Socio-cultural beliefs and perceptions influencing diagnosis and treatment of breast cancer among women in Ghana: a systematic review.

BACKGROUND: Breast cancer is currently the most commonly diagnosed cancer in Ghana and the leading cause of cancer mortality among women. Few published empirical evidence exist on cultural beliefs and perceptions about breast cancer diagnosis and treatment in Ghana. This systematic review sought to map evidence on the socio-cultural beliefs and perceptions influencing the diagnosis and treatment of breast cancer among Ghanaian women. METHODS: This review was conducted following the methodological guideline of Joanna Briggs Institute and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. The literature search was conducted in PubMed, CINAHL via EBSCOhost, PsycINFO, Web of Science, and Embase. Studies that were conducted on cultural, religious, and spiritual beliefs were included. The included studies were screened by title, abstract, and full text by three reviewers. Data were charted and results were presented in a narrative synthesis form. RESULTS: After the title, abstract, and full-text screening, 15 studies were included. Three categories were identified after the synthesis of the charted data. The categories included: cultural, religious and spiritual beliefs and misconceptions about breast cancer. The cultural beliefs included ancestral punishment and curses from the gods for wrongdoing leading to breast cancer. Spiritual beliefs about breast cancer were attributed to spiritual or supernatural forces. People had the religious belief that breast cancer is a test from God and they resorted to prayers for healing. Some women perceived that breast cancer is caused by spider bites, heredity, extreme stress, trauma, infections, diet, or lifestyle. CONCLUSION: This study adduces evidence of the socio-cultural beliefs that impact on the diagnosis and treatment of breast cancer among women in Ghana. Taking into consideration the diverse cultural and traditional beliefs about breast cancer diagnosis and treatment, there is a compelling need to intensify nationwide public education on breast cancer to clarify the myths and misconceptions about the disease. We recommend the need to incorporate socio-cultural factors influencing breast cancer diagnosis and treatment into breast cancer awareness programs, education, and interventions in Ghana.

Health insurance coverage among women of reproductive age in rural Ghana: policy and equity implications.

BACKGROUND: Globally, health insurance has been identified as a key component of healthcare financing. The implementation of health insurance policies in low and middle-income countries has led to a significant increase in access to healthcare services in these countries. This study assessed health insurance coverage and its associated factors among women of reproductive age living in rural Ghana. METHODS: This study used a nationally representative data from the 2017/2018 Ghana Multiple Indicator Cluster Survey (GMICS) and included 7340 rural women aged 15-49 years. Bivariate and multivariable logistic regression models were developed to assess the association between the explanatory and the outcome variable. Statistical significance was considered at p = 0.05. RESULTS: The overall prevalence of health insurance coverage among rural women in Ghana was 51.9%. Women with secondary (aOR = 1.72, 95% CI: 1.38-2.14) and higher education (aOR = 4.57, 95% CI: 2.66-7.84) were more likely to have health insurance coverage than those who had no formal education. Women who frequently listened to radio (aOR = 1.146, 95% CI: 1.01-1.30) were more likely to have health insurance coverage than those who did not. Women who had a child (aOR = 1.81, 95% CI: 1.50-2.17), two children (aOR = 1.59, 95% CI: 1.27-1.98), three children (aOR = 1.41, 95% CI: 1.10-1.80), and five children (aOR = 1.36, 95% CI: 1.03-1.79) were more likely to have health insurance coverage than those who had not given birth. Women who were pregnant (aOR = 3.52, 95% CI: 2.83-4.38) at the time of the survey, and women within the richest households (aOR = 3.89, 95% CI: 2.97-5.10) were more likely to have health insurance coverage compared to their other counterparts. Women in the Volta region (aOR = 1.36, 95% CI: 1.02-1.81), Brong Ahafo region (aOR = 2.82, 95% CI: 2.20-3.60), Northern region (aOR = 1.32, 95% CI: 1.02-1.70), Upper East region (aOR = 2.13, 95% CI: 1.63-2.80) and Upper West region (aOR = 1.56, 95% CI: 1.20-2.03) were more likely to have health insurance coverage than those in the Western region. CONCLUSION: Although more than half of women were covered by health insurance, a significant percentage of them were uninsured, highlighting the need for prompt policy actions to improve coverage levels for insurance. It was found that educational level, listening to radio, parity, pregnancy status, wealth quintile, and region of residence were factors associated with health insurance coverage. We recommend better targeting and prioritization of vulnerability in rural areas and initiate policies that improve literacy and community participation for insurance programs. Further studies to establish health policy measures and context specific barriers using experimental designs for health insurance enrolments are required.

