Browsing by Author "Otupiri, Easmon"

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    A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition
    (BMC Pregnancy and Childbirth, 2014) Ganle, John Kuumuori; Parker, Michael; Fitzpatrick, Raymond; Otupiri, Easmon; 0000-0001-8986-1648
    Background: To reduce financial barriers to access, and improve access to and use of skilled maternal and newborn healthcare services, the government of Ghana, in 2003, implemented a new maternal healthcare policy that provided free maternity care services in all public and mission healthcare facilities. Although supervised delivery in Ghana has increased from 47% in 2003 to 55% in 2010, strikingly high maternal mortality ratio and low percentage of skilled attendance are still recorded in many parts of the country. To explore health system factors that inhibit women’s access to and use of skilled maternal and newborn healthcare services in Ghana despite these services being provided free. Methods: We conducted qualitative research with 185 expectant and lactating mothers and 20 healthcare providers in six communities in Ghana between November 2011 and May 2012. We used Attride-Stirling’s thematic network analysis framework to analyze and present our data. Results: We found that in addition to limited and unequal distribution of skilled maternity care services, women’s experiences of intimidation in healthcare facilities, unfriendly healthcare providers, cultural insensitivity, long waiting time before care is received, limited birthing choices, poor care quality, lack of privacy at healthcare facilities, and difficulties relating to arranging suitable transportation were important health system barriers to increased and equitable access and use of services in Ghana. Conclusion: Our findings highlight how a focus on patient-side factors can conceal the fact that many health systems and maternity healthcare facilities in low-income settings such as Ghana are still chronically under-resourced and incapable of effectively providing an acceptable minimum quality of care in the event of serious obstetric complications. Efforts to encourage continued use of maternity care services, especially skilled assistance at delivery, should focus on addressing those negative attributes of the healthcare system that discourage access and use.
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    Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana
    (The International Journal of Health Planning and Management, 2016) Ganle, John Kuumuori; Fitzpatrick, Raymond; Otupiri, Easmon; Parker, Michael; 0000-0001-8986-1648
    Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care-seeking behaviours have focused on identifying the norms of non-use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expec tant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity care givers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor–patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non-state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor–patient relational practices that positively influence women’s healthcare-seeking behaviours .
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    Aftermath of a Clinical Trial: Evaluating the Sustainability of a Medical Device Intervention in Ghana
    (Journal of Tropical Pediatrics, 2014) Wilson, Patrick T.; Brooks, Joshua C.; Otupiri, Easmon; Moresky, Rachel, T.; Morris, Marilyn C.; 0000-0001-8986-1648
    effectively decreases respiratory rate in children presenting to Ghanaian district hospitals with respiratory distress. A follow-up study 16 months later evaluated the extent to which the skills and equipment necessary for CPAP use have been maintained. Seven of eight CPAP machines were functional, but five of eight oxygen concentrators and three of four electric generators were non-functional. Nurses trained by US study personnel (first-generation) and nurses trained by Ghanaian nurses after the study (second generation) were evaluated on CPAP knowledge and skills. Twenty-eight nurses participated in the study, 9 first-generation and 19 second-generation. First-generation trainees scored significantly higher than second-generation trainees on both skills and knowledge assessments (p ¼ 0.003). Appropriate technical support and training must be ensured to address equipment maintenance. Protocolization of the training program, in conjunction with skills and knowledge assessment, may improve acquisition and retention among second- and future-generation trainees.
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    An Assessment of Female Prisoners’ Perception of the Accessibility of Quality Healthcare: A Survey in the Kumasi Central Prisons, Ghana
    (Annals of Medical and Health Sciences Research, 2015-05) Sarpong, A. A.; Otupiri, Easmon; Yeboah‑Awudzi K ,; Osei-Yeboah, J.; Berchie, G. O.; Ephraim, R. K.D.; 0000-0001-8986-1648
    Background: Accessibility of quality healthcare across the globe has generated a lot of attention among public health practitioners. Aim: This study explored the background characteristics of female prisoners and how it influences their assessment of the quality of accessible healthcare in the Kumasi Female Prison. Subjects and Methods: This descriptive cross‑sectional survey was conducted at the Female section of the Kumasi Central Prisons from June to December 2011. We used pretested questionnaires to obtain quantitative data from all 39 inmates of the female Prisons. An in‑depth interview was used to obtain qualitative data from the prison healthcare giver. Data were analyzed with Epi Info Version 3.5.1, (Centers for Disease Control and Prevention), Excel, and Graph Pad Prism version 5.00 for Windows (Graph Pad software, San Diego California USA, www.graphpad.com). Results: Using a 12‑point scale inventory questionnaire, inmates with no formal education gave the highest mean health provision assessment score (6.0) whereas those with tertiary education gave the lowest (4.5). Females serving prison sentences gave the highest mean health assessment score whereas remand prisoners gave the lowest. Single females’ mean health assessment score was 5.7 whereas that of married inmates was 4.9. Unemployed inmates scored 5.8, informal 5.4 while civil servants scored 5.0. Conclusion: Access to quality healthcare was poor and demographic characteristics, marital status, educational background, and occupation influenced inmates’ perceptions of accessibility to quality healthcare. Inmates should be encouraged to be proactive in seeking healthcare irrespective of their background characteristics.
