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Schuler C, Agbozo F, Ntow GE, Waldboth V. Health-system drivers influencing the continuum of care linkages for low-birth-weight infants at the different care levels in Ghana. BMC Pediatr 2023; 23:501. [PMID: 37798632 PMCID: PMC10552361 DOI: 10.1186/s12887-023-04330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Low birth weight (LBW) is associated with short and long-term consequences including neonatal mortality and disability. Effective linkages in the continuum of care (CoC) for newborns at the health facility, community (primary care) and home care levels have a high tendency of minimizing adverse events associated with LBW. But it is unclear how these linkages work and what factors influence the CoC process in Ghana as literature is scarce on the views of health professionals and families of LBW infants regarding the CoC. Therefore, this study elicited the drivers influencing the CoC for LBW infants in Ghana and how linkages in the CoC could be strengthened to optimize quality of care. METHODS A constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined. RESULTS Emerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers. CONCLUSION A coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.
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Affiliation(s)
- Christina Schuler
- School of Health Sciences, Institute of Nursing, Zurich University of Applied Sciences (ZHAW), Winterthur, Switzerland
| | - Faith Agbozo
- FN Binka School of Public Health, Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | | | - Veronika Waldboth
- School of Health Sciences, Institute of Nursing, Zurich University of Applied Sciences (ZHAW), Winterthur, Switzerland
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Abubakari A, Bukari M, Malechi H, Garti H, Agbozo F. I got frightened and felt strange. I even cried a lot after the diagnosis; the experiences on the screening and management of gestational diabetes mellitus among diagnosed women. BMC Res Notes 2023; 16:236. [PMID: 37770971 PMCID: PMC10540323 DOI: 10.1186/s13104-023-06494-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Understanding the experiences of women diagnosed with Gestational Diabetes Mellitus (GDM) can improve screening, management, and postpartum care. Therefore, this study sought to investigate experiences on the screening and management of GDM among diagnosed women. METHODS This was a facility-based explorative qualitative design among five purposively sampled women diagnosed with GDM who were receiving care from healthcare professionals. Women were asked about their reaction to being diagnosed with GDM, their experiences with care, training, self-monitoring, and challenges with the management of GDM, and data obtained were analysed using thematic analysis. RESULTS Based on the thematic analysis, three main themes and ten sub-themes were generated. They were emotional experience (prior information on GDM before being diagnosed, and feelings about the diagnosis and blood glucose measurement), information source and care experience (source of information on healthy diet, training on blood glucose measurement, experiences with follow-up, and general impressions on GDM care), and dietary and lifestyle experience ( perceptions on dietary approaches, difficulties in getting and adhering to dietary and lifestyle guidelines, alternative treatment methods patronized, and effectiveness of dietary and lifestyle approaches). CONCLUSION The themes generated had psycho-emotional underpinning, and underscores the importance of psychotherapy when disclosing disease status and initiating medical care. The findings of this study could be important for the optimisation of GDM care and services for affected women.
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Affiliation(s)
- Abdulai Abubakari
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Mohammed Bukari
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana.
- Department of Social and Behavioral Change, School of Public Health, University for Development Studies, Tamale, Ghana.
| | - Hawa Malechi
- Department of Obstetrics and Gynaecology, Tamale Teaching Hospital, P.O. Box TL 16, Tamale, Ghana
- Department of Obstetrics and Gynaecology, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Humphrey Garti
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Faith Agbozo
- Heidelberg Institute of Global Health, Heidelberg University, 69120, Heidelberg, Germany
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Allied Health Sciences, Private Mail Box 31, Ho, Ghana
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Osei AN, Djekic-Ivankovic M, Larson CP, Agbemafle I, Agbozo F. Effect of school-based nutrition interventions among primary school children in sub-Saharan Africa: a systematic review protocol. BMJ Open 2023; 13:e068901. [PMID: 37072365 PMCID: PMC10124275 DOI: 10.1136/bmjopen-2022-068901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION Preadolescents are passing through an intensive growth and development period that will benefit from healthy eating practices. For those attending school, school environments offer several potential benefits and have been demonstrated to influence the quality of dietary intakes and consequentially, nutritional status of school-aged children (SAC). Considering the amount of time children spend in school and the enormous potential of evidence-based interventions, the purpose of this review is to critically appraise peer-reviewed literature addressing the impact of school-based interventions on the nutritional status of SAC aged 6-12 years in sub-Saharan Africa. METHODS AND ANALYSIS A systematic search will be conducted in the following databases and online search records: Medline, CINAHL, Web of Science, Embase, Global health, Global Index Medicus, Cochrane library, Hinari and Google Scholar using search terms and keywords codeveloped with two librarians. An additional search will also be conducted from the reference list of identified literature. Search results of titles and abstracts will be initially screened for eligibility criteria by two independent reviewers and where there is disagreement, a third reviewer will be consulted. Articles meeting these criteria will then undergo a full-text review for the eligibility and exclusion criteria. The Joanna Briggs Institute critical appraisal tool will be used to assess the risk of bias. Data from articles meeting all study criteria will be extracted, analysed and synthesised. A meta-analysis will also be conducted if sufficient data are available. ETHICS AND DISSEMINATION This systematic review is limited to publicly accessible data bases not requiring prior ethical approval to access. The results of the systematic review will be disseminated through publications in peer-reviewed journals as well as conference and stakeholder presentations. PROSPERO REGISTRATION NUMBER CRD42022334829.
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Affiliation(s)
- Angela Nyamekye Osei
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | | | - Charles P Larson
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | - Isaac Agbemafle
- Fred N Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Faith Agbozo
- Fred N Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
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Heuschen AK, Abdul-Mumin A, Abubakari A, Agbozo F, Lu G, Jahn A, Müller O. Effects of the COVID-19 pandemic on general health and malaria control in Ghana: a qualitative study with mothers and health care professionals. Malar J 2023; 22:78. [PMID: 36872343 PMCID: PMC9986038 DOI: 10.1186/s12936-023-04513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND COVID-19 has severely impacted health systems and the management of non-COVID-19 diseases, including malaria, globally. The pandemic has hit sub-Saharan Africa less than expected; even considering large underreporting, the direct COVID-19 burden was minor compared to the Global North. However, the indirect effects of the pandemic, e.g. on socio-economic inequality and health care systems, may have been more disruptive. Following a quantitative analysis from northern Ghana, which showed significant reductions in overall outpatient department visits and malaria cases during the first year of COVID-19, this qualitative study aims to provide further explanations to those quantitative findings. METHODS In the Northern Region of Ghana, 72 participants, consisting of 18 health care professionals (HCPs) and 54 mothers of children under the age of five, were recruited in urban and rural districts. Data were collected using focus group discussions with mothers and through key informant interviews with HCPs. RESULTS Three main themes occurred. The first theme-general effects of the pandemic-includes impacts on finances, food security, health service provision as well as education and hygiene. Many women lost their jobs, which increased their dependance on males, children had to drop out of school, and families had to cope with food shortages and were considering migration. HCPs had problems reaching the communities, suffered stigmatisation and were often barely protected against the virus. The second theme-effects on health-seeking-includes fear of infection, lack of COVID-19 testing capacities, and reduced access to clinics and treatment. The third theme-effects on malaria-includes disruptions of malaria preventive measures. Clinical discrimination between malaria and COVID-19 symptoms was difficult and HCPs observed increases in severe malaria cases in health facilities due to late reporting. CONCLUSION The COVID-19 pandemic has had large collateral impacts on mothers, children and HCPs. In addition to overall negative effects on families and communities, access to and quality of health services was severely impaired, including serious implications on malaria. This crisis has highlighted weaknesses of health care systems globally, including the malaria situation; a holistic analysis of the direct and indirect effects of this pandemic and an adapted strengthening of health care systems is essential to be prepared for the future.
