Social and Cultural Norms of Abortion Seeking in Ghana.

Ghanaian women are dying from complications resulting from unsafe abortions. This is despite a law referred to one of the most liberal in sub-Saharan Africa and a policy and regulatory situation that closely mirrors what international agencies call for to eliminate the complications from unsafe abortion. This study sought to answer the question, if safe abortions are available to Ghanaian women legally, why do so many continue to self-induce unsafely? While agencies such as the World Health Organization conclude that women resort to self-induction only if they are not able to access safe services, the women I interviewed suggested a different situation. Ghanaian women are engaging in transactional sexual relationship and are not using contraception. When pregnancies result, these women chose to self-induce not because they could not access a facility-based option but rather on the advice from their social networks. They know of friends who have been treated badly by healthcare providers or they themselves have been treated badly; they are shamed for their promiscuity and for falling pregnant. Some providers have told them that abortions are not available legally in facilities. Women know of others who have successfully self-induced an abortion using Misoprostol, a drug which is widely and inexpensively available in Ghana. It is for these reasons that Ghanaian women choose to self-induce and only seek care for complications. To engage women with the formal healthcare system, major investment into improving the quality of care patients receive is absolutely necessary. Investing in peer education, using these social networks to communicate positive messages about contraception and how to access safe abortion services, are potential interventions to reduce unsafe abortion. When individuals receive poor quality care, they are less likely to seek care in the future, and their entire social networks are likewise unlikely to come for care, relying instead on this system only in case complications arise.PhDHealth Services Organization and PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/113421/1/sarahrom_1.pd

Quality of family planning counseling among women attending prenatal care at a hospital in Addis Ababa, Ethiopia

ObjectiveTo assess the quality of family planning counseling among women attending a prenatal clinic in Addis Ababa, Ethiopia.MethodsIn a descriptive cross‐sectional study conducted between February and April, 2015, at the prenatal care clinic of Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, pregnant women in their third trimester were interviewed about their experience of family planning counseling. Data were collected via a questionnaire. Logistic regression was used to assess predictors of satisfaction with the counseling service.ResultsDuring the study period, 400 women were interviewed. Only 139 women (34.8%) were counseled about family planning. Among those counseled, 126 (90.6%) decided to use a contraceptive method after delivery and 46 (36.7%) decided to use an injectable contraceptive. Women were more likely to report high satisfaction when their provider asked about their partner’s attitude toward contraceptive methods (adjusted odds ratio 6.6; P<0.001), and when asked about their concerns and worries regarding family planning methods (adjusted odds ratio 5.1; P<0.001).ConclusionVery few women were counseled about contraception during prenatal care. Asking about a partner’s attitude toward contraceptives and discussing women’s fears or worries about contraceptives should be considered during family planning counseling to improve satisfaction and quality of care.Despite a hospital policy of universal counseling, only 35% of women attending prenatal care were counseled about family planning methods.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136375/1/ijgo12110.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136375/2/ijgo12110_am.pd

The effects of trace amounts of copper upon some physical properties of electrodeposited nickel

Thesis (M.S.)--Michigan State College of Agriculture and Applied Science, 1949Includes bibliographical references (leaves 22-27

Factors that influence midwifery students in Ghana when deciding where to practice: a discrete choice experiment