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    An exploratory assessment of the management of pediatric traumatic brain injury in three centers in Africa
    (Frontiers in Pediatrics, 2022) Raees, Madiha; Hooli, Shubhada; Amelia O.; André-von Arnim, von Saint; Laeke, Tsegazeab; Otupiri, Easmon; Fabio, Anthony; Rudd, Kristina E....et.al.; 0000-0001-8986-1648
    Purpose: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in low- and middle-income countries (LMICs). Hospital care practices of pediatric TBI patients in LMICs are unknown. Our objective was to report on hospital management and outcomes of children with TBI in three centers in LMICs. Methods: We completed a secondary analysis of a prospective observational study in children (<18 years) over a 4-week period. Outcome was determined by Pediatric Cerebral Performance Category (PCPC) score; an unfavorable score was defined as PCPC > 2 or an increase of two points from baseline. Data were compared using Chi-square and Wilcoxon rank sum tests. Results: Fifty-six children presented with TBI (age 0–17 y), most commonly due to falls (43%, n = 24). Emergency department Glasgow Coma Scale scores were ≤8 in 21% (n = 12). Head computed tomography was performed in 79% (n = 44) of patients. Forty (71%) children were admitted to the hospital, 25 (63%) of whom were treated for suspected intracranial hypertension. Intracranial pressure monitoring was unavailable. Five (9%, n = 5) children died and 10 (28%, n = 36) inpatient survivors had a newly diagnosed unfavorable outcome on discharge. Conclusion: Inpatient management and monitoring capability of pediatric TBI patients in 3 LMIC-based tertiary hospitals was varied. Results support the need for prospective studies to inform development of evidence-based TBI management guidelines tailored to the unique needs and resources in LMICs
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    Anthropometric Measurements: Options for Identifying Low Birth Weight Newborns in Kumasi, Ghana
    (PLOS One, 2014) Otupiri, Easmon; Wobil, Priscilla; Nguah, Samuel Blay; Hindin, Michelle J.; 0000-0001-8986-1648
    Background: In Ghana, 32% of deliveries take place outside a health facility, and birth weight is not measured. Low birth weight (LBW) newborns who are at increased risk of death and disability, are not identified; 13%–14% of newborns in Ghana are LBW. We aimed at determining whether alternative anthropometrics could be used to identify LBW newborns when weighing scales are not available to measure birth weight. Methods: We studied 973 mother and newborn pairs at the Komfo Anokye Teaching and the Suntreso Government hospitals between November 2011 and October 2012. We used standard techniques to record anthropometric measurements of newborns within 24 hours of birth; low birth weight was defined as birth weight ,2.5kg. Pearson’s correlation coefficient and the area under the curve were used to determine the best predictors of low birth weight. The sensitivity, specificity and predictive values were reported with 95% confidence intervals at generated cut-off values. Results: One-fifth (21.7%) of newborns weighed less than 2.5 kg. Among LBW newborns, the following measurements had the highest correlations with birth weight: chest circumference (r = 0.69), mid-upper arm circumference (r = 0.68) and calf circumference (r = 0.66); the areas under the curves of these three measurements demonstrated the highest accuracy in determining LBW newborns. Chest, mid-upper arm and calf circumferences at cut-off values of 29.8 cm, 9.4 cm and 9.5 cm respectively, had the best combination of maximum sensitivity, specificity and predictive values for identifying newborns with LBW. Conclusions: Anthropometric measurements, such as the chest circumference, mid-upper arm circumference and calf circumference, offer an opportunity for the identification of and subsequent support for LBW newborns in settings in Ghana, where birth weights are not measured by standardized weighing scales.