Factors associated with the uptake of clinical breast examination among women of reproductive age in Lesotho: analysis of a national survey.

BACKGROUND: In low-resource settings with weak health systems, the WHO recommends clinical breast examination (CBE) as the most cost-effective breast screening modality for women. Evidence shows that biennial CBE leads to significant downstaging of breast cancer in all women. Breast cancer is the second most common cancer among women in Lesotho with a weaker healthcare system and a low breast cancer screening rate. This study investigated the prevalence and factors associated with the uptake of CBE among women of reproductive age in Lesotho. METHODS: This study used cross-sectional data from the 2014 Lesotho Demographic and Health Survey. A sample of 6584 reproductive-age women was included in this study. We conducted both descriptive and multivariable logistic regression analyses. The study results were presented in frequencies, percentages, and adjusted odds ratios (aOR) with their corresponding confidence intervals (CIs). RESULTS: The prevalence of CBE uptake was 9.73% (95% CI: 8.91, 10.61). Women who were covered by health insurance (aOR = 2.31, 95% CI [1.37, 3.88]), those who were pregnant (aOR = 2.34, 95% CI [1.64, 3.35]), those who had one to three children (aOR = 1.81, 95% CI [1.29,2.52]), and women who frequently read newspapers or magazines (aOR = 1.33, 95% CI [1.02,1.72]) were more likely to undergo CBE than their counterparts. Women who were aware of breast cancer (aOR = 2.54, 95% CI [1.63,3.97]), those who have ever had breast self-examination (BSE) within the last 12 months prior to the study (aOR = 5.30, 95% CI [4.35,6.46]), and those who visited the health facility in the last 12 months prior to the study (aOR = 1.57, 95% CI [1.27,1.95]) were also more likely to undergo CBE than their counterparts. Women residing in the Qacha's-nek region (aOR = 0.42, 95% CI [0.26,0.67]) were less likely to undergo CBE than those in the Botha-bothe region. CONCLUSION: The study found a low prevalence of CBE uptake among reproductive-age women in Lesotho. Factors associated with CBE uptake include health insurance coverage, being pregnant, those who had one to three children, exposure to media, breast cancer awareness, ever had BSE, and those who visited a health facility. To increase CBE uptake, these factors should be considered when designing cancer screening interventions and policies in order to help reduce the burden of breast cancer in Lesotho.

Clinical factors influencing knowledge and self-care practice among adults with type 2 diabetes mellitus.

AIM: The objective of the study was to determine the clinical factors associated with knowledge and self-care practice among adults living with type 2 diabetes mellitus. DESIGN: Descriptive cross-sectional design. METHODS: A convenience sample of 330 participants was recruited over 3-months in 2018 and data were collected using a structured instrument. RESULTS: Participants on insulin treatment modality had four times higher odds of knowledge on diabetes (B = 4.17, p = 0.023) while those on combined therapy (both oral hypoglycaemic agent and insulin) had 7.26 times higher odds of knowledge (B = 7.26, p < 0.001). Participants without medically confirmed diabetic complications had 3.66 higher odds of knowledge of diabetes (B = 3.66, p = 0.002). Participants on insulin treatment modality had a 1.4-fold higher odds of self-care practice (B = 1.4, p = 0.028). It was revealed that participants with hypertension and diabetic foot had lower odds of self-care practice (B = -1.13, p = 0.021). CONCLUSION: In particular, participants who were on insulin and combined therapy (tablet and insulin) had higher knowledge and better self-care practice. Self-care was significantly influenced among those with, than those without diabetic foot and hypertension as complications.

Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review.

BACKGROUND: Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. METHODS: We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS: Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. CONCLUSION: This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities.

