Socio-cultural factors influencing teenage pregnancy in the East Mamprusi Municipality, Ghana.

Teenage pregnancy puts a heavy cost on the mother and newborn child, family and the wider society. Despite measures taken by the Ghana Health Service to tackle the issue of teenage pregnancy, the phenomenon remains a public health concern that is widespread throughout the country. The study investigated the socio-cultural factors influencing teenage pregnancy in the East Mamprusi Municipality using an exploratory descriptive design. The study was conducted in rural communities in the East Mamprusi Municipality, in the North East Region of Ghana. Eighteen (18) participants were purposively sampled. Data collection was done by face to face interviews using an interview guide. The study found that polygamous families, parents' desire for grandchildren, multiple sexual partners and poverty were reportedly influencing teenage pregnancy in the rural community. The bid to establish close family ties also accounted for early marriages. There is a culture of silence on matters of sexuality in the community. Teenage pregnancy is an observed phenomenon admitted by the participants and teenage girls are at risk of serious health complications. This phenomenon paints a gloomy picture of the girl child education in the municipality.

Exploring the Background, Context, and Stressors of Caregiving to Elderly Burned Patients: A Qualitative Inquiry.

Elderly persons are at risk of experiencing burns and require support from both formal and informal caregivers. Informal caregiving in this situation has been minimally explored. Guided by the Stress Process Model, this study aimed at exploring the background, context, and stressors of informal caregivers of elderly burned persons during hospitalization. A qualitative descriptive design was utilized. Purposive sampling approach was used to recruit fourteen (14) informal caregivers who rendered care to elderly burned persons during hospitalization. Interviews were conducted and transcribed verbatim following which directed content analysis was undertaken deductively. Three categories and six subcategories emerged which characterize the background, context, and stressors of informal caregiving to elderly burn patients. All the injuries occurred in the home setting and its sudden nature led to varied postburn emotional responses which characterized the context of burns caregiving. Primary stressors that emerged were related to the injury, actual caregiving demand, and concerns regarding increasing frailty levels. Secondary stressors identified were financial concerns and lifestyle changes. The findings suggest that the occurrence of burn injury served as a precursor to postburn stress response among informal caregivers. Increasing frailty levels, adequacy of household safety measures, and financial issues were key concerns which emphasize the need for psychosocial/transitional support, innovative healthcare financing measures, and continuing education on burns prevention in the home setting.

Self-Directed Female Migration in Ghana: Health and Wellness of Elderly Family Caregivers Left Behind. An Ethnographic Study.

Driven by the global economic crisis, families are developing strategies for survival, including self-directed female migration. Female migration has negative and positive impacts on families in rural areas. The purpose of the project was to explore the health and wellness experiences of elderly family caregivers who have female family members who have migrated to improve the status of their families. In this focused ethnographic study, we interviewed elderly family members who had a female family member who migrated outside their community for employment. Participants were enrolled from northern Ghanaian communities known to be economically disadvantaged in comparison to their southern counterparts. All interviews were audio-recorded, transcribed verbatim, and translated into English. Data were analyzed based on thematic content. Majors themes that emerged were reasons for children leaving their families; physical, emotional, and spiritual health; and social and economic struggles. Challenges of family care work undertaken by the elderly in families with emigrated female kin strongly also emerged as a theme. New contextual knowledge was developed about the impact of self-directed female migration on the health and wellness of elderly family caregivers. The information is valuable for the development of culturally appropriate social support and health practices for female migrants and their families.

"We try our best to offer them the little that we can" coping strategies of Ghanaian community psychiatric nurses: a qualitative descriptive study.

