Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient's perspective.

BACKGROUND: Despite having an effective community-based Directly Observed Therapy Short-course (DOTS) strategy for tuberculosis (TB) care, treatment adherence has been a major challenge in many developing countries including Ghana. Poor adherence results in discontinuity of treatment and leads to adverse treatment outcomes which pose an increased risk of drug resistance. This study explored barriers to TB treatment adherence and recommended potential patient-centered strategies to improve treatment adherence in two high-burden TB settings in the Ashanti region of Ghana. METHODS: The study was conducted among TB patients who defaulted on treatment in the Obuasi Municipal and Obuasi East districts in the Ashanti region. A qualitative phenomenology approach was used to explore the barriers to TB treatment adherence. Purposive sampling was adopted to select study participants with different sociodemographic backgrounds and experiences with TB care. Eligible participants were selected by reviewing the medical records of patients from health facility TB registers (2019-2021). Sixty-one (61) TB patients met the eligibility criteria and were contacted via phone call. Out of the 61 patients, 20 were successfully reached and consented to participate. In-depth interviews were conducted with participants using a semi-structured interview guide. All interviews were audio recorded and transcribed verbatim. The transcripts were imported into Atlas.ti version 8.4 software and analyzed using thematic content analysis. RESULTS: Food insecurity, cost of transportation to the treatment center, lack of family support, income insecurity, long distance to the treatment center, insufficient knowledge about TB, side effect of drugs, improvement in health after the intensive phase of the treatment regimen, and difficulty in accessing public transportation were the main co-occurring barriers to treatment adherence among the TB patients. CONCLUSION: The main barriers to TB treatment adherence identified in this study reveal major implementation gaps in the TB programme including gaps related to social support, food security, income security, knowledge, and proximity to treatment centers. Hence, to improve treatment adherence there is a need for the government and the National Tuberculosis Programme (NTP) to collaborate with different sectors to provide comprehensive health education, social and financial support as well as food aid to TB patients.

Prevalence and associated factors influencing stunting and wasting among children of ages 1 to 5 years in Nkwanta South Municipality, Ghana.

Childhood undernutrition continues to be a major public health problem and one of the most common causes of morbidity and mortality in developing countries. The risk factors of child undernutrition are diverse and change with time, place, and season. The aim of this study was to assess the prevalence and associated factors influencing stunting and wasting among children 1 to 5 years of age in the Nkwanta South Municipality, Ghana. This was a health facility-based descriptive cross-sectional study that used a multistage sampling technique to select 240 children 1 to 5 years of age from April to June 2019. Data were collected using a structured questionnaire and anthropometric measurements. The data were analyzed using ENA software 2011, and Stata version 15. Binary logistic regression was used to find the adjusted estimates and associations between undernutrition (stunting and wasting) and the exposure variables. P ≤ 0.05 was considered statistically significant at a 95% confidence interval. The prevalence of stunting and wasting among the children was 12.5% and 27.5%, respectively. Factors influencing stunting were parents' working status, number of children in the household, child's age, birth interval, exclusive breastfeeding, child's vaccination status, and recurrent diarrhea. Furthermore, factors influencing wasting were parents' educational level, parents' working status, child's age, birth interval, exclusive breastfeeding, poor appetite, child's vaccination status, and recurrent diarrhea. The results showed a high prevalence of stunting and wasting among children 1 to 5 years in the Nkwanta South Municipality. This finding indicates the degree to which nutritional screening for children is very crucial, and thus recommends government and health authorities to adapt or promote nutrition-related interventions such as educational awareness on the utilization of family planning services for birth spacing, exclusive breastfeeding practices, and vaccination to prevent undernutrition among young children.

Factors influencing the use of emergency contraceptives among reproductive age women in the Kwadaso Municipality, Ghana.

BACKGROUND: Unintended pregnancy leads to unsafe abortion, which is one of the commonest causes of maternal deaths in developing countries including Ghana. Lots of unintended pregnancies can be avoided using emergency contraceptives (EC). Emergency contraceptives are mostly used after unprotected sexual intercourse and have a ninety-nine percent chance of preventing unintended pregnancy when taken correctly. However, unlike other modern contraceptives such as condoms, emergency contraceptives cannot prevent sexually transmitted infections. OBJECTIVES: This study aimed at assessing the factors influencing the use of emergency contraceptives among reproductive-age women in the Kwadaso Municipality, Ghana. METHODS: A community-based descriptive cross-sectional study design was conducted in three sub-municipalities of the Kwadaso Municipality. A multistage sampling method was used to select 312 women in their reproductive age within households. A simple random sampling method was first used to select the sub-municipalities (Kwadaso Central, Asuoyeboah, and Agric-Nzema). Participants were selected from households through a systematic sampling procedure and responses were solicited from women who consented to participate in the study. The selection was strictly dependent on the number of eligible women in a household, that is, in an event where more than one woman was found in a household, a simple random sampling method was used to select only one woman from that household. STATA 15.0 was used to analyse the data. Binary logistic regression was used to find the adjusted estimates and associations between EC use and the exposure variables. P-values ≤ 0.05 were considered statistically significant at 95% Confidence Interval (CI). RESULTS: The findings showed that 79.67% of the women had ever used EC. Amongst them, 59.83% used EC following unexpected unprotected sex, and 24.69% used EC following failed coitus interruptus. Women's attitude towards EC (AOR = 8.52, p<0.001), religion (AOR = 4.56, p = 0.004), and monthly income (AOR = 0.29, p = 0.030) were found to have significant influence on their use of EC. CONCLUSION: The level of EC use among the women was high. Women's attitude towards EC, religion, and monthly income were the major factors influencing the use of EC. Thus, strategies to promote EC use should emphasize on addressing the attitude of women towards EC through sex education in schools, various religious institutions, and the community at large with the services of health authorities and support from governmental and non-governmental organizations whose focus is to address the need for reproductive health services in order to reduce the misconception regarding the use of EC.