"Some believe those who say they can cure it" perceived barriers to antiretroviral therapy for children living with HIV/AIDS: Qualitative exploration of caregivers experiences in tamale metropolis.

BACKGROUND: HIV/AIDS is now a chronic disease, as adherence to anti-retrovirals impacts positively on the quality as well as expectancy of life. However, there exist multifaceted barriers to treatments for which children are most disadvantaged. Since Ghana subscribed to the "treat all" policy less percentage (25.5%) of children (2-14 years) living with HIV/AIDS have been enrolled on the antiretroviral program compared to other categories of the population by 2019. At present no study has explored these barriers to children living with HIV/AIDS enrollment and adherence. This study aims to explore the perceived barriers of caregivers of children living with HIV/AIDS in the Tamale Metropolis. METHODS: We used descriptive phenomenology to explore the phenomena. Caregivers were purposively selected and interviewed till information became repetitive at the ninth (9th) caregiver. A semi-structured interview guide was used to collect data through face-to-face in-depth interviews which were audio recorded. The interviews lasted an average of 47 minutes. Audio interviews were transcribed verbatim (English) and translated back-to-back (Daghani) before analysis was done manually according to Collaizi's seven-step approach. We used the Guba and Lincoln guidelines to ensure the rigour of the study and its findings. Results are presented in themes and supported with quotes. RESULTS: Six themes emerged from the analysis of the caregivers' transcripts; (1) denial of HIV/AID diagnosis, (2) stock-outs and privacy at the clinic, (3) busy schedule and poor support, (4) ignorance and alternative herbal cure, (5) stigma and discrimination, (6) transportation and distance. CONCLUSION: Perceived barriers are multi-dimensional and encountered by all PLWHA, especially children. These barriers could derail the gains of HIV/AIDS interventions among children. Adherence counselling among caregivers alongside campaigns among faith and herbal healers are of grave concern to reduce myths of cure.

Leveraging breast cancer screening to promote timely detection, diagnosis and treatment among women in sub-Saharan Africa: a scoping review protocol.

INTRODUCTION: Female breast cancer is now the most often diagnosed cancer in the world. Breast cancer screening aims to reduce mortalities related to cancer, and morbidity associated with advanced stages of the disease, through timely detection in asymptomatic women. This study aims to conduct a comprehensive assessment and evaluation of the evidence on the factors that influence the provision and uptake of breast cancer screening among women in sub-Saharan Africa (SSA). METHODS AND ANALYSIS: PubMed, Web of Science, EMBASE and the Cumulative Index to Nursing and Allied Health Literature including Google Scholar will be searched to identify published studies on barriers and facilitators to breast cancer screening from January 2010 to 2021. Two reviewers will independently assess the quality of all the included studies using the Mixed Methods Appraisal Tool version 2018. We envisage that this review will adduce evidence on common barriers and facilitators to breast cancer screening in SSA. Identifying these barriers and facilitators will help guide the initialisation of effective interventions that will improve breast cancer screening uptake among women in SSA. This review will also guide future research in developing, implementing and evaluating appropriate interventions tailored toward increasing breast cancer screening uptake. ETHICS AND DISSEMINATION: Ethics approval for this protocol is not required since it does not involve collecting data from human participants. The outcomes of this study will be published in a peer-reviewed journal.

Mapping evidence on knowledge of breast cancer screening and its uptake among women in Ghana: a scoping review.

INTRODUCTION: Female breast cancer is currently the most commonly diagnosed cancer globally with an estimated 2.3 million new cases in 2020. Due to its rising frequency and high mortality rate in both high- and low-income countries, breast cancer has become a global public health issue. This review sought to map literature to present evidence on knowledge of breast cancer screening and its uptake among women in Ghana. METHODS: Five databases (PubMed, CINAHL, PsycINFO, Web of Science, and EMBASE) were searched to identify relevant published studies between January 2012 and August 2021 on knowledge of breast cancer screening and its uptake among women. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and the six-stage model by Arksey and O'Malley were used to select and report findings. RESULTS: Of the 65 articles retrieved, 14 records were included for synthesis. The review revealed varied knowledge levels and practices of breast cancer screening among women across a few regions in Ghana. The knowledge level of women on breast cancer screening was high, especially in breast cancer screening practice. Breast cancer screening practice among women was observed to be low and the most identified barriers were lack of technique to practice breast self-examination, having no breast problem, lack of awareness of breast cancer screening, and not having breast cancer risk. The results further showed that good knowledge of breast cancer screening, higher educational level, increasing age, physician recommendation, and household monthly income were enabling factors for breast cancer screening uptake. CONCLUSION: This review showed varied discrepancies in breast cancer screening uptake across the regions in Ghana. Despite the benefits of breast cancer screening, the utilization of the screening methods across the regions is very low due to some varied barriers from the different regions. To increase the uptake of breast cancer screening, health workers could employ various strategies such as community education and sensitization on the importance of breast cancer screening.