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    Assessment of Bypass of the Nearest Primary Health Care Facility Among Women in Ghana
    (JAMA Network Open, 2020-08-20) Bell, Griffith; Macarayan, Erlyn K.; Ratcliffe, Hannah; Kim, June-Ho; Otupiri, Easmon; Lipsitz, Stuart ...et.al.; 0000-0001-8986-1648
    IMPORTANCE: Recent reports have highlighted that expanding access to health care is ineffective at meeting the goal of universal health coverage if the care offered does not meet a minimum level of quality. Health care facilities nearest to patient’s homes that are perceived to offer inadequate or inappropriate care are frequently bypassed in favor of more distant private or tertiary-level hospital facilities that are perceived to offer higher-quality care. OBJECTIVE To estimate the frequency with which women in Ghana bypass the nearest primary health care facility and describe patient experiences, costs, and other factors associated with this choice. DESIGN, SETTING, AND PARTICIPANTS: This nationally representative survey study was conducted in 2017 and included 4203 households to identify women in Ghana aged 15 to 49 years (ie, reproductive age) who sought primary care within the last 6 months. Women who sought care within the past 6 months were included in the study. Data were analyzed from 2018 to 2019. EXPOSURES: Bypass was defined as a woman’s report that she sought care at a health facility other than the nearest facility. MAIN OUTCOMES AND MEASURES: Sociodemographic characteristics, reasons why women sought care, reasons why women bypassed their nearest facility, ratings for responsiveness of care, patient experience, and out-of-pocket costs. All numbers and percentages were survey-weighted to account for survey design. A total of 4289 women met initial eligibility criteria, and 4207 women (98.1%) completed the interview. A total of 1993 women reported having sough health care in the past 6 months, and after excluding those who were ineligible and survey weighting, the total sample included 1946 women. Among these, 629 women (32.3%) reported bypassing their nearest facilities for primary care. Women who bypassed their nearest facilities, compared with women who did not, were more likely to visit a private facility (152 women [24.5%] vs 202 women [15.6%]) and borrow money to pay for their care (151 women [24.0%] vs 234 women [17.8%]). After adjusting for covariates, women who bypassed reported paying a mean of 107.2 (95% CI, 79.1-135.4) Ghanaian Cedis (US $18.50 [95% CI, $13.65-$23.36]) for their care, compared with a mean of 58.6 (95% CI, 28.1-89.2) Ghanaian Cedis (US $10.11 [95% CI, $4.85-15.35]) for women who did not bypass (P = .006). Women who bypassed cited clinician competence (136 women [34.3%]) and availability of supplies (93 women [23.4%]) as the most important factors in choosing a health facility. CONCLUSIONS AND RELEVANCE The findings of this survey study suggest that bypassing the nearest health care facility was common among women in Ghana and that available services at lower levels of primary care are not meeting the needs of a large proportion of women. Among the benefits women perceived from bypassing were clinician competence and availability of supplies. These data provide insights to policy makers regarding potential gaps in service delivery and may help to guide primary health care improvement efforts.
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    Assessment of quality of antenatal care content and timing at the Holy Family Hospital, Nkawkaw- Eastern Region, Ghana
    (JUNE, 2019 ) Baafi, Janet Vanessa; Otupiri, Easmon
    Rendering quality antenatal care (ANC) services to pregnant women would aid in reducing maternal mortality worldwide especially in Sub-Saharan Africa. Worldwide, maternal mortality is the top cause of deaths among women between the ages of 15-49 years old and according to World Health Organization (2015) it is now known that approximately 303,000 women die from pregnancy related complications each year. Approximately 800 women die of pregnancy-related complications every day in Ghana mostly occurring in rural areas and this is because pregnant women report to antenatal clinics late and often do not receive the recommended ANC services as some contents of antenatal are also not available at the health facilities. In 2015, the total ANC coverage of The Holy Family Hospital in the Kwahu West Municipality was 4416 with 3744 consisting of women of reproductive age (WRA). Maternal death was 7and still births 96 out of 3808 deliveries made. It was upon these grounds therefore that the study seeks to assess the quality of ante natal care services, content and timing at the Holy Family Hospital Nkawkaw, eastern region, Ghana using a tool, Content and Timing of Pregnancy (CTP Tool) developed by Beeckman et al (2011). Methods: This cross- sectional study was conducted at the Holy family hospital Nkawkaw, eastern region from July to September, 2016. Simple random sampling method was used to select and elicit information from 422 women between the ages of 15-49 years who were in the first week post-delivery period, attending postnatal clinic and who also utilized ANC services at the Holy Family Hospital, Nkawkaw. Data Analysis was done using Excel version 13 in entering the data and Stata version 12 in analyzing using descriptive statistics such as mean, median and standard deviation and inferential statistics such as logistic regression, Chi-square (χ2) and correlation matrix. Results: In categorizing the women according to CTP tool, the inadequate group consisted of 17.75% of the population, 15.5% of the respondents fell into the intermediate group, the sufficient group consisted of 9.5% and more than half of the women (57.25%) fell in the appropriate