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Ghana has made progress in expanding providers in abortion care but access to the service is still a challenge. We explored stakeholder perspectives on task-sharing in abortion care and the opportunities that exist to optimize this strategy in Ghana. We purposively sampled 12 representatives of agencies that played a key role in expanding abortion care to include midwives for key informant interviews. All interviews were audio recorded, transcribed verbatim, and then coded for thematic analysis. Stakeholders indicated that Ghana was motivated to practice task-sharing in abortion care because unsafe abortion was contributing significantly to maternal mortality. They noted that the Ghana Health Service utilized the high maternal mortality in the country at the time, advancements in medicine, and the lack of clarity in the definition of the term "health practitioner" to work with partner nongovernmental organizations to successfully task-share abortion care to include midwives. Access, however, is still poor and provider stigma continues to contribute significantly to conscientious objection. This calls for further task-sharing in abortion care to include medical or physician assistants, community health officers, and pharmacists to ensure that more women have access to abortion care. [ABSTRACT FROM AUTHOR]

Objective: To explore pregnancy outcomes at a referral hospital in rural western Uganda.Methods: A retrospective study was undertaken using data for all deliveries at Virika Hospital, Fort Portal, Uganda, between July 1, 2009, and October 22, 2011. A detailed review of delivery logs was conducted. Categories were created for obstetric risk factors (e.g. grand multipara, history of hypertension), maternal delivery complications (e.g. eclampsia, hemorrhage), and neonatal complications (e.g. fetal distress, birth defects).Results: Overall, 4883 deliveries were included. Of the 517 neonates who did not survive, 430 (83.2%) had been stillborn. After controlling for parity, gestational age, obstetric risk factors, and neonatal complications, risk factors for stillbirth included maternal delivery complications (risk ratio [RR] 3.32, 95% confidence interval [CI] 2.34-4.71; P<0.001) and living 51-100km from the hospital (RR 3.37, 95% CI 2.41-4.74; P<0.001). Risk factors for neonatal death included neonatal complications (RR 5.79, 95% CI 2.49-13.46; P=0.001) and maternal delivery complications (RR 3.17, 95% CI 1.47-6.82; P=0.003).Conclusion: Qualified providers need to be deployed to rural areas of Uganda to facilitate the prompt identification and management of pregnancy, delivery, and neonatal complications. [ABSTRACT FROM AUTHOR]

Synopsis: Pregnant women in Ghana report skipping antenatal care and reconsidering facility delivery due to concerns about COVID‐19. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine whether facility delivery is related to compliance with recommended infant immunizations, particularly those that occur weeks or months after delivery. Methods: In a retrospective analysis, multivariate logistic regression was used to assess data from the 2011 Ethiopia Demographic and Health Survey (EDHS) to determine the strongest correlates of facility delivery. These correlates were then used, along with facility delivery itself, to determine the relationship between facility delivery and infant immunization. Results: In total, 3334 women delivered a newborn 12–24months before the 2011 EDHS: 90.2% (3007) delivered at home, and 9.8% (327) delivered in a facility. Education, wealth status, urban residence, and number of children under 5years living in the household were the factors most strongly associated with facility delivery. When facility delivery and its strongest correlates were entered into multivariate logistic regression models with infant immunizations as the outcome, facility delivery was significantly associated with increased likelihood of DPT-HepB-Hib, polio, and measles vaccination, and increased likelihood of being fully immunized (all P <0.01). Facility delivery was the strongest single factor associated with infants being immunized, doubling the odds of full immunization. Conclusion: The impact of facility delivery on health outcomes transcends the immediate delivery and postpartum period. [Copyright &y& Elsevier]

Abstract: Objective: To determine the types of access to care most strongly associated with facility-based delivery among women in Ghana. Methods: Data relating to the “5 As of Access” framework were extracted from the 2008 Ghana Demographic Health Survey and analyzed using multivariate logistic regression. Results: In all, 55.5% of a weighted sample of 1102 women delivered in a healthcare facility, whereas 45.5% delivered at home. Affordability was the strongest access factor associated with delivery location, with health insurance coverage tripling the odds of facility delivery. Availability, accessibility (except urban residence), acceptability, and social access variables were not significant factors in the final models. Social access variables, including needing permission to seek healthcare and not being involved in decisions regarding healthcare, were associated with a reduced likelihood of facility-based delivery when examined individually. Multivariate analysis suggested that these variables reflected maternal literacy, health insurance coverage, and household wealth, all of which attenuated the effects of social access. Conclusion: Affordability was an important determinant of facility delivery in Ghana—even among women with health insurance—but social access variables had a mediating role. [Copyright &y& Elsevier]

