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.

Modeling the impact of early interventions on the transmission dynamics of coronavirus infection.

A deterministic model is proposed to describe the transmission dynamics of coronavirus infection with early interventions. Epidemiological studies have employed modeling to unravel knowledge that transformed the lives of families, communities, nations and the entire globe. The study established the stability of both disease free and endemic equilibria. Stability occurs when the reproduction number, R0, is less than unity for both disease free and endemic equilibrium points. The global stability of the disease-free equilibrium point of the model is established whenever the basic reproduction number R0 is less than or equal to unity. The reproduction number is also shown to be directly related to the transmission probability (ß), rate at which latently infected individuals join the infected class (δ) and rate of recruitment (Λ). It is inversely related to natural death rate (µ), rate of early treatment (τ 1), rate of hospitalization of infected individuals (θ) and Covid-induced death rate (σ). The analytical results established are confirmed by numerical simulation of the model.

The experiences of nurses and midwives regarding nursing education in Ghana: A qualitative content analysis.

BACKGROUND: The nursing education in Ghana has only witnessed minimal advancement though one of the earliest in Africa. This study aimed to explore nursing education in Ghana at the bachelor degree level in terms of the program's strengths, weaknesses, opportunities, and threats from the perspectives of nurses and midwives. METHODS: A qualitative design based on the content analysis approach was used in this study. We purposefully sampled and interviewed thirty-five nurses and midwives at the Tamale Teaching in Ghana from September 2018 to May 2019. RESULTS: The data analysis revealed five main categories; professionally developed, diverse implementation, insufficient resources, applied opportunities, and threatening policies. The findings highlight the strengths, weaknesses, opportunities, and threats of nursing education at the bachelor degree level in Ghana. CONCLUSION: The nursing education in Ghana has some internal capabilities in the form of strengths and weaknesses, such as the program being professionally regulated and operates on a well-developed curriculum, yet challenged with insufficient faculty and resources. The external opportunities and threats present as global recognition and career opportunities, amidst the proliferation of adjunct nursing programs. Recommendations have been highlighted.

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.

Challenges and facilitators of professional socialization: A systematic review.

AIMS: This current study aimed to present a review of the challenges and facilitators of professional socialization among undergraduate nursing students. DESIGN: Systematic review. METHODS: A literature search was conducted in Embase, Google Scholar, PubMed and Scopus in April and May 2018 for studies published in the English language. Four thousand three hundred fifty-two articles were retrieved. We conducted further screening for full-text articles after discarding duplicates and irrelevant studies. Finally, eight studies were included. The Joanna Briggs appraisal tools were used to appraise and evaluate study quality. The PRISMA guidelines were followed and a narrative synthesis used for data analysis. RESULTS: Challenges and facilitators of professional socialization were identified and categorized into two major themes. Under each theme, results were grouped into three sub-themes: professional, personal and educational challenges/facilitators.

Assessing the impact of an educational intervention program on sexual abstinence based on the health belief model amongst adolescent girls in Northern Ghana, a cluster randomised control trial.

BACKGROUND: Adolescent pregnancy is a worldwide problem because of its health, social, economic and political repercussions on the globe. Even though the rates of adolescent pregnancy have declined over the decade, there is still unacceptably high rates especially in lower and middle-income countries including Ghana. Although the problem has been widely investigated, there is little information on the effectiveness of different methods to improve adolescent sexual abstinence based on theoretical models. This study is aimed to assess an educational intervention program on sexual abstinence based on the Health Belief Model (HBM) among adolescent girls in Northern Ghana. METHODS: A cluster randomized control trial was conducted in Ghana from April to August 2018. Participants within the ages of 13-19 years were enrolled voluntarily from six randomly selected Senior High Schools (3 for intervention and 3 for control). A total of 363 adolescent were enrolled. A self-structured questionnaire was administered to both groups of participants at baseline and endpoint of the study. Control participants received their normal classes whiles the intervention group additionally received comprehensive sexuality education for 1 month. Qualified midwives conducted the health education program. At least two sessions were conducted for each participating class weekly. The lessons focused on perceived susceptibility, perceived severity of adolescent pregnancy, perceived benefits, perceived barriers to adolescent pregnancy prevention, personal and family values, perceived self-efficacy and knowledge of contraceptives. Educational strategies such as discussions, demonstrations, role-play and problem solving techniques were used to deliver the lessons. Sexual abstinence was the outcome variable of the study and it was measured after 3 months of the intervention. Binary logistic regression was used to assess the impact of the intervention on sexual abstinence practice. RESULTS: At baseline, there was no difference between control and intervention groups. The mean score of Knowledge and attitude for control were (58.17 and 139.42) and intervention (60.49 and 141.36) respectively. Abstinence practice was 69.4% for control and 71.6% in the intervention group. However, after the intervention, the mean score of knowledge and attitude for control were (87.58 and 194.12) respectively. Sexual abstinence in the control was 84.4% and intervention was 97.3% respectively. The educational interventions resulted in a significant difference in sexual abstinence between intervention and control groups (OR = 13.89, 95% Confidence Interval (2.46-78.18, P < 0.003). CONCLUSION: Educational intervention, which was guided by HBM, significantly improved sexual abstinence and the knowledge of adolescents on pregnancy prevention among the intervention group. Provision of comprehensive sex education guided by behavioural theories to adolescents at Senior High Schools in Ghana is recommended. TRIAL REGISTRATION: This trial was retrospectively registered in Protocol Registration and Results System (PRS) with trial number NCT03384251 .

