Adherence to Iron and Folic Acid Supplementation Among Pregnant Women From Northern Ghana

Iron and folic Acid (IFA) supplementation is an effective intervention for reducing the incidence of anaemia during pregnancy. The WHO recommends at least 6 months intake of IFA to pregnant women. However, in Ghana some women experience challenges with adhering to IFA supplementation. The main objective of the study was to assess the level of adherence to iron and folic acid supplementation and its associated factors among pregnant women in a peri-urban municipality in Northern Ghana. A cross-sectional study was conducted from March to December 2021 among 400 pregnant women who attended ANC in Sagnarigu municipality in Ghana and were selected through a 3-stage random sampling technique. A structured questionnaire was used to collect data. The data were analysed using descriptive statistics, univariate and binary logistic regression statistical tools. Self-reported level of adherence to iron and folic acid supplementation was 84.5%. Knowledge of iron and folic acid supplementation (AOR = 0.08: 021, 0.343) was associated with adherence. Three other factors: time of first antenatal visit (AOR = 0.32: 0.153, 0.649) having history of anaemia [AOR = 2.67: 1.373, 5.201] having side effects of IFA [AOR = 3.70, CI: (1.756, 7.793)], and having knowledge of management of side effects of iron and folic acid supplementation (AOR = 0.08: 021, 0.343) were found to be significantly associated with adherence. Adherence to iron and folic supplementation among the pregnant women was generally frequent. Strategies to increase iron and folic acid supplementation adherence among pregnant women could focus on encouraging pregnant women to have early ANC visits and educating them on how to manage side effects.

The competence of street food vendors to provide nutritious and safe food to consumers: a cross-sectional survey among street food vendors in Northern Ghana

Increasingly most people have their meals outside their homes and are vulnerable to illnesses caused by unsafe foods. Unsafe food preparation and supply by vendors have made food safety a concern for public health. The present study evaluated the nutrition knowledge, attitude and food safety and hygienic practices of street food vendors (SFVs) in Northern Ghana. An analytical cross-sectional study design was conducted among 424 SFVs, and the data were collected using questionnaires and observation. The mean ± sd nutrition knowledge score of the SFVs was 7⋅08 ± 1⋅75 in which the majority of the participants (68⋅6 %) knew foods that help fight diseases and build immunity. The mean ± sd food safety and hygienic practice score was 7⋅61 ± 2⋅66 with more than half of the participants reportedly not using hand gloves while preparing and serving food. Factors that were associated with food safety and hygienic practices of the SFVs were level of education (β = -0⋅36, P < 0⋅001), number of hours worked (β = 0⋅15, P = 0⋅002), food hygiene and safety knowledge (β = 0⋅21, P = 0⋅002), having a business certificate (β = -0⋅15, P = 0⋅004) and having medical check-up (β = 0⋅11, P = 0⋅029). The food safety and hygienic practices of the SFVs may constitute a food safety risk to consumers. Improving food safety and hygiene knowledge may be important but regular monitoring and check-up by the FDA could result in SFVs following the required food safety and hygienic practices.

Preparedness of medical students to provide nutrition care following a nutrition education intervention

BACKGROUND

Globally, 71% of deaths are due to non-communicable diseases (NCDs) of which 77% of these deaths occur in low-and-middle income countries. Nutrition is an important contributor to the occurrence, progression and management NCDs. Health care professionals' promotion of the adoption of healthy dietary habits among individuals has been shown to reduce the occurrence of NCDs. We assessed the effects of a nutrition education intervention on medical students' self-perceived preparedness to provide nutrition care.

METHODS

We administered a pre, post and four-weeks follow-up questionnaire to second year medical students who participated in a nutrition education intervention that adapted varied teaching and learning activities. Outcomes were self-perceived preparedness, relevance of nutrition education and perceived need for further training in nutrition. Repeated measures and Friedman tests were used to assess differences in mean scores across pre, post and 4-weeks follow up assessment based on p < 0.5 at 95% confidence interval.

