First trimester antenatal care visit reduces the risk of miscarriage among women of reproductive age in Ghana.

Miscarriage is a common adverse pregnancy outcome in childbearing and an increasing global reproductive health problem. This study explored 1) the national prevalence of the first trimester (≤12 weeks) miscarriage among women (15-49 years) in Ghana, and 2) the influence of first-trimester antenatal care (ANC) visits on miscarriage risk. A cross-sectional study using the Demographic Health Survey (DHS- 2017) on maternal health in Ghana was conducted. We used a nationally representative subsample of (7,846) women with no or early ANC visit of the initial sample (25,062). Women with late ANC visit (≥12 weeks) and those who were never pregnant or had not given birth at the time of the survey were excluded from this analysis. We performed multivariable Poisson regression to estimate miscarriage risk (RR), its associated risk factors, and national prevalence. The national first-trimester miscarriage prevalence was 19.1%. Increasing maternal age and urban residence were significantly associated with the risk of first- trimester miscarriage (p <0.001) while early ANC visits lower the risk of miscarriage by 43% (p=0.0246). We found that first trimester ANC visit decreases miscarriage risk in Ghana and highlights the important role of early ANC visits in reducing miscarriages.

Implications of Walking Aid Selection for Nonweightbearing Ambulation on Stance Limb Plantar Force, Walking Speed, Perceived Exertion, and Device Preference in Healthy Adults 50 Years of Age and Older.

BACKGROUND: Young adults often tolerate the increased energy expenditure, coordination, and stance limb discomfort associated with walking aids for nonweightbearing ambulation. Adults aged ≥50 years may not have the same tolerance. Therefore, the objective of this study was to determine how walking aid selection affects stance limb plantar force, walking speed, perceived exertion, and device preference in adults aged ≥50 years. METHODS: A prospective randomized crossover study was performed using healthy adults, aged ≥50 years, with no use of walking aids within 5 years. Participants walked 200 m in 4 randomized conditions: single nonweightbearing ambulation using crutches, a walker, a wheeled knee walker, and unaided walking. An in-shoe sensor measured stance limb plantar force, a stopwatch timed each walk, perceived exertion was reported using the BORG CR-10 scale, and device preference was identified. RESULTS: Twenty-one participants (7 male; age: 56 ± 5 years; BMI: 26.6 ±1.9) showed stance limb plantar force was lowest when using a wheeled knee walker (P < .001). Walking speed was similar in unaided and wheeled knee walker conditions (1.41 and 1.31 m/s), but slower with crutches or a walker (42%-68%, P < .001). Perceived exertion was similar in unaided and wheeled knee walker conditions (1.6 and 2.8), but higher with crutches or a walker (5.7 and 6.1, P < .001). Most (20/21) participants preferred the wheeled knee walker. CONCLUSIONS: Using a wheeled knee walker for nonweightbearing ambulation reduced stance limb plantar force, maintained unaided walking speed and perceived exertion, and was preferred to crutches or a walker. LEVEL OF EVIDENCE: Level II, comparative study.

Patterns of Birth and Family Planning Acceptor Rates in Ghana: An Ecological Study.

Despite a reported decline in Ghana's birth rate (BR), the pattern of ecological percent decrease in BR as corresponding to the percent increase in family planning acceptor rate (FPAR) in Ghana is not clear. This study explicitly explored and compared the pattern of birth and FPAR in Ghana from 2004-2015. National FPAR and BR data were retrieved from Ghana Health Service and World Bank. A time- trend descriptive analysis was performed via tableau software. Additionally, a segmented regression was applied to inferentially identify where statistically significant log-linear distinct segments exist in the trends. All segmented-related analysis was performed using joinpoint trend analysis software. Whereas, the highest decline in BR was observed from 2013-2015 (-1.4%), the highest increase in FPAR was rather observed from 2004-2008 (7.4%). Unexpectedly, from 2008-2013, a much higher decrease in FPAR (-5.8%) also yielded a moderate decline in BR (-0.7%). FPAR over the eleven years (2004-2015) increased by 1.1% whereas BR declined by -0.7%. BR in Ghana continues to be on a moderate declining trend. However, the decline was uninterrupted by an increase or decrease in FPAR. For a further decrease in Ghana's birth rate, a multifaceted approach is needed, not only focusing on increasing FPAR but also targeting adherence to FP control methods.