Publications by authors named "Cheryl A Moyer"

114 Publications

Migration, personal physical safety and economic survival: drivers of risky sexual behaviour among rural-urban migrant street youth in Kampala, Uganda.

BMC Public Health 2022 06 4;22(1):1119. Epub 2022 Jun 4.

Medicine and Life Sciences, University of Maastricht Faculty of Health, Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands.

Background: Despite the vulnerabilities associated with the youth migration process, knowledge on the drivers of risky sexual behaviour among migrant street youth is limited. This study sought to explore the pathways driving risky sexual behaviour among rural-urban migrant street youth in Kampala, Uganda.

Methods: We conducted 11 focus-group discussions composed of 8-10 participants each, and 15 in-depth interviews with urban street adolescents and youth aged 12-24 years. We purposively recruited street youth who had migrated from other districts to Kampala, Uganda, and who identified themselves as street youth. Data were analysed thematically using an inductive approach facilitated by Dedoose software.

Results: The migration journey acted as a catalyst for risky sexual behaviour among the adolescents and youth moving from rural districts to Kampala. Three primary pathways were found to drive risky sexual behaviour of street youth: 1) rural-urban migration itself, through sexual exploitation of and violence toward street youth especially young girls during movement, 2) economic survival through engaging in casual jobs and sex work upon arrival in the city, and 3) personal physical safety through friendships and networks, which consequently lead to having multiple sexual partners and unprotected sex. Engagement in risky sexual behaviour, especially sex work, was found to be an adaptation to the challenging and complex street life within the city.

Conclusions: This study highlights the migration process, personal physical safety and economic survival as major pathways driving risky sexual behaviour among rural-urban street youth in Kampala. Interventions to improve sexual health, physical safety and protection of street youth during the migration process and within the city spaces should be prioritised.
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http://dx.doi.org/10.1186/s12889-022-13516-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9166484PMC
June 2022

COVID-19 and Decision-Making for Pregnant Women: Taking or Relinquishing Control in Response to a Pandemic.

J Pregnancy 2022 18;2022:6436200. Epub 2022 May 18.

University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI, USA 48109.

COVID-19 has uniquely impacted pregnant women. From the initial unknowns about its virulence during pregnancy, to frequent and rapidly changing hospital guidelines for prenatal care and delivery, pregnant women have felt intense uncertainty and, based on recent research, increased anxiety. This study sought to determine the impact COVID-19 had on women's birth plans. Open-ended qualitative responses from an anonymous, online survey of pregnant women in the United States, conducted on April 3-24, 2020, were analyzed using the Attride-Stirling qualitative framework. A conceptual framework for understanding the impact of COVID-19 on women's birth plans was generated. 2,320 pregnant women (mean age 32.7 years, mean weeks pregnant 24.6 weeks) responded to the open-ended prompts, reflecting the following themes: the impact(s) of COVID-19 on pregnant women (including unanticipated changes and uncertainty), the effect of COVID-19 on decision-making (including emotional reactions and subsequent questioning of the healthcare system), and how both of those things led women to either exercise or relinquish their agency related to their birth plan. These findings indicate that the changes and uncertainty surrounding COVID-19 are causing significant challenges for pregnant women, and absent more clarity and more provider-driven support, women seeking to cope are considering changes to their birth plans. Health systems and providers should heed this warning and work to provide pregnant women and their families with more information, support, and collaborative planning to ensure a positive, healthy birth experience, even during a pandemic.
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http://dx.doi.org/10.1155/2022/6436200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9115605PMC
May 2022

Viability of an urban maternity waiting home in Kumasi, Ghana: A qualitative needs assessment.

Midwifery 2022 Jul 22;110:103349. Epub 2022 Apr 22.

Global REACH, Departments of Learning Health Sciences and Obstetrics and Gynecology, Global REACH, University of Michigan Medical School, Victor Vaughan Building, 2nd Floor, 1111 East Catherine Street, Ann Arbor, MI 48109, United States.

Background: Maternity waiting homes, usually located in rural, low-resource settings, may increase access to skilled care during delivery and ultimately improve maternal-newborn outcomes. Although there are studies exploring maternity waiting homes in rural settings, little is known about interest in and viability of maternity waiting home use in urban environments.

Objective: The purpose of this study was to conduct a qualitative needs assessment about establishing a maternity waiting home as a health system strengthening intervention in urban Kumasi, Ghana.

Design: We conducted an exploratory qualitative needs assessment about the community beliefs, values, and interest in maternity waiting homes as a health system strengthening intervention to improve maternal-newborn outcomes. A semi-structured interview guide was based on several domains from the Tailored Implementation for Chronic Diseases checklist. Latent content analysis was used to analyze the data and elicit themes.

Setting: Data were collected in late 2019 in urban Kumasi, Ghana near a large government hospital and in the community.

Participants: Using purposive and snowball sampling, individual interviews (n = 14) were conducted with community stakeholders and key decision makers, and 8 focus group discussions were conducted with women of childbearing age (n = 38) and family members (n = 38).

Findings: Three major overarching themes were identified: (1) Urban maternity waiting homes are perceived to provide a unique benefit; (2) Urban maternity waiting homes are anticipated to be successful, and; (3) barriers to establishing an urban maternity waiting home may prevent prompt action. There is community buy-in and engagement for building and using urban maternity waiting homes but they are not able to identify concrete sources of funding to pay for the physical construction of the home.

Key Conclusions: There is overwhelming support for building and using maternity waiting homes as a health system strengthening intervention to improve maternal-newborn outcomes in urban Kumasi, Ghana. Participants perceive maternity waiting homes as providing unique benefits to improve maternal-newborn health and anticipate that maternity waiting homes would be a successful intervention. Participants identified financial barriers to establishing an urban maternity waiting home that might prevent timely implementation.

Implications For Practice: Findings highlight interest in mobilizing resources to establish maternity waiting homes in an urban setting. To overcome potential barriers to roll-out, attention needs to be focused on securing funding to build an urban maternity waiting home in Kumasi. As health policy shifts towards women delivering in larger-volume facilities typically located in big cities, there is potential for maternity waiting homes to be implemented in urban settings throughout sub-Saharan Africa to maximize positive health outcomes.
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http://dx.doi.org/10.1016/j.midw.2022.103349DOI Listing
July 2022

Using the Ghana malaria indicator survey to understand the difference between female and male-headed households and their prevention and testing for malaria among children under 5.