Qualitative exploration of the challenges and the benefits of the nursing process in clinical practice: A study among registered nurses in a municipal hospital in Ghana.

AIM: This study aims to explore the challenges and benefits of using the nursing process in a Ghanaian Hospital. DESIGN: The study employed a qualitative descriptive design to explore the challenges and the benefits of the utilization of the nursing process. METHODS: Twelve (12) Registered Nurses were recruited for the study using purposive sampling. Recorded in-depth interviews were conducted and data were analysed using thematic analysis. RESULTS: The study found a low nurse-to-patient ratio, inadequate knowledge, apathy, inadequate logistics, poor supervision as challenges. However, quality and cost-effective care improved nurse-patient relationships, and job satisfaction was found to be the benefits of nursing process use. Interventions to improve its utilization should be targeted towards improving the nurse-to-patient ratio, provision of adequate resources and inclusion of the nursing care plan in patient folders.

Maternal risk factors and neonatal outcomes associated with low birth weight in a secondary referral hospital in Ghana.

INTRODUCTION: Over the past decade, the incidence of low birth weight (LBW) in sub-Saharan Africa has not seen any decline and this is a matter of grave concern for healthcare providers, policymakers, and researchers. Therefore, this study aimed to assess the incidence of LBW and related maternal risk factors (during pregnancy or delivery) as well as neonatal outcomes. METHODS: An institutional-based retrospective cross-sectional study design was employed to select 1,017 mothers who delivered in the study hospital from January to December 2017 with singleton newborn babies without congenital diseases. Data were analysed using STATA version 14.1 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: Stata Corp LP). Chi-square test of independence was used to test the association between the dependent variable (LBW) and risk factors of LBW. Bivariate and multivariable unconditional logistic regression was used to determine the factors associated with LBW. RESULTS: The incidence of LBW was 23.7%. The findings show that being married has a protective effect on LBW [AOR = 0.60 (95%CI: 0.40-0.90), p = 0.013] compared to single mothers. Neonates born between gestational age of 37-42 weeks had 85% lower odds of LBW [AOR = 0.15, (95%CI: 0.10-0.24), p < 0.001)]. Neonates with LBW had a higher risk of low Apgar score in the first minute compared to neonates with normal birth weight [AOR = 0.52 (95%CI: 0.37-0.73), p < 0.001]. Female neonates had 64% higher odds of LBW compared to their male counterparts [AOR = 1.64 (95%CI: 1.19-2.24), p = 0.002]. CONCLUSION: This study revealed a high incidence of LBW. Women's marital status (single mothers), gestational age (<37 weeks), neonatal sex (female), are independent risk factors associated with LBW, while a higher risk of an Apgar score of less than 7 in the first minute was an independent outcome of low birth weight births. The current study findings contribute to the growing literature on the influence of maternal and neonatal factors on LBW in resource-constrained settings. These findings could guide healthcare providers, hospital administrators, stakeholders, and policymakers to develop and implement appropriate clinical and public health strategies aimed at reducing LBW.

Caregivers' Experiences with Caring for a Child Living with HIV/AIDS: A Qualitative Study in Northern Ghana.

