Challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana.

INTRODUCTION: Cervical cancer is one of the causes of female deaths worldwide. Cervical cancer incidence is rising with almost three thousand (2797) women in Ghana being diagnosed with the condition each year, with almost two thousand (1,699) of them dying from its complications Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation, the burden of care, patients' suffering and the alarming number of deaths associated with it. Improving positive patient outcomes require identifying the challenges and support systems available to nursing staff so as to harness these support systems for improving care outcomes. AIM: This study explored the challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana. METHOD: In this study, we adopted an exploratory qualitative design. The study was conducted among eleven (11) nurses and nine (9) midwives engaged at the national referral hospital in Ghana who were providing care for patients with advanced cervical cancer for over a year who were purposively sampled. The data was collected using in-depth interviews with a pre-tested semi-structure interview guide from the twenty participants. We recorded the interviews using an audio-tape. The audio files were transcribed verbatim and thematic analysis was undertaken with the aid of Nvivo 10.0. RESULTS: The challenges when rendering nursing care faced by participants of this study were exposure to frequent deaths, inadequate resources, and workload. Most participants lamented that they received absolutely no support from their workplace, hence their only form of support was from their family and friends. They also added that most of them were general nurses and midwives with no special training in oncology nursing or palliative nursing. CONCLUSION: Nurses and midwives experience resource, knowledge and skill challenges when caring for patients with advanced cervical cancer. However, the nurses and midwives had emotional attachment to their jobs and their patients and were not distracted by their bad experiences. We recommend improving resource allocation for cervical cancer care through the National Health Insurance Authority (NHIA), Ghana and increased training of nurses in oncology and palliative nursing by the Ministry of Health, Ghana to improve knowledge and skills of the nurses and midwives caring for women with advanced cervical cancer to improve their quality of care. Further, hospitals must make it a priority to have more nurses and midwives trained in oncology and end of life care to improve the knowledge and skills of nurses and midwives caring for advanced cervical cancer patients. Also, these findings should trigger policy-level discussions at the Ministry of Health, Ghana on the training of specialized nurses and midwives in cancer and end of life care to help Ghana meet the sustainable development goal targets related to health.

The relationship between trust, belief and adherence among patients who complain of hypertension in Ghana.

AIM: We determined the relationship between trust, belief and adherence among patients who complain of hypertension in Ghana. DESIGN: A cross-sectional design was used. METHOD: We sampled 447 Ghanaians with hypertension receiving care at the Korle Bu Teaching Hospital. Data were collected using a pre-tested self-administered questionnaire. Data analyses were conducted with the aid of Stata 15.0. RESULTS: There is low belief and trust in the biomedical treatment for hypertension. Only 36.9% of the respondents said they adhered to treatment with females expressing higher level of adherence. Trust and belief in allopathic care were associated with adherence to treatment. It is recommended that health workers identify effective ways of improving patients' trust in the allopathic care for hypertension through teaching and re-enforcement models to enhance treatment adherence and reduce the complications of hypertension. Patient or Public Contribution.

Exploring social media adoption by nurses for nursing practice in rural Volta, Ghana.

AIM: The purpose of the study was to inquire into social media adoption by nurses for nursing practice. DESIGN: An exploratory descriptive qualitative design was employed in understanding social media adoption for nursing care among nurses. METHOD: A purposive sampling technique was employed to recruit 12 participants for the study. A semi-structured interview guide was used to conduct in-depth interviews which were audiotaped, transcribed verbatim, coded and analysed. Thematic analysis was used to analyse the data with NVivo 12. RESULTS: The findings revealed nurses found social media to be useful for the dissemination, and reception of information, professional development and enhanced referral networks. Apart from its usefulness, participants believe that it is easy to navigate its apps, clear and understandable to use and does not involve much mental effort hence their favourable attitude towards use. Some participants also believe that inaccurate information, privacy and confidentiality concerns, distraction and addiction were some potential risks that are associated with its usage in nursing practice. Due to this, some participants developed a negative attitude towards its usage. PATIENT OR PUBLIC CONTRIBUTION: Twelve nurses actively participated in the study.

Challenges and coping strategies of nurses and midwives after maternity leave: A cross-sectional study in a human resource-constrained setting in Ghana.