Malar J 2022 Apr 2;21(1):112. Epub 2022 Apr 2.

Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.

Background: Globally, 94% of malaria deaths occur in sub-Saharan Africa, and children under age 5 account for 70% of malaria-related mortality in the region. This study sought to examine differences between female-headed households (FHHs) and male-headed households (MHHs) with regard to malaria prevention and testing among children under age 5 (U5) in Ghana.

Methods: This cross-sectional study used publicly available data from the 2019 Ghana Malaria Indicator Survey (GMIS). Frequencies and descriptive statistics were calculated for all key variables. Bivariate analyses comparing FHHs and MHHs were conducted using t tests and Chi-square analysis. A P value of 0.05 was taken for statistical significance.

Results: Five thousand one hundred and eighty one household were identified, of which 1938 (37.4%) were female-headed and 3243 (62.6%) were male-headed. 51.7% of FHHs included a child U5, whereas 67.8% of MHHs included a child U5. MHHs were significantly more likely to own an ITN than FHHs (83.1% vs. 78.3%, P < 0.001), whereas FHHs were more likely to report taking malaria prevention steps such as spraying the house with insecticide, filling in stagnant puddles, and keeping surroundings clear (all significant at P < 0.001). U5 children in MHHs were more likely to sleep under a bed net the night preceding the survey (51.0%) than U5 children in FHHs (44.8%), although the finding was not statistically significant. The rates of fevers in the previous two weeks among children U5 were similar across MHH and FHH (24.2% vs. 22.3%), and the rates of testing for malaria among those who experienced a febrile episode were also similar across MHHs and FHHs (39.0% vs. 41.3%). Of those tested, the percentage of U5 children who tested positive for malaria was also similar across MHHs and FHHs (63.9% vs. 63.0%).

Conclusions: Both FHHs and MHHs in Ghana make a concerted effort to prevent and test for malaria among children U5 in their households. Despite differences in malaria prevention strategies, there were no significant difference in febrile episodes, malaria testing, and rates of positivity, suggesting that malaria prevention is challenging for all households in Ghana. In the face of a newly-developed malaria vaccine, future research is warranted to ensure adequate uptake across all households.
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http://dx.doi.org/10.1186/s12936-022-04135-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977017PMC
April 2022

"Once you get one maternal death, it's like the whole world is dropping on you": experiences of managing maternal mortality amongst obstetric care providers in Ghana.

BMC Pregnancy Childbirth 2022 Mar 14;22(1):206. Epub 2022 Mar 14.

Global REACH, Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA.

Background: Maternal mortality has a significant global impact, especially in low-resource settings. Little prior research has been conducted on the potential effects of poor maternal outcomes on the personal and professional well-being of healthcare providers. This study explores the in-depth experiences and perspectives of obstetric providers in Ghana who work in a setting with frequent maternal mortalities.

Methods: This is a qualitative study of semi-structured interviews conducted at the Komfo Anokye Teaching Hospital in Ghana. Participants were obstetric healthcare providers, defined as midwives, house officers currently rotating on the obstetrics/gynecology service, and obstetrician/gynecologists at any training or practice level (residents, fellows, and specialists). Interviews were audio-recorded, transcribed verbatim, and uploaded into NVivo for qualitative analysis. Using the Attride-Stirling qualitative model, an incremental and iterative process was used to code interviews with keyword phrases and develop a framework of organizing and global themes.

Results: Interviews were conducted with 27 participants-15 midwives and 12 physicians (three obstetrician/gynecologist residents, six obstetrician/gynecologist specialists, and three house officers), with sample size determined by data saturation. Obstetric providers' experiences in a setting with frequent maternal mortalities were dependent on their level of preparedness to manage maternal mortalities and the workplace environment. Providers' level of preparedness was dependent on both the training they had received on the medical management of obstetric emergencies, as well as a lack of training on the mental health aspects of coping with maternal mortality. The impact of the workplace environment was dependent on systems failures and limited resources, blame from colleagues and supervisors, and a lack of support in the workplace. In turn, obstetric providers' experiences managing frequent maternal mortalities impacted their clinical care performance and mental health.

Conclusions: Maternal deaths have profound personal and professional impacts on the healthcare providers who manage them. A large need exists for additional institutional training and support for obstetric providers who manage maternal mortality, especially in low-resource settings like Ghana.
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http://dx.doi.org/10.1186/s12884-022-04535-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8919901PMC
March 2022

Perspectives on Resuscitation Decisions at the Margin of Viability among Specialist Newborn Care Providers in Ghana and Ethiopia: A Qualitative Analysis.

BMC Pediatr 2022 02 17;22(1):97. Epub 2022 Feb 17.

Division of Neonatal Perinatal Medicine, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, USA.

Background: In high income countries, guidelines exist recommending gestational age thresholds for offering and obligating neonatal resuscitation for extremely preterm infants. In low- and middle- income countries, this approach may be impractical due to limited/inconsistent resource availability and challenges in gestational dating. Scant literature exists on how clinicians in these settings conceptualize viability or make resuscitation decisions for premature infants.

Methods: Qualitative interviews of interprofessional neonatal clinicians were conducted in Kumasi, Ghana, at Komfo Anokye Teaching Hospital and Suntreso Government Hospital, and in Addis Ababa, Ethiopia, at St. Paul's Hospital Millennium Medical College. Transcribed interviews were coded through the constant comparative method.

Results: Three discrete major themes were identified. The principal theme was a respect for all life, regardless of the likelihood for survival. This sense of duty arose from a duty to God, a duty to the patient, and a duty intrinsic to one's role as a medical provider. The duty to resuscitate was balanced by the second major theme, an acceptance of futility for many premature infants. Lack of resources, inappropriate staffing, and historically high local neonatal mortality rates were often described. The third theme was a desire to meet global standards of newborn care, including having resources to adopt the 22-25-week thresholds used in high income countries and being able to consistently provide life-saving measures to premature infants.

Conclusions: Neonatal clinicians in Ghana and Ethiopia described respect for all life and desire to meet global standards of newborn care, balanced with an awareness of futility based on local resource limitations. In both countries, clinicians highlighted how wide variations in regional survival outcomes limited their ability to rely on structured resuscitation guidelines based on gestational age and/or birthweight.
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http://dx.doi.org/10.1186/s12887-022-03146-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8851801PMC
February 2022

In-country data will illuminate under-5 mortality disparities.

