Correlates of Hepatitis B infection in pregnant women attending antenatal clinics in Wa Municipality, Ghana.

Despite the availability of an effective vaccine against viral hepatitis B infection, it remains prevalent, highly transmissible especially through mother-to-child, life-threatening, and a major public health challenge. A positive Hepatitis B e-Antigen (HBeAg) mother has a 90% risk of transmitting the virus to the unborn child in the perinatal period. This study sought to determine the prevalence and risk of Hepatitis B infection among pregnant women in the Wa Municipality of Ghana. A cross-sectional study employing systematic random sampling was conducted among 183 consented pregnant women who went for antenatal care in nine health facilities in the Wa Municipality. A structured validated questionnaire was used to collect information about socio-demographic and obstetric characteristics, awareness of Hepatitis B Virus (HBV) transmission and its prevention. Blood samples (3.0 mls) were collected from each participant to test for HBV serum markers using a Wondfo One Step HBV rapid immunochromatographic assay (Catalog number W003) for the Hepatitis B surface antigen (HBsAg). We conducted descriptive statistics including the prevalence and used multivariable logistic regression to determine the risk of Hepatitis B among study participants. Data was analysed using Stata/SE 15. About 20.2% of the 183 pregnant women screened tested positive for HBsAg. Generally, compared with younger pregnant women, older (> = 25) pregnant women were >9 times less likely to test positive for both chronic Hepatitis B core antibody (HBcAb) and (HBeAg) Hepatitis B infections. However, pregnant women in polygamous relationship were more likely to test positive for both (HBcAb) and (HBsAg and HBeAg) Hepatitis B infections compared with those in monogamous relationship. In a multivariable analysis, pregnant women in a polygamous relationships were about 5 times more likely to test positive for HBsAg (AOR = 4.61, 95% CI: 2.06-9.89) and HBcAb (AOR = 4.89, 95% CI:1.52-6.81) and HBeAg (AOR = 4.62, 95% CI:1.21-6.39) compared with those in a monogamous relationship. This study highlights a high HBsAg prevalence among pregnant women with those in polygamous relationship and younger age more likely to test positive. Facility and community-based health services should emphasize the need for regular screening, education, and vaccination of pregnant women, especially those at high risk, to prevent mother-to-child transmission of viral hepatitis B.

Preterm birth, low birth weight, and their co-occurrence among women with preexisting chronic diseases prior to conception: a cross-sectional analysis of postpartum women in a low-resource setting in Ghana.

BACKGROUND: The incidence of chronic diseases, which are significant contributors to maternal deaths and adverse new-born outcomes, is increasing among women of reproductive age in northern Ghana. This emerging health issue raises serious concerns about the potential exacerbation of adverse birth outcomes in this setting, given that it is one of the regions in the country with a high incidence of such outcomes. We investigated the risks of preterm birth (PTB), low birth weight (LBW), and concurrent PTB and LBW among women with preexisting chronic conditions prior to conception in the Tamale Metropolis of northern Ghana. METHODS: A facility-based cross-sectional study was conducted among 420 postpartum women randomly selected from five public health facilities. Information was collected electronically on participants' self-reported experience of chronic conditions, namely, hypertension, diabetes, asthma, heart disease, and sickle cell disease, prior to their most recent pregnancy. Information on gestational age at delivery and birth weight was also collected. Regression modeling was used to quantify the risk of adverse newborn outcomes among women who reported preexisting chronic conditions prior to pregnancy. RESULTS: Chronic diseases affected 31.2% of our sample. Of these, 28.6% had a single chronic condition, while 2.6% had comorbid chronic conditions. The prevalence of PTB was 24.0% (95% CI: 20.2, 28.4), 27.6% (95% CI: 23.5, 32.1) of the newborns were born LBW, and 17.4% (95% CI: 14.0, 21.3) of the pregnancies resulted in both PTB and LBW. Compared with those without chronic conditions, women with chronic conditions prior to conception had a greater risk of PTB (aOR = 6.78, 95% CI: 3.36, 13.68), LBW (aOR = 5.75, 95% CI: 2.96, 11.18), and the co-occurrence of PTB and LBW (aOR = 7.55, 95% CI: 3.32, 17.18). CONCLUSIONS: We observed significant rates of PTB, LBW, and the co-occurrence of PTB and LBW among women who were already aware that they had preexisting chronic conditions prior to conception. Our findings highlight a potential gap in the quality of prenatal care provided to these women before delivery. Preconception care may offer an opportunity to address preexisting chronic conditions in women before pregnancy and potentially improve maternal and newborn health outcomes.

Quality of antenatal care services received by women of reproductive age prior to delivery in selected public health facilities in the northern zone of Ghana.

