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We assessed the challenges facing 29 women in their quest for maternal health services in the Shai Osudoku District of Ghana. In-depth, semi-structured interviews with health professionals and focus-group discussions with women on uptake of maternal health services were conducted. Findings showed inadequate human resources and logistics for maternal health care and transportation problems. Women whose pregnancies required specialized care at district or regional hospitals deliberately reported late to the community clinics in an advanced stage of labor to avoid referrals. Findings have implications for health policymakers, implementers, and researchers. [ABSTRACT FROM AUTHOR]

Background: Vasectomy is one of the safest and inexpensive modern contraceptive methods but it remains relatively 'invisible' in Ghana. Support of women may be a significant incentive in influencing their partners to adopt vasectomy. Objective: To examine the perspectives of women on vasectomy as a contraceptive option. Materials and Methods: A cross-sectional survey was conducted among 298 women accessing long-term or permanent family planning methods at health facilities in three selected districts in the Central Region of Ghana. Pearson's Chi-square was used to test associations between variables and the attitudes of women towards vasectomy. A p-value of less than 0.05 was considered to be statistically significant. Results: Awareness of vasectomy was low (32%). About 66% of the women who became aware of vasectomy during the study would prefer their partners to go for vasectomy compared with 50% of those who were aware prior to the study. Women who would either not prefer vasectomy or support their partner's choice of vasectomy cited fear of impotency (39.6%). There was a statistically significant association (p<0.05) between ethnicity, previous contraceptive use, awareness of male methods, and preference for vasectomy instead of bilateral tubal ligation (BTL). A statistically significant association (p<0.05) was also found between age of participant, duration of marriage, religious affiliation, and the willingness of women to support their partner's choice of vasectomy. Conclusion: There is, therefore, the need for the involvement of women in the promotion of vasectomy through vigorous publicity and education. [ABSTRACT FROM AUTHOR]

Background: Utilization of maternal health care services is key to reducing the number of perinatal deaths and post-natal complications in sub-Saharan Africa. With a few exceptions, many studies that examine the use of maternal health services in sub-Saharan Africa have focused largely on individual-level explanations and have ignored the importance of contextual and community-level explanations. In Ghana, progress has been made in reducing maternal mortality ratio from 740/100,000 in the late 1990s to 319/100,000 in 2015 but these rates are still high. Our study focuses on impact of individual and community level-factors on maternal outcomes with the hope that it will inform public policy in Ghana. This approach highlights latent or unacknowledged aspects of fragility within health systems designed to improve maternal health and opportunities for improving uptake of services. Methods and findings: Using the 2014 Ghana Demographic and Health Survey, we examined the effects of individual and community-level factors on antenatal care, facility-based delivery, and post-natal care. Multilevel logistic regression models were used to examine the effects of individual and community-level factors on the outcome variables. Our analysis revealed that overall utilization of antenatal, facility-based delivery and post-natal care was substantial across the board; however, both individual and community-level factors were significant predictors of these maternal health outcomes. Wealthier and better educated women were more likely to use antenatal services and facility-based delivery; in contrast poor and uneducated women were more likely to use antenatal and postnatal care but not facility-based delivery. Additionally, use of National Health Insurance Scheme was statistically associated with the utilization of maternal health services. Conclusions: The findings point to areas where services can be better tailored to meet community-specific needs. Policy makers must consider factors such as educational levels and economic security at both individual and community-levels that shape women’s preferences and uptake of maternal health care in Ghana. [ABSTRACT FROM AUTHOR]

