Adolescent sexual and reproductive health literacy needs: a sub-national level assessment in Ghana.

This study assessed young adolescents' access and literacy challenges to sexual and reproductive health information and knowledge gaps in the Effutu Municipality in the Central Region of Ghana. We used a narrative design and a focus group discussion method to glean data from 52 in-school adolescents, aged 11-15. Focus group discussions were conducted using a discussion guide and data were processed using QDA Miner (version 6.0). We analyzed data thematically using an iterative process of data validation, coding and recording. The participants had poor knowledge of the concepts of sexual and reproductive health and its essential domains. Abstinence was the predominant sexual and reproductive health goal of the participants. Yet, many males admitted to having sexual partners. There was difficult linguistic and physical access to structured and safe information. Personal hygiene, signs of sexual maturation and abstinence were the predominant contents available to young adolescents. A revision of adolescent health policies and strategies to embrace actions for improving unrestricted access to easy-to-read educational materials and adolescent health literacy is essential. Creating adolescent corners and introducing peer education in schools within Effutu and other municipalities in the Central Region will be useful.

Literacy-related factors and knowledge of patient rights charter: evidence from nurses in selected hospitals in Ghana.

BACKGROUND: Systems of across the world have developed and implemented patient rights policies to protect and improve the provider-patient relationship. The Patient Charter of Ghana was developed in 2002 to improve service quality and protect patients' rights. However, it is not yet known whether those at the frontline of healthcare delivery can read and understand the contents of the charter. While studies have explored the socioeconomic and institutional level factors related to awareness and knowledge of the Patient Rights Charter, there is a lack of literature on its readability and comprehensibility among nurses. This study assesses nurses' knowledge of the Patient Rights Charter and associated literacy-related factors. METHOD: An exploratory cross-sectional design and quantitative methods were used to collect data on knowledge, comprehension, and readability of the Patient Rights Charter. 205 nurses from four district hospitals in the Central Region were recruited using proportional and total enumeration sampling. Data were collected using structured questionnaires and were processed using SPSS (version 26) and an online text readability consensus calculator (version 2.0). Descriptive and inferential statistical analyses were performed, and data were presented using simple frequencies, readability statistics, and regression output. RESULTS: The results show the charter is written at a higher reading grade level; Flesch-Kincaid Grade Level (13.36), Simple Measure of Gobbledygook (11.57), and Coleman-Liau Readability Index (14.2). The average reading grade level score was 14. The Gunning Fox Index (15.40) and the Flesch Reading Ease Score (34%) show the patient charter is difficult to read and will require at least 14 years of education to be able to read. 87.3% of nurses were able to read and comprehend the charter. Very few (8.3%) read at frustration level. Nurses' actual comprehension of the charter was the only significant predictor of knowledge of the charter. CONCLUSION: Comprehension of the patient charter is an important predictor of its knowledge. The results emphasize the need to enhance the readability and comprehensibility of the charter for providers. Hospitals can stimulate nurses' knowledge of the charter by simplifying the charter's language and deliberately educating nurses on its content.

Breastfeeding-friendly policies and programs in three public Universities in Ghana.

BACKGROUND: The United Nations through its Sustainable Development Goals (SDG) 3 and 5 has championed Women empowerment for exclusive breastfeeding through various action plans and expected the concept to be decentralized through locally mandatory implementation of various institutional policies and programs in member Countries. Using Kabeer's empowerment concept, the authors in this paper assessed availability and implementation of breastfeeding policies and programs in three public universities in Ghana. METHODS: The study design was an exploratory-descriptive-case study involving university employees and student mothers from three public universities in Ghana. The universities were selected via simple random approach whilst selection of participants was purposive. Data were collected between April and July 2018 using an unstructured interview guide developed by the authors, audio recordings, field notes and desktop review of documents. Manual thematic analysis of data was done to present results descriptively. The University of Cape-Coast Ethics Review Board approved the study. RESULTS: Thirty-six respondents participated in the study. Three main themes (Breastfeeding policy and programs, Institutional support, and views on Breastfeeding/Childcare support) emerged. Despite being gender/child friendly, none of the universities in this study has a formal breastfeeding/childcare policy/program and there are no immediate policy plans for on-campus facilities to enhance breastfeeding. Financial cost emerged as a major challenge hindering the universities from implementing a policy/program in this regard. On the part of student mothers, lack of legal protection, lack of breastfeeding-friendly university policies, inadequate availability of breastfeeding facilities, and insufficient awareness of the importance of breastfeeding among nursing mothers has been a major setback for breastfeeding on campus, hence nursing mothers continue to make personal but challenging arrangements for breastfeeding on university campuses. CONCLUSIONS: The study findings reflect negative implications for childcare as it affects optimal child nutrition, hence impacting on achieving the SDGs 3 and 5 in Ghana. The authors recommend introducing formal breastfeeding-friendly policies/programs as one of the criteria for accreditation of universities in Ghana to enhance optimal childcare and sound maternal mind for studies and/or work once there is an assurance of child safety and proximity to breastfeed on demand.

