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The cost burden of occupational injuries has significant effects on the social well-being of workers. Although there seems to be growing evidence on the cost burden on other public health issues, little is known about occupational injuries, especially in low- to middle-income countries including Ghana. This study, therefore, sought to estimate the cost burden of managing occupational injuries among frontline construction workers. A prevalence-based cost of illness approach was used to estimate the cost burden of construction injuries. A structured questionnaire was used to collect cost-related data from 640 frontline construction workers. Descriptive statistics were used to estimate direct and indirect cost of injuries using Microsoft Excel and STATA version 14. Overall, a worker spends an average of GHC 104.84 ($24.52) and GHC 180.89 ($42.31) as direct and indirect costs, respectively. Compared with other injuries, fracture had the highest average cost, GHS 343.33 ($80.30), and concussion and internal injury recorded the lowest cost. Also, compared with other trade specialties, carpenters had the highest average cost burden and laborers had the lowest burden. There is high direct and indirect cost for managing occupational injury among construction workers. Advocacy and awareness about workplace insurance and regulatory policies should adequately be strengthened and prioritized through periodic monitoring and evaluations. [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan African populations are disproportionately affected by cardiovascular disease (CVD). Although diet is an important lifestyle factor associated with CVD, evidence on the relation between dietary patterns (DPs) and CVD risk among sub-Saharan African populations is limited.Objective: We assessed the associations of DPs with estimated 10-y atherosclerotic cardiovascular disease (ASCVD) risk in Ghanaian adults in Ghana and Europe.Methods: Three DPs ('mixed'; 'rice, pasta, meat, and fish'; and 'roots, tubers, and plantain') were derived by principal component analysis (PCA) based on intake frequencies obtained by a self-administered Food Propensity Questionnaire in the multi-center, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study. The 10-y ASCVD risk was estimated using the Pooled Cohort Equations (PCE) for 2976 subjects, aged 40-70 y; a risk score ≥7.5% was defined as 'elevated' ASCVD risk. The associations of DPs with 10-y ASCVD risk were determined using Poisson regression with robust variance.Results: Stronger adherence to a 'mixed' DP was associated with a lower predicted 10-y ASCVD in urban and rural Ghana and a higher 10-y ASCVD in Europe. The observed associations were attenuated after adjustment for possible confounders with the exception of urban Ghana (prevalence ratio [PR] for Quintile 5 compared with 1: 0.70; 95% CI: 0.53, 0.93, P-trend = 0.013). The 'rice, pasta, meat, and fish' DP was inversely associated with 10-y ASCVD across all study sites, with the adjusted effect being significant only in urban Ghana. A 'roots, tubers, and plantain' DP was directly associated with increased 10-y ASCVD risk.Conclusions: Adherence to 'mixed' and 'rice, pasta, meat, and fish' DPs appears to reduce predicted 10-y ASCVD risk in adults in urban Ghana. Further investigations are needed to understand the underlying contextual-level mechanisms that influence dietary habits and to support context-specific dietary recommendations for CVD prevention among sub-Saharan African populations. [ABSTRACT FROM AUTHOR]

Objective the objective of this study is to understand the barriers final year midwifery students face when deciding to practice in a rural, deprived area. Design a cross-sectional study design using a computer based structured survey. Setting 15 of the 16 publicly funded midwifery colleges across all ten regions in Ghana. Participants a national sample of final-year midwifery students from publically funded midwifery colleges in Ghana. Measurements basic frequencies and percentages were calculated for the variables cited as the top three factors motivating participants to study midwifery stratified by student type (post-basic verses diploma) and program location (urban, peri-urban, and rural). Odds ratios were calculated using separate logistic regression models to analyze the relationship between students' experience with rural communities and how it affected their willingness to work in a rural area following graduation. Findings eight hundred and fifty-six midwifery students ( N = 856) completed a computerised survey for a response rate of 91.8%. The top motivation to study midwifery was a ‘desire to help others’. Over half (55%) of participants reported they will ‘definitely work’ (11%) or ‘were likely to work’ (44%) in a deprived area. When examined by student type and location of school, the top reason cited by participants was ’to serve humanity’. Those born in a rural area, currently living in a rural area, or under obligation to return to a rural or peri-urban area had greater odds of being willing to work in a deprived area after graduation. Key conclusions findings from our study are unique in that they examine the distinct motivational factors from a national sample of midwifery students about to join the workforce. Regardless of the type of student or the location of the school, midwifery students in Ghana were highly motivated by altruistic values. Strategies to address the rural shortage of midwifery providers in Ghana is presented. Implication for practice understanding the factors that motivate midwifery students to work in rural, deprived areas will help develop effective policy interventions affecting practice. [ABSTRACT FROM AUTHOR]

