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The objective of the study was to determine the clinical factors associated with knowledge and self-care practice among adults living with type 2 diabetes mellitus.Descriptive cross-sectional design.A convenience sample of 330 participants was recruited over 3-months in 2018 and data were collected using a structured instrument.Participants on insulin treatment modality had four times higher odds of knowledge on diabetes (B = 4.17, p = 0.023) while those on combined therapy (both oral hypoglycaemic agent and insulin) had 7.26 times higher odds of knowledge (B = 7.26, p 0.001). Participants without medically confirmed diabetic complications had 3.66 higher odds of knowledge of diabetes (B = 3.66, p = 0.002). Participants on insulin treatment modality had a 1.4-fold higher odds of self-care practice (B = 1.4, p = 0.028). It was revealed that participants with hypertension and diabetic foot had lower odds of self-care practice (B = -1.13, p = 0.021).In particular, participants who were on insulin and combined therapy (tablet and insulin) had higher knowledge and better self-care practice. Self-care was significantly influenced among those with, than those without diabetic foot and hypertension as complications.

Background Breast cancer is currently the most diagnosed cancer in Ghana and the leading cause of cancer mortality among women. Little published empirical evidence exists on cultural beliefs and perceptions about breast cancer diagnosis and treatment in Ghana. This scoping review sought to map evidence on the sociocultural beliefs and perceptions that influence the diagnosis and treatment of breast cancer among women. Methods This review was conducted following the methodological guideline of JBI and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The literature search was conducted in PubMed, CINAHL via EBSCOhost, PsycINFO, Web of Science, and Embase. Studies that were conducted on cultural, religious, and spiritual beliefs were included. The included studies were screened by title, abstract, and full text by three reviewers. Data was charted and results were represented in a narrative synthesis form. Results This review included 15 studies. Three categories were identified after the synthesis of the charted data. The categories included: cultural, religious, and spiritual beliefs and misconceptions about breast cancer. The cultural beliefs included ancestral punishment and curses from the gods for wrongdoing leading to breast cancer. Spiritual beliefs about breast cancer were attributed to spiritual or supernatural forces. People had the religious belief that breast cancer was a test from God and resulted in prayers for healing. Conclusion This study adduces evidence of the sociocultural beliefs that impact on untimely diagnosis and treatment of breast cancer among women in Ghana. Taking into consideration the diverse cultural and traditional beliefs about breast cancer diagnosis and treatment, there is a compelling need for nationwide public education on breast cancer to clarify the myths and misconceptions about the disease. We recommend that sociocultural factors influencing breast cancer diagnosis and treatment be incorporated into breast cancer awareness programs, education, and intervention programs in Ghana.

BACKGROUND Many countries have committed to health systems reforms to achieve universal health coverage (UHC). The World Health Report 2013 calls for research to provide robust evidence to achieve UHC. In Ghana, the national health insurance scheme (NHIS) implemented about two decades ago is one of the leading policies in the country, with significant research evaluations. Apart from the NHIS, there is limited synthesized evidence on the implications of other health financing and health service delivery reforms for sustainability, efficiency, equity of access, and quality of care in Ghana. OBJECTIVE This review aims to systematically and comprehensively appraise the literature on the country’s health financing and service delivery reforms over two decades (2000-2020) to provide evidence for policy. METHODS This scoping review approach was adopted, guided by Arksey and O’Malley and Levac et al. frameworks following the Joanna Briggs Institute (JBI) recommendations. JBI’s 3-step strategy was used to identify relevant articles through a comprehensive and systematic search in PubMed, Embase, Web of Science, Cochrane library, CINAHL, and Hinari databases. Grey literature search will be done using the Google Scholar search engine and ProQuest Dissertation & Theses Global database, as well as by reviewing official documents and reports from the Ghana Ministry of Health, the Ghana Health Service, and other state institutions responsible for health policy formulation. Additional documents will be identified by reviewing the included studies' reference lists. A data charting template adapted from the JBI will guide data extraction. RESULTS A narrative reporting format will be used to summarize all the extracted data while describing the studies’ characteristics, including their objectives. The results will mainly focus on a broad range of health sector reforms, identify gaps for further research, and present an overview of the status for priority-setting and decision-making for health policy administrators. CONCLUSIONS This study will explore a broad range of health financing and service delivery reforms in Ghana’s health sector and identify gaps for research agenda-setting and policy decision-making purposes toward UHC. Dissemination of evidence from this review will be in two folds: to scientific and academic audiences and for policy and practice. CLINICALTRIAL This scoping review was registered in the Open Science framework with the following Registration DOI 10.17605/OSF.IO/9DMXW

IntroductionMedication adherence is a vital component of successful healthcare, yet poor adherence exists, especially in older adults with mild cognitive impairment. Therefore, this study seeks to conduct a systematic review of eHealth-based interventions aimed at improving medication adherence among older adults with mild cognitive impairment.Methods and analysisAn open electronic database search will be conducted in PubMed, CINAHL, PsycINFO, EMBASE and Cochrane library to identify potential studies till 2022. Two authors will independently screen the titles and abstracts, after which studies that will be eligible for full-text review will be independently assessed by two reviewers for inclusion. Studies will be selected if they evaluate eHealth interventions aiming to improve medication adherence among older adults with mild cognitive impairment. Data will be analysed by using the Comprehensive Meta-Analysis software V.3 and Review Manager (RevMan) software V.5. The authors will separately analyse each outcome measure, compute intervention effects and present them as relative risks with 95% CIs for dichotomous data. Continuous data will be presented as mean differences and standardised mean differences (if required) with 95% CIs. If substantive statistical heterogeneity is identified, we will consider the use of random-effects models that can be incorporated into the statistical analysis. We envisage that this review will adduce evidence on eHealth interventions that will improve medication adherence among older adults with mild cognitive impairment. The findings can also inform health professionals and other relevant stakeholders on current eHealth-based interventions that are used to improve medication adherence among older adults with mild cognitive impairment.Ethics and disseminationEthical approval is not required for systematic reviews. Findings will be disseminated widely through peer-reviewed publication and at conferences.PROSPERO registration numberCRD42021268665.

