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Background: Ghana was one of the few countries commended to have halved extreme poverty after the MDG era yet the under-five mortality rate (U5MR) was dire. Ghana's U5MR is still above the national and global SDG target. As a result, the government has over the years implemented other complementary social and policy interventions to improve the socioeconomic status of households to ensure better child health outcomes. Yet key gaps exist and threaten child health outcome sustainability, and child health-related SDG targets. In this regard, we hypothesize that household wealth should therefore not influence under-five child deaths significantly. Methods: The paper first reports the under-five mortality trend over the past 30 years in Ghana. It uniquely analyses the levels and trends in wealth as measured by the Gross National Income per capita at purchasing power parity (ln GNI/p, ppp) as a proxy of the mean Comparative Wealth Index (CWI) against under-five child deaths in Ghana. Using data from the 2014 Ghana Demographic and Health Survey and employing the logistic regression estimation technique, the paper further estimates the effect of household wealth and other key covariates on under-five child deaths. Implemented government poverty-alleviating policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify risk gaps to child deaths. Results: The 30 year trend analysis from 1990 to 2020 shows that the under-five mortality rate in Ghana is still high, falling short of the rate of decline that is expected toward achieving the 2030 SDG target for U5MR of 25 deaths per 1000 live births. Our empirical estimations show that household wealth still has a negative and significant relationship with under-five child deaths despite the government's existing poverty-alleviating and pro-poor health policies. In addition, the results show that regional differences, maternal age, the number of children alive, and attendance to postnatal healthcare services are crucial for child survival. Conclusion: The results imply that the government should consolidate universal programmes with intensified targeted interventions toward improving household wealth, especially in the Northern Savannah regions. A new and dynamic child health policy is imminent to reflect strategies towards achieving the SDG target on U5MR. Additionally, intensive education on active maternal participation in postnatal care should be given critical consideration to improve child survival. [ABSTRACT FROM AUTHOR]

Research on vaccines confirms the crucial role media play in framing discourses and mobilizing public support for successful immunization campaigns. What journalists cover on vaccination issues and their diligence in producing stories can influence attitudes to and uptake of vaccines. This paper contributes to emerging discussions on the role of the media in pandemics and in vaccination programs by interrogating the information seeking and verification practices of journalists reporting on COVID-19 vaccines in Ghana. A cross-sectional online survey was conducted among journalists from June to July 2021 through self-administered questionnaires by means of Google forms. The opinions of 300 respondents, randomly drawn from members of the Ghana Journalists' Association, were solicited and a response rate of 73% obtained. Majority of journalists surveyed relied on official health sources for their information on COVID-19 vaccines (61.5%) and were confident the benefits of vaccines outweigh the risks (70%). While journalists relied on a variety of expert sources, social media platforms served as important sources of information also, with respondents stating a preference for Facebook (48.3%), and WhatsApp (44%). Journalists stated they were guided by sound practices such as source credibility and relevance, but betrayed weaknesses in their verification practices with a third of them admitting to sharing unsolicited information from social media. Journalists in Ghana generally display a positive attitude towards COVID-19 vaccines and regularly search for information from official sources to inform their work, thus making them vital allies in overcoming vaccine hesitancy. Laxity in verification practices, however, makes them inadvertent agents of misinformation. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine landlords' health support systems to tenants to control COVID-19 in selected informal settlement rental housing (ISRH) in Ghana, dwelling on landlords' views. Design/methodology/approach: The paper used the concurrent imbedded mixed-methods approach and grounded the findings in the socio-ecological theory. The authors collected both qualitative and quantitative data from 242 landlords in 13 informal settlements across Ghana using quotas. The authors undertook semi-structured face-to-face and telephone interviews. The authors conducted content and thematic qualitative data analysis and used simple descriptive statistical data analysis. Findings: The paper discovered that tenants had limited knowledge on the transmission of the pandemic, forcing landlords to regulate their building services usage, ventilation and thermal control, entertainment, common areas and rent advancement for tenants to control the pandemic. Also, tenants found it difficult to comply with the rules on ventilation for fear of criminal attacks, while high social connection and interaction among renters and inadequate enforcement caused the non-adherence by renters to social gathering. Again, landlords had difficulty in contract-tracing visitors suspected to be infected with the virus. Originality/value: The use of concurrent and imbedded mixed methods to investigate landlords' viewpoints on their support in health needs of their tenants to regulate COVID-19. The prescriptions from the study provide practical applications to formulate a mix of housing and health policies to formalize the support of landlords to their tenants in ISRH in Ghana. [ABSTRACT FROM AUTHOR]

Background: Community‐based health interventions have been implemented as a key strategy for achieving improved health outcomes in Ghana. Effectiveness, however, largely depends on the successful implementation of patient–public engagement (PPE). Although several PPE studies have been conducted in Ghana, little research has been done to understand the specific role of PPE in the context of implementing community‐based health programmes. This paper, therefore, examines the extent of PPE implementation in three selected community‐based health programmes (Community‐based Health Planning and Service [CHPS], Community‐based Maternal and Child Health and Buruli Ulcer) to understand their specific effects on health outcomes. Methods: Three focus groups, involving 26 participants, were held in three districts of the Ashanti region of Ghana. Participants were mainly health service users involving community health committee members/volunteers, residents and health professionals. They were invited to participate based on their roles in the design and implementation of the programmes. Participants focused on each of Rifkin's spider‐gram components. Data were transcribed and analysed descriptively using NVIVO 12 Plus. Results: PPE implementation was found to be extensive across the three programmes in specific areas such as organisation and resource mobilisation. PPE was more restricted in relation to community needs assessment, leadership and management, particularly for the CHPS and Buruli Ulcer programmes. Conclusion: Findings suggest that benefits from community‐based health interventions are likely to be greater if PPE can be widely implemented across all dimensions of the spider‐gram framework. [ABSTRACT FROM AUTHOR]

Skin‐bleaching is a common practice globally and is associated with many cutaneous and systemic health risks. Anecdotally, skin‐bleaching is linked to impairments in wound healing, but there are little data to support the claim. This cross‐sectional survey of health care professionals serving the Greater Accra Region, Ghana region investigates their observations of wound healing in patients who skin‐bleach and their methods for screening skin‐bleach use in patients. A 25‐item self‐administered questionnaire using 5‐point Likert scale was distributed with convenient sampling to physicians and nurses employed at Ghanaian hospitals. Fifty‐seven electronic and 78 paper responses were collected (total = 135). Most respondents agreed that wounds in skin‐bleaching patients heal more slowly (4.22), are more prone to infection (4.11), haemorrhage (3.89), wound dehiscence (3.9), and are more difficult to manage (4.13). No respondent reported universal screening of all patients for skin‐bleaching, but most ask about skin‐bleaching if there is suspicion of it (42.2%). Our findings support the anecdotes about observable wound healing impairments in patients who skin‐bleach. There is also wide variation in skin‐bleaching screening practices, suggesting a need for guidelines to properly identify these patients and facilitate early risk prevention. [ABSTRACT FROM AUTHOR]

Since the adoption of the sustainable development goals (SDGs) by the United Nations (UN), the search has been on to identify interventions that have effects on multiple SDG-targets simultaneously. Like other developing countries, Ghana has a youthful population and would require creative, urgent, youth-focused interventions to be able to attain the SDGs by 2030. This paper describes the application of the accelerator model on data from a sample of Ghanaian adolescents to identify potential accelerators towards selected SDG targets involving youth. The data for 944 adolescents, 10–19 years (mean age 12.31 ± 3.51 years), extracted from two cross-sectional surveys on children and adolescents aged 6–19 years in Kumasi, Ghana, were analysed in this paper. Variables considered suitable proxies for SDG targets and potential accelerators were identified from the study instruments. Consequently, four aligned SDG targets (good mental health, access to ICT, school completion and no open defaecation) and five accelerators (cognitive stimulation, no relative poverty, low student–teacher ratio, high caregiver education and safe water) were extracted. Associations between accelerators and SDG targets were assessed using multivariable logistic regression adjusting for sociodemographic covariates and multiple testing. Cumulative effects were tested by marginal effects modelling. The three hypothesised accelerators identified were cognitive stimulation, low student–teacher ratio, and no relative poverty. A combination of all three accelerators was associated with a higher likelihood of adolescents having access to Information and Communication Technology (ICT) by +73% (CI 0.72–0.74), no open defecation by +44% (CI 0.43–0.46), school completion by +27% (CI 0.26–0.27) and good mental health by +9% (CI 0.08–0.10). Three hypothesized accelerators showed association across all four SDG aligned targets. The accelerator model has been further validated in this dataset from Ghana. Robust interventions designed around these accelerators may represent an opportunity for achieving the SDGs in Ghana. [ABSTRACT FROM AUTHOR]

