Background It is estimated that hospital delivery could reduce 16%–33% of maternal deaths. Despite the importance of delivering at health institutions, in many countries, mothers still prefer to give birth at home.Study aim The aim was to ascertain the determinants of hospital delivery among mothers attending post-natal mother-baby clinic services in Busia district.Methods We used analytical cross-sectional design, with mixed method approach. A sample of 385respondent mothers were interviewed using semi-structured questionnaires. Two Focus Group Discussions (FGD) were held with mothers.Results Hospital delivery was at 82.6%, with most mothers delivering from government hospitals (50.9%) and private hospitals. Place of residence of mothers was associated with Hospital Delivery (X2(1) = 1.515, p < 0.002). Mothers who lived in urban settings were 2.7times more likely to deliver from health facilities than mothers who lived in rural settings [cPR = 2.686, 95% CI (0.394–1.194)]. Husband’s educational level was a determinant of Hospital Delivery (X2(3) = 2.054, p < 0.006). Mothers whose husbands had primary education, secondary education and tertiary education were 2.2 times, 1.5 times and 1.3 times more odd of delivering from health facility respectively.Conclusion Hospital delivery in Busia was acceptably high. Women’s decision power enormously contributes to the choice of place of delivery.
Background The UNAIDS 90-90-90 targets, aimed at ending the AIDS pandemic by 2030, have increased ART initiation among people living with HIV (PLWH). However, retention in care remains a challenge in some settings due to the growing patient load on already overwhelmed health systems. Decentralizing HIV services to the community is critical to decongest facilities and improve access. This study explored the experiences of patients and healthcare workers (HCWs) with retention in care under Zambia’s Community Adherence Group (CAG) model.Method This qualitative study was nested within a community ART retention project that implemented three decentralized ART models across five communities in Zambia. Between September and December 2018, data were collected through audio-recorded focus group discussions (FGDs) with purposively selected PLWH (8 FGDs, n = 42) enrolled in the CAG model and interviews with healthcare providers (n = 6). Recordings were transcribed verbatim, translated into English, and analyzed thematically using the Social Ecological Model to explore participants’ experiences.Results Patient retention in CAGs was influenced by factors across different levels of the Social Ecological Model. At the individual level, participants noted increased free time and reduced opportunity costs, enabling them to access ART while continuing with livelihood activities. Interpersonal factors, such as peer support and shared knowledge during group meetings, further enhanced engagement. At the organizational level, reduced clinic-based stigma encouraged continued care. Although the CAG helped with patient retention in care, a few participants felt it didn’t address conflicts with patients’ livelihood activities, particularly business ventures, which required patients to travel outside the community for an extended period.Conclusions CAG models were perceived as practical models for improving ART patient retention because they provided an important option for PLWH to access ART services as close as possible to their homes. For the models to be effective, it is important to consider the socio-economic context, including various livelihood situations for PLWH.
A chronic disease diagnosis produces significant changes to an individual’s lifestyle and behavior. Coping with these changing circumstances requires a process of psychological adjustment that can be difficult to attain for many. Consequently, severe psychological conditions, including, but not limited to, depression and anxiety, have been linked to chronic conditions. This study aims to examine the association between chronic conditions and emotional distress in Cape Coast, Ghana. Data were collected, using convenience sampling approaches, from a sample of 375 adults living in the Cape Coast metropolis of Ghana. To assess the relationship between chronic diseases and depression and anxiety, a multivariable logistic regression was run. The role of self‑efficacy in this relationship was assessed by interacting the self‑efficacy and chronic disease variables. The majority had no chronic conditions, were very confident or completely confident about their ability to take care of their health. Individuals living with chronic conditions were more likely to experience depression and anxiety. Self‑efficacy attenuated this positive relationship between chronic conditions and depression and anxiety. The finding of protective effect of self‑efficacy in reducing emotional distress among individuals with chronic conditions calls for increased self‑management interventions to increase patient empowerment and improve the ability of individuals living with chronic conditions to self‑manage their conditions.