Lancet 2021 09 17;398(10303):821-822. Epub 2021 Aug 17.

Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda; Global Public Health, Karolinska Institute, Stockholm, Sweden.

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http://dx.doi.org/10.1016/S0140-6736(21)01110-7DOI Listing
September 2021

High Prevalence of Low Birth Weight Babies Born to Pregnant Women Referred to a District Hospital in Rural Zambia.

Matern Child Health J 2021 Aug 16;25(8):1182-1186. Epub 2021 Jun 16.

Department of Health Behavior and Biological Sciences, Global Affairs, PAHO/WHO Collaborating Center, University of Michigan School of Nursing, Ann Arbor, MI, 48109, USA.

Objectives: Low birthweight (LBW) is a significant public health problem in sub-Saharan Africa and LBW in rural Zambia is high. Our study explored the prevalence of LBW for newborns whose mothers were referred from a rural health center to a district referral hospital in Lundazi, Zambia.

Methods: A five-month retrospective record review of Ministry of Health data was performed to examine birthweight characteristics of a convenience sample of newborns from ten facilities referring to one district hospital (n = 234).

Results: Among all cases, 21% (n = 49) of newborns were LBW. For LBW newborns, 73% (n = 36) were preterm with mothers having a pregnancy duration of less than 37 weeks. Newborns whose mothers experienced twin pregnancies (p = .021) and prolonged labor (p = .033) were more often LBW. However, regression models demonstrated no difference among newborns with and without LBW for prolonged labor (p = .344) and twin pregnancies (p = .324) when controlling for variables that could interact with the maternal-newborn delivery outcomes.

Conclusions: for Practice Healthcare providers and policy makers need to address the short and long-term effects of LBW throughout the lifecycle in rural Zambia. More maternal-newborn health research is needed to understand the underlying socioeconomic, social, and cultural determinants influencing LBW in rural Zambia.
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http://dx.doi.org/10.1007/s10995-021-03190-8DOI Listing
August 2021

Provider perspectives on in Ghana.

J Biosoc Sci 2021 Apr 19:1-13. Epub 2021 Apr 19.

Departments of Learning Health Sciences and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.

Neonatal mortality is one of the leading causes of under-five mortality globally, with the majority of these deaths occurring in low- and middle-income countries. In Ghana, there is a belief in an array of newborn conditions, called Asram, that are thought to have a spiritual, rather than physical, cause. These conditions are predominantly managed by traditional healers as they are considered unable to be treated by allopathic medical providers. Through a series of semi-structured qualitative interviews of medical providers in Kumasi, Ghana, conducted in July-August 2018, this study sought to elucidate perspectives of allopathic medical providers about Asram, including the perceived implications of traditional newborn care patterns on newborn health and higher-level neonatal care. Twenty health care providers participated and represented a tertiary care hospital and a district hospital. Medical providers were universally aware of Asram but varied on the latitude they gave this belief system within the arena of newborn care. Some providers rationalized the existence of Asram in the backdrop of high neonatal mortality rates and long-standing belief systems. Others highlighted their frustration with Asram, citing delays in care and complications due to traditional medical treatments. Providers utilized varying approaches to bridge culture gaps with families in their care and emphasized the importance of open communication with the shared goal of improved newborn health and survival. This study describes the importance of providers being aware of socio-cultural constructs within which pregnant women operate and suggests a focus on the shared goal of timely and effective newborn care in Ghana.
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http://dx.doi.org/10.1017/S0021932021000158DOI Listing
April 2021

Stigma Associated With Sickle Cell Disease in Kumasi, Ghana.

J Transcult Nurs 2021 11 15;32(6):757-764. Epub 2021 Apr 15.

University of Michigan, Ann Arbor, MI, USA.

Introduction: People with sickle cell disease (SCD) often face stigmatization in Ghana and elsewhere in Africa. Research is needed to understand whether it is necessary to design an SCD stigma reduction program in the Ghanaian setting. The aim of this study was to explore the perception of stigmatization for adults with SCD in Kumasi, Ghana.

Methodology: Using in-depth qualitative interviews, researchers conducted a phenomenological study to investigate the perception of stigmatization for people with SCD in Kumasi, Ghana. Snowball and purposive sampling was used to identify the participants.

Results: Participants ( = 12) were mostly female, Akan, and Christian. Researchers categorized three main themes: (a) Feelings of social isolation, (b) Fear of disclosure, and (c) Bullying about physical appearance.

Discussion: The findings highlight the need to develop effective strategies to counteract stigma. Transcultural health care providers can implement stigma reduction interventions that might be applicable throughout Africa where findings are likely to resonate with patients with SCD.
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http://dx.doi.org/10.1177/10436596211008216DOI Listing
November 2021

The Association Between Maternity Waiting Home Use and Maternal-Newborn Knowledge: Latent Class Analysis.

J Nurs Meas 2021 Aug 1;29(2):334-346. Epub 2021 Apr 1.

University of Michigan, Ann Arbor, MI.

Background And Purpose: An exploratory latent class analysis (LCA) was performed assessing the association between maternity waiting home (MWH) use and maternal-newborn care knowledge.

Methods: A two-group comparison design using a face-to-face interview ( = 250) was conducted to understand if MWH use was associated with greater maternal knowledge of newborn care.

Results: High levels of maternal knowledge of newborn care were associated with MWH use. Mothers with low levels of knowledge were less likely to use an MWH prior to delivery and more likely to have fewer pregnancies, attend less than four antenatal care (ANC) visits, and receive no education about newborn health problems during ANC.

Conclusions: Nurses need to target younger, primigravida mothers attending fewer ANC visits with educational opportunities while advocating for expansion of health education at MWHs to potentiate long-term benefits for improved maternal-newborn health and delivery outcomes.
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http://dx.doi.org/10.1891/JNM-D-19-00093DOI Listing
August 2021

Self-reported medicinal plant use by Ghanaian women during pregnancy is associated with poor neonatal health.

J Public Health (Oxf) 2022 06;44(2):319-328

Department of Learning Health Sciences, Medical School, The University of Michigan, Ann Arbor 48109, MI, USA.