Refuse heaps are common scenes in cities in developing countries amidst the springing up of urban cropping but with low yields. However, the linkages between refuse generation and use in urban cropping appear to be little addressed in the existing literature. This paper sought to explore the separation of refuse into biodegradable and non-degradable and the use of the biodegradable portion as compost in urban cropping to improve crop production often linked to urban food availability. Hence, refuse generation at the household levels and refuse at the dumping sites were determined and sorted out using Wa Zongo as a study area. By combining convenience and simple random sampling, fifteen respondents from fifteen houses within a 150-metre radius of a dumping site were interviewed. Descriptive statistics, connecting and classifying, were employed in the data analysis. Findings revealed that more refuse is generated; a greater portion is decomposable; 93.3% of the respondents do not know the use of refuse for cropping; and, 53.3% prefer inorganic fertilizers for farming. To reduce refuse and eliminate the heaps, this study recommends refuse segregation at home and dump sites, biodegradable refuse for the production of compost and the use of public education to achieve this feat. [ABSTRACT FROM AUTHOR]

Migrants face several unmet health needs due to the inability of the healthcare system to address their healthcare challenges. As a result, they adopt coping strategies to overcome their healthcare needs. Consequences can include infrequent but severe adverse reactions, dangerous drug interactions, incorrect dosage etc. Little is known in Ghana about the role played by cultural and linguistic barriers in shaping migrants' access to formal healthcare and the coping mechanisms adopted by these migrants to overcome their healthcare challenges. Surprisingly, most of the studies that have been conducted have focused on financial barriers to care accessibility. This presents a loss opportunity for any health programme aimed at addressing this inequity. Thus, the purpose of this paper is to fill this gap by exploring the challenges of healthcare accessibility and coping strategies adopted by migrants to overcome their healthcare needs in the informal urban settlement of Madina, in the Greater Accra Region. The author employed a narrative type of qualitative research design. A purposive and then snowball sampling technique were used to select 20 participants to participate in the study after saturation was reached. Twelve in‐depth interviews (IDIs) and six key informants' interviews (KIIs), as well as two focus group discussions (FGDs), were conducted. The study is consistent with the ecological model, which posits that health is determined by influences at multiple levels. The author found linguistic, cultural, stigmatisation and financial challenges as the main barriers to healthcare accessibility among the migrants. As a result, self‐medication and the use of lay health personnel for addressing healthcare needs were more pronounced. The study also found other means of survival that posed a health risk to the migrants. Based on this, it was recommended that healthcare systems take into account the healthcare needs of migrants who are people with culturally and linguistically diverse backgrounds. [ABSTRACT FROM AUTHOR]

It has been found that people with disabilities remain at the margin as far as the different aspects of their lives are concerned. This paper tests the hypothesis that disability leads to lower quality of life among older adults in low and middle-income countries. The data from the Study on Global Ageing and Adult Health (SAGE) was used in this study which was conducted in Ghana, China, India, Russia, South Africa and Mexico. The disability scores have been made utilising Item Response Theory, Partial Credit Model and are centered on eight functioning and health areas. Bivariate analysis, binary logistic regression and pooled regression analysis have been used to fulfil the objectives of the paper. The findings reveal that disability acts as a hindrance in attaining a high quality of life (HQOL) amongst the older adults in the above mentioned low and middle-income countries. The older adults with disability are as much as 60% less likely to enjoy an HQOL with respect to the older adults without disability. Better socio-economic development like improved health care for disabled older adults with disability enhanced living standards for both abled and disabled, efficient pension schemes for older adults with disability and effective social service schemes would be very much essential to improve overall QOL among older adults. [ABSTRACT FROM AUTHOR]

Background: Although Ghana is lauded for its National Health Insurance Scheme (NHIS), concerns exist about the scheme's functioning and sustainability. An often-cited issue—contributing to the scheme's decreasing membership, long-standing financial deficit, and frequent out-of-pocket payments among members—is the large benefits package (BP). While, on paper, the BP covers over 95% of the conditions occurring in Ghana, its design was not informed by any budget analysis, nor any systematic prioritization of interventions. This paper aims to provide evidence-based input into ongoing discussions regarding a review of the NHIS benefits package. Methods: An existing analytic framework is used to calculate net health benefit (NHB) for a range of interventions in order to assess their cost-effectiveness and enable the prioritization of 'best buys'. The framework is expanded upon by incorporating concerns for financial protection, and practical feasibility, as well as the political economy challenges of disinvesting in currently funded activities. Five different options for the benefits package, each based on policy discourse in Ghana's health sector, are presented and evaluated. Results: Implementing all interventions for which data was available to 100% of the population in need was estimated to cost GH₵4323 million (US$994 million), while the available NHIS budget was only GH₵970 million (US$223 million). Options for the benefits package that focussed on cost-effectiveness and primary care provision achieved the best health outcomes, while options reflecting the status quo and allowing for co-payments included a higher number of healthcare interventions. Apart from the package option focussing on primary care, all packages were faced with physician shortages. Conclusions: Current funding to the NHIS is insufficient to provide the historical benefits package, which promises to cover over 95% of disease conditions occurring in Ghana, to the total population. Shifting the NHIS focus from intervention coverage to population coverage is likely to lead to better health outcomes. A primary care package may be most feasible in the short-term, though additional physicians should be trained to provide higher-level care that is highly cost-effective, such as emergency neonatal care. [ABSTRACT FROM AUTHOR]

Promoting female learning otherwise known as Girl Child Education continues to engage the attention of policy makers and practitioners in education and development generally; a situation greatly shaped by the myriad of obstacles militating against girl child education. In the current study, we probed the influence of CAMFED's girl child education support scheme on school enrollment, retention and progression. We applied a reflexive evaluation approach anchored on a concurrent mixed methods research design in the study. Using a multistage sampling procedure, selected respondents were administered a combination of semi-structured questionnaires and in-depth interviews. We analyzed our data using multiple regression and descriptive statistics, supported by content analysis. The findings show that school enrollment and progression of the girl child increased substantially after the introduction of CAMFED's intervention. However, gender-based perceptions continue to stifle girl child education, in spite of the behavior change component of the intervention scheme. The paper concludes that policy interventions should address the sociocultural bottlenecks inhibiting the education of the girl child if the gains made so far must be sustained. Going forward, studies could focus on measurement of performance as a function of girl child education support schemes beyond the basic level of education. [ABSTRACT FROM AUTHOR]

The paper contributes to unravelling the perceptions of urban commercial drivers regarding their vulnerability to catching the SARS-CoV-2 virus while at work. It further examines how the perception of vulnerability influences personal use of face masks by drivers, as well as on their insistence on appropriate masking behaviour by other persons on-board public transport. Overcrowding and unsanitary conditions in informal public transport in Africa could facilitate the spread of the corona virus. However, the use of face masks, among other enhanced mitigation measures significantly contain and minimize the spread of the virus. Primary data, obtained through surveys at five major public transport terminals in Accra, was analysed and interpreted using the Health Belief Model as an explanatory framework. Results indicate that most drivers have a high vulnerability perception to Covid-19. It further emerged that older drivers, in particular, consistently wore face masks and insisted on other persons in their commercial vehicles to follow suit. Socio-demographic factors, and the need to ensure one's personal safety and those of loved ones were critical determinants of face mask use among surveyed drivers. The study thus recommends that public awareness campaigns should strategically focus attention on the younger generation of drivers (i.e. 18–39 years) who perceived themselves to be immune to the SARS-CoV-2 virus. Also, the collaborative efforts of state and non-state actors, like the transport operator unions, must be further strengthened if the gains made so far against Covid-19 is to be sustained. [ABSTRACT FROM AUTHOR]

