unintended pregnancies. Identifying the period within which any form of discontinuation or switching is likely to occur and the reasons influencing these, will facilitate the identification of opportunities for providing a more accurate guide to users and encourage the delivery of context–appropriate support to users of family planning services. OBJECTIVE: This study sought to identify the occurrence of contraceptive discontinuation and switching among women in the Shai-Osudoku and Ningo Prampram districts, Ghana. METHODS: Individual in-depth interviews with 20 women reporting for reproductive and child health care services at the district Hospital were undertaken. This was complimented by a retrospective survey of 1,114 women using a structured questionnaire that incorporated the contraceptive calendar to collect reproductive histories. Cox regression and life table analysis was used to estimate discontinuation or switching. RESULTS: All method discontinuation for any reason at 12, 24 and 36 months after starting use were 4%, 18% and 38% respectively. This study identifies increasing age, number of children, use of contraceptives between births, after childbearing and receiving counselling on methods were associated with the reduced risk of contraceptive discontinuation at all times of follow up. A change in marital status and was associated with increased contraceptive discontinuation. At 12 months of use 10% of women discontinued because they are afraid of side effects of contraceptives, this increases to 37% at 24 months of use. Women who expressed fear of side effects of contraceptives had a 60% increase in the hazard of discontinuation at all times of follow up [HR=1.60 95% CI (1.17, 2.20)] whilst women who experienced side effects had a 50% increase in the hazard of discontinuation [HR=1.34; 95% CI (1.04, 1.75)] compared to women who discontinued for any other reason implying dissatisfaction with the method. A reduced need for contraceptives was associated with a 57% increase in the hazard of discontinuation at all times of follow up [HR=1.57; 95% CI (1.22, 2.01)]. Discontinuation of the pill was significantly increased compared to users of the male condom [HR=2.35, 95% CI (1.40, 3.97)] and compared to all other methods [HR=1.68; 95% CI (1.26, 2.25)]. Approximately 39% of switching occurred within the next month of use. Increasing number of children and counselling on methods were associated with a reduction in the hazard of discontinuation. The choice of switching to modern method was associated with an increased hazard at all times of follow up and the male condom was the preferred method for 20% of all switchers. Overall, 3.4% of pregnancies were identified as unintended, with the emergency contraceptive identified as the method with the most failures recorded. CONCLUSION: A reduced need for contraceptives, fear of side effects and the experience of side effects carry an increased risk of discontinuation compared to all other reasons. The strength of the influence that fears of side effects play in method selection, discontinuation and choice of method switched to where switching occurs, is a critical but amenable element if allocated the necessary attention.