Modeling Clinical And Non-Clinical Determinants of Intrapartum Stillbirths In Singletons In Six Public Hospitals In The Greater Accra Region of Ghana: A Retrospective Case-Control Study

Background: The Greater Accra Region (GAR) of Ghana records 2000 stillbirths annually and 40 % of them occur intrapartum. An understanding of the contributing factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. This study identified determinants of intrapartum stillbirths in GAR.Method: A retrospective 1:2 unmatched case-control study was conducted in six public hospitals in the Greater Accra Region of Ghana. A multivariable ordinary logistic regression model with robust standard error was used to quantify the effect of exposures on intrapartum stillbirth. The area under the receiver operating characteristics curve and the Brier scores were used to assess the predictive performance of the regression models. Results: The following maternal factors increased the odds of intrapartum stillbirths: pregnancy-induced hypertension (PIH) [adjusted Odds Ratio; aOR=3.72, 95% CI:1.71-8.10, p<0.001]; antepartum haemorrhage (APH) [aOR=3.28, 95% CI: 1.33-8.10, p<0.05] and premature rupture of membranes (PROM) [aOR=3.36, 95% CI: 1.20-9.40, p<0.05]. Conclusions: Improved management of PIH, APH, PROM, and preterm delivery will reduce intrapartum stillbirth. Hospitals should improve on the quality of monitoring women during labor. Auditing of intrapartum stillbirths should be mandatory for all hospitals and Ghana Health Service (GHS) should include fetal autopsy in stillbirth auditing to identify other causes of fetal deaths. Interventions to reduce intrapartum stillbirth must combine maternal, fetal, and service delivery factors to make them effective.

Physician Experiences and Perceived Barriers to Providing Quality Infertility Care in the Greater Accra Region of Ghana

High-quality, patient-centered care is essential to achieving equity and dignity for individuals with infertility, yet few studies have explored quality of infertility care in sub-Saharan Africa. We interviewed 13 non-specialist physicians and 2 medical school faculty to explore experiences in and perceptions of providing infertility care in Greater Accra, Ghana. We used a patient-centered infertility care model to inform our analysis and results. Individualized care and taking time to counsel and emotionally support patients were perceived as the most important things a physician can do to provide quality infertility care. Financial costs and lack of infertility services within a single facility were the most common barriers reported to providing quality infertility care. To the best of our knowledge, our study is the first to explore quality of infertility care provided by physicians in public sector facilities in Ghana, shedding light on existing barriers and identifying strategies for improvement.

INFLUENCE OF PRE-MARITAL COUNSELLING ON SUSTAINABILITY OF MARRIAGES IN GREATER ACCRA REGION, GHANA

The study focused on elements discussed during pre-marital counselling and how those elements mediate on the sustainability of marriages in Greater Accra Region. Concurrent triangulation mixed method design was chosen for the study. For the quantitative phase 100 marriage people were randomly selected from 10 churches. At the qualitative phase 4 head pastors were conveniently selected from the 10 churches. Mean and standard deviation was used to analysed the questionnaire for the quantitative phase while the semi-structured interview scheduled was thematically analysed to explain issues as they emerged in the study. The study showed conflict resolution, communication, adjusting to individual difference, sex and romance, family lifecycles in marriage and separation from past-memories and families were some elements discussed during pre-marital counselling to help sustain the marriages. Again, respondents were of the view that pre-marital counselling is vital for the sustainability of marriages and should be made compulsory for new couples. Lastly, it was revealed the philosophy of pre-marital counselling is not only being aware of potential land mines in their relationship, but to equip married people to learn the skills necessary to successfully deal with challenges throughout their marriage which help in the sustainability. Therefore, it was recommended that the churches should employ professional counsellors who understand the principle of marriage counselling to perform the act of counselling and follow-up service should be done to check if the elements discussed during pre-marital counselling are being put into practice.

Review on Connecting the Complex Dots of Environmental Problems in Greater Accra Metropolitan Area (GAMA) of Ghana

For years, Accra has been facing huge environmental challenges. Efficient policy frameworks coupled with prudent urban management are deemed as reasonable balance to environmental benefits. Research reveals urban areas in Ghana are confronted with the rapid loss of natural resources as urbanization increases. This synthesis report examines the ramifications of major issues faced by the Greater Accra region based on existing literature by (i) highlighting contemporary environmental problems in Accra (ii) probing into human-induced and natural factors that alterate environmental harmony in the study area (iii) discussing measures on safeguarding the environment through a sustainable approach in Accra, and (iv) presenting policy implications of environmental problems in Accra. Findings indicated urbanization, poverty and inappropriate urban planning systems influence environmental degradation in the study domain. Anthropogenic activities such as pollution and natural hazards like: flooding, drought and windstorms events have altered the physical properties of Accra. This paper reveals the assumption and execution of values to safeguard environmental resources in the Greater Accra Metropolitan Area.