Aims: To explore the experiences of health professionals and families concerning supporting low‐birth weight (LBW) infants along the continuum of care (CoC) in Ghana with the goal to unveil new strategies to improve the quality of neonatal care. Design: A constructivist grounded theory. Method: Simultaneous data collection and analysis among health professionals alongside families with LBW infants from September 2020 to April 2021. The study used constructivist grounded theory strategies for data collection and analysis. Results: The analysis of 25 interviews resulted in a theoretical model describing 10 themes along the CoC for LBW infants, categorized into health and family systems drivers. In this paper, we focus on the latter. Early bonding and family involvement were empowering. Mothers needed assistance in balancing hope and confidence which enabled them to render special care to their LBW infants. Providing mothers with financial and domestic support as well as creating awareness on newborn health in communities were important. Conclusion: To achieve family involvement, a coordinated CoC must entail key players and be culturally inclusive. It must be applied at all levels in the CoC process in a non‐linear faction. This can help LBW infants to thrive and to reach their full developmental potential. Impact The theoretical model developed shows the importance of family involvement through family systems care for a comprehensive response in addressing needs of health professionals and families with LBW infants and bridging the fragmentations in the neonatal CoC in Ghana. Context‐tailored research on family systems care in the neonatal period is necessary to achieve a quality CoC for LBW infants and their families. Patient or Public Contribution: Caregivers and providers participated by granting in‐depth interviews. Care providers further contributed through their feedback on preliminary findings. [ABSTRACT FROM AUTHOR]

Few studies exist on the early care and education (ECE) of children who are deaf in low-to-middle-income countries, and none examine the roles of deaf adults in such provision. A research base is needed to inform contextually sensitive "deaf-infused" models of ECE in such contexts that build on indigenous deaf community experience, knowledge, and local expertise. This paper discusses the development of ECE in Ghana in sub-Saharan Africa focusing specifically on the perspectives of deaf adults on their roles in ECE support and leadership. Seventeen deaf adults with different leadership and advocacy roles in Ghana were interviewed about their perceptions of ECE priorities in this context, and the role of deaf adults in the development and delivery of early support. The participants expressed diverse views on ECE for the children and their families and suggested ways of building capacity and leadership among deaf adults to support ECE for the children and their families. [ABSTRACT FROM AUTHOR]

Problems associated with environmental degradation abound in developing countries, with dire consequences on young people. Young people are the future leaders of the world. Therefore, their appreciation and behavior have the capacity to facilitate their commitment toward environmental citizenship. The paper examined the predisposing factors of environmental citizenship behavior among Senior High School students in the Cape Coast Metropolis. It was guided by the Value-Belief-Norm theory of environmentalism. Quantitative data collected from 292 Senior High School students within the metropolis was analyzed by using appropriate descriptive and inferential statistics. The findings indicate that the students were predisposed to exhibiting pro-environmental behavior, in terms of their environmental values. The students had high biospheric and altruistic values which are prerequisite values, particularly for environmental citizenship behaviors. The study recommended that the students' environmental engagements should be boosted by school authorities through environmental literacy. Environmental clubs in schools should also be supported by the Ghana Education Service in order to help nurture affinity for nature as well as promote the platform for public sphere environmental actions. [ABSTRACT FROM AUTHOR]

Access to safe drinking water is critical in improving health and well-being. It is estimated that >40% of urban households in Ghana do not have access to safe drinking water. Although the willingness and ability of community members to collectively take local initiatives are essential to curtailing inequities in water access in Ghana, the determinant of collective action is less explored. This paper explores determinants of collective action in water-insecure neighbourhoods and examines how perceived inequities in access to water and trust mediate the relationship between lack of access to water and collective action in urban Ghana. The results show that the urban poor OR = 12.047 (p = 0.000) were more likely to participate in water-related collective action compared to wealthy individuals. Primary decision-makers were 1.696 times more likely to participate in collective (p = 0.02). We also found that perceived inequities OR = 0.381 (p = 0.00) significantly predict participation in collective action to address water insecurity. Water service providers should be subjected to a rigid state-level framework that ensures inclusivity, fairness and justice in their distribution systems. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between child labour and educational attainment and explores the distinction between harmful and non-harmful agricultural cocoa work. We conduct a secondary analysis of data on 3,338 children who reported attending school in 2018 across cocoa growing regions of Ghana and Côte d’Ivoire. To address differences between harmful and non-harmful child labour, we differentiated work completed by a child by hazardous activity engagement. These groups of child labour were then modelled against educational attainment, defined by a whether or not the child needed to repeat a class. We then conducted mediation analysis to assess whether injury mediates this relationship. Our results show that hazardous child labour increases the odds of repeating a class and work-related injury compared to non-hazardous labour. The effect of hazardous child labour on academic attainment was also found to be mediated by work-related injuries by 14%. Educational attainment is associated with hazardous labour activities and the odds of injury and not the act of participation in agricultural labour alone. Programmes based on strong measures of harmful work will foster better protection for children who are most at risk and may inform global debates around the benefits versus the risks of child labour. [ABSTRACT FROM AUTHOR]

This paper presents findings of a study that explored the challenges and coping strategies of parents of children with mental disorders. In-depth interviews were conducted with 35 parents of children with mental disorders at the Psychiatric Unit of the Komfo Anokye Teaching Hospital in Kumasi. Data were analyzed using thematic content analysis. Findings indicated that financial constraints, inability to secure permanent employment, and stigma were the challenges of the parents. Having faith in God and accepting their children's condition were the coping strategies adopted by the parents. However, lack of effective support system makes coping difficult for the parents. [ABSTRACT FROM AUTHOR]

Integrating consumers' experiences into quality mental health service assessment is relevant to improve service outcomes. Despite this, limited studies have attempted to explore consumers' experiences, particularly in developing countries, such as Ghana. This paper aims to explore consumers' subjective experiences of the quality of mental health services. A qualitative method involving in-depth interviews was used to collect data from 21 consumers of mental health services. Thematic analysis was used to analyse the data, which is discussed using a realistic evaluation approach. The study identifies four themes, 33 inductive codes and 594 references. The themes used to interpret the verbatim narratives are the available mental health services, therapeutic interaction with the professionals, competency and skills of the professionals, and the changes experienced in the consumers' lives. The study indicates that the mental health services aim to provide a range of treatments and medications as well as recovery-oriented services, using mechanisms such as ensuring an effective therapeutic relationship and improving technical competency and skills. The contextual factors and the mechanisms have helped to achieve some changes in the lives of consumers (increased satisfaction, reduced symptoms, improved functionality, feeling normal, improved living skills and self-care, work and capabilities, and social inclusion). The study concludes that policymakers and clinicians should integrate evidence-based recovery services, principles and values into the existing mental health services. The mechanisms used to promote quality of mental health services should be strengthened, through periodic monitoring and evaluation, using approaches such as sensor data capturing, to ensure good coordination and continuity. [ABSTRACT FROM AUTHOR]

Despite a growing burden of stroke in low‐middle‐income countries, research on patient's experiences and access to rehabilitation services remains limited. This study explores the experiences of stroke patients in relation to access and use of stroke rehabilitation services, coping strategies and strategies to improve care in Ghana. A cross‐sectional study was conducted. A total of 136 adult stroke patients hospitalised and subsequently discharged in three major referral hospitals in Ghana participated in the study. A paper‐based questionnaire was used to collect data. Data were inputted into STATA version 12, cleaned and analysed using descriptive statistics and Chi‐Square tests. Findings showed that stroke patients experience stroke differently. Early detection (awareness) of stroke symptoms at onset was low (29.4%). Hypertension was the major (58.1%) predisposing risk factor for stroke, followed by diabetes (14.7%). Multiple barriers impede access to outpatient rehabilitation services: high cost of medications (43.4%), transportation constraints (10.3%), long waiting time (6.6%), forgetfulness about appointment (4.4%), limited education on rehabilitation (20.6%), lack of community support (12.5%) and ineffective communication with healthcare providers (5.2%). Recommended strategies to improve access to rehabilitation care included public education on stroke and its associated risk, reduction in the cost of drugs and increased stroke rehabilitation funding by the NHIS, especially for physiotherapy consultation and training support to caregivers on patient care. Given the difference in stroke experience and barriers in accessing rehabilitation care, multi‐level health policy and service delivery reforms are needed to improve access to rehabilitation care, including national public awareness campaigns on early signs of stroke and subsidised cost of stroke rehabilitation. [ABSTRACT FROM AUTHOR]

