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Lori JR, Kukula VA, Liu L, Apetorgbor VEA, Ghosh B, Awini E, Lockhart N, Amankwah G, Zielinski R, Moyer CA, Williams J. Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana. BMC Pregnancy Childbirth 2024; 24:37. [PMID: 38182969 PMCID: PMC10768124 DOI: 10.1186/s12884-023-06224-x] [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] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Although the majority of Ghanaian women receive antenatal care (ANC), many exhibit low health literacy by misinterpreting and incorrectly operationalizing ANC messages, leading to poor maternal and newborn health outcomes. Prior research in low-resource settings has found group antenatal care (G-ANC) feasible for women and providers. This study aims to determine the effect of G-ANC on increasing maternal health literacy. We hypothesized that pregnant women randomized into G-ANC would exhibit a greater increase in maternal health literacy than women in routine, individual ANC. METHODS A 5-year cluster randomized controlled trial was conducted in 14 rural and peri-urban health facilities in the Eastern Region of Ghana. Facilities were paired based on patient volume and average gestational age at ANC enrollment and then randomized into intervention (G-ANC) vs. control (routine, individual ANC); 1761 pregnant women were recruited. Data collection occurred at baseline (T0) and post-birth (T2) using the Maternal Health Literacy scale, a 12-item composite scale to assess maternal health literacy. Logistic regression compared changes in health literacy from T0 to T2. RESULTS Overall, women in both the intervention and control groups improved their health literacy scores over time (p < 0.0001). Women in the intervention group scored significantly higher on 3 individual items and on overall composite scores (p < 0.0001) and were more likely to attend 8 or more ANC visits. CONCLUSION While health literacy scores improved for all women attending ANC, women randomized into G-ANC exhibited greater improvement in overall health literacy post-birth compared to those receiving routine individual care. Life-saving information provided during ANC must be presented in an understandable format to prevent women and newborns from dying of preventable causes. TRIAL REGISTRY Ethical approval for the study was obtained from the Institutional Review Boards of the University of Michigan (HUM#00161464) and the Ghana Health Service (GHS-ERC: 016/04/19).
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Affiliation(s)
- Jody R Lori
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America.
| | - Vida Ami Kukula
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Liya Liu
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | | | - Bidisha Ghosh
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Elizabeth Awini
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Nancy Lockhart
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Georgina Amankwah
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Ruth Zielinski
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Cheryl A Moyer
- Department of Learning Health Sciences, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, United States of America
| | - John Williams
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
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Kukula VA, Odopey S, Arthur E, Odonkor G, Awini E, Adjei A, Salami O, Nkeramahame J, Horgan P, Olliaro P, Williams J, Baiden R. Understanding Health Worker and Community Antibiotic Prescription-Adherence Practices for Acute Febrile Illness: A Nested Qualitative Study in the Shai-Osudoku District of Ghana and the Development of a Training-and-Communication Intervention. Clin Infect Dis 2023; 77:S182-S190. [PMID: 37490740 PMCID: PMC10368414 DOI: 10.1093/cid/ciad327] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The aim was to explore behavioral factors relating to the prescription and communication of prescription-adherence messages for patients with acute febrile illness, from which to develop a training-and-communication (T&C) intervention to be delivered as part of a clinical trial. METHODS The study undertook a content analysis of primary, qualitative data collection using in-depth interviews and focus group discussions, informed by the Capability, Opportunity, Motivation (COM-B) theory of behavior, the Theoretical Domains Framework (TDF), and Behavior Change Wheel (BCW) approach, in health facilities (39 health workers) and communities (66 community members) in the Shai-Osudoku District of Ghana. RESULTS Health workers perceive that prescribers' and dispensers' communication with patients is influenced by the following factors: patient's educational level, existing disease conditions, health worker's workload, patient's religion, language barrier between health worker and patient, outcome of laboratory results, and medicine availability. Community members' adherence to prescription was influenced by the availability of money and affordability of medicine (outside of provision by the national health insurance scheme), the severity of the condition, work schedule, and forgetfulness. CONCLUSIONS Our study contributes to knowledge on nesting qualitative methods in a clinical trial and reveals factors that affect the antibiotic prescription communication process. Tailored messages for patient-specific needs can shape antibiotic prescription adherence behavior and ultimately contribute to decreasing the incidence of antibiotic resistance.
