Association between breastfeeding duration and educational attainment in rural Southwest Uganda: a population-based cohort study.

BACKGROUND: Breastfeeding is important for early childhood nutrition and health. The positive effects on educational outcomes may be attributed to socioeconomic factors. Socioeconomic status is not a strong predictor of breastfeeding in sub-Saharan African countries. Yet, few studies have investigated the association between breastfeeding and educational outcomes in these countries. OBJECTIVE: This study investigated the association between breastfeeding duration and children's educational attainment in rural Southwest Uganda. METHODS: We analysed longitudinal data on 3018 children who had information on breastfeeding and were followed for at least 5 years, with at least one primary school grade recorded by 2005. Data on breastfeeding duration were collected from mothers. The highest school grade was recorded repeatedly between ages 6 and 12 years. We calculated age-for-grade based on whether a child was on, over, or under the official age for a grade. Generalised estimating equations and binary logistic regression estimated the effect of breastfeeding duration on being 2 years, 3 or more years, or any years over-age for grade in primary school, adjusting for socioeconomic status and maternal-child characteristics. RESULTS: Most mothers breastfed for more than a year. Just over one-third breastfed for 18-23 months, and 30% breastfed for longer. By age eight, 42% of the children were two years over-age for their grade. Three or more years over-age for grade increased from 19% at age nine to 56% at age 12. Both adjusted and unadjusted estimates were consistent in showing reduced odds for children being 2 years, 3 or more years, or any years over-age for grade among children breastfed for 7-12, 13-17, 18-23, and > 23 months compared to those breastfed for 0-6 months. There was no evidence to support an overall association between breastfeeding duration and being over-age for grade. There was no evidence of association in the sex and age sub-group analyses. CONCLUSION: Although we found no association between breastfeeding duration and educational attainment, breastfeeding remains important for children's health and nutrition, and mothers should be encouraged and supported to breastfeed for the recommended duration.

Main findings: We found no clear evidence of an association between breastfeeding duration and educational attainment in rural Uganda.Added knowledge: The findings of this study contribute to a better understanding of the relationship between breastfeeding and educational outcomes in sub-Saharan African countries, where evidence on this topic is limited.Global health impact for policy and action: Our findings should not discourage breastfeeding, as it is essential for infant health and nutrition.

Reading, singing, and storytelling: the impact of caregiver-child interaction and child access to books and preschool on early childhood development in Ghana.

Optimal early childhood development (ECD) is crucial in shaping future academic and economic accomplishments. Recognising its profound influence, the United Nations has included a specific target and indicator related to ECD in the Sustainable Development Goals to ensure universal access to high-quality ECD for all preschoolers by 2030. This study investigated whether caregiver-child engagements, early stimulation, and learning opportunities are associated with ECD among children aged 36-59 months. Data on 6752 children were pooled from the 2011 and 2017 Ghana Multiple Indicator Cluster Surveys. The ECD outcomes of interest were literacy-numeracy, social-emotional, learning-cognitive, and physical development, measured with UNICEF's Early Childhood Development Index (ECDI). Binary logistic regression assessed the effects of various caregiver-child engagements and early learning opportunities on the ECD outcomes. We found that most children were developmentally on track in the physical (95.0%) and learning-cognitive (86.4%) domains, but fewer were on track in the literacy-numeracy (36.7%) and social-emotional (68.6%) domains. Reading to or with a child (aOR 1.72; 95% CI 1.35-2.19), telling them stories (aOR 1.61; 95% CI 1.26-2.04), counting or drawing with them (aOR 1.63; 95% CI 1.30-2.04) and a child's attendance at preschool (aOR 4.62; 95% CI 3.34-6.38) were associated with a higher odds for on track literacy-numeracy development. Playing with a child was associated with higher odds of on-track social-emotional development (aOR 1.29; 95% CI 1.04-1.59), physical development (aOR 1.61; 95% CI 1.01-2.55), and learning-cognitive development (aOR 1.51; 95% CI 1.14-2.00). However, singing songs to or with a child (aOR 0.78; 95% CI 0.62-0.89) and taking a child outside the home (aOR 0.78; 95% CI 0.64-0.95) were associated with lower odds for on track social-emotional development. Access to children's books at home was associated with higher odds for on track literacy-numeracy and social-emotional development. In subgroup analysis, some observed associations varied depending on a child's residence (urban or rural). Our findings confirmed that caregiver-child  interaction and early learning opportunities could increase a child's likelihood of achieving early developmental milestones.

Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi.

The benefits of exclusive breastfeeding (EBF) for infant health and survival are well documented. However, its impact on educational outcomes has been contested and poorly researched in Africa. It has been hypothesised that positive associations reported in high-income countries can be attributed to residual confounding by socioeconomic status (SES). Our study investigated whether EBF duration in infancy is associated with educational attainment and age-for-grade attainment trajectories at school-age in rural Malawi. Longitudinal data on 1021 children at the Karonga demographic surveillance site in Malawi were analysed. Breastfeeding data were collected 3 months after birth and again at age one. The school grade of each child was recorded each year from age 6 until age 13. We calculated age-for-grade based on whether a child was at, over, or under the official expected age for a grade. Generalised estimating equations estimated the average effect of breastfeeding on age-for-grade. Latent class growth analysis identified age-for-grade trajectories, and multinomial logistic regression examined their associations with EBF. Maternal-child characteristics, SES, and HIV status were controlled. Overall, 35.9% of the children were exclusively breastfed for 6 months. Over-age for grade steadily increased from 9.6% at age 8 to 41.9% at age 13. There was some evidence that EBF for 6 months was associated with lower odds of being over-age for grade than EBF for less than 3 months (aOR = 0.82, 95%CI = 0.64-1.06). In subgroup analyses, children exclusively breastfed for 6 months in infancy were less likely to be over-age for grades between ages 6-9 (aOR = 0.64, 95%CI = 0.43-0.94). Latent class growth analysis also provided some evidence that EBF reduced the odds of falling behind in the early school grades (aOR = 0.66, 95%CI = 0.41-1.08) but not later. Our study adds to the growing evidence that EBF for 6 months has benefits beyond infant health and survival, supporting the WHO's recommendation on EBF.

Systematic review and meta-analysis of the prevalence and determinants of exclusive breastfeeding in the first six months of life in Ghana.

BACKGROUND: Exclusive breastfeeding is a public health priority in sub-Saharan Africa. However, systematic reviews on its determinants in Ghana remain scarce. Therefore, we systematically reviewed the prevalence and determinants of exclusive breastfeeding in children 0-6 months in Ghana. METHODS: We conducted systematic searches in Embase, Medline, and Africa-Wide Information from the databases' inception until February 2021 for studies that assessed the prevalence and determinants of exclusive breastfeeding in children 0-6 months in Ghana. Random-effects meta-analysis was used to estimate the pooled prevalence of exclusive breastfeeding and narrative synthesis to summarise the determinants. We calculated the proportion of total variability that was due to between study heterogeneity using I² statistics, and Egger's test assessed publication bias. The review is registered with PROSPERO, CRD42021278019. RESULTS: Out of the 258 articles identified, 24 met the inclusion criteria. Most of the included studies were cross-sectional and were published between 2005 and 2021. The pooled prevalence of exclusive breastfeeding (EBF) among children 0-6 months in Ghana was 50% (95%CI 41.0-60.0%). The prevalence was higher in rural areas (54%) than in urban areas (44%). Several factors were identified as facilitators of EBF, including older maternal age, self-employment, unemployment, living in a large house, being a house owner, giving birth in a health facility, non-caesarean delivery, adequate antenatal attendance, counselling services, participation in support groups, adequate knowledge about EBF, positive attitude towards EBF, and higher maternal education among rural dwellers. Additionally, having an average birthweight facilitated EBF. Barriers to EBF were also identified, including higher maternal education among urban dwellers, less than three months of maternity leave, maternal HIV-positive status, the experience of partner violence, lack of access to radio, inadequate breastmilk production, lack of family support, having a partner who wants more children, counselling on complementary feeding, healthcare worker recommendation of complementary feed, single marital status, and infant admission to neonatal intensive care units. CONCLUSION: In Ghana, EBF rates are low, with only about half of all children aged 0-6 months breastfed exclusively. A multi-dimensional approach is required to tackle the diverse sociodemographic, obstetric, and infant-related issues that hinder EBF practice in Ghana.

