Cigarette smoking during breastfeeding in Papua New Guinea: Prevalence and demographic and socio-economic predictors.

BACKGROUND: Cigarette smoking during breastfeeding is reported to contribute to significant changes in the composition of breast milk not only by reducing its protective features but also affecting infants' response to breastfeeding and breast milk. However, studies on the prevalence of cigarette smoking and associated factors during breastfeeding are limited in Papua New Guinea (PNG). This study estimates the prevalence of cigarette smoking and its association with demographic and economic factors among breastfeeding women in PNG. METHODS: We used weighted survey data from the 2016-2018 PNG Demographic and Health Survey (PNGDHS). A weighted sample of 3,822 women who were breastfeeding during the survey were included in the study. The outcome variable in the present study is current cigarette smoking. A multiple logistic regression analysis was used to estimate the association between current cigarette smoking status and socio-demographic and economic variables of breastfeeding women. The regression analysis results were reported using adjusted odds ratios (aOR) with their respective 95% confidence intervals (CIs). RESULTS: From the weighted sample, the prevalence of cigarette smoking among breastfeeding women was 21.9%; of which 60.8% smoked daily. The mean number of cigarettes smoked in the last 24 hours preceding the survey was 6.05(SD = 5.99). Multiple logistic regression analysis revealed that breastfeeding women who were from the Momase (aOR: 2.337, CI: 1.786-3.058, p<0.001) and Highlands (AOR: 1.589, CI: 1.213-2.082, p = 0.001), had no religious affiliation (aOR: 3.665, CI: 1.235-10.877, p = 0.019), and households with daughters as household heads (aOR: 1.901, CI: 1.231-2.935, p = 0.004) and being in more than one union (aOR: 2.374, CI: 1.805-3.123, p<0.001) were significantly more likely to smoke cigarette compared to women from southern region, those affiliated to Anglican church, those with husband as household heads, and being in one union respectively. CONCLUSION: Cigarette smoking among breastfeeding women in PNG is relatively high, and region of residence, religion, relationship to household head, and the number of unions remain independent predictors. Interventions should target the individual socio-economic and cultural contexts within which breastfeeding occurs.

Models and frameworks of mental health recovery: a scoping review of the available literature.

BACKGROUND: The recovery approach involves providing a holistic and integrated service that is centered on and adapts to the aspirations and needs of consumers, who are seen as the expert on their health and well-being. Evidence is needed to address the current ambiguities related to the concept of recovery and its application. AIM: A scoping review was conducted to identify papers describing theories, models, and frameworks of recovery to delineate the central domains of recovery. METHODS: Three literature search strategies were used: electronic database searching; hand-searching of key journals; and a reference list review of included papers. Inclusion criteria outlined theories, models and frameworks developed to support consumers' recovery and those supporting mental health professionals (MHPs) to deliver recovery-oriented services. RESULTS: Twelve studies (eleven articles and one book) were included in the review. The dimensions of recovery were synthesized into a framework named the Consolidated Framework for Recovery-oriented Services (CFRS). There are three domains within the framework: mechanisms/strategies; recovery as an internal process; and recovery as an external process. Each of these domains, as well as their relationships, are discussed. CONCLUSIONS: The CFRS can be used by practitioners, researchers, funders, and collaborative members to conceptualize, implement, and evaluate recovery-oriented services.

A systematic review of measures assessing mental health professionals' perspectives of recovery.

Recovery is internationally recognized as a concept to improve the well-being of consumers. Compared with the numerous measures assessing consumer perspectives of recovery, only a few measures have been developed to assess Mental Health Professionals' (MHPs) perspectives of recovery to inform practice. The present study aims to systematically review the literature to identify existing measures designed to assess MHPs' perspectives of recovery and evaluate their psychometric properties, and the methodological considerations of the design and use of these measures. We searched literature across eight electronic databases: MEDLINE, Web of Science, PsycINFO, PsyArticles, CINAHL, Scopus, EMBASE, and Google scholar. We identified 2631 articles across all databases. Of these, 40 articles met the inclusion criteria, which comprised 14 original measures assessing mental health recovery and 26 articles reassessing the psychometric properties of the original 14 measures. Our results suggested that while there are existing measures for assessing MHPs' perspectives of recovery, only a few of these measures met standard evaluation criteria for psychometric properties. Specifically, the validation of the identified measures is still in its infancy. For example, the easiness of applying the measures differs among the studies, and only a few of the measures fully involved consumers in the scale development phase. The implication of the findings for future use and development of recovery measures in mental health practice and research are discussed and recommended.