This study aimed to investigate the impact of intrapartum and post-partum complications and newborn care practices on early initiation of breastfeeding (EIBF). Data for the study came from a prospective cohort study in Ethiopia that recruited and followed pregnant and post-partum women from 2019 to 2021. Resident enumerators conducted interviews at enrolment in 2019 and follow-ups at 6 weeks, 6 months and 1 year post-partum. The present analysis is based on data from the baseline survey and 6 weeks follow-up. Multivariable logistic regression was used to estimate the effects of newborn care practices and intrapartum and post- partum complications on EIBF (the proportion of newborns who initiated breastfeeding within the first hour of birth). Overall, 2660 mother-infant pairs were included in this analysis. After adjustment, EIBF was less likely among women who experienced intrapartum haemorrhage (adjusted odds ratio [AOR]: 0.76, 95% confidence interval [CI]: 0.59-0.97), malpresentation (AOR: 0.46, 95% CI: 0.30-0.72) and convulsions (AOR: 0.48, 95% CI: 0.34-0.66) during childbirth. Mother-newborn skin-to-skin contact increased the likelihood of EIBF (AOR: 1.47, 95% CI: 1.11-1.94). Women who experienced post-partum haemorrhage (AOR: 0.63, 95% CI: 0.47-0.84), retained placenta for more than 30 min (AOR: 0.36, 95% CI: 0.24-0.52) and convulsions after delivery (AOR: 0.57, 95% CI: 0.41-0.79) were less likely to initiate breastfeeding early. Also, women who had a caesarean birth (AOR: 0.28, 95% CI: 0.18-0.41), delivered outside of a healthcare facility (AOR: 0.70, 95% CI: 0.50-0.99) or had twin birth (AOR: 0.43, 95% CI: 0.22-0.85) were less likely to initiate breastfeeding early. Skin-to-skin contact should be encouraged whenever possible, and women with obstetric complications should be encouraged and supported to initiate breastfeeding early.

IntroductionGlobal Health Security borders on prevention, detection and response to public health threats like the novel coronavirus disease 2019 (COVID-19). Global Health Security Index (GHSI) of 2019 and 2021 revealed the world remains ill-prepared to deal with future pandemics, evident in the historic impact of COVID-19 on countries. As at 7th December 2022, COVID-19 has infected over 600 million people and claimed over six million lives, mostly in countries with higher GHSI scores.ObjectiveDetermine whether the GHSI scores of countries have a correlation with COVID-19 cases, deaths and vaccination coverage, while adjusting for country level dynamics.MethodsThis paper utilizes GHSI database of 195 countries. Data consists of 171 questions grouped into 37 indicators across six overarching categories on health security and COVID-19. Multivariate multiple regression analysis with robust standard errors was conducted to test the hypothesis that high GHSI ratings do not guarantee better COVID-19 outcomes like cases, deaths and vaccination coverage. Also, avplots STATA command was used to check outliers with potential negative effect on outcome and predictor variables.ResultsGlobal average GHSI score for all 195 countries was 38.9. United States of America recorded the highest GHSI score of 75.9 but also recorded one of the highest COVID-19 cases and deaths; Somalia recorded the worst GHSI score of 16.0 and one of the lowest COVID-19 cases and deaths. High GHSI scores did not associate positively with reduction in COVID-19 cases (Coef=157133.4, p-value=0.009, [95%CI 39728.64 274538.15]) and deaths (Coef=1405.804, p-value=0.047, [95%CI 18.1 2793.508]). However, high GHSI ratings associated with increases in persons fully vaccinated per 100 population (Coef=0.572, p-value=0.000, [95%CI.272.873]).ConclusionIt appears the world might still not be adequately prepared for the next major pandemic, if the narrative remains unchanged. Countries that recorded higher GHSI scores, counter-intuitively, recorded higher COVID-19 cases and deaths. Countries need to invest more in interventions towards attaining Universal Health Coverage (UHC) including integrated health systems and formidable primary health care to enhance preparedness and response to pandemics.

Introduction: Cervical cancer is the second most common cancer among women and approximately 500,000 new cases are diagnosed yearly. It is increasingly imperative to use effective methods of early detection and initialization of treatment for cervical cancer especially among women from vulnerable poor communities through the initiation of effective health promotion interventions. This study will coalesce the sporadic, and uncoordinated interventions that have been used by researchers to give a single unit that describes and assess the most effective means of health promotion interventions. Methods: The PRISMA Extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) scoping review methodology will be used to guide the reporting of this scoping review. The three-step search strategy for scoping reviews will be adopted to electronically search databases such as PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL via EBSCOhost), Web of Science, and EMBASE. After search completion, the citations of the articles will be imported to EndNote X9 (version 1.19.6) reference manager for screening, removal of duplicates, and storage. Two of the researchers (AA, KDK) will independently screen the titles and abstracts in accordance with the inclusion criteria specified in this protocol. The proposed review will consider primary published peer-review articles published articles in English language from 2010-2021. Data extracted from selected studies will include author(s), publication year, country, research design and aim, study population, interventions, outcome measure, and major findings. The JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses will be used to assess the quality of the included articles.Discussion: We envisage that the findings from this review will firstly identify the various types of interventions implemented in the sub-Saharan African countries to increase the uptake of cervical cancer screening. Secondly, the findings will provide an overview of the outcome measures and identify effective interventions implemented in all the studies to increase cervical cancer uptake in SSA. Finally, the review will guide future research in developing, implementing, and evaluating appropriate health promotion interventions tailored towards increasing cervical cancer screening uptake.Scoping review registration: The review has been registered in the Open Science Framework with the registration number (osf.io/yad46)

Background Women have experienced labour pain over the years as various attempts have been made to effectively manage this pain. There is paucity of literature on the experiences and perceptions about labour pain management with the contemporary Ghanaian health system. This study explored the perspective of puerperal women on the use of non-pharmacological labour pain management at Adidome Government Hospital. Methods The study adopted an exploratory descriptive qualitative approach as data was collected through individual interviews. Informed consent was obtained from all participants who were purposely sampled until data saturation was reached on the 17th participant. Interviews were audio recorded and transcribed immediately. Thematic analysis was engaged in three interrelated stages, namely data reduction, data display, and data conclusion to analyse the transcript and field notes. Results were presented with supporting quotes from the transcripts. Results The women described labour pain as very severe, severe and moderate as the pain lasted more than 12 h. The various strategies adopted in managing labour pains included shouting and walking around, crying and screaming and staying calm and snapping the fingers. Other pain management strategies adopted during labour included women engaged in deep breathing exercises, chatting with other people and relatives, diversion therapy, reassurance, taking a shower, assuming side lying positions, and receiving intravenous therapy. The presence of the husband of a labouring woman during labour improved pain bearing ability. Conclusion It is important that midwives institute pragmatic protocols in the labour ward that ensure a relaxing atmosphere for women in labour, respond to the sensitivity and specificity of labouring women needs and when possible significant others (e.g., husband) of the labouring women could be allowed to visit. Labour wards should be made sound proof to allow women the ability to express themselves satisfactorily during labour without fear of being heard outside., Plain Language Summary During childbirth, women have complained of severe pains as health personnel over the years keep looking for appropriate means to alleviate the pain. We therefore studied women with children less than 42 days to understand their perspective on the use of non-drug methods in relieving pain during birth. With the intention of exploring this phenomenon we had an interview with 17 women in the Adidome government hospital. The women showed that labour is a very painful experience. The methods they adopted in reducing pain included shouting, walking around the hospital, crying or screaming, staying calm and snapping the fingers. These women were generally happy with the care that was rendered by midwives. Other methods used to reduce pain were taking deep breaths, talking with a family member or friend, taking a bath, assuming a lying position and receiving intravenous infusion. Women who had their husband present during labour said it helped their pain endurance. We therefore suggested that midwives should be encouraging and supportive of women who are in labour and if possible, allow their spouses into the birth room to augment the pain adaptation ability. Also, labour wards should have sound resilient so that women can make any sound if they so wish to.