Analysis of national and subnational prevalence of adolescent pregnancy and changes in the associated sexual behaviours and sociodemographic determinants across three decades in Ghana, 1988-2019.

OBJECTIVE: Understanding the determinants of adolescent pregnancy and how they have changed over time is essential for measuring progress and developing strategies to improve adolescent reproductive health. This study examined changes over time in the prevalence and determinants of adolescent pregnancy in Ghana. METHODS: A total of 11 nationally representative surveys from the Ghana Demographic and Health Survey (1988, 1993, 1998, 2003, 2008, 2014), Multiple Indicator Cluster Survey (2006, 2011, 2017-2018) and Malaria Indicator Survey (2016 and 2019) provided data on 14 556 adolescent girls aged 15-19 for this analysis. A random-effect meta-analysis, time trends and multivariable logistic regression models were used to track the prevalence and determinants of adolescent pregnancy. RESULTS: The pooled prevalence of adolescent pregnancy in Ghana was 15.4% (95% CI=13.49% to 17.30%). Rural areas (19.5%) had a higher prevalence of adolescent pregnancy than urban areas (10.6%). In the overall sample, middle adolescents (15-17 years) (aOR=0.30, 95% CI=0.23 to 0.39), adolescents in urban areas (aOR=0.56, 95% CI=0.43 to 0.74), large households (aOR=0.62, 95% CI=0.49 to 0.78), not working (aOR=0.62, 95% CI=0.43 to 0.90) and those unaware of contraceptive methods (aOR=0.49, 95% CI=0.27 to 0.90) were less likely to become pregnant. Adolescents from middle-income (aOR=0.91, 95% CI=0.67 to 1.24) or high-income (aOR=0.59, 95%CI=0.36 to 0.94) households, those who were semiliterate (aOR=0.56, 95%CI=0.39 to 0.82) or literate (aOR=0.28, 95%CI=0.21 to 0.37) and those with fewer previous sex partners were less likely to become pregnant. Not all determinants in the overall sample were consistently associated with adolescent pregnancy in the last three decades. Between 1988 and 1998, determinants of adolescent pregnancy were age, literacy, employment, household size and whether the mother was alive. Between 2003 and 2008, age, literacy, household size, income, age of last sexual partner, number of previous partners and contraception knowledge determined adolescent pregnancy. From 2011 to 2019, age, residence, literacy and menstrual cycle knowledge were determinants of adolescent pregnancy. CONCLUSION: Interventions and policies to prevent adolescent pregnancy should prioritise adolescents from disadvantaged backgrounds.

The impact of intrapartum and immediate post-partum complications and newborn care practices on breastfeeding initiation in Ethiopia: A prospective cohort study.

This study aimed to investigate the impact of intrapartum and post-partum complications and newborn care practices on early initiation of breastfeeding (EIBF). Data for the study came from a prospective cohort study in Ethiopia that recruited and followed pregnant and post-partum women from 2019 to 2021. Resident enumerators conducted interviews at enrolment in 2019 and follow-ups at 6 weeks, 6 months and 1 year post-partum. The present analysis is based on data from the baseline survey and 6 weeks follow-up. Multivariable logistic regression was used to estimate the effects of newborn care practices and intrapartum and post- partum complications on EIBF (the proportion of newborns who initiated breastfeeding within the first hour of birth). Overall, 2660 mother-infant pairs were included in this analysis. After adjustment, EIBF was less likely among women who experienced intrapartum haemorrhage (adjusted odds ratio [AOR]: 0.76, 95% confidence interval [CI]: 0.59-0.97), malpresentation (AOR: 0.46, 95% CI: 0.30-0.72) and convulsions (AOR: 0.48, 95% CI: 0.34-0.66) during childbirth. Mother-newborn skin-to-skin contact increased the likelihood of EIBF (AOR: 1.47, 95% CI: 1.11-1.94). Women who experienced post-partum haemorrhage (AOR: 0.63, 95% CI: 0.47-0.84), retained placenta for more than 30 min (AOR: 0.36, 95% CI: 0.24-0.52) and convulsions after delivery (AOR: 0.57, 95% CI: 0.41-0.79) were less likely to initiate breastfeeding early. Also, women who had a caesarean birth (AOR: 0.28, 95% CI: 0.18-0.41), delivered outside of a healthcare facility (AOR: 0.70, 95% CI: 0.50-0.99) or had twin birth (AOR: 0.43, 95% CI: 0.22-0.85) were less likely to initiate breastfeeding early. Skin-to-skin contact should be encouraged whenever possible, and women with obstetric complications should be encouraged and supported to initiate breastfeeding early.