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Affiliation(s)
- Anna-Katharina Heuschen
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany.
| | - Alhassan Abdul-Mumin
- School of Medicine, Department of Paediatrics and Child Health, University for Development Studies, Tamale, Ghana.,Tamale Teaching Hospital, Tamale, Ghana
| | - Abdulai Abubakari
- School of Public Health, Department of Global Health, University for Development Studies, Tamale, Ghana
| | - Faith Agbozo
- Fred Binka School of Public Health, Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Guangyu Lu
- School of Public Health, Medical School, Yangzhou University, Yangzhou, China
| | - Albrecht Jahn
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
| | - Olaf Müller
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
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Schuler C, Waldboth V, Ntow GE, Agbozo F. Experiences of families and health professionals along the care continuum for low-birth weight neonates: A constructivist grounded theory study. J Adv Nurs 2023; 79:1840-1855. [PMID: 36762678 DOI: 10.1111/jan.15566] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/16/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023]
Abstract
AIMS To explore the experiences of health professionals and families concerning supporting low-birth weight (LBW) infants along the continuum of care (CoC) in Ghana with the goal to unveil new strategies to improve the quality of neonatal care. DESIGN A constructivist grounded theory. METHOD Simultaneous data collection and analysis among health professionals alongside families with LBW infants from September 2020 to April 2021. The study used constructivist grounded theory strategies for data collection and analysis. RESULTS The analysis of 25 interviews resulted in a theoretical model describing 10 themes along the CoC for LBW infants, categorized into health and family systems drivers. In this paper, we focus on the latter. Early bonding and family involvement were empowering. Mothers needed assistance in balancing hope and confidence which enabled them to render special care to their LBW infants. Providing mothers with financial and domestic support as well as creating awareness on newborn health in communities were important. CONCLUSION To achieve family involvement, a coordinated CoC must entail key players and be culturally inclusive. It must be applied at all levels in the CoC process in a non-linear faction. This can help LBW infants to thrive and to reach their full developmental potential. IMPACT The theoretical model developed shows the importance of family involvement through family systems care for a comprehensive response in addressing needs of health professionals and families with LBW infants and bridging the fragmentations in the neonatal CoC in Ghana. Context-tailored research on family systems care in the neonatal period is necessary to achieve a quality CoC for LBW infants and their families. PATIENT OR PUBLIC CONTRIBUTION Caregivers and providers participated by granting in-depth interviews. Care providers further contributed through their feedback on preliminary findings.
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Affiliation(s)
- Christina Schuler
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Veronika Waldboth
- School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | | | - Faith Agbozo
- Department of Family and Community Health, University of Health and Allied Sciences, School of Public Health, Ho, Ghana
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Singh A, Torres KA, Maharjan N, Shrestha J, Agbozo F, Abubakari A, Abdul-Rahman L, Mukuria-Ashe A. Learning from health system actor and caregiver experiences in Ghana and Nepal to strengthen growth monitoring and promotion. PLoS One 2023; 18:e0282807. [PMID: 36893119 PMCID: PMC9997959 DOI: 10.1371/journal.pone.0282807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Globally, growth monitoring and promotion (GMP) of infants and young children is a fundamental component of routine preventive child health care; however, programs have experienced varying degrees of quality and success with enduring challenges. The objective of this study was to describe implementation of GMP (growth monitoring, growth promotion, data use, and implementation challenges) in two countries, Ghana and Nepal, to identify key actions to strengthen GMP programs. METHODS We conducted semi-structured key informant interviews with national and sub-national government officials (n = 24), health workers and volunteers (n = 40), and caregivers (n = 34). We conducted direct structured observations at health facilities (n = 10) and outreach clinics (n = 10) to complement information from interviews. We coded and analyzed interview notes for themes related to GMP implementation. RESULTS Health workers in Ghana (e.g., community health nurses) and Nepal (e.g., auxiliary nurse midwives) had the knowledge and skills to assess and analyze growth based on weight measurement. However, health workers in Ghana centered growth promotion on the growth trend (weight-for-age over time), whereas health workers in Nepal based growth promotion on measurement from one point in time to determine whether a child was underweight. Overlapping challenges included health worker time and workload. Both countries tracked growth-monitoring data systematically; however, there was variation in growth monitoring data use. CONCLUSION This study shows that GMP programs may not always focus on the growth trend for early detection of growth faltering and preventive actions. Several factors contribute to this deviation from the intended goal of GMP. To overcome them, countries need to invest in both service delivery (e.g., decision-making algorithm) and demand generation efforts (e.g., integrate with responsive care and early learning).
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Affiliation(s)
- Akriti Singh
- USAID Advancing Nutrition, Helen Keller International, New York, New York, United States of America
| | - Kelsey A. Torres
- USAID Advancing Nutrition, JSI Research & Training Institute, Inc., Arlington, Virginia, United States of America
- * E-mail:
| | - Nashna Maharjan
- Mother and Infant Research Activities, Kathmandu, Bagmati Province, Nepal
| | - Jyoti Shrestha
- Mother and Infant Research Activities, Kathmandu, Bagmati Province, Nepal
| | - Faith Agbozo
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Abdulai Abubakari
- Department of Global and International Health, University for Development Studies, Tamale, Northern Region, Ghana
| | | | - Altrena Mukuria-Ashe
- USAID Advancing Nutrition, Save the Children, Washington, DC, United States of America
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Agbozo F, Schuler C, Jahn A. Adherence to appointments for gestational diabetes testing and experiences with two-hour postprandial glucose test: a mixed-methods study in Ghana. BMC Pregnancy Childbirth 2022; 22:287. [PMID: 35387606 PMCID: PMC8985290 DOI: 10.1186/s12884-022-04559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background Failure to attend scheduled appointments is a common problem in healthcare. In obstetrics, diagnostic and treatment protocols for gestational diabetes mellitus (GDM) require client booking, test preparations, management and follow-up reviews. We identified the socio-demographic, obstetric and medical drivers influencing adherence to appointments for GDM testing and experiences of pregnant women’s regarding performing oral glucose tolerance test (OGTT). Methods A convergent parallel mixed-methods study comprising a cross-sectional survey and an explorative qualitative descriptive design were used. We recruited 817 women in their first trimester of pregnancy from the antenatal clinics of primary, secondary and tertiary health facilities in Ghana. After obtaining their demographic and health history, we scheduled them for 2-h OGTT between 24 and 28 gestational weeks and estimated the odds of returning for the test. In the qualitative phase, we called 166 participants to ascertain why they failed to report. Also, we had in-depth and focused group discussions with 60 postpartum women who performed the OGTT to explore their experiences with the test. Results Out of 817 pregnant women scheduled, 490 (59.97%) reported of which 54.59, 54.33 and 53.24% completed fasting plasma glucose, 1-h and 2-h OGTT, respectively. Maternal age above 35 years (OR: 3.56, 95% CI:1.49–8.47), secondary education (OR: 3.21, 95% CI: 1.19–8.69), formal sector employment (OR: 2.02, 95% CI: 1.16–3.51) and having same-sex children (OR: 4.37, 95% CI: 1.98–9.66) increased odds of appointment adherence whereas healthcare in a tertiary hospital (OR:0.46, 95% CI:0.22–0.96), rural residence (OR: 0.53, 95% CI: 0.34–0.85) and being overweight (OR: 0.45, 95% CI: 0.25–0.78) decreased the likelihood. Experiences were thematized into feelings about test procedure, acceptability of test, skillfulness of the health workers and information on the test. Despite the apprehension and discomforts associated with the test, the desire to know one’s disease status was the chief motivation. Empathy, reassurance and receiving ample information on the test procedures eased anxiety and improved test compliance. Conclusions Although 40% of participants scheduled did not return, the test was generally acceptable. Socio-cultural underpinnings influenced the health-seeking behaviors, meaning that health worker interactions on test procedures need to be sensitive to the woman’s situation.
