Preterm birth, low birth weight, and their co-occurrence among women with preexisting chronic diseases prior to conception: a cross-sectional analysis of postpartum women in a low-resource setting in Ghana.

BACKGROUND: The incidence of chronic diseases, which are significant contributors to maternal deaths and adverse new-born outcomes, is increasing among women of reproductive age in northern Ghana. This emerging health issue raises serious concerns about the potential exacerbation of adverse birth outcomes in this setting, given that it is one of the regions in the country with a high incidence of such outcomes. We investigated the risks of preterm birth (PTB), low birth weight (LBW), and concurrent PTB and LBW among women with preexisting chronic conditions prior to conception in the Tamale Metropolis of northern Ghana. METHODS: A facility-based cross-sectional study was conducted among 420 postpartum women randomly selected from five public health facilities. Information was collected electronically on participants' self-reported experience of chronic conditions, namely, hypertension, diabetes, asthma, heart disease, and sickle cell disease, prior to their most recent pregnancy. Information on gestational age at delivery and birth weight was also collected. Regression modeling was used to quantify the risk of adverse newborn outcomes among women who reported preexisting chronic conditions prior to pregnancy. RESULTS: Chronic diseases affected 31.2% of our sample. Of these, 28.6% had a single chronic condition, while 2.6% had comorbid chronic conditions. The prevalence of PTB was 24.0% (95% CI: 20.2, 28.4), 27.6% (95% CI: 23.5, 32.1) of the newborns were born LBW, and 17.4% (95% CI: 14.0, 21.3) of the pregnancies resulted in both PTB and LBW. Compared with those without chronic conditions, women with chronic conditions prior to conception had a greater risk of PTB (aOR = 6.78, 95% CI: 3.36, 13.68), LBW (aOR = 5.75, 95% CI: 2.96, 11.18), and the co-occurrence of PTB and LBW (aOR = 7.55, 95% CI: 3.32, 17.18). CONCLUSIONS: We observed significant rates of PTB, LBW, and the co-occurrence of PTB and LBW among women who were already aware that they had preexisting chronic conditions prior to conception. Our findings highlight a potential gap in the quality of prenatal care provided to these women before delivery. Preconception care may offer an opportunity to address preexisting chronic conditions in women before pregnancy and potentially improve maternal and newborn health outcomes.

Attitudes and Barriers of Emergency Nurses and Physicians Toward Family Presence During Resuscitation in Iran: A Cross-Sectional Study.

INTRODUCTION: Implementing family presence during resuscitation poses many challenges in developing countries, especially in developing countries like Iran, where cultural and contextual factors play significant roles. This study examined the attitudes and barriers of Muslim emergency nurses and physicians toward family presence during resuscitation in Iran. METHODS: A cross-sectional study included 300 physicians and 500 nurses. Data were analyzed using descriptive and analytic statistics. RESULTS: The overall score of physicians' attitudes toward family presence during resuscitation was higher than nurses' (P = .001). Female nurses had a higher attitude score than male nurses (P = .001). Other demographic variables were not significant with nurses' attitudes toward family presence during resuscitation. The most significant barriers to family presence during resuscitation included increased stress on staff and unwanted events during cardiopulmonary resuscitation. The attitude of Iranian physicians and nurses toward family presence during resuscitation is becoming more positive, with more than half of them agreeing with both the concept and the practice. DISCUSSION: The findings suggest that hospitals should develop and adopt policies to ensure consistent performance when implementing family presence during resuscitation and that the procedure is safe and effective.

Investigating hemolysis, elevated liver enzymes and low platelet count in preeclampsia: A case-control study in Ghana.

