Challenges and coping strategies when caring for terminally ill persons with cancer: perspectives of family caregivers.

INTRODUCTION: Terminal illness is an irreversible illness that, without life-sustaining procedures, usually results in death or permanent disability from which recovery is unlikely. When involved, family caregivers are believed to improve health outcomes, such as reduced hospitalization, and establishing a patient's initial access to professional treatment services. However, caring for a patient with a terminal illness is viewed as one of the most difficult aspects of providing care. This study aimed to identify the challenges, and coping strategies developed by family caregivers to cope with the care of the terminally ill person. METHODS: An exploratory descriptive qualitative approach was used. Twenty (20) family caregivers voluntarily participated in the study from the Korle-Bu Teaching Hospital. Semi-structured interviews were conducted with the participants. The transcribed interviews were then analysed using thematic analysis. RESULTS: From the analysis, three main themes emerged: challenges, coping strategies, and social support. These themes encompassed sixteen subthemes including financial burden, bad health conditions, faith and prayer, and support from health professionals. From the study, both male and female family caregivers narrated that providing care for sick relatives undergoing terminal disease is characterized as a daily duty demanding one's time and fraught with emotional strain. In addition, even though it was a difficult job, family members who provided care for ailing relatives never gave up, citing responsibility, the importance of family, and religious beliefs as the primary motivations for doing so. CONCLUSION: The difficulties and demands of family caregiving roles for terminally ill relatives are complex and multifactorial. The findings call for multidisciplinary professional attention for family caregivers and policies that will support their lives holistically.

The use of antibiotics during pregnancy: A cross-sectional study of knowledge, attitude, and practices among antenatal care attendees in Northern Ghana.

Background and aims: The promotion of rational use of antibiotics among pregnant women is eminent not only for the risk of teratogenicity in the developing fetus but also the risk of drug resistance with its concomitant high cost of health care. Studies on antibiotic self-medication among pregnant women in Northern Ghana are rare. Improving the knowledge and awareness among the vulnerable groups about the appropriate use of antibiotics can help in limiting the antibiotic resistance menace. We, therefore, conducted this study to assess the knowledge, attitude, and practice (KAP) toward antibiotic use among pregnant women attending an antenatal clinic at a primary health care in Tolon, Northern Region, Ghana. Method: We conducted a cross-sectional study using an interviewer-administered questionnaire to assess the KAP of 702 pregnant women on antibiotic use. This study was conducted in the Tolon Health Center (THC) from March 2021 and ended in October 2021. Results: In this study, 55.6% of pregnant women had good knowledge and 45.3% of them had engaged in self-medication with antibiotics while pregnant. There were statistically significant associations between participants' background and obstetric characteristics and knowledge of antibiotic use and antibiotic resistance, except for age, marital status, and parity. Also, there was a significant association between pregnant women's knowledge and self-medication or over-the-counter purchase of antibiotics. Conclusion: We concluded that higher education level, monthly income, good practice, and good knowledge were significantly associated with a reduced likelihood of self-medication with antibiotics. A well-structured education that could be easily accepted and understood by pregnant women on the risks of antibiotic self-medication should be included in the routine education at the antenatal clinics.

The development of a framework for clinical education programme of undergraduate nursing students in Ghana.

INTRODUCTION: Clinical education is an important aspect of the training of nursing students but it is faced with challenges in Ghana. The development of a framework will respond to the need for improvement in the quality of clinical nursing education. This study describes part of a larger study which culminated in the development of a framework for a clinical education programme for undergraduate nursing students in Ghana. The aim of the current study was to integrate findings from a scoping review and situational analysis to develop a framework for clinical education in nursing. METHODS: A sequential multimethod design approach was used to conduct the study. A scoping review on the practices that facilitate clinical nursing education and situational analysis were first conducted. The lessons learnt from the scoping review and the situational analysis provided the data matrix that was triangulated to develop the framework. The framework was developed using the model for clinical education developed by South African Nursing Education Stakeholders in consultation with experts in nursing education. An implementation plan was developed from the framework and evaluated using a Delphi technique. FINDINGS: The resulting framework indicates the need for effective communication and collaboration between nursing education institution and the service setting to ensure that there is a well-structured clinical placement, formal supervision system and effective clinical assessment of students. The framework also proposes that to ensure quality clinical nursing education there is the need for Nursing Education Institutions to implement innovative and cost-effective clinical teaching methods. CONCLUSION: The framework spells out the functions of the various stakeholders in nursing education and how these can be integrated and implemented to enhance quality clinical nursing education. Effectiveness of the thematic areas of the framework will increase the quality of clinical nursing education.