BACKGROUND: Over the past two decades, antenatal care (ANC) coverage has increased in most settings across low- and middle-income countries, including Ghana. However, evidence shows that there is a need to focus on both access and quality to improve maternal and newborn health outcomes. We investigated ANC quality among public healthcare facilities in the northern region of Ghana. METHODS: We conducted a facility-based study involving 420 postpartum women, selected randomly from five public health facilities. We collected information on a set of prenatal services that respondents self-reported to have received during their most recent pregnancy. Women who received all the interventions assessed were considered to have received quality ANC. Using multilevel (mixed-effects) regression analysis, we identified the independent factors associated with ANC quality, with healthcare facility as the cluster variable. RESULTS: Of the 420 women, 31.2% (95% CI: 26.9, 35.8) received ANC services of high quality. ANC quality differed significantly by women's background characteristics and ANC use. However, gestational age at first ANC and the number of follow-up visits before delivery were significantly associated with ANC quality: booking the first visit in the second or third trimester reduced the odds of receiving high-quality ANC compared to booking in the first trimester (aOR = 0.15, 95% CI: 0.07, 0.31, and aOR = 0.09, 95% CI: 0.01, 0.83, respectively). In contrast, achieving a minimum of eight ANC follow-ups before delivery increased the odds of receiving high-quality ANC compared to attaining fewer than eight visits (aOR = 4.82, 95% CI: 2.33, 9.99). CONCLUSIONS: A significant proportion of pregnant women in the study setting received suboptimal quality ANC during their most recent pregnancy. ANC quality was primarily associated with the timing of the first visit and the number of follow-up visits before delivery. Timely initiation of ANC and frequent follow-up visits will be crucial in the study's setting for pregnant women to benefit from comprehensive ANC services.

Protocol for pesticide residue monitoring and risk assessment on water, sediment, and fish: A case study of two selected reservoirs in Ghana.

Background: Africa is experiencing a significant surge in the use of pesticides on farms. Though the use of pesticide products on farms is increasing rapidly, the ability to monitor and regulate the practice has not kept pace. Despite their potential significance, the health and environmental impacts of the growing pesticide usage in developing nations remain inadequately comprehended and recorded. Objective: This paper presents a research protocol for a study that seeks to provide criteria for future monitoring of pesticide residues in aquatic environments and food sources. This study aims to evaluate pesticide utilisation methods and the potential hazards of pesticide residues in aquatic ecosystems. Additionally, the study seeks to assess the human health risks linked to pesticide applications. Methods: This study will employ a quantitative approach and cross-sectional design. It will utilise a combination of survey and the collection of biological and environmental samples. Our methodology consists of four distinct steps. These outline the processes for studying pesticide residue in environmental and fish samples. Additionally, we plan to employ mathematical algorithms to evaluate the ecological and health risks associated with these pesticide residues. Conclusion: This study is an effort to monitor and assess the hazards to the environment and human well-being associated with the increasing utilisation of pesticides. It also aims to gather relevant data on pesticide utilisation practices that contribute to the contamination of aquatic ecosystems. It will specifically focus on determining the concentration of pesticide residues in both biological and environmental samples. Additionally, the study will assess the ecological and health risks associated with these pesticide residues. This will enable the incorporation of organised research efforts and coordinated pesticide surveillance operations for toxicovigilance.

Impact of hospital-community diabetes management intervention in Central Region, Ghana: A retrospective study.

OBJECTIVE: Effective diabetes management remains suboptimal in low-resourced countries including Ghana. We determined the effectiveness of hospital-community link diabetes management intervention on glycaemic control and other outcomes. METHODS: A retrospective study design, using secondary data from the Ghana-Netherlands for Health Foundation diabetes programme. The z-test was used for proportions, to compare parameters between baseline (2017) and endpoint (2022). The Friedman test was used to assess changes in blood glucose levels, and the multivariable Logistic regression to identify factors associated with blood glucose control. RESULTS: Analyses of 251 clinical records showed decline in median blood glucose levels across six years from 8.8 mmol/L (7.2-12.9) in 2017 to 6.5 mmol/L (5.7-7.2) (p = 0.001) in 2022, recording 43 % increase in patients attaining glycaemic control in 2022 (p = 0.001). The Friedman test showed significant reduction in glucose levels (χ2 = 319.2, p = 0.001), with an effect size of 0.25 using the Kendall test. The logistic regression analyses revealed that patients on metformin and Glibenclamide combination were more likely to achieve glycaemic control than those on metformin monotherapy (adjusted OR = 7.30, 95 % CI 2.31-23.01, p = 0.001). CONCLUSION: The intervention achieved significant reduction in blood glucose levels. Patients with diabetes benefit from the hospital-community link diabetes management intervention regarding glycaemic control.

Pregnancy outcomes before and during COVID-19 pandemic in Tamale Metropolis, Ghana: A retrospective cohort study.