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Affiliation(s)
- Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Private Mail Bag, 31, Ho, Ghana. .,Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany.
| | | | - Albrecht Jahn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
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Agbozo F, Amobaa ND, Runge-Ranzinger S, Grys P. 1072Mental health difficulties among adolescents in Ghana, coping mechanisms and the support systems: a mixed-methods study. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite their vulnerability, mental health of adolescents has received little attention in developing countries. We investigated the mental health difficulties faced by adolescents, their coping strategies and school-based support systems.
Methods
Design was a convergent mixed-methods study. Quantitative data was collected
using the validated strengths and difficulties questionnaire to assess the mental health of 405 adolescents in four senior high schools (SHS) in the Techiman Municipality, Ghana. Qualitative data was collected through in-depth interview with 18 teachers and seven focused group discussions among 35 students. Adjusted odds ratio (OR) for mental health difficulties were estimated through ordinal logistic regression in Stata 14.2. Qualitative data were analysed by thematic content analysis using ATLAS.ti 7.1.
Results
Over half (58.5%) experienced abnormalities related to peer (20.5%), emotional (16.3%), conduct (13.3%) and hyperactivity (3.0%) problems and prosocial behaviours (5.4%). Significant determinants were being female (OR = 2.27, 95% confidence interval [CI]:1.47-3.50), bullied (OR = 1.72, CI:1.07-2.75), domestic violence (OR = 1.87, CI:1.10-3.17), substance abuse (OR = 8.14, CI: 1.41-46.8), academic pressure (OR = 2.40, CI:1.30-4.42), and perceived poor performance (OR = 7.36 CI:2.83-19.16). Mental health difficulties were attributed to financial challenges, spiritual influences, intimate relationships, bullying, and domestic violence. Coping strategies included isolation, substance abuse and spiritual help. Guidance and counselling unit, the main support system, was ineffective due to issues with trust, confidentially, and qualified counsellors.
Conclusions
As mental health difficulties were prevalent, school-based support systems, particularly guidance and counselling needs strengthening, including being manded by trained personnel. It is time to incorporate mental health education into school curricula.
Key messages
Mental disorders among adolescents are common. While guardians and religious bodies are critical, many of the triggers occur in school necessitating mental health-friendly school environments.
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Affiliation(s)
- Faith Agbozo
- University of Health and Allied Sciences, Family and Community Health Department, Ho, Ghana
| | - Noella Dufie Amobaa
- Heidelberg Institute of Global Health, Heidelberg University Germany, Heidelberg, Germany
| | - Silvia Runge-Ranzinger
- Heidelberg Institute of Global Health, Heidelberg University Germany, Heidelberg, Germany
| | - Pauline Grys
- Heidelberg Institute of Global Health, Heidelberg University Germany, Heidelberg, Germany
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Hinneh T, Jahn A, Agbozo F. Barriers to screening, diagnosis and management of hyperglycaemia in pregnancy in Africa: a systematic review. Int Health 2021; 14:211-221. [PMID: 34432050 PMCID: PMC9070469 DOI: 10.1093/inthealth/ihab054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/01/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022] Open
Abstract
Gestational diabetes mellitus (GDM) complicates pregnancies in Africa. Addressing the burden is contingent on early detection and management practices. This review aimed at identifying the barriers to diagnosing and managing GDM in Africa. We searched PUBMED, Web of Science, WHOLIS, Google Scholar, CINAHL and PsycINFO databases in May 2020 for studies that reported barriers to diagnosis and management of hyperglycaemia in pregnancy. We used a mixed method quality appraisal tool to assess the quality and risk of bias of the included studies. We adopted an integrated and narrative synthesis approach in the analysis and reporting. Of 548 articles identified, 14 met the eligibility criteria. Health system-related barriers to GDM management were the shortage of healthcare providers, relevant logistics, inadequate knowledge and skills, as well as limited opportunities for in-service training. Patient-related barriers were insufficient knowledge about GDM, limited support from families and health providers and acceptability of the diagnostic tests. Societal level barriers were concomitant use of consulting traditional healers, customs and taboos on food and body image perception. It was concluded that constraints to GDM detection and management are multidimensional. Targeted interventions must address these barriers from broader, systemic and social perspectives.
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Affiliation(s)
- Thomas Hinneh
- Dormaa East District Hospital, Department of Nursing, P.O. Box 38, Wamfie, Ghana.,Heidelberg Institute of Global Health, Heidelberg University, Heidelberg 69120, Germany
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg 69120, Germany
| | - Faith Agbozo
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg 69120, Germany.,University of Health and Allied Sciences, Department of Family & Community Health, Private Mail Bag 31, Ho, Ghana
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Agbozo F, Jahn A. COVID-19 in Ghana: challenges and countermeasures for maternal health service delivery in public health facilities. Reprod Health 2021; 18:151. [PMID: 34281582 PMCID: PMC8287110 DOI: 10.1186/s12978-021-01198-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
We provide a situational update on COVID-19 in Ghana, the seventh African country reporting the most cases. Some modifications occurring within the health system to curtail the outbreak and its potential impact on the delivery of antenatal care services are also highlighted. With the discovery of the Delta variant in Ghana, the current attention is to prevent a third wave of infection, and also control and manage existing cases. Efforts to procure vaccines, vaccinate special populations and sensitize the public on the implications of vaccine hesitancy are ongoing. Amidst these activities, we suggest some innovations and countermeasures to safeguard primary healthcare services and potentially reinvest efforts towards achieving the sustainable development goal three within the context of maternal healthcare, citing examples specific to developing countries.
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Affiliation(s)
- Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, PMB 31, Ho, Ghana.