Routine growth monitoring (RGM) for 9 to 24-month-old children enables early detection of developmental problems for corrective interventions. Unfortunately, many caregivers cease active RGM activities once they exhaust the government-recommended vaccines. The study aimed to find out the effects of health education using mobile technologies on caregivers’ knowledge of RGM. The study was quasi-experimental in design. Caregivers in interventional arm 1, received health education (HE) messages sent via a Short Text Message (STM). Caregivers in interventional arm 2, received HE messages using Voice Calls (VC). Control arms received the usual care. Post-intervention results revealed that there was an increase in the number of respondents who knew the importance of RGM for their children. Post-intervention analysis showed that caregivers in intervention arms 1 and 2 were more presumably to know when their children should be taken for RGM (OR = 3.000; 95% CI: 2.098 – 4.29), what is done during RGM visits to a child welfare clinic, the benefits of RGM, and problems associated with failure to engage in RGM compared to those in the control arm and at the beginning of the study. Health education using mobile technologies improved caregivers’ knowledge of routine growth monitoring.
Objective Emergency medicine healthcare professionals need to be continuously updated and trained in emergency medicine. Continuing professional development (CPD) courses are frequently offered but are seldom quality assured by other means than learner satisfaction evaluations or pre–post-test of knowledge retention. This study explores the quality of multiple choice questions (MCQs) used in a mandatory cross-disciplinary Norwegian CPD e-learning course in emergency medicine primary care.Design Cross-sectional study design.Setting We extracted MCQ assessment data from the e-learning platform ‘Oppvakt’ at National Centre for Emergency Primary Health Care (NKLM).Subjects Physicians and nurses working in the Out-of-Hour service in Norway.Main outcome measures Results from the MCQ exam and information about the participants’ professional role was extracted. Statistical analyses were performed to determine the level of difficulty of the MCQ items and their discriminatory power.Results A total of 2310 physicians and 1547 nurses completed the e-learning module, and 79% of the physicians and 67% of the nurses passed their first exam attempt. The physicians and nurses had an average of 85% and 81% correct answers, respectively. More than half of the MCQ items tested facts and knowledge retrieval, and not knowledge application. 70% of the items were found to be ‘easy’ or ‘too easy’. A third of the items had a low level of discrimination.Conclusions Our results indicate that there is room for improvement of the MCQ exam. Overall, the items were too easy and lacked the ability to discriminate between high and low-performance participants.
Chronic illnesses have become a significant global health threat, particularly to families who often bear the caring burden. This article details the major challenges families experience in caring for people with chronic illnesses in Ethiopia. This qualitative study conducted 20 in-depth interviews with 10 different families recruited from Tikur Anbessa Specialized Hospital in Addis Ababa, who accompanied people with cancer, diabetes, and hypertension for medical appointments. It analyzed the collected data thematically. The findings revealed that families often bear the responsibility of caring for people with chronic illnesses, facing challenging situations. These challenges include a lack of knowledge about the illness, chaotic emotions intensified by the illness, and the trauma and unpredictability of the diseases. A lack of knowledge about the illness often leads to misunderstanding and strained relationships, hindering the ability to provide optimal care. Thus, caregivers experience chaotic emotions, such as shock, anxiety, fear, or sadness. Besides, external factors like work-related stress affect families dealing with chronic illnesses, resulting in sudden hospital stays, disruptions to daily routines, and unexpected financial strains. The study highlights that families often need to have a better understanding of the illnesses to be better equipped to deal with the challenges of chronic illnesses.