BACKGROUND: The COVID-19 pandemic affected expectant mothers seeking maternal health services in most developing countries. Access and utilization of maternal health services including antenatal care (ANC) attendance and skilled delivery declined drastically resulting in adverse pregnancy outcomes. This study assessed pregnancy outcomes before and during COVID-19 pandemic in Tamale Metropolis, Ghana. METHODS/DESIGN: A retrospective cohort study design was employed. A random sampling technique was used to select 450 women who delivered before or during the COVID-19 pandemic in Tamale Metropolis, Ghana. The respondents were interviewed using structured questionnaire at their homes. In this study, the data collected were socio-demographics characteristics, ANC attendance, before or during pandemic delivery, place of delivery and birth outcomes. Chi-square test and bivariate logistic regression analyses were performed under significant level of 0.05 to determine factors associated with the outcome variables. RESULT: Of the 450 respondents, 51.8% were between 26 and 30 years of age. More than half (52.2%) of the respondents had no formal education and 93.3% were married. The majority (60.4%) of the respondents described their residence as urban setting. About 31.6% of the women delivered before the pandemic. The COVID-19 pandemic influenced place of delivery. The proportion of women who attended at least one ANC visit (84.5% before vs 70.5% during), and delivered at a hospital (76.8% before vs 72.4% during) were higher before the pandemic. More women were likely to deliver at home during COVID-19 (OR: 2.38, 95%CI: 1.52-3.74, p<0.001). Similarly, there was statistically significance difference between before and during COVID-19 delivery on at least one ANC attendance (OR: 2.72, 95%CI: 1.58-1.67, p<0.001). Women who delivered during COVID-19 were about twice more likely to develop complications (OR: 1.72, 95%CI: 1.03-2.87, p = 0.04). CONCLUSION: ANC attendance and health facility delivery decreased while pregnancy complications increased during COVID-19. During disease outbreaks, outreach engagement strategies should be devised to increase access and utilization of maternal health services for marginalized and underserved populations. The capacity of health workers should be strengthened through skills training to manage adverse birth outcomes.

Population-based cross-sectional study of factors influencing full vaccination status of children aged 12- 23 months in a rural district of the Upper East Region, Ghana.

BACKGROUND: Achieving universal health coverage includes ensuring that children have access to vaccines that are of high quality, safe, efficacious, and affordable. The Immunisation Agenda 2030 aims to expand services to zero-dose and incompletely vaccinated children and reduce immunisation rate disparities as a contribution to vaccination equity. This study explored the factors influencing full vaccination status among children aged 12 - 23 months in a rural district of the Upper East Region of Ghana. METHODS: A population-based cross-sectional study was conducted among carers of children aged 12 -23 months in the Kassena Nankana West district. A multistage sampling technique was used to select 360 carers. Information regarding the vaccination status of children was gathered through a combination of children's health record books and carers' recollections. Information on potential determinants was also systematically collected for analysis in Stata version 15.0. RESULTS: The results showed that 76.9% (95% CI: 72.3 - 81.0) of children had full vaccinations per the national schedule. All children received at least one vaccination. A higher percentage of carers with incompletely vaccinated children reported that they had travelled with their children as the primary reason for missing certain vaccine doses. Full vaccination status was significantly associated with secondary (aOR = 2.60; 95% CI: 1.20-5.63) and tertiary (aOR = 3.98, 95% CI: 1.34-11.84) maternal educational level, being in a partnership relationship (aOR = 2.09, 95% CI: 1.03-4.25), and residing in close proximity to healthcare facilities (aOR = 0.41, 95% CI: 0.21-0.80). CONCLUSIONS: Our study found that nearly one-quarter of children aged 12-23 months in the study setting are underserved with vaccination services for a variety of reasons. Effectively reaching these children will require strengthening health systems, including eliminating vaccine shortages, addressing the unique challenges faced by unmarried women with children aged 12-23 months, and improving accessibility to vaccination services.

Predictors of vaccination card retention in Tamale Metropolis, Ghana.

