Linking Female Adolescents' Knowledge, Attitudes and Use of Contraceptives to Adolescent Pregnancy in Ghana: A Baseline Data for Developing Sexuality Education Programmes

Toward contraception education in basic schools: Teachers' knowledge, perceptions, and attitudes regarding contraceptive use by basic school pupils in a Ghanaian Municipality

Objectives

We examined teachers' knowledge, perceptions, and attitudes regarding contraception by basic school pupils in a Ghanaian Municipality.

Methods

This was an explorative, analytical cross-sectional study using the mixed-method approach. Participants comprised 183 public and private basic school teachers and 20 school health coordinators in the study area. The statistical tests carried out were in two folds. Quantitative data were analyzed with a statistical package for social sciences version 20 to generate tables. A logistic regression model was used to examine associations between the predictor and the binary response variables. Adjusted odds ratio accounted for other predictor variables in the model. For the qualitative data, recorded interviews were transcribed and content analysis was done to identify themes, subthemes, and results presented as participants' direct quotations/paraphrased statements. Knowledge, perceptions, and attitudes were assessed using 3-Likert scale type questions developed by the author.

Results

Participants' sociodemographic characteristics were associated with perceptions and attitudes toward contraception in basic schools. At 95% confidence intervals, the p-values were not significant for any of the variables tested. However, the adjusted odds ratio (aOR) showed positive perceptions among participants aged 35-39 (aOR = 7.24; p = 0.35), women (aOR = 4.22; p = 0.25), higher educated (aOR = 4.32; p = 0.56), work experience between 16 and 20 years (aOR = 6.65; p = 0.96), four or more children (aOR = 6.35; p = 0.96); divorcee (aOR = 10.12; p = 2.92); intrauterine contraceptive device (IUD) (aOR = 5.02; p = 2.43); or condoms users (aOR = 7.09; p = 0.32). Negative perceptions were noted among affiliates of other religions compared to Christians (aOR = 0.19; p = 0.01) and subject teachers (aOR = 0.39; p = 0.01). Participants' perceptions were directly influenced by attitudes toward contraception and knowledge (p = 0.081). The qualitative findings showed mixed feelings about contraceptive education in basic schools.

Conclusions

Basic school teachers have challenges with contraceptive education which have implications for comprehensive sex education in Ghanaian basic schools. We recommend a similar study among parents of the pupils and a nationwide study to examine this concept further.

Socio-cultural factors influencing adolescent pregnancy in Ghana: a scoping review

Background

Adolescent pregnancy is a public health challenge that has well-defined causes, associated health risks, and social and economic consequences for adolescent, their families, communities, and society. The purpose of this scoping review is to summarize studies published on socio-cultural determinants of adolescent pregnancy in Ghana.

Methods

Search for records was done in four major databases, including PubMed CENTRAL, Science Direct and JSTOR. Records from Google and Google Scholar were also added, and results and findings from published and unpublished studies were included. All the 22 studies that met the eligibility criteria, were critically appraised. The guidelines for conducting scoping reviews by Arksey and O’Malley were followed.

Results

The result revealed that poverty, peer influence, low level of education, dysfunctional family, lack of communication between parents and their daughters, lack of sexual and reproductive health education, child marriage, coerced sex, misconception and non-usage of contraceptives, and decline in cultural values such as puberty rites and virginity inspection are some of the determinants of adolescent pregnancy in Ghana. The study also showed that there is a lack of high-quality observational studies that adjust for confounding variables.

Conclusion

Interventions and policies should be designed to take into consideration the needs, context, and background of adolescents. Programmes to enhance adolescent reproductive health need to consider multilevel factors such as person, family, community, institutions, national, and global issues that affect such programmes.

A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country

Introduction

Obstetric intensive care unit admission (ICU) suggests severe morbidity. However, there is no available data on the subject in Ghana. This retrospective review was conducted to determine the indications for obstetric ICU admission, their outcomes and factors influencing these outcomes to aid continuous quality improvement in obstetric care.

Methods

This was a retrospective review conducted in a tertiary hospital in Ghana. Data on participant characteristics including age and whether participant was intubated were collected from patient records for all obstetric ICU admissions from 1^st January 2010 to 31^st December 2019. Descriptive statistics were presented as frequencies, proportions and charts. Hazard ratios were generated for relations between obstetric ICU admission outcome and participant characteristics. A p-value <0.05 was deemed statistically significant.

Results

There were 443 obstetric ICU admissions over the review period making up 25.7% of all ICU admissions. The commonest indications for obstetric ICU admissions were hypertensive disorders of pregnancy (70.4%, n = 312/443), hemorrhage (14.4%, n = 64/443) and sepsis (9.3%, n = 41/443). The case fatality rates for hypertension, hemorrhage, and sepsis were 17.6%, 37.5%, and 63.4% respectively. The obstetric ICU mortality rate was 26% (115/443) over the review period. Age ≥25 years and a need for mechanical ventilation carried increased mortality risks following ICU admission while surgery in the index pregnancy was associated with a reduced risk of death.

Conclusion

Hypertension, haemorrhage and sepsis are the leading indications for obstetric ICU admissions. Thus, preeclampsia screening and prevention, as well as intensifying antenatal education on the danger signs of pregnancy can minimize obstetric complications. The establishment of an obstetric HDU in CCTH and the strengthening of communication between specialists and the healthcare providers in the lower facilities, are also essential for improved pregnancy outcomes. Further studies are needed to better appreciate the wider issues underlying obstetric ICU admission outcomes.

Plain language summary

This was a review of the reasons for admitting severely-ill pregnant women and women who had delivered within the past 42 days to the intensive care unit (ICU), the admission outcomes and risk factors associated with ICU mortality in a tertiary hospital in a low-resource country. High blood pressure and its complications, bleeding and severe infections were observed as the three most significant reasons for ICU admissions in decreasing order of significance. Pre-existing medical conditions and those arising as a result of, or aggravated by pregnancy; obstructed labour and post-operative monitoring were the other reasons for ICU admission over the study period. Overall, 26% of the admitted patients died at the ICU and maternal age of at least 25 years and the need for intubation were identified as risk factors for ICU deaths. Attention must be paid to high blood pressure during pregnancy.

Socio-demographic determinants of pregnancy termination among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa

BACKGROUND

Most of the unintended pregnancies that occur among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) end up in pregnancy termination. In this study, the socio-demographic determinants of pregnancy termination among AGYW (aged 15-24) in selected countries with high fertility rates in SSA were examined.

METHODS

This was a cross-sectional analysis of data from the most recent Demographic and Health Surveys of nine countries in SSA. The countries included are Angola, Burkina Faso, Burundi, Chad, Gambia, Mali, Niger, Nigeria, and Uganda. A total of 62,747 AGYW constituted the sample size for the study. Fixed and random effects models were used to examine the determinants of pregnancy termination with statistical significance at p < 0.05.

RESULTS

Higher odds of pregnancy termination were found among AGYW aged 20-24, those who were cohabiting and married, those who listened to radio and watched television at least once a week and those who lived in communities with high literacy level. Conversely, the odds of pregnancy termination were lower among AGYW with three or more births and those with secondary/higher education.

CONCLUSION

The socio-demographic determinants of pregnancy termination among AGYW in this study were age, level of education, marital status, exposure to radio and television, parity, and community literacy level. The findings provide the needed information for designing health interventions to reduce unwanted pregnancies and unsafe abortions in countries with high fertility rates in SSA. It is recommended that governments and non-governmental organisations in these countries should enhance sexuality education and regular sensitization of adolescent sexual and reproductive health programmes targeted at AGYW who are at risk of pregnancy termination.