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Heidelberg University Medical Faculty, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Agbozo F, Abubakari A, Zotor F, Jahn A. Gestational Diabetes Mellitus per Different Diagnostic Criteria, Risk Factors, Obstetric Outcomes and Postpartum Glycemia: A Prospective Study in Ghana. Clin Pract 2021; 11:257-271. [PMID: 34066909 PMCID: PMC8161461 DOI: 10.3390/clinpract11020039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
The surge in gestational diabetes mellitus (GDM) globally requires a health system tailored approach towards prevention, detection and management. We estimated the prevalence of GDM using diverse recommended tests and diagnostic thresholds, and also assessed the risk factors and obstetric outcomes, including postpartum glycemia. Using a prospective cohort design, 446 singleton pregnant women without pre-existing diabetes did GDM tests in five hospitals in Ghana from 20–34 weeks using fasting plasma glucose (FPG), one-hour and 2-h oral glucose tolerance test (OGTT). Birth outcomes of 403 were assessed. GDM was diagnosed using six international diagnostic criteria. At 12 weeks postpartum, impaired fasting glucose (6.1–6.9 mmol/L) and diabetes (FPG ≥7.0 mmol/L) were measured for 100 women. Per FPG and 2-h OGTT cut-offs, GDM prevalence ranged between 8.3–23.8% and 4.4–14.3%, respectively. Risk factors included overweight (OR = 2.13, 95% CI: 1.13–4.03), previous miscarriage (OR = 4.01, 95% CI: 1.09–14.76) and high caloric intake (OR = 2.91, 95% CI: 1.05–8.07). Perineal tear (RR = 2.91, 95% CI: 1.08–5.57) and birth asphyxia (RR = 3.24, 95% CI: 1.01–10.45) were the associated perinatal outcomes. At 12 weeks postpartum, 15% had impaired fasting glucose, and 5% had diabetes. Tackling modifiable risk factors is crucial for prevention. Glycemic monitoring needs to be integral in postpartum and well-child reviews.
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Affiliation(s)
- Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Ho, Ghana, Private Mail Bag 31 Ho, Ghana;
- Heidelberg Institute of Global Health, University Hospital Heidelberg Germany, Im Neuenheimer Feld 130.3, 60120 Heidelberg, Germany;
- Correspondence:
| | - Abdulai Abubakari
- Public Health Department, University for Development Studies, Tamale Ghana, Tamale P.O. Box TL 1350, Ghana;
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Ho, Ghana, Private Mail Bag 31 Ho, Ghana;
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, University Hospital Heidelberg Germany, Im Neuenheimer Feld 130.3, 60120 Heidelberg, Germany;
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Abdul-Mumin A, Abubakari A, Agbozo F, Abdul-Karim A, Nuertey BD, Mumuni K, Heuschen AK, Hennig L, Denkinger CM, Müller O, Jahn A. Field evaluation of specificity and sensitivity of a standard SARS-CoV-2 antigen rapid diagnostic test: A prospective study at a teaching hospital in Northern Ghana. PLOS Glob Public Health 2021; 1:e0000040. [PMID: 36962111 PMCID: PMC10021174 DOI: 10.1371/journal.pgph.0000040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
The testing capacity for SARS-CoV-2 in Africa is rather limited. Antigen detection rapid diagnostic tests (Ag-RDTs) are a cheap and rapid alternative to reverse transcriptase-polymerase chain reaction (RT-PCR) tests, but there is little data about their performance under real life conditions in tropical countries. The objective of this study is to evaluate the performance of a standard Ag-RDT in a population of a major hospital in northern Ghana. Prospective, cross-sectional, blinded verification of the performance of the SD Biosensor Standard Q SARS-CoV-2 Ag-RDT under real life conditions in 135 symptomatic patients and 58 contacts of RT-PCR positives at Tamale Teaching Hospital in February 2021. Nasopharyngeal samples were taken under standard conditions and tested against RT-PCR in the hospital laboratory. 193 participants (median age 35 years, 109 male) were included into the study for which both RT-PCR test and Ag-RDT results were available. A total of 42 (22%) were RT-PCR positive. Of the 42 RT-PCR positives, 27 were Ag-RDT positive, resulting in a sensitivity of 64% (95% CI 49-79). Sensitivity among symptomatic patients was 58% (95% CI 38-78). 123 were identified Ag-RDT negatives of the 151 RT-PCR negatives, resulting in a specificity of 81% (95% CI 75-87). SARS-CoV-2 Ag-RDTs appear to have a rather low sensitivity and particularly a low specificity under real life conditions in Africa. The role of existing Ag-RDTs in countries with high-temperature climates and limited resources still needs more data and discussion.
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Affiliation(s)
- Alhassan Abdul-Mumin
- Department of Paediatrics and Child Health, University for Development Studies, School of Medicine, Tamale, Ghana
- Tamale Teaching Hospital, Tamale, Ghana
| | - Abdulai Abubakari
- Department of Global Health, University for Development Studies, School of Public Health, Tamale, Ghana
| | - Faith Agbozo
- Department of Family and Community Health, University of Health and Allied Sciences, School of Public Health, Hohoe, Ghana
| | - Abass Abdul-Karim
- Zonal Public Health and Reference Laboratory, Ghana Health Service, Tamale, Ghana
| | | | | | - Anna-Katharina Heuschen
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Lisa Hennig
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Claudia M Denkinger
- Division of Tropical Medicine, Department of Infectious Diseases, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Olaf Müller
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Albrecht Jahn
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Mauti J, Gautier L, Agbozo F, Shiroya V, Jessani NS, Tosun J, Jahn A. Addressing Policy Coherence Between Health in All Policies Approach and the Sustainable Development Goals Implementation: Insights From Kenya. Int J Health Policy Manag 2020; 11:757-767. [PMID: 33233034 PMCID: PMC9309906 DOI: 10.34172/ijhpm.2020.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 10/14/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Addressing health in the Sustainable Development Goals (SDGs) calls for intersectoral strategies that mutually enhance both health promotion and sustainable development. Health in All Policies (HiAP) approach aims to address this as well as promote ownership among key stakeholders. Kenya was at the forefront of adopting the SDGs and has committed to the HiAP approach in its Health Policy document for the period 2014-2030. This study aims to assess how the adoption of the HiAP approach can leverage on SDGs implementation in Kenya. METHODS This is an exploratory case study using qualitative data and some descriptive quantitative data. The Organisation for Economic Co-operation and Development's (OECD's) eight building blocks for policy coherence on sustainable development was our guiding framework. Qualitative data was derived from a review of relevant peer-reviewed and grey literature, as well as 40 key informant interviews and analyzed in NVIVO. Quantitative data was accessed from the United Nations SDG indicator database and exported to Excel. RESULTS Kenya has expressed a strong political commitment to achieving the SDGs and has now adopted HiAP. The study showed that Kenya can leverage on local level implementation and long-term planning horizons that it currently has in place to address the SDGs as it rolls out the HiAP approach. The SDGs could be mapped out against the sectors outlined in the Adelaide statement on HiAP. It is also possible to map out how various ministries could coordinate to effectively address HiAP and SDGs concurrently. Funding for HiAP was not addressed in the OECD framework. CONCLUSION Kenya can advance a HiAP approach by leveraging the ongoing SDGs implementation. This will be made possible by facilitating coordinated intersectoral action both at national and local level. Funding for HiAP is crucial for its propagation, especially in low- and middle-income countries (LMICs) and can be considered in the budgetary allocations for SDGs.
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Affiliation(s)
- Joy Mauti
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Lara Gautier
- Département de Gestion, Évaluation et Politique de Santé, École de Santé Publique, Université de Montréal, Montreal, Canada.,Department of Sociology, McGill University, Montreal, Canada
| | - Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Ho, Ghana.,Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Veronica Shiroya
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Nasreen S Jessani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Evidence Based Health Care, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.,Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Jale Tosun
- Institute of Political Science, Heidelberg University, Heidelberg, Germany
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Agbozo F, Abubakari A, Zotor F, Jahn A. Counselling as a Complementary Maternal and Child Health Intervention in Ghana: The Effect on Pregnancy Outcomes. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa059_002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To identify the main issues midwives reportedly counsel pregnant women on, the influence of counseling on pregnancy outcomes and the implementation gaps.