RESULTS

The proportion of participants who felt prepared to provide nutrition care increased significantly (p = 0.001) from 38% (n = 35) at baseline to 65.2% (n = 60) immediately post-intervention and to 63.2% (n = 54) at 4-weeks follow-up. At baseline, 74.2% (n = 69) of the students perceived nutrition education to be relevant to their future career as medical doctors which increased to 85% (n = 78) immediately after the intervention (p = 0.026) and to 76% (n = 70) 4-weeks follow-up. The proportion of participants who reportedly said they will benefit from further training in nutrition increased from 63.8% (n = 58) at pre-intervention to 74.0% (n = 68) at post-intervention (p = 0.016).

CONCLUSION

An innovative, multiple-strategy nutrition education intervention can improve medical students' self-perceived preparedness to provide nutrition care.

Nutrition education intervention improves medical students' dietary habits and their competency and self-efficacy in providing nutrition care: A pre, post and follow-up quasi-experimental study

Objective

Most doctors and medical students report inadequate competencies in nutrition care. We evaluated the impact of a nutrition education intervention on medical students' lifestyle habits, dietary diversity, nutrition care knowledge, attitude toward nutrition care, and their level of self-efficacy in the provision of nutrition care.

Methods

All 2nd-year medical students were enrolled into a 5 week, 24-h nutrition education intervention that involved both deductive and practical sessions. Pre-, post and 4 weeks follow-up assessments were conducted.

Results

At post- and 4-weeks post-intervention the number of days participants consumed vegetables and engaged in moderate-to-vigorous physical activity significantly (p = 0.003 and 0.002) improved respectively from baseline. Mean nutrition care knowledge scores of participants increased by 3.27 points (95% Cl: 1.98-4.56, p < 0.001) from 19.49 at baseline through to 24.78 post- and 22.76 4 weeks follow-up. No significant [X ( 2 ) 2 = 1.568, p = 0.457] change in mean attitude toward nutrition care score was recorded. Mean level of self-efficacy in the provision of nutrition care improved significantly by 1.73 (95% Cl: 1.17-2.28, p < 0.001) at post-intervention and 4 weeks follow-up compared to the baseline scores.

Conclusion

The intervention improved the nutrition care knowledge, self-efficacy in the provision of nutrition care as well as medical students' own consumption of vegetables, dietary diversity and their engagement in moderate-to-vigorous physical activity. However, continuous implementation of nutrition education interventions is needed to sustain these outcomes and further improve the nutrition education experience of medical students.

Reported dietary habits and lifestyle behaviors of students before and during COVID-19 lockdown: A cross-sectional survey among university students from Ghana

Background:

COVID-19 lockdowns involved precautions and social rules that resulted in drastic changes to daily life activities in every setting. University students were not left out as their education was affected and they had to resort to online learning from their homes. The lockdowns did not only affect their education but also potentially affected their dietary habits and lifestyle behaviors. We evaluated the reported dietary habits and lifestyle behaviors of students from a Ghanaian University before and during the COVID-19 lockdown.

Materials and Methods:

Following a cross-sectional design, 220 students were recruited from the University for Development Studies in Ghana. Data was collected by means of an online questionnaire. Chi-square test (χ²) analysis was used to examine associations among variables.

Results:

About 59% of the students skipped meals before COVID-19 whereas 47.8% skipped meals during the COVID-19 lockdown. While 64.1% consumed homemade meals before the COVID-19, 82.3% consumed homemade meals during the COVID-19 lockdown. In addition, there was a significant increase in the consumption of homemade food (p < 0.001), level of healthy foods choices (p = 0.029), and a reduced skipping of meals (0.014) during the COVID-19 lockdown. Again, 56.4% of the students engaged in exercise before the lockdown while 45% participated in exercise during the lockdown.

Conclusions:

The lockdown had an impact on some of the dietary and lifestyle habits of the students. University students should be supported with appropriate nutrition education and counseling programs to help them adopt healthy dietary and lifestyle habits.

Food advertisement influences food decision making and not nutritional status: a study among university students in Ghana

Background

Consumers are exposed to a wide range of advertisements through different channels daily, which tends to have an influence on their food decision making. The aim of this study was to evaluate the different forms of food advertisements students are exposed to on campus and how they influence their food choices and nutritional status.