Objective: To determine the relationship between the traditional Chinese practice of postpartum care, known as zuoyuezi, and postpartum depression (PPD) in China.Methods: A total of 342 Chinese women were surveyed 6- to 8-weeks post partum using the Edinburgh Postnatal Depression Scale (EPDS) and items assessing sociodemographics, health history, peripartum experiences, zuoyuezi, and social support.Results: Prevalence of PPD was 15.5% (EPDS cutoff >or=13). PPD was associated with lower income, difficult pregnancy experience, poor infant health status, not attending childbirth classes, and low spousal involvement before and after delivery. Among the 96% of women who practiced zuoyuezi, those for whom the caregiver was her mother-in-law or who perceived zuoyuezi as unhelpful had twice the odds of PPD.Conclusion: These data highlight the importance of the peripartum experience in assessing PPD risk. Zuoyuezi is still commonly practiced in urban China, and further research is needed to explore its role in the potential prevention of PPD. [ABSTRACT FROM AUTHOR]

Objective To examine the relationship between the quantity and content of information about mammography in popular magazines and the educational level of their target audience. Design Articles published in popular magazines from January 1988 through April 1994 in which ≥ 25% of all readers were females ≥ 35 years of age were identified (n=65). We used the proportion of readers who were college graduates to stratify the magazines into three education levels. We used a content analysis to assess the relationship between media messages about mammography and readers’ education levels. Results Seventy-eight percent of lowest education level articles were categorized as persuasive or prescriptive compared with 28% of articles in the highest education level (P < 0.01). Only 26% of the lowest education level articles that discussed screening guidelines for women under 50 years of age considered the issue controversial, while 59% of the high education level articles considered it controversial (P < 0.01). Conclusion Women with lower education levels received a clearly persuasive or prescriptive message urging mammography screening, while higher educated women received more balanced and informative messages. Such differences suggest that women may be entering their physicians’ offices with very different sets of information from which to draw when faced with clinical decisions. Physicians and other health-care providers should be aware of these potential differences, and further research should be done to explore the relationship between women’s preferences for participation in shared decision-making and the types of messages they are receiving from popular media. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence of maternal near-miss (MNM) and its associated risk factors in a community setting in Central Uganda.Methods: A cross-sectional research design employing multi-stage sampling collected data from women aged 15-49 years in Rakai, Uganda, who had been pregnant in the 3years preceding the survey, conducted between August 10 and December 31, 2013. Additionally, in-depth interviews were conducted. WHO-based disease and management criteria were used to identify MNM. Binary logistic regression was used to predict MNM risk factors. Content analysis was performed for qualitative data.Results: Survey data were collected from 1557 women and 40 in-depth interviews were conducted. The MNM prevalence was 287.7 per 1000 pregnancies; the majority of MNMs resulted from hemorrhage. Unwanted pregnancies, a history of MNM, primipara, pregnancy danger signs, Banyakore ethnicity, and a partner who had completed primary education only were associated with increased odds of MNM (all P<0.05).Conclusions: MNM morbidity is a significant burden in Central Uganda. The present study demonstrated higher MNM rates compared with studies employing organ-failure MNM-diagnostic criteria. These findings illustrate the need to look beyond mortality statistics when assessing maternal health outcomes. Concerted efforts to increase supervised deliveries, access to emergency obstetric care, and access to contraceptives are warranted. [ABSTRACT FROM AUTHOR]