Methods
Mixed method design was used. Quantitative data included interviews with 299 pregnant women above 27 gestational weeks randomly recruited from five hospitals in Ghana who had four or more antenatal care (ANC) visits. Their maternal health record books were reviewed for documented counseling sessions. Where half of the recommended topics were discussed, it was considered as adequate counseling (AC). Binary logistic regression was modeled in STATA to estimate the unadjusted odds ratio (OR) of AC on pregnancy outcomes. For the qualitative data, in-depth were conducted with 15 midwives and exit interviews with all the women and analyzed thematically.
Results
According to the women, the most discussed topics were usage of insecticide-treated nets (60.5%), personal/environmental hygiene (57.5%) and breastfeeding (52.3%). Conversely, the midwives documented discussing mostly nutrition/anaemia (37.6%), danger signs in pregnancy (30.1%) and birth preparedness/complication readiness (29.9%). Most women disliked group counseling and cited non-tailoring of advice. Main implementation gaps were heavy work schedules, inadequate staff, limited time for counseling and hefty documentation. The 45% who were adequately counseled significantly reduced their likelihood for poor dietary intake (OR: 0.54, 95% CI: 0.32–0.90), incidence of malaria (OR: 0.22, 95% CI: 0.06–0.78), preeclampsia (OR: 0.25 CI: 0.06–0.99) and need for neonatal intensive care (OR: 0.29 CI: 0.09–0.94) while increasing the newborn's birth weight (OR: 1.85 CI: 1.08–3.19).
Conclusions
Strengthening ANC, training midwives to counsel effectively using different skills in varying situations and adopting peer counsellors would facilitate client-centred nutrition education and empower women to take healthier actions, thus promoting behaviour change.
Funding Sources
None.
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Affiliation(s)
| | | | - Francis Zotor
- University of Health and Allied Sciences, Family and Community Health Department
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Heidelberg University
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Abdul-Mumin A, Agbozo F, Abubakari A, Jahn A. Maintaining quality newborn care in Ghana amid the COVID-19 pandemic. Pan Afr Med J 2020; 35:6. [PMID: 32528617 PMCID: PMC7266469 DOI: 10.11604/pamj.2020.35.4.22797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alhassan Abdul-Mumin
- Department of Pediatrics and Child Health, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana.,Department of Pediatrics and Child Health, Tamale Teaching Hospital, Tamale, Ghana
| | - Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Abdulai Abubakari
- Department of Public Health, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Heidelberg University Medical Faculty, Germany
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Agbozo F, Ocansey D, Atitto P, Jahn A. Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices. J Hum Lact 2020; 36:175-186. [PMID: 31112053 DOI: 10.1177/0890334419848728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the Baby-Friendly Hospital Initiative has improved breastfeeding rates globally, weak monitoring still affects hospital-level implementation. RESEARCH AIM To reassess compliance of a Baby-Friendly Hospital with the Ten Steps to Successful Breastfeeding, International Code of Marketing of Breast-milk Substitutes, HIV and Infant Feeding, and Mother-Friendly Care following the WHO/UNICEF global criteria. METHODS In this cross-sectional, prospective, mixed-methods study (N = 180), clinical staff (n = 60), pregnant women (n = 40), postpartum mothers (n = 60), and mothers of babies in intensive care (n = 20) were randomly selected from one urban secondary-level public hospital in Ghana designated as Baby-Friendly in 2004 but never reassessed. Data were collected through interviews, document reviews, and observations using the revised WHO/UNICEF external reassessment tool and analyzed quantitatively using the Baby-Friendly Hospital Initiative computer tool. Scores higher than 80% signified a pass (high compliance). Scores rated as low (< 50%) and moderate (50-80%) signified noncompliance. RESULTS The facility passed the criteria for full compliance with the International Code (86%) but failed other components. Compliance with the Ten Steps was moderate (55%). Step 7 about rooming-in (84%) and Step 9 about human milk substitutes (100%) were passed, whereas Step 1 about written breastfeeding policies (0%), Step 2 about staff training (7%), and Step 4 about early breastfeeding initiation (31%) were met the least. Compliance with Mother-Friendly Care (34%) and HIV and Infant Feeding (47%) were low. Main implementation gaps were unavailability of policies and staff's inadequate knowledge about Baby-Friendly practices. CONCLUSIONS Improving staff training and maternal counseling, routinely reassessing designated facilities, and providing technical support in problematic areas might sustain implementation.
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Affiliation(s)
- Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana.,Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Germany
| | - Doris Ocansey
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Prosper Atitto
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Germany
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Tahiru R, Agbozo F, Garti H, Abubakari A. Exclusive Breastfeeding and Associated Factors among Mothers with Twins in the Tamale Metropolis. Int J Pediatr 2020; 2020:5605437. [PMID: 32099551 PMCID: PMC6996674 DOI: 10.1155/2020/5605437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/09/2019] [Accepted: 11/20/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding (EBF) for the first six months after birth has been recommended by the WHO as the best infant feeding strategy. Data on EBF rates among twin infants in Ghana remain limited and for that matter hypothesized to be low. AIM The study sought to measure the prevalence of EBF and identify associated factors among twins in the Tamale metropolis. METHODS A cross-sectional survey involving 185 mother-twin pairs was conducted in four health facilities in the Tamale metropolis providing Child welfare Clinic (CWC) services. Socio-demographics data on both mother and twin were taken. Biomedical (e.g. perceived onset of lactation, confidence of producing enough milk, parity, delivery place, delivery type, time of breastfeeding initiation) and bio cultural factors (e.g. family cooperation for current infant feeding, breastfeeding counselling) were also obtained. In-depth interviews were also conducted with a sub sample of mothers (30) who were purposively selected to generate qualitative data on breastfeeding and associated cultural factors in twins as this data was necessary to aid in the explanation of the quantitative results. RESULTS Only 17% of twin infants were exclusively breastfed for six months. Women who were not confident that they could produce enough breast milk were about 83% less likely to practice exclusive breast-feeding (EBF) compared to those who were confident that they could produce enough breast milk (AOR = 0.17; CI = 0.04, 0.73; p-value = 0.017). Moreover, mothers who had no access to radio were about 87% less likely to practice EBF (AOR = 0.13; CI = 0.02, 0.79; p-value = 0.017). Moreover, mothers who had no access to radio were about 87% less likely to practice EBF (AOR = 0.13; CI = 0.02, 0.79. CONCLUSIONS The study shows that, ownership of radio, confidence of producing enough breast milk and admission of the children into NICU were identified as the most important factors affecting exclusive breastfeeding of twins. Beyond Educating, encouraging and assuring twin mothers of their abilities to produce enough breast milk to satisfy their children, healthcare professionals should pay more attention on providing appropriate information on breastfeeding to mothers and caregivers.