IntroductionFemale breast cancer is now the most often diagnosed cancer in the world. Breast cancer screening aims to reduce mortalities related to cancer, and morbidity associated with advanced stages of the disease, through timely detection in asymptomatic women. This study aims to conduct a comprehensive assessment and evaluation of the evidence on the factors that influence the provision and uptake of breast cancer screening among women in sub-Saharan Africa (SSA).Methods and analysisPubMed, Web of Science, EMBASE and the Cumulative Index to Nursing and Allied Health Literature including Google Scholar will be searched to identify published studies on barriers and facilitators to breast cancer screening from January 2010 to 2021. Two reviewers will independently assess the quality of all the included studies using the Mixed Methods Appraisal Tool version 2018. We envisage that this review will adduce evidence on common barriers and facilitators to breast cancer screening in SSA. Identifying these barriers and facilitators will help guide the initialisation of effective interventions that will improve breast cancer screening uptake among women in SSA. This review will also guide future research in developing, implementing and evaluating appropriate interventions tailored toward increasing breast cancer screening uptake.Ethics and disseminationEthics approval for this protocol is not required since it does not involve collecting data from human participants. The outcomes of this study will be published in a peer-reviewed journal.

The purpose of this study was to examine the effects and risk factors of cognitive decline, sensory impairment, and functional limitation associated with frailty among older adults. We conducted secondary data analysis using data from the Korean Longitudinal Study of Aging (2006–2018). The participants of this study consisted of 1,789 older adults over the age of 65 in South Korea who had never experienced frailty at the beginning of the survey (2006). Participants were classified into two groups, frailty and non-frailty, based on frailty events over time. We used Kaplan–Meier analysis to determine the effects of frailty-related group differences on cognitive decline (K-MMSE), sensory impairment (visual and hearing), and functional limitation (K-ADL) from 2006 to 2018. To determine the risk factors associated with frailty, the Cox regression analysis was performed. This study established that over time, approximately 71.2% of the older adults (n = 1,274) developed frailty. The study also revealed that over time, both physical (sensory impairment and functional limitation) and psychological factors (cognitive decline) could lead to frailty. We also identified that demographic (age, female), physical (BMI, chronic disease, hearing, vision, and K-ADL), and psychological (K-MMSE) factors were associated with frailty. This study provides an opportunity for healthcare professionals and policymakers to implement intervention programs tailored to ensure regular monitoring prevention and among of these risk factors.

Objective Eclampsia remains a public health issue, especially in low-resource countries worldwide. Midwives are the backbone of the pregnancy and delivery process. Midwives trained in the necessary knowledge and skills are more likely to notice early warning signals of preeclampsia and immediately help clients in such emergencies. This study explored midwives’ experiences in managing patients with eclampsia in Ghana. Methods This study was conducted among eight registered midwives at maternity units of two district hospitals in the Eastern Region of Ghana, using an exploratory, descriptive qualitative research design. A purposive sampling technique was adopted to select and interview participants. Interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis. The right of participation and withdrawal from the study was respected. Findings The three emerged overriding themes are: 1. Midwives have knowledge (warning signs, regimens, and prevention of complications) about the management of eclampsia. 2. Challenges in managing clients included inadequate equipment, staffing, and access to drugs. 3. Strategies for mitigating barriers to care for women with eclampsia (adherence to protocols, teamwork, peer mentoring and supervision, midwives’ attitude, and client education. Conclusion Midwives working in underserved facilities have the knowledge and skill to monitor and manage pregnant women experiencing eclampsia. However, they need to be supported with appropriate resources and advanced equipment to ensure adherence to protocols on managing eclampsia promptly referred. Continuous training and workshops for midwives in the management of hypertension in pregnancy are recommended and the public educated on the dangers of eclampsia.

Background The aim of the third WHO challenge released in 2017 was to attain a global commitment to lessen the severity and to prevent medication-related harm by 50% within the next five years. To achieve this goal, comprehensive identification of barriers to reporting medication errors is imperative. Objective This review systematically identified and examined the barriers hindering nurses from reporting medication administration errors in the hospital setting. Design An integrative review. Review methods PubMed, Web of Science, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) including Google scholar were searched to identify published studies on barriers to medication administration error reporting from January 2016 to December 2020. Two reviewers (AA, and KDK) independently assessed the quality of all the included studies using the Mixed Methods Appraisal Tool (MMAT) version 2018. Results Of the 10, 929 articles retrieved, 14 studies were included in this study. The main themes and subthemes identified as barriers to reporting medication administration errors after the integration of results from qualitative and quantitative studies were: organisational barriers (inadequate reporting systems, management behaviour, and unclear definition of medication error), and professional and individual barriers (fear of management/colleagues/lawsuit, individual reasons, and inadequate knowledge of errors). Conclusion Providing an enabling environment void of punitive measures and blame culture is imperious for nurses to report medication administration errors. Policymakers, managers, and nurses should agree on a uniform definition of what constitutes medication error to enhance nurses’ ability to report medication administration errors.

Introduction: According to statistics released by the International Agency for Research on Cancer (IARC) in December 2020, female breast cancer (BC) has overtaken lung cancer as the world's most commonly diagnosed cancer. It is estimated that by 2050 the prevalence rate of breast cancer in SSA will double. Breast cancer screening aims to reduce mortalities related to cancer, and morbidity associated with advanced stages of the disease, through early detection in asymptomatic women. This study aims to review and analyze empirical and grey literature on barriers and facilitators to breast cancer screening among women in SSA.Methods: PubMed, Web of Science, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) including Google scholar will be searched to identify published studies on barriers and facilitators to breast cancer screening from January 2010 to 2021. Two reviewers independently assessed the quality of all the included studies using the Mixed Methods Appraisal Tool (MMAT) version 2018.Conclusion: We envisage that this review will adduce evidence on common barriers and facilitators to BC screening in SSA. Identifying these barriers and facilitators will help guide the initialization of effective interventions that will improve BC screening uptake among women in SSA. This review will also guide future research in developing, implementing, and evaluating appropriate interventions tailored towards increasing BC screening uptake.Systematic review registration: Open Science Framework (OSF) registration DOI: 10.17605/OSF.IO/KY3PF