Background: More than a third of pregnant women in Africa use medicinal plants (hereafter, 'herbs') during pregnancy, yet little is known about herb use among urban African women, or about the potential impact on newborns.

Methods: This cross-sectional study of 504 women giving birth at an urban government hospital in Kumasi, Ghana (May-July 2018) collected data via chart reviews and maternal interviews. Data were analyzed using conditional logistic regression.

Results: Of 380 singleton births with complete data, 102 mothers (26.84%) reported using herbs during pregnancy and/or delivery. Herb users and non-users did not differ significantly across a range of sociodemographic variables. Controlling for age, education, neonatal birthweight and household running water (socioeconomic status (SES) indicator), herb-using women were twice as likely to have their newborn admitted to the hospital (odds ratio (OR) = 2.05; confidence interval (CI) 95% 1.17, 3.60) and four times as likely to bear a child with a low Apgar score (OR = 4.09; CI 95% 1.66, 10.07) compared with non-users.

Conclusion: Urban-dwelling Ghanaian women from diverse backgrounds use herbs during pregnancy. Maternal herb use was associated with poor neonatal outcomes, regardless of the baby's birthweight and mother's age, education or SES, suggesting the importance of educating all women about the possible negative impacts of herb use during pregnancy and delivery.
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http://dx.doi.org/10.1093/pubmed/fdab033DOI Listing
June 2022

The impact of COVID-19 on prenatal care in the United States: Qualitative analysis from a survey of 2519 pregnant women.

Midwifery 2021 Jul 16;98:102991. Epub 2021 Mar 16.

Global REACH, 1111 E. Catherine Street, University of Michigan, Ann Arbor, MI, USA 48109; Department of Obstetrics & Gynecology, 1500 E. Medical Center Drive, University of Michigan, Ann Arbor, MI, USA 48109; Department of Learning Health Sciences, 1111 E. Catherine Street, University of Michigan, Ann Arbor, MI, USA 48109. Electronic address:

Objective: To explore if and how women perceived their prenatal care to have changed as a result of COVID-19 and the impact of those changes on pregnant women.

Design: Qualitative analysis of open-ended prompts included as part of an anonymous, online, cross-sectional survey of pregnant women in the United States.

Setting: Online survey with participants from 47 states within the U.S.

Participants: Self-identified pregnant women recruited through Facebook, Twitter, and other online sources.

Measurements And Findings: An anonymous, online survey of pregnant women (distributed April 3 - 24, 2020) included an open-ended prompt asking women to tell us how COVID-19 had affected their prenatal care. Open-ended narrative responses were downloaded into Excel and coded using the Attride-Sterling Framework. 2519 pregnant women from 47 states responded to the survey, 88.4% of whom had at least one previous birth. Mean age was 32.7 years, mean weeks pregnant was 24.3 weeks, and mean number of prenatal visits at the point of the survey was 6.5. Predominant themes of the open narratives included COVID-19's role in creating structural changes within the healthcare system (reported spontaneously by 2075 respondents), behavioral changes among both pregnant women and their providers (reported by 429 respondents), and emotional consequences for women who were pregnant (reported by 503 respondents) during the pandemic. Changes resulting from COVID-19 varied widely by provider, and women's perceptions of the impact on quality of care ranged from perceiving care as extremely compromised to perceiving it to be improved as a result of the pandemic.

Key Conclusions And Implications For Practice: Women who are pregnant during the COVID-19 pandemic have faced enormous upheaval as hospitals and healthcare providers have struggled to meet the simultaneous and often competing demands of infection prevention, pandemic preparedness, high patient volumes of extremely sick patients, and the needs of 'non-urgent' pregnant patients. In some settings, women described very few changes, whereas others reported radical changes implemented seemingly overnight. While infection rates may drive variable responses, these inconsistencies raise important questions regarding the need for local, state, national, or even global recommendations for the care of pregnant women during a global pandemic such as COVID-19.
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http://dx.doi.org/10.1016/j.midw.2021.102991DOI Listing
July 2021

"Even when people live just across the road…they won't go": Community health worker perspectives on incentivized delays to under-five care-seeking in urban slums of Kampala, Uganda.

PLoS One 2021 26;16(3):e0244891. Epub 2021 Mar 26.

Departments of Learning Health Sciences and OB/GYN, University of Michigan, Ann Arbor, Michigan, United States of America.

Background: Although under-five (U5) mortality in Uganda has dropped over the past two decades, rates in urban slum neighborhoods remain high. As part of a broader verbal and social autopsy study of U5 deaths, this study explored the perspectives of volunteer community health workers, called Village Health Teams (VHTs), on why children under five in Kampala's informal settlements are still dying despite living in close proximity to nearby health facilities.

Methods: This exploratory, qualitative study took place between January and March 2020 in the Rubaga division of Kampala, Uganda. VHTs from the slums of Kawaala and Nankulabye parishes, both located near a large government health center, were interviewed by a trained local interviewer to determine their perceptions of barriers to care-seeking and attribution for U5 childhood deaths. All interviews were audiotaped, transcribed into English, imported into NVivo V 12.0 and thematically analyzed using the Attride-Stirling framework.

Results: 20 VHTs were interviewed, yielding two global themes, the first focusing on VHTs perceptions of their role in the community to promote positive health outcomes, and the second focusing on VHTs' perceptions of how prompt care-seeking is disincentivized. Within the latter theme, three inter-related sub-themes emerged: disincentives for care-seeking at the health system level, which can drive negative beliefs held by families about the health system, and in turn, drive incentives for alternative health behaviors, which manifest as "incentivized delays" to care-seeking.

Discussion: This study illustrates VHT perspectives on the complex interactions between health system disincentives and the attitudes and behaviors of families with a sick child, as well as the reinforcing nature of these factors. Findings suggest a need for multi-pronged approaches that sensitize community members, engage community and health system leadership, and hold providers accountable for providing high-quality care. VHTs have enormous potential to foster improvement if given adequate resources, training, and support.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244891PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997045PMC
August 2021

Utilisation of sexual and reproductive health services among street children and young adults in Kampala, Uganda: does migration matter?

BMC Health Serv Res 2021 Feb 23;21(1):169. Epub 2021 Feb 23.

Department of Health Promotion and Education, Faculty of Health Medicine and Life Sciences, Maastricht University Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands.

