Women's experiences of midwifery care immediately before and after caesarean section deliveries at a public Hospital in the Western Region of Ghana.

BACKGROUND: Childbirth remains a uniquely multifaceted, mental-cognitive and a major life experience to women. It is composed of a variety of psycho social and emotional aspects and creates memories, sometimes bad experiences and unmet expectations which leaves the mother with lasting scars. Therefore, this study aimed at exploring post-caesarean section delivered mothers experiences of midwifery care in a public hospital in Ghana. METHODS: This descriptive exploratory qualitative research used an interpretative approach to explore mothers' experiences of midwifery care immediately before and after caesarean section (CS). The study employed a purposive sampling technique in recruiting 22 participants who had knowledge of the phenomenon under study. Data collection was guided by an interview guide, which involved face to face individual interviews and focus group discussion at the postnatal ward and clinic. All interviews were audio-recorded and lasted 30-40 min. Audio recordings were transcribed verbatim and inductive thematic data analysis employed. RESULTS: Four major themes emerged from the analysis of participants' transcripts: Support by Midwives (physical and psychological, and attitude towards patients' pain management); Protection of mothers (provision of privacy, confidentiality and physical environment); Provision of information/communication (before caesarean section, and before a minor task) and midwives' attitude (attitude towards delivery care). CONCLUSION: Mothers delivered by caesarean section had varied experiences of midwifery care which were both positive and negative ones. Provision of psychological support and adequate pain management were positive experiences. The challenges experienced were related to provision of information, privacy, and physical support. Participants, who underwent emergency CS in particular, were dissatisfied with the provision of information concerning the surgical procedure. Provision of privacy and physical support were also issues of great concern. We therefore, recommend supportive and sensitive midwifery care particularly for mothers undergoing emergency CS. Documenting women's diverse experiences of midwifery care before and after CS delivery is important to healthcare providers, hospital managers and policy makers as the feedback garnered can be used to improve maternity services and inform decisions on midwifery care.

Determinants of use of mobile phones for sexually transmitted infections (STIs) education and prevention among adolescents and young adult population in Ghana: implications of public health policy and interventions design.

BACKGROUND: Sexually Transmitted Infections (STIs) are a major public health challenge globally especially among adolescents and young adults in lower-middle-income countries (LMICs) in Africa including Ghana. In light of this, mobile phone innovations are advocated to enhance public health education and prevention of STIs in developing health systems. OBJECTIVE: This study assessed mobile phone usage among adolescents and young adult populations pursuing tertiary education and their use of these technologies in the education and prevention of STIs. METHOD: This was a cross-sectional analytical study among 250 adolescents and young adults aged 18-24 at Ghana's premier and biggest public University. The study was however conducted in only one public university in the Greater Accra region  which potentially poses generalizability challenges due to socio-cultural and economic differences in other regions of the country. Data was collected using structured questionnaire and data analysis done with STATA (version 12.0). Univariate probit regression (VCE, Robust) analysis was used to determine factors associated with adolescents and young adult population's usage of mobile phones in the education and prevention of STIs. RESULTS: Out of the 250 adolescents and young adults interviewed, 99% owned mobile phones. Out of this number, 58% them were smartphone users. Also, it was found that male young adults (Coef. = 1.11, p = 0.000) and young adults who owned a smartphone (Coef. = 0.46, p = 0.013) were more likely to use mobile phones for education and prevention of STIs. CONCLUSION: Mobile phone penetration among young adults is nearly 100% in line with the national trend. Additionally, these young adults largely believe in the use of mobile phone programmes for STIs education and prevention. Moreover, respondents were found to be more comfortable using mobile applications than traditional text messaging or phone calls in STIs education and prevention. Future mobile phone programmes for STIs education and prevention should consider innovating customized mobile applications to promote acceptability by the youth and enhance sustainability of such interventions on STIs in Ghana. Even though this study was conducted in only one public university in Ghana, the findings are nonetheless informative and future researchers could consider using a larger sample size across private and public universities in other regions of the country.

Cultural beliefs and practices of women influencing home births in rural Northern Ghana.

Background: One of the maternal health care strategies identified by the World Health Organization as being crucial for saving lives of pregnant women, which also serves as an indicator for progress in reducing maternal mortality, is the provision and utilization of skilled birth care. Despite the importance of skilled birth care in preventing maternal morbidity and mortality, many women continue to give birth at home without the assistance of skilled birth attendants in rural communities of Ghana. Purpose: The purpose of this study was to explore the cultural beliefs that potentially influenced the choice of home births among rural women in Ghana. Methods: A qualitative approach was utilized to conduct this study. Twenty participants who delivered at home were purposefully selected and interviewed individually. Semistructured interviews were used to explore the cultural belief patterns that potentially influenced the choice of home births among women in rural Ghana. Thematic analysis approach was used to analyze the data. Results: Four major themes emerging from the data analysis which influenced rural women's decision to give birth at home are namely: opportunity to access psychological support through family members, opportunity to access culturally acceptable food, opportunity to adopt a birthing position of choice, and opportunity for safe and culturally accepted disposal of placenta. Conclusion: This study concluded that the cultural beliefs held by these women greatly affected their decision to deliver at home. Hence, there is a need for health care managers to facilitate collaborative practices between the skilled birth attendants and traditional birth attendants. This is because this approach could enhance the integration of the cultural beliefs and practices of women in the orthodox health care delivery system to facilitate the utilization of skilled birth care.

