Ernest Maya

How women are treated during facility-based childbirth: development and validation of measurement tools in four countries – phase 1 formative research study protocol

BackgroundEvery woman has the right to dignified, respectful care during childbirth. Recent evidence has demonstrated that globally many women experience mistreatment during labour and childbirth in health facilities, which can pose a significant barrier to women attending facilities for delivery and can contribute to poor birth experiences and adverse outcomes for women and newborns. However there is no clear consensus on how mistreatment of women during childbirth in facilities is defined and measured. We propose using a two-phased, mixed-methods study design in four countries to address these research gaps. This protocol describes the Phase 1 qualitative research activities.Methods/DesignWe will employ qualitative research methodologies among women, healthcare providers and administrators in the facility catchment areas of two health facilities in each country: Ghana, Guinea, Myanmar and Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) will be conducted among women of reproductive age (15–49 years) to explore their perceptions and experiences of facility-based childbirth care, focused on how they were treated by healthcare workers and perceived factors affecting how they were treated. IDIs will also be conducted with healthcare providers of different cadres (e.g.: nurses, midwives, medical officers, specialist obstetricians) and facility administrators working in the selected facilities to explore healthcare providers’ perceptions and experiences of facility-based childbirth care and how staff are treated, colleagues and supervisors. Audio recordings will be transcribed and translated to English. Textual data will be analysed using a thematic framework approach and will consist of two levels of analysis: (1) conduct of local analysis workshops with the research assistants in each country; and (2) line-by-line coding to develop a thematic framework and coding scheme.DiscussionThis study serves several roles. It will provide an in-depth understanding of how women are treated during childbirth in four countries and perceived factors associated with this mistreatment. It will also provide data on where and how an intervention could be developed to reduce mistreatment and promote respectful care. The findings from this study will contribute to the development of tools to measure the prevalence of mistreatment of women during facility-based childbirth.

MHealth to Train Community Health Nurses in Visual Inspection with Acetic Acid for Cervical Cancer Screening in Ghana

Objective There is a shortage of trained health care personnel for cervical cancer screening in low-/middle-income countries. We evaluated the feasibility and limited efficacy of a smartphone-based training of community health nurses in visual inspection of the cervix under acetic acid (VIA). Materials and Methods During April to July 2015 in urban Ghana, we designed and developed a study to determine the feasibility and efficacy of an mHealth-supported training of community health nurses (CHNs, n = 15) to perform VIA and to use smartphone images to obtain expert feedback on their diagnoses within 24 hours and to improve VIA skills retention. The CHNs completed a 2-week on-site introductory training in VIA performance and interpretation, followed by an ongoing 3-month text messaging–supported VIA training by an expert VIA reviewer. Results Community health nurses screened 169 women at their respective community health centers while receiving real-time feedback from the reviewer. The total agreement rate between all VIA diagnoses made by all CHNs and the expert reviewer was 95%. The mean (SD) rate of agreement between each CHN and the expert reviewer was 89.6% (12.8%). The agreement rates for positive and negative cases were 61.5% and 98.0%, respectively. Cohen &kgr; statistic was 0.67 (95% CI = 0.45–0.88). Around 7.7% of women tested VIA positive and received cryotherapy or further services. Conclusions Our findings demonstrate the feasibility and efficacy of mHealth-supported VIA training of CHNs and have the potential to improve cervical cancer screening coverage in Ghana.

Women’s perspectives of mistreatment during childbirth at health facilities in Ghana: findings from a qualitative study

Abstract Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women’s perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to “correct” disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman’s experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth.

Why we need epidemiologic studies of polycystic ovary syndrome in Africa

The primary objective of the Ghana Polycystic Ovary Syndrome Epidemiology and Phenotype (Ghana‐PEP) study will be to assess the relevance and phenotypic distribution of polycystic ovarian syndrome (PCOS) in a medically unbiased population of reproductive‐aged women. In addition, the study will also attempt to identify sociodemographic, environmental, and psychological factors that may play a role in the development of PCOS phenotype. The study aims to recruit 990 randomly selected women aged 18–45 years living in Nsawam, the district capital of the Nsawam‐Adoagyiri Municipality, in the Eastern region of Ghana. Participants will complete a questionnaire with the aid of trained personnel, undergo a physical examination, and undergo ultrasonography and biochemical evaluations relevant to PCOS. It is anticipated that the study will provide the population prevalence and phenotypes, and distribution of PCOS.