Background: While the nexus of migration and health outcomes is well acknowledged, the effect of rural-urban migration on the use of sexual and reproductive health (SRH) services has received less attention. We assessed the effect of rural-urban migration on the use of SRH services, while controlling for confounding, and whether there is a difference in the use of SRH services among migrant and non-migrant street children and young adults.

Methods: Data were collected from 513 street children and young adults aged 12-24 years, using venue-based time-space sampling (VBTS). We performed multivariate logistic regression analysis using Stata 16.0 to identify factors associated with SRH services use, with rural-urban migration status as the main predictor. Participants were further classified as new migrants (≤ 2 years of stay in city), established migrants (> 2 years of stay in city) or non-migrants (lifelong native street children) with no rural-urban migration history.

Results: Overall, 18.13% of the street children and young adults had used contraception/family planning, 58.67% had tested for human immunodeficiency virus (HIV) and knew their status and 34.70% had been screened for sexually transmitted infections (STIs). Non-migrants were 2.70 times more likely to use SRH services (HIV testing, STI screening and family planning) compared to the migrants (aOR = 2.70, 95% CI 1.23-5.97). Other factors associated with SRH services use among street children and young adults include age (aOR = 4.70, 95% CI 2.87-7.68), schooling status (aOR = 0.33, 95% CI 0.15-0.76), knowledge of place of care (aOR = 2.71, 95% CI 1.64-4.46) and access to SRH information (aOR = 3.23, 95% CI 2.00-5.24).

Conclusions: SRH services utilisation among migrant street children and young adults is low compared to their non-migrant counterparts and is independently associated with migration status, age, schooling status, knowledge of place of care and access to SRH information. Our findings call for the need to design and implement multi-dimensional interventions to increase the use of SRH services among street children and young adults, while taking into consideration their migration patterns.
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http://dx.doi.org/10.1186/s12913-021-06173-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903651PMC
February 2021

Demographic and behavioural drivers of intra-urban mobility of migrant street children and youth in Kampala, Uganda.

PLoS One 2021 18;16(2):e0247156. Epub 2021 Feb 18.

Department of Health Education & Promotion, University of Maastricht Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands.

While research on the nexus of migration and wellbeing of individuals has gained recognition in recent years, far less attention has been devoted to intra-urban mobility especially among the urban poor young populations. We assess the drivers of intra-urban mobility using a random sample of 412 migrant street children and youth in Kampala city, Uganda. This paper draws from a larger cross-sectional survey of circular migration and sexual and reproductive health choices among street children in Kampala, Uganda. We define 'migrants' as street children and youth with a rural-urban migration experience and 'intra-urban mobility' as the number of places stayed in or moved since migrating to the city, measured on a continuous scale. More than half (54.37%) of the migrant street children and youth had lived in two or more places since migrating to the city. Multivariate negative binomial regression analysis reveals migrant street children and youth's intra-urban mobility to be associated with gender (aIRR = 0.71, 95%CI 0.53-0.96), sex work (aIRR = 1.38, 95%CI 1.01-1.88), a daily income of one USD or more (aIRR = 1.57, 95%CI 1.16-2.13) and duration of stay in the city (aIRR = 1.54, 95%CI 1.17-2.01). Other drivers of intra-urban mobility included availability of causal work, personal safety and affordability of rental costs. Our findings suggest the need for urban housing and health policies to take into account street children and youth's intra-urban mobility and its drivers. Future research on all drivers of street children and youth's intra-urban mobility and its linkage with their health outcomes is recommended.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247156PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891785PMC
August 2021

Neonatal mortality in rural northern Ghana and the three delays model: are we focusing on the right delays?

Trop Med Int Health 2021 05 4;26(5):582-590. Epub 2021 Mar 4.

Department of Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA.

Objective: The Three Delays Model outlines, three common delays that lead to poor newborn outcomes: (i) recognising symptoms and deciding to seek care; (ii) getting to care and; (iii) receiving timely, high-quality care. We gathered data for all newborn deaths within four districts in Ghana to explore how well the Three Delays Model explains outcomes.

Methods: In this cross-sectional, observational study, trained field workers conducted verbal and social autopsies with the closest surviving relative (typically mothers) of all neonatal deaths across four districts in northern Ghana from September 2015 until April 2017. Data were collected using Survey CTO and analysed using StataSE 15.0. Frequencies and descriptive statistics were calculated for key variables.

Results: 247 newborn deaths were identified. Nearly 77% (190) of newborns who died were born at a health facility, and 48.9% (93) of those who died before discharge. Of the 149 newborns who were discharged or born at home, 71.8% (107) sought care at a facility for illness, and 72.9% (N = 78) of those did so within the same day of illness recognition. Of the 83 respondents who arranged for transportation, 82% (68) did so within 1 h. Newborns received prompt care but insufficient interventions - 25% or fewer received IV fluids, oral medications, antibiotics or oxygen.

Conclusions: These data suggest that women are following recommendations for safe delivery and prompt care-seeking. In rural northern Ghana, behaviour change interventions focused on mothers and families may not be as pressing as interventions focused on the Third Delay - obtaining timely, high-quality care.
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http://dx.doi.org/10.1111/tmi.13558DOI Listing
May 2021

Feasibility of establishing a network of community health workers to support care of people with sickle cell disease in Kumasi, Ghana.

J Community Genet 2021 Jan 5;12(1):155-161. Epub 2021 Jan 5.

Departments of Learning Health Sciences and Obstetrics & Gynecology, Global REACH, University of Michigan Medical School, Victor Vaughan Building, 2nd Floor, 1111 East Catherine Street, Ann Arbor, MI, 48109, USA.

Globally, sickle cell disease (SCD) is a common, yet often neglected, non-communicable disease. Community health worker (CHW) interventions have been shown to improve outcomes for chronic diseases but have not been evaluated with SCD. This study assessed the interest in and feasibility of establishing a network of CHWs to support care of people with SCD in Kumasi, Ghana. Using in-depth interviews with key stakeholders (N = 15) identified through purposive and snowball sampling from January to March 2020, we gathered focused information about interest in and feasibility of establishing a network of CHWs. Respondents were chosen for their knowledge and oversight of health services for people with SCD. Latent content analysis was used to examine the data. Participants expressed interest in establishing a network of CHWs to better support care for people with SCD. Three primary themes emerged from the data: (1) support by CHWs could be beneficial for people with SCD; (2) using existing CHW networks for SCD services would be best; and (3) funding of expanded CHW network might be a problem. We advocate for the mobilization of resources to expand the current network of CHWs to include a focus on SCD in Kumasi, Ghana. Participants believe that it is feasible to use CHWs to improve care outcomes of people with SCD. There is potential for findings from this exploratory project to be adapted and implemented in other settings throughout sub-Saharan Africa, as well as areas of higher income countries where there are higher proportions of people living with sickle cell.
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http://dx.doi.org/10.1007/s12687-020-00501-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846619PMC
January 2021

Self-reported challenges to border screening of travelers for Ebola by district health workers in northern Ghana: An observational study.