Methods

This cross-sectional study was conducted to find out the influence of different forms of food advertisements on students’ food choices and nutritional status. A self-reported semi-structured questionnaire was used to elicit responses from 367 students. About 51.5% of the students were females and 48.5% males. Body Mass index (BMI) was derived from weight and height measured according to standard procedures. Data was analysed and presented as frequencies and percentages. Chi-square was used to determine association between categorical variables (socio-demographic characteristics, food choices and nutritional status).

Results

The students reported ‘use of internet’ (58.9%) as the main source of food advertisement on campus, followed by television (21.0%). A large number of students (74.9%) were affirmative about food advertisements influencing their food decision making. Those with poor nutritional status (underweight, overweight and obese) were more likely to patronize sugar sweetened beverages (10.1%) as compared to fruits and vegetables (1.4%). There was statistical significance (p = 0.003) for type of food patronized due to advertisement and the source of advertisement. However, there was no statistical significance (p = 0.832) for type of food patronized due to advertisement and BMI of students.

Conclusion

Owing to the increased patronage of internet and television as channels of food advertisements by students, policy makers should prioritize the designing and implementation of intervention programmes through these channels that would influence healthy food decision making and promote consumption of nutrient rich foods. As this population has high self-reported advertisements’ influence on food choices, it is vital to investigate further the influence of contextual cues such as environment and advertisement on their eating habits and dietary patterns.

Determinants of Nutrition Care Practice by Midwives and Nurses in the Antenatal and Postnatal Care Settings: A Multi-Site Cross-Sectional Survey From Ghana

Aim. Midwives and nurses are critical in nutrition care for pregnant women and lactating mothers. Ghanaian nurses and midwives’ perception of the adequacy and their satisfaction with nutrition education received during training in school, level of nutrition care competencies, and nutrition practice behavior is unknown. We evaluated the adequacy of nutrition education received in nursing and midwifery school; nutrition care competencies; self-efficacy and the nutrition care practice of midwives and nurses. We also evaluated determinants of nutrition care practice during routine antenatal and postnatal care. Methods. Cross-sectional study conducted among midwives and nurses working at antenatal and postnatal clinics in Ghana. Data was collected using a self-administered questionnaire. Data analysis was done using descriptive statistics, correlation, and linear regression. Findings. Almost 90% (n = 267) of the participants received nutrition education during training, 77.5% were unsatisfied with the amount of time allocated for nutrition education and 40% felt inadequately prepared from school to provide nutrition care. Self-efficacy ranged from moderate to low. Determinants of nutrition care practice were age of respondents (B = 0.04; P = .002), nutrition-related knowledge (B = 0.05; P = .016), adequacy of nutrition education (B = 0.14; P = .006), nutrition training after school (B = 0.38; P = .010) and nutrition care self-efficacy (B = 0.03; P = .048). Conclusion. Notable knowledge gaps in basic nutrition, inadequate preparedness, and poor confidence to provide nutrition care was common. There is a need to improve the nutrition education experiences of midwives and nurses through curricula revision and refresher training courses.

Nutrition Knowledge is Associated With the Consumption of Iron Rich Foods: A Survey Among Pregnant Women From a Rural District in Northern Ghana

INTRODUCTION

Iron deficiency anaemia is an international public health concern and pregnant women are at an increased risk. We investigated the consumption of iron rich foods and associated factors among pregnant women in a rural district from Ghana.

METHODS

Following a cross-sectional design, dietary intake of iron rich foods was obtained from 252 pregnant women using a 24-hour recall food check list. Nutrition knowledge, attitudes and socio-demographic characteristics were also assessed.

FINDINGS

Participants had a mean (SD) knowledge score of 54.66 (22.74)%. About 73% of the participants had heard about iron-deficiency anaemia. Only 16.3% of the participants knew foods that help the body to absorb and use iron while 9.1% knew beverages that decrease iron absorption. About 71% of the participants ate fish and/or seafood while 67.1% of them ate green leafy vegetables. Only 4.4% of the participants ate organ meat, and 29% took flesh meat. Only 22.4% of the study participants usually drank coffee or tea while 78.2% ate vitamin C-rich foods. With regards to attitudes, 88.5% of the participants perceived anaemia to be a serious disease. Nutrition knowledge was significantly associated with the consumption of iron rich foods (β = .02; 95% CI = 0.01-0.02).

CONCLUSION

Nutrition knowledge may be an important determinant of the consumption of iron rich foods among pregnant women making it necessary for healthcare providers to continue to provide nutrition education to pregnant women during routine antenatal care.