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Affiliation(s)
- Vida Ami Kukula
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Selase Odopey
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Emmanuel Arthur
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Gabriel Odonkor
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Elizabeth Awini
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Alexander Adjei
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | | | | | - Philip Horgan
- Department of Medicine, FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Department of Medical Affairs, Evidence and Impact Oxford, Oxford, United Kingdom
| | - Piero Olliaro
- Department of Medicine, FIND, Geneva, Switzerland
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - John Williams
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Rita Baiden
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
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Kukula VA, MacPherson EE, Tsey IH, Stothard JR, Theobald S, Gyapong M. A major hurdle in the elimination of urogenital schistosomiasis revealed: Identifying key gaps in knowledge and understanding of female genital schistosomiasis within communities and local health workers. PLoS Negl Trop Dis 2019; 13:e0007207. [PMID: 30897093 PMCID: PMC6428244 DOI: 10.1371/journal.pntd.0007207] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/31/2019] [Indexed: 12/24/2022] Open
Abstract
Background Urogenital schistosomiasis is endemic throughout Ghana with elevated infection levels in certain areas e.g. Lake Volta Region. While the primary focus of the national control program is on mass drug administration of praziquantel to school-aged children, Female Genital Schistosomiasis (FGS), a disease-specific affliction of girls and women, has been largely overlooked. To better focus future actions, our study investigated the perceptions, knowledge and understanding of FGS amongst community members and health providers. Method/Principal findings We used qualitative methods including 12 focus group discussions and 34 in-depth interviews. We purposively selected 16 communities along the Lake Volta in the Shai-Osudoku District. Participant selection was based on gender, age and occupation; providing an opportunity to explore community understanding of FGS through participants own words and perceptions. Awareness of schistosomiasis was reported and is commonly experienced among children (12–17 years) and younger adults (18–25 years) in the study communities but is typically considered a boy’s disease. Knowledge of FGS was lacking in women, girls and front-line health workers. There was a general misconception that FGS may be the result of sexual promiscuity. Adolescent girls reporting vaginal discharge and itching were often stigmatized by health workers and treated for sexually transmitted infections. Limited alternatives to the river as key source of water meant that all members of the community faced the regular risk of schistosomiasis. Conclusion/Significance There is a clear imperative for the national control program to better engage on FGS and implement interventions to meet girls and women’s needs. The key consideration is to integrate more adequately preventive services with sexual and reproductive primary health care with future training of health workers for improved management of FGS cases. More broadly, harmonizing the portfolio of all actions on FGS is needed, especially with a call for improved access to safe water and sanitation for all those at current or future risk. Female Genital Schistosomiasis (FGS) is a serious, chronic gynecological condition that affects up to 56 million African women and girls. To date, FGS has been mostly overlooked within national neglected tropical disease control programs and associated health systems in sub-Saharan Africa. Furthermore, knowledge and understanding of FGS within affected communities themselves are often incomplete and confused with other ailments. Using qualitative research methods, we explored the knowledge and understanding of girls and women on FGS, as well as, local health care providers’ knowledge and practice relating to FGS. While, our work found that FGS was rarely on the radar of suspicion for health workers, more importantly, adolescent girls were often stigmatized by health care workers when they sought care in public health facilities owing to misdiagnosis of the disease as sexually transmitted infections. Our work speaks to the urgent need for national control programs to expand their remit outside current focus of annual provision of praziquantel to in-school children and integrate such treatments within sexual and reproductive health services available in primary health care services. Ultimately, urogenital and intestinal schistosomiasis is a disease of poverty and there is an urgent need to extend access to improved water and sanitation facilities to all affected communities.