Background Childbirth remains a uniquely multifaceted, mental-cognitive and a major life experience to women. It is composed of a variety of psycho social and emotional aspects and creates memories, sometimes bad experiences and unmet expectations which leaves the mother with lasting scars. Therefore, this study aimed at exploring post-caesarean section delivered mothers experiences of midwifery care in a public hospital in Ghana. Methods This descriptive exploratory qualitative research used an interpretative approach to explore mothers’ experiences of midwifery care immediately before and after caesarean section (CS). The study employed a purposive sampling technique in recruiting 22 participants who had knowledge of the phenomenon under study. Data collection was guided by an interview guide, which involved face to face individual interviews and focus group discussion at the postnatal ward and clinic. All interviews were audio-recorded and lasted 30–40 min. Audio recordings were transcribed verbatim and inductive thematic data analysis employed. Results Four major themes emerged from the analysis of participants’ transcripts: Support by Midwives (physical and psychological, and attitude towards patients’ pain management); Protection of mothers (provision of privacy, confidentiality and physical environment); Provision of information/communication (before caesarean section, and before a minor task) and midwives’ attitude (attitude towards delivery care). Conclusion Mothers delivered by caesarean section had varied experiences of midwifery care which were both positive and negative ones. Provision of psychological support and adequate pain management were positive experiences. The challenges experienced were related to provision of information, privacy, and physical support. Participants, who underwent emergency CS in particular, were dissatisfied with the provision of information concerning the surgical procedure. Provision of privacy and physical support were also issues of great concern. We therefore, recommend supportive and sensitive midwifery care particularly for mothers undergoing emergency CS. Documenting women’s diverse experiences of midwifery care before and after CS delivery is important to healthcare providers, hospital managers and policy makers as the feedback garnered can be used to improve maternity services and inform decisions on midwifery care.

Background Adverse medical events (AMEs) are threats to delivery of quality healthcare services, particularly in resource-poor settings such as Ghana. In sub-Saharan Africa, 30% of deaths are attributed to AMEs and a significant proportion of these events are not reported. This study explored personal experiences of nurses with AMEs and the constraints to reporting them. Methods This is a descriptive cross-sectional study among professional (n = 133) and auxiliary (n = 88) nurses in a regional referral hospital in northern Ghana. A test for differences in experiences of professional and auxiliary nurses was done using Wilcoxon Mann-Whitney test. Ordered logistic regression analysis (proportional odds ratio models) and probit regression were used to ascertain the determinants of staff’s knowledge on AMEs and the odds of exposure, respectively. Results Overall, knowledge and awareness level on AMEs was average (mean = 3.1 out of the five-point Likert scale of 1 = “Very poor” to 5 = “Excellent”). Knowledge levels among professional nurses (mean = 3.2) were relatively higher than those among auxiliary nurses (mean = 3.0), (p = 0.006). The predominant type of AME experienced was wrongful documentation (n = 144), and the least experienced type was wrong transfusion of blood and/or intravenous fluids (IVF) (n = 40). Male staff had higher odds of experiencing medical errors relative to female staff, OR = 2.39 (95% confidence interval (CI), 1.34–4.26). Inadequate logistics was the most perceived cause of AMEs. Knowledge on types of AMEs was significantly associated with gender of the respondents, OR = 1.76 (95% CI, 1.05–2.94); moreover, male staff had higher odds of knowing AME post-exposure action than female staff, OR = 1.75 (95% CI, 1.04–2.93). Conclusion Knowledge levels of nursing staff on AMEs were generally low, and even though exposures were high they were not reported. There is the need to integrate AME modules into the pre-service and in-service training curricula for nurses to enhance their knowledge on AMEs; reporting registers for AMEs should be made available in clinical sites and staff incentives given to those who report AMEs. Lastly, protocols on AMEs should form part of the quality assurance value chain for health facilities to promote compliance.

Background Data on nurses’ adherence to standard protocol on nasogastric (NG) tube feeding remain scanty in Ghana even though patients in critical medical conditions are routinely managed using this procedure. This study explored self-rated adherence to standard protocols on NG tube feeding among professional and auxiliary nurses and the perceived barriers impeding compliance to these standard protocols. Methods This is a descriptive analytical cross-sectional study among professional (n = 89) and auxiliary (n = 24) nurses in a major referral hospital in one of the ten administrative regions in Ghana. Four-point Likert scale was used to ascertain the level of adherence to standard guidelines on nasogastric tube, ranging from 4 “Very large extent” to 1 “Very little extent”. Wilcoxon Mann-Whitney test and univariate ordered logistic regression tests (proportional odds models) were performed to determine the odds of higher self-ratings among professional and auxiliary nurses. Results Overall, the odds of higher self-ratings on adherence to standard nursing protocols on NG tube feeding was higher among auxiliary nurses than professional nurses (OR = 2.76, p = 0.031) after adjusting for age, gender, education and years of work experience. Key barriers to adherence to standard protocols on NG tube feeding were: limited opportunities for in-service trainings and insufficiency of NG tube feeding protocols on the wards. Conclusion There is the need for more routine in-service trainings for nursing staff to update their knowledge on NG tube feeding. Hospital management should also make current nursing protocols available to nurses to guide their practice alongside routine onsite supervision of nurses. Electronic supplementary material The online version of this article (10.1186/s12913-019-3931-6) contains supplementary material, which is available to authorized users.

Background Neonatal jaundice is a major reason babies are frequently re-admitted after hospital discharge following delivery. One means of improving neonatal care and reducing potential mortality associated with neonatal jaundice in resource-limited settings is to create awareness among caregivers. Caregivers who tend to have higher knowledge and awareness, also have positive attitudes, and are not guided by outmoded socio-cultural beliefs and practices are more likely to seek early care and treatment for neonatal jaundice. Objective This study investigated caregivers’ knowledge, attitude and practices regarding neonatal jaundice in a tertiary health facility in the Volta region of Ghana. Methods This was a descriptive cross-sectional study that employed a quantitative approach for data collection. A total of 202 caregivers from the Ho Teaching Hospital in the Volta region of Ghana were sampled using a systematic random sampling strategy where quantitative data was collected using a questionnaire and analyzed with STATA version 14.0. Ordered logistic regression was used to determine the factors that were associated with caregivers’ knowledge regarding neonatal jaundice and attitude after controlling for relevant covariates. Results Less than half of the caregivers demonstrated good knowledge (45.5%) and attitude (47.5%) but 58.9% had good practices regarding neonatal jaundice. Caregivers who had prior awareness and education on neonatal jaundice were three times more likely to have good knowledge about jaundice than those without previous education [AOR = 3.02, (95%CI: 1.59–5.74), p = 0.001]. A caregiver employed in the public sector was two times more likely to have a good attitude about jaundice than those employed in the private sector [AOR = 2.08, (95%CI: 1.03–4.21), p = 0.042]. Conclusion Less than two thirds of the caregivers demonstrated good practice with limited knowledge and poor attitude. Efforts to promote well informed and improved caregivers’ attitude will advance positive maternal health-seeking behavior and reduce disabilities and death through early detection and intervention of infants with neonatal jaundice. Public awareness and education about neonatal jaundice especially among caregivers in the private sector should also be intensified.