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Affiliation(s)
- Rafatu Tahiru
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box 1883, Tamale, Ghana
- Yendi Nursing and Midwifery Training College, Ghana Health Service, Yendi, Ghana
| | - Faith Agbozo
- University of Health and Allied Sciences, Ho, Ghana
| | - Hmphrey Garti
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box 1883, Tamale, Ghana
| | - Abdulai Abubakari
- Department of Public Health, School of Allied Health Sciences, University for Development Studies, P. O. Box 1883, Tamale, Ghana
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Nuri NN, Sarker M, Ahmed HU, Hossain MD, Dureab F, Agbozo F, Jahn A. Overall Care-Seeking Pattern and Gender Disparity at a Specialized Mental Hospital in Bangladesh. Mater Sociomed 2019; 31:35-39. [PMID: 31213953 PMCID: PMC6511372 DOI: 10.5455/msm.2019.31.35-39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: The National Institute of Mental Health (NIMH) is the only national level mental health institution in Bangladesh, with both academic and clinical functions, thus playing a crucial role in delivering specialized mental health care for the entire population. Aim: This study examined the overall pattern of mental health care seeking, age and sex distribution of patients and mental health problems diagnosed in the facility. Methods: Using a facility-based cross-sectional study design, secondary data was collected from various hospital records and reports from April 2001 to June 2016, and quantitatively analyzed. Results: There has been a steady increase in the number of patients at NIMH over the years. Typically, female patients were about half in number compared to male patients and fewer in each age group and all disease categories except inpatients with neurotic, stress-related and somatoform disorders. The highest number of inpatients and outpatients were 15-30 years old and those with schizophrenia, schizotypal and delusional disorders. Conclusion: Minors and females seeking care at NIMH were underrepresented, thus highlighting the need for interventions to improve access for these patients.
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Affiliation(s)
- Nazmun Nahar Nuri
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Malabika Sarker
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.,James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | | | - Fekri Dureab
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Faith Agbozo
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.,University of Health and Allied Sciences, Department of Family and Community Health, Volta Region, Ghana
| | - Albrecht Jahn
- National Institute of Mental Health, Dhaka, Bangladesh
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Schuler C, Ntow GE, Agbozo F. Mothers' Experiences with Neonatal Care for Low Birth Weight Infants at Home; A Qualitative Study in the Hohoe Municipality, Ghana. J Pediatr Nurs 2019; 45:e44-e52. [PMID: 30660426 DOI: 10.1016/j.pedn.2018.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To explore knowledge and beliefs of mothers on low birth weight (LBW), examine care provision at home and societal perceptions of LBW infants. DESIGN AND METHODS This qualitative study was conducted using hermeneutic phenomenological approach. Data of mothers who delivered LBW infants within 2 years preceding the study were purposively extracted from the medical records of the Hohoe Municipality Hospital in Ghana. Twenty semi-structured interviews and three focus group discussions were conducted. A thematic analysis approach was performed using Atlas.ti. RESULTS Mothers identified and described LBW babies based on frailty, size and activity levels. LBW recognition was easier for multiparous mothers by comparing with previous deliveries. LBW was linked to poor maternal diet, diseases during pregnancy and heavy workload. Although most mothers perceived their LBW babies as healthy irrespective of the size a few home-care practises differed. Smaller LBW infants were less likely to be socially accepted. In the first few weeks after birth the care of LBW infants is the core responsibility of grandmothers. Primiparous mothers and those whose infants were smaller (<2 kg) quested for more information and support on LBW newborn care at home. CONCLUSION There is a need to increase knowledge on risk factors and tackle lapses in the recognition and care of LBW infants. Counselling on recommended neonatal care should begin during antenatal care and reiterated during postnatal care. PRACTICAL IMPLICATION Tailored in-depth and culturally-adapted counselling, discharge instructions and home-based postnatal visits targeted at LBW infants and their primary caregivers could improve care.
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Affiliation(s)
- Christina Schuler
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana; Ghana Health and Education Initiative, Sefwi Bekwai, Ghana.
| | - George Edward Ntow
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana; Institute of Public Health, Medical Faculty, University of Heidelberg, Germany
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Agbozo F, Amardi-Mfoafo J, Dwase H, Ellahi B. Nutrition knowledge, dietary patterns and anthropometric indices of older persons in four peri-urban communities in Ga West municipality, Ghana. Afr Health Sci 2018; 18:743-755. [PMID: 30603008 PMCID: PMC6307008 DOI: 10.4314/ahs.v18i3.33] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Older adults are vulnerable to malnutrition due to sociologic, physiologic and anatomical effects of ageing. OBJECTIVE To investigate the influence of nutrition knowledge and dietary patterns on nutritional status of community-dwelling ambulatory older adults. METHODS This cross-sectional survey involved 120 elderly aged 60-70 years purposively selected from four peri-urban communities in Ga West municipality, Ghana. Nutrition knowledge was assessed using a structured questionnaire and dietary intakes obtained using a standardized food frequency questionnaire. BMI from weight/height measurements was proxy for nutritional status. Data was analyzed descriptively in SPSS. Associations were tested using correlation analyses (-1 RESULTS 28% had adequate knowledge on geriatric nutrition. Dietary patterns were mostly fair (40%) or poor (53%). Bloating (25%), constipation (18%), appetite loss (12%) and chewing difficulties (11%) affected intakes. Underweight was 10% while 21.7% were overweight or obese (16.6%). Positive insignificant corrections existed between knowledge and nutritional status (r=0.261) and with diet quality (r=0.415). However, strong significant (p=0.027) positive correlation (r=0.699) existed between diet quality and nutritional status. CONCLUSION Nutrition knowledge was adequate but dietary intake was poor and a quarter were malnourished. The associations reaffirm that supporting the elderly to make healthy dietary choices and ensuring household food security is crucial to preventing malnutrition.
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Affiliation(s)
- Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Joyce Amardi-Mfoafo
- Department of Family and Consumer Sciences, College of Agriculture and Consumer Sciences, University of Ghana, Legon, Accra
| | - Helen Dwase
- Department of Family and Consumer Sciences, College of Agriculture and Consumer Sciences, University of Ghana, Legon, Accra
| | - Basma Ellahi
- Faculty of Health and Social Care, University of Chester, Chester, CH1 4BJ, UK
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Agbozo F, Atitto P, Jahn A, Abubakari A. Nutrient composition and dietary diversity of on-site lunch meals, and anthropometry of beneficiary children in private and public primary schools in Ghana. Nutr Health 2018; 24:241-249. [PMID: 30092704 DOI: 10.1177/0260106018793048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND On-site lunch provided through the Ghana School Feeding Programme is expected to be nutritionally adequate thereby contributing to reducing hunger and malnutrition. AIM The aim of this study was to assess the dietary diversity and nutrient composition of on-site school lunch and estimate the extent to which it met the Food and Agriculture Organization Reference Nutrient Intakes for children aged 3-12 years. METHODS In this cross-sectional food consumption survey, on-site lunch menus were reviewed, dietary diversity assessed and meal preparation/serving observed during a typical school week. Three randomly selected portion sizes were weighed and the average weight (grams) entered into the RIING nutrient software to estimate the nutrient composition. Anthropometry of participants enrolled in seven public (n = 113) and six private (n = 216) primary schools in Hohoe municipality, Ghana was analysed using World Health Organization Anthroplus software. RESULTS The menu consisted largely of energy-dense staples, some vegetables and fish. Eggs, dairy and fruits were never served. Meals served in the public and private schools were statistically similar. Fat (23.8 vs. 27.7 g), iron (3.0 vs. 2.8 mg), vitamins A (417.3 vs. 280.8 µg retinol equivalent) and C (25.1 vs. 16.5 mg) requirements were fully met. Energy (420.6 vs. 462.2 kcal), protein (6.8 vs. 6.8 g), thiamin (0.18 vs. 0.17 mg) and zinc (1.3 vs. 1.2 mg) were 50-75% met. Calcium (62.6 vs. 61.4 mg), riboflavin (0.09 vs. 0.07 mg) and niacin (1.6 vs. 1.3 mg) were 26-37% met. Concerning nutritional status, prevalence of stunting (8.9% vs. 7.9%), underweight (3.6% vs. 5.7%), thinness (1.8% vs. 3.7%) and overweight/obesity (3.5% vs. 4.2%) were also statistically similar. CONCLUSION Enhancing dietary diversity is crucial to achieving nutrient-dense school meals.