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Affiliation(s)
- Vida Ami Kukula
- Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
- * E-mail: ,
| | - Eleanor E. MacPherson
- Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
- Department of International Public Health, COUNTDOWN Consortium, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Irene Honam Tsey
- Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
| | - J. Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Department of International Public Health, COUNTDOWN Consortium, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Margaret Gyapong
- COUNTDOWN Consortium, Institute for Health Research, University of Health and Allied Sciences, Ho, Ghana
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Sakeah E, Okawa S, Rexford Oduro A, Shibanuma A, Ansah E, Kikuchi K, Gyapong M, Owusu-Agyei S, Williams J, Debpuur C, Yeji F, Kukula VA, Enuameh Y, Asare GQ, Agyekum EO, Addai S, Sarpong D, Adjei K, Tawiah C, Yasuoka J, Nanishi K, Jimba M, Hodgson A, The Ghana Embrace Team. Determinants of attending antenatal care at least four times in rural Ghana: analysis of a cross-sectional survey. Glob Health Action 2018; 10:1291879. [PMID: 28578634 PMCID: PMC5496066 DOI: 10.1080/16549716.2017.1291879] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Improving maternal health is a global challenge. In Ghana, maternal morbidity and mortality rates remain high, particularly in rural areas. Antenatal care (ANC) attendance is known to improve maternal health. However, few studies have updated current knowledge regarding determinants of ANC attendance. OBJECTIVE This study examined factors associated with ANC attendance in predominantly rural Ghana. METHODS We conducted a cross-sectional study at three sites (i.e. Navrongo, Kintampo, and Dodowa) in Ghana between August and September 2013. We selected 1500 women who had delivered within the two years preceding the survey (500 from each site) using two-stage random sampling. Data concerning 1497 women's sociodemographic characteristics and antenatal care attendance were collected and analyzed, and factors associated with attending ANC at least four times were identified using logistic regression analysis. RESULTS Of the 1497 participants, 86% reported attending ANC at least four times, which was positively associated with possession of national health insurance (AOR 1.64, 95% CI: 1.14-2.38) and having a partner with a high educational level (AOR 1.64, 95% CI: 1.02-2.64) and negatively associated with being single (AOR 0.39, 95% CI: 0.22-0.69) and cohabiting (AOR 0.57, 95% CI: 0.34-0.97). In site-specific analyses, factors associated with ANC attendance included marital status in Navrongo; marital status, possession of national health insurance, partners' educational level, and wealth in Kintampo; and preferred pregnancy timing in Dodowa. In the youngest, least educated, and poorest women and women whose partners were uneducated, those with health insurance were more likely to report at least four ANC attendances relative to those who did not have insurance. CONCLUSIONS Ghanaian women with low socioeconomic status were less likely to report at least four ANC attendances during pregnancy if they did not possess health insurance. The national health insurance scheme should include a higher number of deprived women in predominantly rural communities.
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Affiliation(s)
- Evelyn Sakeah
- a Social Science Department , Navrongo Health Research Centre, Ghana Health Service , Navrongo , Upper East , Ghana
| | - Sumiyo Okawa
- b Department of Community and Global Health , The University of Tokyo , Tokyo , Japan
| | - Abraham Rexford Oduro
- c Navrongo Health Research Centre, Research and Development Division , Ghana Health Service , Navrongo , Upper East , Ghana
| | - Akira Shibanuma
- b Department of Community and Global Health , The University of Tokyo , Tokyo , Japan
| | - Evelyn Ansah
- d Research & Development Division , Ghana Health Service , Accra , Ghana
| | - Kimiyo Kikuchi
- b Department of Community and Global Health , The University of Tokyo , Tokyo , Japan
| | - Margaret Gyapong
- e Dodowa Health Research Centre, Research and Development Division , Ghana Health Service , Dodowa , Greater Accra , Ghana
| | - Seth Owusu-Agyei
- f Kintampo Health Research Centre, Research and Development Division , Ghana Health Service , Kintampo , Brong Ahafo , Ghana
| | - John Williams
- g Population Department , Navrongo Health Research Centre, Ghana Health Service , Navrongo , Upper East , Ghana
| | - Cornelius Debpuur
- a Social Science Department , Navrongo Health Research Centre, Ghana Health Service , Navrongo , Upper East , Ghana
| | - Francis Yeji