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.

Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review.

BACKGROUND: Adolescent pregnancy has been persistently high in sub-Saharan Africa. The objective of this review is to identify factors influencing adolescent pregnancies in sub-Saharan Africa in order to design appropriate intervention program. METHODS: A search in MEDLINE, Scopus, Web of science, and Google Scholar databases with the following keywords: determinants, factors, reasons, sociocultural factors, adolescent pregnancy, unintended pregnancies, and sub- Saharan Africa. Qualitative and cross-sectional studies intended to assess factors influencing adolescent pregnancies as the primary outcome variable in sub- Saharan Africa were included. Our search was limited to, articles published from the year 2000 to 2017 in English. Twenty-four (24) original articles met the inclusion criteria. RESULTS: The study identified Sociocultural, environmental and Economic factors (Peer influence, unwanted sexual advances from adult males, coercive sexual relations, unequal gender power relations, poverty, religion, early marriage, lack of parental counseling and guidance, parental neglect, absence of affordable or free education, lack of comprehensive sexuality education, non-use of contraceptives, male's responsibility to buy condoms, early sexual debut and inappropriate forms of recreation). Individual factors (excessive use of alcohol, substance abuse, educational status, low self-esteem, and inability to resist sexual temptation, curiosity, and cell phone usage). Health service-related factors (cost of contraceptives, Inadequate and unskilled health workers, long waiting time and lack of privacy at clinics, lack of comprehensive sexuality education, misconceptions about contraceptives, and non-friendly adolescent reproductive services,) as influencing adolescent pregnancies in Sub-Saharan Africa CONCLUSION: High levels of adolescent pregnancies in Sub-Saharan Africa is attributable to multiple factors. Our study, however, categorized these factors into three major themes; sociocultural and economic, individual, and health service related factors as influencing adolescent pregnancies. Community sensitization, comprehensive sexuality education and ensuring girls enroll and stay in schools could reduce adolescent pregnancy rates. Also, provision of adolescent-friendly health services in schools and healthcare centers and initiating adolescent empowerment programs could have a positive impact.

Effects Of First-Line Anti-Retroviral Therapy On Blood Coagulation Parameters Of HIV-Infected Patients Attending A Tertiary Hospital At Abuja, Nigeria

Background: Blood coagulation abnormalities are common in persons infected with the human immunodeficiency virus (HIV). However, few studies showed the association of these abnormalities with anti-retroviral therapy (ART). Objective: This cross-sectional study investigated the effects of ART on blood coagulation parameters of patients infected with HIV attending HIV special clinics of the University of Abuja Teaching Hospital (UATH), Gwagwalada, Abuja, Nigeria. Material and Methods: A total of 191 patients comprising 128 HIV subjects on ART (test subjects) and 63 other HIV patients not on ART (control subjects) were included in the study. CD4+ lymphocyte counts, platelet counts, prothrombin time (PT) and partial thromboplastin time with kaolin (PTTK) of subjects were determined using flow cytometry, automated hematology analyser and Quick one-stage methods respectively. Results: Of the total test subjects, 21 (16.4%) were CD4 lymphopaenic, and the mean CD4+ cell count for the test subjects was statistically higher than that of the control subjects (578 versus 322 cells/ mm3 ) (p = 0.014). Eight (6.3%) of test subjects had prolong PTTK, and the mean values of PT and PTTK were statistically not significant between test subjects and control subjects (p = 0.358 and p= 0.141 respectively). Eight (6.3%) of test subjects had thrombocytopaenia, the mean platelet count was significantly lower than that of the control subjects (238 versus 278.6 x 109 /L, p = 0.001), and also varied significantly with the duration of ART (p = 0.0086). Conclusion: Findings from this study revealed ART decreased platelet counts of HIV-infected individuals, but did not affect the PT and PTTK results.