AIM: This study examined the challenges and coping strategies adopted by nurses and midwives after child birth when they return to work. DESIGN: A cross-sectional design was used. METHOD: Two hundred nurses and midwives with history of maternity leave were recruited from the Korle-Bu Teaching Hospital to take part in this study. Data were collected using a pre-tested self-administered questionnaire. The data were analysed with the aid of Stata 13.0. RESULTS: Most of the respondents claimed that they received support from relatives, day care centres and paid house helps while they resumed work. Seventy percent of the respondents indicated that they were given off day when they needed to send their child for postnatal care. Nurses and midwives depend on family members, paid house helps and day care centres to help them cater for their babies. It is recommended that hospitals set-up day care centres and breastfeeding bays attached to the institutions.

Burnout and allostatic load among health workers engaged in human resourced-constrained hospitals in Accra, Ghana.

BACKGROUND: Burnout syndrome is a psycho-social disorder which develops in an individual exposed to chronic stress on the job. Health workers in sub-Saharan Africa (SSA) are at increased risk of burnout due to job-related challenges. Burnout does not only affect the job performance of employees, but could result in dysregulation of multiple physiological systems (allostatic load) in victims and predispose them to non-communicable diseases (NCDs). This study examined the association between burnout and allostatic load among health workers engaged in human resourced-constrained hospitals in Accra, Ghana. METHOD: This study was a hospital-based cross-sectional study involving 1264 health workers (clinicians and non-clinicians) from three public hospitals in Accra, Ghana who were recruited using a proportionate stratified random sampling technique. The participants completed a questionnaire which collected general and burnout information. In addition, each participant's anthropometric; biochemical and hemodynamic indices were measured. The allostatic load in the participants was determined using eleven (11) biomarkers from the neuro-endocrine, cardiovascular, metabolic and anthropometric measures. The relationship between burnout and allostatic overload (high allostatic load) was determined at the bivariate and multivariable levels. The data analysis was done with the aid of Stata 15.0 at a 95% confidence level. RESULTS: The prevalence of burnout was 20.57%, higher in non-clinicians than clinicians (26.74% vs 15.64, p <  0.001). Also, non-clinical participants had higher levels of emotional exhaustion and depersonalization than the clinical participants. Over a quarter (26.27%) of the participants had allostatic overload manifesting as high allostatic load. Furthermore, for a one unit increase in overall burnout, the odds of experiencing allostatic overload was increased by 17.59 times (AOR = 17.59, 95% CI: 11.7-26.4) as compared to those without burnout and similar findings were found for the individual components of burnout syndrome with high allostatic load. CONCLUSION: Burnout among health workers is associated with multi-system physiological dysregulation manifesting as high allostatic load; a major risk factor for NCDs. It is recommended that measures aimed at reducing burnout and allostatic overload such as structured psychological counseling and healthy lifestyle patterns are recommended for health workers engaged in stressful work settings to reduce their risk of NCDs.

Burnout syndrome among healthcare workers during COVID-19 Pandemic in Accra, Ghana.