Income Level but Not Nutrition Knowledge Is Associated with Dietary Diversity of Rural Pregnant Women from Northern Ghana

Essential nutrients are necessary for reducing the risk of maternal mortality, prenatal mortality, and low-birthweight infants. Dietary diversity can play an important role in supplying essential nutrients to both the mother and the foetus. We evaluated nutrition knowledge, attitudes, and dietary diversity of pregnant women. In addition, we investigated the sociodemographic determinants of dietary diversity among pregnant women from a rural district in Ghana. Participants were pregnant women receiving antenatal care from a rural district hospital in Ghana. Dietary diversity was measured using a 24-hour dietary recall questionnaire. Multiple linear regression was used to determine the sociodemographic characteristics of dietary diversity. About 85% of the pregnant women knew that they should eat more in comparison to nonpregnant women, and only 16.9% knew the importance of folic acid supplementation during pregnancy. Mean (SD) dietary diversity score of the participants was 5.27 (1.35), 85.4% did not consume any fruits, and 82.3% did not take milk and milk products. Almost all participants took at least one food item in the starchy staples and green leafy vegetables food groups. Moreover, 53% consumed vitamin A-rich fruits, vegetables, and tubers; 7.7% organ meats; and 30.8% eggs. Those who earned a monthly income of ≥GHC 500 or US$ 87 (B = 1.82; 0.90-2.73; p < 0.001) significantly had higher dietary diversity scores compared to those who earned less. Dietary diversity of the pregnant women was suboptimal. The consumption of vitamin A- and iron-rich foods was inadequate. Income was an important determinant of the dietary diversity of pregnant women from Northern rural Ghana.

Utilization of growth monitoring and promotion is highest among children aged 0-11 months: a survey among mother-child pairs from rural northern Ghana

Background

More than half of all deaths in under 5 children is related to malnutrition. Child malnutrition could be prevented through regular monitoring of the growth and development of children and the implementation of growth promotion activities referred to as growth monitoring and promotion (GMP). Mothers’/caregivers utilization of these activities through child welfare clinics could improve the growth and development of under 5 children. We evaluated mothers’ knowledge on GMP, utilization and associated factors among mother-child pairs from a poor socio-economic district in Northern Ghana.

Methods

Using an analytical cross-sectional design, participants included mothers with children aged 0–59 months, grouped into 0–11 months, 12–23 months and 24–59 months. A semi-structured questionnaire containing both closed- and open-ended questions was used to collect data. Multivariate logistic regression was used to identify determinants of GMP utilization.

Results

Four hundred mother-child pairs were included in the study. Overall, 28.5% (n = 114) of the mothers utilized GMP services. Almost 60%(n = 237) of the mothers knew the recommended age to seek for GMP service for their children. Only 9% of the mothers could correctly interpret the directions of the growth curves in their children’s Health Record booklet. Mothers with children aged 0–11 months were 3.9 times more likely (p = 0.009) to utilize GMP services compared to their counterparts with children aged 12–23 months and 24–59 months. Mothers who had low level of knowledge were 2.19 times (p = 0.003) more likely to utilize GMP services compared to their counterparts with high level of knowledge..

Conclusion

Utilization of GMP services was low and particularly lower in children aged 24–59 months. Mothers’ knowledge in GMP was optimal although there were notable gaps.

Mothers' knowledge and attitudes regarding child feeding recommendations, complementary feeding practices and determinants of adequate diet

BACKGROUND

Complementary feeding is critical for optimal nutrition in infants and young children as it ensures their growth, health and development to attain their full potential. However, evidence shows that children from developing countries do not meet the core indicators for appropriate complementary feeding. We evaluated mothers' knowledge and attitudes regarding child feeding recommendations and the determinants of adequate diet among children aged 6-23 months.

METHODS

This cross-sectional study included 200 children aged 6-23 months and their mothers/care givers recruited during child welfare clinics of two health facilities in Ghana. Data was collected using a structured questionnaire. Multivariate logistic regression was used to assess determinants of adequate diet.