BACKGROUND: The home-based vaccination card is an important health record for determining vaccination status of children during surveys, particularly in low- and middle-income countries. However, there are limited evidence on the factors that influence its retention in Ghana. We assessed the predictors of vaccination card retention in Tamale Metropolis, Ghana. METHODS: We conducted a cross-sectional study from 21st December 2022 to 10th January 2023 among children aged 0-59 months in the Tamale Metropolis. Multi-stage sampling was used to select caregivers of children aged 0-59 months for enrolment in the study. Data were collected using validated questionnaire through face-to-face interviews of caregivers. A vaccination card was retained if it was presented for physical inspection by research assistants. The factors that influence vaccination card retention were determined in a multivariate logistic regression analysis at p<0.05. RESULTS: A total of 1,532 eligible children were enrolled in this study. Vaccination card retention was 91.5%. Negative predictors of card retention included: being resident in the Nyohini (AOR = 0.28; 95% CI = 0.15-0.50) and Tamale Central (AOR = 0.51; 95% CI = 0.29-0.90) sub-Metro areas and being caregivers of children aged 24-59 months (AOR = 0.39; 95% CI = 0.22-0.68). On the other hand, paying for the vaccination card (AOR = 5.14; 95% CI = 2.95-8.95) was a positive predictor of vaccination card retention. CONCLUSION: In this study, vaccination card retention among children aged 0-59 months was higher than national estimates. Vaccination card retention was mainly influenced by sub-Metro area, age of child and mode of acquisition of the card such as out-of-pocket payment. There is need to design and deliver tailored messages including the importance of vaccination card retention to caregivers of children based on geographic context. Additionally, the policy on sale of vaccination cards should be revised to allow for cost sharing to enhance its retention.

Knowledge and predictors of attitudes of hepatitis B virus infection prevention among adults in Tolon, Northern Ghana.

INTRODUCTION: Viral hepatitis is one of the major public health concerns, targeted for eradication by 2030. Though previous research has concentrated largely on pregnant women and urban areas, rural populations are reported to be greatly affected in northern Ghana. This study determined knowledge and predictors of attitudes toward hepatitis B virus (HBV) infection prevention among adults in Tolon District, Northern Ghana. METHODOLOGY: This was a population-based cross-sectional descriptive study with a quantitative approach. A multistage stratified random sampling technique was used to select 195 adults. Data were analysed using SPSS version 26. Composite scores were generated for knowledge and attitude levels. At 0.05 precision level, multiple linear regression was performed to determine predictors of respondents' attitudes. RESULTS: The overall knowledge level (48.7%) of participants on HBV infection was average, with the majority (67.0%) demonstrating unsatisfactory attitudes towards the prevention. The regression equation was statistically significant (F (3,191) = 61.051), p < 0.001. About half (49%) of the variance in attitude was explained by the independent variables. Participants predicted attitude score was determined as 3.784 - 0.040 (age) + 0.435 (knowledge), where age was measured in years and knowledge was measured as scores on a continuous variable scale. CONCLUSIONS: Knowledge levels are sub-optimal with unsatisfactory attitudes toward HBV infection prevention in the study setting. Participants' age and knowledge of HBV are significant predictors of attitudes toward its prevention. There is a need to increase access to formal education and health promotion programs in the district, to complement government efforts to attain Sustainable Development Goal 3 (SDG-3).

Temporal trend analysis of the HIV/AIDS burden before and after the implementation of antiretroviral therapy at the population level from 1990 to 2020 in Ghana.

BACKGROUND: Antiretroviral therapy (ART) has helped reduce the burden of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the majority of countries. Its contribution to the HIV/AIDS burden in Ghana is still understudied. This study examined HIV/AIDS trends in Ghana before (1990-2004) and after (2004-2020) the implementation and expansion of ART. METHODS: We obtained HIV/AIDS epidemiology and treatment data for the years 1990-2020 from the United Nations Programme on HIV/AIDS. We investigated the impact of the ART rollout on HIV/AIDS in Ghana using Joinpoint regression models. RESULTS: The HIV incidence, prevalence, and AIDS-related deaths decreased significantly after 2004, as ART coverage increased from 1% to 2004 to 60% in 2020. The HIV incidence decreased by approximately 3% (AAPC = -2.6%; 95% CI: -3.2, -1.9) per year from 1990 to 2004 and approximately 5% (AAPC = -4.5%; 95% CI: -4.9, -4.2) per year from 2004 to 2020. Between 1990 and 2004, the HIV prevalence increased by approximately 5% (AAPC = 4.7%; 95% CI: 3.6, 5.8) per year but decreased by 2% (AAPC = -1.9%; 95% CI: -2.1, -1.6) per year between 2004 and 2020. Between 1990 and 2004, the annual increase in AIDS-related mortality was 14% (AAPC = 13.8%; 95% CI: 12.6, 15.0), but between 2004 and 2020, it decreased at nearly a 4% (AAPC= -3.6%; 95% CI: -4.7, -2.5) annual rate. CONCLUSIONS: We found trends indicating progress in Ghana's fight against HIV/AIDS. However, the most significant declines occurred after the introduction of ART, suggesting that the scale-up of ART may have contributed to the decline in HIV/AIDS in Ghana. We advocate for the rapid expansion of ART in Ghana.

Utilization of growth monitoring and promotion services and undernutrition of children less than two years of age in Northern Ghana.