Prevalence and factors associated with the awareness of obstetric fistula among women of reproductive age in The Gambia: a multilevel fixed effects analysis.

BACKGROUND: An obstetric fistula is an inappropriate connection between the vagina, rectum, or bladder that results in faecal or urine incontinence. Young women from rural areas with poor socioeconomic situations and education are the majority of victims, which restricts their access to high-quality healthcare. Obstetric fistulas can have devastating effects on the physical health of affected women if they are not promptly treated. Inadequate awareness of the symptoms delays recognition of the problem, prompt reporting, and treatment. Women with poor awareness of the disorder are also more likely to develop complications, including mental health issues. Using data from a nationally representative survey, this study investigated the prevalence and factors associated with the awareness of obstetric fistula among women of reproductive age in The Gambia. METHODS: This study used population-based cross-sectional data from the 2019-2020 Gambia Demographic and Health survey. A total of 11823 reproductive-aged women were sampled for this study. Stata software version 16.0 was used for all statistical analyses. Obstetric fistula awareness was the outcome variable. Multilevel logistic regression models were fitted, and the results were presented as adjusted odds ratios (aOR) with statistical significance set at p < 0.05. RESULTS: The prevalence of obstetric fistula awareness was 12.81% (95%CI: 11.69, 14.12). Women aged 45-49 years (aOR = 2.17, 95%CI [1.54, 3.06]), married women (aOR = 1.39, 95%CI [1.04, 1.87]), those with higher education (aOR = 2.80, 95%CI [2.08, 3.79]), and women who worked as professionals or occupied managerial positions (aOR = 2.32, 95%CI [1.74, 3.10]) had higher odds of obstetric fistula awareness. Women who had ever terminated pregnancy (aOR = 1.224, 95%CI [1.06, 1.42]), those who listened to radio at least once a week (aOR = 1.20, 95%CI [1.02, 1.41]), ownership of a mobile phone (aOR = 1.20, 95%CI [1.01, 1.42]) and those who were within the richest wealth index (aOR = 1.39, 95%CI [1.03, 1.86]) had higher odds of obstetric fistula awareness. CONCLUSION: Our findings have revealed inadequate awareness of obstetric fistula among women of reproductive-age in The Gambia. Obstetric fistulas can be mitigated by implementing well-planned public awareness initiatives at the institutional and community levels. We, therefore, recommend reproductive health education on obstetric fistula beyond the hospital setting to raise reproductive-age women's awareness.

The association of breastfeeding with cognitive development and educational achievement in sub-Saharan Africa: A systematic review.

Background: Systematic reviews and meta-analyses of studies mainly from high-income countries suggest that breastfeeding improves cognitive function and educational achievement. However, these associations may be a manifestation of who breastfeeds in these settings rather than an actual effect of breastfeeding. We investigated the association of breastfeeding with cognitive development and educational achievements in sub-Saharan Africa, where breastfeeding is the norm, and socioeconomic status is not strongly correlated with ever breastfeeding. Methods: We searched Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), and Africa-Wide Information in January 2021 for studies that assessed the cognitive and educational benefits of breastfeeding in children and adolescents in sub-Saharan Africa. Two reviewers independently screened, extracted, and critically appraised the included studies. Results: After reviewing 5552 abstracts and 151 full-text articles, seventeen studies on cognitive development and two on educational achievements met our predefined inclusion criteria. The included studies were from ten sub-Saharan African countries and published between 2013 and 2021, with sample sizes ranging from 54 to 6573. Most of the studies (n = 14) were prospective cohort studies, but only nine collected data on breastfeeding prospectively. The studies differed in analytic approaches and cognitive and educational achievements measurements. Of the 17 studies on cognitive development, only four adjusted sufficiently for key confounders. None of these four studies found an overall association between breastfeeding and cognitive development in children or adolescents in sub-Saharan Africa. The two studies on education measured achievements based on the highest grade of school attained, 12 or more years of education, or grade repetition at age 7-11 years. Both studies adjusted for a range of sociodemographic factors and found no evidence that children exclusively breastfed or breastfed for a longer duration have a better educational outcome than sub-optimally breastfed children. Conclusions: The current evidence from sub-Saharan Africa is limited but does not corroborate previous findings that breastfeeding is associated with improved cognitive development and educational achievement. Registration: This study is registered with PROSPERO, CRD42021236009.