RESULTS

Sixty-eight percent of the mothers knew the recommended duration of continued breastfeeding, 56.5% how to ensure dietary diversity and enrich their children's diets and 94% (n = 188) had positive attitude towards recommended infant and young child feeding practices. Majority of the mothers (92%, n = 183) practiced continued breastfeeding, 10.5% of the children met minimum diet diversity score, 39.5% minimum meal frequency and 8.5% received minimum adequate diet. Determinants of receipt of minimum adequate diet were: having high knowledge in child feeding recommendations (100% vs. 0.0, p < 0.001) and child's father reportedly earning adequate income to cater for the family (AOR = 12.1 (1.32-109.72, p = 0.027).

CONCLUSION

Motherss knowledge levels regarding infant and young child feeding recommendations had notable deficiencies although they generally had a positive attitude towards child feeding recommendations. Knowledge regarding infant and young child feeding recommendations as well as the child's father having adequate income were important determinants of adequate diet. Nutrition education should emphasize on improving mothers' nutrition knowledge regarding infant and young child feeding recommendations and supporting mothers to overcome barriers to feed their children with adequate diets.

Future doctors' perspectives on health professionals' responsibility regarding nutrition care and why doctors should learn about nutrition: A qualitative study

Background

Improved dietary and nutrition behavior may help reduce the occurrence of noncommunicable diseases which have become global public health emergencies in recent times. However, doctors do not readily provide nutrition counseling to their patients. We explored medical students' perspectives on health professionals' nutrition care responsibility, and why doctors should learn about nutrition and provide nutrition care in the general practice setting.

Methods

Semistructured interviews were conducted among 23 undergraduate clinical level medical students (referred to as future doctors). All interviews were recorded and transcribed verbatim with data analysis following a comparative, coding, and thematic process.

Results

Future doctors were of the view that all health professionals who come into contact with patients in the general practice setting are responsible for the provision of nutrition care to patients. Next to nutritionists/dieticians, future doctors felt doctors should be more concerned with the nutrition of their patients than any other health-care professionals in the general practice setting. Reasons why doctors should be more concerned about nutrition were as follows: patients having regular contacts with the doctor; doctors being the first point of contact; patients having more trust in the doctors' advice; helping to meet the holistic approach to patient care; and the fact that nutrition plays an important role in health outcomes of the patient.

Discussion

Future doctors perceived all health professionals to be responsible for nutrition care and underscored the need for doctors to learn about nutrition and to be concerned about the nutrition of their patients.

Attitudes towards, facilitators and barriers to the provision of diabetes self-care support: A qualitative study among healthcare providers in Ghana

STATEMENT OF THE PROBLEM

Self-care support provided by healthcare providers (HCPs) is critical to diabetes self-care. However, a number of barriers prevent HCPs from providing self-care support to people with diabetes. We explored attitudes towards, barriers and facilitators of the provision of diabetes self-care support among Ghanaian HCPs.

METHODS

Fourteen semi-structured interviews were conducted among HCPs recruited from three diabetes clinics in Tamale, Ghana. All interviews were digitally recorded and transcribed verbatim. Transcripts were coded and analysed thematically.

RESULTS

HCPs reported a sense of responsibility and urgency to provide self-care education to diabetes patients; while believing it was the patients' responsibility to self-care for their diabetes condition. Accordingly, HCPs perceived their role to be limited to information sharing rather than behaviour change interventions. Facilitators to the provision of self-care support included patients' motivation, and team work among healthcare professionals. Barriers that hindered self-care support included language barriers and poor inter-professional collaboration. Furthermore, HCPs discussed that they felt inadequately trained to provide self-care support. Healthcare-system-related barriers were inadequate office space, lack of professional development programmes, high patient numbers, inadequate staff numbers, inadequate health insurance and a lack of sufficient supplies and equipment in the hospital.

CONCLUSION

HCPs attitudes were generally favourable towards supporting self-care, albeit with a focus on information provision rather than behaviour change. Training in effective strategies for providing self-care support are needed, and better use of the resources that are available.

Barriers to diabetic self-care: A qualitative study of patients' and healthcare providers' perspectives

AIMS AND OBJECTIVES

To explore patient and healthcare provider (HCP) perspectives about patients' barriers to the performance of diabetic self-care behaviours in Ghana.