BACKGROUND: Child undernutrition is a major public health problem and an important indicator of child's health. Adequate nutrition is critical for a child's growth and development. Growth monitoring and promotion (GMP) services is a nutrition intervention aimed at improving the nutritional status of children. We assessed the utilization of growth monitoring and promotion services and nutritional status of children less than two years of age in northern Ghana. METHODS: This was a descriptive cross-sectional study that involved face-to-face interviews among 266 mothers with children < 2 years of age attending child welfare clinics (CWC). We also collected anthropometric measurements. Descriptive statistic was performed and data presented as percentage. The nutritional status of children was classified as underweight (weight-for-age z score < -2 standard deviations), stunted (length-for-age Z score < - 2) and wasted (weight-for-length z score < -2) while utilization of GMP services was based on attendance to CWC and ability to interpret different growth curves. Chi square test was used to determine the relationship between utilization of GMP services and nutritional status of children at an alpha of 0.05. RESULTS: The prevalence of undernutrition shows that, 18.6% of the children were underweight, 14.7% were stunted and 7.9% were wasted. About 60% of the mothers accessed GMP services regularly. Less than half of the mothers were able to interpret the children's growth curve correctly: falling growth curve (36.8%), flattening growth curve (35.7%) and rising growth curve (27.4%). In combining children < 6 and 6-23 months of age, only one-third (33.1%) of mothers practiced appropriate infant and young child feeding. Regular GMP services was found to have a statistically significant relationship with underweight (P < 0.001), stunting (P = 0.006) and wasting (P = 0.042). CONCLUSION: The level of undernutrition remains high and child feeding practices is poor. Maternal utilization of GMP services is also low in the study area. Similarly, ability to interpret the child's growth curve appropriately persist as a challenge among women. Thus, attention is needed to improve utilization of GMP services to address child undernutrition challenges.

Experiences of nurses on COVID-19 preventive protocols implementation in Tamale Metropolis, Ghana: A qualitative exploration.

The Coronavirus Disease, 2019 (COVID-19) disrupted healthcare delivery. Health workers, particularly nurses are key members of the interdisciplinary healthcare team. They are faced with many challenges due to the pandemic. In addition to providing basic healthcare services, nurses are required to adhere to the COVID-19 recommended safety protocols. This study explored experiences of nurses on the implementation of COVID-19 preventive protocols in Tamale Metropolis, Ghana. A qualitative study was conducted among seventeen (17) nurses, comprising five (5) staff with COVID-19 infection, and twelve (12) ward managers or in-charges who did not have COVID-19 infection, using explorative design and an interview guide. The participants were purposively selected. The ward managers/in-charges and infected staff were interviewed face-to-face and by mobile phone respectively. Content analysis was conducted on the data and the results presented as themes and sub-themes. After the analysis, five (5) main themes and fourteen (14) sub-themes were identified on experiences of nurses regarding COVID-19 preventive protocols implementation. These included understanding COVID-19 transmission/spread (patients-to-staff, staff-to-staff and through fomites), communicating the preventive protocols (social media, ward meetings and administrative memoranda), and attitude of nurses on the protocol's implementation (growing apathy, discomfort in applying personal protective equipment (PPEs) and outright defiance). Nurses also experienced some challenges and inadequate support (progressive decline in supply of PPEs, infrequent supply of water and limited infrastructure), in addition to dealing with issues of protocols implementation in healthcare setting (inapplicability of social distancing in hospital setting and improvising PPEs). In conclusion, the nurses had varied experiences on COVID-19 preventive protocols implementation. The themes explored were mode of COVID-19 transmission, communication approaches, negative attitudes, inadequate logistics and inability to implement social distance. Overall, these affected the effective implementation of the protocols. Thus, health facilities should be provided with adequate logistics/supplies and trainings to enable nurses implement COVID-19 preventive protocols effectively.

Prevalence and factors associated with the utilisation of modern contraceptive methods among married women of childbearing age in Yemen: a secondary analysis of national survey data.

OBJECTIVE: Improving reproductive health requires access to effective contraception and reducing the unmet need for family planning in high-fertility countries, such as Yemen. This study investigated the utilisation of modern contraception and its associated factors among married Yemeni women aged 15-49 years. DESIGN AND SETTING: A cross-sectional study was conducted. Data from the most recent Yemen National Demographic and Health Survey were used in this study. PARTICIPANTS: A sample of 12 363 married, non-pregnant women aged 15-49 was studied. The use of a modern contraceptive method was the dependent variable. DATA ANALYSIS: A multilevel regression model was used to investigate the factors associated with the use of modern contraception in the study setting. RESULTS: Of the 12 363 married women of childbearing age, 38.0% (95% CI: 36.4 to 39.5) reported using any form of contraception. However, only 32.8% (95% CI: 31.4 to 34.2) of them used a modern contraceptive method. According to the multilevel analysis, maternal age, maternal educational level, partner's educational level, number of living children, women's fertility preferences, wealth group, governorate and type of place of residence were statistically significant predictors of modern contraception use. Women who were uneducated, had fewer than five living children, desired more children, lived in the poorest households and lived in rural areas were significantly less likely to use modern contraception. CONCLUSIONS: Modern contraception use is low among married women in Yemen. Some individual-level, household-level and community-level predictors of modern contraception use were identified. Implementing targeted interventions, such as health education on sexual and reproductive health, specifically focusing on older, uneducated, rural women, as well as women from the lowest socioeconomic strata, in conjunction with expanding availability and access to modern contraceptive methods, may yield positive outcomes in terms of promoting the utilisation of modern contraception.