Abstract Background Mal-distribution of the health workforce with a strong bias for urban living is a major constraint to expanding midwifery services in Ghana. According to the UN Millennium Development Goals (MDG) report, the high risk of dying in pregnancy or childbirth continues in Africa. Maternal death is currently estimated at 350 per 100,000, partially a reflection of the low rates of professional support during birth. Many women in rural areas of Ghana give birth alone or with a non-skilled attendant. Midwives are key healthcare providers in achieving the MDGs, specifically in reducing maternal mortality by three-quarters and reducing by two-thirds the under 5 child mortality rate by 2015. Methods This quantitative research study used a computerized structured survey containing a discrete choice experiment (DCE) to quantify the importance of different incentives and policies to encourage service to deprived, rural and remote areas by upper-year midwifery students following graduation. Using a hierarchical Bayes procedure we estimated individual and mean utility parameters for two hundred and ninety eight third year midwifery students from two of the largest midwifery training schools in Ghana. Results Midwifery students in our sample identified: 1) study leave after two years of rural service; 2) an advanced work environment with reliable electricity, appropriate technology and a constant drug supply; and 3) superior housing (2 bedroom, 1 bathroom, kitchen, living room, not shared) as the top three motivating factors to accept a rural posting. Conclusion Addressing the motivating factors for rural postings among midwifery students who are about to graduate and enter the workforce could significantly contribute to the current mal-distribution of the health workforce.http://deepblue.lib.umich.edu/bitstream/2027.42/112340/1/12909_2012_Article_752.pd

The Role of Antibiotic-Target-Modifying and Antibiotic-Modifying Enzymes in Drug Resistance

The incidence and prevalence of non-tuberculous mycobacterial (NTM) infections have been increasing worldwide and lately led to an emerging public health problem. Among rapidly growing NTM, is the most pathogenic and drug resistant opportunistic germ, responsible for disease manifestations ranging from "curable" skin infections to only "manageable" pulmonary disease. Challenges in treatment stem from the bacteria's high-level innate resistance and comprise long, costly and non-standardized administration of antimicrobial agents, poor treatment outcomes often related to adverse effects and drug toxicities, and high relapse rates. Drug resistance in is conferred by an assortment of mechanisms. Clinically acquired drug resistance is normally conferred by mutations in the target genes. Intrinsic resistance is attributed to low permeability of cell envelope as well as to (multi)drug export systems. However, expression of numerous enzymes by , which can modify either the drug-target or the drug itself, is the key factor for the pathogen's phenomenal resistance to most classes of antibiotics used for treatment of other moderate to severe infectious diseases, like macrolides, aminoglycosides, rifamycins, β-lactams and tetracyclines. In 2009, when genome sequence became available, several research groups worldwide started studying antibiotic resistance mechanisms. At first, lack of tools for genetic manipulation severely delayed research endeavors. Nevertheless, the last 5 years, significant progress has been made towards the development of conditional expression and homologous recombination systems for . As a result of recent research efforts, an erythromycin ribosome methyltransferase, two aminoglycoside acetyltransferases, an aminoglycoside phosphotransferase, a rifamycin ADP-ribosyltransferase, a β-lactamase and a monooxygenase were identified to frame the complex and multifaceted intrinsic resistome of , which clearly contributes to complications in treatment of this highly resistant pathogen. Better knowledge of the underlying mechanisms of drug resistance in could improve selection of more effective chemotherapeutic regimen and promote development of novel antimicrobials which can overwhelm the existing resistance mechanisms. This article reviews the currently elucidated molecular mechanisms of antibiotic resistance in , with a focus on its drug-target-modifying and drug-modifying enzymes

Discontinuation of long‐acting reversible contraception versus short‐term hormonal methods in urban Ghana: A pilot longitudinal study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144677/1/ijgo12518.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144677/2/ijgo12518_am.pd

Rural Origin and Exposure Drives Ghanaian Midwives Reported Future Practice

A primary cause of Ghana’s higher than global average maternal mortality rate is limited access to maternal care in rural areas. To date, few studies have examined how rural background/training of midwives impacts their future willingness to work in remote areas. The purpose of this paper is to describe the relationship between Ghanaian student midwife place of origin and rural training on their willingness to choose a future rural practice location. A cross-sectional computer-based survey was completed by 238 final year Ghanaian midwifery students from two public midwifery training schools located in urban Ghana between October and December 2009. The relationship between rural exposure and willingness to work in rural Ghana was analyzed using independent t-test, chi-square, and bivariate logistic regression. Participants who experienced a rural rotation (OR: 1.51, 95% CI: 0.71, 3.22) and those born in a rural area (OR: 2.24, 95% CI: 0.74, 6.75) resulted in greater odds ratio to choose rural practice following graduation. This study indicates an association between midwifery students’ place of origin and training and their willingness to practice in a rural area after graduation. (Afr J Reprod Health 2014; 18[3]: 95-100)Keywords: Midwifery, Ghana, human resources for health, maldistribution, rural practice, rural incentive

