Mistreatment of Women in Health Facilities by Midwives during Childbirth in Ghana: Prevalence and Associated Factors

Studies have shown that many women worldwide experience mistreatment during pregnancy and childbirth. However, there are few quantitative estimates of the prevalence of mistreatment of women during facility-based childbirth in many developing countries including Ghana. Based on a cross-sectional retrospective survey of 253 randomly selected women who gave birth between November 2017 and April 2018 in a second-tier referral hospital in Ghana, this study examines mistreatment of women by midwives during childbirth and associated factors. Bivariate and logistic regression analyses were performed at 95% confidence level and p < 0.05. Results show that 83% of women were mistreated. Manifestations of mistreatments included detention for non-payment of bills (43.1%), non-confidential care (39.5%), abandonment (30.8%), verbal abuse (25.3%), discrimination (21.3%), physical abuse (14.2%) and non-consented care (13.3%). Factors that significantly independently predicted mistreatment after potential confounders were controlled for were being HIV positive (aOR: 0.11; 95% CI = 0.022–0.608; p = 0.011), being attended by a midwife rather than an obstetrician/gyneacologist (aOR: 0.07; 95% CI = 0.018–0.279; p < 0.01), and a woman’s husband earning lower monthly income. There is need for interventions to train midwives and other maternity care service providers in patient-centered care and interpersonal communication so as to minimize mistreatment of women during childbirth

Measuring adherence to ARVs among HIV-positive adolescents in Cameroon: a comparative assessment of self-report and medication possession ratio methods

Introduction:&nbsp;adherence to ARV medications has been shown to improve treatment outcomes in HIV positive patients. Given that ARV treatment is lifelong, adherence has become a critical issue as it may reduce over time. Measuring adherence is therefore imperative in programming. There are different methods of measuring adherence each with its advantages and disadvantages, depending on the context and the time. This study therefore compares two widely used adherence measurement scales in Cameroon, namely, the self-report and the medication possession ration (MPR) methods. Methods:&nbsp;the study was done in some selected health facilities of the North West and South West regions of Cameroon among adolescents on ARV. The study was designed as an analytical cross-sectional study with a record review component and systematic random sampling was used to select the participants. Adherence was measured through self-report and the medication possession ratio. Adolescents with adherence levels of at least 95% were considered adherent. Viral load suppression was considered as having the most recent viral load suppression results of less than 1000 copies per ml. The kappa statistics of inter-rate agreement was used to ascertain the difference between adherence as measured by self-report and MPR. The difference in adherence between the two scales was also compared using Fischer´s exact test and p-values were reported. Results:&nbsp;the study shows that adherence level using the self-report technique is 82.9% while that of MPR was 73.4%. When compared using the using Kappa statistics, there was substantial agreement between the two scales of 66% (p=0.54). The results of both self-report adherence and MPR were also compared with viral load suppression and the difference between viral load suppression and MPR was significant (p&lt;0.01). The difference in adherence between viral load suppression and the self-report measure also showed to be significant (p&lt;0.01). Conclusion:&nbsp;adherence from the self-report measure was higher than from MPR, but there was substantial agreement between the scales. Although there is no gold standard for adherence measurement, self-report or medication possession ratio could be used and complemented with laboratory markers like viral load counts

'What men don't know can hurt women's health': a qualitative study of the barriers to and opportunities for men's involvement in maternal healthcare in Ghana