Exclusive breastfeeding among beneficiaries of a nutrition enhancement programme and its associated factors in Ghana.

INTRODUCTION: Despite the gains on exclusive breastfeeding (EBF), recent nationwide surveys have consistently revealed a decline in EBF rates in Ghana. The World Food Programme implemented an intervention for Enhanced Nutrition and Value Chain (ENVAC) which was based on three pillars including pregnant women, lactating women, adolescent and children under two years old being beneficiaries of the third pillar since the first 1000 days are critical for averting malnutrition. The social behavior change communication (SBCC) interventions implemented as part of this project have a potential to increase EBF among beneficiaries but this has not been measured. Therefore, this study assessed the prevalence of EBF practice among mothers with children under two years old who were beneficiaries of the ENVAC project and its associated factors in northern Ghana. METHODS: This was a cross-sectional study involving 339 mother-child pairs in two districts of the northern region of Ghana. Participants were mother-child pairs who benefitted from the ENVAC project, which used SBCC strategies to promote good feeding and care practices as well as address other causes of malnutrition during antenatal care and child welfare clinic services among pregnant women, lactating mothers, and children under two years. We used WHO standard questionnaire to assess breastfeeding practices. Factors associated with EBF were modelled using multivariable logistic regression. RESULTS: Exclusive breastfeeding was 74.6% (95%CI = 69.5% -79.2%) in the ENVAC project areas, a 31.7% points higher than recent national levels. Adjusted analyses showed that EBF practice was associated with increasing maternal education: moderately educated women [aOR = 4.1 (95% CI = 2.17-7.66), P<0.001], and high [aOR = 9.15, (95% CI = 3.3-25.36), P<0.001], and access to pipe-borne water in households [aOR = 2.87, (95% CI = 1.11-7.43), P = 0.029]. CONCLUSION: A social behaviour change communication strategy implemented by ENVAC to lactating mothers likely improved exclusive breastfeeding practice in two districts of northern Ghana. EBF practices were higher among beneficiaries with high education and households with access to pipe-borne water. A combination of SBCC strategies and maternal and household factors are likely the best way to increase EBF rates in impoverished communities and warrants further investigation through future research.

Risk of adverse newborn outcomes among women who experienced physical and psychological intimate partner abuse during pregnancy in Ghana's northern region.

Background: Intimate partner violence (IPV) is common worldwide. However, the health effects of exposure to IPV during pregnancy are significantly more severe. We investigated the relationship between exposure to IPV during pregnancy and the risk of preterm and low birthweight births among women in Ghana's northern region. Methods: We recruited 402 postnatal women aged 15-49 years from five selected public health facilities in the Tamale Metropolis of the northern region of Ghana. Using Kobo Collect, information on a wide range of factors, including exposure to IPV during the last pregnancy and pregnancy outcomes, was collected electronically. Multiple logistic regression analyses were conducted in Stata to determine the associations between prenatal exposure to IPV and binary measures of gestational age at birth and birthweight. Results: Overall, 35.1% (95% CI: 30.5, 39.9) of the respondents experienced IPV during their recent pregnancy; 6.7% (95% CI: 4.6, 9.6) experienced physical IPV; and 34.8% (95% CI: 30.3, 39.6) experienced psychological IPV. The prevalence of preterm and low birthweight deliveries was 18.9% (95% CI: 15.4, 23.1) and 9.0% (95% CI: 6.5, 12.2), respectively. Prenatal exposure to IPV was linked to poor newborn outcomes by multivariable binary regression models. Women who suffered IPV during their last pregnancy were three times more likely to deliver low birthweight babies (AOR = 3.12: 95% CI: 1.42, 6.84). Exposed women were also about twice as likely to deliver prematurely, although this association was not statistically significant (AOR = 1.81; 95% CI: 0.97, 3.38). Conclusion: Exposure to IPV during pregnancy increases a woman's risk of delivering prematurely and having a low birthweight baby. IPV screening should be a regular part of ANC, so that pregnant women who are experiencing IPV can be monitored and supported to avoid adverse outcomes for their babies.

Factors associated with anaemia in pregnancy: A retrospective cross-sectional study in the Bolgatanga Municipality, northern Ghana.