With the advent of Anti-Retroviral Therapy, Human Immune Virus, and Acquire Immuno-Deficiency Syndrome is increasingly becoming a chronic disease as life expectancy among People Living With HIV/AIDS has increased. For Children Living With HIV/AIDS the role of the caregivers becomes essential as caregivers' decisions affect CLWH health. However, the experiences of these caregivers are often unnoticed while all interventions are directed at PLWH. This study aimed at exploring the experiences of caregivers of CLWH in some selected hospitals in northern Ghana. This study employed a qualitative descriptive phenomenological approach. Purposive sampling technique was used to recruit 9 participants from 3 public hospitals in the Tamale Metropolis of Ghana. Data was manually analyzed using the approach of Collaizi and the findings were presented in themes and sub-themes. We conducted individual face to face interviews in English and Dagbani from September to November 2019. These interviews were conducted at the convenience of the participants in hospitals and at their homes. They were introduced to the study while awaiting to take antivirals for their CLWH. Five themes emerged: changed family dynamics, discovery of diagnosis, reaction to diagnosis, disclosure, stigma and discrimination, and burden and challenges of care. Caregivers were severely impacted by caring for CLWH and traumatized by changed family dynamics which exposed them to many difficulties. Stigma was widely perpetrated by immediate family members and majority reacted badly to their children HIV-positive status with fear, shame, guilt and even suicidal ideation.

"We are left with nothing to work with"; challenges of nurses working in the emergency unit at a secondary referral hospital: A descriptive qualitative study.

INTRODUCTION: In recent times, there has been an increasing burden in traumatic, medical, and surgical emergency conditions, placing more emphasis on the need for quality emergency care. This study aimed to explore the challenges experienced by nurses working in the emergency unit of a secondary referral hospital. METHODS: The study used an exploratory qualitative research design with a constructivist approach and a grounded theory method. Data were collected through in-depth interviews lasting between 30 to 45 minutes using a semi-structured interview guide. Inductive content analysis was used to analyse data. RESULTS: Eleven (11) participants were interviewed. The majority were female (9), aged between 31-40 years. From the inductive content analysis, four themes emerged. These were; 1) overcrowding in the emergency unit, 2) understaffing at the emergency unit, 3) lack of emergency equipment, 4) inadequate managerial support. CONCLUSION: The study identified several major challenges confronting nurses working in the emergency unit which are linked with managerial processes and inadequate managerial support. These challenges need to be addressed to promote quality emergency nursing care. To foster a positive working environment, hospital management should validate and address the aforementioned concerns of the Emergency Department nurses.

Knowledge of chronic complications of diabetes among persons living with type 2 diabetes mellitus in northern Ghana.

INTRODUCTION: Diabetes mellitus is a complex disease that affects many organ systems, leading to concerns about deteriorating population health status and ever-increasing healthcare expenditure. Many people with diabetes do not achieve optimal glycaemic control and other metabolic indices, leading to a heightened risk of developing complications. Adequate knowledge of diabetes complications is a prerequisite for risk-factor reduction and prevention of the consequences of the disease. Therefore, this study aimed to evaluate the knowledge of chronic complications of diabetes among persons living with type 2 diabetes mellitus in northern Ghana. METHOD: A descriptive cross-sectional study was conducted among 320 patients with type 2 diabetes mellitus in northern Ghana. The consecutive sampling technique was employed to recruit participants from September to November 2018. Data analysis was performed using IBM statistical package for social science version 23. Descriptive statistics such as frequencies and percentages were used. Both bivariate and multivariate logistic regression analysis were employed to determine associations between knowledge of diabetes complications and demographic/clinical characteristics of participants, at 95% confidence interval with statistical significance at P<0.05. RESULTS: The majority of participants (54.1%) had inadequate knowledge and 45.9% had adequate knowledge of diabetes complications. The factors associated with inadequate level of knowledge were female gender [AOR = 0.29 (95%CI: 0.14-0.56), p<0.001], older age [AOR = 0.45 (95%CI:0.20-0.99), p = 0.049], primary education [AOR = 0.13 (95%CI: 0.03-0.51), p = 0.004], no formal education [AOR = 0.16 (95%CI: 0.05-0.50), p = 0.002], rural dwellers [AOR = 0.50 (95%CI: 0.27-0.95), p = 0.033] and unknown family history diabetes [AOR = 0.38 (95%CI: 0.17-0.82), p = 0.014]. CONCLUSION: More than half of the studied population had inadequate knowledge of diabetes complications. Female gender, rural dwellers, and low education level were factors positively associated with inadequate knowledge of diabetes complications. A multisectoral approach is needed, where the government of Ghana together with other sectors of the economy such as the health, education and local government sectors work collaboratively in the development of locally tailored diabetes education programmes to promote healthy self-care behaviours relevant for the prevention of diabetes and its complications.