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted. [ABSTRACT FROM AUTHOR]

Background: Collaborative clinical facilitation converges key players to guide students individually and within groups towards achieving clinical nursing competence. However, experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and nursing and midwifery students are often fragmented and have been largely unexplored in Ghana. Aim: To describe the experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and final year nursing and midwifery students in Northern Ghana. Setting: The study was conducted at two nursing and midwifery colleges and an academic hospital in Northern Ghana. Methods: A qualitative, descriptive, exploratory design was utilized. Forty-six participants comprising 16 nurse educators, 10 clinical preceptors, 10 nursing students and 10 midwifery students were purposively sampled. Focus groups and in-depth interviews were used to gather data and analysed thematically. Results: Three themes revealed facilitative experiences of collaborative clinical facilitation: team-based clinical mentorship and supervision, personalised preceptorship, and clinical conferences. Two themes emerged inhibitory to collaborative clinical facilitation: staff shortages and lack of timely communication. Conclusion: This study found that team mentorship, preceptorship and conferences fostered collaborative clinical partnerships for students' clinical learning. However, failure to engage in timeous communication in the midst of staff shortages hampered its smooth practice. Orientation workshops need to be organised for key players to share relevant updates and explore ways to navigate the challenges often experienced within the clinical training environment. Contribution: This paper provides insight into the collaborative nature of clinical facilitation; and highlights the need for coordinated clinical placements to enhance students' clinical learning. [ABSTRACT FROM AUTHOR]

Background: COVID-19 vaccine hesitancy is a major public health challenge with the potential to prevent communities from achieving the coverage level necessary for herd immunity against the COVID-19 virus. Objective/aim: The study determined COVID-19 vaccine acceptance and associated factors among residents of the Afadzato South District of Ghana. Methods: A descriptive cross-sectional study was conducted among 422 respondents aged 18 years and above using a self-administered and interviewer administered structured questionnaires for persons who could read and with no formal education respectively. The study was conducted and reported in line with the Strobe statement for cross sectional studies. Data analysis was done using the Stata-17.0 software. The association between the dependent and independent variables was examined using a logistic regression analysis, with a p-value of < 0.05 considered statistically significant. Results: More than half of the respondents (n = 291, 68.96%) were below 25 years old. Majority of the respondents were females (n = 218, 51.66%) and had attained secondary education (n = 291, 68.96%). Less than half of the respondents 35.5% (151) indicated acceptance of the COVID-19 vaccine and more than half (n = 271, 64.22%) indicated non-acceptance of the COVID-19 vaccine. The results showed that education level, information source, overall knowledge of COVID-19 vaccine, and misconception of COVID-19 vaccine were significantly associated with acceptance of the COVID-19 vaccine. Conclusion: The study found high vaccine hesitancy among the respondents. Important significant predictors of COVID-19 vaccine hesitancy were education level, information source, overall knowledge of COVID-19 vaccine, and misconception of COVID-19 vaccine. In the attempt to address vaccine hesitancy by health agencies, it is important to take into consideration the varying educational backgrounds of the population in context and their diversified sources of information. This may ensure that everyone in the community is reached with important information on COVID-19 and its vaccines to reduce misconceptions and misinformation. [ABSTRACT FROM AUTHOR]

Introduction: Terminal illness is an irreversible illness that, without life-sustaining procedures, usually results in death or permanent disability from which recovery is unlikely. When involved, family caregivers are believed to improve health outcomes, such as reduced hospitalization, and establishing a patient's initial access to professional treatment services. However, caring for a patient with a terminal illness is viewed as one of the most difficult aspects of providing care. This study aimed to identify the challenges, and coping strategies developed by family caregivers to cope with the care of the terminally ill person. Methods: An exploratory descriptive qualitative approach was used. Twenty (20) family caregivers voluntarily participated in the study from the Korle-Bu Teaching Hospital. Semi-structured interviews were conducted with the participants. The transcribed interviews were then analysed using thematic analysis. Results: From the analysis, three main themes emerged: challenges, coping strategies, and social support. These themes encompassed sixteen subthemes including financial burden, bad health conditions, faith and prayer, and support from health professionals. From the study, both male and female family caregivers narrated that providing care for sick relatives undergoing terminal disease is characterized as a daily duty demanding one's time and fraught with emotional strain. In addition, even though it was a difficult job, family members who provided care for ailing relatives never gave up, citing responsibility, the importance of family, and religious beliefs as the primary motivations for doing so. Conclusion: The difficulties and demands of family caregiving roles for terminally ill relatives are complex and multifactorial. The findings call for multidisciplinary professional attention for family caregivers and policies that will support their lives holistically. [ABSTRACT FROM AUTHOR]

Background: High completed fertility among married and cohabiting women has profound consequences, including straining resources, increasing healthcare challenges, and contributing to educational and gender inequalities. This study examined the factors associated with high completed fertility among married and cohabiting women aged 40–49 years in Ghana. Methods: Data for the study was sourced from the 2022 Ghana Demographic and Health Survey (GDHS). A spatial map was used to present the women's geographic variations in high completed fertility. A mixed-effect multilevel binary logistic regression analysis was performed to identify the factors associated with high completed fertility. The findings were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI). Results: The national proportion of high completed fertility among married and cohabiting women aged 40–49 years in Ghana was 52.0% [48.8, 55.2]. Women who were Ga/Dangme/Ewe by tribe [aOR = 2.32, 95% CI = 1.06, 5.08] had higher odds of high completed fertility than Akans. Women who indicated 6 + as their ideal number of children had a higher [aOR = 5.60, 95% CI = 2.90, 10.82] likelihood of high completed fertility compared to those whose ideal number of children was 0–3. Those who were using contraceptives at the time of the survey had a higher [aOR = 2.31, 95% CI = 1.17, 4.55] likelihood of high completed fertility compared to those who were not using contraceptives. Women with secondary/higher education [aOR = 0.32, 95% CI = 0.17, 0.58] had lower odds of high completed fertility than those without no formal education. Women with females as household heads [aOR = 0.56, 95% CI = 0.33, 0.95] had lower odds of high completed fertility than males. Women in Volta, Western North, Ahafo, and Bono regions had lower odds of high completed fertility compared to those living in the Northeast region, with the lowest odds among those living in the Volta region [aOR = 0.08, 95% CI = 0.02, 0.40]. Conclusion: High completed fertility is prevalent in Ghana, with more than half of married and cohabiting women having at least five or more children. The government and policymakers in Ghana should promote education for women, increase culturally sensitive family planning programs, increase access to family planning resources, address ideal family size preferences, and improve understanding of contraceptive use. [ABSTRACT FROM AUTHOR]

Background: This study assessed knowledge, behaviors, and perceptions towards hypertension following community dissemination on cardiovascular disease (CVD) risk within the Navrongo Health and Demographic Surveillance Site in Northern Ghana. Methods: A cross-sectional mixed methods study was conducted among middle aged men and women following education on CVD and their risk factors. Knowledge and attitudes of participants regarding hypertension were measured in 310 participants using a survey tool and the resultant data was analyzed with descriptive statistics. Focus group discussions (FDG) were used to assess perceptions of 40 study participants on their lived experiences with hypertension. Recorded interviews were transcribed verbatim and coded into themes using Nvivo 12 software before thematic analysis. Results: Of the 310 surveyed participants, 54% were women and the mean age was 50 ± 6 years. The results showed that 84% of participants had heard about hypertension, 70% knew it was an increase in blood pressure and could be caused by excess salt intake, poor diet and physical inactivity. About 22.3% of participants were aware of the had hypertension. In terms of management, majority of the participants were aware that hypertension could be treated with antihypertensive medication and that untreated or uncontrolled hypertension could result in adverse health consequences. Few participants had ever had their blood pressure measured and did not access screening or healthcare care services and rather perceived the health system as inadequate to screen, and manage hypertension. Conclusion: Though, knowledge on hypertension was high, awareness of hypertension status and access to screening and healthcare services was low. Community beliefs and perceptions strongly influence treatment, and control of hypertension. Effective sustained community dissemination efforts addressing misperceptions could improve hypertension treatment and control. [ABSTRACT FROM AUTHOR]