BACKGROUND: The emergence of the corona virus disease 2019 (COVID-19) has increased the workload of health workers particularly those in sub-Saharan Africa predisposing them to extra job-related stress and its associated job-related burnout. Burnout reduces the number, distribution and productivity of health workers. This study sought to determine personal and job-related characteristics of health workers in Accra, Ghana that influenced their experience of burnout during the COVID-19 pandemic. METHOD: A cross-sectional study was conducted among 1,264 health workers recruited from three public hospitals in Accra, Ghana between March to November, 2020. The participants were recruited using a proportionate stratified sampling technique and completed a pre-tested questionnaire that collected information on socio-demographic and job-related factors. Also, the questionnaire assessed participants' level of resilience and job-related burnout. Pearson's chi-square test was used to determine the association between burnout and the socio-demographic as well as job-related factors. However, for variables with observations less than six, a Fisher's exact test, was used to determine the associations. After the binary analysis, multivariate logistic regressions were used to determine the strength of association between the socio-demographic as well as job-related factors and burnout. Data analyses were conducted at a significant level (alpha 0.05) and power of 95% confidence with the aid of Stata 15.0. RESULTS: The prevalence of burnout among the participants was 20.57% with non-clinicians displaying higher burnout compared to clinicians (26.74&% v 15.64%, p< 0.001). Health workers with 1-5 years working experience were 26.81 more likely to experience burnout (AOR = 26.81, CI = 6.37-112.9). Night shifts defined as shifts between 8:00pm to 8:00am was associated with the 1.86 odds of experiencing burnout (OR = 1.86; 95% CI: 1.33-2.61; p<0.001). Also, participants of the primary level facility were 3.91 times more likely (AOR = 3.91, 95% CI = 2.39-6.41) to experience burnout on the job. Similarly, participants with additional jobs were 1.14 times more likely (AOR = 1.14, 95% CI = 0.75-1.74) to experience burnout. In addition, participants harboring intentions of leaving their current jobs were 4.61 times more likely (AOR = 4.61, 95% CI = 2.73-7.78) to experience burnout. Furthermore, participants with perceived high workload were 2.38 times more likely (AOR = 2.38, 95% CI = 1.40-4.05) to experience burnt-out on the job. CONCLUSION: There is high prevalence of burnout among health workers in Accra particularly during the onslaught of the COVID-19 pandemic. Working on night shifts and at the primary level of healthcare is significantly associated with increased odds of experiencing burnout.We recommend shift rotation for staff and adequate resource provision for primary level hospitals. The high burnout in this study could be influenced by other factors such as the grief caused by multiple losses and also the limited supportive resources for health workers.

Factors associated with pregnancy uptake decisions among seropositive HIV people receiving antiretroviral therapy in sub-Saharan Africa: A systematic review.

AIM: This study determined the factors associated with pregnancy uptake decision among seropositive HIV people receiving antiretroviral therapy in sub-Saharan Africa. DESIGN: Systematic review. METHODS: The population, intervention, comparison and outcomes framework was adopted to search for literature after a scoping review using the preferred reporting items for systematic reviews and meta-analyses guidelines adopted in searching, and screening articles from four databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Google scholar) to find 12 articles suitable for this study. RESULTS: Motivators of pregnancy uptake among HIV-positive women include desire to have children, knowledge about PMTCT, cultural duty for married women to have children, and household income. Demotivating factors included the modern method of contraception and burden associated with pregnancy. CONCLUSION: There is a need to improve on services that reduce conception-related risks especially for women who choose to conceive and to incorporate fertility-related counselling into HIV treatment services.

The Nurse or Midwife at the Crossroads of Caring for Patients With Suicidal and Rigid Religious Ideations in Africa.

Nurses and midwives are the majority of healthcare professionals globally, including Africa, and they provide care at all levels of the health system including community levels. Nurses and midwives contribute to the care of patients with rigid or dogmatic religious beliefs or those with suicidal ideations. This review paper discusses acute and chronic diseases that have suicidal tendencies such as terminal cancer, diseases with excruciating pain, physical disability, stroke, end-stage renal failure, and diabetics who are amputated. It was reiterated that nurses and midwives taking care of these patients should be alert and observant to identify their suicidal tendencies. The paper also discusses religious or spiritual inclinations that negatively affect healthcare access and adherence, especially to biomedical or western medicine. It was emphasized that some religious beliefs do not allow their followers to employ biomedical treatment and nurses and midwives should not impose their faith on patients and their families. The paper ends with a discussion on the specific roles of nurses and midwives in the care of patients with suicidal ideations such as assessment, counseling, administering medication, observation, social interaction, ensuring safety measures, and providing an enabling environment for the family to part of the care and for the observation of religious coping strategies. Nurses and midwives should enhance their knowledge and skills on suicide and increase public education on suicide prevention and identification of those at risk.

Influence of nurse-patient relationship on hospital attendance. A qualitative study of patients in the Kwahu Government Hospital, Ghana.