Background and Aims: Preeclampsia poses a heightened risk for women, particularly in the development of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, leading to adverse outcomes for both mothers and newborns. The incidence of HELLP syndrome tends to be notably higher among women with preeclampsia compared with those with normotensive pregnancies. However, there is a dearth of research on the frequency of HELLP syndrome within the context of preeclampsia specifically in Ghana. Furthermore, the potential predictive value of serum erythrocyte adenylate kinase (EAK), a marker of hemolysis, in anticipating the onset of preeclampsia remains largely unexplored. Methods: Conducted between May 2020 and April 2022, this research employed a case-control methodology at the War Memorial and Upper East Regional Hospitals. A total of 291 pregnant women participated, comprising 111 diagnosed with preeclampsia and 180 control subjects, aged between 18 and 43 years. Venous blood samples were collected and subjected to analysis for platelet count, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and EAK, utilizing automated analyzers, alongside the ELISA technique. Diagnosis of HELLP syndrome was established using the Mississippi triple-class definition. Results: The median serum ALT level (with interquartile range) was significantly elevated in the preeclampsia group compared with controls [20.0 (13.7-27.0) vs. 13.0 (9.4-18.6); p < 0.001]. Moreover, the frequency of Mississippi class 3 HELLP syndrome was notably higher among preeclampsia cases (2/111; 1.8%) compared with controls (1/180; 0.6%). Serum ALT emerged as the superior predictor of preeclampsia, outperforming LDH (with an area under the curve of 0.73 compared with 0.58). The sensitivity and specificity of ALT were measured at 47.8% and 87.2%, respectively. Conclusion: Although the occurrence of HELLP syndrome in preeclampsia cases appears relatively low, it may escalate as the prevalence of preeclampsia is anticipated to rise in low and middle-income nations.

Maternal hepatitis B status and Sex at birth: A cross-sectional study in a Ghanaian population.

Maternal carrier status of hepatitis B has been associated with excess sons while maternal immunity to it has been associated with excess daughters at birth. However, the proportion of males at birth (sex ratio) is relatively low in Sub-Saharan Africa despite the relatively high prevalence of hepatitis B. However, no known study has tested this hypothesis in the Ghanaian population; hence the aim of the study. The study was cross-sectional between January and September 2023 at the Tamale Central Maternal and Child Health unit. The study involved 380 mothers of whom mothers with daughters (MD) were 145 (38.2 %) while the rest were mothers with sons (MS). The mothers were aged between 18 and 43 years and were sampled within one week of delivery to singleton births. Maternal venous blood samples were collected and tested for hepatitis B surface antigen (HBsAg), surface antibody (HBsAb), envelop antigen (HBeAg) envelope antibody (HBeAb) and core antibody (HBcAb) using immunochromatographic technique and total testosterone (TT), using ELISA. There was no significant difference in the serum total testosterone level between MD and MS (0.32 ± 0.13 vs 0.32 ± 0.27, P = 0.991). Moreover, while the mothers were seropositive for HBsAg (10.5 %), HBsAb (35.5 %), HBeAg (0.0 %), HBeAb (5.3 %) and HBcAb (11.8 %), there was no significant association between sex at birth and maternal hepatitis B status for HBsAg (ꭓ2: 0.531, P = 0.472), HBsAb (ꭓ2: 2.655, P = 0.140), HBeAb (ꭓ2: 0.251, P = 0.633) and HBcAb (ꭓ2: 0.101, P = 1.000). Maternal hepatitis B status may not be associated with the offspring sex at birth in the studied population from Ghana.

Population-based cross-sectional study of factors influencing full vaccination status of children aged 12- 23 months in a rural district of the Upper East Region, Ghana.

BACKGROUND: Achieving universal health coverage includes ensuring that children have access to vaccines that are of high quality, safe, efficacious, and affordable. The Immunisation Agenda 2030 aims to expand services to zero-dose and incompletely vaccinated children and reduce immunisation rate disparities as a contribution to vaccination equity. This study explored the factors influencing full vaccination status among children aged 12 - 23 months in a rural district of the Upper East Region of Ghana. METHODS: A population-based cross-sectional study was conducted among carers of children aged 12 -23 months in the Kassena Nankana West district. A multistage sampling technique was used to select 360 carers. Information regarding the vaccination status of children was gathered through a combination of children's health record books and carers' recollections. Information on potential determinants was also systematically collected for analysis in Stata version 15.0. RESULTS: The results showed that 76.9% (95% CI: 72.3 - 81.0) of children had full vaccinations per the national schedule. All children received at least one vaccination. A higher percentage of carers with incompletely vaccinated children reported that they had travelled with their children as the primary reason for missing certain vaccine doses. Full vaccination status was significantly associated with secondary (aOR = 2.60; 95% CI: 1.20-5.63) and tertiary (aOR = 3.98, 95% CI: 1.34-11.84) maternal educational level, being in a partnership relationship (aOR = 2.09, 95% CI: 1.03-4.25), and residing in close proximity to healthcare facilities (aOR = 0.41, 95% CI: 0.21-0.80). CONCLUSIONS: Our study found that nearly one-quarter of children aged 12-23 months in the study setting are underserved with vaccination services for a variety of reasons. Effectively reaching these children will require strengthening health systems, including eliminating vaccine shortages, addressing the unique challenges faced by unmarried women with children aged 12-23 months, and improving accessibility to vaccination services.