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Affiliation(s)
- Faith Agbozo
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana.,Institute of Public Health, Heidelberg University Medical Faculty, Germany
| | - Prosper Atitto
- Department of Public Health, Ghana Health Service, Anfoega, Ghana
| | - Albrecht Jahn
- Institute of Public Health, Heidelberg University Medical Faculty, Germany
| | - Abdulai Abubakari
- Department of Community Nutrition, University for Development Studies, Tamale, Ghana
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Agbozo F, Colecraft E, Jahn A, Guetterman T. Understanding why child welfare clinic attendance and growth of children in the nutrition surveillance programme is below target: lessons learnt from a mixed methods study in Ghana. BMC Nurs 2018; 17:25. [PMID: 29950927 PMCID: PMC6009038 DOI: 10.1186/s12912-018-0294-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 06/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Growth monitoring and promotion (GMP) programmes promote not only child health but serve as a service delivery strategy to enhance coverage for other crucial nutrition-specific interventions. This study compared community-based and facility-based GMP programme with respect to attendance rates, children's nutritional status, caregivers' satisfaction with services received and perceptions of service providers and users on factors influencing utilization. Methods Explanatory sequential mixed methods study conducted in Ga West municipality, Ghana. It comprised 12-month secondary data analysis using growth monitoring registers of 220 infants aged 0-3 months enrolled in two community-based (CB = 104) and two facility-based (FB = 116) child welfare clinics; cross-sectional survey (exit interview) of 232 caregiver-child pairs accessing CB (n = 104) and FB services (n = 116); and in-depth interviews with 10 health workers and 15 mothers. Quantitative data were analyzed through Fisher's exact, unpaired t-tests, and logistic regression at 95% confidence interval (CI) using SPSS version 20. Qualitative data were analyzed by thematic content analysis using ATLAS.ti 7.0. Results Mean annual attendance to both programmes was similar with an average of six visits per year. Only 13.6% of caregiver-child pairs attained more than nine visits in the 12-months period. At least 60% of children in both programs had improved weight-for-age z-scores (WAZ) scores during participation. Predictors for improved WAZ were being underweight at baseline (AOR:11.1, 95%CI:4.0-31.0), annual attendance of at least six visits (AOR:2.2, 95%CI:1.1-4.1) and meeting the Ghana Health Service target of nine visits (AOR:4.65, 95%CI:1.4-15.1). Compared to 31.5% CB users, significant proportion of FB caregivers (57.4%) were visited at home. Half were dissatisfied with services received (CB:55.6% vs. FB:62.0%, p = 0.437) citing long waiting times, negative staff attitude and extortions of money. Regarding perceptions on factors hindering service utilization, emerged themes included extremes of maternal age, high parity, postpartum socio-cultural beliefs and practices, financial commitments, undue delays, unprofessional staff behaviours, high premium on vaccination and general misconceptions about the programme. Conclusion The association of increased attendance with improved growth reaffirms the need to strengthen primary healthcare systems to improve service delivery; sensitize caregivers on contribution of growth monitoring and promotion to early child development; and increase contacts through home visits.
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Affiliation(s)
- Faith Agbozo
- 1Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, PMG, 31 Ho, Ghana.,2Institute of Public Health, University of Heidelberg Medical Faculty, Heidelberg, Germany
| | - Esi Colecraft
- 3Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Albrecht Jahn
- 2Institute of Public Health, University of Heidelberg Medical Faculty, Heidelberg, Germany
| | - Timothy Guetterman
- 4Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI USA
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Agbozo F, Abubakari A, Narh C, Jahn A. Accuracy of glycosuria, random blood glucose and risk factors as selective screening tools for gestational diabetes mellitus in comparison with universal diagnosing. BMJ Open Diabetes Res Care 2018; 6:e000493. [PMID: 29942522 PMCID: PMC6014183 DOI: 10.1136/bmjdrc-2017-000493] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/20/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Despite the short-term and long-term health implications of gestational diabetes mellitus (GDM), opinions are divided on selective vis-à-vis universal screening. We validated the accuracy of screening tests for GDM. RESEARCH DESIGN AND METHODS Pregnant women (n=491) were recruited to this prospective, blind comparison with a gold standard study. We did selective screening between 13 and 20 weeks using reagent-strip glycosuria, random capillary blood glucose (RBG) and the presence of ≥1 risk factor(s). Between 20 and 34 weeks, we did universal screening following the 'one-step' approach using glycated hemoglobin (HbA1c), fasting venous plasma glucose (FPG), and the 1-hour and the 'gold standard' 2-hour oral glucose tolerance test (OGTT). Tests accuracy was estimated following the WHO and the National Institute for Health and Care Excellence (NICE) diagnostic criteria. Overall test performance was determined from the area under the receiver operating characteristic curve (AUC). RESULTS GDM prevalence per 2-hour OGTT was 9.0% for the WHO criteria and 14.3% for the NICE criteria. Selective screening using glycosuria, RBG and risk factors missed 97.4%, 87.2% and 45.7% of cases, respectively. FPG threshold ≥5.1 mmol/L had the highest clinically relevant sensitivity (68%) and specificity (81%), but FPG threshold ≥5.6 mmol/L had higher positive predictive value. Although sensitivity of 1-hour OGTT was 39.5%, it had the highest accuracy and diagnostic OR. Regarding test performance, 1-hour OGTT and FPG were very good (AUC>0.8), RBG was poor (AUC≈0.60), whereas HbA1c was invaluable (AUC<0.5). CONCLUSIONS Selective screening using glycosuria and random blood glucose is unnecessary due to its low sensitivity. Fasting glucose ≥5.1 mmol/L could be applicable for screening at the population level. Where 2-hour OGTT is not available, FPG ≥5.6 mmol/L, complemented by the presence of risk factors, could be useful in making therapeutic decision.
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Affiliation(s)
- Faith Agbozo
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
- Department of Family and Community Health, University of Health and Allied Health Sciences, Ho, Ghana
| | - Abdulai Abubakari
- Department of Community Nutrition, University for Development Studies, Tamale, Ghana
| | - Clement Narh
- Department of Epidemiology and Biostatistics, University of Health and Allied Health Sciences, Ho, Ghana
| | - Albrecht Jahn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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Abstract
The objective of this study was to investigate the factors associated with the optimal use of antenatal care (ANC) during pregnancy. A facility-based cross-sectional survey was conducted between February and August 2014 among nursing mothers (n = 578) attending postnatal and child welfare clinics in three districts in Northern Ghana, representing urban, peri-urban, and rural zones. The developed questionnaire aided the collection of information on maternal demographic characteristics, health status, household assets, and ANC attendance. Binary logistic regression was modeled to estimate the association between optimal ANC use and mothers' characteristics. Approximately 81% of the respondents had ≥4 ANC visits during pregnancy, and coverage was over 99%. Mothers who had any formal education (adjusted odds ratio [AOR] = 1.7, 95% confidence interval [CI] = 1.0-2.8, P = 0.040) lived in middle class socioeconomic households (AOR = 2.6, 95%CI = 1.4-4.8, P = 0.003) and resided in urban areas (AOR = 2.0, 95%CI = 1.2-3.3, P = 0.006) were significantly more likely to report the optimal ANC use. Mothers' education, socioeconomic status, and proximity to a health facility were positively associated with the optimal ANC use. Education of females and policy initiatives aimed at improving the rural-urban divide are essential to optimize the use of ANC.
