Maternal and neonatal morbidities and mortalities have received much attention over the years in sub-Saharan Africa; yet addressing them remains a profound challenge, no more so than in the nation of ...Ghana. This study focuses on finding explanations to the conditions which lead to maternal and neonatal morbidities and mortalities in rural Ghana, particularly the Upper West Region.
Mixed methods approach was adopted to investigate the medical and non-medical causes of maternal and neonatal morbidities and mortalities in two rural districts of the Upper West Region of Ghana. Survey questionnaires, in-depth interviews and focus group discussions were employed to collect data from: a) 80 expectant mothers (who were in their second and third trimesters, excluding those in their ninth month), b) 240 community residents and c) 13 healthcare providers (2 district directors of health services, 8 heads of health facilities and 3 nurses).
Morbidity and mortality during pregnancy is attributed to direct causes such urinary tract infection (48%), hypertensive disorders (4%), mental health conditions (7%), nausea (4%) and indirect related sicknesses such as anaemia (11%), malaria, HIV/AIDS, oedema and hepatitis B (26%). Socioeconomic and cultural factors are identified as significant underlying causes of these complications and to morbidity and mortality during labour and the postnatal period. Birth asphyxia and traditional beliefs and practices were major causes of neonatal deaths.
These findings provide focused targets and open a window of opportunity for the community-based health services run by Ghana Health Service to intensify health education and promotion programmes directed at reducing risky economic activities and other cultural beliefs and practices affecting maternal and neonatal morbidity and mortality.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Despite decades of implementation of maternity healthcare programmes, including a focus on increasing the use of antenatal care (ANC) and concomitant birth preparedness and complication readiness ...(BPCR), the uptake of ANC continues to be below expectations in many developing countries. This has attendant implications for maternal and infant morbidity and mortality rates. Known barriers to ANC use include cost, distance to health care services and forces of various socio-cultural beliefs and practices. As part of a larger study on BPCR in rural Ghana, this paper reflects on the use of ANC in the study areas from rights-based and maternal engagement theoretical perspectives, with a focus on the barriers to ANC use.
Mixed methods approach was adopted to collect data from 8 study communities from individual in-depth interviews with 80 expectant mothers and 13 health care professionals, and 24 focus groups comprising 240 community members. The qualitative data followed a thematic analytical method, while the quantitative data was analysed using descriptive statistics.
The average number of ANC visits were 3.34±1.292, and the majority of expectant mothers (71.3%) enrolled for ANC at the 8th week or later, with the longest delay recorded at the 6th month of gestation. Traditional norms significantly influenced this delay. Likewise, overall use of ANC during pregnancy was shaped by cultural factors related to perceptions of pregnancy, gender-based roles and responsibilities and concerns that ANC would result in an overweighed baby and culturally inappropriate delivery at a health care facility.
Greater understanding of the sociocultural barriers to ANC is essential if proposed changes in community-specific health education programs are to facilitate early commencement and increased use of ANC.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
Over the years, governments and stakeholders have implemented various policies/programmes to improve maternal health outcomes in low-middle-income countries. In Ghana, Community ...Health Officers were trained as midwives to increase access to skilled maternal healthcare. The government subsequently banned traditional birth attendants from providing direct maternal healthcare in 2000. Despite these, there is an unprecedented utilisation of TBAs’ services, including herbal uterotonics. This has attempted to defeat stakeholders’ campaigns to improve maternal health outcomes. Thus, we explored and highlighted
herbal uterotonic consumption in pregnancy and birth and the implications on maternal and newborn health outcomes in North-Western Ghana.
Methods
This was an exploratory qualitative study that investigated traditional birth attendants (
n
= 17) and healthcare providers' (
n
= 26) perspectives on the intake of herbal uterotonics in pregnancy and childbirth in rural Ghana, using in-depth interviews. A combination of convenience, purposive and snowball sampling procedures were employed in selecting participants.
Results
Findings were captured in two domains: (1) perceived rationale for herbal uterotonic intake, and (2) potential adverse impacts of herbal uterotonic intake in pregnancy and labour, and nine topics: (i) confidence in unskilled attendance at birth, (ii) cost and a shortage of essential medicines, (iii) herbal uterotonics as a remedy for obstetric problems, (iv) herbal uterotonics facilitate birth, (v) attraction of home birth for cultural reasons, (vi) affordability of herbal uterotonics, (vii) unintended consequences and adverse outcomes, (viii) risks using herbal uterotonics to manage fertility and (ix) risks using herbal uterotonics to facilitate home birth
.
