Search

Additional file 1. Search strategies.

Additional file 2 Mixed Methods Appraisal Tool (MMAT) in selected studies (N=26).

Adolescents are persons between 10 and 19 years of age. In Ghana, about 23% of the total population are adolescents. They often experience a higher risk of sexual and reproductive health problems. Health worker’s knowledge on adolescent health, services provision and challenges are critical. Thus, this study explored health worker’s knowledge on adolescent health, services provision and challenges in Kumbungu District, Ghana. A purposive sampling technique was used to select eight key informants from five sub-districts. The sample was determined based on pragmatic considerations such as limited availability of participants. The interviews were transcribed and data analyzed using thematic analysis. The study was conducted between June and September 2017. All participants had heard of adolescent health. They said adolescent health covers teenagers between 10 and 19 years of age, their sexual lifestyle, teenage pregnancy, family planning, sexually transmitted infections, counselling services, personal hygiene and general curative care. The participants rated their knowledge as low due to inadequate training. The health services include family planning, counselling, nutrition education, menstrual hygiene and curative care due to the type of health facility, capacity, resources and demands of the adolescents. Challenges health workers face include low knowledge, inadequate staff, lack of separate rooms to ensure privacy/confidentially, language barriers and inadequate logistics. In conclusion, the participant’s knowledge on adolescent health was low, while some challenges were experienced. Thus, health workers should be trained on adolescent health in the district and there is the need for more resources to improve availability and variety of services.

Additional file 1.

Additional file 1. Test for internal consistency of CLES + T (Cronbach’s alpha).

Ghana, one of the challenging contexts settings in sub-Saharan Africa, is a strong democratic nation and one of the area’s emerging economies, yet the country still faces poor maternal health with maternal mortality ratios at 350/100,000 live births. This statistic means that the country’s efforts to achieve Millennium Development Goal-5—the reduction of maternal mortality by 75 per cent by 2015—remains a mere dream. In this dissertation, I explore rural Ghanaian women’s perspectives on the influence of social structures—especially, kinship and gender relations, individual maternal practices, the social meaning of motherhood and cultural beliefs—on their reproductive health decisions and maternal health service utilization. Secondly, I explore rural midwives’ perspectives on providing services to women in Talensi-Nabdam district of the Upper East Region. Using ethnographic methods— participant observation, face-to- face interviews, focus groups, “deep hanging out”—I gathered data in six villages and four health clinics. Participants included 27 women of childbearing age as well as older women who provide traditional maternal health services to rural women and four midwives. My findings suggest that a complexity of socio-cultural structures and concepts, sustained gender-based violence and, an increased disproportionate gendered division of labour, affect women’s reproductive health decisions at the household level. At the level of the health care system and government, poor health care provider attitudes, over medicalization of reproduction, application of unrealistic, unsustainable and culturally inappropriate local and foreign policies, poor infrastructural development and weak social protection policies all impact women’s reproductive health decisions and access to care with profound negative implications for maternal wellbeing. I highlight not only typical issues, often taken-for-granted by many scientists, but also how these issues have extreme negative impacts on women’s wellbeing. This diverse perspective offers a better understanding of maternal health services provision and utilization that will challenge the status quo and prompt improvements in maternal health in Ghana and other Sub-Saharan African nations. I offer recommendations, as well as future research, for health care providers, policymakers, medical and nursing education and government in an effort to promote a better understanding of rural women’s reproductive health and general wellbeing.

Ghana, a low-income developing country in sub-Saharan Africa is experiencing low maternal health service utilization and high rates of maternal mortality, especially in the rural areas. The Talensi-Nabdam District is one of the poorest and most remote districts in Ghana. The reproductive health status of women in the most remote communities in this District is poor. Dialogue about women’s reproductive health care needs in Ghana have been influenced by health care authorities, professionals, researchers and experts’ perceptions. The purpose of this ethnographic research was to explore rural Ghanaian women’s experiences of seeking reproductive health care from their own perspectives. The study was based on data collected from participant observations, unstructured face-to-face interviews and focus group discussions. A total of 27 women of varying socio-demographic backgrounds participated in the study. Interviews were conducted at locations of the women’s choice and in women’s local dialect. Data were translated and transcribed verbatim, and analyzed thematically. Four major themes emerged from the findings: submitting to the voices of family, women’s experiences of receiving nursing care, the community of gossip, and gaining voice. The findings of this study have implications for nursing practice, education and nursing inquiry. Awareness of barriers that rural women encounter in meeting their reproductive health care needs among health care providers is important in facilitating positive health care seeking behaviours. Nurse educators should orient themselves to the challenges to meeting women’s health care needs, and include in culturally sensitive approaches in nursing education programs. Further research is needed to investigate strategies that will enhance women’s reproductive health care seeking behaviours in rural settings and to focus on women’s perspectives in particular. In addition, research is needed to examine nurses’ perspectives on factors that influence quality care delivery to address women’s reproductive health issues.