BACKGROUND

Sub-Saharan African urban populations are increasingly affected by type 2 diabetes due to nutrition transition, sedentary lifestyles and ageing. Diabetic self-care is critical to improving clinical outcomes. However, little is known about barriers to diabetic self-care (diet, exercise, medication taking, self-monitoring of blood glucose and foot care) in sub-Saharan Africa.

DESIGN

Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

METHODS

Semi-structured interviews were conducted among 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. Interviews were audiotaped and transcribed verbatim. The constant comparative method of data analysis was used and identified themes classified according to constructs of the theory of planned behaviour (TPB): attitudes/behavioural beliefs, subjective norms and perceived behavioural control.

RESULTS

Barriers relating to attitudes included misconceptions that diabetes was caused by spiritual forces or curses, use of herbal medicines, intentional nonadherence, difficulty changing old habits, and feeling or lacking motivation to exercise. Barriers relating to subjective norms were inadequate family support, social stigma (usually by spouses and other members of the community) and cultural beliefs. Perceived behavioural control barriers were poor income levels, lack of glucometers, busy work schedules, long distance to the hospital and inadequate access to variety of foods due to erratic supply of foods or seasonality.

CONCLUSIONS

Both patients and HCPs discussed similar barriers and those relating to attitude and behavioural control were commonly discussed.

RELEVANCE TO CLINICAL PRACTICE

Interventions to improve adherence to diabetic self-care should focus on helping persons with diabetes develop favourable attitudes and how to overcome behavioural control barriers. Such interventions should have both individualised and community-wide approaches.

Psychometric evaluation of the summary of diabetes self-care activities measure in Ghanaian adults living with type 2 diabetes

AIMS

We evaluated the content validity, factorial structure, internal consistency, construct validity, and floor and ceiling effects of the SDSCA among Ghanaian persons with type 2 diabetes.

METHODS

The summary of diabetes self-care activities measure (SDSCA) was administered to 187 adults living with type 2 diabetes from three diabetes clinics.

RESULTS

A confirmatory factor analysis maintained the four factor structure of the SDSCA. However, two items, 3 (fruit and vegetable servings) and 4 (red meat or full-fat dairy products) had factor loadings of 0.26 and 0.16 respectively. The model also had a statistical power of 0.72 (below acceptable criteria). Modification of the model by removing item 4 resulted in an improved revised model with a power of 0.82. Construct validity was found for the exercise and diet subscales of the SDSCA but not for the self-monitoring of blood glucose and foot care subscales. The internal consistency of the SDSCA measure was 0.68, below acceptable criteria for internal consistency. No floor effects were present but the exercise subscale had ceiling effects.

CONCLUSION

The SDSCA measure had content validity, maintained its multidimensionality and met the criteria for floor effects but not for construct validity, internal consistency and ceiling effects. The SDSCA measure may require improvements to evaluate self-care behaviours of adult type 2 diabetes patients in Ghana and probably in other sub-Saharan countries.

Reproductive-Age Women's Knowledge and Care Seeking for Malaria Prevention and Control in Ghana: Analysis of the 2016 Malaria Indicator Survey

INTRODUCTION

Malaria is a major cause of morbidity and mortality worldwide, requiring individual and environmental level controls to prevent its adverse morbidity effects. This study examined reproductive-aged women's knowledge and care-seeking practices for malaria prevention and control in Ghana.

METHODS

The 2016 Ghana Malaria Indicator Survey data for reproductive-age women was analysed (n=5,150). Multilevel mixed-effects logistic regression model was used to determine factors associated with reproductive-aged women's knowledge and care-seeking practices for malaria.

RESULTS

62.3%, 81.3%, and 64.6% knowledge levels on causes, signs/symptoms, and prevention of malaria were found, respectively, among respondents. Age, wealth and educational status, religion, region, and place of residence (rural) were found to significantly influence respondents' knowledge of causes, signs/symptoms, and care-seeking practices for malaria. A 15% differential among Insecticide Treated Nets (ITNs) awareness and use was found. Increasing age (≥35 years) was associated with increasing knowledge of malaria. Regional variations were observed to significantly influence knowledge of malaria treatment.

CONCLUSION

Though ownership of ITNs and knowledge of malaria prevention were high, it did not necessarily translate into use of ITNs. Thus, there is a need to intensify education on the importance and the role of ITNs use in the prevention of malaria.