Time trends in the prevalence and determinants of age-appropriate breast feeding among children aged 0-23 months in Ghana: a pooled analysis of population-based surveys, 2003-2017.

OBJECTIVE: We assessed the sociodemographic and maternal-child characteristics associated with age-appropriate breast feeding among children aged 0-23 months in Ghana. METHODS: We pooled data on 12 743 children aged 0-23 months from three Demographic and Health Surveys (2003, 2008 and 2014) and three Multiple Indicator Cluster Surveys (2006, 2011 and 2017-2018). The outcome was age-appropriate breast feeding from birth to 23 months, with age-appropriate breast feeding defined as exclusive breast feeding at 0-5 months (ie, at less than 6 months) and breastfeeding alongside appropriate complementary feeding at 6-23 months. Potential determinants were maternal-child sociodemographic, obstetric and healthcare factors. Logistic regression was used to determine the factors associated with age-appropriate breast feeding. We accounted for the complex sampling design of the cross-sectional surveys in the analysis. RESULTS: Most children aged 0-3 months were exclusively breastfed. Among children aged 4-5 months, the most common feeding pattern was breastfeeding alongside water and/or solid foods. Exclusive breastfeeding prevalence in children less than 6 months peaked in 2008 at 62.8% and declined to 42.9% in 2017. For 6-11 month olds, the percentage experiencing age-appropriate breast feeding has been stable over the last four surveys, ranging from 79.3% in 2008 to 81.1% in 2017. Age-appropriate breast feeding in 12-23 month olds declined from 77.8% in 2003 to 61.2% in 2017. Rural residence, younger age, non-facility births and multiple births were associated with decreased odds of exclusively breast feeding. For 6-11 month olds, age-appropriate breast feeding was less likely if the woman did not receive postnatal care. Younger age, being unmarried, high income, wanting a child later and earlier birth order were associated with decreased odds of age-appropriate breast feeding in 12-23 month olds. CONCLUSION: Ghanaian children are now less likely to be exclusively breastfed than they were a decade ago. To succeed, breastfeeding promotion programmes should adopt approaches that address the predictors of suboptimal breast feeding at each age, as identified in this study.

Anxiety and Depression Among Dentists in the Kingdom of Saudi Arabia.

Purpose: Dentists face a great deal of professional stress, in dental school and in practice. Their personal, as well as professional lives, get affected negatively by stress and poor mental health. This study aims to evaluate anxiety and depression among dentists of Abha in kingdom of Saudi Arabia. Materials and Methods: A cross-sectional study was carried out among 246 registered dentists of Abha to assess anxiety and depression. Participants willing to participate, and completely filled questionnaire were included in study. Data regarding demography, work-related characters, lifestyle and self-reported physical and mental status were collected. Mental status was measured by using pre validated questionnaire Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS). Data were analyzed using Statistical Package for Social Sciences (SPSS 20) by IBM. Descriptive statistics, Pearson correlation, independent t test and one way ANOVA were used to analyze the data at the significant interval of p≤0.05. Results: Different levels of anxiety and depression were noticed both in males and female dentist. There was no statistical difference in the mean scores between males and females. There was a statistical difference of anxiety and depression scores noticed among dentist working in government institution, with five to ten years of experience. Habits of smoking were shown to significantly affect the risk of anxiety and depression scores. Conclusion: Dentist due to nature of the practice are prone for anxiety and clinical depression. Stress coping methods should be included in dental curriculum which would indirectly improve professional abilities and personal life.