PLoS One 2021 5;16(1):e0245039. Epub 2021 Jan 5.

Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana.

Background: The 2013-2016 Ebola Virus Disease (EVD) outbreak remains the largest on record, resulting in the highest mortality and widest geographic spread experienced in Africa. Ghana, like many other African nations, began screening travelers at all entry points into the country to enhance disease surveillance and response. This study aimed to assess the challenges of screening travelers for EVD at border entry in northern Ghana.

Design And Methods: This was an observational study using epidemiological weekly reports (Oct 2014-Mar 2015) of travelers entering Ghana in the Upper East Region (UER) and qualitative interviews with 12 key informants (7 port health officers and 5 district directors of health) in the UER. We recorded the number of travelers screened, their country of origin, and the number of suspected EVD cases from paper-based weekly epidemiological reports at the border entry. We collected qualitative data using an interview guide with a particular focus on the core and support functions (e.g. detection, reporting, feedback, etc.) of the World Health Organization's Integrated Disease Surveillance and Response system. Quantitative data was analyzed based on travelers screened and disaggregated by the three most affected countries. We used inductive approach to analyze the qualitative data and produced themes on knowledge and challenges of EVD screening.

Results: A total of 41,633 travelers were screened, and only 1 was detained as a suspected case of EVD. This potential case was eventually ruled out via blood test. All but 52 of the screened travelers were from Ghana and its contiguous neighbors, Burkina Faso and Togo. The remaining 52 were from the four countries most affected by EVD (Guinea, Liberia, Sierra Leone, and Mali). Challenges to effective border screening included: inadequate personal protective equipment and supplies, insufficient space or isolation rooms and delays at the border crossings, and too few trained staff. Respondents also cited lack of capacity to confirm cases locally, lack of cooperation by some travelers, language barriers, and multiple entry points along porous borders. Nonetheless, no potential Ebola case identified through border screening was confirmed in Ghana.

Conclusion: Screening for Ebola remains sub-optimal at the entry points in northern Ghana due to several systemic and structural factors. Given the likelihood of future infectious disease outbreaks, additional attention and support are required if Ghana is to minimize the risk of travel-related spread of illness.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245039PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785234PMC
May 2021

Providing respectful maternity care in northern Ghana: A mixed-methods study with maternity care providers.

Midwifery 2021 Mar 11;94:102904. Epub 2020 Dec 11.

University of California San Francisco, 550 16(th) St, 3(rd) Floor, 3573, San Francisco, CA 94158, USA. Electronic address:

Objective: This study explored providers' perspectives and behavior regarding respectful maternity care, including knowledge, attitudes, and practices.

Design: Mixed-methods cross-sectional study combining quantitative survey data, qualitative interviews, and observations of labor and delivery across four health facilities SETTING: Government health facilities in rural northern Ghana PARTICIPANTS: 43 front-line maternity care providers completed a survey of practice patterns before a quality of care training. We then used purposive and convenience sampling to recruit a sub-sample for in-depth interviews (N=17), and convenience sampling and self-selection to observe approximately half (N=8) providing clinical care.

Measurements And Findings: We calculated descriptive statistics from quantitative data and used the framework approach for qualitative analysis. Observational data were examined using the CHANGE Project's Assessment Tools for Caring Providers. We utilized split frame methodology to make comparisons across data sources. Quantitative survey results (N=43) indicate most providers report explaining procedures to women (89.5%), involving women and families in care decisions (84.1%), and covering or screening women for privacy (81.5%). At the same time, 38.9% reported they have shouted at, scolded, insulted, threatened, or talked rudely to a woman, and 26.4% said they have treated a woman differently because of her personal attributes. Qualitative interview data (N=17) suggested that providers can articulate a vision of respectful care, aspire to offer respectful care, and recognize they do not always meet those aspirations. Among those (N=8) volunteering to be observed, introductions and explanations for procedures were rare, privacy screening was infrequent, and participants were observed slapping, scolding, and restraining women in labor, often associated with patient non-compliance to provider instructions.

Key Conclusions: Even among providers knowledgeable about respectful maternity care and who agreed to be observed providing delivery care, disrespect and abuse were present.

Implications For Practice: Further research and programmatic efforts are needed to address the gap between knowledge and behavior.
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http://dx.doi.org/10.1016/j.midw.2020.102904DOI Listing
March 2021

Preparedness to deal with maternal mortality among obstetric providers at an urban tertiary hospital in Ghana.

Int J Gynaecol Obstet 2021 Aug 13;154(2):358-365. Epub 2021 Jan 13.

Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Objective: This study explores the impacts of managing frequent maternal mortalities on obstetric healthcare providers in Ghana.

Methods: Two hundred and seventy obstetric providers at the Komfo Anokye Teaching Hospital in Ghana completed an electronic survey. Questions included coping strategies, sources and adequacy of support, training, and emotional impact. Logistic regression assessed predictors of perceived preparedness to manage maternal mortalities.

Results: Over half of participants (55.1%) did not report adequate support to deal with maternal death and only 35.9% received training. The vast majority (96.4%) agreed that managing maternal deaths takes a large emotional toll-27.6% considered giving up their obstetric practice, half experienced guilt or shame, and half worried about legal or disciplinary action. After adjusting for age, gender, years in practice, and annual maternal mortalities managed, perceived adequacy of support (odds ratio [OR] 6.6, 95% confidence interval [CI] 3.0-14.7, P < 0.001) and receiving training (OR 9.5, 95% CI 3.5-25.8, P < 0.001) were significantly associated with preparedness to deal with maternal mortality.