Sociodemographic and Maternal Determinants of Postnatal Care Utilization: A Cross-Sectional Study.

Introduction: Postnatal care (PNC) is critical for the newborn and the mother, as it offers the opportunity to examine the mother and child to ensure early and timely intervention of any obstetric anomalies that might have gone unnoticed during delivery. However, there is a lack of data on PNC utilization and associated determinants in Ghana. Meanwhile, it is suspected that the PNC service should be more patronized by mothers, particularly within the first 2 days after delivery; therefore, investigating PNC utilization and associated factors could inform policies to enhance PNC uptake. Objective: The objective is to determine the level of utilization of PNC service and associated factors in the Savannah region of Ghana. Methods: The study used a facility-based analytical cross-sectional study design. The study was carried out in 311 postnatal mothers using consecutive sampling. Data collection was carried out using a questionnaire. Univariate and multiple logistic regression was performed to establish the determinants of PNC. Variables/variable categories with P < .05 were significantly associated with PNC. The significance level is anchored at P < .05. Results: The study showed that almost all respondents (98.7%) have heard about PNC services through health workers (39.7%), media (13.0%), and friends and relatives (47.2%). Most of the respondents (88.7%) have used PNC services within 48 h. Mothers aged 25-39 years were about seven times more likely to utilize PNC compared to those who were less than 25 years old (AOR [adjusted odds ratio] = 7.41, 95% CI [confidence interval]: 1.98-7.71); mothers with high school education (SHS) and above were also approximately four times more likely to use PNC compared to those who had no formal education (AOR = 3.65, 95% CI 1.97-13.66). In the same vein, married mothers were 10 times more likely to use PNC compared to those who are single mothers (AOR = 10.34, 95% CI: 3.69-28.97), whereas mothers who had at least four antenatal care (ANC) visits during pregnancy were approximately seven times more likely to use PNC compared to those who had less than four ANC visits (AOR = 6.92, 95% CI: 1.46-32.78). Reasons for not attending PNC include waiting time (40.5%), health workers' attitude (32.4%), being attended by a student (16.2%), being busy (27.0%), inadequate information on PNC (24.3%), and no family support (18.9%). Conclusion: All mothers knew about the PNC services, with a higher proportion patronizing the services. The increasing age, the level of mothers, marital status, and participation in ANC were significant determinants of the use of PNC. More education during ANC on the importance of PNC service is required to achieve universal coverage of PNC.

Factors that affect levels of alexithymia, empathy and communication skills of nursing students in northern Iran.

AIM: The inability of nurses to express their own emotions, understand others' emotions and show empathy could result in communication gaps that could affect patient care outcomes. This study investigates the factors associated with the levels of alexithymia, empathy and communication skills among nursing students. DESIGN: A survey was conducted among 365 nursing students, and data were collected using an online questionnaire. METHODS: Data analyses were done using SPSS software version 22. RESULTS: There was a significant positive association between age and empathy and a negative association between the number of times a nurse took the entrance exam. The level of education and interest in nursing correlate with communication skills. All the predictor variables of alexithymia in this current study were not significant. Emphasis should be placed on improving nursing students' empathy and communication skills. Student nurses should be taught how to recognize and express their emotions. To assess their mental health, they must be screened regularly.

A qualitative study of Ghanaian pediatric oncology nurses' care practice challenges.

BACKGROUND: Pediatric cancer is a global problem, and some studies have emphasized that nurses caring for these children experience work-related challenges. This has caused many children diagnosed with cancer to have a prolonged hospital stay and suffer unnecessary pain. However, there is insufficient documentary evidence on this issue. This study aims to explore and understand the challenges faced by pediatric oncology nurses in caring for children in Ghana. METHODS: An exploratory qualitative research design study was conducted from August 2019 to April 2020. The study was conducted at the pediatric oncology unit which is located at the Tamale Teaching Hospital (TTH), Ghana. The study was conducted among 14 Ghanaian pediatric oncology nurses who were purposively sampled. A semi-structured interview guide was used to collect data. The interviews were recorded, transcribed verbatim, and analyzed inductively using Elo and Kyngas content analysis approach. The criteria proposed by Guba and Lincoln were used to ensure the validity of the study. RESULTS: From the analysis of participants transcripts, eight subcategories emerged from two major categories. The subcategories were; time-consuming care, low job motivations, inadequate logistics, work stress, reduced labour force, low knowledge level, lack of teamwork and the perception of contracting cancer. CONCLUSIONS: The results point to several organizational and personal constraints experienced by the nurses who work at the pediatric oncology ward. It is hoped that by addressing these challenges, it would lead to further improvement in the care that is provided to children with cancer. There is the need for the administrative managers of hospitals, government and other stakeholders to invest in human, material and financial resources for delivering childhood cancer care services.