category. Socio-demographic characteristics such as age, parity, and NHIS status influenced the content of ANC. Pregnant women who were between 34 -39 years were less than 35% as likely to receive recommended content of ANC compared with women within the age group of 16-21yrs (OR = 0.34; 95% CI; 0.12-0.95;p-value 0.04). Women with parity of ≥3 were almost four times as likely to receive recommended content of ANC compared with women with less than 3 children (OR=3.75; 95% CI; 1.09-3.55;p-value 0.02); and those who were non-insured were less than 5% as likely to receive the recommended content of ANC compared with those who were insured (OR=0.04;95% CI; 0.009-0.23;p-value 0.00). Socio-demographic characteristics such as age, parity, basic education and NHIS status influenced the timing of ANC services. Pregnant women who were between 34–39 years were less than 35% as likely to initiate ANC in the first trimester compared with women between 16-21 years (OR= 0.31; 95% CI; 0.11-0.85;p-value 0.05). Women with parity of ≥3 were almost twice as likely to initiate ANC in the first trimester compared with women who had less than 3 children (OR= 1.76;95%CI; 0.98-3.14;p- value 0.05). Women with basic education were less than 25% as likely to initiate ANC in the first trimester compared with their counterpart with no education (OR= 0.22;95% CI; 1.02-19.21;p-value 0.04) ; and non-insured women were less than 5% as likely to initiate ANC in the first trimester compared with insured (OR=0.04;95%CI; 0.009- 0.22;p-value 0.00). In assessing client’s perspectives on quality of ANC, 75.5% of the women showed that they were satisfied with the overall quality of ANC received, 69.25% showed that they were very satisfied with the cognitive and emotional support provided at the ANC and dissatisfaction was found among (23.5%) of the women with regards to the cost of ANC services. as maternal services are to be free according to the NHIS. Conclusion: The CTP tool focusses on three basic interventions which cannot be solely used in assessing the quality of ANC as ANC encompasses more than these three interventions as recommended by WHO. The CTP tool should be revised to include other interventions to render it more accurate.
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    Association of Household Savings and Expected Future Means with Delivery Using a Skilled Birth Attendant in Ghana and Nigeria: A Cross-Sectional Analysis
    (Matern Child Health J, 2017) Yang, Fan; Larissa Jennings; Otupiri, Easmon; Akinlo, Ambrose; Okunlola, Michael; Hindin, Michelle; 0000-0001-8986-1648
    Objectives: This study examined the association between household savings and related economic measures with utilization of skilled birth attendants (SBAs) at last birth among women living in peri-urban households (n = 381) in Ghana and Nigeria. Methods Data were drawn from the 2011–2014 Family Health and Wealth Study. Multivariable logistic regression models were used to estimate the odds of delivery with an SBA for individual and composite measures of household savings, expected financial means, debt, lending, and receipt of financial assistance, adjusting for demographic and reproductive characteristics. Results Seventy-three percent (73 %) of women delivered with an SBA during their last birth (89 %, Ghana; 63 %, Nigeria), and roughly one third (34 %) of households reported having any in-cash or in kind savings. In adjusted analyses, women living in households with savings were significantly more likely to deliver with an SBA compared to women in households without any savings (aOR = 2.02, 95 % CI 1.09–3.73). There was also a consistent downward trend, although non significant, in SBA utilization with worsening financial expectations in the coming year (somewhat vs. much better: aOR = 0.70, 95 % CI 0.40–1.22 and no change/worse vs. much better: aOR = 0.46, 95 % CI 0.12–1.83). Findings were null for measures relating to debt, lending, and financial assistance. Conclusion Coupling birth preparedness and complication readiness strategies with savings-led initiatives may improve SBA utilization in conjunction with targeting non-economic barriers to skilled care use.
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    Barriers to Condom use among the Youth in a Municipal Town in Ghana
    (Journal of the Ghana Science Association, 2007-01-09) Abdul-Kabir, M.; Otupiri, Easmon; Opare, D.; 0000-0001-8986-1648
    Condom-use has been identified as one way to reduce the spread of HIV/AIDS but the prevalence of consistent condom-use remains low, especially in West Africa. An analytical cross-sectional survey was conducted in the Sunyani Municipality in the Brong-Ahafo to identify barriers to condom-use among young people. The association between study variables were tested and quantified. Two hundred and twenty (220) sexually active individuals aged 15-24 years were interviewed using a questionnaire to elicit information on their sexual history and behaviour, condom-use history and the extent to which certain behavoiurs and experiences impede condom-use in their sexual relationships. Condom-use at last intercourse was reported by only 37.5% of males and 38.9% of females (p<0.832). Age, education and marital status were significantly associated with condom-use (p<0.001, p<0.005, p<0.030). Partner trust, non-availability of condoms, not achieving the desired sexual satisfaction and embarrassment of condom purchase were the main barriers to condom-use. Prevention strategies based on perceived severity or adequate knowledge about HIV/AIDS may not be sufficient to induce condom-use. Reproductive health services to young people should emphasize personal vulnerability to HIV and other sexually transmitted infections to encourage condom-use among sexually active young people.