Objective: to determine what midwifery students throughout Ghana were witnessing, perceiving, and learning with regard to respectful care during labour and childbirth. Design: cross-sectional survey. Setting: public midwifery schools in all 10 regions of Ghana. Participants: all graduating midwifery students in Ghana. Measurements: 929 final-year students at 15 public midwifery schools in Ghana were asked to complete a self-administered computerised survey addressing a range of topics, including experiences during training. All data were collected anonymously and analyzed using Stata 13.0. Findings: 853 students completed the questionnaire (91.8% response rate): 72.0% said maltreatment was a problem in Ghana and 77.4% said women are treated more respectfully in private than public facilities. Students described providers: telling women to stop making noise (78.5%), shouting at women (68.8%), scolding women if they didn't bring birth supplies (54.5%), treating educated/wealthy women better than less educated / poor women (41.5%/38.9%), detaining women who couldn't pay (37.9%), and speaking disrespectfully to women (34%). Only 4% of students reported not witnessing any disrespectful treatment. Students reported providers being overworked (76.5%), stressed (74.2%), and working without adequate resources (64.1%). Where students performed their clinical training (teaching hospital, district hospital, public health clinic, private facility) had no effect on perception of maltreatment as a problem. However, students who trained in district hospitals witnessed more types of disrespectful care than those who did not train in district hospitals (p=0.01). Conclusions and implications: a majority of midwifery students throughout Ghana witness disrespectful care during their training. Implications include the need for provider curricula that address psychosocial elements of care, as well as the need to improve monitoring, accountability, and consequences for maltreatment within facilities without creating a culture of blame. [ABSTRACT FROM AUTHOR]

Acute Respiratory Infection (ARI) is one of the topmost childhood killers ahead of diarrhoea and malnutrition in children. This exploratory qualitative study sought to examine the influence of maternal social constructs on the recognition and care seeking for fast breathing in children to inform the development of an intervention aimed at addressing fast breathing and acute respiratory infection related illness among children in Ghana. Focus group discussions with 23 mothers with children aged 6 weeks – 12 weeks old was conducted. The study used an abbreviated grounded theory and thus the full iterative cycle was not performed during the interview and data analysis. Fast breathing is locally called 'oteeso' (difficulty in breathing), and 'mframa-ko-ne-mu' (air has entered the child). Evil spirit, heredity , and exposure to windy weather were mentioned as the causes. Herbs and herbal preparations are perceived to be more effective in managing fast breathing. Mothers have varying construction of causes, presentation and treatment options for fast breathing, and these have implications in control and prevention. Understanding the local construction of illness beliefs is key to designing interventions aimed at empowering mothers to seek early care for their children on respiratory related illness. [ABSTRACT FROM AUTHOR]

Background Validated absolute risk equations are currently recommended as the basis of cardiovascular disease (CVD) risk stratification in prevention and control strategies. However, there is no consensus on appropriate equations for sub-Saharan African populations. We assessed agreement between different cardiovascular risk equations among Ghanaian migrant and home populations with no overt CVD. Methods The 10-year CVD risks were calculated for 3586 participants aged 40–70 years in the multi-centre RODAM study among Ghanaians residing in Ghana and Europe using the Framingham laboratory and non-laboratory and Pooled Cohort Equations (PCE) algorithms. Participants were classified as low, moderate or high risk, corresponding to < 10%, 10–20% and > 20% respectively. Agreement between the risk algorithms was assessed using kappa and correlation coefficients. Results 19.4%, 12.3% and 5.8% were ranked as high 10-year CVD risk by Framingham non-laboratory, Framingham laboratory and PCE, respectively. The median (25th–75th percentiles) estimated 10-year CVD risk was 9.5% (5.4–15.7), 7.3% (3.9–13.2) and 5.0% (2.3–9.7) for Framingham non-laboratory, Framingham laboratory and PCE, respectively. The concordance between PCE and Framingham non-laboratory was better in the home Ghanaian population (kappa = 0.42, r = 0.738) than the migrant population (kappa = 0.24, r = 0.732) whereas concordance between PCE and Framingham laboratory was better in migrant Ghanaians (kappa = 0.54, r = 0.769) than the home population (kappa = 0.51, r = 0.758). Conclusion CVD prediction with the same algorithm differs for the migrant and home populations and the interchangeability of Framingham laboratory and non-laboratory algorithms is limited. Validation against CVD outcomes is needed to inform appropriate selection of risk algorithms for use in African ancestry populations. [ABSTRACT FROM AUTHOR]

Abstract: Background: Lack of midwives in rural and remote areas of Ghana is a national concern as the country attempts to reach targets set by Millennium Development Goals to reduce maternal and child mortality by 2015. Objectives: To understand factors influencing third-year Ghanaian midwifery students’ willingness to work in rural areas. Setting: Two of the largest midwifery schools in Ghana. Participants: Third-year midwifery students (n =238) about to graduate and enter the workforce. Methods: Based on focus group discussions with midwifery students, we refined a computerized survey to assess students’ preferences for rural posting after graduation. We then administered this survey to midwifery students in Ghana. We used Pearson''s chi-squared to compare the top reasons for choosing job location between those students likely and not likely to work in a rural area. Logistic regression models were used to calculate the odds ratios. Results: An opportunity to gain additional education was the most important factor for the midwifery students in deciding where they would eventually work (72%). Poor quality of clinical facilities (26%), poor quality of education for children (19%), and lack of social amenities (17%) were major deterrents to working in rural communities. For student midwives willing to work in rural areas the top reasons cited included to serve humanity (74%), and increased opportunities to gain clinical experience (62%). More experiences overall with rural communities resulted in greater odds of being willing to work in a rural area. Being born in a rural area (OR: 1.95, 95% CI: 0.736, 5.16) and living in a rural area after age 5 for one-year or more (OR: 1.52, CI: 0.857, 2.70). An exception to this was midwifery students who performed health work for six weeks or more in a rural area during training. These students were found to have 0.83 lower odds of willingness to work in a rural area (95% CI: 0.449, 1.55). Conclusion: By better understanding the motivating factors for rural healthcare workers, specific policy interventions can be established to improve the distribution of midwives thereby decreasing the burden of maternal and infant mortality. [ABSTRACT FROM AUTHOR]