Towards a comprehensive breastfeeding-friendly workplace environment: insight from selected healthcare facilities in the central region of Ghana.

BACKGROUND: In the last three decades, Ghana has championed the objectives of Baby-Friendly Hospital Initiatives to provide pregnant women and nursing mothers with the skills and support systems necessary for attaining optimal breastfeeding. Yet, little is known in literature on how these intervention regimes practically promote breastfeeding-friendly work environment in healthcare facilities and their level of effectiveness. This study explores the extent to which healthcare facilities in Ghana's Effutu Municipality provide breastfeeding-friendly workplace environment to breastfeeding frontline health workers. METHODS: A descriptive mixed-method approach was employed to collect data from fifty-four participants, comprising healthcare facility representatives and breastfeeding frontline health workers. A self-administered questionnaire with structured responses was administered to frontline health workers, followed by interview guides for representatives of hospital management. Thematic analysis was used to analyze interview responses. Responses to questionnaires were processed with SPSS version 23.0 and presented using frequencies and percentages. RESULTS: Three main themes emerged, namely, Standpoints on workplace breastfeeding support; Breastfeeding support, and Suggested future directions. Beyond this, six sub-themes emerged, including backings for workplace breastfeeding support; perceived benefits of breastfeeding support; factors of poor breastfeeding workplace support; maternity protection benefits; workplace support gaps, and awareness creation on benefits. Breastfeeding frontline health workers held that their hospitals have no breastfeeding policy (96%), no breastfeeding facility (96%), they do not go to work with baby (96%), but had 12 weeks maternity leave (96%) and worked half-day upon return to work (70%). CONCLUSION: Health facilities in the study do not provide a breastfeeding-friendly work environment except for the privileges provided by the Labor Act and conditions of service. Continuous advocacy on breastfeeding workplace support and stakeholder engagement to build consensus on the mix of strategies suitable to cushion breastfeeding frontline health workers is recommended for optimal breastfeeding and improved productivity.

Perceived work environment and patient-centered behavior: A study of selected district hospitals in the central region of Ghana.

INTRODUCTION: Quality work environment has been established as a marker of employee value creation. A plethora of qualitative evidence suggested that sustained focus on employee satisfaction through changes in the work environment, communication of patient-centered care strategic vision, management of staff workload, and workplace social support are factors that stimulate Patient-centered care. Yet, it seems that the effect of work environment on the patient-centered behavior of hospital employees has not been statistically estimated, and it is unclear which of the elements of the work environment best predict patient-centered behavior. METHODS: Using a survey design and quantitative methods to gather and analyze data, a sample of 179 respondents from three district hospitals were included in the study using a multi-stage proportional sampling technique. Data were collected using self-administered Likert item questionnaires. Simple linear regression was used to estimate the influence of work environment elements on patient-centered behavior. Stepwise multiple regression was used to determine the best predictors of patient-centered behavior of hospital employees. RESULTS: Perceived internal communication of patient-centered care strategies (ß = 0.23; P<0.001), supervisor support (ß = 0.31; P<0.001), coworker support (ß = 0.50; P<0.001), and working conditions (ß = 0.18; P<0.013) had a positive significant effect on patient-centered behavior of employees. Good predictors of employees' patient-centered behavior were perceived coworker support (ß = 0.51; P<0.001) and job characteristics (ß = 0.16; P<0.01). CONCLUSION: The work environment of hospital employees significantly affects their patient-centered behavior. Co-worker support and job characteristics were the best predictors of the patient-centered behavior of hospital employees. Hospitals Managers seeking to improve patient-centered behavior through employee value creation may consider improved job characteristics in combination with workplace social support and or communication of PCC strategies and goals.

Self-medication among pregnant women in two municipalities in the Central Region of Ghana.

Self-medication in pregnancy is a concern in Ghana. We assessed the practice among 136 pregnant women in Effutu and Agona West Municipalities using facility-based, cross-sectional design and mixed method approach of data collection. Our findings show that pregnant women of varying backgrounds self-medicate for sociocultural and economic reasons, with 69% prevalence, motivated by cheaper treatment cost (17%), minor ailments (29%) and positive outcomes (33%). Commonly used medications include antibiotics (23%), pain killers (20%) and herbal preparations (19%). We recommend further studies on pharmacological compositions of the medications used and effects on pregnancy outcomes to inform policy and programs decisions.

Association between health insurance membership and anaemia among children under-five years. Evidence from Ghana.