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    Birth preparedness and complication readiness among pregnant women in resource-limited setting in rural Northern Ghana
    (PAMJ - One Health, 2021-12-11) Bapula, Alex; Newton, Sam Kofi; Dormechele,, William; Rahinatu, Beatrice Baah; Otupiri, Easmon; 0000-0001-8986-1648
    Introduction: in developing countries, complications during pregnancy and childbirth are still a leading cause of maternal morbidity and mortality. Birth preparedness and complication readiness (BPCR) is a key strategy to encourage pregnant women to seek care from skilled birth attendants. Birth preparedness and complication readiness status and its associated factors are currently unknown in rural Northern Ghana. This study assessed BPCR status among pregnant women in Sissala East and Sissala West Districts of Rural Northern Ghana. Methods: we conducted a community-based descriptive cross-sectional study in two districts in rural Northern Ghana. A total of 549 participants were sampled using the multi stage sampling technique and data were analyzed both descriptively and analytically using binary logistic regression. Results: the study enrolled 549 mothers. Less than half (4.7%) of respondents had adequate knowledge of warning signs during pregnancy. With respect to BPCR, only 46.5% of the mothers were well prepared. With respect to multivariate analysis, respondents who had attended primary (aOR = 1.77, 95% CI: 1.15, 2.73), secondary (aOR = 4.43, 95% CI: 2.61, 7.52) or tertiary education (aOR = 4.78, 95% CI: 1.89, 12.11) were significantly associated with good birth preparedness and complication readiness. Pregnant Islamic women were less likely to have adequate knowledge of warning signs during pregnancy when compared with Christian women (aOR = 0.14, 95% CI: 0.02, 0.81). Conclusion: this study showed that poor knowledge of warning signs during pregnancy and inadequate BPCR among mothers. Providing adequate BPCR information and counseling, with emphasis on warning signs during pregnancy and delivery is essential.
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    Breast Developmental Anomalies in Dormaa Municipality of Ghana: Prevalence and Impact on the Life of the Individual
    (Plastic Surgery International, 2013) Agbernoku, P.; Otupiri, Easmon; Fugar, S.; 0000-0001-8986-1648
    Background. Breast developmental anomalies (BDAs) are abnormalities of breast tissue that arise during breast development. Some of the anomalies can have negative impact on the person’s life. This study seeks to assess the prevalence of BDA in the Dormaa Municipality in Ghana and its impact on the life of the individual. Materials and Methods. A descriptive study involving 500 female respondents aged between 11 and 25 years from selected schools in the Dormaa Municipality using self-administered questionnaires and interviews. Results. From the study, it was found that the prevalence of BDA in the municipality was 12.8%. The commonest BDA was bilateral hypoplasia which accounted for 31.3% of the BDAs found in the study. Nine (14.1%) complained of the BDA affecting their lives with most being teased in school. Twenty-two (34.4%) girls out of the 64 with BDAs had a family member with a BDA. Conclusion. BDA is a worry; therefore, comprehensive educational programs for health workers and the general public are needed to increase awareness. Also, work should be done to include education on BDA when awareness is being raised about breast cancer and on the importance of breast self-Examination (BSE).
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    Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study
    (PLOS One, 2016-06-27) Ganle, John Kuumuori; Otupiri, Easmon; Obeng, Bernard; Edusie, Anthony Kwaku; Ankomah, Augustine; Adanu, Richard; 0000-0001-8986-1648
    While a number of studies have examined the factors affecting accessibility to and utilisa tion of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few stud ies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. Methods and Findings A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling’s thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their dis ability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include:healthcare providers’ insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Conclusions Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for healthcare providers as well as the provision of disability-friendly transport and healthcare facilities and services are needed.