Medication adherence and self-care behaviours among patients with type 2 diabetes mellitus in Ghana.

BACKGROUND: Diabetes often coexists with other medical conditions and is a contributing cause of death in 88% of people who have it. The study aimed at evaluating medication adherence, self-care behaviours and diabetes knowledge among patients with type 2 diabetes mellitus in Ghana. METHODS: A total of 330 participants were recruited into the study from three public hospitals in the Tamale metropolis. A validated medication adherence questionnaire and the Summary of Diabetes Self-care Activities tool were used to assess medication adherence and self-care activities respectively. Logistic and linear regressions were used to determine factors positively associated with non-adherence to medication and self-care behaviours respectively. RESULTS: Of the 330 participants whose data were analysed, the mean (SD) age was 57.5 (11.8) years. The majority (84.5%) were adherent to anti-diabetes medication. Participant's age, educational level, and practice of self-care behaviours influenced adherence to anti-diabetes medication. Participants aged 70 years and above were 79% less likely to be non-adherent to medication as compared to those below 50 years [OR = 0.21 (95%CI: 0.06-0.74), p = 0.016]. Participants with senior high school education were 3.7 times more likely to be non-adherent to medication than those with tertiary education [OR = 3.68 (95%CI: 1.01-13.44), p = 0.049]. Participants with tertiary education had an increase in the level of practice of self-management by 1.14 (p = 0.041). A unit increase in knowledge score also increased the level of practice of self-management by 3.02 (p<0.001). CONCLUSION: The majority of participants were adherent to anti-diabetes medication. Non-adherence to medication was associated with younger age and low level of education. Interventions to improve adherence should target younger and newly diagnosed patients through aggressive counselling to address healthy self-management behaviours.

Women's knowledge and its associated factors regarding optimum utilisation of antenatal care in rural Ghana: A cross-sectional study.

INTRODUCTION: Improving maternal health is a global public health challenge especially in sub-Saharan Africa. The optimum utilisation of antenatal care (ANC) by pregnant women is known to improve maternal health outcomes. Maternal morbidity and mortality rates in Ghana remain unacceptably high, particularly in rural settings where skilled delivery care often times is disproportionally low. This study assessed factors associated with optimum utilisation of antenatal care in rural Ghana. METHODS: A cross-sectional design was applied to collect data among eligible participants between October 2018 and January 2019. A total of 322 women who gave birth and attended the postnatal clinic were recruited for the study. Consecutive sampling was employed in recruiting participants. The associations between the dependent variables (ANC service utilisation and knowledge of ANC) and independent variables (socio-demographic characteristics) were examined using ordinary least squares logistic regression at 95% confidence interval in STATA version 14.0. RESULTS: Of the 322 participants, 69.0% reported utilising at least four or more times ANC services. Determinants of women attending ANC for four or more times was significantly associated with age [OR = 4.36 (95%CI: 2.16-8.80), p<0.001], educational level [OR = 10.18 (95%CI: 3.86-26.87), p<0.001], and insured with National Health Insurance Scheme [OR = 3.42 (95%CI: 1.72-6.82), p<0.001]. Not married [OR = 0.65 (0.39-1.09), p = 0.011] or divorced [OR = 0.33 (95%CI: 0.13-0.83), p = 0.019] was negatively associated with utilisation of four or more ANC services. The majority (79.0%) of the participants had a good level of knowledge regarding antenatal care. CONCLUSION: Although the majority of women in this study had good knowledge of ANC services, a significant number of them did not complete the recommended number of ANC visits for at least four times during a normal pregnancy. Awareness and further education to reproductive-age women on the significant role adequate ANC attendance plays in advancing health and well-being require further investments, particularly among rural women in Ghana.

Final Year Nursing Students' Knowledge and Attitudes regarding Children's Pain.

