Sheila A. Boamah

Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana

BackgroundThe Ghana Community based Health Planning and Services (CHPS) strategy targets to bring health services to the doorsteps of clients in a manner that improves maternal and child health outcomes. In this strategy, referral is an important component but it is threatened in a rural context where transportation service is a problem. Few studies have examined perceptions of rural dwellers on transportation challenges in accessing maternal health care services within CHPS.MethodsUsing the political ecology of health framework, this paper investigates transportation barriers in health access in a rural context based on perceived cause, coping mechanisms and strategies for a sustainable transportation system. Eight (8) focus group discussions involving males (n = 40) and females (n = 45) in rural communities in a CHPS zone in the Upper West Region of Ghana were conducted between September and December 2013.ResultsLack of vehicular transport is suppressing the potential positive impact of CHPS on maternal and child health. Consistent neglect of road infrastructural development and endemic poverty in the study area makes provision of alternative transport services for health care difficult. As a result, pregnant women use risky methods such as bicycle/tricycle/motorbikes to access obstetric health care services, and some turn to traditional medicines and traditional birth attendants for maternal health care services.ConclusionThese findings underscore the need for policy to address rural transport problems in order to improve maternal health. Community based transport strategy with CHPS is proposed to improve adherence to referral and access to emergency obstetric services.

Engaging new nurses: the role of psychological capital and workplace empowerment

The purpose of this study was to test a hypothesised model linking perceptions of workplace empowerment and psychological capital (PsyCap) to new graduate nurses’ work engagement by integrating theories of empowerment, PsyCap and work engagement. In response to the nursing shortage, efforts are needed to retain nurses by creating empowering work environments that leverage employee PsyCap to foster work engagement. A secondary analysis of data (n = 205) from a study by Laschinger et al. (2012) was conducted to test the hypothesised model. Hierarchical multiple linear regression analysis was used to test the influence of empowerment and psychological capital on new graduate nurses’ work engagement. Measures of structural empowerment (Conditions of Work Effectiveness Questionnaire-II), PsyCap (Psychological Capital Questionnaire) and work engagement (Utrecht Work Engagement Scale) were used. The hypothesised model was supported. The combined effect of workplace empowerment and PsyCap explained 38% of the variance in new nurses’ work engagement. Workplace empowerment and PsyCap were significant independent predictors of work engagement (β = 0.45 and 0.36, p < 0.05, respectively). The results suggest that the combination of personal and organisational resources is related to greater work engagement among new graduate nurses.

Exploring the linkage between exposure to mass media and HIV testing among married women and men in Ghana

ABSTRACT Although HIV testing is critical to the treatment and prevention of HIV/AIDS, utilization rate of HIV testing services among married women and men remains low in Ghana. Mass media, as a tool to increase overall HIV testing turnouts, has been considered one of the important strategies in promoting and enhancing behavioural changes related to HIV/AIDS prevention. Using the 2014 Ghana Demographic and Health Survey, the current study examines the relationship between levels of exposure to print media, radio, and television and the uptake of HIV testing among married women and men in Ghana. Results show that HIV testing is more prevalent among married women than their male counterparts. We also find that higher levels of exposure to radio is associated with HIV testing among women, while higher levels of exposure to print media and television are associated with HIV testing among men. Implications of these findings are discussed for Ghanas HIV/AIDS strategic framework, which aims to expanding efforts at dealing with the HIV/AIDS epidemic. Specifically, it is important for health educators and programme planners to deliver HIV-related messages through television, radio, and print media to increase the uptake of HIV testing particularly among married women and men in Ghana.

Unsafe Occupational Health Behaviors: Understanding Mercury-Related Environmental Health Risks to Artisanal Gold Miners in Ghana

The relationship between environmental exposure and health outcomes is complex, multidirectional and dynamic. Therefore, we need an understanding of these linkages for effective health risk communication. Despite the severe health hazards, artisanal gold mining is widespread globally, with an estimated 30 million people engaged in it. In this study, the relationships between artisanal gold miners’ knowledge of environmental and health effects of Hg and compositional, contextual and occupational factors were assessed using generalized linear models (negative log-log regression). A cross-sectional survey in three urban gold mining hubs in Ghana (Prestea, Tarkwa and Damang), was carried out among 588 (482 male and 106 female) artisanal gold miners. The results showed that 89% of artisanal gold miners had very low to low levels of knowledge whereas 11% had moderate to very high levels of knowledge of deleterious health effects of Hg. Also, individuals who perceived their health-related work conditions to be excellent had very low to low levels of knowledge of environmental and health effects of Hg. Interestingly, artisanal gold miners who were still working were less likely to know the environmental and health effects of Hg compared with their counterparts who were currently unemployed. Similarly, artisanal gold miners who had attained either primary or secondary education were less likely to know the environmental and health effects of Hg compared with their counterparts who had no formal education. This finding, although counterintuitive, can be understood within the fact that artisanal gold miners in Ghana without formal education tend to have considerably higher number of years of practical experience compared with their counterparts with formal education. Female artisanal gold miners were 68% less likely to know the environmental and health effects of Hg compared with their male counterparts (OR=0.32, p<0.05). Artisanal gold miners who had previously encountered occupational health problems were significantly more likely to know the environmental and health effects of Hg compared with their counterparts without any previous occupational health problems (OR=4.86, p<0.0001). Although artisanal gold miners who are 25-34 years old were more likely to know than their counterparts who are 18-24 years old, there were no differences in knowledge