Refugees and asylum seekers bring with them a plurality of cultures, traditions, and values that could prove crucial in influencing perceived health needs, requests for intervention, or willingness to undergo specific health treatments. Although studies have focused on the health consequences of forced migration, in recent years, there has been a lack of information on how refugees and asylum seekers represent their experiences of perceived health needs and elements that influence well-being, in a community context. This study aims to explore the experience of refugees and asylum seekers in an Italian multicultural community about perceived health needs. A qualitative phenomenological study was conducted with an interpretive approach. The data were collected using a semi-structured face-to-face interview. The interviews were transcribed, read thoroughly, and analyzed. Nineteen refugees and asylum seekers were interviewed. Three main themes were extracted: (1) the centrality of the family to feel healthy; (2) feeling part of a community; and (3) stability and security. The results confirm that health needs, experiences, and different cultural representations of health and illness should be read and addressed with a culturally competent vision. This study was not registered. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: A sustainable point-of-care (POC) diagnostic testing implementation in low-resourced facilities enhances quick diagnostic investigation and halts unnecessary referrals. This study identified the barriers impeding the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana; as well as explored potential solutions that could enhance the accessibility and effectiveness of POC diagnostic testing, ultimately improving the quality of healthcare delivery. Methods: A total of twenty-eight participants were purposively selected from health facilities in low-resourced settings in the Bono Region for a descriptive qualitative study. Of the twenty-eight participants, seventeen including ten healthcare providers from CHPS facilities, six district health depot managers, and one regional depot manager were engaged in in-depth interviews. Additional eleven including nine healthcare providers and two district depot managers were also engaged in focus group discussions. NVivo version 12 software was employed for condensation, labelling, and grouping of themes. Data was analysed narratively. Results: Work overloads, limited POC testing services, stock-outs of POC tests at the facilities, and supply-related challenges of POC test kits were identified as major barriers to POC testing services. To solve these barriers, adequate funding, an effective delivery system, stakeholders' engagement and advocacy, and in-service and refresher training courses were suggested as potential solutions to POC diagnostic testing services implementation by the stakeholders. Conclusions: This study's findings emphasize the need to address the barriers hindering the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana. The suggested solutions provide a roadmap for improving the accessibility and effectiveness of POC testing, which has the potential to enhance the quality of healthcare delivery, reduce unnecessary referrals, and ultimately improve patient health outcomes in underserved settings. [ABSTRACT FROM AUTHOR]

Introduction: People with disabilities (PwDs) constitute a large and diverse group within the global population, however, their sexual and reproductive health (SRH) needs are often neglected, particularly in low-and middle-income countries. This may result in adverse outcomes, such as sexually transmitted infections (STIs), unintended pregnancies, and experience of interpersonal violence (IV). This study aimed to assess the factors that influence the sexual lives of PwDs in two districts of Ghana. Methods: A sequential explanatory mixed-methods study design was used to collect data from PwDs. Quantitative data were obtained from 402 respondents using a pretested questionnaire, and qualitative data gathered from 37 participants using in-depth interviews. The quantitative data were analysed using descriptive and inferential statistics, while the qualitative data were analysed using inductive thematic analysis. Results: Most PwDs (91%) reported that they have ever had sex, which was associated with age, disability severity, and household size. The prevalence of poor SRH status, STIs, unintended pregnancy, pregnancy termination, and unsafe abortion were 10.5%, 5.7%, 6.4%, 21.6%, and 36.9% respectively. These outcomes were influenced by education, income, health insurance subscription, and proximity to a health facility. The prevalence of IV was 65%, which was related to disability type and severity. The qualitative data revealed five main themes: curiosity to engage in sexual activities, feelings of despair and insecurity with abled partners, preference for sexual relationships with other PwDs, IV and its perpetrators, and adverse SRH outcomes. Conclusion: The study findings indicate that most adult PwDs have ever had sex and they face various challenges in their sexual lives. They experience multiple forms of abuse and neglect from different perpetrators at different levels of society, which have negative impacts on their well-being. There is a need for comprehensive and inclusive interventions that address the SRH needs of PwDs, as well as the underlying social and structural factors that contribute to their vulnerability. Further research is recommended to explore the perspectives of stakeholders on how to improve the SRH outcomes of PwDs. Plain Language summary: People with disabilities make up 16 percent of the world population, but their sexual and reproductive health (SRH) needs are often unmet, especially in poorer countries, contributing to adverse outcomes. This study assessed factors influencing the sex lives of PwDs in two districts of Ghana. Quantitative data were collected from 402 respondents, while qualitative data were collected from 37 participants. The results showed that age, severity of disability, and household size influence sexual activity. Many respondents also reported adverse SRH issues including STIs and unintended pregnancies. Sixty-five percent reported experiencing violence or abuse, which is related to their disability type and severity. The study also found that PwDs encounter many challenges in their sexual lives, including abuse and neglect. The findings suggest the need to pay attention to the sexual health needs and the social issues that make PwDs vulnerable to various abuses. [ABSTRACT FROM AUTHOR]

Background: Being aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period is often overlooked but remains a significant contributor to unintended pregnancies and may lead to maternal and neonatal comorbidities. Exploring the extent of awareness and associated factors could help tailor more interventions toward reducing the rates of short-interval unplanned pregnancies. Objective: This study explores the extent to which Ghanaian women are aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period and its associated factors. Design: A cross-sectional study was conducted using the 2017 Ghana Maternal Health Survey. The women participants were sampled using a two-stage cluster sampling design. Methods: We analyzed the 2017 Ghana Maternal Health Survey data of 8815 women who had given birth and received both antenatal care and postnatal checks after delivery in health facilities (private and public) and responded to questions on being aware of short interpregnancy intervals. A multivariable survey logistic regression was used for the analysis. Results: Of the 8815 women, approximately 62% of women who received both antenatal care and postnatal examinations before discharge reported being aware of short interpregnancy intervals. Postnatal examination before discharge but not antenatal care was associated with a higher awareness of short interpregnancy intervals. Women who received a postnatal examination were more aware of short interpregnancy intervals than their counterparts (adjusted odds ratio = 1.29, 95% confidence interval: 1.03–1.61). Also, awareness of short interpregnancy intervals increased with age, education, knowledge of the fertile period, contraceptive use, and delivery via cesarean section. Conclusion: Over a decade following the initiation of Ghana's free maternal health policy, there remains a significant gap in the awareness of short interpregnancy intervals, even among women who received both antenatal pregnancy care and postnatal examinations before discharge. The unawareness of the short interpregnancy interval observed in approximately 38% of women raises concerns about the effectiveness of counseling or education provided during antenatal care and immediate post-partum care regarding birth spacing, contraceptive use, the timing of resumption of sexual activity, and the extent to which women adhere to such guidance. Plain Language Summary: A study found more women were unaware of pregnancy soon after birth before menses Unplanned pregnancies may lead to worsened health conditions for mothers and newborn infants. One possible way this unplanned pregnancy could happen is through unknowingly becoming pregnant soon after birth before menstruation resumes. However, the more we know about pregnancy soon after birth before menstruation resumes, the better we can introduce measures to reduce it. This study examines how well Ghanaian women are aware of the possibility of becoming pregnant soon after birth before menstruation resumes and factors that may influence the awareness. This study analyzed 2017 data collected from women who received pre-delivery care and post-delivery checks before discharge from a health facility. The study findings revealed that 38% of the 8815 women who received both pre-delivery care and post-delivery checks were unaware of pregnancy soon after birth before menstruation resumed. Factors such as post-delivery checks, contraceptive use, delivery through cesarean section, women aged 30 years and over with secondary education and higher, and having knowledge of the periods more appropriate for a woman to be pregnant were more aware of pregnancy soon after birth before menstruation resumed. We proposed that effective counseling and adherence from women who are not planning to get pregnant soon after birth could help reduce the rate of pregnancy soon after birth before menstruation resumes. These unplanned pregnancies can also be avoided by educating women about birth spacing, contraceptive use, and the timing of resumption of sexual activity. [ABSTRACT FROM AUTHOR]