Pain is one of the commonest reasons why children visit the hospital. Inadequately treated pain in children can negatively affect their physical, psychological, and social well-being; it also places financial burden on families of affected children and healthcare systems in general. Considering the eventual suffering of vulnerable children and their families if nursing students are insufficiently educated and ill-prepared, the current study aimed at assessing final year nursing student's knowledge and attitudes pertaining to pediatric pain. A descriptive cross-sectional study was conducted among 100 final year undergraduate nursing students at a private university college in Ghana. In addition to their ages and gender, the students responded to the 42 individual items on the Pediatric Nurses' Knowledge and Attitudes Survey regarding pain (PNKAS) instrument. Descriptive statistical analysis was aided by the Statistical Package for Social Sciences version 25 software. The mean age of the final year nursing students was 29 years (range of 21 to 47 years); a majority of them were females (78%). Participants had an average (SD) correct answer score of 44.0% (10.6%). Good pediatric pain knowledge and attitudes were observed in items that were related to the individualized and multidimensional nature of the pain experience and its treatment, benefits of pre-emptive analgesia, pharmacodynamics, and pain assessment. Poor pediatric pain knowledge and attitudes occurred in items that focused on pain perceptions, opioid drug administration, useful pain medications, pain physiology, and nonpharmacological pain management interventions. Final year nursing students have insufficient knowledge and attitudes toward children's pain management. Areas of good and poor pediatric pain knowledge and attitudes should be considered when designing and implementing educational interventions on this subject. Curricular revisions should be made on existing nursing curriculum to lay more emphasis on children's pain management and use educational interventions that support knowledge translation for improved care.

Women's experiences of midwifery care immediately before and after caesarean section deliveries at a public Hospital in the Western Region of Ghana.

BACKGROUND: Childbirth remains a uniquely multifaceted, mental-cognitive and a major life experience to women. It is composed of a variety of psycho social and emotional aspects and creates memories, sometimes bad experiences and unmet expectations which leaves the mother with lasting scars. Therefore, this study aimed at exploring post-caesarean section delivered mothers experiences of midwifery care in a public hospital in Ghana. METHODS: This descriptive exploratory qualitative research used an interpretative approach to explore mothers' experiences of midwifery care immediately before and after caesarean section (CS). The study employed a purposive sampling technique in recruiting 22 participants who had knowledge of the phenomenon under study. Data collection was guided by an interview guide, which involved face to face individual interviews and focus group discussion at the postnatal ward and clinic. All interviews were audio-recorded and lasted 30-40 min. Audio recordings were transcribed verbatim and inductive thematic data analysis employed. RESULTS: Four major themes emerged from the analysis of participants' transcripts: Support by Midwives (physical and psychological, and attitude towards patients' pain management); Protection of mothers (provision of privacy, confidentiality and physical environment); Provision of information/communication (before caesarean section, and before a minor task) and midwives' attitude (attitude towards delivery care). CONCLUSION: Mothers delivered by caesarean section had varied experiences of midwifery care which were both positive and negative ones. Provision of psychological support and adequate pain management were positive experiences. The challenges experienced were related to provision of information, privacy, and physical support. Participants, who underwent emergency CS in particular, were dissatisfied with the provision of information concerning the surgical procedure. Provision of privacy and physical support were also issues of great concern. We therefore, recommend supportive and sensitive midwifery care particularly for mothers undergoing emergency CS. Documenting women's diverse experiences of midwifery care before and after CS delivery is important to healthcare providers, hospital managers and policy makers as the feedback garnered can be used to improve maternity services and inform decisions on midwifery care.

Risk Factors Associated with Neonatal Sepsis: A Case Study at a Specialist Hospital in Ghana.