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Affiliation(s)
- Abdulai Abubakari
- a Department of Nutritional Sciences, School of Allied Health Sciences , University for Development Studies , Tamale , Ghana
| | - Faith Agbozo
- b Department of Family and Community Health, School of Public Health , University of Health and Allied Sciences , Ho , Ghana
| | - Gilbert Abotisem Abiiro
- c Department of Planning, Faculty of Planning and Land Management , University for Development Studies , Wa , Ghana
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Agbozo F, Colecraft E, Ellahi B. Impact of type of child growth intervention program on caregivers' child feeding knowledge and practices: a comparative study in Ga West Municipality, Ghana. Food Sci Nutr 2016; 4:562-72. [PMID: 27386106 PMCID: PMC4930500 DOI: 10.1002/fsn3.318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/10/2015] [Accepted: 11/01/2015] [Indexed: 11/08/2022] Open
Abstract
Community-based growth promotion (CBGP) delivered by community volunteers aims at enhancing the traditional growth monitoring and promotion (GMP) program delivered by community health nurses through the promotion of optimum infant and young child feeding (IYCF) leading to improved child growth. This study compared IYCF knowledge and practices among caregiver-child pairs (0-24 months) receiving child welfare services from CBGP (n = 124) and GMP (n = 108) programs. Semistructured questionnaires were used to interview caregivers on IYCF knowledge/practices and validated food frequency questionnaire used to record infants' food intakes. Group differences were determined using Chi-square and independent samples t-tests (P < 0.05; 95% confidence interval [CI]). Mean IYCF knowledge scores were similar (CBGP: 10.84 ± 1.69 vs. GMP: 10.23 ± 1.38, P = 0.062). However, more CBGP caregivers (17%) were highly knowledgeable than their GMP counterparts (5%) (P = 0.011). Early breastfeeding initiation (CBGP: 54% vs. GMP: 28%, P < 0.0001), exclusive breastfeeding (CBGP: 73% vs. GMP: 56%, P = 0.001), and timely complementary feeding (CBGP: 72% vs. GMP: 49%, P = 0.014) were reportedly higher among CBGP caregivers. Underweight was 11% (CBGP: 8% vs. GMP: 14%, P = 0.154). Mean dietary diversity scores (10 food groups) were similar (CBGP: 4.49 ± 1.89 vs. GMP: 3.87 ± 1.89, P = 0.057) but more CBGP caregivers (77%) achieved minimum dietary diversity than their GMP counterparts (61%) (P = 0.035). Few caregivers achieved minimum meal frequency (CBGP: 31% vs. GMP: 29%, P = 0.486) and minimum acceptable diet (CBGP: 23% vs. GMP: 21%, P = 0.464) indicators. Number of children under 5 years owned by caregiver (adjusted odds ratio [AOR]: 0.405; 95% CI: 1.13-78.53, P = 0.038), her educational level (AOR: 0.112; 95% CI: 0.02-0.90, P = 0.040), and IYCF knowledge (AOR: 0.140; 95% CI: 0.03-0.79, P = 0.026) significantly predicted optimum child feeding. Nutrition education on optimum complementary feeding and birth spacing strategies should intensify.
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Affiliation(s)
- Faith Agbozo
- Department of Family and community HealthSchool of Public HealthUniversity of Health and Allied SciencesHo (Hohoe campus)Ghana
| | - Esi Colecraft
- Department of Nutrition and Food ScienceUniversity of GhanaP. O. Box LG 134LegonGhana
| | - Basma Ellahi
- Faculty of Health and Social CareUniversity of ChesterChesterCH1 4BJUnited Kingdom
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Agbozo F, Abubakari A, Der J, Jahn A. Prevalence of low birth weight, macrosomia and stillbirth and their relationship to associated maternal risk factors in Hohoe Municipality, Ghana. Midwifery 2016; 40:200-6. [PMID: 27474932 DOI: 10.1016/j.midw.2016.06.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/20/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION birth weight is vital to the development potential of the newborn. Abnormal birth weight (such as low birth weight and macrosomia) is an important determinant of child survival, disabilities, stunting, and long-term adverse consequences for the onset of non-communicable diseases in the life course and therefore demands appropriate public health interventions. Stillbirths are also considered one of the most important, but most poorly understood and documented adverse outcomes of pregnancy. Therefore, this study aimed to assess the prevalence of abnormal birth weight and related maternal risk factors, as well as pregnancy outcomes, such as stillbirth. METHODS a retrospective study design was used to analyze 4262 delivery records for singleton pregnancies from January 2013 to December 2014 seen at the Hohoe municipal hospital, Volta region in Ghana. The data on birth weight and related factors were derived from the delivery book. Data was analyzed using STATA. Multinomial logistic regression was used to assess the association between maternal factors such as parity, age and intermittent preventive treatment of malaria, sex of infant and abnormal birth weight. Association between stillbirth and related factors was assessed using logistic regression. RESULTS prevalence of low birth weight (<2.5kg) was 9.69% and macrosomia (≥4.0kg) was 3.03%. There was an increased risk of a first born being of low birth weight than second or third born (RR; 2.04, CI; 1.59-2.64, p<0.0001). There were also an increased risks of mothers <20 years giving birth to low-birthweight infants (RR; 1.46, CI; 1.11-1.93, p=0.007) compared to mothers who were within the age ranges of 20-30 years and also among those who took only one (RR; 1.57, CI; 1.02-2.39, p=0.039) or no intermittent preventive treatment for malaria during pregnancy (RR; 1.57, CI; 1.24-1.98, p=<0.0001) compared to those who took three doses. Risk of macrosomic birth was particularly high among 5th born (RR; 2.66, CI; 1.43-4.95, p=0.002) compared to first or second born. Stillbirth rate was 27/1000 births. Thirty-two percent of the stillbirths (n=38) had low birth weight whereas 6.8% (n=8) were macrosomic. There was a greater than fivefold (AOR; 5.6, CI; 3.6-8.7) and greater than twofold (AOR; 2.4, CI; 1.1-5.3, p=0.025) increase in odds for stillbirth among low birth weight and macrosomic infants respectively. CONCLUSION macrosomia and low birth weight co-existed among infants in Hohoe municipality, both of which are associated with adverse pregnancy outcome such as stillbirth. Given the apparent association between maternal age <20 years and increased risk, health promotion strategies aimed at preventing pregnancies among teenagers could be implemented to aid the reduction of stillbirth rates.
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Affiliation(s)
- Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Hohoe campus, Ho, Ghana; Institute of Public Health, Medical Faculty, University of Heidelberg, Germany
| | - Abdulai Abubakari
- Institute of Public Health, Medical Faculty, University of Heidelberg, Germany; Department of Community Nutrition, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana.
| | - Joyce Der
- Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ghana
| | - Albrecht Jahn
- Institute of Public Health, Medical Faculty, University of Heidelberg, Germany
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Agbozo F, Atito P, Abubakari A. Malnutrition and associated factors in children: a comparative study between public and private schools in Hohoe Municipality, Ghana. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0073-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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