Menstrual knowledge, sociocultural restrictions, and barriers to menstrual hygiene management in Ghana: Evidence from a multi-method survey among adolescent schoolgirls and schoolboys.

On a daily basis, schoolgirls in low and middle-income countries discover blood on their clothing for the first time in school environments without toilets, water, or a supportive teacher, mentor, or role model to help them understand the changes happening in their bodies. This study aimed to examine the menstrual knowledge, sociocultural restrictions, and barriers to menstrual hygiene management in school environment among adolescent schoolgirls in a rural community. We collected quantitative data from 250 adolescent schoolgirls and qualitative data from thirty schoolboys and five schoolteachers in five Junior High Schools in the Kumbungu district of northern Ghana. Binary logistic regression models were fitted to determine the predictors of poor menstrual knowledge. Qualitative data were transcribed verbatim, coded, and organized into themes. Overall, 53.6% of the girls had poor knowledge about menstruation. Most of the boys had heard about menstruation and had an idea about what menstruation is with most of them describing it as "the flow of blood through the vagina of a female." The boys revealed that terms such as "Vodafone," "Red card," and "Palm oil" are used to describe menstruation in the schools and within the community. After adjusting for the effect of other sociodemographic factors, we found evidence that girls in their late adolescents were less likely to have poor menstrual knowledge compared to those aged 10-14 years (aOR 0.20, 95%CI 0.08-0.48). Maternal education was protective against poor menstrual knowledge. When compared to adolescents whose mothers were illiterates, those whose mothers had basic education (aOR 0.62, 95%CI 0.28-1.40) and those whose mothers had secondary or higher education (AOR 0.22, 95%CI 0.06-0.76) were less likely to have poor knowledge about menstruation. Adolescents from homes with no television and radio sets were more likely to have poor menstrual knowledge compared to those from homes with television and radio sets (aOR 2.42, 95%CI 1.41-4.15). Comfort, safety, and cost were the major factors that influenced their choice of sanitary products. Most of the teachers said the schools do not provide students with sanitary products, even in emergencies. We found that girls were not to prepare some local dishes (e.g. Wasawasa) during their periods and are forbidden from participating in religious activities (i.e. read the Holy Quran or pray in the mosque) during the period of menstruation. Open discussions about menstruation and its management are not encouraged and girls are considered unclean and impure during the period of menstruation. None of the schools had a regular supply of water in WASH facilities, a mirror for girls to check their uniforms for bloodstains or soap in the toilet facilities for handwashing. Menstrual education through the standard school curriculum, starting from primary school, could prepare girls for menarche, improve their knowledge on menstruation, and teach boys how to support girls and women during the period of menstruation. This could also eliminate the sociocultural misconceptions surrounding menstruation.

Sociodemographic Factors Associated with Women's Perspectives on Male Involvement in Antenatal Care, Labour, and Childbirth.

BACKGROUND: Evidence suggests that in patriarchal societies such as Ghana, access to and survival of maternal and child healthcare services require the active involvement of men. However, interventions to promote men's involvement in maternal and child health care are less likely to succeed if the views and concerns of women are not considered. This study provides an understanding of women's perspective on men's involvement in antenatal care, labour, and childbirth in the Northern Region of Ghana. METHODS: Data for this cross-sectional study were collected from 300 pregnant women using a structured questionnaire. Logistic regression models were then used to determine the socio-demographic factors associated with women's perspectives on men's involvement in antenatal care, labour, and childbirth. RESULTS: The mean age of the participants was 28 (SD = 5.21) years. More than four-fifths of the women in this study express the desire for male partner involment in natenatal care (ANC) services (n = 258, 86%) and as companions during labour and child birth (n = 254, 84.7%). We found that married women were 9.8 times more likely (95%CI 1.59, 60.81) to encourage male involvement in ANC compared to women who were unmarried. The probability of encouraging male involvement in ANC decreased with increased level of education among the women while support for male companionship during childbirth increased significantly with an increased level of education. After accounting for the effect of other significant covariates, there was good evidence to suggest that married women (p = 0.002), women with only primary/Junior High School education (p = 0.048) and those with two (p = 0.010), three (p = 0.008), or ≥4 (p = 0.044) previous pregnancies had a desire for male partner involvement in ANC while women who attained secondary (p = 0.004) or tertiary (p = 0.001) level education expressed the desire for male companionship in labour and childbirth in the adjusted model. CONCLUSION: Male involvement in antenatal care, labour, and childbirth received overwhelming support from the women in this study.