- a Social Science Department , Navrongo Health Research Centre, Ghana Health Service , Navrongo , Upper East , Ghana
| | - Vida Ami Kukula
- h Maternal and Child Health Unit , Dodowa Health Research Centre, Ghana Health Service , Dodowa , Greater Accra , Ghana
| | - Yeetey Enuameh
- i Maternal and Child Health Unit, Kintampo Health Research Centre , Ghana Health Service , Kintampo , Brong Ahafo , Ghana
| | | | - Enoch Oti Agyekum
- k Japan International Cooperation Agency Health Section , Accra , Ghana
| | - Sheila Addai
- l Dodowa Health Research Centre , Ghana Health Service , Dodowa , Greater Accra , Ghana
| | - Doris Sarpong
- m Dodowa Health Research Centre and Regional Institute for Population Studies , University of Ghana , Accra , Ghana
| | - Kwame Adjei
- i Maternal and Child Health Unit, Kintampo Health Research Centre , Ghana Health Service , Kintampo , Brong Ahafo , Ghana
| | - Charlotte Tawiah
- n Maternal and Child Health Unit , Kintampo Health Research Centre , Kintampo , Brong Ahafo , Ghana
| | - Junko Yasuoka
- b Department of Community and Global Health , The University of Tokyo , Tokyo , Japan
| | - Keiko Nanishi
- o Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine , The University of Tokyo , Tokyo , Japan
| | - Masamine Jimba
- b Department of Community and Global Health , The University of Tokyo , Tokyo , Japan
| | - Abraham Hodgson
- p Research and Development Division , Ghana Health Service , Accra , Greater Accra , Ghana
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Kukula VA, Dodoo AAN, Akpakli J, Narh-Bana SA, Clerk C, Adjei A, Awini E, Manye S, Nagai RA, Odonkor G, Nikoi C, Adjuik M, Akweongo P, Baiden R, Ogutu B, Binka F, Gyapong M. Feasibility and cost of using mobile phones for capturing drug safety information in peri-urban settlement in Ghana: a prospective cohort study of patients with uncomplicated malaria. Malar J 2015; 14:411. [PMID: 26481106 PMCID: PMC4615326 DOI: 10.1186/s12936-015-0932-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/07/2015] [Indexed: 11/28/2022] Open
Abstract
Background The growing need to capture data on health and health events using faster and efficient means to enable prompt evidence-based decision-making is making the use of mobile phones for health an alternative means to capture anti-malarial drug safety data. This paper examined the feasibility and cost of using mobile phones vis-à-vis home visit to monitor adverse events (AEs) related to artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria in peri-urban Ghana. Methods A prospective, observational, cohort study conducted on 4270 patients prescribed ACT in 21 health facilities. The patients were actively followed by telephone or home visit to document AEs associated with anti-malarial drugs. Call duration and travel distances of each visit were recorded. Pre-paid call cards and fuel for motorbike travels were used to determine cost of conducting both follow-ups. Ms-Excel 2010 and STATA 11.2 were used for analysis. Results Of the 4270 patients recruited, 4124 (96.6 %) were successfully followed up and analyzed. Of these, 1126/4124 (27.3 %) were children under 5 years. Most 3790/4124 (91.9 %) follow-ups were done within 7 days of ACT intake. Overall, follow up by phone (2671/4124—64.8 %) was almost two times the number done by home visits (1453/4124—35.2 %). Duration of telephone calls ranged from 38 s to 53 min, costing between GH¢0.26 (0.20USD) and GH¢41.70 (27.USD). On the average, the calls lasted 3 min 51 s (SD = 3 min, 21 s) costing GH¢2.70 (0.77USD). Distance travelled for home visit ranged from 0.65 to 62 km costing GH¢0.29 (0.20USD) and GH¢279.00 (79.70USD). Thirty-two per cent (1128/4124) of patients reported AEs. In total, 1831 AE were reported, 1016/1831(55.5 %) by telephone and 815/1831 (44.5 %) by home visits. Events such as nausea, dizziness, diarrhoea, and vomiting were commonly reported. Conclusion Majority of patients was successfully followed up by telephone and reported the most AEs. The cost of telephone interviewing was almost two times less than the cost of home visit. Telephone follow up should be considered for monitoring drug adverse events in low resource settings.
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Affiliation(s)
| | - Alexander A N Dodoo
- Centre for Tropical Clinical Pharmacology, College of Health Sciences, University of Ghana, Legon, Ghana.
| | | | | | - Christine Clerk
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.
| | | | | | - Simon Manye
- Dodowa Health Research Centre, Dodowa, Ghana.
| | | | | | | | | | - Patricia Akweongo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.
| | | | | | - Fred Binka
- INDEPTH-Network, Accra, Ghana. .,University of Science and Allied Sciences, Ho, Ghana.
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