BACKGROUND:The importance of men's involvement in facilitating women's access to skilled maternal healthcare in patriarchal societies such as Ghana is increasingly being recognised. However, few studies have been conducted to examine men's involvement in issues of maternal healthcare, the barriers to men's involvement, and how best to actively involve men. The purpose of this paper is to explore the barriers to and opportunities for men's involvement in maternal healthcare in the Upper West Region of Ghana. METHODS: Qualitative focus group discussions, in-depth interviews and key informant interviews were conducted with adult men and women aged 20-50 in a total of seven communities in two geographic districts and across urban and rural areas in the Upper West Region of Ghana. Attride-Stirling's thematic network analysis framework was used to analyse and present the qualitative data. RESULTS: Findings suggest that although many men recognise the importance of skilled care during pregnancy and childbirth, and the benefits of their involvement, most did not actively involve themselves in issues of maternal healthcare unless complications set in during pregnancy or labour. Less than a quarter of male participants had ever accompanied their wives for antenatal care or postnatal care in a health facility. Four main barriers to men's involvement were identified: perceptions that pregnancy care is a female role while men are family providers; negative cultural beliefs such as the belief that men who accompany their wives to receive ANC services are being dominated by their wives; health services factors such as unfavourable opening hours of services, poor attitudes of healthcare providers such as maltreatment of women and their spouses and lack of space to accommodate male partners in health facilities; and the high cost associated with accompanying women to seek maternity care. Suggestions for addressing these barriers include community mobilisation programmes to promote greater male involvement, health education, effective leadership, and respectful and patient-centred care training for healthcare providers. CONCLUSIONS: The findings in this paper highlight the need to address the barriers to men's involvement, engage men and women on issues of maternal health, and improve the healthcare systems - both in terms of facilities and attitudes of health staff - so that couples who wish to be together when accessing care can truly do so

NGOs and the Promotion of the Sexual and Reproductive Rights of Girls and Young Women with Disabilities in Zimbabwe

This case study investigates strategies used by the NGO Leonard Cheshire Disability Zimbabwe (LCDZ) to promote the SRHRs of girls and young women with disabilities in Zimbabwe. The findings show that LCDZ employed a combination of six strategies. These are: (1) building practical knowledge on SRHRs; (2) increasing community awareness and sensitivity; (3) providing SRHRs-related education; (4) enhancing access to justice and related services for survivors of sexual violence; (5) delivering assistive devices; and (6) promoting the livelihoods and economic empowerment. LCDZ made use of multi-stakeholder partnerships to implement these strategies, leveraging complementary skills and experience in the promotion of SRHRs. In each of these strategies, girls and young women with disabilities are the target group, with other stakeholders brought together to support them

Inequities and their determinants in coverage of maternal health services in Burkina Faso

Background: Poor and marginalized segments of society often display the worst health status due to limited access to health enhancing interventions. It follows that in order to enhance the health status of entire populations, inequities in access to health care services need to be addressed as an inherent element of any effort targeting Universal Health Coverage. In line with this observation and the need to generate evidence on the equity status quo in sub-Saharan Africa, we assessed the magnitude of the inequities and their determinants in coverage of maternal health services in Burkina Faso. Methods: We assessed coverage for three basic maternal care services (at least four antenatal care visits, facility-based delivery, and at least one postnatal care visit) using data from a cross-sectional household survey including a total of 6655 mostly rural, poor women who had completed a pregnancy in the 24 months prior to the survey date. We assessed equity along the dimensions of household wealth, distance to the health facility, and literacy using both simple comparative measures and concentration indices. We also ran hierarchical random effects regression to confirm the presence or absence of inequities due to household wealth, distance, and literacy, while controlling for potential confounders. Results: Coverage of facility based delivery was high (89%), but suboptimal for at least four antenatal care visits (44%) and one postnatal care visit (53%). We detected inequities along the dimensions of household wealth, literacy and distance. Service coverage was higher among the least poor, those who were literate, and those living closer to a health facility. We detected a significant positive association between household wealth and all outcome variables, and a positive association between literacy and facility-based delivery. We detected a negative association between living farther away from the catchment facility and all outcome variables. Conclusion: Existing inequities in maternal health services in Burkina Faso are likely going to jeopardize the achievement of Universal Health Coverage. It is important that policy makers continue to strengthen and monitor the implementation of strategies that promote proportionate universalism and forge multi-sectoral approach in dealing with social determinants of inequities in maternal health services coverage

Ghanaian women's knowledge on whether malaria treatment is covered by the national health insurance: a multilevel regression analysis of national data