Conclusion
The findings have suggested that the intake of non-conventional herbal uterotonic is widespread in the study area, although the constituents of the herb are unknown. However, complex and multiple factors of healthcare cost, desire for homebirth, unawareness of the negative effects of such substances, perceived way of addressing obstetric problems and cultural undertones, among others, accounted for herbal uterotonics consumption. We also encourage research into the constituents of ‘mansugo’ and the potential benefits and adverse effects. We recommend qualitative studies involving previous users of this herbal uterotonic to inform policy and healthcare provision.
Introduction: Aboriginal and Torres Strait Islanders' social and emotional well-being provides a strength-based framework to discuss social and emotional well-being. This paper focuses on Elders' and ...older Aboriginal people's experiences of social and emotional well-being and their cultural obligations relating to social and emotional well-being. These cultural obligations, along with social and emotional well-being experiences, inform and/or are influenced by Elders and older people's occupations.
Methods: An Indigenous Standpoint Theory guided this research and supported yarning as a research method. In total, 16 older Aboriginal people participated in this research. A modified version of an existing thematic analysis process was used to organise the data, which enabled research yarning members to participate and engage in all stages of data analysis.
Results: Three key themes were identified: 1). Every day you will learn something; 2). It all comes back to culture; 3). The old wings, they used to be flyin', are just lying beside them. These themes highlight the importance of older Aboriginal people participating in learning activities and fulfilling cultural obligations that support social and emotional well-being. Factors like disrespect, poor health and/or well-being, broken cultural connections, and geography negatively influence participation in roles, responsibilities, and occupations.
Conclusion: Elders and older people are integral in maintaining the cultural well-being of family, community, and country. This social and emotional well-being framework provides a respectful foundation to discuss Elders' and older Aboriginal people's cultural obligations, with the cultural domain providing a solid foundation for exploring Elders' and older people's occupations.
Despite the many maternal healthcare policy programmes in Ghana such as free the antenatal care (ANC) and the fee-exemption policy under the National Health Insurance Scheme, among others, the ...country has yet to make substantial improvements in addressing low skilled care utilisation in pregnancy and delivery. From previous studies, maternal mortality has been linked to women's healthcare decision-making power at the household level in many low and middle-income countries. Thus, a pregnant women's ability to choose a healthcare provider, act on her preferences, and to be sufficiently financially empowered to take the lead in deciding on reproductive and pregnancy care has significant effects on service utilisation outcomes. Therefore, we explored rural community-level barriers to seeking care related to obstetric complications and delivery from the perspectives of mothers, youth, opinion leaders and healthcare providers in Nadowli-Kaleo and Daffiama-Bussie-Issa districts in the Upper West Region of Ghana.
This exploratory qualitative study was based on the narratives of women, health providers and community stakeholders regarding the expectant women's autonomy to decide and utilise maternal care. To achieve maximal diversity of responses, purposive sampling procedures were followed in selecting 16 health professionals, three traditional birth attendants and 240 community members (opinion leaders, youth and non-pregnant women) who participated in individual depth interviews and focus group discussions.
Women's lack of autonomy to seek care without prior permission, perceived quality care of traditional birth attendants, stigmatisation of unplanned pregnancies and cultural beliefs associated with late disclosure of childbirth labour all delayed mothers timely use of skilled care in the study communities. These barriers compounded problems arising from communities that are geographically isolated from hospital care.
Decisions about seeking maternal care were usually made by the expectant woman's husband and family without providing adequate support to pregnant women during the latter stages of pregnancy and delivery. We conclude that this is primarily a cultural issue. The study recommends a change in the approach to community-level health education campaigns for maximum impacts through the increased involvement of men and families in health service delivery and utilisation.
At least 20% of young people aged between 14 and 25 years who live in inland Australia experience a mental health or substance use problem at any given point in time. Many of these young people ...experience significant geographic, economic and sociocultural barriers to obtaining youth-friendly health advice and care, particularly in relation to key issues of mental health and drug and alcohol use. Only a small percentage ever receives care from health professionals. The use of schools to provide mental health and substance use education and care is explored as a possible means of overcoming these barriers and better addressing the needs of youth in rural and remote locations. Author abstract
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
ObjectivesIn considering explanations for poor maternal and newborn health outcomes, many investigations have focused on the decision-making patterns and actions of expectant mothers and families, as ...opposed to exploring the ‘supply side’ (health service provider) barriers. Thus, we examined the health system factors impacting on access to and delivery of quality maternal and newborn healthcare in rural settings.DesignA semistructured qualitative study using face-to-face in-depth interviews with health professionals, and focus group sessions with community members, in eight project sites in two districts of Upper West Region, Ghana, was employed. Participants were purposively selected to generate relevant data to help address the study objective. The survey was guided by WHO standard procedures and Ghana Health Ministry’s operational work plan for maternal and newborn care.SettingNadowli–Kaleo and Daffiama–Bussie–Issa districts in Upper West Region, Ghana.ParticipantsTwo hundred and fifty-three participants were engaged in the study through convenient and purposive sampling: healthcare professionals (pharmacist, medical doctor, two district directors of health services, midwives, community health and enrolled nurses) (n=13) and community members comprising opinion leaders, youth leaders and adult non-pregnant women (n=240 in 24 units of focus groups).ResultsResults show significant barriers affecting the quality and appropriateness of maternal and neonatal health services in the rural communities and the Nadowli District Hospital. The obstacles were inadequate medical equipment and essential medicines, infrastructural challenges, shortage of skilled staff, high informal costs of essential medicines and general limited capacities to provide care.ConclusionImplementation of the birth preparedness and complication readiness strategy is in its infancy at the health facility level in the study areas. Increasing the resources at the health provider level is essential to achieving international targets for maternal and neonatal health outcomes and for bridging inequities in access to essential maternal and newborn healthcare.