INTRODUCTION: Community psychiatric nurses work in extremely stressful environments with intense patient relationships as they try to prevent self-harm and manage aggressive behaviors. In order to improve their ability to manage the stressful work environments, community psychiatric nurses need to incorporate formal coping strategies into their daily work routines. With evidence-based coping strategies, community psychiatric nurses can effectively manage the stressful situations in their work environment to increase their work longevity. The purpose of this study was to explore the individual coping strategies currently used by community psychiatric nurses in practice in order to develop an intervention strategy for future implementation. METHODS: This was an exploratory qualitative study using an interpretative approach. A purposive sampling method was used to identify participants from the community psychiatric nurses in a region of Ghana. Participants were recruited and interviewed, guided by semi-structured questions, until saturation was reached. The interviews were audio-taped, transcribed verbatim, and analyzed thematically. RESULTS: A total of 13 participants, 10 women and 3 men ages 26 to 60 years, were interviewed for this study. From the inductive analysis, four coping themes emerged from the data including: 1) self-disguise, 2) reliance on religious faith, 3) self-motivation, and 4) reduction in the number of home visits. The participants described their work environment as stressful, almost to the point of overwhelming. In this regard, they identified the individual coping strategies as critical daily practices for self care to manage their high stress levels. CONCLUSION: Individual coping strategies are often used by community psychiatric nurses in daily practice. The participants identified personal coping strategies as critical interventions to manage stress and to decrease their risk for burnout. However, community psychiatric nurses must develop.personal-mastery in various coping strategies to care for themselves, as well as motivate them despite the challenging working environment. The individual coping strategies adopted by community psychiatric nurses was not only helped them deliver care, but also protected their clients so people would not label them as 'mental patients.' Collectively, the four strategies reported in this study need to be developed into a cohesive and comprehensive intervention.

Globalisation and transitions in abortion care in Ghana.

BACKGROUND: Access to safe abortion is a globally contested policy and social justice issue - contested because of its religious and moral dimensions regarding the right to life and personhood of a foetus vs. the rights of women to make decisions about their own bodies. Many nations have agreed to address the health consequences of unsafe abortion, though stopped short of committing to providing comprehensive services. Ghana has a relatively liberal abortion law dating from 1985 and has ratified most international agreements on provision of care. Policy implementation has been very slow, but modest efforts are now being made to reduce maternal mortality caused by unsafe abortions. Understanding whether globalisation has played a role in this transition to practice is important to institutionalise the transition in Ghana and to learn lessons for other countries seeking to implement policies, but analysis is lacking. METHODS: Drawing on 58 in-depth key informant interviews and policy document analysis we describe the development of de jure law and policies on comprehensive abortion care in Ghana, de facto interpretation and implementation of those policies, and assess what role globalization played in the transition in abortion care in Ghana. RESULTS: We found that an accumulation of global influences has converged to start a transition in the culture of abortion care and service provision in Ghana, from a restrictive interpretation of the law to facilitating more widespread access to legal, safe abortion services through development of policies and guidelines and a slow change in attitudes and practices of health providers. These global influences can be categorised as: a global governance architecture of reproductive rights-obligations which creates pressure on signatory governments to act; and global communication of ideas and mobility of health providers (particularly through cross-cultural training opportunities and interaction with international NGOs) which facilitate global cultural interaction on the benefits of safe abortion services for reducing consequences of unsafe abortions. CONCLUSION: Globalisation of information, debate and training experience as well as of international rights frameworks can together create a powerful force for good to protect women and their children from the needless pain and death resulting from unsafe abortions.

Beyond the Diagnosis: Lived Experiences of Persons with Spinal Cord Injury in a Selected Town in Ghana.

BACKGROUND: Although several studies have been conducted on the lived experiences of persons with spinal cord injury (SCI) in high income countries, there is no published data on such experiences in Ghana. The purpose of this study was to explore the lived experiences of persons with SCI in the Tamale Metropolis of the Northern Region of Ghana. MATERIAL AND METHODS: A qualitative descriptive design involving thirteen participants was conducted at the Tamale Metropolis-Ghana. A purposive sampling technique was used to recruit participants, using the Neurosurgical Unit of the Tamale Teaching Hospital as an outlet for recruitment of the sample. Data was gathered mainly through face-to-face in-depth interviews. The data was analyzed concurrently with data collection, using thematic content analysis. Ethical approval was obtained for the study from the Noguchi Memorial Institute for Medical Research and the research unit of the Tamale Teaching Hospital. RESULTS: The three main themes that emerged from the data during analysis were "physical effects," "psychological effects," and "social issues." Conclusion. The findings from the study suggest that SCI is a life threatening condition and that persons with SCI grapple with a myriad of physical symptoms that range from chronic pain and paralysis of lower and/or upper limbs, to bladder and bowel incontinence. These physical symptoms have significant psychological and social effects on the functioning of the affected persons.