Background: To obviate malaria and other healthcare costs and enhance healthcare utilization, the government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2005. Nonetheless, there is dearth of empirical evidence on Ghanaian women's knowledge about whether malaria treatment is covered by the NHIS or not. The current study, therefore, investigated factors associated with knowledge of malaria treatment with the NHIS among women aged 15-49 in Ghana. Methods: The study is a secondary analysis of data from women respondents in the 2014 Ghana Demographic and Health Survey. A total of 2,560 women participated in this study. Descriptive computation of the weighted proportion of women who knew that malaria is covered by NHIS was conducted at 95% confidence interval (CI). A multilevel logistic regression analyses was carried out with Stata's MLwinN package version 3.05. We declared significance at 5% alpha. Findings from the models were reported as adjusted odds ratios (aOR) and credible intervals (CrIs). Results: In all, 81.0% of Ghanaian women included in the study knew that NHIS covers malaria treatment. Women aged 45-49 had higher odds of knowing that NHIS covers malaria relative to those aged 15-19 age category [aOR=1.5;95%crl=1.2-2.1]. Women with higher education (post-secondary) had higher odds of knowing that NHIS covers malaria treatment compared with women who had no formal education [aOR=1.6;95%Crl=1.2-2.0]. Richest women were more likely to know that NHIS covers malaria treatment compared to the poorest women [aOR=1.3;95%Crl=1.2-1.7]. Women who had subscribed to the NHIS were more likely to report that NHIS covers malaria treatment [aOR=1.5;95%Crl=1.2-1.8]. The study revealed that the variance in the tendency for a woman to be aware that NHIS covers malaria treatment is attributable to 10.8% community level factors. Conclusion: This study has shown that individual, community and regional level factors affect women's knowledge on whether NHIS covers malaria treatment or not. As knowledge that malaria treatment is covered by NHIS may increase use of malaria prevention and treatment services in health facilities, we recommend that the Ghana Health Service intensifies community level education and awareness creation efforts, targeted at women among whom awareness levels are currently low

Participant perceptions of disability training for health workers: a qualitative study in Ghana

Background: Disabled people often report poor treatment by health workers, and health workers often report wanting more training about how to care for disabled people. However, existing disability training for health workers is usually delivered in one-off interventions, with little follow-up, evaluation, and focus on long-term learning. This insufficiency makes it important to understand how disability training for health workers can be more effective. Therefore, we interviewed stakeholders involved in an existing disability training intervention in Ghana. The aim of the study was to understand how disability training for health workers could be improved by exploring the perspectives of individuals who were involved in previous training interventions. Methods: A phenomenological study was conducted. In-depth, qualitative interviews were conducted with 33 people (17 trainers and 16 trainees) involved in disability training in Ghana. Data were analysed using thematic analysis. Results: Participants spoke about the challenges with existing training, namely how the current approach was insufficient, the consequences of informality in running training and the need for more sign language instruction. Several participants suggested improvements for training, including having external motivation (i.e., professional development credits, monetary benefits, etc.), more collaborative initiatives across institutions and government, and curriculum integration. We developed a theory of change model to show how different components of disability training support learning. Conclusions: These results show that disability training for health workers is important and that there is scope to refine and standardize training. In particular, the findings demonstrate how future initiatives to train health workers can be developed and implemented. They also emphasize the need to solicit perspectives from individuals who have experienced training in order to improve future iterations

Urban Family Planning in Sub-Saharan Africa: an Illustration of the Cross-sectoral Challenges of Urban Health

The multi-sectoral nature of urban health is a particular challenge, which urban family planning in sub-Saharan Africa illustrates well. Rapid urbanisation, mainly due to natural population increase in cities rather than rural–urban migration, coincides with a large unmet urban need for contraception, especially in informal settlements. These two phenomena mean urban family planning merits more attention. To what extent are the family planning and urban development sectors working together on this? Policy document analysis and stakeholder interviews from both the family planning and urban development sectors, across eight sub-Saharan African countries, show how cross-sectoral barriers can stymie efforts but also identify some points of connection which can be built upon. Differing historical, political, and policy landscapes means that entry points to promote urban family planning have to be tailored to the context. Such entry points can include infant and child health, female education and employment, and urban poverty reduction. Successful cross-sectoral advocacy for urban family planning requires not just solid evidence, but also internal consensus and external advocacy: FP actors must consensually frame the issue per local preoccupations, and then communicate the resulting key messages in concerted and targeted fashion. More broadly, success also requires that the environment be made conducive to cross-sectoral action, for example through clear requirements in the planning processes’ guidelines, structures with focal persons across sectors, and accountability for stakeholders who must make cross-sectoral action a reality