Introduction. Effective​ self-reporting of medication administration errors (MAEs) is crucial for patient safety globally, yet underreporting persists as a significant challenge, hindering policy interventions. Despite extensive studies on barriers to MAE reporting by nurses, limited attention has been given to this issue in Ghana. This study aimed to explore the reasons behind nurses' reluctance to report MAEs, contributing to a broader understanding of this critical issue. Methods. A cross-sectional study was conducted among registered nurses at two public health facilities in the Ashanti Region, Ghana. Self-administered questionnaires were distributed to 153 respondents using stratified and simple random sampling. Descriptive and inferential statistics, including chi-square and logistic regression, were employed to analyze 150 completed questionnaires using SPSS version 23, with a significance level set at P < 0.05. Results. The majority (60.7%) of nurses reported MAEs, primarily to the ward in-charge (72.0%) and documented in the incidence book (54.3%), while only 9% reported to patients. Reasons for nonreporting included fear of criticism (34.5%), litigation (19.5%), losing practice licenses (18.6%), and stigma (17.7%). Significant correlations were found between nurses' sociodemographic characteristics (age, marital status, years of practice, and rank) and their self-reporting of MAEs (P < 0.05). Conclusion. Despite high levels of self-reported MAEs among nurses, fear remains a pervasive barrier to reporting. Addressing the culture of blame, criticism, and stigma is imperative to enhance nurses' confidence in reporting MAEs globally, transcending geographical boundaries and fostering patient safety on a broader scale. [ABSTRACT FROM AUTHOR]

We explored the views of members of parliament (MPs) in Ghana on the call to decriminalise attempted suicide. We applied reflexive thematic analysis to Parliamentary Hansards (2017–2020) on calls to decriminalise attempted suicide in Ghana. 11 MPs shared their stance for or against the call. We developed three major themes that entailed, often, opposing views: (1) deterrent effect of the law (against: the law punishes and deters to protect life; for: the law is insensitive and has ironic effects), (2) enforcement of the law (against: leave things as they are, the law is not enforced, anyway; for: crime is not self-inflicted) and (3) prioritisation of suicide prevention (against: focus on more pressing issues, but resource support systems; for: the law and legitimate support systems cannot co-exist). The findings indicate two needs: to extend suicide literacy to Ghanaian MPs, and to initiate a public/private member's bill on attempted suicide decriminalisation. [ABSTRACT FROM AUTHOR]

Background. Although inappropriate gestational weight gain is considered closely related to adverse maternal and birth outcomes globally, little evidence was found in low- and middle-income countries. Study Objectives. This study is aimed at identifying the determinants of gestational weight gain and examine the association between gestational weight gain and maternal and birth outcomes in the Northern Region of Ghana. Study Methods. The study used a facility-based cross-sectional study design involving 611 antenatal and delivery records in Tatale district, Tamale west, and Gushegu municipal hospitals. A two-stage sampling method involving cluster and simple random sampling was employed. Descriptive statistical analysis and measures of central tendency were used to describe the sample. The multinomial logistic regression model was used to determine the determinants of gestational weight gain and its association with maternal and birth outcomes. Results. Among the 611 women included in the study, 516 (84.45%) had inadequate gestational weight gain, and 19 (3.11%) had excessive gestational weight gain. The gestational weight gain ranged from 2 kg to 25 kg with a mean of 7.26 ± 3.70 kg. The risk factor for inadequate gestational weight gain was low prepregnancy BMI (adjusted odds ratio AOR = 1.33 , 95% CI = 1.18 − 2.57 , P = 0.002). Pregnant women who had inadequate gestational weight gain were significantly less likely to deliver through caesarean section (AOR = 0.27 , 95% CI = 0.12 − 0.61 , P = 0.002), and those who had excessive weight gain were more likely to undergo caesarean section (AOR = 19.81 , 95% CI = 5.38 − 72.91 , P = 0.001). The odds of premature delivery (birth < 37 weeks) among pregnant women with inadequate weight gain were 2.88 (95% CI = 1.27 − 6.50 , P = 0.011). Furthermore, subjects who had excessive weight gain were 43.80 times more likely to give birth to babies with macrosomia (95% CI = 7.07 − 271.23 , P = 0.001). Conclusion. Inappropriate gestational weight gain is prevalent in Ghana, which is associated with caesarean section, preterm delivery, delivery complications, and macrosomia. Urgent policy interventions are needed to improve on the frequent monitoring and management of gestational weight gain of pregnant women till term. [ABSTRACT FROM AUTHOR]

Background: Oral disease poses a significant public health burden for many countries and affects individuals throughout their lifetime, causing pain, disfigurement, impairment of function and reduced quality of life. Among children and adolescents globally, there is a recognized trend of poor oral hygiene, attributed to the accumulation of plaque and calculus deposits that increase with age. This study assessed the knowledge, practice and factors associated with the practice of oral hygiene among Junior High School students (JHS) in Koforidua, in the Eastern Region of Ghana. Methods: A school-based cross-sectional study design was conducted among 233 JHS students in Koforidua township using a multistage sampling technique. Descriptive and inferential statistics, including frequency, percentage, and Pearson's Chi-square test, were conducted. The results were interpreted using tables and graphs. Results: Findings from the study revealed that more than half 126 (54.1%) of the respondents had a good level of knowledge of oral hygiene. The majority 130 (55.8%) of them also had good oral hygiene practice. The findings further indicated that a significant relationship was found between the class or education level of students and good oral hygiene practice (χ2 = 17.36, p < 0.001). Conclusion: Overall, the current study found that over half of the JHS students had good knowledge as well as practice of oral hygiene. This reinforces the significance of oral health education and awareness campaigns, especially in school settings, to improve knowledge, attitudes, and behaviours related to oral hygiene. The study however found only class or education level of students to be statistically associated with the practice of oral hygiene. While other variables did not reach statistical significance, our research serves as a starting point for further investigation and exploration of the various factors that may contribute to oral hygiene practices. [ABSTRACT FROM AUTHOR]

Background: The need for primary care physicians to be heavily involved in the provision of palliative care is growing. International agencies and practice standards advocate for early palliative care and the use of specialized palliative care services for patients with life-threatening illnesses. This study was conducted to investigate physicians' referral practices and perceived barriers to timely referral at the Korle Bu Teaching Hospital. Methods: A cross-sectional study design was employed using a convenience sampling technique to recruit 153 physicians for the study. Data on socio-demography, referral practices, timing and perceived barriers were collected using a structured questionnaire. Binary Logistic regression using crude and adjusted odds was performed to determine the factors associated with late referral. Significance was set at p < 0.05. Results: The prevalence of late referral was reported to be 68.0%. There were poor referral practices among physicians to palliative care services, and the major barriers to late referral were attributed to the perception that referring to a palliative care specialist means that the physician has abandoned his patient and family members' decisions and physicians' personnel choices or opinions on palliative care. Conclusion: The healthcare system needs tailored interventions targeted at improving physicians' knowledge and communication strategies, as well as tackling systemic deficiencies to facilitate early and appropriate palliative care referrals. It is recommended that educational programs be implemented, palliative care training be integrated into medical curricula and culturally sensitive approaches be developed to address misconceptions surrounding end-of-life care. [ABSTRACT FROM AUTHOR]

Background: Children's initiation of early sex has several negative implications on their sexual and reproductive health, growth and development. In Ghana, few studies on early sexual debut have focused on adolescents. Therefore, this study examined the prevalence, causes, correlates and effects of early sexual debut among children aged 8 to 17 in Ghana using secondary data from the Department of Children of the Ministry of Gender, Children, and Social Protection. Methods: A convergent parallel mixed-method approach guided the study. Descriptive statistics and multivariable binary logistic regression were used to analyse the quantitative data, while thematic analysis was used to analyse the qualitative data. Results: The study found that the prevalence of early sexual debut among children was 13.2%, which is more predominant among female children. The main causes of early sexual debut include engaging in sex after watching pornography, self-desire to have sex, and being influenced by alcohol consumption. Also, age, sex, education, marital status, religion, ecological zone, living arrangements, and access to the Internet were significant correlates of early sexual debut. Early sexual debut increases children's risk of unwanted pregnancy, which leads to the termination of children's education or induced abortion. Also, early sexual debut had adverse impacts on the wellbeing of pregnant children and increased children's risk of multiple lifetime sexual partners. Conclusions: This study demonstrated that socio-demographic characteristics of children (e.g., age, sex, education, and marital status) were significant correlates of early sexual debut. Policymakers need to design appropriate interventions, considering the socio-demographic characteristics of children, to curb its occurrence in Ghana. [ABSTRACT FROM AUTHOR]