BACKGROUND: The relationship of nurses and patients in healthcare settings has been central in ensuring good and efficient healthcare delivery. The total hospital attendance in the Kwahu Government Hospital have reduced in recent years. The study explored patients' perceptions of the nurse-patient relationship and its influence on hospital attendance at the Kwahu Government Hospital. METHODS: A phenomenological qualitative study design, with a purposive sampling technique, was used to interview ten participants from the various wards in the hospital on their perceptions of the nurse patient relationship and its influence on hospital attendance. The data were transcribed and analysed using a thematic content analysis approach that embraces three interrelated stages, namely data reduction, data display, and data conclusion drawing. RESULTS: Many of the participants had positive perceptions regarding the attitude of nurses, and that influenced hospital attendance while others opined that nurses' attitudes towards them made them attend a private facility. Almost all the participants suggested that patients should exhibit an equally good attitude and behaviour towards nurses, and better communication between patients and nurses as vital ways of improving the nurse-patient relationship. Nurses in the Kwahu Government Hospital are described as friendly, respectful and attend promptly to patient health care needs adequately. The range of perceived respect differed from patient to patient and include the nurse called patient by name, respond promptly to patient needs, helped "helpless patients" to feed and also assisted them change diapers, listen to patient concerns, linked patient to other professionals, work within the cultural context of hierarchy and that the nurse is sociable and interacted with patient positively. CONCLUSION: Hospital management should conduct regular evaluations of patients' experiences as well as nurses' experiences to address deficiencies in communication and nurse-patient interactions.

Factors influencing the utilization of Focused antenatal care services during pregnancy, a study among postnatal women in a tertiary healthcare facility, Ghana.

Aim: To assess the factors that influence the utilization of FANC services among pregnant women. Methodology: A cross-sectional quantitative study conducted among 210 postnatal women in Ho Teaching Hospital. Data were entered into Microsoft excel, cleaned and transported to SPSS and analysed. Cross tabulations were used to explore associations between variables. Results: The respondents indicated that FANC would enable them to receive comprehensive ANC (74.8%). Higher parity was significantly associated with low utilization of FANC (p = .028). Long distance to the health facility, seeking permission to use FANC was significantly associated with low utilization of FANC (p < .001). Fear associated with witchcraft was associated with low FANC utilization (p < .001).

Prevalence and Pattern of Road Traffic Accidents among Commercial Motorcyclists in the Central Tongu District, Ghana.

BACKGROUND: The World Health Organisation estimates that 1.35 million people die as a result of road traffic crashes. Motorcycles as a means of transport are increasingly becoming the preferred and easiest means of transportation for most people in developing countries despite the associated risk. This study determined the prevalence and pattern of motorcycle crashes in Adidome among commercial motorcyclists. METHODS: A descriptive, cross-sectional study design was used as 114 commercial motorcyclists were recruited to respond to a pretested research questionnaire in the Adidome district of the Volta Region. Data were analyzed using SPSS, version 22.0. Data were presented as simple descriptive statistics. A chi-square relationship was determined using the demographic variables, and the history of accident at a 95% confidence interval with 0.05 was considered as statistically significant. RESULTS: The prevalence of road traffic crashes at Adidome was 64.0%. Motorcyclists (74.0%) were reported to have been involved in crashes in the past one year prior to the study. Motorcyclists attributed the last accident to excessive speeding (31.5%) and bad roads (23.3%), this accident as a result of colliding with another motorcycle (50.7%), and slippery surfaces (24.7%). The majority (63.0%) of the respondents had an accident once. The consumption of alcohol was associated with the occurrence of an accident as 34.2% occurred among cyclists who drank alcohol, compared with 29.8% who did not (p < 0.05). CONCLUSION: There should be strict implementation of current road traffic regulations of Ghana by the MTTD of the Ghana Police Service, and penalties should be awarded against anybody caught riding a motorcycle under the influence of alcohol. Helmet and other protective devices must be made compulsory for motorcycle riders to prevent injuries, especially head injuries, if an accident occurs.

Practice and Sociodemographic Factors Influencing Self-Monitoring of Blood Pressure in Ghanaians with Hypertension.