Individual and medical characteristics of adults presenting to an urban emergency department in Ghana

Background: The aims of this study were to characterize the patients seeking acute care for injury and noninjury complaints in an urban Emergency Department in Ghana in order to 1) inform the curriculum of the newly developed Emergency Medicine resident training program 2) improve treatment processes, and 3) direct future community-wide injury prevention policiesStudy Design: A prospective cross-sectional survey of patients 18 years or older seeking care in an urban Accident and Emergency Center (AEC) was conducted between 7/13/2009 and 7/30/2009. Questionnaires were administered by trained research staff and each survey took 10-15 minutes to complete. Patients were asked questions regarding demographics, overall health and chief complaint.Results: 254 patients were included in the sample. Participants’ chief complaints were classified as either medical or injury-related. Approximately one third (38%) of patients presented with injuries and 62% presented for medical complaints. The most common injury at presentation was due to a road traffic injury, followed by falls and assault/fight. The most common medical presentation was abdominal pain followed by difficulty breathing and fainting/ blackout. Only 13% arrived to AEC by ambulance and 51% were unable to ambulate at the time of presentation.Conclusion: Approximately one-third of non-fatal adult visits were for acute injury. Future research should focus on developing surveillance systems for both medical and trauma patients. Physicians that are specifically trained to manage both the acutely injured patient and the medical patient will serve this population well given the variety of patients that seek care at the AEC.Keywords: Emergency Medicine, Injury, Surveillance, Ghana, Characteristic

In vitro susceptibility of Neisseria gonorrhoeae to netilmicin and etimicin in comparison to gentamicin and other aminoglycosides

PURPOSE Single doses of gentamicin have demonstrated clinical efficacy in the treatment of urogenital gonorrhea, but lower cure rates for oropharyngeal and anorectal gonorrhea. Formulations selectively enriched in specific gentamicin C congeners have been proposed as a less toxic alternative to gentamicin, potentially permitting higher dosing to result in increased plasma exposures at the extragenital sites of infection. The purpose of the present study was to compare the antibacterial activity of individual gentamicin C congeners against Neisseria gonorrhoeae to that of other aminoglycoside antibiotics. METHODS Antimicrobial susceptibility of three N. gonorrhoeae reference strains and 152 clinical isolates was assessed using standard disk diffusion, agar dilution, and epsilometer tests. RESULTS Gentamicin C1, C2, C1a, and C2a demonstrated similar activity against N. gonorrhoeae. Interestingly, susceptibility to the 1-N-ethylated aminoglycosides etimicin and netilmicin was significantly higher than the susceptibility to their parent compounds gentamicin C1a and sisomicin, and to any other of the 25 aminoglycosides assessed in this study. Propylamycin, a 4'-propylated paromomycin analogue, was significantly more active against N. gonorrhoeae than its parent compound, too. CONCLUSION Selectively enriched gentamicin formulations hold promise for a less toxic but equally efficacious alternative to gentamicin. Our study warrants additional consideration of the clinically established netilmicin and etimicin for treatment of genital and perhaps extragenital gonorrhea. Additional studies are required to elucidate the mechanism behind the advantage of alkylated aminoglycosides

Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs

Abstract Background Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness. Methods In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0. Results 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1) Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2) Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3) Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or “red earth sand.” Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill. Conclusions This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of facility-based delivery, the disconnect between healthcare providers and the community, and the critical role grandmothers play in ensuring clean delivery practices. Future interventions to address clean delivery and prevention of neonatal infections include educating healthcare providers about harmful traditional practices so they are specifically addressed, strengthening facilities, and incorporating influential community members such as grandmothers to ensure success.http://deepblue.lib.umich.edu/bitstream/2027.42/112409/1/12884_2011_Article_543.pd