Ghanaian Men Living with Sexual Transmitted Infections: Knowledge and Impact on Treatment Seeking Behaviour- A Qualitative Study.

The purpose of the study was to explore Ghanaian men's knowledge about sexually transmitted infections (STIs) and their treatment seeking behaviour. An exploratory descriptive design was used. The research site for this study was a STI clinic at a large government hospital in the Ashanti region in central Ghana. Purposive sampling was used to recruit men diagnosed with or previously infected with STI/HIV attending the clinic. Twelve participants were interviewed, and the data was thematically analysed. The findings were presented as themes: knowledge of STI, misconception, health seeking behaviour: visiting the hospital, buying drugs, using herbal treatment, visiting the traditional healer, and -shopping for health‖. Participants had good knowledge of the causes and/or mode of transmission of STIs/HIV. Their source of information was the radio, friends and education at the STIs/HIV unit of the hospital. Participants had little knowledge about the STIs/HIV treatment options before they received health education from the personnel at the STI/HIV unit. Participants had fallacies and believed they developed STIs/HIV infection because of a curse or someone who wanted them dead or bewitched them. The overarching reason for participants' choice of care was an expectation to recover from the infection. Seeking treatment at the hospital was one of the major choices for treatment. Participants tried various forms of treatment to find the most effective treatment. The research findings have several implications for health education, research, and practice in Ghana. There is the need to scale up health education by the various health institutions. Further research is needed on the general treatment seeking behaviour of men with an emphasis on the contextual and cultural differences that influence men's behavioural change. Gender based research is mostly focused on women and further studies are needed on the health and treatment seeking behaviour of men.

Stigmatized by association: challenges for abortion service providers in Ghana.

BACKGROUND: Unsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally. Abortion evokes religious, moral, ethical, socio-cultural and medical concerns which mean it is highly stigmatized and this poses a threat to both providers and researchers. This study sought to explore challenges to providing safe abortion services from the perspective of health providers in Ghana. METHODS: A descriptive qualitative study using in-depth interviews was conducted. The study was conducted in three (3) hospitals and five (5) health centres in the capital city in Ghana. Participants (n = 36) consisted of obstetrician/gynaecologists, nurse-midwives and pharmacists. RESULTS: Stigma affects provision of safe-abortion services in Ghana in a number of ways. The ambiguities in Ghanaian abortion law and lack of overt institutional support for practitioners increased reluctance to openly provide for fear of stigmatisation and legal threat. Negative provider attitudes that stigmatised women seeking abortion care were frequently driven by socio-cultural and religious norms that highly stigmatise abortion practice. Exposure to higher levels of education, including training overseas, seemed to result in more positive, less stigmatising views towards the need for safe abortion services. Nevertheless, physicians open to practicing abortion were still very concerned about stigma by association. CONCLUSIONS: Stigma constitutes an overarching impediment for abortion service provision. It affects health providers providing such services and even researchers who study the subject. Exposure to wider debate and education seem to influence attitudes and values clarification training may prove useful. Proper dissemination of existing guidelines and overt institutional support for provision of safe services also needs to be rolled out.

Shaping legal abortion provision in Ghana: using policy theory to understand provider-related obstacles to policy implementation.