BACKGROUND: In sub-Saharan Africa, the prevalence of hypertension has assumed epidemic levels and currently accounts for numerous complications such as stroke, heart failure, and kidney damage. Management of hypertension involves both drug and nonpharmacological approaches. Self-monitoring of blood pressure is an important nonpharmacological approach that facilitates early detection of deteriorating blood pressures and complications. AIMS: We determined the practice and sociodemographic factors influencing self-monitoring of blood pressure among Ghanaians with hypertension. METHODS: In a cross-sectional design, we recruited four hundred and forty-seven (447) Ghanaians with hypertension receiving care at the hypertensive Outpatient Department (OPD) Clinics of the Medical Department at the Korle-Bu Teaching Hospital (KBTH). The respondents were sampled using a simple random sampling technique of balloting without replacement. A structured questionnaire was used to gather data on the practice of self-monitoring of blood pressure and sociodemographic factors influencing self-monitoring in the respondents. We also measured some anthropometric and haemodynamic indices of the respondents. The data was entered in Microsoft Excel 2010 and exported into SPSS 21.0 to aid with the data analysis. A chi-square test and Student's t-test analysis were done to determine the relationship between the practice of self-monitioring and other sociodemographic variables. Data analayses were conducted at a significant level (alpha 0.05) and power of 95% confidence. Thus, p < 0.05 was considered statistically significant. RESULTS: The practice of self-monitoring of blood pressure was 25.3% with more female respondents claiming to practice self-monitoring as compared to their male counterparts (28.6% vs. 20.7%). Awareness of self-monitoring of blood pressure was associated with increased practice of self-monitoring of blood pressure. Health workers (46.8%), colleague patients (39.8%), relatives/spouses (6.7%), and the media (6.7%) were identified as the sources of information about self-monitoring of blood pressure. Awareness of self-monitoring, level of education, valid health insurance, occupation, income levels, and marital status had a significant relationship with self-monitoring of blood pressure among the respondents. Thus, respondents with higher education, awareness of self-monitoring, valid health insurance, formal employment, and higher income were likely to monitor their blood pressure. CONCLUSION: Several sociodemographic factors influence the practice of self-monitoring of blood pressure in Ghanaians with hypertension. Thus, targeted hypertension education and social-cognitive interventions should focus on these sociodemographic factors so as to improve self-monitoring of blood pressure in order to reduce the complications of hypertension.

Practices of Adults in a Periurban Community of the Ho Municipality on Prevention of Hypertension.

BACKGROUND: Hypertension remains a rising health threat among developing countries and it is due to poor knowledge and lifestyles. Integrated knowledge and practices are central towards the control of hypertension, especially in the developing world. OBJECTIVES: This study assessed the practices of adults in a periurban community in the Ho Municipality of the Volta region on the prevention of hypertension. Methodology. A cross-sectional descriptive research design was carried out in a periurban community in the Volta region. Adults were recruited using a systematic sampling technique in the Ahoe community. Pretested questionnaires were used to collect information on sociodemographic, knowledge, and lifestyle practices regarding hypertension prevention. The data were entered into Microsoft excel 2013 spreadsheet, cleaned, and transported to the Statistical Package for Social Sciences (SPSS) version 22 software for analyses. The data were analysed using simple descriptive statistics. RESULTS: In this study, 49.3% explained that hypertension means the increased force of blood through the blood vessels as 90.8% indicated that taking antihypertensive medications can control hypertension. In describing the associated effects of hypertension, adults in the Ahoe community described the effects of hypertension as stroke (89.8%), heart attack (84.0%), diabetes (56.5%), and heart failure (82.3%). Also, 54.1% described hypertension as a lifelong disease while 55.8% indicated hypertension can be cured. Also, 92.2% identified exercising as an important factor in controlling hypertension as 32.7% use herbal preparations to control hypertension. Only 3.7% of adults in the Ahoe community were smokers and 54.5% smoked less than a year. The majority (61.6%) of the respondents did not drink alcohol as 69.7% engage in active exercises. CONCLUSION: Education on hypertension should be intensified, and emphasis should be laid on regular exercised and strict dietary restrictions that ensure reduction in hypertension risk. Healthcare authorities should engage hypertensive clients to desist from the intake of herbal medications whose actual composition has not been scientifically determined.

Practices of pica among pregnant women in a tertiary healthcare facility in Ghana.

Aim: This study assessed the practice of pica among pregnant women in the Ho Teaching Hospital. Design: Descriptive cross-sectional. Methods: Systematic sampling technique was used to recruit 286 pregnant women. Questionnaire was used to collect data. Data entered into Statistical Package for Social Sciences for analysis. Result: Of the 286 pregnant women, 21.2% and 17.8% considered white clay and ice respectively as nutritious. Prevalence of pica was 47.5%, while 44.9% of pregnant women who practised pica reported they feel uncomfortable when they do not eat pica as 63.3% considered intake of pica as harmful. Among women who received education against pica practice, 49.4% have ever taken pica as 50.9% of them with education on effects of pica were currently engaged in the activity (χ2 = 1.93 p = .17). Conclusion: Health professionals, especially midwives must intensify education on effects of pica among pregnant women.