The state and significant drivers of health systems efficiency in Africa: A systematic review and meta-analysis.

Background: Low-and-middle-income countries, especially in Africa, lack the capacity to adequately invest in health systems to attain universal health coverage (UHC). As such, countries must improve efficiency and provide more services within the available resources. This systematic review synthesised evidence on the efficiency of health systems in the African region and its drivers. Methods: We conducted a systematic literature review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Related studies were grouped and meta-analysed, while others were descriptively analysed. We employed a qualitative content synthesis for synthesising the drivers of efficiency. Results: Overall, 39 studies met a predetermined inclusion criterion and were included from a possible 4 609 records retrieved through a rigorous search and selection process. Using a random effects restricted maximum likelihood method, the pooled efficiency score for the Africa region was estimated to be 0.77, implying that on the flip side, health system inefficiency across countries in the African region was approximately 23%. Across 22 studies that used data envelopment analysis to examine efficiency at the level of health facilities and sub-national entities, the efficiency level was 0.67. Facility-level studies tended to estimate low levels of efficiency compared to health system-level studies. Across the 39 studies, 21 significant drivers of inefficiency were reported, including population density of the catchment area, governance, health facility ownership, health facility staff density, national economic status, type of health facility, education index, hospital size and bed occupancy rate. Conclusion: With approximately 23% of the inefficiency of health systems in Africa, improving efficiency alone will yield an average of 34% improvement in resource availability, assuming all countries are performing similarly to the frontier countries. However, with the low level of health expenditure per capita in Africa, the efficiency gains alone will be insufficient to meet the minimum funding requirement for UHC. Registration: PROSPERO: CRD42022318122.

Unveiling how Clinical Nursing Education can be Improved in Northern Ghana: The Perspectives of Key Informants.

Introduction: Clinical nursing education is an important component of the professional development of nursing students. Key informants such as nursing lecturers, nurse managers and clinical placement coordinators play an essential role in clinical education. Purpose: The purpose of the study was to explore the perspectives of key informants on how the current state of clinical nursing education in Northern Ghana can be improved. Methods: The study used an exploratory qualitative design. Sixteen participants were purposively selected and data were collected through face-to-face individual interviews. Data were analysed using framework analysis. Findings: The study findings indicate that clinical nursing education can be improved by decreasing the overcrowding of students in the clinical setting, decreasing the theory-practice gap and providing relevant material resources in the clinical facilities. Also, nursing education institutions can improve clinical nursing education by equipping the skills laboratories, engaging an adequate number of lecturers, and carrying out clinical accompaniment. Conclusion: There is a need to improve clinical education through collaboration between nursing education institutions and clinical facilities. Effective collaboration will ensure the planning of clinical placement to avoid overcrowding, provision of continuous professional development programmes for preceptors and improvement in clinical supervision. Also, the provision of material resources in skills laboratories and clinical facilities to enhance clinical teaching should be given priority.

Determinants and preventive practices of midwives and physicians toward vertical transmission of hepatitis B in Ghana: a cross-sectional survey.

Introduction: countries in sub-Saharan Africa, including Ghana, are disproportionately affected by hepatitis B viral (HBV) infection. In these areas, mother-to-child transmission (MTCT) is an essential mode of HBV transmission. Evidently, timely hepatitis B birth dose vaccination remains an effective preventive intervention against MTCT of HBV. Considering that midwives and physicians are the primary care providers of newborns in Ghana, we sought to examine their preventive practices toward vertical transmission of HBV in the eastern region of Ghana. Methods: a cross-sectional survey was conducted with 126 healthcare providers (HCP; midwives and physicians). The participants were conveniently recruited from one regional hospital and four district hospitals. Statistical significance was set at 0.05 alpha level. Results: the findings indicate that 42.9% (n = 54) of HCPs' prevention of mother to child transmission (PMTCT) practices for hepatitis B were good (X2 = 2.57, p > 0.05). Explicitly, 79% indicated screening all pregnant women for hepatitis B as part of antenatal care (X2 = 41.14, p < 0.001). Additionally, about half of the participants (52.4%) reported providing pre-test counselling (X2 = 0.29, p > 0.05), whereas one-third (33%) reported routinely administering a birth dose of the hepatitis B vaccine to neonates of mothers with hepatitis B (X2 = 14.00, p < 0.001). However, only 37% reported administering the hepatitis B vaccine to newborns within 12 hours of birth (X2 = 9.18, p < 0.01). The binary logistic regression analyses identified training as the only significant predictor of good practice on PMTCT of hepatitis B at the 5% level (Wald = 3.91, p =0.05). Conclusion: given that more than half of the participants in the study area had incorrect PMTCT practices for hepatitis B, it is imperative that a series of workshops on hepatitis B be done for healthcare providers in Ghana. In addition, hepatitis B birth dose vaccine must be incorporated into the ´Expanded Programme on Immunisation´ to remove the cost that acts as a barrier to access.