Worldwide, neonatal sepsis accounts for an estimated 26% of under-five deaths, with sub-Saharan Africa having the highest mortality rates. Though worldwide neonatal deaths have decreased by over 3.6 million per year since 2000, neonatal sepsis remains a notable hindrance to the progress in the decline of cause-specific mortality rates especially in sub-Saharan Africa. This study aimed at examining the risk factors of neonatal sepsis at the Trauma and Specialist Hospital, Winneba. The study was an unmatched case control retrospective study. Cases were neonates who had sepsis with their index mothers and controls were neonates who did not have sepsis with their index mothers. Neonatal and maternal medical records were retrieved from January to December 2017. Data abstraction lasted for one month and 2650 folders for the neonates and their index mothers were retrieved. Nine hundred (900) neonatal folders were considered valid for the study and likewise for the maternal folders. One hundred and three (103) folders were considered cases while 797 were considered as controls. Data were entered using the Statistical Package for Social Sciences Version 22. Logistic regression was used to determine the risk of neonatal sepsis. Maternal factors that predicted the occurrence of sepsis among neonates were parity (p<0.027), mode of delivery (p<0.001), bleeding disorder (p<0.001), and PROM (p<0.001). Neonatal risk factors which predicted the occurrence of sepsis were APGAR score in the first and fifth minute (p<0.001), resuscitation at birth (p<0.004), duration of stay in the facility (p<0.001), and neonatal age on admission (p<0.001). The study found both maternal and neonatal factors to have a strong association with the risk of developing neonatal sepsis. Encouraging maternal antenatal care utilization would help identify the risk factors during prenatal and postnatal care and appropriate interventions implemented to reduce the likelihood of the neonate developing sepsis.

Patients' Knowledge of Artemisinin-Based Combination Therapy Treatment and Its Impact on Patient Adherence.

Despite increased support from government and other stakeholders for malaria control over the past decade, malaria burden remains high in many endemic countries, particularly in Sub-Saharan Africa. This study aimed to assess patients' knowledge of antimalarial treatment (ACT) and its association with patient adherence. A descriptive cross-sectional study design was employed in this study. Data were collected from April to May 2017. Both descriptive and inferential statistics in the form of frequencies, percentages, mean values, standard deviations, and Pearson's chi-square test were generated by use of Microsoft excel spreadsheet and IBM Statistical Package for Social Sciences (SPSS) version 23. The average age of the respondents surveyed for this study was 42.27 ± 11.09. Adherence level to ACT was 47%. The results showed that there was a significant association between respondents' knowledge of the efficacy of antimalarial medication (p = 0.003), benefits of completing antimalarial treatment course (p = 0.001), and consequences of not completing the doses of antimalarial medication prescribed (p = 0.002) and adherence to ACT. This study then recommends that improving patients' knowledge regarding the efficacy, benefits of completing ACT, and consequences of not completing ACT treatment may improve the likelihood of patients adhering fully to ACT.

Risk Factors for Neonatal Sepsis: A Retrospective Case-Control Study among Neonates Who Were Delivered by Caesarean Section at the Trauma and Specialist Hospital, Winneba, Ghana.

The third Sustainable Development Goal (SDG) for child health, which targets ending preventable deaths of neonates and children under five years of age by 2030, may not be met without substantial reduction of neonatal sepsis-specific mortality in developing countries. This study aimed at assessing the prevalence and risk factors for neonatal sepsis among neonates who were delivered via caesarean section. A retrospective case-control study was conducted among neonates who were delivered via caesarean section at the Trauma and Specialist Hospital, Winneba, Ghana. Data collection lasted for 4 weeks. The extracted data were double-entered using Epidata software version 3.1 to address discrepancies of data entry. Descriptive statistics such as frequencies and percentages of neonatal characteristics were generated from the data. Both univariate and multivariate logistic regression were used to determine associations between neonatal sepsis and neonatal characteristics with odds ratios, 95% confidence intervals, and p values calculated using variables that showed significant association (p<0.05) in the chi-square analysis for the multivariate logistic regression. A total of 383 neonates were recruited; 67 (17.5%) had sepsis (cases). The neonatal risk factors associated with sepsis were birth weight (χ2=6.64, p=0.036), neonatal age (χ2=38.31, p<0.001), meconium passed (χ2=12.95, p<0.001), reason for CS (χ2=24.27, p<0.001), and the duration of stay on admission (χ2=36.69, p<0.001). Neonatal sepsis poses a serious threat to the survival of the newborn as the current study uncovered 6.0% deaths among sepsis cases. The findings of this study highlight the need for routine assessment of neonates in order to identify risk factors for neonatal sepsis and to curb the disease burden on neonatal mortality.