COVID-19 and family violence: Is this a perfect storm?

Disasters including public health crises like the COVID-19 pandemic are known to increase instances of family violence against women, children, and other diverse populations. This paper discusses and provides evidence of disaster-related vulnerability of and violence towards specific groups of people. We argue that the COVID-19 pandemic presents the 'perfect storm' for family violence, where a set of rare circumstances combine, resulting in a significant aggravation of the resulting event. Given the mental health implications of family violence, mental health professionals need to be aware of this issue during the pandemic and ready to assist with the development of strategies to overcome the situation where possible. To provide protection and prevent violence, there is a need to include at-risk groups in disaster response and community planning. Such a plan could involve gender and disaster working groups at the local community, state, and national levels.

Preparedness for viral respiratory infection pandemic in residential aged care facilities: A review of the literature to inform post-COVID-19 response.

AIMS AND OBJECTIVES: To examine what was known about disaster preparedness in residential care and to consider this in the light of the current COVID-19 pandemic. BACKGROUND: Care homes provide long-term care to vulnerable, frail older people, as well as to young people with profound disabilities. The COVID-19 pandemic has shown that the residential care sector has been seriously affected in many parts of the world and has exposed major flaws and vulnerabilities in infection control and other processes that have resulted in considerable loss of life of residents of these facilities. DESIGN: Discursive paper informed by a systematic literature. Review was carried out in line with PRISMA reporting guidelines. The review protocol was registered with PROSPERO on 2020 [CRD42020211847]. RESULTS: The review identified six papers meeting inclusion criteria across care residential facilities in different countries. Several prevention and mitigation strategies were identified to manage and reduce the spread and severity of viral respiratory infection pandemics. These strategies include isolation, restriction of movement, personal protective and hygienic measures, health education and information sharing, monitoring and coordination, and screening and treatment. Preparedness strategies identified were contingency planning such as reporting/communication, leadership, human resource, insurance, occupational health and resource availability. The prevention/mitigation and preparedness strategies helped to achieve decline in disease severity, reduced prevalence, reduced spread of the disease, improved readiness criteria, resource usefulness and increased intervention acceptability. This paper presents a conceptual framework exploring the interconnectedness of preparedness and prevention/ mitigation strategies and associated outcomes. We discuss areas of concern in the context of workforce employment patterns in the sector. Concerns related to the unintended consequences of strategies placed on aged care facilities, which may worsen mental health outcomes for residents, are discussed. CONCLUSIONS: Persons in residential care settings are at greater risk of infection during a pandemic, and therefore, strict measures to protect their safety are warranted. However, they are also a group who already experience social isolation and so any measures involving restrictions to visiting and social interaction, particularly over the longer term, must be accompanied by strategies to mitigate potential loneliness and mental health sequelae arising from long-term pandemic restrictions. RELEVANCE TO CLINICAL PRACTICE: Though there was evidence of activity in preparedness for disasters within the residential care sector, various contextual factors affecting the sector were clearly not adequately considered or addressed in pre-pandemic disaster planning, particularly in the areas of staff movements between care homes and the length of time that social isolation and restriction measures would need to be in place. Future pandemic planning should consider the nature of the workforce model in the care home sector, and factor in strategies to better support the mobile and highly casualised workforce.

Pandemic-related behaviours and psychological outcomes; A rapid literature review to explain COVID-19 behaviours.