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

Rates of contraceptive discontinuation are high worldwide,1 including in Ghana.2 Although long-acting reversible contraceptive (LARC) methods are widely available and safe for most women,3 few Ghanaian women use them.4 We aimed to prospectively assess whether discontinuation rates differed among women who adopted a LARC method versus those who adopted a short-term hormonal method. This article is protected by copyright. All rights reserved.

Comparing Women's Contraceptive Preferences With Their Choices in 5 Urban Family Planning Clinics in Ghana

Womens method choice largely matched their stated desired duration of effectiveness but not their desires to avoid certain side effects. While most women reported they were counseled about side effects, many fewer reported being specifically counseled about common menstrual side effects with their chosen method, including side effects the women said would cause them to stop using the method. Womens method choice largely matched their stated desired duration of effectiveness but not their desires to avoid certain side effects. While most women reported they were counseled about side effects, many fewer reported being specifically counseled about common menstrual side effects with their chosen method, including side effects the women said would cause them to stop using the method. ABSTRACT Background: Concern about contraceptive side effects is a common reason reported by women for not using contraception or discontinuing use. We sought to characterize womens preferences related to method characteristics and side effects and to examine whether their adopted method was consistent with their stated preferences. Methods: Between June 1, 2015, and August 31, 2015, we surveyed women attending 5 urban family planning clinics in Kumasi and Accra, Ghana, before and after their counseling sessions. All women attending these clinics were approached to gauge their interest and eligibility for inclusion. Before counseling, women were asked about desired method characteristics and bothersome and intolerable side effects. After counseling, women were asked about method adoption and the counseling received about side effects. We then used crosstabs to compare the side effects women were counseled to expect, as well as those they reported would be intolerable, with their adopted methods to determine consistency between womens preferences and choices. Results: In total, 414 and 411 women completed the pre- and post-counseling surveys, respectively. The analysis sample consisted of 336 participants who adopted a method and were matched between the 2 surveys. The 3 most commonly chosen methods were the implant (n=135, 40.1%), injectables (n=109, 32.4%), and the intrauterine device (IUD) (n=52, 13.4%). The large majority (at least 87%) of method adopters chose a method that was well matched with their desired duration of effectiveness. Consistency between womens expressed intolerable side effects and their chosen methods was substantially lower: at least 70% of women choosing the implant, IUD, or injectables had stated they would stop using a method if they experienced those side effects that are in fact common with their respectively chosen methods. While 65.0% of those who adopted a method reported they were counseled to expect side effects, substantially less were counseled to expect the side effects common with use of their adopted method. Conclusion: Womens choice of contraceptive methods generally matched their stated preferences related to desired duration of effectiveness but not to potential side effects, and most women reported they were not counseled to expect the side effects common with use of their chosen method. Providers need to address potential side effects during counseling both to ensure women choose methods that will be a good fit with their desires and to reassure them that commonly experienced side effects are not harmful.

Perinatal mortality among infants born during health user-fees (Cash & Carry) and the national health insurance scheme (NHIS) eras in Ghana: a cross-sectional study

BackgroundThis research determined the rates of perinatal mortality among infants delivered under Ghana’s national health insurance scheme (NHIS) compared to infants delivered under the previous “Cash and Carry” system in Northern Region, especially as the country takes stock of its progress toward meeting the Millennium Development Goals (MDG) 4 and 5.MethodsThe labor and maternity wards delivery records of infants delivered before and after the implementation of the NHIS in Northern Region were examined. Records of available daily deliveries during the two health systems were extracted. Fisher’s exact tests of non-random association were used to examine the bivariate association between categorical independent variables and perinatal mortality.ResultsOn average, 8% of infants delivered during the health user-fee (Cash & Carry) died compared to about 4% infant deaths during the NHIS delivery fee exemption period in Northern Region, Ghana. There were no remarkable difference in the rate of infant deaths among mothers in almost all age categories in both the Cash and Carry and the NHIS periods except in mothers age 35 years and older. Infants born to multiparous mothers were significantly more likely to die than those born to first time mothers. There were more twin deaths during the Cash and Carry system (p = 0.001) compared to the NHIS system. Deliveries by caesarean section increased from an average of 14% in the “Cash and Carry” era to an average of 20% in the NHIS era.ConclusionThe overall rate of perinatal mortality declined by half (50%) in infants born during the NHIS era compared to the Cash and Carry era. However, caesarean deliveries increased during the NHIS era. These findings suggest that pregnant women in the Northern Region of Ghana were able to access the opportunity to utilize the NHIS for antenatal visits and possibly utilized skilled care at delivery at no cost or very minimal cost to them, which therefore improved Ghana’s progress towards meeting the MDG 4, (reducing under-five deaths by two-thirds).