Adherence to standard nursing protocols on nasogastric tube feeding in a secondary referral hospital in Ghana: comparing self-ratings by professional and auxiliary nurses.

BACKGROUND: Data on nurses' adherence to standard protocol on nasogastric (NG) tube feeding remain scanty in Ghana even though patients in critical medical conditions are routinely managed using this procedure. This study explored self-rated adherence to standard protocols on NG tube feeding among professional and auxiliary nurses and the perceived barriers impeding compliance to these standard protocols. METHODS: This is a descriptive analytical cross-sectional study among professional (n = 89) and auxiliary (n = 24) nurses in a major referral hospital in one of the ten administrative regions in Ghana. Four-point Likert scale was used to ascertain the level of adherence to standard guidelines on nasogastric tube, ranging from 4 "Very large extent" to 1 "Very little extent". Wilcoxon Mann-Whitney test and univariate ordered logistic regression tests (proportional odds models) were performed to determine the odds of higher self-ratings among professional and auxiliary nurses. RESULTS: Overall, the odds of higher self-ratings on adherence to standard nursing protocols on NG tube feeding was higher among auxiliary nurses than professional nurses (OR = 2.76, p = 0.031) after adjusting for age, gender, education and years of work experience. Key barriers to adherence to standard protocols on NG tube feeding were: limited opportunities for in-service trainings and insufficiency of NG tube feeding protocols on the wards. CONCLUSION: There is the need for more routine in-service trainings for nursing staff to update their knowledge on NG tube feeding. Hospital management should also make current nursing protocols available to nurses to guide their practice alongside routine onsite supervision of nurses.

Perceived needs of health tutors in rural and urban health training institutions in Ghana: Implications for health sector staff internal migration control.

BACKGROUND: The population of Ghana is increasingly becoming urbanized with about 70% of the estimated 27 million people living in urban and peri-urban areas. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32% of the national health sector workforce works. Moreover, the rural-urban disparities in the density of health tutors (staff responsible for pre-service training of health professionals) are enormous. This paper explores perceived needs of health tutors in rural and urban health training institutions in Ghana. METHODS: This is a descriptive qualitative study conducted in the Greater Accra and Northern regions of Ghana. The Study used the deductive thematic and sub-thematic analysis approaches. Five health training institutions were randomly sampled, and 72 tutors engaged in separate focus group discussions with an average size of 14 participants per group in each training institution. RESULTS: Perceived rural-urban disparities among health tutors were found in the payment of extra duty allowances; school infrastructure including libraries and internet connectivity; staff accommodation; and opportunities for scholarships and higher education. Health tutors in rural areas generally expressed more frustration with these work conditions than those in urban areas. CONCLUSIONS: There is the need to initiate and sustain work incentives that promote motivation of rural health tutors to control ongoing rural-urban migration of qualified staff. It is recommended the following incentives be prioritized to promote retention of qualified health tutors in rural health training schools: payment of research, book and rural allowances; early promotion of rural staff; prioritizing rural tutors for scholarships, and introduction of national best health tutor awards.

Sources of support for women experiencing obstetric fistula in northern Ghana: A focused ethnography.

OBJECTIVE: we explored how women in northern Ghana who have or have had obstetric fistula and those close to them perceive support. DESIGN: focused ethnography, that includes in-depth interviews, participant observation, and scrutiny of relevant records. SETTING: a fistula treatment centre in a regional urban centre and three remote villages located in northern Ghana. PARTICIPANTS: the sources of data included in-depth interview (n=14), non-participant observation and interaction, as well as scrutiny of relevant health records and documents. Participants for in-depth interviews and observation included women affected by obstetric fistula, their partners, parents, relatives, nurses and doctors. FINDINGS: presentation of obstetric fistula information, particularly by Non-Governmental Organisations was not in a format that was readily understandable for many women and their families. Food and other basic requirements for daily living were not necessarily available in the fistula treatment centre. Travelling for care was costly and frequently not easily accessed from their communities. Fistula repair surgery was available at unpredictable times and only for a few days every one to two months. CONCLUSIONS: women perceived support from spouses/partner, family members, and other relatives but much of this is limited to tangible support. Perceptions of support were particularly focused on access to information and finances. IMPLICATIONS FOR PRACTICE: the implementation of strategies to increase support for women living with obstetric fistula include improving access to fistula repair treatment, directing resources to create a dedicated specialist fistula centre located where most cases of OF occur and providing education to front-line workers. Strategies to prevent fistula as well as identify and support safe motherhood practices are needed for women affected by obstetric fistula.

Lived experiences of Ghanaian women with obstetric fistula.

Obstetric fistula is a worldwide problem that is devastating for women. This qualitative descriptive study explores the experiences of Ghanaian women who sustained obstetric fistula during childbirth. In-depth interviews were conducted with 10 participants. The resultant themes include cultural beliefs and practices surrounding prolonged labor in childbirth, barriers to delivering at a health care facility, and the challenges of living with obstetric fistula, including psychosocial, socioeconomic, physical, and health care access issues. Recommendations include strategies to address this complex problem, including education of men and women on safe motherhood practices, training of traditional birth attendants (TBAs), and improving access to health care.