Menstrual Hygiene Management and School Absenteeism among Adolescents in Ghana: Results from a School-Based Cross-Sectional Study in a Rural Community.

The study aimed to deepen our understanding of the menstrual hygiene management (MHM) of adolescents and the influence of menstruation on school absenteeism. We employed a school-based cross-sectional design in five Junior High Schools combining both quantitative and qualitative data collection methods. A questionnaire was used to collect quantitative data from 250 schoolgirls, and key informant interviews were conducted with a teacher in each of the five schools. We performed logistic regression analysis to provide crude and adjusted effect estimates and 95% confidence intervals. About fifty percent of the girls were engaged in good MHM, and approximately forty percent of them reported menstrual-related school absenteeism. We did not find evidence (p = 0.858) of association between MHM and menstrual-related school absenteeism. However, after controlling for the effect of other factors, we found evidence that the age of the schoolgirls, their father's occupation, and the receipt of allowance for menstrual care products were associated with MHM. When compared to those aged 17 to 19, those aged 10 to 13 years had 0.72 (95% CI 0.21, 2.44) decreased odds of poor MHM while those aged 14 to 16 had almost 3-fold increased odds (95% CI 1.49, 4.55) of poor MHM. The adolescents whose fathers were farmers had 0.42 (95% CI 0.21, 0.82) decreased odds of poor MHM while those whose fathers were unemployed had 0.24 (95% CI 0.10, 0.61) decreased odds of poor MHM. We found that girls who did not receive regular allowance for menstrual care products had nearly 2-fold increased odds (95% CI 1.06, 3.09) of poor MHM compared to those who received allowance for menstrual care products. Menstrual pain (82.2%), fear of staining clothing (70.3%), fear of being teased (70.3%), nonavailability of sanitary pad (63.4%), and lack of private place to manage period at school (60.4%) were the common reasons cited for menstrual-related school absenteeism.

Maternal obstetric and socio-demographic determinants of low birth weight: a retrospective cross-sectional study in Ghana.

BACKGROUND: Birth weight is an important predictor of early neonatal mortality, morbidity, and long-term health outcomes. Annually, approximately 20 million babies are born globally with weights less than 2.5kg. In sub-Saharan Africa, the prevalence of LBW is around 13 to 15 percent. In Ghana, 10% of babies born in 2014 were with LBW. The aim of this study was to identify maternal socio-demographic and obstetric risk factors associated with the birth weight of newborns in the Sunyani Municipality of Ghana. METHODS: This retrospective cross-sectional study analysed data from 931 birth records of all deliveries between January 1 and December 31, 2017, at the Sunyani Municipal Hospital in the Brong-Ahafo Region of Ghana. Univariate and multivariable logistic regression models were fitted to estimate the effect of maternal factors on low birth weight. RESULTS: We found that the mean age of the participants and the mean gestational age at birth were 27.21(SD = 5.50) years and 37.95(SD = 1.85) weeks respectively. Nearly 10% of the infants born within the study period had birth weights below 2.5kg. The findings revealed that the odds of delivering LBW baby were significantly high (OR 1.77, 95%CI 1.14-2.76) among urban dwellers. However, mothers who attended or completed secondary or higher education were 63% (95% CI 0.20-0.78) less likely to give birth to a LBW baby when compared with uneducated mothers. We found that the odds of LBW significantly decreased with every one-week increase in gestational age (OR 0.67 95%CI 0.59-0.76) and significantly increased with increasing parity (OR 1.43 95%CI 1.21-1.70). Further, the likelihood of delivering LBW baby decreased with every additional ANC visit (OR 0.78 95%CI 0.67-0.90) and with every additional gram of haemoglobin (OR 0.78 95%CI 0.63-0.95). CONCLUSION: The evidence from this study suggests that maternal educational level, residence, haemoglobin level, parity, number of ANC visits, and gestational age are independent predictors of low birth weight. The current findings add substantially to the growing literature on the influence of maternal socio-demographic and obstetric factors on LBW in resource-constrained settings and provide empirical data for clinical and public health interventions aimed at reducing low birth weight and its associated complications.