Why nutrition education is inadequate in the medical curriculum: a qualitative study of students' perspectives on barriers and strategies

BACKGROUND

The provision of nutrition care by doctors is important in promoting healthy dietary habits, and such interventions can lead to reductions in disease morbidity, mortality, and medical costs. However, medical students and doctors report inadequate nutrition education and preparedness during their training at school. Previous studies investigating the inadequacy of nutrition education have not sufficiently evaluated the perspectives of students. In this study, students' perspectives on doctors' role in nutrition care, perceived barriers, and strategies to improve nutrition educational experiences are explored.

METHODS

A total of 23 undergraduate clinical level medical students at the 5th to final year in the School of Medicine and Health Sciences of the University for Development Studies in Ghana were purposefully selected to participate in semi-structured individual interviews. Students expressed their opinions and experiences regarding the inadequacy of nutrition education in the curriculum. Each interview was audio-recorded and later transcribed verbatim. Using the constant comparison method, key themes were identified from the data and analysis was done simultaneously with data collection.

RESULTS

Students opined that doctors have an important role to play in providing nutrition care to their patients. However, they felt their nutrition education was inadequate due to lack of priority for nutrition education, lack of faculty to provide nutrition education, poor application of nutrition science to clinical practice and poor collaboration with nutrition professionals. Students opined that their nutrition educational experiences will be improved if the following strategies were implemented: adoption of innovative teaching and learning strategies, early and comprehensive incorporation of nutrition as a theme throughout the curriculum, increasing awareness on the importance of nutrition education, reviewing and revision of the curriculum to incorporate nutrition, and involving nutrition/dietician specialists in medical education.

CONCLUSION

Though students considered nutrition care as an important role for doctors they felt incapacitated by non-prioritisation of nutrition education, lack of faculty for teaching of nutrition education, poor application of nutrition science and poor collaboration with nutrition professionals. Incorporation of nutrition as a theme in medical education, improving collaboration, advocacy and creating enabling environments for nutrition education could address some of the barriers to nutrition education.

Nurses' knowledge and attitudes regarding malnutrition in children and its management in Ghana

Background

Malnutrition contributes significantly to child morbidity and mortality. Nurses require appropriate knowledge, skills and attitudes to prevent and treat malnutrition in children using appropriate guidelines or protocols.

Objectives

The aim of this article was to assess nurses’ knowledge, attitudes towards malnutrition and its management using the World Health Organization (WHO) or United Nations International Children’s Fund guidelines for the treatment of severely malnourished children and to evaluate factors associated with their knowledge and attitudes.

Methods

Participants included 104 nurses working in the outpatient and paediatric units or departments of four hospitals in Tamale metropolis. An 88-item questionnaire was used to measure nurses’ socio-demographic characteristics as well as their knowledge and attitudes towards malnutrition in children and its management using the WHO guidelines for the inpatient treatment of severely malnourished children.

Results

Nurses’ knowledge in malnutrition and its management was slightly above average (54.0%), but their attitudes were highly positive. Factors that were associated with nurses’ knowledge were number of nutrition courses undertaken in nursing school, number of years working as a nurse, receipt of a refresher course on nutrition after school and receipt of training on the guidelines. Nurses’ attitudes were associated with report of having awareness on the guidelines, number of years a nurse has been involved in the treatment of a severely malnourished child.

Conclusion

Nurses’ knowledge levels in the inpatient treatment of severely malnourished children were not desirable. However, their attitudes were generally positive. Receipt of previous training, awareness of the WHO guidelines, practice experience and number of years as a nurse significantly affected knowledge and attitude scores in the positive direction.

Adherence to and factors associated with self-care behaviours in type 2 diabetes patients in Ghana

BACKGROUND

Previous research has failed to examine more than one self-care behaviour in type 2 diabetes patients in Ghana. The purpose of this study is to investigate adult Ghanaian type 2 diabetes patients' adherence to four self-care activities: diet (general and specific), exercise, self-monitoring of blood glucose (SMBG) and foot care.

METHODS

Consenting type 2 diabetes patients attending diabetes outpatient clinic appointments at three hospitals in the Tamale Metropolis of Ghana completed a cross-sectional survey comprising the Summary of Diabetes Self-Care Activities Measure, and questions about demographic characteristics and diabetes history. Height and weight were also measured. Multiple linear regression analyses were conducted to identify the factors associated with adherence to each of the four self-care behaviours.