Exclusive breastfeeding is recognized as the safest and healthiest feeding choice for infants in their first six months of life. Premature discontinuation can lead to risks of malnutrition, infections, impaired brain development, and increase the maternal susceptibility to breast and ovarian cancers. This study aimed to identify Multi-level risk factors for early termination of EBF for infants. A weighted sample of 1626 (Wt = 100%) mothers with infants was included in the final analysis. A mixed-effects multilevel logistic regression model employed to identify factors contributing to premature cessation. Intra-cluster correlation median odds ratio, and proportional change in variance used to assess random effects. The average age of women with paired infants was 27.4 (±6.25) years, while the mean age of infants was 4.79 (±2.34) months. The estimated national rate of early termination of exclusive breastfeeding was 15.8% (95% CI: 14.11–17.66). The final multilevel logistic regression model indicated that certain factors were significant predictors for early cessation of Exclusive Breastfeeding (EBF) in Ethiopia. These included infant age 5–6 months (Adjusted odds ratio = 2.14), male infants (Adjusted odds ratio = 0.56), delayed initiation of breastfeeding (Adjusted odds ratio = 156.8), infant co-morbidities (Adjusted odds ratio = 2.3), maternal education level (Adjusted odds ratio = 3.16), lowest wealth index (Adjusted odds ratio = 3.2), and peripheral regions (Adjusted odds ratio = 2.12). This study found that one in every six lactating women discontinued EBF before their infants reached six months of age.
Since 2011, Ethiopia has implemented a community-based health insurance program to improve universal health coverage and promote access to health care by reducing health expenditures for low-income families. Various studies on household satisfaction with the CBHI scheme and its determinants have been undertaken in Ethiopia, and the results have been inconsistent across regions, with significant variability. However, no nationwide study assessed the pooled estimates to understand the inconsistencies and decision-making better. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of household satisfaction with the CBHI scheme in Ethiopia. Systematic review and meta-analysis were performed in compliance with PRISMA 2020 guidelines using a comprehensive search of PubMed/Medline, HINARI, SCOPUS, and Google scholar, supplemented by a manual search. The I2 test statistic was used to examine heterogeneity between studies. A random effects model estimated the overall prevalence of household satisfaction with the CBHI program. Of the 207 studies identified, five were included in this meta-analysis, and the overall pooled prevalence of household satisfaction with the CBHI scheme was 66.36% (95% CI 52.25%, 80.47%) in Ethiopia. Subgroup analysis showed a higher satisfaction rate of 67.55 (95% CI44.15, 90.95) in studies conducted in the Amhara region than in the SNNP region 65.94 (95% CI: 44.08, 87.8). Ethiopia’s pooled prevalence of household satisfaction with the CBHI program is moderate. Stakeholders involved in health service delivery must focus on dimensions of high service quality and enhance their knowledge of CBHI benefit packages through education and information campaigns.
Maternal health literacy (MHL) among pregnant women is identified as a key determinant of maternal health. This study sought to assess pregnant women’s perspectives on opportunities and challenges in maternal health literacy selected ANCs in WA Municipality, Ghana. The study used a qualitative study design to understand pregnant women’s perspectives on health literacy attending antenatal sessions. An in-depth interview guide was used to collect data from the pregnant women and a midwife from each of the selected facilities. We analysed data using the interpretative phenomenological approach. The themes identified included Screening and counselling were clustered to form Antenatal care services (screening and counselling); antenatal care communication (special classes/outreach engagements, images/pictures, online/internet/book and verbal/oral) and maternal health literacy challenges (health facility challenges and socio-cultural challenges. Generally, it was observed that various services, channels of engagements and the environment of pregnant women influence their utilisation of maternal health literacy resources in the study area. The Municipal Health Directorate could consider appropriate timing for the deployment of maternal health information and multiple channels that use both verbal and visual aids that reinforce each other. The planning and implementation of these literacy resources should incorporate the socio-cultural issues of the pregnant women’s environment.