Pre-service knowledge, perception, and use of emergency contraception among future healthcare providers in northern Ghana.

BACKGROUND: Emergency contraception, if used properly, can prevent up to over 95 % of unwanted and mistimed pregnancies. However, a number of obstacle including healthcare providers knowledge, perception, and attitude towards emergency contraception (EC) prevent women and adolescents from having access to EC. METHODS: This was a cross-sectional study among 191 female final year nursing and midwifery students of Tamale Nurses and Midwives Training College in the Northern Region of Ghana. Purposive sampling method was used to sample 100 students from the nursing programme and 91 from the midwifery programme. Chi-square and Fisher's exact tests were performed to determine factors associated with awareness about EC and use of EC. RESULTS: Over four-fifths, 166(86.91%), of the participants indicated they had heard about EC prior to the study. Majority (80.10%) of the participants correctly indicated the time within which to take emergency contraceptive pills (ECPs). More than half, 105(54.97%), of the participants did not know the appropriate time within which to use IUD as EC. Almost four-fifths, 74(38.74%), of the participants indicated it is morally wrong to use EC and more than half, (n = 104, 54.45%), of them said EC use promotes promiscuity. Only 49(25.65%) participants said they had ever used ECP. Of the number that indicated ever-using ECP, 36(73.47%) cited condom breakage or slippage as the reason for using the method. CONCLUSION: Though there was a relatively high level of EC awareness and knowledge among the students, some students lacked detailed knowledge about the method, especially the use of IUD as EC. We found that it was easy to access EC in the study area but the use of EC was low among the students. Most of the students demonstrated a positive attitude towards EC, but many of them believed EC encourages promiscuous sexual behaviour and that it is morally wrong to use EC. The curriculum for nursing and midwifery education should provide opportunity for detailed information and practical knowledge on EC to demystify negative perceptions and attitudes of nursing and midwifery students towards EC and other forms of contraception and to improve their knowledge on EC.

Motivational factors for blood donation, potential barriers, and knowledge about blood donation in first-time and repeat blood donors.

BACKGROUND: Blood transfusion is an essential component of the health care system of every country and patients who require blood transfusion service as part of the clinical management of their condition have the right to expect that sufficient and safe blood will be available to meet their needs. However, this is not always the case, especially in developing countries. To recruit and retain adequate regular voluntary non-remunerated blood donors the motivators and barriers of donors must be understood. Equally important to this goal is the knowledge of blood donors. METHODOLOGY: A cross-sectional study was conducted at the donor clinic of Tamale Teaching Hospital in the Northern Region of Ghana from 06 January to 02 February 2018. Purposive sampling technique was used to sample 355 eligible first-time and repeat whole blood donors. Data were collected face-to-face with a 27-item self-administered questionnaire. Chi-square test was used to determine the association between donor status and the motivators of blood donation, barriers to blood donation and the socio-demographic characteristics of donors. RESULTS: Out of the 350 donors, 192(54.9%) were first-time blood donors while 158 (45.1%) were repeat donors. Nearly all the donors, 316(90.3%), indicated they were motivated to donate when someone they know is in need of blood. Over four-fifths of the donors endorsed good attitude of staff (n = 291, 83.4%) and the desire to help other people in need of blood (n = 298, 85.1%) as motivators. Approximately two-thirds, 223(63.7%), of the donors endorsed poor attitude of staff as a deterrent to blood donation. More than half of the donors considered the level of privacy provided during pre-donation screening (n = 191, 54.6%) and the concern that donated blood may be sold 178(50.9%) as deterrents. Only a little over one-third of the donors knew the minimum age for blood donation (n = 126, 36.0%) and the maximum number of donations per year (n = 132, 37.7%). CONCLUSION: Our findings suggest that public education on blood donation, regular prompts of donors to donate when there is a shortage, and friendly attitude of staff have the potential to motivate donors and eliminate barriers to blood donation.