Objective: This paper explores pharmacist perceptions of a pilot study assessing the impact of specialist training on depression for rural community pharmacists on their understanding of treatment ...and psychological well‐being of patients.
Design: Mixed method survey.
Setting: Rural community pharmacies.
Participants: Thirty‐two rural based community pharmacists.
Interventions: Recruited pharmacists were allocated to either the ‘control’ or ‘intervention’ group. Intervention pharmacists were given training in depression and asked to dispense medication with extra advice and support, while control pharmacists provided usual care.
Outcome measures: Understanding of depression, current involvement in patients with depression, changes in practice.
Results: All pharmacists were more likely to initiate conversation, discuss medication and its side effects, point out the importance of remaining on the medication, provide ongoing follow‐up and encourage patients to talk with their GPs and pharmacists by the end of the project. Intervention pharmacists were more likely than the control pharmacists to initiate conversation on dispensing a repeat prescription and to discuss extended support.
Conclusion: Response to the project by pharmacists was generally very positive. It is recommended that a longitudinal study based on this project be undertaken which involves pharmacists, GPs and other mental health professionals and trials a holistic approach to mental health care.
Objective: Documentation and evaluation of patient outcomes in a pilot study into the role of rural community pharmacists in the management of depression.
Design: Parallel groups design with a ...control and intervention group.
Setting: Thirty‐two community pharmacies in rural and remote New South Wales, Australia.
Participants: One hundred and six patient participants, mean age of 46 years, predominantly female, not currently employed, recruited by participating pharmacists.
Interventions: Intervention pharmacists were given video‐conference training on the nature and management of depression by a psychiatrist, psychologist and general practitioner and asked to dispense medication with extra advice and support. Control pharmacists were asked to provide usual care.
Main outcome measures: Adherence by self‐report, K10, Drug Attitude Index.
Results: The results indicated that adherence to medications was high in both groups (95% versus 96%) and that both groups had improved significantly in wellbeing (a reduction K10 score of 4 (control) versus 4.7 (intervention)). No significant change was found in attitude to drug treatment once baseline scores were controlled for.
Conclusions: Because both groups improved in wellbeing it is not possible to claim that the training provided to the intervention pharmacists was responsible for the success. However, the improvements gained in such a short time (two months) suggest that the involvement of pharmacists has had a beneficial rather than negative effect. Further research into the most appropriate ways in which to integrate the skills of pharmacists into a model of mental health care delivery in rural communities is recommended.
There is a large number of patients with chronic kidney disease (CKD), diabetes mellitus (DM), and hypertension (HT) but whether the targets on blood pressure (BP) control in patients with DM and/or ...CKD are met is not clear. This narrative review therefore investigated evidence on services aimed at achieving desirable clinical results in patients with CKD and DM, and HT in Australia. Literature pertaining to pathology diagnosis and management of these patients as well as the complexities in management were considered. This involved evidence from PubMed-listed articles published between 1993 and 2016 including original research studies, focusing on randomised controlled trials and prospective studies where possible, systematic and other review articles, meta- analyses, expert consensus documents and specialist society guidelines, such as those from the National Heart Foundation of Australia, American Diabetes Association, the Department of Health, The Royal College of Pathologists of Australasia, and The Australasian College of Emergency Medicine. Based on the literature reviewed, it is yet unknown as to how effective programs, such as diabetes inpatient services, endocrine out-patient services, and cardiac rehabilitation services, are at achieving guideline recommendations. It is also not clear how or whether clinicians are encumbered by complexities in their efforts of adhering to DM, HT, and glucose control recommendations, and the potential reasons for clinical inertia. Future studies are needed to ascertain the extent to which required BP and glucose control in patients is achieved, and whether clinical inertia is a barrier.
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