Schistosomiasis is one of the most prevalent neglected tropical diseases and a major health problem in many low- and middle-income countries. Despite the implementation of various control programs and measures, the prevalence of urogenital schistosomiasis in Ghana has risen significantly over the past few decades. Within this context, we estimated the prevalence and assessed knowledge, attitudes, and practices (KAP) associated with urogenital schistosomiasis among school-aged children in rural communities in the Cape Coast Metropolis in Ghana. This cross-sectional study enrolled 232 participants and spanned between January and April 2017. A questionnaire was used to gather demographic and epidemiological information of study participants. About 20–30 ml of terminal urine was collected from each participant and examined for eggs of urogenital schistosomiasis. Multiple logistic regression evaluated the association between KAP and the infection. The prevalence of urogenital schistosomiasis was 14(6%) and all the infections recorded were light infections with mean egg intensity of 2.88. There was no association between KAP of urogenital schistosomiasis and the type of infection. Overall, the respondents’ KAP about urogenital schistosomiasis was adequate and could be the cause of the hypo-endemic outcome for urogenital schistosomiasis in these communities.
A subset of patients suffering from ME/CFS (Myalgic encephalomyelitis/chronic fatigue syndrome) are severely ill, bedridden, and dependent on personal care. This study aims to describe the medical and social conditions of the most severely ill patients with ME/CFS in Denmark and the situation of their caregivers. Qualitative data were collected during 19 home visits to severely ill patients in Denmark. The patients interviewed were characterised by extremely low physical and mental functioning and longstanding illness. Relative to their dire condition, the participants received very little help from medical professionals and health services such as institutions and hospitals. There was an overall negative interaction with psychiatric interventions, and the relations between patients and the health system were generally characterised by mutual distrust. Social services were often dismissed, and obtaining the services was often described as more of a burden than a benefit. In conclusion, the most severely ill patients with ME/CFS and their caregivers must be characterised as a systematically neglected patient group not comparable to any other similarly ill group.
Malaria is an infectious disease caused protozoa in genus Plasmodium. In spite of the efforts made in the fight against malaria, this tropic infectious disease is still one of the most common vector borne disease in the WHO African region. Therefore, this systematic review focuses on current malaria control interventions, treatment options and elimination in Africa with specific focus on Zimbabwe. The literature was searched in electronic databases such as PubMed, MEDLINE, ClinicalTrials.gov, DOAJ, Europe PubMed Central, Web of Science and Google Scholar. Furthermore, the literature search was expanded to include reference lists in peer-reviewed scientific publications. Some of the key phrases chosen in the literature search were ‘malaria control interventions’, ‘Zimbabwe and malaria’, ‘Malaria treatment’, ‘Malaria prevalence in Zimbabwe’, ‘Malaria prevalence in Africa’, ‘malaria and Africa’, and ‘Africa and malaria therapy’. In this study, 185 articles were reviewed and literature was summarized in line with the objectives of the study. Based on literature survey, it was noted that intensification of malaria control interventions and treatment has led to a remarkable decline in malaria morbidity and mortality. However, malaria remains a public health concern in most African countries including Zimbabwe. This has been attributed to the (1) development of physiological and behavioral resistance among malaria vectors in response to insecticides overuse, (2) development of resistance in P. falciparum to antimalarial drugs, (3) migration of malaria tolerant and positive individuals from malaria endemic areas to settings where malaria is less common, (4) emergence of genetically distinct malaria parasites which has limited the development of an effective malaria vaccine and protective immunity.
Non-adherence to tuberculosis (TB) treatment poses a significant challenge, leading to multidrug-resistant TB and extensively drug-resistant TB. Addressing TB treatment non-adherence is crucial for curing individual patients, controlling TB spread, and reducing TB drug resistance. This study aimed to enhance TB treatment adherence through the application of the Behaviour Change Wheel. The BCW guide was followed to develop the intervention strategy for improving TB treatment adherence among patients. The process involved eight steps across three stages: understanding the behavior, identifying intervention options, and determining content and implementation options. Stage 1 data comprised 16 interviews with TB patients, three with TB district managers, eight with facility operation managers, eight with facility TB focal persons, and three focus group discussions with 18 direct observed treatment supporters. Findings from Stage 1 informed the intervention strategy development. A one-day stakeholder workshop, guided by Stages 2 and 3 of the BCW model, was conducted. The COM-B model analyzed results to identify necessary changes. The BCTv1 taxonomy helped select appropriate behavior change strategies for the intervention. The intervention strategy, named Adherence Improvement Management Strategy (AIMS), was developed through the stakeholder workshop, integrating insights from both approaches and guided by the last two stages of BCW. AIMS involves door-to-door campaigns by community health workers, distributing patient information leaflets to patients, communities, and family members. The BCW framework proved valuable in developing an intervention strategy to enhance TB treatment adherence among patients. Recent research indicates that AIMS is well-structured, patient-centered, coordinated, accessible, safe, and of high quality.