COVID-19 spread rapidly causing widescale loss of life and economic devastation. Efforts to contain it have resulted in measures such as closing of borders and restrictions around travel, social activities and attending places of worship. We conducted this rapid review to systematically examine, synthesize, and critically appraise the available evidence on the relationship between pandemic-related behaviours and psychological outcomes. The methods were compliant with the PRISMA guidelines. The review was preregistered with PROSPERO (Registration #: CRD42020181576). A literature search was conducted from January 2010 to April 2020 using ProQuest, Web of Science, PsycINFO, PsycARTICLES, Scopus, SAGE Journals, and CINAHL. Of 3844 articles identified, we included 11 quantitative articles in the final synthesis, representing data from 32, 049 individual respondents from eight countries. We identified three pandemics (COVID-19, MERS-CoV, Influenza A(H1N1) pdm09) as well as several psychological outcomes including anxiety, mental distress, post-traumatic stress disorder, and anger. We also identified several behaviours during pandemics and categorized them into protective, preparedness, and perverse behaviours. The review showed that even though there is limited evidence regarding pandemic-related behaviours and psychological outcomes, the current findings showed that the psychological outcomes significantly impacted on the adoption of the pandemic-related behaviours. Given the negative effects of psychological outcomes on behaviours, we recommend that mental health professionals should promote mental health support to people exhibiting psychological distress resulting from similar events in the future. Also, we recommend that future research should test the hypothesized effects of pandemics and psychological outcomes on behaviour change.

Recovery services and expectation of consumers and mental health professionals in community-based residential facilities of Ghana.

BACKGROUND: In the past decades, considerable global attention has been drawn to recovery services that seek to promote the personal recovery journey of consumers with mental illness. However, in most settings, including Ghana, limited empirical studies have attempted to explore, from the perspectives of Mental Health Professionals (MHPs) and consumers, the effectiveness of recovery services and expectation towards the recovery. This study, therefore, explored consumers' and MHPs perspectives concerning recovery services and expectations towards recovery in two community-based residential facilities in Ghana. METHODS: A qualitative method, involving in-depth interviews and observations, were used to collect data from 24 participants (5 MHPs and 19 consumers). Thematic analysis was used to analyze the data. RESULTS: The study identified three global themes and nine organizing themes. The global themes were recovery services offered to consumers, expectation regarding personal recovery and challenges in achieving recovery. The study found that recovery services were expected to improve the internal and external recovery processes of consumers. The internal recovery process was independent living whilst the external recovery process were management of illness, economic empowerment and social inclusion. Several systemic and consumer-related factors influenced consumers' and MHPs expectation concerning the recovery journey. CONCLUSION: The study concludes that the government should prioritize the use of recovery services through policies, financial incentives, infrastructure support, and adequate training of MHPs.

Knowledge and attitudes of mental health professionals and students regarding recovery: A systematic review.

This review was conducted to synthesize and critically appraise the literature on knowledge, attitudes, understanding, perceptions, and expectations of mental health professionals (MHPs) and mental health professional (MHP) students' regarding recovery. A systematic search in Scopus, CINAHL, PsycINFO, Web of Science, Medline, and Embase as well as Google scholar and web-based repositories was conducted. The searches were conducted using a combination of key terms: "mental health professionals", "students", 'knowledge', "understanding", "perception" "attitude", "expectation", "recovery". After screening and quality assessment, the review included 29 studies (18 quantitative, 8 qualitative, and 3 mixed-method studies) published in English, from January 2006 to June 2019, and was analysed systematically using a mixed-method synthesis. The findings revealed that there is increasing evidence (especially among MHPs) of knowledge, attitudes, understanding, perceptions, and expectations regarding recovery. However, there are disparities in how MHPs perceive and understand recovery. While some understood it to mean a personal process, others explained it as a clinical process. In addition, there was limited knowledge among the MHPs and MHP students regarding the nonlinearity nature of the recovery process and expectations regarding recovery. The implications from these findings are the need for more in-service training for MHPs, and examination of the curriculum used to educate MHP students. In particular, they should be sufficiently informed about the nonlinearity nature of the recovery process and how to develop hopeful and realistic expectations for consumers throughout the recovery process. The review was preregistered with PROSPERO (Registration No: CRD42019136543).