INTRODUCTION: Anaemia is prevalent among children in developing countries. The main objective of this study was to assess the association between health insurance membership and anaemia among Ghanaian children under-five years. METHODS: We obtained Ghana's Multiple Indicators Cluster Survey, 2011 dataset from the United Nations International Children's Emergency Fund. Data were analyzed with the aid of Stata/IC, version 15. RESULTS: The prevalence of anaemia among Ghanaian children under-five years was estimated to be 57%. Majority (73%) of the children were not insured. Health insurance membership was found to be a significant predictor of anaemia among children under-five years. CONCLUSION: Health insurance membership is a protective factor against anaemia among children under-five years. In the quest to eradicate anaemia among children, stakeholders would have to review the benefit package of the National Health Insurance Scheme coupled with prioritizing anaemia prevention interventions among more vulnerable children.

Examining working mothers' experience of exclusive breastfeeding in Ghana.

BACKGROUND: Although substantial evidence exists on factors that influence exclusive breastfeeding, there is a general lack of qualitative studies that examine how specific workplace factors constrain or promote exclusive breastfeeding among working mothers. The current study therefore examines working mothers' experience of exclusive breastfeeding, laying emphasis on the influence of workplace factors on working mothers' decision to exclusively breastfeed their babies. METHODS: The study uses a qualitative research approach and a three-stage purposive sampling procedure to select 20 mothers from 10 organizations in five industries for in-depth interviews on their exclusive breastfeeding experience. Data collected from the interviews were analysed using content analysis, with two major themes emerging for discussion. RESULTS: The results suggest that two major factors influence exclusive breastfeeding among working mothers: practice of exclusive breast feeding (knowledge and understanding of exclusive breastfeeding, and experience in exclusive breastfeeding) and workplace factors (length of maternity leave, closing time, absence of maternity policy in organizations, inadequate institutional support and family work-life balance). CONCLUSION: The results of the study suggest that workplace factors play an equally crucial role in the decision by mothers to exclusively breastfeed their babies. Thus, in the special case of working mothers where breastfeeding prevalence is low, the findings of this study can be crucial in evolving appropriate policies to support working mothers in their effort to exclusively breastfeed their babies.

Implications of self-medication in pregnancy for Safe Motherhood and Sustainable Development Goal-3 in selected Ghanaian communities.

Objectives: This study explored self-medication in pregnancy and its implications for achieving Safe Motherhood and Sustainable Development Goal-3 initiatives in some Ghanaian communities. Study design: A facility-based cross-sectional descriptive design using mixed method approach of data collection. Methods: Multi-staged simple random and purposive sampling techniques were used to select 136 pregnant women from public Antenatal Clinics in Efutu and Agona West municipalities in the Central Region of Ghana from June to August 2018. Quantitative data were collected using structured questionnaires and analyzed with Statistical Package for Social Sciences version 23.0 whilst interview guides were used to collect qualitative data via Focus Group Discussions and content analysis done. Results: Self-medication in the study area is a common practice among most (88%) pregnant women of all socioeconomic backgrounds, those in the first trimester of pregnancy (68.7%) and routine Antenatal clinic attendants (69%). Religion (p â€‹= â€‹0.003) and educational (p â€‹= â€‹0.004) backgrounds of respondents were significantly associated with self-medication in pregnancy and motivated by reproductive intentions, availability of medicines, time factor, media advertisements and societal influences relating to beliefs, fears, expectations and perceptions. Majority (90%) of respondents had no side effects. Conclusions: A nation-wide evaluation of public health education on the dangers of self-medication in pregnancy and implementation of drug regulatory policies are highly recommended in Ghana.

Facilitators and barriers of patient-centered care at the organizational-level: a study of three district hospitals in the central region of Ghana.

BACKGROUND: Improving patient experience of care has gained enormous attention from policy makers and providers of healthcare services in Ghana. In spite of the supposed support for patient-centered care as the means for improving patient experience of care, scientific evidence point to poor patient experience of care in Ghana. Moreover, there seem to be little evidence on organizational-level factors that facilitate or hamper patient-centered care. In this study we assess organizational-level factors that facilitate or impede patient-centered care in three district hospitals in the Central Region of Ghana. METHODS: The study was exploratory research that used qualitative methods to collect data from seven senior managers and 3 junior managers in three district hospitals in the Central Region of Ghana. Data were collected with the aid of an interview guide and a checklist. Data were analyzed using content analysis. RESULTS: Two main Organizational-level factors were identified, namely, facilitators and barriers of patient-centered care. Facilitators to patient-centered care included: 1) Leadership commitment. 2) Leadership support. 3) Training and education for patient-centered care. Patient-centered care barriers identified in the hospitals were: 1) Leadership conceptualization of patient-centered care. 2) Lack of goals and sufficient activities for patient-centered care. 3) Communication related challenges.4) Ownership type. 5) Degree of centralization. 6) Financial constraints. CONCLUSION: Organizational-level factors that promoted patient-centered care were fairly present in the hospitals. Yet, several other factors negatively affected patient-centered care in the hospitals. A suitable patient-focused intervention is recommended for implementation at the health system and institutional-levels to improve patient-centered care. Hospitals managers should develop suitable goals and activities to stimulate patient-centered care with the full participation of hospital employees and patients and families.