Alzheimer’s disease and Related Dementia (ADRD) is a growing concern for low- and middle-income countries. Yet, studies on the prevalence and risk factors for dementia in sub-Saharan Africa are limited. This study estimated the prevalence and identified the risk factors for ADRD in Ghana. A cross-sectional design involving 384 participants aged 60 years or more completed the Brief Community Screening Instrument for Dementia (CSID) with an additional set of questions on risk factors. The prevalence of dementia was 16% (62/384). Age (AOR = 1.031 (95% CI 1.002-1.061, p = 0.035), education (AOR = 0.689 (95% CI 0.517-0.919, p = 0.011), and employment (AOR = 0.320 (95% CI 0.149-0.685, p = 0.004) were associated with dementia. Also, ‘experience of stressful life event from age 16-64’ (AOR = 1.325 (95% CI 1.034-1.698, p = 0.024), ‘experience of stressful life event from age 65+’ (AOR = 1.258 (95% CI 1.024-1.546, p = 0.042), and ‘activities of daily living’ (AOR = 0.925 (95% CI 0.868-0.986, p = 0.037) identified as risk factors of dementia. The burden of ADRD was high. Urgent actions are needed to address this problem. There is a possibility that the burden of dementia may have been overestimated because of the study instrument. Findings should be interpreted in light of this limitation.
AbstractPhysical contact such as tackling is a part of youth sport, but associated with concussion risk. Coach communication with athletes about how to approach contact could be a strategy to reduce concussion risk. We interviewed n = 50 adult stakeholders (coaches, referees and administrators) in youth football and soccer to identify barriers and facilitators to coach communication about contact. We framed interviews using the Theory of Planned Behavior, discussing: knowledge/experience, attitudes/beliefs, norms/values and perceived behavioral control. Stakeholders could easily describe ‘good’ contact (knowledge/experience) like keeping your head up (football) and tackling shoulder-to-shoulder (soccer), and ‘bad’ contact like spearing (football) and retaliating against an opponent (soccer). They also talked about the importance of sportsmanship and playing by the rules. Most coaches believed ‘bad’ contact was associated with greater injury (attitudes/beliefs). Coaches felt responsible for managing contact (norms/values), but also described not receiving any information indicating that this was part of their role. Coaches worried about creating a fear of injury, and felt it was important for discussions to be framed positively (perceived behavioral control). In summary, youth football and soccer coaches believe ‘bad’ contact is associated with greater injury risk and feel it is their role to provide youth guidance about contact, but describe a lack of institutional guidance regarding this role. They also are concerned about barriers, including creating fear, and describe ways to address this barrier with language. Developing programs to support coach communication about contact with youth athletes presents a potential strategy for concussion prevention.
Due to little dietary supplement regulation and misinformation online, there is a need to educate consumers on them, which could be addressed using a higher education course to provide students resources to evaluate supplement information. The objective of this paper was to describe the design of a 3-credit dietary supplement elective course (HNF 102- Dietary Supplements: Evidence vs Hype) for undergraduate students. Furthermore, to analyze student perspectives and skills developed resulting from course completion. HNF 102 is a 5-unit asynchronous online course which consists of the following units: Unit (1) provides an overview of nutrition and dietary supplements; Unit (2) describes dietary supplement regulation; Unit (3) provides credible sources of dietary supplement information and tools to evaluate dietary supplement information; Unit (4) describes research on dietary supplements claimed to improve general health; Unit (5) describes research on dietary supplements purported to improve performance. A process evaluation inquiring about student opinions following course completion was offered as an extra credit opportunity. Overall, students indicated course lecture materials and assignments improved their understanding of dietary supplements and their ability to evaluate dietary supplement information. Dietary supplement undergraduate courses can be an effective method to improve consumer dietary supplement health literacy.