Correlates and Barriers Associated with Motorcycle Helmet Use in Wa, Ghana.

OBJECTIVE: This study was conducted to investigate the correlates and barriers to helmet use among motorcycle riders in Wa, a motorcycle-predominant town in Ghana. An additional objective was to determine the association between helmet use and riders' knowledge, attitudes, and beliefs toward helmets. METHODS: Cross-sectional surveys including both observation of helmet use and interviews were conducted among motorcycle riders at 6 randomly selected fuel stations and 4 motorcycle service centers within and outside the Central Business District of Wa. Questions covered riders' sociodemographic and riding characteristics, helmet use, reasons for use or nonuse of helmets, and knowledge, attitudes, and beliefs about helmets. Analyses were based on frequencies and testing of strength of association using adjusted odds ratios (with 95% confidence intervals) in binary logistic regression. RESULTS: The prevalence of helmet use among the 271 sampled riders was 46% (95% confidence interval [CI], 40.2-52.0). Gender, age, marital status, and occupation were significant sociodemographic correlates of helmet use in Wa. Compared to currently married riders, unmarried riders were 5 times less likely to use a helmet. No significant association existed between riders' educational attainment and helmet use. Helmet use was also positively correlated with helmet ownership and license holding. The leading reasons stated for helmet nonuse among nonusers were not traveling a long distance and helmets block vision and hearing. Protection from injury, legal requirement, and coping with the police for fear of being accosted for helmet nonuse were identified as common reasons for helmet use. Positive attitudes and beliefs were also significantly correlated with helmet use. CONCLUSIONS: Despite the existence of a legislation mandating the use of helmets on all roads as well as the high level of awareness among riders on this legislation and the benefits of helmets, the incidence of helmet use among motorists continue to be low in Wa, Ghana. This means that efforts to identify strategies to increase helmet use need to continue. The evidence provided by this study suggests that stakeholders in road safety need to put in interventions to ensure a rigorous enforcement of the helmet use legislation and improvement in helmet design. These should be combined with the development of targeted educational programs with the aim of changing unfavorable attitudes and beliefs toward helmet use.

A cross-sectional observational study of helmet use among motorcyclists in Wa, Ghana.

Motorcyclists' injuries and fatalities are a major public health concern in many developing countries including Ghana. This study therefore aimed to investigate the prevalence of helmet use among motorcyclists in Wa, Ghana. The method used involved a cross-sectional roadside observation at 12 randomly selected sites within and outside the CBD of Wa. A total of 14,467 motorcyclists made up of 11,360 riders and 3107 pillion riders were observed during the study period. Most observed riders (86.5%) and pillion riders (61.7%) were males. The overall prevalence of helmet use among the observed motorcyclists was 36.9% (95% CI: 36.1-37.7). Helmet use for riders was 45.8% (95% CI: 44.8-46.7) whilst that for pillion riders was 3.7% (95 CI: 3.0-4.4). Based on logistic regression analysis, higher helmet wearing rates were found to be significantly associated with female gender, weekdays, morning periods and at locations within the CBD. Riders at locations outside the CBD were about 7 times less likely to wear a helmet than riders within the CBD (48.9% compared to 42.3%; χ(2)(1)=49.526; p<0.001). The study concluded that despite the existence of a national helmet legislation that mandates the use of helmets by both riders and pillion riders on all roads in Ghana, helmet use is generally low in Wa. This suggests that all stakeholders in road safety should jointly intensify education on helmet use and pursue rigorous enforcement on all road types especially at locations outside the CBD to improve helmet use in Wa.