Objective: Eclampsia remains a public health issue, especially in low resource countries around the world, where approximately 63, 000 women die annually with young adolescence (ages 10-14) facing a higher risk of complication. Little is known about the challenges associated with the care of eclamptic clients. We sought to explore the challenges and coping strategies adopted by midwives in nursing patients with eclampsia in a low resource setting.Methods: This study employed an exploratory descriptive qualitative research design. A total of 8 midwives were purposively selected and individual interviews were conducted. Data were analysed through qualitative thematic analysis.Findings: From thematic data analysis two overarching themes emerged with six sub-themes. The two overarching themes were inadequate resources and coping strategies. The subtheme under inadequate resources includes a shortage of drugs, inadequate resuscitation equipment, and inadequate and inappropriate beds. The subtheme under coping strategies includes: coping with drug shortages, inadequate resuscitation equipment, and inadequate and inappropriate beds. Conclusion: Currently, the quest of midwives to promote and provide quality care for women with eclampsia faces some bottlenecks. These bottlenecks led to the adaptation of some coping strategies to provide care for women with eclampsia. One major coping strategy in the absence of drugs (MgSO4) was a referral to a higher health facility. They also borrowed equipment from neighbouring wards for resuscitation. Midwives improvised by admitting eclamptic women on the floor due to lack of beds. In times that they had beds without side rails patient relatives were asked to sit by the side of the bed to prevent falls in case of seizures.

BackgroundIn 2017, a total of 295,000 women lost their lives due to pregnancy and childbirth across the globe, with sub-Saharan Africa and South Asia accounting for approximately 86 % of all maternal deaths. The maternal mortality ratio in Ghana is exceptionally high, with approximately 308 deaths/100,000 live births in 2017. Most of these maternal deaths occur in rural areas than in urban areas. Thus, we aimed to explore and gain insights into midwives’ experiences of working and providing women-centred care in rural northern Ghana.MethodsA qualitative descriptive exploratory design was used to explore the challenges midwives face in delivering women-centred midwifery care in low-resource, rural areas. A total of 30 midwives practicing in the Upper East Region of Ghana were purposefully selected. Data were collected using individual semistructured interviews and analysed through qualitative content analysis.ResultsFive main themes emerged from the data analysis. These themes included were: inadequate infrastructure (lack of bed and physical space), shortage of midwifery staff, logistical challenges, lack of motivation, and limited in-service training opportunities.ConclusionsMidwives experience myriad challenges in providing sufficient women-centred care in rural Ghana. To overcome these challenges, measures such as providing adequate beds and physical space, making more equipment available, and increasing midwifery staff strength to reduce individual workload, coupled with motivation from facility managers, are needed.

Background: The aim of the third WHO challenge released in 2017 was to attain a global commitment to lessen the severity and to prevent medication-related harm by 50% within the next five years. To achieve this goal, comprehensive identification of barriers to reporting medication errors is imperative.Objective: This review aimed to identify studies that investigated barriers to reporting medication administration errors among nurses, systematically summarize the findings to make recommendations for improving error reporting, and for future investigation.Design: An integrative review Review methods: PubMed, Web of Science, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) including Google scholar were searched to identify published studies on barriers to medication error reporting from January 2016 to December 2020. The reviewers independently assessed the quality of all the included studies using the Mixed Methods Appraisal Tool (MMAT) version 2018.Results: Of the 10937 articles reviewed, 14 studies were included. The main themes and subthemes identified after the integration of results from qualitative and quantitative studies were; organizational barriers (inadequate reporting systems, management behavior, and unclear definition of medication error), and professional and individual barriers (fear of management/colleagues/lawsuit, individual reasons and inadequate knowledge of errors).Conclusion: It is not expected that nurses will freely report medication errors in a fearful, punitive, and blaming culture. Providing an enabling environment void of punitive measures and blame culture is imperative for nurses to report medication errors. To minimize the burden on nurses reporting medication errors, an effective, non-time consuming, and uncomplicated anonymous system is required. An open feedback system for motivating or rewarding nurses for reporting medication errors is imperative and will therefore increase the rate of error reporting. Policymakers, managers, and nurses should agree on a uniform definition of what constitutes medication error to enhance nurses' ability to report.

ObjectiveThis study assessed the correlates of late initiation and underutilisation of the WHO’s recommended eight or more antenatal care visits among women in Ghana.DesignWe analysed secondary data from 2163 women in the 2019 Ghana Malaria Indicator Survey, which collected data on malaria and antenatal care indicators among women of reproductive age across the previous 10 regions of Ghana.Setting and participantsWomen of reproductive age across the 10 regions of Ghana.Main outcome measuresLate initiation and underutilisation of the recommended eight or more antenatal care visits among women of reproductive age.ResultsAbout half (49%) of the participants were between the ages of 25 and 34 years; mean (±SD)=30 (±7.10). The majority (57%) of the participants obtained less than eight antenatal care visits, while 32% initiated antenatal care visits after the first trimester. The significant factors associated with the late initiation of antenatal care visits were age, region and parity (pConclusionA majority of the women underused antenatal care services. A significant minority of the women started antenatal care visits late. Socio-demographic factors, parity and socioeconomic factors were identified as the significant factors associated with the late initiation and underutilisation of antenatal care services. Maternal health interventions should prioritise young, multiparous and poor women.