Examining the Factor Structure of the MLQ Transactional and Transformational Leadership Dimensions in Nursing Context

The Multifactor Leadership Questionnaire (MLQ) is the most widely used instrument for assessing dimensions of leadership style; yet, most studies have failed to reproduce the original MLQ factor structure. The current study evaluates the dimensionality and nomological validity of Bass’s transactional and transformational leadership model using the MLQ in a sample of registered nurses working in acute care hospitals in Canada. A combination of exploratory and confirmatory factor analyses were used to evaluate the hypothetical factor structure of the MLQ consisting of five transformational factors, and three transactional factors. Results suggest that the eight-factor solution displayed best fit indices; however, two transactional factors should be extracted due to high interscale correlations and lack of differential relationships with the two leadership variables. The findings support a scale refinement and the need for new theory concerning the five transformational leadership and contingent reward dimensions of the MLQ.

Utilisation of skilled birth attendants over time in Nigeria and Malawi

Nutrition is a direct contributor and target to Sustainable Development Goal 2 (“End hunger achieve food security and improved nutrition and promote sustainable agriculture”) a foundation and pre-requisite to Sustainable Development Goal 3 (“Ensure healthy lives and promote well-being for all at all ages”) and a decisive enabler to the remaining goals of the Sustainable Development Agenda 2030. The World Health Organization (WHO) supports all Member States to achieve “a world free of all forms of malnutrition where all people achieve health and well-being” a vision supported by our work with Member States and their partners to ensure universal access to effective nutrition actions and to healthy and sustainable diets1 in the context of the overall effort to ensure universal health coverage2. To do this WHO uses its convening power to help facilitate and align priority setting to mainstream nutrition in the health and development agenda; develop evidence-informed guidance supported by the highest quality science and ethical frameworks; support the adoption of guidance its implementation and the integration of effective actions into existing or new delivery platforms in the health systems. WHO guidelines are documents developed by WHO containing recommendations for clinical practice or public health policy and programmes. A recommendation tells the intended end-user of the guideline what he or she can or should do in specific situations to achieve the best health and nutrition outcomes possible individually or at the population level. It offers a choice among different interventions or measures having an anticipated positive impact on health and nutrition and implications for the use of resources.3 The WHO Department of Nutrition for Health and Development (NHD) develops guidelines in accordance with the procedures established in the WHO Handbook for Guideline Development.2 The WHO guideline development process ensures that WHO guidelines are of high methodological quality and are developed through an independent transparent evidence-informed consensual decision-making process. Though the process with which WHO develops guidelines is highly structured systematic and transparent the process for priority setting (i.e. prioritizing topics4 for guideline development) has been a dynamic one in order to accommodate new and renewed high-level commitments from the WHO Secretariat as well as emerging issues arising from discussions among Member States in the Governing Body fora such as the World Health Assembly (WHA). The priority issues are determined by their importance (i.e. magnitude prevalence and distribution of disease or nutrition problems) or the existence of preventable or modifiable biological behavioural and contextual determinants (risk factors). Updating guidelines is challenging if evidence has to be retrieved to support an increasing number of recommendations. In this situation it is important to give priority to assuring the principle of “primum non nocere” (first do no harm) to address controversial areas and to set a position on areas in which new evidence has emerged and requires prompt action. Ensuring a well-understood and efficiently communicated prioritization process is therefore crucial as external partners and stakeholders play an important role in the WHO guideline implementation process. Independence and transparency of the prioritization process gives the Organization a means of providing assurance that the process is free of any undue influence that may affect the reputation and objectivity of WHO. Therefore in an effort to maintain transparency in the normative work of WHO and to enhance the understanding of the process used to prioritize topics for guideline development among Member States and stakeholders the Department of Nutrition for Health and Development (NHD) is leading the work on making the prioritization process more accessible and has developed an online tool to further facilitate the participation of Member States and their stakeholders in the guideline prioritization process. This process aims to complement the decisions of the World Health Assembly (WHA) the decision-making body of WHO. (ExcerptsABSTRACT Despite recent modest progress in reducing maternal and infant mortality rates in sub-Saharan Africa, Nigeria and Malawi were still in the top 20 countries with highest rates of mortalities globally in 2015. Utilisation of professional services at delivery – one of the indictors of MDG 5 – has been suggested to reduce maternal mortality by 50%. Yet, contextual, socio-cultural and economic factors have served as barriers to uptake of such critical service. In this paper, we examined the impact of residential wealth index on utilisation of Skilled Birth Attendant in Nigeria (2003, 2008 and 2013), and Malawi (2000, 2004 and 2010) using Demographic and Health Survey data sets. The findings from multivariate logistic regressions show that women in Nigeria were 23% less likely to utilise skilled delivery services in 2013 compared to 2003. In Malawi, women were 75% more likely to utilise skilled delivery services in 2010 than in 2000. Residential wealth index was a significant predictor of utilisation of skilled delivery services over time in both Nigeria and Malawi. These findings illuminate progress made - based on which we make recommendations for achievement of SDG-3: ensure healthy lives and promote well-being for all at all ages in Nigeria and Malawi, and similar context.