The burden of caregiving among mental health nurses providing services to consumers with depression in Ghana.

PURPOSE: The study aims to explore the burden of caregiving among mental health nurses providing services to consumers with depression in Ghana. DESIGN AND METHODS: Interpretative phenomenological design and qualitative data FINDINGS: The study shows that several health system constraints and individual factors contribute to the burden of caregiving among mental health nurses. Health system challenges are the poor state of the psychiatric facility, while individual factors are stigmatizing attitudes, nonadherence to medication instructions, limited family support, and physical and verbal abuse. The coping strategies used by mental health nurses are self-motivation, emotional boundaries, and the perceived clinical outcomes of treatment. PRACTICE IMPLICATIONS: Clinical policies, procedures, and health facility practices should adequately address caregiving challenges, to facilitate effective mental health services.

Knowledge and sources of accessing sexual and reproductive health information among visually impaired women in Ghana.

OBJECTIVE: This study aims to explore the knowledge and sources of accessing sexual and reproductive health services and care information among visually impaired women in Ghana. Qualitative data involving in-depth interviews and focus group discussions were conducted among 21 visually impaired women selected through purposive and snowballing sampling techniques. Thematic Analysis was used to analyse the data. RESULTS: The study showed that visually impaired women were active seekers of SRH information (knowledgeable about SRH information and understand the relevance of accessing such information) and passive recipient of SRH information (through formal and informal sources). However, some contextual factors (lack of family and caregivers support services) created barriers for visually impaired women when accessing SRH information. Government advocacy and awareness campaigns on SRH services should consider both formal and informal sources. Family caregivers and SRH health centres should provide adequate support services for visually impaired women regarding information on SRH service.

Use and completion of partograph during labour is associated with a reduced incidence of birth asphyxia: a retrospective study at a peri-urban setting in Ghana.

BACKGROUND: Morbidity of birth asphyxia has been estimated to be 42 million disability-adjusted life years. The study sought to assess the impact of the use and completion of partograph during labour on reducing birth asphyxia at the St Anthony's Hospital, Dzodze, in the Volta Region of Ghana. METHODS: A retrospective study design using a quantitative approach was adopted for the study. A simple random sampling technique was used to select a total of 200 folders of labouring women who were admitted and delivered at St Anthony's Hospital, Dzodze, between 1st May 2015 and 30th April 2016. A structured checklist, which was developed by using labour and foetal monitoring parameters based on the standards of the World Health Organization partograph usage, was used to review all the 200 existing maternal records. RESULTS: The findings revealed that partographs were used by midwives at St Anthony's Hospital with the majority of the maternal folders fully completed. The use and completion of partograph were found to be associated with less non-asphyxiated birth outcomes. Labours which were monitored with partograph were 4.29 times less likely to result in birth asphyxia [AOR (95% CI) 4.29 (1.35-14.81)], and those that were monitored with a completed partograph were 5.3 times less likely to result in birth asphyxia [AOR (95% CI) 5.31 (2.011-16.04)]. CONCLUSION: Midwives used partographs during labour at St Anthony's Hospital. The use and completion of partograph were significantly associated with a reduced incidence of birth asphyxia at the hospital. Birth asphyxia could be reduced if partographs are used and completed by midwives during labour in all cases.

The predictors of treatment pathways to mental health services among consumers in Ghana.

PURPOSE: To explore factors influencing treatment pathways to mental health services among consumers in Ghana. DESIGN AND METHODS: Cross-sectional design using quantitative method. FINDINGS: Treatment pathways for mental illness were general hospitals/clinics, psychiatric hospitals, and faith-based practices. The predisposing (age, household size, primary occupation, ethnicity, marital status, religion, and geographic location, as well as attitudes and beliefs), enabling (affordability), and need factors (severity of mental illness) were significant predictors of treatment pathways. PRACTICE IMPLICATIONS: Current advocacy and awareness for mental health services in Ghana should consider the predisposing, enabling, and need factors of consumers. Policy initiatives on mental health services should ensure adequate financing mechanisms and further establish collaboration between biomedical and faith-based services.