Supplemental material, sj-doc-1-smo-10.1177_2050312121994360 for Urban health nexus with coronavirus disease 2019 (COVID-19) preparedness and response in Africa: Rapid scoping review of the early evidence by Robert Kaba Alhassan, Jerry John Nutor, Aaron Asibi Abuosi, Agani Afaya, Solomon Salia Mohammed, Maxwel Ayindenaba Dalaba, Mustapha Immurana, Alfred Kwesi Manyeh, Desmond Klu, Matilda Aberese-Ako, Phidelia Theresa Doegah, Evelyn Acquah, Edward Nketiah-Amponsah, John Tampouri, Samuel Kaba Akoriyea, Paul Amuna, Evelyn Kokor Ansah, Margaret Gyapong, Seth Owusu-Agyei and John Owusu Gyapong in SAGE Open Medicine

Introduction: Severe acute respiratory syndrome coronavirus 2 also called coronavirus disease 2019 was first reported in the African continent on 14 February 2020 in Egypt. As at 18 December 2020, the continent reported 2,449,754 confirmed cases, 57,817 deaths and 2,073,214 recoveries. Urban cities in Africa have particularly suffered the brunt of coronavirus disease 2019 coupled with criticisms that the response strategies have largely been a ‘one-size-fits-all’ approach. This article reviewed early evidence on urban health nexus with coronavirus disease 2019 preparedness and response in Africa. Methods: A rapid scoping review of empirical and grey literature was done using data sources such as ScienceDirect, GoogleScholar, PubMed, HINARI and official websites of World Health Organization and Africa Centres for Disease Control and Prevention. A total of 26 full articles (empirical studies, reviews and commentaries) were synthesised and analysed qualitatively based on predefined inclusion criteria on publication relevance and quality. Results: Over 70% of the 26 articles reported on coronavirus disease 2019 response strategies across Africa; 27% of the articles reported on preparedness towards coronavirus disease 2019, while 38% reported on urbanisation nexus with coronavirus disease 2019; 40% of the publications were full-text empirical studies, while the remaining 60% were either commentaries, reviews or editorials. It was found that urban cities remain epicentres of coronavirus disease 2019 in Africa. Even though some successes have been recorded in Africa regarding coronavirus disease 2019 fight, the continent’s response strategies were largely found to be a ‘one-size-fits-all’ approach. Consequently, adoption of ‘Western elitist’ mitigating measures for coronavirus disease 2019 containment resulted in excesses and spillover effects on individuals, families and economies in Africa. Conclusion: Africa needs to increase commitment to health systems strengthening through context-specific interventions and prioritisation of pandemic preparedness over response. Likewise, improved economic resilience and proper urban planning will help African countries to respond better to future public health emergencies, as coronavirus disease 2019 cases continue to surge on the continent.

IntoductionGlobally, a total of 295 000 women lost their lives due pregnancy and childbirth in 2017, with sub-Saharan Africa and South Asia accounting for approximately 86% of all maternal deaths. Currently the Maternal Mortality Ratio (MMR) in Ghana is uncceptably high with about 308 deaths/100,000 live births in 2017 and most of these maternal deaths occur less in urban areas than in rural areas. As midwives play a vital role in maternity care and in the reduction of MMR, this study therefore sought to explore and describe challenges experienced by midwives working in rural communities in the Bongo District of the Upper East region of Ghana.MethodsA qualitative descriptive exploratory design was used to gain better insight into midwives’ experiences of working and providing women-centred midwifery care in rural areas of Ghana. A total of 30 midwives providing midwifery care in rural areas of the Upper East region of Ghana for at least three years were purposefully selected for this study. Data were collected using individual semi-structured interviews and analysed through qualitative content analysis. ResultsFive main themes emerged from the data analysis. These thematic areas included inadequate infrastructure (lack of bed and physical space), lack of logistics, shortage of midwifery staff, lack of motivation, and limited in-service training opportunities.ConclusionThe study concludes that although the rural midwives perform a multidisciplinary function in providing midwifery care in rural northern Ghana, they experience a myriad of challenges in providing midwifery care. There is the need for the Ghana Health Service and other stakeholders to motivate midwives working in rural areas through policy interventions such as rural incentive allowances, supportive supervision and in-service training opportunities for midwives in order to encourage them to accept posting to rural areas of Ghana to improve maternal and child health care.

Background Breast and cervical cancers constitute the two leading causes of cancer deaths among women in Ghana. This study examined breast and cervical screening practices among adult and older women in Ghana. Methods Data from a population-based cross-sectional study with a sample of 2749 women were analyzed from the study on global AGEing and adult health conducted in Ghana between 2007 and 2008. Binary and multivariable ordinal logistic regression analyses were performed to assess the association between socio-demographic factors, breast and cervical screening practices. Results We found that 12.0 and 3.4% of adult women had ever had pelvic screening and mammography respectively. Also, 12.0% of adult women had either one of the screenings while only 1.8% had both screening practices. Age, ever schooled, ethnicity, income quantile, father’s education, mother’s employment and chronic disease status were associated with the uptake of both screening practices. Conclusion Nationwide cancer awareness campaigns and education should target women to improve health seeking behaviours regarding cancer screening, diagnosis and treatment. Incorporating cancer screening as a benefit package under the National Health Insurance Scheme can reduce financial barriers for breast and cervical screening.

Introduction Community psychiatric nurses work in extremely stressful environments with intense patient relationships as they try to prevent self-harm and manage aggressive behaviors. In order to improve their ability to manage the stressful work environments, community psychiatric nurses need to incorporate formal coping strategies into their daily work routines. With evidence-based coping strategies, community psychiatric nurses can effectively manage the stressful situations in their work environment to increase their work longevity. The purpose of this study was to explore the individual coping strategies currently used by community psychiatric nurses in practice in order to develop an intervention strategy for future implementation. Methods This was an exploratory qualitative study using an interpretative approach. A purposive sampling method was used to identify participants from the community psychiatric nurses in a region of Ghana. Participants were recruited and interviewed, guided by semi-structured questions, until saturation was reached. The interviews were audio-taped, transcribed verbatim, and analyzed thematically. Results A total of 13 participants, 10 women and 3 men ages 26 to 60 years, were interviewed for this study. From the inductive analysis, four coping themes emerged from the data including: 1) self-disguise, 2) reliance on religious faith, 3) self-motivation, and 4) reduction in the number of home visits. The participants described their work environment as stressful, almost to the point of overwhelming. In this regard, they identified the individual coping strategies as critical daily practices for self care to manage their high stress levels. Conclusion Individual coping strategies are often used by community psychiatric nurses in daily practice. The participants identified personal coping strategies as critical interventions to manage stress and to decrease their risk for burnout. However, community psychiatric nurses must develop. personal-mastery in various coping strategies to care for themselves, as well as motivate them despite the challenging working environment. The individual coping strategies adopted by community psychiatric nurses was not only helped them deliver care, but also protected their clients so people would not label them as ‘mental patients.’ Collectively, the four strategies reported in this study need to be developed into a cohesive and comprehensive intervention.