BACKGROUND: Anaemia in pregnancy (AIP) remains a severe public health problem associated with adverse outcomes. This study assessed haemoglobin levels and the prevalence of anaemia during antenatal care (ANC) registration, at 28 weeks and 36 weeks of gestation as well as the factors associated with AIP at the different stages of pregnancy. METHODS: A retrospective cross-sectional design was implemented. Using ANC registers as the sampling frame, 372 pregnant women, within 36 and 40 weeks of gestation were randomly sampled from 28 health facilities for the study. The participants were all receiving ANC in the Bolgatanga Municipality. Data were collected via clinical records review and a questionnaire-based survey between October and November, 2020. Using the Statistical Package for the Social Sciences (SPSS), descriptive analysis of haemoglobin levels and the prevalence of anaemia were performed. In addition, binary logistic regression was used to identify the factors associated with anaemia in pregnancy. AIP was determined using the national practice of 11.0g/dl haemoglobin cut-off point and the World Health Organisation's recommended adjustment for the 2nd trimester of pregnancy was made using the cut-off of 10.5g/dl to account for the effect of haemodilution. RESULTS: At booking, AIP prevalence was 35.8% (95%CI:30.9, 40.9) using a cut-off of 11.0g/dl and 25.3% (95%CI:20.9, 30.0) using a cut-off of 10.5g/dl for those in the 2nd trimester. At 28 weeks, AIP prevalence was 53.1% (95%CI:45.8, 60.3) and 37.5 (95%CI:30.6, 44.8) using a cut-off of 11.0g/dl and 10.5g/dl for those in the 2nd trimester, respectively. At 36 weeks, AIP prevalence was 44.8% (95%CI:39.2, 50.4) using a cut-off of 11.0g/dl. At p<0.05, registering after the first trimester (AOR = 1.87, 95%CI: 1.17, 2.98, P = 0.009) and at a regional hospital (AOR = 2.25, 95%CI: 1.02, 4.98, P = 0.044) were associated with increased odds of AIP but registering at a private hospital (AOR = 0.32, 95%CI: 0.11, 0.92, P = 0.035) was associated with decreased odds of AIP at booking. At 28 weeks, age group 26-35 years (AOR = 0.46, 95%CI: 0.21, 0.98, P = 0.044), Christianity (AOR = 0.32, 95%CI: 0.31, 0.89, P = 0.028.), high wealth (AOR = 0.27, 95%CI: 0.09, 0.83, P = 0.022) and tertiary education (AOR = 0.09, 95%CI:0.02, 0.54, P = 0.009) were associated with decreased odds of AIP. At 36 weeks, booking after first trimester of pregnancy was associated with increased odds (AOR = 1.72, 95%CI: 1.05, 2.84, P = 0.033) whilst high wealth (AOR = 0.44, 95%CI: 0.20, 0.99, P = 0.049), higher age groups-26-35 (AOR = 0.38, 95%CI: 0.21, 0.68, P = 0.001) and 36-49 years (AOR = 0.35, 95%CI: 0.13, 0.90, P = 0.024) and secondary education of spouse were associated with reduced odds (AOR = 0.35, 95%CI: 0.14, 0.88, P = 0.026) of AIP. CONCLUSION: AIP consistently increased from registration to 36 weeks of gestation. Given the observed correlates of AIP, we recommend that interventions geared towards early ANC registration, improved household wealth, and improved maternal education are required to reduce AIP.

A qualitative study of health workers' perspectives on malaria case identification and management among pregnant women in Savelugu Municipality, Ghana.

Despite successes in malaria control interventions over the past two decades, malaria remains a major public health concern. Over 125 million women live in endemic areas and experience adverse pregnancy outcomes due to malaria. Understanding health workers' perspectives on malaria identification and management is important to informing policy changes on the control and eradication of the disease. This study explored the perspectives of health workers on malaria case identification and management among pregnant women in Savelugu Municipality, Ghana. A qualitative study with a phenomenology design was conducted among participants. Participants were purposively selected and interviewed using a semi-structured interview guide. Thematic analysis was performed and the results were presented as themes and sub-themes. Four themes and eight sub-themes regarding case identification and management of malaria in pregnancy were identified including malaria case identification training (trained and untrained), identification approach (signs/symptoms and routine laboratory test), diagnostic tools (rapid diagnostic test and microscopy) and management options. It revealed that attending malaria training programs was generally optional. Some of the participants had not undergone any refresher training for malaria identification after their formal training at health institutions. Participants identified malaria by its signs and symptoms. However, they often referred clients for routine laboratory tests for confirmation. When malaria is confirmed in pregnancy, quinine is used for first trimester treatment, while Artemisinin-based Combination Therapies are prescribed after the first trimester. Clindamycin was not used in the first trimester treatment. This study found that training programs were optional for health workers. Some participants have not received refresher training after graduating from health institutions. Treatment of confirmed cases did not include clindamycin for first trimester malaria infections. Malaria refresher training programs should be made mandatory for health workers. Every suspected case should be confirmed using Rapid Diagnostic Test or microscopy before treatment.