Reporting in the abstracts presented at the 5th AfriNEAD (African Network for Evidence-to-Action in Disability) Conference in Ghana.

INTRODUCTION: The abstracts of a conference are important for informing the participants about the results that are communicated. However, there is poor reporting in conference abstracts in disability research. This paper aims to assess the reporting in the abstracts presented at the 5th African Network for Evidence-to-Action in Disability (AfriNEAD) Conference in Ghana. METHODS: This descriptive study extracted information from the abstracts presented at the 5th AfriNEAD Conference. Three reviewers independently reviewed all the included abstracts using a predefined data extraction form. Descriptive statistics were used to analyze the extracted information, using Stata version 15. RESULTS: Of the 76 abstracts assessed, 54 met the inclusion criteria, while 22 were excluded. More than half of all the included abstracts (32/54; 59.26%) were studies conducted in Ghana. Some of the included abstracts did not report on the study design (37/54; 68.5%), the type of analysis performed (30/54; 55.56%), the sampling (27/54; 50%), and the sample size (18/54; 33.33%). Almost all the included abstracts did not report the age distribution and the gender of the participants. CONCLUSION: The study findings confirm that there is poor reporting of methods and findings in conference abstracts. Future conference organizers should critically examine abstracts to ensure that these issues are adequately addressed, so that findings are effectively communicated to participants.

Enablers and barriers in accessing sexual and reproductive health services among visually impaired women in the Ashanti and Brong Ahafo Regions of Ghana.

The need to improve the sexual and reproductive health (SRH) and rights of women with disabilities is increasingly acknowledged. Unfortunately, women with disabilities in low- and middle-income settings, including Ghana, face several barriers (including structural, financial, physical, social and attitudinal) to accessing SRH services and care. This paper explores the enablers and barriers to accessing SRH services and care among visually impaired women in the Ashanti and Brong Ahafo Regions of Ghana. Qualitative data from in-depth interviews and focus group discussions were collected from 21 visually impaired women, selected through purposive and snowballing sampling techniques. Thematic analysis was used to develop codes, and data were further grouped into emerging themes. The barriers to accessing SRH services and care were financial difficulties and lack of preferential treatment. The enablers which facilitated access to SRH services and care were the support provided by caregivers and friendly relationships with health providers. To address these challenges and promote access, SRH related policies, services and programmes should be inclusive of the needs of visually impaired women, and measures to remove financial challenges to service utilisation and foster positive relationships with health workers, church and community members should be adopted.

Knowledge of mental health legislation in Ghana: a case of the use of certificate of urgency in mental health care.

INTRODUCTION: Mental illness can affect anyone irrespective of race, gender or personal characteristics. The study sought to investigate health workers' Knowledge on Mental Health Legislation in Ghana focusing on the Certificate of Urgency. METHODS: A descriptive study design was employed for this study. The study population included medical doctors, physician assistants, and nurses/midwives. A simple random sampling technique was used to select 384 respondents for the study. Data was collected through the use of semi-structured questionnaires. RESULTS: Respondents who were psychiatrists were 9.56 times more knowledgeable in the use of Certificate of Urgency than those in other specialties like primary care, obstetrics and gynaecology, surgery and internal medicine; adjusted odds ratio (AOR) = 9.56 [95% confidence interval (CI) 1.57-65.2]. Respondents who had used the Certificate of Urgency before had 4.7 times more knowledge as compared to those who had not used it at all; adjusted odds ratio (AOR) = 4.77 [95% confidence interval (CI) 1.021-14.01]. CONCLUSION: Knowledge of Certificate of Urgency was generally low. Authorities of the various hospitals should organize regular in-service training to enlighten all healthcare workers on the legislation governing mental healthcare in Ghana.