Objective To assess knowledge, attitudes, and practices of maternity care providers regarding the provision of postpartum intrauterine contraceptive devices (IUDs) in Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Methods A descriptive, cross-sectional study was conducted between June 28 and July 15, 2011. Specialists, residents, house officers, and nurse midwives who had been working in the Department of Obstetrics and Gynecology for at least 3 months were included. Self-administered questionnaires assessed formal training, current proficiency in IUD insertion, and attitudes toward postpartum IUD provision. Results Of 91 providers surveyed, 70 (77%) reported previous training in contraceptive counseling. Fewer than one in three respondents had ever inserted an IUD: 17 (44%) of 39 physicians and 9 (17%) of 52 midwives reported ever having inserted an IUD. A total of 33 (36%) respondents reported that they would recommend an IUD in the immediate postpartum period. Conclusion Although most maternity care providers at KATH had received training in contraceptive counseling, few felt confident in their ability to insert an IUD. Further training in postpartum contraceptive management is needed. [ABSTRACT FROM AUTHOR]

Background. Patient-centered assessments are increasingly important. Patients repeatedly emphasize the importance of trust in health care institutions and personnel. Objectives. (1) Develop a conceptual framework for trust in health care organizations and a comprehensive, reliable measure of trust in health insurers. (2) Examine predictors and correlates of trust in insurers. Study Design. A conceptual framework for trust in health organizations based on theory and empirical studies was used to develop items for a structured telephone survey, which also included measures of health and utilization, doctor–patient trust, and satisfaction with care. Principal components factor analyses identified hypothesized domains of trust in health insurers and identified items for scales. Internal consistency assessment used Cronbach's α. Univariate analyses used Pearson's r or Student's t-tests. Sample. Insured residents of Southeastern Michigan ( n=400). Results. Respondents were diverse in age, gender, ethnicity, health, and socioeconomic status. One dominant factor (eigenvalue>10) included hypothesized domains: administrative competence, clinical competence, advocacy and beneficence, fairness, honesty and openness, and one global item. Multidimensional scales were reliable (long version 13 items, α=0.95, short: 9 items, α=0.91). Insurer trust correlated strongly with trust in doctors ( r=0.49 and 0.46) and satisfaction with care ( r=0.70 and 0.66), and with an item assessing overall worry about health insurance ( r=−0.37 and −0.35). Those with less trust in their insurer were more likely to say that they would change insurance plans ( p<.001). Conclusions. This well-grounded, reliable measure of enrollee trust in insurers can be a useful patient-centered assessment tool. [ABSTRACT FROM AUTHOR]

Objective: This study explores the impacts of managing frequent maternal mortalities on obstetric healthcare providers in Ghana. Methods: Two hundred and seventy obstetric providers at the Komfo Anokye Teaching Hospital in Ghana completed an electronic survey. Questions included coping strategies, sources and adequacy of support, training, and emotional impact. Logistic regression assessed predictors of perceived preparedness to manage maternal mortalities. Results: Over half of participants (55.1%) did not report adequate support to deal with maternal death and only 35.9% received training. The vast majority (96.4%) agreed that managing maternal deaths takes a large emotional toll—27.6% considered giving up their obstetric practice, half experienced guilt or shame, and half worried about legal or disciplinary action. After adjusting for age, gender, years in practice, and annual maternal mortalities managed, perceived adequacy of support (odds ratio [OR] 6.6, 95% confidence interval [CI] 3.0–14.7, P < 0.001) and receiving training (OR 9.5, 95% CI 3.5–25.8, P < 0.001) were significantly associated with preparedness to deal with maternal mortality. Conclusion: Managing maternal mortalities has significant emotional impact on obstetric healthcare providers. Preparedness to deal with maternal death is significantly improved when providers receive adequate support and training. Synopsis: Managing maternal mortalities has significant emotional impacts on obstetric healthcare providers. Preparedness is significantly improved when provided with adequate support and training. [ABSTRACT FROM AUTHOR]