Sexual violence is a major social and public health problem in various sectors of society including institutions of higher education. Several measures have been put in place to combat the vice; however, it continues to prevail in various sectors of society. The study investigated the extent of Rape Myth Acceptance (RMA) among undergraduate students and determines the relationship between demographic factors, awareness of campus sexual violence, and rape myth acceptance. A mixed method approach was used and data was collected using a questionnaire and an interview guide. Using the updated Illinois Rape Myth Acceptance Scale (IRMAS), the study has revealed that the students endorsed rape myths in subtle ways. The study also found that there were statistically significant differences in levels of RMA between gender, year of study, and knowing someone who was sexually harassed and RMA. There were no statistically significant differences in the levels of RMA based on attending a sexual violence workshop and knowing someone who was raped and RMA and there was no correlation between age and RMA. The study recommends the implementation of targeted education programs that challenge subtle rape myths, tailored to different genders and year levels and establish peer education initiatives and provide continuous monitoring to adapt strategies effectively.
There is a growing global concern that suicide research has paid less than enough attention to young children. We drew on local media reports (January 2000–March 2022) to provide initial descriptive evidence on attempted suicide and suicide among children aged 12 and younger in Ghana. We applied summative content analysis to 30 eligible media reports (one attempted suicide and 29 suicides). We observed a discernible upward pattern in media reports of children suicide since 2015. Most of the suicides (n = 22) were boys. Hanging was the reported method of all the suicides. Parents and caregivers reported subtle or no warning sign of the suicides. While further research is needed globally on suicide among children, more studies are particularly needed from low and middle-income countries (including Ghana) to nuance our understanding of suicidal behaviour among this young population.
This systematic review explores Long-Term Services and Support (LTSS) for older individuals with Intellectual and Developmental Disabilities (IDD) in Africa. Guided by the research question, what is the current state of LTSS for older individuals with IDD in Africa? The Preferred Reporting Items for Systematic Reviews, Meta-Analyses approach and a comprehensive multidisciplinary approach were adopted to analyze various aspects of LTSS, including types, accessibility, affordability, impact on families and caregivers, social inclusion and cultural influences. A systematic search of relevant literature sources was conducted, and data were synthesized to provide a holistic view of the challenges and opportunities in this field. The review reveals a significant gap in indigenous research and emphasizes the need to recognize the unique needs of older adults with IDD in Africa. Challenges related to accessibility, affordability and social inclusion persist, while cultural factors play vital roles in shaping the provision of LTSS. Family caregivers face increasing demands, leading to stress and psychological burden. These findings call for urgent attention to the provision of LTSS for older individuals with IDD in Africa. By addressing the identified challenges and promoting culturally sensitive and inclusive services, policymakers can enhance the well-being and social inclusion of this vulnerable population.
A subset of patients suffering from ME/CFS (Myalgic encephalomyelitis/chronic fatigue syndrome) are severely ill, bedridden, and dependent on personal care. This study aims to describe the medical and social conditions of the most severely ill patients with ME/CFS in Denmark and the situation of their caregivers. Qualitative data were collected during 19 home visits to severely ill patients in Denmark. The patients interviewed were characterised by extremely low physical and mental functioning and longstanding illness. Relative to their dire condition, the participants received very little help from medical professionals and health services such as institutions and hospitals. There was an overall negative interaction with psychiatric interventions, and the relations between patients and the health system were generally characterised by mutual distrust. Social services were often dismissed, and obtaining the services was often described as more of a burden than a benefit. In conclusion, the most severely ill patients with ME/CFS and their caregivers must be characterised as a systematically neglected patient group not comparable to any other similarly ill group.
