A qualitative examination of factors influencing pregnancy-related anxiety in Northern Ghana

INTRODUCTION

Despite high prevalence of anxiety among pregnant women in low- and -middle-income countries, research on context-specific conceptualisation, measurement, and predictors of pregnancy-related anxiety (PrA) is limited in these contexts. We explored local conceptualisations of factors influencing PrA in the Northern Region of Ghana.

METHODS

We conducted 15 focus group discussions with antenatal care seekers in the Mion District, Savelugu Municipality, and Tamale Metropolis of the Northern Region, in July and August 2021. Multistage stratified purposive sampling was used to select respondents (n = 108). The data were audio-recorded and transcribed, and then we conducted a thematic analysis of the data.

RESULTS

At the individual level, fear of anaemia; pre-existing health conditions; challenges with daily activities; and physical, emotional, and sexual abuses from spouses contributed to PrA. Health system failures resulting in unexpected out-of-pocket payments, negative health worker attitudes, diagnostic errors, constraints on birth preparation and birth process, and potential adverse birth outcomes were understood as driving PrA. Socio-cultural factors influencing PrA comprised beliefs and practices around baby naming/outdooring ceremonies, fear of spiritual attacks, social construction of gender roles, and contextual factors such as transportation challenges.

CONCLUSION

Pregnant women in the region understood, experienced, and could identify perceived predictors of PrA. To address PrA, we recommend that mental health services should be integrated into the basic package of antenatal care and rural health services should be improved. Perceived predictors of PrA identified here could be included in the design of a context-specific PrA measure for use in the region.

Measurement of pregnancy-related anxiety worldwide: a systematic review

Background

The perinatal period is often characterized by specific fear, worry, and anxiety concerning the pregnancy and its outcomes, referred to as pregnancy-related anxiety. Pregnancy-related anxiety is uniquely associated with negative maternal and child health outcomes during pregnancy, at birth, and early childhood; as such, it is increasingly studied. We examined how pregnancy-related anxiety is measured, where measures were developed and validated, and where pregnancy-related anxiety has been assessed. We will use these factors to identify potential issues in measurement of pregnancy-related anxiety and the geographic gaps in this area of research.

Methods

We searched the Africa-Wide, CINAHL, MEDLINE, PsycARTICLES, PsycINFO; PubMed, Scopus, Web of Science Core Collection, SciELO Citation Index, and ERIC databases for studies published at any point up to 01 August 2020 that assessed pregnancy-related anxiety. Search terms included pregnancy-related anxiety, pregnancy-related worry, prenatal anxiety, anxiety during pregnancy, and pregnancy-specific anxiety, among others. Inclusion criteria included: empirical research, published in English, and the inclusion of any assessment of pregnancy-related anxiety in a sample of pregnant women. This review is registered on PROSPERO (CRD42020189938).

Results

The search identified 2904 records; after screening, we retained 352 full-text articles for consideration, ultimately including 269 studies in the review based on the inclusion and exclusion criteria. In total, 39 measures of pregnancy-related anxiety were used in these 269 papers, with 18 used in two or more studies. Less than 20% of the included studies (n = 44) reported research conducted in low- and middle-income country contexts. With one exception, all measures of pregnancy-related anxiety used in more than one study were developed in high-income country contexts. Only 13.8% validated the measures for use with a low- or middle-income country population.

Conclusions

Together, these results suggest that pregnancy-related anxiety is being assessed frequently among pregnant people and in many countries, but often using tools that were developed in a context dissimilar to the participants’ context and which have not been validated for the target population. Culturally relevant measures of pregnancy-related anxiety which are developed and validated in low-income countries are urgently needed.

The pattern of neonatal admissions and mortality at a regional and district hospital in the Upper West Region of Ghana; a cross sectional study

Background

High global neonatal deaths have triggered efforts to improve facility-based care. However, the outcomes achievable at different levels of care are unclear. This study compared morbidity and mortality patterns of newborns admitted to a regional and a district hospital in Ghana to determine outcome, risk and modifiable factors associated with mortality.

Objective

This study compared morbidity and mortality patterns of newborns admitted to a regional and a district hospital in Ghana to determine outcome, risk and modifiable factors associated with mortality

Methods

A cross-sectional study involving a records-review over one year at the Upper West Regional Hospital, and three years at St Joseph’s District Hospital, Jirapa was carried out. Age, sex, gestational age, weight, duration of admission, diagnosis, among others were examined. The data were analysed and statistical inference made.

Results

Altogether, 2004 newborns were examined, comprising 1,241(62%) from St Joseph’s District Hospital and 763(38%) from Upper West Regional Hospital. The proportion of neonatal deaths was similar, 8.94% (St Joseph’s District Hospital) and 8.91% (Upper West Regional Hospital). Prematurity, neonatal sepsis, birth asphyxia, low birth weight, neonatal jaundice and pneumonia contributed the most to mortality and suspected infections including malaria accounted for almost half (45.5%). Mortality was significantly associated with duration of stay of 48 hours, being premature, and being younger than 3 days.

Conclusion

Majority of the mortality among the neonates admitted was due to preventable causes. Better stabilization and further studies on the epidemiology of sepsis, prematurity, low birth weight, including the contribution of malaria to these and outcome of transferred neonates are needed.

Maternal perceptions about caesarean section deliveries and their role in reducing perinatal and neonatal mortality in the Upper West Region of Ghana; a cross-sectional study

Background

Maternal perceptions about caesarean section contribute to delayed presentation of women for emergency obstetric care. This increases the risks of perinatal and neonatal mortality and slows down the reductions needed to achieve the sustainable development goal (SDG) target of reducing neonatal mortality and ending new-born deaths. The aim of the study is to determine maternal perceptions about caesarean section deliveries and their role in reducing neonatal mortality at a regional and a district hospital in the Upper West Region of Ghana.

Methods

This descriptive study was carried out at two hospitals in the Upper West Region, the most rural region in Ghana, between 15th January and 29th June, 2018. Maternal perceptions were examined among antenatal care attendants at the Upper West Regional Hospital (UWRH) and St Joseph’s Hospital Jirapa (SJH), a district hospital, using questionnaires administered by trained nurses.

Results

Altogether, 416 completed questionnaires were obtained, comprising 206 from expectant women attending the UWRH and 210 from SJH. Although the majority of women in this study preferred spontaneous vaginal delivery (87.4%, n = 348) to caesarean section, most of the respondents (n = 281, 73%) indicated their willingness to have a caesarean section if necessary. The main reason for not wanting a CS was the long recovery time (51.8%, n = 148). Almost half of women interviewed, representing 45.1% (180) did not know or feel that CS can promote child survival and about a fifth, 21.6% (85) believed that CS can have adverse effects on child survival. Factors associated with poor perception of CS included, no formal education, age less than 19 years and no employment.

Conclusion

Majority of women in this study had a positive attitude towards the uptake of CS if it becomes necessary. Lack of formal education, age less than 19 years and unemployment are associated with poor maternal perception of CS. Education to improve the perception of CS as a promoter of child survival is necessary and to discourage perceptions that it causes adverse perinatal or neonatal outcome particularly in at risk populations.