Facilitators to the continuous abuse of tramadol among the youth: A qualitative study in Northern Ghana.

STUDY AIM: Considering the alarming rate at which young people abuse tramadol, as evidenced by the numerous media reports on the subject, this qualitative study was conducted to explore the facilitators to the abuse of tramadol by young people. DESIGN AND METHODS: A qualitative exploratory descriptive design was employed in conducting the study. A total of 18 participants were purposively sampled. Data for the study were collected through two focused group discussions and three in-depth-interviews. Thematic analysis was used to analyse the data. RESULTS: The findings of the study revealed four main themes. These themes were initiating factors of abuse; desirable physical effects; desirable psychological effects; and undesirable effects. It was revealed that many young people initially get into tramadol abuse because of peer pressure, curiosity or post-traumatic addiction. However, they often continue the practice for various physical and psychological gratifications including euphoria, attentiveness, high energy levels, pain relief and improved sexual performance. The study also revealed some unpleasant side effects of tramadol abuse such as severe vomiting, loss of appetite, seizures, emotional aloofness and irritability. Many of the participants in this study also expressed willingness to quit tramadol abuse because of social discrimination and the enormous side effects that come with the abuse of the drug.

Perceived Barriers of Child Adoption: A Qualitative Study among Women with Infertility in Northern Ghana.

BACKGROUND: Having a child is important among married women in Northern Ghana. Among married women, infertility is the main factor causing childlessness. Child adoption provides an alternative for married women to have children. The purpose of the study was to explore the perceived barriers of child adoption among women with infertility. METHODS: The study used an exploratory qualitative approach to understand barriers of child adoption. The study was conducted among 15 women attending fertility clinic in a mission hospital in Northern Ghana. Participants were purposively recruited and data collected by individual face-to-face in-depth interviews. The interviews were audio-recorded, transcribed, and analysed using content analysis. Data were collected between January and March, 2016, in an office in the hospital. RESULTS: The results suggest that barriers of child adoption include negative reaction of husbands, psychological dissatisfaction, and family dynamics. It was realised that husbands' reaction includes preference for biological children and marrying of second wives. Child adoption was psychologically dissatisfying to participants with some suggesting that it will make no difference and is a sign of acceptance of defeat in the quest to have biological children. The study findings also suggested that family dynamics that could hinder the practice of child adoption includes high value for blood relations, blaming of the woman, unpredictable family influence, discrimination against the adopted child, and family not allowing the adopted child to inherit property. CONCLUSION: The preference for biological children is by far an outstanding barrier and a major influence of all the emanating barriers associated with child adoption. There is the need for public education and special counselling session for husbands and other family members on child adoption as an alternative solution for infertility.

Exploring the Determinants of Antenatal Care Services Uptake: A Qualitative Study among Women in a Rural Community in Northern Ghana.

BACKGROUND: Global evidence has shown significant contribution of Antenatal care (ANC) in the detection and treatment of pregnancy related complications. Over the years, many areas in Ghana have recorded high uptake of ANC. However, this is not the case for Binduri district in Northern Ghana where only 37.4% of pregnant women utilised the services of ANC during their period of pregnancy compared to a national figure of 87%. We therefore sought to explore the determinants of ANC uptake among women who failed to utilise ANC services during their period of pregnancy in Binduri District in Northern Ghana. METHODOLOGY: The study was an exploratory descriptive study using purposive sampling technique. A total of 15 women who met the inclusion criteria for the study were recruited for a face-to-face interview. The data were analysed using the procedure of inductive thematic analysis. RESULTS: The study findings showed that several factors hindered the use of ANC among our participants. The individual factors that were responsible for nonutilisation of ANC included financial constraints hindering registration with the national health insurance scheme, excuses of being busy, perception that pregnancy was not sickness and concentration on work. Perceived poor attitude of nurses was the only health system factor that contributed to non utilisation of ANC services. CONCLUSION: There is the need for establishment of registration centres of the national health insurance in all communities to make the scheme more accessible. There should also be intensive public education on importance of attending ANC.