Background: Since its emergence, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused severe health, social and economic challenges. Mental healthcare has been significantly affected globally, and even worse in developing countries. An emerging economy like Ghana in West Africa was not spared its disruptive effects. This study aimed to elucidate the impact of the coronavirus disease 2019, the COVID-19 pandemic (caused by SARS-CoV-2), on Ghana's mental healthcare system. Methods: This is a mixed-method study using an emergent sequential exploratory design. A total of 15 front-line healthcare professionals were recruited from the three psychiatric hospitals, including the mental health department of a new teaching hospital in Ghana. Purposive sampling techniques and a semi-structured interview approach were used for recruitment and data collection. Quantitative data from hospital registries were collected and analysed to triangulate qualitative findings. Results: Fifteen mental health workers were enrolled in the study. The mean age of participants was (34.47 ± 4.07) years, average work experience of (6.23 ± 3.64) years and the majority as males (60%). This study found an average decline of 23% in hospital attendance and a 35% decline in admissions in all four facilities compared to the previous year, 2019. The lived experiences shared by mental healthcare providers were grouped under 3 main themes: Adjustments to workplace regulations, accessibility to mental healthcare, and psychological wellbeing of mental healthcare workers. The fear of contracting SARS-CoV-2 among healthcare workers, medication shortages, and logistical challenges were also reported to affect Mental Health services during the pandemic. Conclusion: This study highlights the challenges in mental healthcare during the COVID-19 pandemic in Ghana. The experiences encountered present an opportunity to gain insights into future pandemic preparedness and establish a framework for optimal mental healthcare delivery in Ghana. [ABSTRACT FROM AUTHOR]

Aim: The study's main objective was to use a fuzzy set qualitative comparative analysis to identify the configuration of recipes that predict nurses' safety compliance behaviour. Design: A cross-sectional design. Methods: A survey was used where questionnaires were collected from 285 nurses across four primary healthcare hospitals within the Ashanti Region, Ghana. The data collection happened between June 1 to August 2, 2022. A fuzzy set qualitative comparative analysis was used to identify the recipes of psychological factors that determine nurses' safety compliance behaviour. Results: Results from the study suggest that the necessary configurations that explained nurses' safety compliance behaviour came from the presence of subjective norm, attitude, perceived behavioural control, perceived organizational support and negation of intention. The result highlights the need for safety protocols to be conscious of the interplay between nurses' assessment of self, social clues and perception of management care and support since such psychological factors must be considered concurrently to achieve the optimal safety compliance behaviour among nurses. Conclusion: A health and safety protocol that fails to recognize the importance of psychological antecedents on subordinates' safety compliance behaviour could limit the safety policy's usefulness in bringing the appropriate behavioural change in nurses. Impact: To date, no study has combined the antecedents of theory planned behaviour with perceived organizational support and cue to action to assess how they collectively predict nurses' safety compliance behaviour. Findings from the study suggest that nurses in primary health facilities inform their safety compliance behaviour by assessing self-capabilities, social signals from superiors and colleagues and perception of management support. Hospital administrators and nursing managers in sub-Saharan Africa may rely on these psychological forces to persuade nurses to develop positive safety compliance behaviour at the health facility. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study used qualitative data from 30 women in three of Ghana's 16 administrative regions to explore motivations and barriers to help-seeking among victims of intimate partner violence. Results of the thematic analysis showed low reporting to formal support networks, such as the Domestic Violence and Victim Support Unit or the police, with higher preference for informal sources, such as family members and friends. Motivations to seek help included fatigue, severity of abuse, abusive partner's negligence in honoring marital obligations, and trust in family members. Barriers to help-seeking included: fear of divorce, stigmatization, lack of trust in formal support channels, sociocultural norms emphasizing gender role expectations, and family privacy. [ABSTRACT FROM AUTHOR]

Introduction: Breastfeeding has proven over the years to be one of the most effective means to ensure child survival. The advocators and myth busters of breastfeeding myths are supposed to be health professionals. However very little is known about myths surrounding breastfeeding as expressed by these health professionals (nurses and midwives). Hence this study. Objective: The study aimed at exploring the myths about breastfeeding as voiced by lactating nurses and midwives. Method: Qualitative exploratory descriptive design was used to investigate the subject matter. Twenty-five nurses and midwives were purposely selected to participate in the study after they had voluntarily opted to be part of the study. Data was audiotaped, transcribed verbatim and inductively analyzed. Results: It was evident that participants believed in myths about breastfeeding. The main themes discovered were breastfeeding myth beliefs and sociocultural myth influences. Six sub-themes identified were green stools/diarrhoea, childhood disease, teeth discoloration, child becoming stupid, culture and close relatives. Conclusion: Health professionals believe in unfounded myths about breastfeeding. Steps should be taken for them to get better lactation support. The outcomes of this study underscore the need for health professionals to address breastfeeding myths, understand the sociocultural context, and support evidence-based practice. Improving lactation support and education for nurses and midwives can lead to better clinical practice and, as a result, help to promote successful and healthy breastfeeding in Ghana. [ABSTRACT FROM AUTHOR]

Background: Systems of across the world have developed and implemented patient rights policies to protect and improve the provider-patient relationship. The Patient Charter of Ghana was developed in 2002 to improve service quality and protect patients' rights. However, it is not yet known whether those at the frontline of healthcare delivery can read and understand the contents of the charter. While studies have explored the socioeconomic and institutional level factors related to awareness and knowledge of the Patient Rights Charter, there is a lack of literature on its readability and comprehensibility among nurses. This study assesses nurses' knowledge of the Patient Rights Charter and associated literacy-related factors. Method: An exploratory cross-sectional design and quantitative methods were used to collect data on knowledge, comprehension, and readability of the Patient Rights Charter. 205 nurses from four district hospitals in the Central Region were recruited using proportional and total enumeration sampling. Data were collected using structured questionnaires and were processed using SPSS (version 26) and an online text readability consensus calculator (version 2.0). Descriptive and inferential statistical analyses were performed, and data were presented using simple frequencies, readability statistics, and regression output. Results: The results show the charter is written at a higher reading grade level; Flesch-Kincaid Grade Level (13.36), Simple Measure of Gobbledygook (11.57), and Coleman-Liau Readability Index (14.2). The average reading grade level score was 14. The Gunning Fox Index (15.40) and the Flesch Reading Ease Score (34%) show the patient charter is difficult to read and will require at least 14 years of education to be able to read. 87.3% of nurses were able to read and comprehend the charter. Very few (8.3%) read at frustration level. Nurses' actual comprehension of the charter was the only significant predictor of knowledge of the charter. Conclusion: Comprehension of the patient charter is an important predictor of its knowledge. The results emphasize the need to enhance the readability and comprehensibility of the charter for providers. Hospitals can stimulate nurses' knowledge of the charter by simplifying the charter's language and deliberately educating nurses on its content. [ABSTRACT FROM AUTHOR]

Aim: To explore nurse managers' perceptions of patient‐centered care (PCC), its influence on quality nursing care, nurse job satisfaction, and to provide baseline data for a context‐driven PCC model. Design: The study utilized a qualitative, phenomenological design, employing individual in‐depth interviews to collect data on nurse managers' PCC perceptions until data saturation. Methods: Sampling involved purposive selection of Northern Ghana, random selection of the tertiary hospital cluster with the three participating hospitals, and purposive sampling of the nine nurse managers. Data analysis employed thematic analysis based on a six‐phase framework. Methodological trustworthiness was ensured through various strategies including prolonged engagement, supervisor discussions and crosschecking with interviewees. Results: Three main themes emerged from the study including nurse managers' conceptualization of PCC, perceived patient‐centred practices and its influence on nursing quality and job satisfaction. The findings emphasized the patient's individuality, cultural values, holistic care, the importance of strong nurse‐patient relationships and a patient‐centric environment. The nurse managers perceived PCC as positively influencing quality nursing care and nurse job satisfaction. The findings offer nuanced insights into nurse managers' perspectives on patient‐centeredness and highlight areas for improvement. [ABSTRACT FROM AUTHOR]