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    Community-Based Management of Acute Malnutrition Programme: Rural and Urban Maternal Socio-Demographic and Implementation Differentials in Ghana
    (Journal of Food Science and Nutrition Research, 2022-05-19) Apenkwa, Joana; Amponsah, Samuel Kofi; Edusei, Anthony; Nakua, Emmanuel; Newton, Sam; Otupiri, Easmon; Adaobi, Chukwuma Chinaza; 0000-0001-8986-1648
    Malnutrition is a public health problem in Ghana, and is estimated to contribute indirectly to more than half of under-five deaths. This study was designed to describe how implementation of the Community based Management of Malnutrition (CMAM) programme in Ghana differs in the rural and urban parts of the country. A mixed methods approach was used in a community-based survey that studied 497 mothers/caregivers and under-five pairs quantitatively, 25 health service providers qualitatively, and 25 mothers caregivers qualitatively. Quantitative data were analysed descriptively with Stata 14.0 (Stata Corp, Texas, USA) while the qualitative data were analysed thematically with Atlas.ti, version 7.5 (Scientific Software Development GmbH, Berlin). Programme implementation was assessed using the following variables: availability of CMAM tools, availability of CMAM supplies, organization of out-patient therapeutic and supplementary feeding programmes, personnel availability, availability of community-based components of CMAM and maternal experience with CMAM services. While the number of children alive, provision of nutrition education and counselling, and demonstration of food preparation significantly influenced program effectiveness (p<0.05) in the urban site, no variables were found to do similar in the rural district. The rural facilities were more likely than the urban ones to be without tools. Less than 10% of mothers/caregivers in both study sites acknowledged the availability of the community-based components of CMAM. Programme implementation in the two study districts is poor; in order to ensure that the CMAM intervention translates into a reduced malnutrition burden among children under-five in Ghana, the programme implementation should be revised to address the identified shortcomings.
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    Comparison of childhood household injuries and risk factors between urban and rural communities in Ghana: A cluster-randomized, population-based, survey to inform injury prevention research and programming
    (Injury, 2021) Stewart, Barclay; Gyedu, Adam; Otupiri, Easmon; Nakua, Emmanuel; Boakye, Godfred; Mehta, Kajal; Donkor, Peter; Mock, Charles; 0000-0001-8986-1648
    Background: Childhood household injuries incur a major proportion of the global disease burden, particularly in low- and middle-income countries (LMICs). However, household injury hazards are differentially distributed across developed environments. Therefore, we aimed to compare incidence of childhood household injuries and prevalence of risk factors between communities in urban and rural Ghana to inform prevention initiatives.Methods: Data from urban and a rural cluster-randomized, population-based surveys of caregivers of children <5 years in Ghana were combined. In both studies, caregivers were interviewed about childhood injuries that occurred within the past 6 months and 200 meters of the home that resulted in missed school/work, hospitalization, and/or death. Sampling weights were applied, injuries and incidence rate ratios (IRRs) were described, and multi-level regression was used to identify and compare risk factors. Results: We sampled 200 urban and 357 rural households that represented 20,575 children in Asawase and 14,032 children in Amakom, Ghana, respectively. There were 143 and 351 injuries in our urban and rural samples, which equated to 594 and 542 injuries per 1,000 child-years, respectively (IRR 1.09, 95%CI 1.05-1.14). Toddler-aged children had the highest odds of injury both urban and rural communities (OR 3.77 vs 3.17, 95%CI 1.34-10.55 vs 1.86-5.42 compared to infants, respectively). Urban children were more commonly injured by falling (IRR 1.50, 95%CI 1.41-1.60), but less commonly injured by flame/hot sub stances (IRR 0.51, 95%CI 0.44-0.59), violence (IRR 0.41, 95%CI 0.36-0.48), or motor vehicle (IRR 0.50, 95%CI 0.39-0.63). Rural households that cooked outside of the home (OR 0.36, 95%CI 0.22-0.60) and that also supervised older children (OR 0.33, 95%CI 0.17-0.62) had lower odds of childhood injuries than those that did not. Conclusions: Childhood injuries were similarly common in both urban and rural Ghana, but with different patterns of mechanisms and risk factors that must be taken into account when planning prevention strategies. However, the data suggest that several interventions could be effective, including: community-based, multi-strategy initiatives (e.g., home hazard reduction, provision of safety equipment, establishing community creches); traffic calming interventions in rural community clusters; and passive injury surveillance systems that collect data to inform violence and broader prevention strategies.