Conclusion: Managing maternal mortalities has significant emotional impact on obstetric healthcare providers. Preparedness to deal with maternal death is significantly improved when providers receive adequate support and training.
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http://dx.doi.org/10.1002/ijgo.13537DOI Listing
August 2021

COVID-19 is increasing Ghanaian pregnant women's anxiety and reducing healthcare seeking.

Int J Gynaecol Obstet 2021 03 10;152(3):444-445. Epub 2020 Dec 10.

Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana.

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http://dx.doi.org/10.1002/ijgo.13487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9087653PMC
March 2021

Optimizing task-sharing in abortion care in Ghana: Stakeholder perspectives.

Int J Gynaecol Obstet 2020 Jul;150 Suppl 1:17-24

The Ghana Health Service, Accra, Ghana.

Ghana has made progress in expanding providers in abortion care but access to the service is still a challenge. We explored stakeholder perspectives on task-sharing in abortion care and the opportunities that exist to optimize this strategy in Ghana. We purposively sampled 12 representatives of agencies that played a key role in expanding abortion care to include midwives for key informant interviews. All interviews were audio recorded, transcribed verbatim, and then coded for thematic analysis. Stakeholders indicated that Ghana was motivated to practice task-sharing in abortion care because unsafe abortion was contributing significantly to maternal mortality. They noted that the Ghana Health Service utilized the high maternal mortality in the country at the time, advancements in medicine, and the lack of clarity in the definition of the term "health practitioner" to work with partner nongovernmental organizations to successfully task-share abortion care to include midwives. Access, however, is still poor and provider stigma continues to contribute significantly to conscientious objection. This calls for further task-sharing in abortion care to include medical or physician assistants, community health officers, and pharmacists to ensure that more women have access to abortion care.
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http://dx.doi.org/10.1002/ijgo.13000DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540373PMC
July 2020

Women's Empowerment and Child Vaccination in Kenya: The Modifying Role of Wealth.

Am J Prev Med 2021 01 12;60(1 Suppl 1):S87-S97. Epub 2020 Nov 12.

Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.

Introduction: Although vaccination coverage is high in Kenya relative to other African nations, undervaccinated children remain, making it important to identify characteristics of these children and their caregivers. Potentially relevant but understudied factors are women's empowerment and early marriage. Women who marry older and have more autonomous decision-making authority may be better able to ensure their children receive health services, including immunizations. This analysis examines the relationship between early marriage and multiple dimensions of women's empowerment and child vaccination status in Kenya and explores whether these relationships are modified by wealth.

Methods: Data were from the 2014 Kenya Demographic and Health Survey. The analysis was completed in 2020 using updated data made available to researchers in 2019. Logistic regressions assessed relationships among early marriage, 3 dimensions of women's empowerment (enabling conditions, intrinsic agency, and instrumental agency), and child vaccination. Analyses were stratified by wealth to explore potential effect modification.

Results: For women in the middle wealth tertile, the odds of having a fully vaccinated child were 3.45 (95% CI=1.51, 7.91) times higher for those with higher versus lower empowerment. Further, among the wealthiest women, those with middle empowerment were 5.99 (95% CI=2.06, 17.40) times more likely to have a fully vaccinated child than women with lower empowerment.

Conclusions: Results suggest a threshold effect of wealth's role in the relationship between empowerment and vaccination. Enabling conditions may not influence immunization among the poorest women but exert a stronger positive influence on childhood vaccination among wealthier women.

Supplement Information: This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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http://dx.doi.org/10.1016/j.amepre.2020.08.015DOI Listing
January 2021

Preeclampsia knowledge among postpartum women treated for preeclampsia and eclampsia at Korle Bu Teaching Hospital in Accra, Ghana.

BMC Pregnancy Childbirth 2020 Oct 15;20(1):625. Epub 2020 Oct 15.

Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA.

Background: Preeclampsia/eclampsia is a major cause of maternal morbidity and mortality worldwide, yet patients' perspectives about their diagnosis are not well understood. Our study examines patient knowledge among women with preeclampsia/eclampsia in a large urban hospital in Ghana.

Methods: Postpartum women diagnosed with preeclampsia or eclampsia were asked to complete a survey 2-5 days after delivery that assessed demographic information, key obstetric factors, and questions regarding provider counseling. Provider counseling on diagnosis, causes, complications, and future health effects of preeclampsia/eclampsia was quantified on a 4-point scale ('Counseling Composite Score'). Participants also completed an objective knowledge assessment regarding preeclampsia/eclampsia, scored from 0 to 22 points ('Preeclampsia/Eclampsia Knowledge Score' (PEKS)). Linear regression was used to identify predictors of knowledge score.

Results: A total of 150 participants were recruited, 88.7% (133) with preeclampsia and 11.3% (17) with eclampsia. Participants had a median age of 32 years, median parity of 2, and mean number of 5.4 antenatal visits. Approximately half of participants reported primary education as their highest level of education. While 74% of women reported having a complication during pregnancy, only 32% of participants with preeclampsia were able to correctly identify their diagnosis, and no participants diagnosed with eclampsia could correctly identify their diagnosis. Thirty-one percent of participants reported receiving no counseling from providers, and only 11% received counseling in all four categories. Even when counseled, 40-50% of participants reported incomplete understanding. Out of 22 possible points on a cumulative knowledge assessment scale, participants had a mean score of 12.9 ± 0.38. Adjusting for age, parity, and the number of antenatal visits, higher scores on the knowledge assessment are associated with more provider counseling (β 1.4, SE 0.3, p < 0.001) and higher level of education (β 1.3, SE 0.48, p = 0.008).

Conclusions: Counseling by healthcare providers is associated with higher performance on a knowledge assessment about preeclampsia/eclampsia. Patient knowledge about preeclampsia/eclampsia is important for efforts to encourage informed healthcare decisions, promote early antenatal care, and improve self-recognition of warning signs-ultimately improving morbidity and reducing mortality.
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http://dx.doi.org/10.1186/s12884-020-03316-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566025PMC
October 2020

Pregnancy-related anxiety during COVID-19: a nationwide survey of 2740 pregnant women.

Arch Womens Ment Health 2020 12 29;23(6):757-765. Epub 2020 Sep 29.

Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.