BACKGROUND: Unsafe abortion is a major public health problem in Ghana; despite its liberal abortion law, access to safe, legal abortion in public health facilities is limited. Theory is often neglected as a tool for providing evidence to inform better practice; in this study we investigated the reasons for poor implementation of the policy in Ghana using Lipsky's theory of street-level bureaucracy to better understand how providers shape and implement policy and how provider-level barriers might be overcome. METHODS: In-depth interviews were conducted with 43 health professionals of different levels (managers, obstetricians, midwives) at three hospitals in Accra, as well as staff from smaller and private sector facilities. Relevant policy and related documents were also analysed. RESULTS: Findings confirm that health providers' views shape provision of safe-abortion services. Most prominently, providers experience conflicts between their religious and moral beliefs about the sanctity of (foetal) life and their duty to provide safe-abortion care. Obstetricians were more exposed to international debates, treaties, and safe-abortion practices and had better awareness of national research on the public health implications of unsafe abortions; these factors tempered their religious views. Midwives were more driven by fundamental religious values condemning abortion as sinful. In addition to personal views and dilemmas, 'social pressures' (perceived views of others concerning abortion) and the actions of facility managers affected providers' decision to (openly) provide abortion services. In order to achieve a workable balance between these pressures and duties, providers use their 'discretion' in deciding if and when to provide abortion services, and develop 'coping mechanisms' which impede implementation of abortion policy. CONCLUSIONS: The application of theory confirmed its utility in a lower-middle income setting and expanded its scope by showing that provider values and attitudes (not just resource constraints) modify providers' implementation of policy; moreover their power of modification is constrained by organisational hierarchies and mid-level managers. We also revealed differing responses of 'front line workers' regarding the pressures they face; whilst midwives are seen globally as providers of safe-abortion services, in Ghana the midwife cadre displays more negative attitudes towards them than doctors. These findings allow the identification of recommendations for evidence-based practice.

Attitudes and experiences of women admitted to hospital with abortion complications in Ghana.

Unsafe abortion is one of the major contributors to high levels of maternal mortality in Ghana, despite a relatively liberal legal environment. This paper presents findings from a semi-structured hospital-based survey of 131 Ghanaian women who had experienced unsafe abortion. The majority of respondents were young and single, with no children or just one child. Most had middle-school education or higher and were employed, as were their partners. While knowledge of family planning was high, knowledge of specific methods was barely moderate and only 17% respondents had ever used it - much lower than the national ever-use of 39%. There were widespread misunderstandings about who could use family planning and 41% said they were afraid of side-effects. Eleven percent said their pregnancy was planned and 31% that they wanted their pregnancy but were pressured by partners or families to abort. Overall, about one-third of respondents said they aborted because they were not married and two-thirds said they aborted because of socio-cultural pressures. This study highlights clear ongoing failings of the family planning programme which needs to be revamped, as well as an urgent need for improving public knowledge about access to safe, legal abortion services.

Pregnancy following eclampsia: a longitudinal study at korle-bu teaching hospital.

SUMMARY OBJECTIVE: To find out the reproductive performance of patients in the immediate pregnancy following an eclampsia. DESIGN: Longitudinal survey. SETTING: Obstetrics Unit of Department of Obstetrics and Gynaecology in a teaching hospital. SUBJECTS AND METHODS: Three hundred and ninety seven women whose previous pregnancies were complicated by eclampsia were followed up based on a schedule of antenatal care from 14-16 weeks gestation till delivery. The occurrence of hypertensive complications, timing of delivery, fetal outcome and birth weight were noted. RESULTS: There were no cases of recurrent eclampsia and no maternal death. Pregnancy-induced hypertension and pre-eclampia recurred in 15.8% of the women. These recurrencies were more significant among those who had changed their male partners (p = 0.0005). The caesarean section rate was 65.9%. The mean ponderal indices in those who developed hypertensive complications were significantly lower than the normotensives (P<0.03 However, the overall perinatal mortality rate of 23.3 per 1000 deliveries was lower than the 62.8 per 1000 in the general obstetric population. CONCLUSION: Previous episode of eclampsia does not necessarily affect perinatal and maternal outcome adversely in subsequent pregnancy, provided adequate antenatal surveillance and timely delivery are offered to the patients.