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    Comprendre la qualité de la relation des couples et la pratique contraceptive à Kumasi, au Ghana
    (Perspectives Internationales sur la Santé Sexuelle et Génésique,, 2014) Carie, Par; Cox, Muntifering; Hindin, Michelle J.; Otupiri, Easmon; Larsen-Reindorf, Roderick; 0000-0001-8986-1648
    CONTEXTE: La connaissance, les attitudes et les pratiques relatives à l’usage de la contraception sont abondam ment documentées. Les aspects affectifs des relations susceptibles d’influencer la décision en matière de procréa tion sont cependant souvent omis. MÉTHODES: Les données de l’enquête 2010 sur la santé et la richesse des familles ont servi à la réalisation d’ana lyses de régression logistique bivariées et multinomiales, afin d’identifier les associations entre la qualité de la relation et la pratique contraceptive courante de 698 couples mariés ou en concubinage à Kumasi (Ghana). Les indicateurs de qualité de la relation se mesurent sur quatre échelles — engagement, confiance, communication constructive et communication destructive —, avec aussi une question de satisfaction au sein de la relation. La pratique contraceptive courante est répartie en trois catégories: aucune, méthode discrète (injectable, pilule, stérilet, implant et diaphragme) et méthode évidente (abstinence périodique, retrait, préservatif et spermicide). RÉSULTATS: La pratique contraceptive globale s’est révélée faible — avec 22% de femmes déclarant ne pratiquer aucune méthode au moment de l’enquête. En général, les répondants font état de hauts niveaux de qualité de la relation. Les cotes de satisfaction des femmes au sein de la relation présentent une association positive avec la pratique des méthodes évidentes plutôt que l’absence de pratique (rapport de risque relatif, 1,2). Côté masculin, les cotes de confiance sont associées positivement à la pratique des méthodes discrètes plutôt qu’à l‘absence de pratique (1,1) et celles de communication constructive le sont aux deux types de méthodes plutôt qu’à l’absence de pratique (1,1 chacun). CONCLUSIONS: La qualité de la relation des couples semble jouer un rôle important dans leur décision relative à la pratique contraceptive. Il convient d’en tenir compte dans les efforts de conception et de mise en œuvre des programmes et politiques de planification familiale.
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    Contraceptive and abortion practices of young Ghanaian women aged 15–24: evidence from a nationally representative survey
    (Reproductive Health, 2021) Keogh, Sarah C.; Otupiri, Easmon; Castillo, Philicia W.; Li, Naomi W.; Apenkwa, Joana; Polis, Chelsea B.; 0000-0001-8986-1648
    Background: Young Ghanaian women experience high rates of unmet need for contraception and unintended pregnancy, and face unique barriers to accessing sexual and reproductive health services. This study provides a comprehensive national analysis of young women’s contraceptive and abortion practices and needs. Methods: In 2018, we conducted a nationally representative survey of women aged 15–49, including 1039 women aged 15–24. We used descriptive statistics, multivariable logistic and multinomial regression to compare young versus older (25–49 year-old) women’s preferred contraceptive attributes, reasons for discontinuing contraception, quality of counseling, use of Primolut N-tablet, method choice correlates, and friends’ and partners’ influence. We also examined youth’s self-reported abortion incidence, abortion methods, post-abortion care, and barriers to safe abortion. Results: Among Ghanaian 15–24 year-olds who had ever had sex, one-third (32%) were using contraception. Compared to older women, they had higher desires to avoid pregnancy, lower ever use of contraception, more intermittent sexual activity, and were more likely to report pregnancies as unintended and to have recently ended a pregnancy. Young contraceptors most commonly used condoms (22%), injectables (21%), withdrawal (20%) or implants (20%); and were more likely than older women to use condoms, withdrawal, emergency contraception, and N-tablet. They valued methods for effectiveness (70%), no risk of harming health (31%) nor future fertility (26%), ease of use (20%), and no effect on menstruation (19%). Infrequent sex accounted for over half of youth contraceptive dis continuation. Relative to older women, young women’s social networks were more influential on contraceptive use. The annual self-reported abortion rate among young women was 30 per thousand. Over half of young women used abortion methods obtained from non-formal providers. Among the third of young women who experienced abortion complications, 40% did not access treatment. Conclusions: Young people’s intermittent sexual activity, desire for methods that do not harm their health, access barriers and provider bias, likely contribute to their greater use of coital-dependent methods. Providers should be equipped to provide confidential, non-discriminatory counseling addressing concerns about infertility, side effects.and alternative methods. Use of social networks can be leveraged to educate around issues like safe abortion and correct use of N-tablet.