Objective: The Three Delays Model outlines, three common delays that lead to poor newborn outcomes: (i) recognising symptoms and deciding to seek care; (ii) getting to care and; (iii) receiving timely, high‐quality care. We gathered data for all newborn deaths within four districts in Ghana to explore how well the Three Delays Model explains outcomes. Methods: In this cross‐sectional, observational study, trained field workers conducted verbal and social autopsies with the closest surviving relative (typically mothers) of all neonatal deaths across four districts in northern Ghana from September 2015 until April 2017. Data were collected using Survey CTO and analysed using StataSE 15.0. Frequencies and descriptive statistics were calculated for key variables. Results: 247 newborn deaths were identified. Nearly 77% (190) of newborns who died were born at a health facility, and 48.9% (93) of those who died before discharge. Of the 149 newborns who were discharged or born at home, 71.8% (107) sought care at a facility for illness, and 72.9% (N = 78) of those did so within the same day of illness recognition. Of the 83 respondents who arranged for transportation, 82% (68) did so within 1 h. Newborns received prompt care but insufficient interventions – 25% or fewer received IV fluids, oral medications, antibiotics or oxygen. Conclusions: These data suggest that women are following recommendations for safe delivery and prompt care‐seeking. In rural northern Ghana, behaviour change interventions focused on mothers and families may not be as pressing as interventions focused on the Third Delay – obtaining timely, high‐quality care. [ABSTRACT FROM AUTHOR]

Maternity waiting homes (MWHs) in Liberia promote facility‐based delivery to reduce maternal mortality. However, women often must bring their own food and supplies to MWHs, which makes food insecurity a barrier to the utilisation of MWHs. Consumption of edible indigenous insects is a common practice and has notable nutritional benefits but has not been studied in Liberia as a potential solution to food insecurity at MWHs. The purpose of this study is to (a) examine the acceptability of insect consumption in the context of Liberian beliefs, (b) identify species commonly consumed by pregnant women in Liberia, and (c) examine the feasibility of harvesting insects as food and income generation for women staying at MWHs. Focus groups were conducted at 18 healthcare facilities in Liberia. Participants included chiefs, community leaders, women of reproductive age, traditional birth attendants, women staying at MWHs, and male partners. Focus group participants identified many different species of insects consumed by pregnant women in the community as well as the perceived health impacts of insect consumption. They also described their own experiences with insect hunting and consumption and the perceived marketability of insects, particularly palm weevil larvae. The results of these discussions demonstrate that insect consumption is an acceptable practice for pregnant women in rural Liberia. These findings suggest that it is feasible to further explore the use of palm weevil larvae as dietary supplementation and income generation for women staying at MWHs in Liberia. [ABSTRACT FROM AUTHOR]

Objective: In this study, we sought to determine to what extent the abortion law in Ghana is reflective of public opinion.Methods: In a cross-sectional, community-based survey, individuals in two fishing communities in Accra were interviewed about their beliefs on abortion between May and July 2016, and sociodemographic, attitudinal, and experience data were collected. Factors associated with the outcome variable (abortion is justified to save the life/health of the woman: Yes/No) were entered into a multivariate logistic regression.Results: A total of 508 participants completed the survey. Thirty-nine percent (n=198) of the sample agreed that abortion was justified to save the life/health of the woman, with no significant differences in this finding when controlling for understanding of the law, gender, marital status, or personal experience of abortion in multivariate analysis. Higher education (odds ratio [OR] 1.64 [P<0.001]) and older age (OR 1.28 [P<0.001]) are positively associated with abortion being justified to save life/health, while those who have had an experience of unwanted sex are less likely to believe that (OR 0.60 [P=0.029]).Conclusion: The participants held conservative views about the justification of abortion to save a woman's life and/or health. Improving access to safe abortion services will require acknowledgment of the broader social and cultural context that may make accessing such services difficult. [ABSTRACT FROM AUTHOR]

Background: Few evidence‐based interventions exist on how to improve respectful maternity care (RMC) in low‐resource settings. We sought to evaluate the effect of an integrated simulation‐based training on provision of RMC. Methods: The pilot project was in East Mamprusi District in northern Ghana. We integrated specific components of RMC, emphasizing dignity and respect, communication and autonomy, and supportive care, into a simulation training to improve identification and management of obstetric and neonatal emergencies. Forty‐three providers were trained. For evaluation, we conducted surveys at baseline (N = 215) and endline (N = 318) 6 months later, with recently delivered women to assess their experiences of care using the person‐centered maternity care scale. Higher scores on the scale represent more respectful care. Results: Compared to the baseline, women in the endline reported more respectful care. The average person‐centered maternity care score increased from 50 at baseline to 72 at endline, a relative increase of 43%. Scores on the subscales also increased between baseline and endline: 15% increase for dignity and respect, 87% increase for communication and autonomy, and 55% increase for supportive care. These differences remained significant in multivariate analysis controlling for several potential confounders. Conclusions: The findings suggest that integrated provider trainings that give providers the opportunity to learn, practice, and reflect on their provision of RMC in the context of stressful emergency obstetric simulations have the potential to improve women's childbirth experiences in low‐resource settings. Incorporating such trainings into preservice and in‐service training of providers will help advance global efforts to promote RMC. [ABSTRACT FROM AUTHOR]