Striving to reduce suffering: A Phenomenological Study of nurses experience in caring for children with cancer in Ghana.

Aim: To provide insights into nurses lived experiences in caring for children with cancer. Background: Little is known about the paediatric oncology nurses shared practices of caring for children with cancer in Ghana. Design: A hermeneutic phenomenological qualitative study. Methods: A semi-structured interview with 14 purposely sampled Ghanaian paediatric oncology nurses. Findings were analysed using Diekelman, Allen and Tanner's approach. Results: The theme "Striving to reduce suffering" and three relational subthemes: "knowing children's needs," "Rendering a hopeful fight" and "Ensuring continuity and coordination of care" emerged. Increased awareness of this phenomenon for the nurses who care for these children is vital to ensure quality and holistic care that is meaningful and satisfying by nurses for children with cancer. Paediatric oncology nurses can use the result of the study to evaluate their caring practice and as an avenue to develop better caring practice.

Perspectives of parents on the meaning of happiness in children with long-term illness: A hybrid concept analysis.

Aim: To define the concept of happiness among children with chronic disease. Background: Happiness is an old human quest, the existing literature on the definition of happiness among children with chronic diseases is sparse. Methods: The three-phase hybrid model was used. In the first (theoretical) phase, a literature review was conducted. In the second (fieldwork) phase, the semi-structured interview data were analysed through content analysis. Ten participants were purposively sampled. In the third (final analytic) phase, the practical definition of the concept was identified. Results: The practical definition of happiness in a Ghanaian chronically ill child is the "subjective and positive lifelong process of adapting to biological, physiological, psychosocial, economic and environmental changes caused by the disease trajectory, which affects the well-being of the child and the family." Conclusions: This study offers a background for selecting appropriate health indicators and outcome measures in promoting happiness in children with chronic diseases.

Knowledge and practice of exclusive breastfeeding among mothers in the tamale metropolis of Ghana.

BACKGROUND: The prevalence of exclusive breastfeeding (EBF) for the first six months of life has remained low worldwide and in Ghana, despite strong evidence in support of its practice. This study was aimed at assessing the knowledge and practice of exclusive breastfeeding among mothers in the Tamale metropolis of Ghana. METHODS: In a descriptive cross-sectional study, 393 mother-infant pairs attending child welfare clinics from three health facilities in the Tamale Metropolis were surveyed. A structured item questionnaire was used to collect data on the socio-demographic Characteristics of the participants, their knowledge regarding breastfeeding and level of practice of exclusive breastfeeding (EBF). The results were presented in frequency counts, percentages and inferences were made using a contingency table and chi-square values were computed to check for the relationship between participants demographic characteristics, the Knowledge and the practice of EBF and P value was set at 0.05. RESULTS: The Analysis of the data was done with SPSS version 20. The study surveyed a total of 393 mothers from Tamale metropolis, of whom 27.7% reported having exclusively breastfed their infant for the first 6 months of life. The socio-demographic of the participants showed that they all had some level of education. The study revealed that 39.4% initiated breastfeeding within one hour after birth. Majority of participants had heard of EBF 277 (70.5%), about 344 (87.5%) of participants believed that EBF should be practised for 5 months in their locality. Pearson Chi-square test of the association between sociodemographic characteristics associated and EBF showed a significant association between EBF and the sex of the child, X2 = 4.177, P = .041. Whiles, EBF and the Knowledge on child spacing was X2 = 17.769, P < .001 and EBF and knowledge on Breast cancer reduction was also significant X2 = 4.384, P = .036. CONCLUSIONS: Although all the participants had some level of education background, a majority did not have adequate knowledge on EBF and EBF practice was low in the study community. Thus, we suggest improved education at the child welfare clinics and the media should be used as a platform to educate women adequately about importance of EBF.