Expectation and Satisfaction with Nursing Care among Hypertensives Receiving Care at a Resource-Constrained Hospital in Ghana.

BACKGROUND: Hypertension accounts for a third of the global preventable premature deaths. In Sub-Saharan Africa, hypertension is the most rapidly increasing cardiovascular disease (CVD) and the second leading cause of death. Proper management of hypertension requires adherence to management by patients and this is partly possible if patients feel satisfied with the nursing care they receive. Satisfaction with nursing care is only possible if there is a congruence between the expectations of care and the actual care received from nurses. AIM: We explored the expectations and satisfaction of Ghanaian hypertensives with nursing care received at the Korle-Bu Teaching Hospital (KBTH). METHODS: In this qualitative study, a phenomenological approach was used to gather data about the lived experiences of patients with hypertension about nursing care. In-depth interviews (IDIs) were conducted among sixteen (16) patients with hypertension from the hypertensive Out-Patient Department (OPD) Clinics of the Medical Department at the KBTH. Only patients with history of previous admission(s) at the KBTH during the immediate past six months were purposively recruited. The respondents were interviewed about the nursing care received during their immediate past admission(s) at the KBTH using an IDI-guide. The IDIs were recorded digitally, transcribed verbatim, and reviewed severally and thematic analysis was done. Nvivo 11 software was used to manage the data and aid with the thematic analysis. RESULTS: The results of this study showed that Ghanaian hypertensive patients perceived nurses as key players in the management of patients. On the respondents' expectations from nurses prior to their immediate past admissions at the KBTH, the data revealed the responsiveness of nurses to patient needs, prompt pain management, high confidentiality level of nurses, rendering of efficient health education, maintenance of therapeutic work environment, and ensuring effective communication as well as professional/ethical practice from the nurses. On the question of what made nursing care satisfying, it was observed from the respondents that they considered the competence of nurses, maintenance of therapeutic environment, and also effective handling of confidential information as determinants of their satisfaction with nursing care. Further, the respondents identified some key areas of dissatisfaction and these included the responsiveness of nurses to patient needs, prompt pain management, effectiveness of health education, and provision of culturally sensitive communication. Disproportionate distribution of nursing staff across the three nursing shifts, unethical practice among some nurses, inadequate resources for work, and low work morale of some nurses were identified as factors responsible for the gaps between patient expectations and actual care received. CONCLUSION: Our study concludes that continuous professional development programs for nurses should focus on the areas of dissatisfaction so as to improve care for hypertensives. We also recommend that nursing staff distribution across the various shifts should be of keen interest to nurse managers if hypertension care in particular and overall patient care in general are to improve.

Awareness and Malaria Prevention Practices in a Rural Community in the Ho Municipality, Ghana.

BACKGROUND: Malaria is no doubt a burden on both the financial and human resources of Ghana. In this study, we examined the awareness of malaria prevention practices among indigenes of Godokpe, a rural community in the Ho Municipality of Ghana. METHODS: This descriptive cross-sectional survey that used a self-developed questionnaire recruited 246 residents of Godokpe who were aged 18 years and above using a systematic sampling technique. The Statistical Package for Social Sciences (SPSS) was used to analyze data into descriptive and analytical statistics. The descriptive statistics comprised frequency, percentage, and means. Also, analytical statistics of cross tabulation was conducted considering a p<0.05 at a 95% Confidence Interval to be statistically significant. FINDINGS: About 54% and 20% of the respondents, respectively, had satisfactory and good levels of knowledge on malaria prevention. The methods used in malaria prevention included mosquito coils (72%), cleaning and prevention of water stagnation (62%), mosquito spray (54%), and mosquito net (59%). Also, malaria treatment methods mostly used were quinine (70%) and chloroquine (50.4%). The major sources of information on malaria were television (74%), health professionals (66%), schools (62%), family/friends (60%), and the Internet (51%). CONCLUSION: School children showed good understanding of malaria and its vectors. There is, therefore, the need to increase the empowerment of teachers with appropriate health information including malaria so that they can continue to deliver malaria information to the pupils.