Introduction Addressing strategies of coping among community psychiatric nurses (CPNs) could help increase an individual’s ability to cope effectively and as a result, reduce experienced levels of stress. It is known that the level of work stress experienced by CPNs is remarkably high, because psychiatric nurses face more intense relationships with their patients, trying to prevent self-harm, and most at times face challenging situations with aggressive patient behaviors in the working environment. Therefore, the study aimed to explore the coping strategies employed by CPNs during healthcare delivery in the community. Methods An exploratory qualitative study design using an interpretative approach was employed. A total of 13 CPNs were purposively sampled, and data gathered through individual interviews using an interview guide. The interviews were audio-taped, transcribed verbatim and analyzed thematically, describing some of the coping strategies employed by CPNs in Ghana. Results Participants’ ages ranged from 26-60years. They comprised 3 males and 10 females. An inductive thematic analysis identified the following major coping strategies of community psychiatric nurses; self-disguise (wearing of mufti), reliance on religious faith, self-motivation and reduction in the number of home visits. Conclusion Coping strategies among community psychiatric nurses are essential for both individuals and organisations. Thus, community psychiatric nurses must acquire personal-mastery coping strategies such as the reduction in the number of home visits, self-disguise (wearing mufti) the use of faith to motivate themselves in the face the challenging working environment. The coping strategies adopted by community psychiatric nurses was not to only help them deliver care, but also as a way of protecting the clients so that people would not tag them as ‘mental patients’

Background. Traditional birth attendants play significant roles in maternal health care in the rural communities in developing countries such as Ghana. Despite their important role in maternal health care, there is paucity of information from the perspective of traditional birth attendants regarding their role on maternal health care in rural areas in Ghana. Objective. The aim of this study was to explore and describe the role of traditional birth attendants in maternal health care in the rural areas in Ghana. Methods. A qualitative explorative approach was adopted to explore the role of traditional birth attendants in maternal health care in the rural areas of Ghana. Ten (10) out of a total of twenty-seven (27) practising traditional birth attendants in the study area were purposefully selected from five (5) rural communities in the Bongo District of Ghana for the study. Data were collected through in-depth, unstructured, individual interviews using a guide. Data collected from the interviews were transcribed verbatim and analysed to identify themes. Results. Six main roles of traditional birth attendants on maternal health care in rural areas were identified in this study: traditional birth attendants conduct deliveries at home, they provide health education to women on nutrition during pregnancy and lactation, they arrange means of transport and accompany women in labour to health facilities, they provide psychological support and counselling to women during pregnancy and childbirth, and traditional birth attendants are not paid in cash for the services they render to women in the rural areas. Conclusion. Our study brought to light the critical role traditional birth attendants play in maternity in rural and remote areas in Ghana. There is a need for skilled birth attendants to collaborate with traditional birth attendants in rural and deprived communities to provide quality and culturally accepted care in the rural communities.

Despite increased support from government and other stakeholders for malaria control over the past decade, malaria burden remains high in many endemic countries, particularly in Sub-Saharan Africa. This study aimed to assess patients’ knowledge of antimalarial treatment (ACT) and its association with patient adherence. A descriptive cross-sectional study design was employed in this study. Data were collected from April to May 2017. Both descriptive and inferential statistics in the form of frequencies, percentages, mean values, standard deviations, and Pearson’s chi-square test were generated by use of Microsoft excel spreadsheet and IBM Statistical Package for Social Sciences (SPSS) version 23. The average age of the respondents surveyed for this study was 42.27 ± 11.09. Adherence level to ACT was 47%. The results showed that there was a significant association between respondents’ knowledge of the efficacy of antimalarial medication (p =0.003), benefits of completing antimalarial treatment course (p =0.001), and consequences of not completing the doses of antimalarial medication prescribed (p =0.002) and adherence to ACT. This study then recommends that improving patients’ knowledge regarding the efficacy, benefits of completing ACT, and consequences of not completing ACT treatment may improve the likelihood of patients adhering fully to ACT.

Background: Labor and delivery process is an exciting, anxiety-provoking, but rewarding time for a woman and her family after successful delivery of a newborn. The intrapartum period is the time where mothers expect more care from nurses/midwives. Taking care of a mother in delivery with no side effects is the task of a professional midwife who is trained to care of mothers and babies. Therefore, the aim of this study was to explore mother’s experiences regarding intrapartum quality of care. Methods: Focused ethnographic study was employed. Data were collected from May to June 2016 using semi structured interview guide. Purposive sampling was employed to recruit 20 participants. Eight individual interviews were conducted in postnatal ward of the Tamale Teaching Hospital in Ghana after 48 hours of delivery, followed by three focus group discussions two weeks after delivery when mothers visited postnatal clinic. Interviews lasted for about 30-45 minutes during each session. Data were analyzed using thematic analysis. Results: The average age of women were 29years with ages ranging from 19years to 43years. Participants’ experiences of nursing/midwifery care during birth were influenced by reception and respect, provision of information, technical skill, providers’ behavior, pain management and availability of nurses/midwives. Conclusion: The study findings have revealed that women’s experience of care is affected by a wide range of determinants. Therefore, maternal health programmes and policies in Ghana must take into account women’s expectations on the care they need and their feedback on services they receive. Nursing education should re-enforce communication/relational skills. Keywords: Nursing Care, Labor, Delivery, Qualitative Study

Introduction Over the past decade, the incidence of low birth weight (LBW) in sub-Saharan Africa has not seen any decline and this is a matter of grave concern for healthcare providers, policymakers, and researchers. Therefore, this study aimed to assess the incidence of LBW and related maternal risk factors (during pregnancy or delivery) as well as neonatal outcomes. Methods An institutional-based retrospective cross-sectional study design was employed to select 1,017 mothers who delivered in the study hospital from January to December 2017 with singleton newborn babies without congenital diseases. Data were analysed using STATA version 14.1 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: Stata Corp LP). Chi-square test of independence was used to test the association between the dependent variable (LBW) and risk factors of LBW. Bivariate and multivariable unconditional logistic regression was used to determine the factors associated with LBW. Results The incidence of LBW was 23.7%. The findings show that being married has a protective effect on LBW [AOR = 0.60 (95%CI: 0.40–0.90), p = 0.013] compared to single mothers. Neonates born between gestational age of 37–42 weeks had 85% lower odds of LBW [AOR = 0.15, (95%CI: 0.10–0.24), p < 0.001)]. Neonates with LBW had a higher risk of low Apgar score in the first minute compared to neonates with normal birth weight [AOR = 0.52 (95%CI: 0.37–0.73), p < 0.001]. Female neonates had 64% higher odds of LBW compared to their male counterparts [AOR = 1.64 (95%CI: 1.19–2.24), p = 0.002]. Conclusion This study revealed a high incidence of LBW. Women's marital status (single mothers), gestational age (, Low birth weight; Neonatal risk factors; Maternal risk factors; Prevalence; Ghana.