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    Contraceptive Characteristics of Women Living with HIV in the Kumasi Metropolis, Ghana
    (International Journal of MCH and AIDS, 2013) Gyimah, Akosua A.; Nakua, Emmauel K.; Owusu-Dabo, Ellis; Otupiri, Easmon; 0000-0001-8986-1648
    Objectives: Contraceptive use among women living with HIV is important to prevent the transmission of the infection to their partners, prevent unintended pregnancies and prevent the mother-to-child transmission of the infection. The study sought to determine the contraceptive characteristics of women living with HIV in the Kumasi metropolis. Methods: A cross-sectional study was conducted from July to August 2012 at two HIV/AIDS clinics in the Kumasi Metropolis in the Ashanti Region, Ghana. Interviewer- administered questionnaires were used to collect data from two hundred and ninety five women. Data from one hundred and eighty three women living with HIV and who were sexually active were analyzed. Factors associated with contraceptive use were examined using logistic regression. Results: The overall contraceptive use was high; 84.7% were using a modern contraceptive method. The male condom was the commonest contraceptive method (77.0%) used and this was the main contraceptive method promoted at the HIV/AIDS clinic. Dual method usage was low (4.4%). Multivariate analysis showed that the significant predictor of contraceptive use was HIV status disclosure to partner (AOR = 0.25; 95% CI = 0.07-0.87; p = 0.03). Conclusions and Public Health Implications: The integration of family planning and HIV/AIDS services could stress dual method use and encourage HIV status disclosure to partner.
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    Coverage Assessment for Community-Based Management of Acute Malnutrition In Rural and Urban Ghana: A Comparative Cross-Sectional Study
    (Journal of Food Science and Nutrition Research, 2022) Apenkwa, Joana; Amponsah, Samuel K.; Newton, K. Sam; Osei-Antwi, Reuben; Nakua, Emmanuel; Edusei, Anthony K.; Otupiri, Easmon; 0000-0001-8986-1648
    Background: Ghana for years has implemented the Community-based Management of Acute Malnutrition (CMAM) to reduce malnutrition in children. However, the prevalence of malnutrition remains high. This study aimed to determine CMAM coverage levels in the Ahafo Ano South (AAS), a rural district and Kumasi Subin sub-metropolis (KSSM), an urban district. Methods: The study was a cross-sectional comparative study with a mixed-methods approach. In all, 497 mothers/caregivers and children under-five were surveyed using a quantitative approach while qualitative methods were used to study 25 service providers and 40 mothers/ caregivers who did not participate in the quantitative survey. Four types of coverage indicators were assessed: point coverage (defined as the number of Severe Acute Malnutrition cases [SAM] in treatment divided by total number of Severe Acute Malnutrition cases in the study district), geographical coverage (defined as total number of health facilities delivering treatment for SAM divided by total number of healthcare facilities in the study district), treatment coverage (defined as children with SAM receiving therapeutic care divided by total number of SAM children in the study district) and programme coverage (defined as number of SAM cases in the CMAM programme ÷ Number of SAM cases that should be in the programme). The qualitative approach was used to support the assessment of the coverage indicators. Data were analyzed using STATA version 14, and Atlas.ti, version 7.5 for the quantitative and qualitative data respectively. Results: Geographically, only 6% of the facilities in the urban communities were participating in the CMAM programme as against 29% of rural district facilities. The districts had point coverage of 41% and 10% for the urban and rural districts respectively. The urban setting recorded a SAM prevalence of 52% as against 36% in the rural setting. The proportion of SAM children enrolled in CMAM was higher in KSSM as compared to AAS; 41% and 33% respectively. In both districts, the most likely factors to attract mothers/caregivers to utilize the CMAM services were: ‘free services’ and ‘a cured child.’ The qualitative approach showed that coverage improvement in both districts is hampered by distance, transportation cost, lack of trained personnel in the communities for community mobilization home visits and insufficient feeds. Conclusion: To improve CMAM coverage, there is the need to train health workers to embark on aggressive health education strategies to encourage mothers/caregivers of malnourished children to utilize CMAM while ensuring that services reach those who need them.
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    Detection and management of zoonotic diseases at the Kumasi slaughterhouse in Ghana
    (Acta Tropica, 2000) Otupiri, Easmon; Adam, M.; Laing, E.; Akanmori, B. D.; 0000-0001-8986-1648
    Slaughterhouse surveys are important in the detection and management of zoonotic diseases. Routine reports from the Kumasi slaughterhouse, in the Ashanti region of Ghana, include cases of zoonotic diseases. Due to its location and size, Kumasi is the major cattle market and an important transit point for cattle trade from places within and outside Ghana. This present study was designed to examine slaughterhouse reports and to explore the nature of the knowledge, attitude and practices of butchers who operate at this slaughterhouse, in relation to zoonoses. The study was largely descriptive, employing qualitative methods and tools. Butchers were interviewed and their practices along the production line observed. The study indicates that zoonotic diseases are frequently detected at the Kumasi slaughterhouse. However the knowledge, attitudes, practices and beliefs of the butchers are largely inadequate for their profession in view of the important public health role that butchers play. The butchers have never received any form of training. It is recommended that the butchers receive training on a regular basis and that laws be formulated and implemented to protect the health of the butchers and the general public.