Caregivers' use of insecticide-treated nets is associated with the use of ITNs by children under the age of five in Ghana.

BACKGROUND: Malaria poses a greater risk to children under the age of five years due to its high morbidity and mortality rates. The use of Insecticide-Treated Net (ITN) has been proven to be an effective preventive intervention in the control of malaria. However, its utilisation remains low. This study assessed the association of mother or caregiver's utilisation of ITN on its use by their children under five years of age in Ghana. METHODS: This study used data from the 2019 Ghana Malaria Indicator Survey (GMIS). The study analysed a weighted sample of 1,876 women aged 15-49 years who had at least one child under the age of five. In this study, the outcome variable is mosquito bed net use in children under five years. We performed descriptive statistics, chi-square tests, and multinomial logistic regressions. RESULTS: Of the women studied, 58.59% [95% CI: 55.39, 61.71] slept under mosquito bed nets the previous night. The utilisation of ITN in children under five was 61.88% [95% CI: 58.43, 65.2] on the night before the study. The adjusted logistic regression revealed that mothers/caregivers who slept under a mosquito bed net were more likely to have their children under five years of age sleeping under a mosquito bed net (RRR = 2.47, 95% CI: 1.48, 4.12; p <0.001). In addition, the use of ITN in children under five was also found to be predicted by the number of ANC visits, the number of children under five in the household, and wealth status. CONCLUSION: The study found that the use of ITN by mothers/caregivers and their children remains low in Ghana. Nevertheless, we found that when a mother uses ITN, her children under the age of five are more likely to use it as well.

Bacterial infections epidemiology and factors associated with multidrug resistance in the northern region of Ghana.

Bacterial infections caused by multidrug resistant organisms are a major global threat. There is still a knowledge gap on this situation in the Northern Region of Ghana. This study determined the prevalence and resistance profile of bacterial infections. It also identified factors associated with multidrug resistance in the study area. This was a retrospective cross-sectional design and it analyzed data from the samples received at the Tamale Zonal Public Health Reference Laboratory from June 2018 to May 2022. The data were analyzed using the R software version 4.2.0. Univariate and multivariable binary logistic regression analyses were used to determine the factors associated with multidrug resistance. The samples included all specimen types possible. The specimens were collected for the purpose of clinical bacteriology diagnostics. Overall a total of 1222 isolates were obtained. The three (3) main bacteria responsible for infections were: Klebsiella spp. (27%), Moraxella spp. (22%), Escherichia spp. (16%). High resistance levels were found against the tested antibiotics and about 41.60% of the bacterial strains isolated were multidrug resistant. Hospitalization was associated with multidrug resistance in univariate (COR 1.96; 95% CI 1.43-2.71; P-value < 0.001) and multivariable analyses (AOR 1.78; 95% CI 1.28-2.49; P-value < 0.001). There is the need for further research on the molecular epidemiology of antibiotic resistance genes in the study area to effectively control the spread of multidrug resistant pathogens. In addition, efforts to build the capacity of health professionals on infection prevention and control as well as diagnostic and antimicrobial stewardship needs urgent attention.

Utilisation of antenatal care and skilled delivery services among mothers in Nanton District of Northern Ghana: a mixed-method study protocol.

INTRODUCTION: Maternal morbidity and mortality are a global phenomenon with devastating effects on low-income and middle-income countries among which sub-Saharan Africa (SSA) is the hardest hit. Low utilisation of maternal health services has been recorded in recent times in the Nanton District of Ghana. This has raised concerns about the utilisation of antenatal care (ANC) and skilled delivery (SD) services in the district. However, we found no specific existing literature which has addressed these questions on ANC and SD utilisation in the study setting. Thus, this study seeks to explore the utilisation of ANC and SD services among mothers in the Nanton District of Northern Ghana. METHODS AND ANALYSIS: This will be an observational study. It will use a mixed-method approach, particularly, convergent parallel design to implement the study. This will include quantitative and qualitative aspects using a questionnaire and focus group discussion guide. The planned sample size is 411 participants. The data will be collected at the communities. Before participation in the study, the research team will receive individual written consent from the participants. Descriptive and inferential data analysis will be performed after the data collection. The results will be presented as frequency tables, bar charts and line graphs to indicate the proportions of the outcome indicators. The strength of association among variables will be determined at 95% CI and a significance level of alpha (0.05) will be used. ETHICS AND DISSEMINATION: Ethical clearance has been sought from the Ghana Health Service Ethics Review Board (GHS-ERC 027/03/22). The outcomes from this study may serve as a reference document for the District Health Directorate to use when developing strategies for ANC and SD services. The results will be published in open access and peer-reviewed journals.