Timing and utilisation of antenatal care service in Nigeria and Malawi

ABSTRACT As the world draws curtains on the implementation of Millennium Development Goals (MDGs), there is increasing interest in evaluating the performance of countries on the goals and assessing related challenges and opportunities to inform the upcoming Sustainable Development Goals (SDGs). This study examined changes in the timing and utilisation of maternal health care services in Nigeria and Malawi; using multivariate negative log–log and logistic regression models fitted to demographic and health survey data sets. Predicted probabilities were also computed to observe the net differences in the likelihood of both the first and the required number of antenatal care (ANC) visits for each of the three analysis years. Women in Nigeria were 7% less likely in 2008 compared to 2003, and in Malawi, 32% more likely in 2013 compared to 2000, to utilise ANC in the first trimester of pregnancy. Timing of first ANC visit was strongly influenced by wealth in Nigeria but not in Malawi. The findings in our case studies show how various contextual factors may enable or inhibit policy performance. Maternal and child health, SDGs should incorporate both wealth and degrees of urbanicity into country level implementation strategies.

EXPLAINING THE GAP IN ANTENATAL CARE SERVICE UTILIZATION BETWEEN YOUNGER AND OLDER MOTHERS IN GHANA.

Over two-thirds of pregnant women (69%) have at least one antenatal care (ANC) coverage contact in sub-Saharan Africa. However, to achieve the full life-saving potential that ANC promises for women and babies, a nuanced understanding of age-specific gaps in utilization of ANC services is required. Using the 2008 Ghana Demographic and Health Survey of 1456 individuals, this study examined the disparities in the use of ANC services between younger and older mothers by applying four counterfactual decomposition techniques. The results show that cross-group differences in the explanatory variables largely account for the differentials in ANC service utilization between younger and older mothers. Birth order (parity) accounts for the largest share of the contribution to the overall explained gap in ANC utilization between the younger and older mothers, suggesting that ANC differentials between the two groups are probably due to biosocial factors. To a lesser extent, wealth status of the two groups also contributes to the overall explained gap in ANC service utilization. The policy implications of these findings are that in order to bridge the ANC service utilization gap between the two groups, policymakers must systematically address gaps in cross-group differences in the explanatory variables in order to increase the utilization of ANC to attain the minimum recommendation of four visits as per World Health Organization guidelines.

Linking Nurses' Clinical Leadership to Patient Care Quality: The Role of Transformational Leadership and Workplace Empowerment:

Background While improving patient safety requires strong nursing leadership, there has been little empirical research that has examined the mechanisms by which leadership influences patient safety outcomes. Aim To test a model examining relationships among transformational leadership, structural empowerment, staff nurse clinical leadership, and nurse-assessed adverse patient outcomes. Methods A cross-sectional survey was conducted with a randomly selected sample of 378 registered nurses working in direct patient care in acute care hospitals across Ontario, Canada. Structural equation modeling was used to test the hypothesized model. Results The model had an acceptable fit, and all paths were significant. Transformational leadership was significantly associated with decreased adverse patient outcomes through structural empowerment and staff nurse clinical leadership. Discussion This study highlights the importance of transformational leadership in creating empowering practice environments that foster high-quality care. The findings indicate that a more complete understanding of what drives desired patient outcomes warrants the need to focus on how to empower nurses and foster clinical leadership practices at the point of care. Conclusion In planning safety strategies, managers must demonstrate transformational leadership behaviors in order to modify the work environment to create better defenses for averting adverse events.

Evaluating the complex interactions between malaria and cholera prevalence, neglected tropical disease comorbidities, and community perception of health risks of climate change

ABSTRACT The burgeoning literature on the climate change–human health nexus has focused almost exclusively on the health impacts of climate change with little attention to how ill-health and disease influence public perception of the health risks of climate change. Based on a cross-sectional survey of 1,253 individuals, linear regression was used to examine the independent effects of malaria and cholera prevalence, and neglected tropical disease comorbidities on perceived health risks of climate change. Individuals who reported more comorbidities had higher scores on perceived health risks of climate change compared with those who did not report any comorbidities. Unexpectedly, at the multivariate level, there were no statistically significant relationships between age of respondents, gender, and educational attainment on the one hand, and perceived health risks of climate change on the other hand. Individuals who were diagnosed with cholera in the past 12 months had higher scores on perceived health risks of climate change but there was no relationship between diagnosis with malaria in the past 12 months and perceived health risks. Individuals who had attained secondary education had lower scores on perceived health risks of climate change compared with those without any formal education. Given that this relationship did not exist at the bivariate level, it indicates that biosocial and sociocultural factors suppressed the relationship between secondary education attainment and perceived health risks of climate change. The findings underscore the complex relationship between perceived health risks of climate change and infectious disease, comorbidities, compositional, and contextual factors at the multivariate level.