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.

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.

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.

Predictors of knowledge and adherence to COVID-19 safety protocols among nurses at health facilities in Tamale Metropolis of Northern Ghana.

BACKGROUND: Corona Virus Disease of 2019 (COVID-19) emerged in 2019 and caused widespread disruption to many facets of life, including healthcare. Healthcare workers, particularly nurses, became the front-line fighters against the pandemic, making it imperative to comply with recommended safety protocols. However, many nurses were infected by the virus in the Tamale Metropolis, raising concerns regarding their level of adherence to the safety protocols. This study assessed the predictors of knowledge and adherence to COVID-19 safety protocols among nurses at selected health facilities in the Tamale Metropolis of northern Ghana. METHODS: A facility based cross-sectional study design was adopted and 339 nurses from six (6) public health facilities in the Tamale Metropolis were recruited for the study using questionnaires. The questionnaires were transformed into Google Forms for respondents to answer online via WhatsApp or email. The data were exported from the Google spreadsheet into SPSS and analyzed using descriptive and inferential statistics. RESULTS: Of the 339 participants, 60.2% were classified as having adequate knowledge while only 9.1% demonstrated high adherence to COVID-19 safety protocols. Knowledge of COVID-19 was predicted by source of information, and marital status, whereas health facility types predicted level of adherence. The odds of having adequate knowledge were higher among unmarried nurses (AOR = 1.94; 95% CI: 1.16-3.25; p = 0.012) and nurses using social media (AOR = 1.80; 95%CI 1.02-3.18; p = 0.042) compared to their counterparts. Meanwhile, primary health care nurses (AOR = 0.24; 95% CI = 0.12-0.50; p<0.001) and secondary health care nurses (AOR = 0.52; 95% CI = 0.31-0.88; P = 0.016) had reduced odds of exhibiting higher adherence compared to nurses from tertiary-level facility. CONCLUSION: In this study, we found that knowledge was high but adherence to COVID-19 safety protocols was low. We suggest that facility managers should enforce compliance of their staff to the safety protocols to prevent spread of the virus within healthcare settings.