Background: Social Health Insurance (SHI) is widely used by countries attempting to move toward Universal Health Coverage (UHC). While evidence suggests that SHI is a promising strategy for achieving UHC, low-income countries often struggle to implement and sustain SHI systems. It is therefore important to understand how SHI enrollees use health insurance and how it affects their health-seeking behavior. This paper examines how SHI affects patient decision-making regarding when and where to seek care in Kenya and Ghana, two countries with established SHI systems in sub-Saharan Africa.Methods: This paper draws from two datasets collected under the African Health Markets for Equity (AHME) program. One dataset, collected in 2013 and 2017 as part of the AHME qualitative evaluation, consists of 106 semi-structured clinic exit interviews conducted with patients in Ghana and Kenya. This data was analyzed using an inductive, thematic approach. The second dataset was collected internally by the AHME partner organizations. It derives from a cross-sectional survey of social franchise clients at three social franchise networks supported by AHME. Data collection took place from February - May 2018 and in December 2018.Results: Many clients appreciated that insurance coverage made healthcare more affordable, reported seeking care more frequently when covered with SHI. Clients also noted that the coverage gave them access to a wider variety of providers, but rarely sought out SHI-accredited providers specifically. However, clients sometimes were charged for services that should have been covered by insurance. Due to a lack of understanding of SHI benefits, clients rarely knew they had been charged inappropriately.Conclusions: Clients and providers would benefit from education on what is included in the SHI package. Providers should be monitored and held accountable for charging clients inappropriately; in Ghana this should be accompanied by reforms to make government financing for SHI sustainable. Since clients valued provider proximity and both Kenya and Ghana have a dearth of providers in rural areas, both countries should incentivize providers to work in these areas and prioritize accrediting rural facilities into SHI schemes to increase accessibility and reach. [ABSTRACT FROM AUTHOR]

Background: Hepatitis E virus is an emerging infection in Africa with poor maternal and foetal outcomes. There is scanty data on the sero-prevalence of HEV infection among pregnant women in Ghana. This study highlighted the prevalence and risk factors associated with HEV infection among pregnant women in Cape Coast Metropolis, Central Region of Ghana. Methods: A multicenter (3 selected sites) analytical cross sectional study involving 398 pregnant women in the Cape Coast metropolis was conducted. HEV (Anti-HEV IgG and Anti-HEV IgM) ELISA was performed. Sero-positive women had liver chemistries done and data collected on maternal and neonatal outcomes. Data analyses were performed using Stata version 13 software (STATA Corp, Texas USA). Results: Mean age was 28.01 (± 5.93) years. HEV sero-prevalence was 12.2% (n = 48) for IgG and 0.2% (n = 1) for IgM with overall of 12.3%. The odds of being HEV sero-positive for women aged 26–35 years was 3.1 (95% CI: 1.1–8.1), p = 0.02 and ≥36 years it was 10.7 (95% CI; 3.4–33.5), p = 0.0001. Living in urban settlement was associated with lowest odds of HEV infection {OR 0.4 (95% CI; 0.2–0.8), p = 0.01}. Factors with no statistical evidence of association include main source of drinking water and history of blood transfusion. The sero-prevalence of HEV IgG increased progressively across trimesters with the highest among women in their third trimester (55.3%). None of the 49 HEV sero-positive women had elevated ALT level. Ten (N = 41) of the neonates born to sero-positive women developed jaundice in the neonatal period. The mean birth weight was 3.1kg (SD 0.4). Conclusion: HEV sero-prevalence among pregnant women in the Cape Coast Metropolis is high enough to deserve more attention than it has received so far. It is therefore important to conduct further research on the potential impact on maternal and neonatal mortality and morbidity in Ghana. [ABSTRACT FROM AUTHOR]

Neonatal mortality is a significant problem in many low-resource countries, yet for every death there are many more newborns who suffer a life-threatening complication but survive. These “near-misses” are not well defined, nor are they well understood. This study sought to explore how health care providers at three tertiary care centers in Ghana (each with neonatal intensive care units (NICUs)) understand the term “near-miss.” Eighteen providers from the NICUs at three teaching hospitals in Ghana (Korle Bu Teaching Hospital in Accra, Komfo Anokye Teaching Hospital in Kumasi, and Cape Coast Teaching Hospital in Cape Coast) were interviewed in depth regarding their perceptions of neonatal morbidity, mortality, and survival. Near the end of the interview, they were specifically asked what they understood the term “near-miss” to mean. Participants included nurses and physicians at various levels and with varying years of practice (mean years of practice = 9.33, mean years in NICU = 3.66). Results indicate that the concept of “near-misses” is not universally understood, and providers differ on whether a baby is a near-miss or not. Providers disagreed on the utility of a near-miss classification for clinical practice, with some suggesting it would be helpful to draw their attention to those at highest risk of dying, with others suggesting that the acuity of illness in a NICU means any baby could become a ‘near-miss’ at any moment. Further efforts are needed to standardize the definitions of neonatal near-misses, including developing criteria that are able to be assessed in a low-resource setting. In addition, further research is warranted to determine the practical implications of using a near miss tool in the process of providing care in a resource-limited setting and whether it might be best reserved as a retrospective indicator of overall quality of care provided. [ABSTRACT FROM AUTHOR]