While the understanding of child marriage in Ghana has improved in recent decades, scholarship on this important topic remains scant, especially research examining the reasons for child marriage across socio-cultural contexts. We apply the social-ecological model to explore the drivers of child marriage in the Bawku West District in Ghana. After purposive sampling, we conducted in-depth interviews with 15 women who married before the age of 18 and thematic content analysis to summarize the text. The findings reveal that child marriage is commonplace in the study area and has several drivers, including community/societal factors such as poverty and bride price payment. Other drivers include teenage pregnancy and low educational levels. The results corroborate the social-ecological model in which child marriage has multiple levels of influence. Findings suggest that addressing child marriage in Ghana requires practical solutions across all sectors and levels. Highlights: Female child marriage remains unacceptably high in Ghana. Research examining reasons for child marriage in Ghana is limited. This study examined reasons for child marriage in the Bawku West District of Ghana. Factors at multiple levels of the social-ecological system influence child marriage. Preventing child marriage requires practical solutions across all sectors and levels. [ABSTRACT FROM AUTHOR]

Sida cordifolia has been used to treat malaria in Ghana albeit without scientific evidence of antimalarial activity and safety. This work aimed to assess the antimalarial properties and acute toxicity of the aqueous leaf extract of S. cordifolia in murine models. Aqueous extract of the plant was analysed for both suppressive and curative antimalarial properties in chloroquine-sensitive ANKA strains of rodent Plasmodium berghei-infected mice. Acute toxicity evaluation was performed in rats according to the OECD 425 guidelines. The extract displayed antiplasmodial activity in vivo with ED50 of 117.49 ± 15.22 mg/kg and 144.84 ± 18.17 mg/kg in suppressive and curative studies, respectively. The highest % parasitaemia suppression exerted was 76.90 ± 0.64% and 61.50 ± 0.97%, respectively, in the suppressive and curative studies. Survival of infected mice treated with the extract was significantly prolonged. This was dependent on the dose of the extract but imperfectly related to the % parasitaemia suppression. Related antimalarial parameters including percentage hematocrit, changes in body weight, and temperature of experimental mice indicated alleviation of malarial symptoms of treated animals. The extract did not show toxicity in rats. Sida cordifolia L. has antimalarial properties, and was safe. It suppressed parasitaemia in both suppressive and curative studies, was not toxic to animals and prolonged the life of infected animals under treatment. This, therefore, justifies the traditional use of S. cordifolia for the treatment of malaria in Ghana. [ABSTRACT FROM AUTHOR]

Menstruation-related school absenteeism significantly affects girls' academic progress and general wellbeing. This study aimed to assess menstruation-related school absenteeism in an urban population in the Northern Region of Ghana. A school-based cross-sectional study was conducted to determine the prevalence of school absenteeism among girls using a structured questionnaire, which was pretested. The data were analyzed using Stata 16. Descriptive and inferential statistics, including cross-tabulation, the chi-square test, and binary logistic regression, were performed. The majority (59%) was between the ages of 15 and 19 years. Approximately one fifth of all respondents missed school during menstruation. Reasons assigned to missing school were menstrual pains (57%), stained clothes (43%), heavy bleeding (40%), and self-stigmatization (2%). The majority (95%) of respondents used some form of materials to absorb menstrual blood. About 88% of respondents used sanitary pads, 11% used cloth, and 1% used tissues to absorb their menstrual blood. The multivariable analysis showed that school girls < 15 years old (AOR: 3.69, 95% CI: 2.02–6.73), first year of Junior High School (AOR: 4.68, 95% CI: 2.14–10.22), and public school (AOR: 3.57, 95% CI: 1.83–6.94) were associated with increased odds of menstruation-related school absenteeism. Menstruation-related school absenteeism is considered high and could affect girls' educational attainment. School absenteeism due to menstruation, particularly in public schools, warrants attention by the Ghana Education Service. [ABSTRACT FROM AUTHOR]

Aim: This study assessed adolescents' satisfaction with services received during their most recent abortion and the factors associated with satisfaction at reproductive health centres in the Greater Accra region of Ghana. Design: A facility‐based cross‐sectional survey was used for this study. Methods: Overall, 254 adolescent girls aged between 15 and 19 years, who had an abortion within 1 week of the study period were recruited for the study. All the 254 respondents were recruited consecutively as they visited health facilities for abortion services from March 2019 to February 2020. Written informed consent was signed by respondents, and data were collected using the Patient Satisfaction with Nursing Care Quality Questionnaire, and the data were analysed using Stata version 15.0. Univariate, bivariate and multivariate logistic regression analyses were conducted. Results: A majority of adolescents reported being satisfied with the abortion services they received. Ample waiting space and the system of 'first‐come‐first‐served' were the highest rated elements of service satisfaction. Adolescents were least satisfied with the inadequacy of instructions and lack of information on medications received and their therapeutic or side effects. Ethnicity, having a stable intimate partner and perceived adequacy of staff were the factors associated with satisfaction with abortion services. Conclusion: Adolescents are unique group of people with peculiar health needs. If they are treated with respect and dignity, they are likely to be satisfied with services received from the reproductive health centres offering comprehensive abortion care. Impact: The study addresses adolescent satisfaction with abortion care received; if health providers treat adolescent seeking abortion care with respect, friendly and non‐judgemental attitude, it will enable adolescents to seek abortion care from qualified professionals instead of unskilled service providers to reduce maternal mortality. Patient's contribution: Patients from 11 reproductive centres responded to the questionnaire used for the data collection. [ABSTRACT FROM AUTHOR]

Purpose: Anaemia remains a serious concern among pregnant women, and thus, it is closely monitored from the onset of pregnancy through to delivery to help prevent adverse maternal and neonatal outcomes. In malaria-endemic settings, continuous low-level carriage of P.falciparum parasites is common and its contribution to maternal anaemia should not be underestimated. In this study, we evaluated the impact of adherence to malaria control measures [number of antenatal clinics (ANC) attended, supervised intake of sulphadoxine pyrimethamine (SP), and use of insecticide treated bed nets (ITNs)] on asymptomatic malaria and anaemia outcomes among pregnant women on ANC in hospitals in the Central region of Ghana. Methods: The study was conducted during two seasons; October–November 2020 (dry season, n = 124) and May–June 2021 (rainy season, n = 145). Among the women, there was a high adherence to the control measures for both seasons (ANC ≥ 3 visits; ~ 82.0%, intake of SP; ~ 80.0% and ITNs use; ~ 75.0%). Results: Asymptomatic P. falciparum carriage was high for both seasons (44.4% for the dry season; 46.9% for the rainy season). Correspondingly, the occurrence of anaemia was high for both seasons (57.3% for the dry season; 68.3% for the rainy season) and was strongly predicted by carriage of P. falciparum parasites. Despite the high adherence to ANC protocols, asymptomatic P. falciparum infection was common and contributed to the high burden of maternal anaemia. Conclusions: Our findings emphasize the need for improved control measures that can clear asymptomatic/sub-microscopic P. falciparum infection and protect against malaria-induced anaemia among pregnant women attending ANC in malaria endemic-settings. [ABSTRACT FROM AUTHOR]

Background: Globally, over 40 million lives have been claimed by HIV/AIDS. In Ghana, more than 350,000 people are living with HIV. Non-disclosure of HIV status is a major barrier to HIV/AIDS eradication; yet, little is known of the determinants of HIV status disclosure in resource limited settings in Africa like Ghana. Objective: Determine the predictors of HIV status disclosure among people living with HIV (PLHIV) and stimulate policy discourse on support systems for self-disclosure in Africa. Methods: This is a descriptive cross-sectional study among PLHIV (n = 181) in sub-Saharan Africa, specifically the Volta region of Ghana. Bivariate probit regression was run to determine factors associated with HIV status disclosure among PLHIV. Results: HIV status self-disclosure was reported by 50% of the respondents; nearly 65% disclosed their status to non-family members and non-partners. Significant correlates of HIV status disclosure either to partners or non-partners were marital status, monthly income, type of occupation, and being divorced due to HIV status (p < 0.05). Conclusions: HIV status disclosure remains low in Ghana like many African countries. There is the need for a renewed policy debate on tailored guidelines for HIV status self-disclosure and targeted support systems for PLHIV to ameliorate their predicaments and promote eradication of the epidemic in Africa. [ABSTRACT FROM AUTHOR]