Objective: To explore basic and comprehensive emergency obstetric service provision across four districts in rural northern Ghana, and whether women were more likely to deliver at facilities with more skilled care.Methods: Field workers geo-coded all health facilities in East Mamprusi, Sissala East, Kassena Nankana Municipal, and Kassena Nankana West districts, and administered surveys to assess providers and emergency obstetric care available. Data were also prospectively collected on delivery locations of women and neonates who died, or nearly died (near misses), between September 1, 2015 and April 30, 2017.Results: There were 14 physicians for a population of nearly 360 000 women. Six (6%) facilities could provide basic emergency care, and 3 (3%) could provide comprehensive care. Services were distributed unequally, with 6 (67%) of the emergency facilities located in the least populated district. Among the sample of women and neonates who died or nearly died, 175 (39%) delivered at locations unable to provide basic emergency services.Conclusion: Access to emergency obstetric and neonatal care was distributed inequitably across these districts, suggesting the need to revisit geographic placement of facilities relative to population. The study also raised the question of how to ensure facilities are equipped to respond to emergencies. [ABSTRACT FROM AUTHOR]

Objective To investigate factors associated with self-reported pregnancy termination in Ghana and thereby appreciate the correlates of abortion-seeking in order to understand safe abortion care provision. Methods In a retrospective study, data from the Ghana 2008 Demographic and Health Survey were used to investigate factors associated with self-reported pregnancy termination. Variables on an individual and household level were examined by both bivariate analyses and multivariate logistic regression. A five-point autonomy scale was created to explore the role of female autonomy in reported abortion-seeking behavior. Results Among 4916 women included in the survey, 791 (16.1%) reported having an abortion. Factors associated with abortion-seeking included being older, having attended school, and living in an urban versus a rural area. When entered into a logistic regression model with demographic control variables, every step up the autonomy scale (i.e. increasing autonomy) was associated with a 14.0% increased likelihood of reporting the termination of a pregnancy (P < 0.05). Conclusion Although health system barriers might play a role in preventing women from seeking safe abortion services, autonomy on an individual level is also important and needs to be addressed if women are to be empowered to seek safe abortion services. [ABSTRACT FROM AUTHOR]

Many women blame themselves for the development of preeclampsia, and patients may benefit from an explicit discussion about the causes of preeclampsia with their healthcare provider. [ABSTRACT FROM AUTHOR]

Objective To calculate perinatal mortality (stillbirth and early neonatal death: END) rates in the Upper East region of Ghana and characterize community-based stillbirths and END in terms of timing, cause of death, and maternal and infant risk factors. Methods Birth outcomes were obtained from the Navrongo Health and Demographic Surveillance System over a 7-year period. Results Twenty thousand four hundred and ninty seven pregnant women were registered in the study. The perinatal mortality rate was 39 deaths/1000 deliveries, stillbirth rate 23/1000 deliveries and END rates 16/1000 live births. Most stillbirths were 31 weeks gestation or less. Prematurity, first-time delivery and multiple gestation all significantly increased the odds of perinatal death. Approximately 70% of END occurred during the first 3 postnatal days, and the most common causes of death were birth asphyxia and injury, infections and prematurity. Conclusion Stillbirths and END remain a significant problem in Navrongo. The main causes of END occur during the first 3 days and may be modifiable with simple targeted perinatal policies. [ABSTRACT FROM AUTHOR]

A case series of Ugandan women with fistula and other birth injuries suggested that the root causes included social, cultural, and system ‐ based factors. [ABSTRACT FROM AUTHOR]