The aim of this study is to explore the impact of the COVID-19 pandemic on pregnant women's anxiety and identify factors most strongly associated with greater changes in anxiety. An anonymous, online, survey of pregnant women (distributed April 3-24, 2020) included a modified pregnancy-related anxiety scale (PRAS) reflecting respondents' perception of pregnancy anxiety before COVID-19 and a current assessment of pregnancy-related anxiety. The difference between these scores was used as the outcome variable. Data were analyzed using bivariate and multivariate linear regression analyses. Two thousand seven hundred forty pregnant women from 47 states completed the survey. 25.8% (N = 706) stopped in-person visits, 15.2% used video visits (N = 415), and 31.8% (N = 817) used phone visits for prenatal care as a result of COVID-19. Those planning a hospital birth dropped from 2641 (96.4%) to 2400 (87.7%) following COVID-19. More than half of women reported increased stress about food running out (59.2%, N = 1622), losing a job or household income (63.7%, N = 1745), or loss of childcare (56.3%, N = 1543). More than a third reported increasing stress about conflict between household members (37.5%, N = 1028), and 93% (N = 2556) reported increased stress about getting infected with COVID-19. Slightly less than half of respondents (either selves or family members) were healthcare workers (41.4%, N = 1133) or worked in essential services (45.5%, N = 1246). In multivariate analysis, those reporting higher agreement with COVID-19-related stressors had greater changes in pre- to post-COVID-19 pregnancy-related anxiety. The COVID-19 pandemic is profoundly affecting pregnant women's mental health, and factors independent of pregnancy appear to be driving changes in pregnancy-specific anxiety.
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http://dx.doi.org/10.1007/s00737-020-01073-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522009PMC
December 2020

Caregiver Perception of Sickle Cell Disease Stigma in Ghana: An Ecological Approach.

J Pediatr Health Care 2021 Jan - Feb;35(1):84-90. Epub 2020 Sep 1.

Introduction: Sickle cell disease (SCD) stigma is a major community health issue. The challenges of caring for someone with SCD can be overwhelming. We explored stigma and related factors for caregivers of pediatric patients with SCD in Kumasi, Ghana.

Method: Guided by the Ecological Systems Theory, we used in-depth interviews with a semistructured guide to learn about the perception of stigmatization for Ghanaian caregivers of patients with SCD.

Results: Overall, participants were knowledgeable about SCD. We identified three themes, including (1) blame for SCD, (2) public misconception about SCD, and (3) shame for the financial burden of SCD.

Discussion: Findings demonstrate the need to design an SCD stigma reduction program for caregivers, families, and the community. Providers need to consider SCD stigma and interaction with multiple ecological levels, including the family, community, health care system, culture, and health policy in Ghana. Findings can be used as a catalyst to explore the reduction of stigmatization in other sub-Saharan countries.
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http://dx.doi.org/10.1016/j.pedhc.2020.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738399PMC
October 2021

Exploring self-blame and the perceived causes of preeclampsia in urban Ghana.

Int J Gynaecol Obstet 2021 02 11;152(2):280-281. Epub 2020 Sep 11.

Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA.

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http://dx.doi.org/10.1002/ijgo.13358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7855006PMC
February 2021

Maternal knowledge of essential newborn care in rural Zambia.

Health Care Women Int 2021 13;42(4-6):778-793. Epub 2020 Jul 13.

Department of Health Behavior and Biological Sciences, PAHO/WHO Collaborating Center, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.

Maternity waiting homes (MWHs) may offer an intervention to improve newborn outcomes in rural Zambia. This study compared maternal knowledge of newborn care for women referred from facilities with and without MWHs. Topics assessed included: (1) umbilical cord care; (2) thermal and skin care; (3) nutrition, and; (4) prevention of diarrhea, and; (5) newborn danger signs prompting care-seeking. A two-group comparison design with a convenience sample was employed using a face-to-face interviews at one district hospital. Descriptive, inferential, and multivariate analyses were employed to compare knowledge. Overall, mothers demonstrated newborn care knowledge in accordance with World Health Organization (WHO) guidelines for newborn health and there were no significant differences in maternal knowledge of newborn care practices among MWH and non-MWH users. Younger mothers more often did not know about umbilical cord care, newborn skin care, and newborn danger signs. MWH users went more often for antenatal care than non-MWH users. In both groups, we found as the number of ANC visits increases, odds of answering "Don't know" decreases. This study is the first to assess maternal newborn care knowledge and MWH use in rural Zambia. Both MWH users and non-users in the rural district were knowledgeable about essential newborn care.
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http://dx.doi.org/10.1080/07399332.2020.1781125DOI Listing
November 2021

' is really killing us here': attribution for pregnancy losses and newborn mortality in the Ashanti Region of Ghana.

J Biosoc Sci 2021 07 24;53(4):497-507. Epub 2020 Jun 24.

University of Michigan, Ann Arbor, MI, USA.

While overall neonatal mortality rates are improving in Ghana, the Ashanti Region has the highest mortality rate in the country. The clinical causes of newborn deaths are well known, yet local beliefs about illness aetiology, cause of death and care-seeking are less well understood. This exploratory qualitative study sought to understand how community members perceive and respond to neonatal illness. Researchers worked with public health nurses, community health nurses and opinion leaders in the Ashanti Region of Ghana to identify women who had lost a baby, either during pregnancy or after delivery. In-depth interviews and focus group discussions were conducted about knowledge, attitudes and beliefs regarding neonatal mortality. The transcripts were coded and analysed using NVivo 10.0. A total of 100 participants were interviewed: 24% reported a previous stillbirth; 37% reported a previous miscarriage; and 45% reported losing a baby who was born alive. Nine per cent experienced more than one type of loss. The local illness of asram - an illness with supernatural causes - was cited as a leading cause of death of newborns. Every participant reported hearing of, knowing someone, or having a child who had become ill with asram. While women gave varying information on symptoms, method of contraction and treatment, all participants agreed that asram was common and often fatal. Four overarching themes emerged: 1) asram is not a hospital sickness; 2) there is both a fear of traditional healers as a source of asram, as well as a reliance upon them to cure asram; 3) there are rural/urban differences in perceptions of asram; and 4) asram may serve as a mechanism of social control for pregnant women and new mothers. Local beliefs and practices must be better understood and incorporated into health education campaigns if neonatal mortality is to be reduced in Ghana.
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http://dx.doi.org/10.1017/S0021932020000322DOI Listing
July 2021
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