Introduction In recent times, there has been an increasing burden in traumatic, medical, and surgical emergency conditions, placing more emphasis on the need for quality emergency care. This study aimed to explore the challenges experienced by nurses working in the emergency unit of a secondary referral hospital. Methods The study used an exploratory qualitative research design with a constructivist approach and a grounded theory method. Data were collected through in-depth interviews lasting between 30 to 45 minutes using a semi-structured interview guide. Inductive content analysis was used to analyse data. Results Eleven (11) participants were interviewed. The majority were female (9), aged between 31–40 years. From the inductive content analysis, four themes emerged. These were; 1) overcrowding in the emergency unit, 2) understaffing at the emergency unit, 3) lack of emergency equipment, 4) inadequate managerial support. Conclusion The study identified several major challenges confronting nurses working in the emergency unit which are linked with managerial processes and inadequate managerial support. These challenges need to be addressed to promote quality emergency nursing care. To foster a positive working environment, hospital management should validate and address the aforementioned concerns of the Emergency Department nurses.

IntroductionDiabetes mellitus is a complex disease that affects many organ systems, leading to concerns about deteriorating population health status and ever-increasing healthcare expenditure. Many people with diabetes do not achieve optimal glycaemic control and other metabolic indices, leading to a heightened risk of developing complications. Adequate knowledge of diabetes complications is a prerequisite for risk-factor reduction and prevention of the consequences of the disease. Therefore, this study aimed to evaluate the knowledge of chronic complications of diabetes among persons living with type 2 diabetes mellitus in northern Ghana.MethodA descriptive cross-sectional study was conducted among 320 patients with type 2 diabetes mellitus in northern Ghana. The consecutive sampling technique was employed to recruit participants from September to November 2018. Data analysis was performed using IBM statistical package for social science version 23. Descriptive statistics such as frequencies and percentages were used. Both bivariate and multivariate logistic regression analysis were employed to determine associations between knowledge of diabetes complications and demographic/clinical characteristics of participants, at 95% confidence interval with statistical significance at PResultsThe majority of participants (54.1%) had inadequate knowledge and 45.9% had adequate knowledge of diabetes complications. The factors associated with inadequate level of knowledge were female gender [AOR = 0.29 (95%CI: 0.14-0.56), pConclusionMore than half of the studied population had inadequate knowledge of diabetes complications. Female gender, rural dwellers, and low education level were factors positively associated with inadequate knowledge of diabetes complications. A multisectoral approach is needed, where the government of Ghana together with other sectors of the economy such as the health, education and local government sectors work collaboratively in the development of locally tailored diabetes education programmes to promote healthy self-care behaviours relevant for the prevention of diabetes and its complications.

BackgroundDiabetes often coexists with other medical conditions and is a contributing cause of death in 88% of people who have it. The study aimed at evaluating medication adherence, self-care behaviours and diabetes knowledge among patients with type 2 diabetes mellitus in Ghana.MethodsA total of 330 participants were recruited into the study from three public hospitals in the Tamale metropolis. A validated medication adherence questionnaire and the Summary of Diabetes Self-care Activities tool were used to assess medication adherence and self-care activities respectively. Logistic and linear regressions were used to determine factors positively associated with non-adherence to medication and self-care behaviours respectively.ResultsOf the 330 participants whose data were analysed, the mean (SD) age was 57.5 (11.8) years. The majority (84.5%) were adherent to anti-diabetes medication. Participant's age, educational level, and practice of self-care behaviours influenced adherence to anti-diabetes medication. Participants aged 70 years and above were 79% less likely to be non-adherent to medication as compared to those below 50 years [OR = 0.21 (95%CI: 0.06-0.74), p = 0.016]. Participants with senior high school education were 3.7 times more likely to be non-adherent to medication than those with tertiary education [OR = 3.68 (95%CI: 1.01-13.44), p = 0.049]. Participants with tertiary education had an increase in the level of practice of self-management by 1.14 (p = 0.041). A unit increase in knowledge score also increased the level of practice of self-management by 3.02 (pConclusionThe majority of participants were adherent to anti-diabetes medication. Non-adherence to medication was associated with younger age and low level of education. Interventions to improve adherence should target younger and newly diagnosed patients through aggressive counselling to address healthy self-management behaviours.

Randomization and sampling procedure. Source: WOTRO-COHEiSION Ghana Project (2012â 2014); Legend: GAR (Greater Accra); WR (Western Region); SCE (Systematic Community Engagement) (DOCX 33 kb)

Overview of the Systematic Community Engagement (SCE) Interventions Implementation Steps. Source: WOTRO-COHEiSION Ghana Project, cited in Alhassan et al. (2015) (DOCX 13 kb)

Questionnaire. List of questions in Questionnaire. (PDF 53 kb)

Worldwide, neonatal sepsis accounts for an estimated 26% of under-five deaths, with sub-Saharan Africa having the highest mortality rates. Though worldwide neonatal deaths have decreased by over 3.6 million per year since 2000, neonatal sepsis remains a notable hindrance to the progress in the decline of cause-specific mortality rates especially in sub-Saharan Africa. This study aimed at examining the risk factors of neonatal sepsis at the Trauma and Specialist Hospital, Winneba. The study was an unmatched case control retrospective study. Cases were neonates who had sepsis with their index mothers and controls were neonates who did not have sepsis with their index mothers. Neonatal and maternal medical records were retrieved from January to December 2017. Data abstraction lasted for one month and 2650 folders for the neonates and their index mothers were retrieved. Nine hundred (900) neonatal folders were considered valid for the study and likewise for the maternal folders. One hundred and three (103) folders were considered cases while 797 were considered as controls. Data were entered using the Statistical Package for Social Sciences Version 22. Logistic regression was used to determine the risk of neonatal sepsis. Maternal factors that predicted the occurrence of sepsis among neonates were parity (pppppppp

Systematic Community Engagement (SCE) implementation steps. Source: WOTRO-COHEiSION Ghana Project baseline and follow-up field data (2014), cited in Alhassan et al. (2015); Legend: C=Client; P=Provider; I=Insure; NHIS (National Health Insurance Scheme); NHIA (National Health Insurance Authority) (DOCX 30 kb)

The third Sustainable Development Goal (SDG) for child health, which targets ending preventable deaths of neonates and children under five years of age by 2030, may not be met without substantial reduction of neonatal sepsis-specific mortality in developing countries. This study aimed at assessing the prevalence and risk factors for neonatal sepsis among neonates who were delivered via caesarean section. A retrospective case-control study was conducted among neonates who were delivered via caesarean section at the Trauma and Specialist Hospital, Winneba, Ghana. Data collection lasted for 4 weeks. The extracted data were double-entered using Epidata software version 3.1 to address discrepancies of data entry. Descriptive statistics such as frequencies and percentages of neonatal characteristics were generated from the data. Both univariate and multivariate logistic regression were used to determine associations between neonatal sepsis and neonatal characteristics with odds ratios, 95% confidence intervals, and p values calculated using variables that showed significant association (pχ2=6.64, p=0.036), neonatal age (χ2=38.31, pχ2=12.95, pχ2=24.27, pχ2=36.69, p