Family planning among undergraduate university students: a CASE study of a public university in Ghana.

BACKGROUND: Globally, the rate of unplanned pregnancies among students at institutions of higher education, continue to increase annually despite the universal awareness and availability of contraceptives to the general population. This study examined family planning among undergraduate university students focusing on their knowledge, use and attitudes towards contraception in the University of Education Winneba. METHODS: The study was a descriptive cross-sectional survey using a structured self-administered questionnaire. One hundred undergraduate students from the University of Education Winneba were selected using a multistage simple random sampling technique. A Likert scale was used to assess the attitude of the respondents towards family planning methods. RESULTS: Findings show that the respondents had a positive attitude towards family planning with an average mean score of about 4.0 using a contraceptive attitude Likert scale. Knowledge of contraception, awareness and benefits however do not commensurate contraceptive use among undergraduate students since availability, accessibility and preference influence usage. Emergency Contraception (Lydia) was reported as easy to get contraceptive, hence the most frequently used contraceptive (31%) among young female students aged 21-24 years who appeared as the most vulnerable in accessing and using contraceptives due to perceived social stigma. CONCLUSION: The observation that levels of Family Planning awareness levels do not commensurate knowledge and usage levels calls for more innovative strategies for contraceptive promotion, and Education on the various university campus. The study recommends that public Universities in Ghana should consider a possible curriculum restructuring to incorporate family planning updates. In this regard, a nationwide mixed method study targeting other tertiary institutions including colleges of education in Ghana is required to explore the topic further to inform policy and programme decisions.

Institutional support for breastfeeding in Ghana: a case study of University of Education, Winneba.

OBJECTIVES: This study explored institutional support for breastfeeding student-mothers in the University of Education, Winneba, Ghana. It also examined challenges associated with combining academic work with breastfeeding and childcare. RESULTS: Findings show that although the University as an institution does not have any formal system in place to support breastfeeding among student-mothers, it does follow the provisions made for breastfeeding under the maternity protection section of the labor Act (Act, 651) for its employees. Consequently, breastfeeding student mothers use under trees, lobbies, and Junior Common Rooms of on-campus halls of residence as lactation sites which exposes their babies to risk of infection. The absence of support put student-mothers through stress, divided attention, and conflicting responsibilities between academic work and childcare. Further studies to investigate the situation on other university campuses are recommended to promote policy and interventions on breastfeeding and childcare in tertiary institutions in Ghana to enable students maintain a balance between breastfeeding, childcare and academic work.

Maternal work and exclusive breastfeeding practice: a community based cross-sectional study in Efutu Municipal, Ghana.

BACKGROUND: Maternal work has been identified as one of the factors that affect exclusive breastfeeding in the first six months of life. In Ghana, mothers engaged in the formal sector of employment are unable to exclusively breastfeed after maternity leave because facilities at their work places and conditions of work do not support exclusive breastfeeding. Even though maternal work and exclusive breastfeeding does not seem well matched, not all maternal work are incompatible with the practice of exclusive breastfeeding. This study seeks to identify the features of maternal work associated with exclusive breastfeeding in Effutu Municipal in the Central Region of Ghana. To achieve the above aim, I discuss the different types of maternal work, their characteristics, and how the work may influence exclusive breastfeeding. METHODS: The study is a community based cross-sectional study involving 225 mother-infant pairs attending community based Child Welfare Clinics in Effutu Municipal, Ghana. Data were collected through face-to-face structured interviews and focus group discussions over a period of five months in 2015. Data on breastfeeding is based on the breastfeeding practice in the 24 h preceding the survey. Chi-square test is used to identify strength of association between the features of maternal work and exclusive breastfeeding practice. RESULTS: The exclusive breastfeeding rate among mothers with infants between the ages of 0 - 5 months is 72%. The mean and median number of breastfeeds per day is 11 ± 2.7 and 13.5 respectively. A significant difference in exclusive breastfeeding was established between mothers in the formal (16%) and informal (84%) sectors of employment (p = 0.020). The study also established a significant difference in breastfeeding frequency between mothers in the formal (9%) and informal (91%) sectors of employment (p = 0.001). There was also a significant difference in breastfeeding frequency among respondents that go to work with their infant (64%) and those who do not go to work with their infant (36%) (p = 0.000). CONCLUSION: Interventions to promote exclusive breastfeeding should include the use of existing family structures, supportive cultural beliefs, and practices and promotion of an infant-friendly work environment.