RESULTS

In the last 7 days, participants exercised for a mean (SD) of 4.78 (2.09) days and followed diet, foot care and SMBG for a mean (SD) of 4.40 (1.52), 2.86 (2.16) and 2.15 (0.65) days, respectively. More education was associated with a higher frequency of reported participation in exercise (r = 0.168, p = 0.022), following a healthy diet (r = 0.223, p = 0.002) and foot care (r = 0.153, p = 0.037) in the last 7 days. Males reported performing SMBG (r = 0.198, p = 0.007) more frequently than their female counterparts.

CONCLUSION

Adherence to diet, SMBG and checking of feet were relatively low. People with low education and women may need additional support to improve adherence to self-care behaviours in this type 2 diabetes population.

Adherence to self-care behaviours and associated barriers in type 2 diabetes patients of low-and middle-income countries: a systematic review protocol

BACKGROUND

Diabetes has become a global health emergency affecting high-, middle- and low-income countries. Previous systematic reviews have either focused on patients' adherence to diabetes self-care behaviours only or barriers to diabetes care (including self-care) only in the published literature and have not also analysed data separately for low- and middle-income countries (LMICs). Thus, none have focused on adherence with, and barriers to, self-care behaviours from the perspectives of both patient and providers in low- and middle-income countries (LMICs). This systematic review will evaluate the published literature on adherence to five diabetes self-care behaviours (i.e., diet, exercise, self-monitoring of blood glucose, medication taking and foot care) and associated barriers in type 2 diabetes patients in LMICs. Healthcare providers' barriers to the provision of diabetes self-care support will also be reviewed.

METHODS

This narrative review will be reported in accordance with the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). The electronic databases, MEDLINE, EMBASE, CINAHL, SCOPUS, PsycINFO, Cochrane Library and the British Nursing Index will be searched. Qualitative and quantitative studies reporting on type 2 diabetes patients' adherence to self-care behaviours and associated barriers in LMICs will be included. Studies also reporting on barriers encountered by providers in LMICs providing diabetes care and supporting patients to adhere to self-care behaviours will also be included. Cross-sectional studies, observational cohort studies, baseline data of randomised controlled trials and qualitative studies will be eligible. Two independent reviewers will screen articles for inclusion, undertake quality assessment of included studies and execute data extraction using standardised forms. Discrepancies will be discussed to reach consensus, and another reviewer will adjudicate if the need arises. The Guidance of Narrative Synthesis in Systematic Reviews will be employed to explore relationships within and between included studies.

DISCUSSION

This review will provide evidence on adherence to self-care behaviours by type 2 diabetes patients in LMICs. Barriers experienced by patients in LMICs to adhere to recommended self-care behaviours will also be identified. Barriers experienced by healthcare providers in LMICs in providing self-care support patients will also be determined.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016035406.

Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

OBJECTIVE

To determine what, how, for whom, why, and in what circumstances educational interventions improve the delivery of nutrition care by doctors and other healthcare professionals work.

DESIGN

Realist synthesis following a published protocol and reported following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multidisciplinary team searched MEDLINE, CINAHL, ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar and Science Direct for published and unpublished (grey) literature. The team identified studies with varied designs; appraised their ability to answer the review question; identified relationships between contexts, mechanisms and outcomes (CMOs); and entered them into a spreadsheet configured for the purpose. The final synthesis identified commonalities across CMO configurations.

RESULTS

Over half of the 46 studies from which we extracted data originated from the USA. Interventions that improved the delivery of nutrition care improved skills and attitudes rather than just knowledge; provided opportunities for superiors to model nutrition care; removed barriers to nutrition care in health systems; provided participants with local, practically relevant tools and messages; and incorporated non-traditional, innovative teaching strategies. Operating in contexts where student and qualified healthcare professionals provided nutrition care in developed and developing countries, these interventions yielded health outcomes by triggering a range of mechanisms, which included feeling competent, feeling confident and comfortable, having greater self-efficacy, being less inhibited by barriers in healthcare systems and feeling that nutrition care was accepted and recognised.

CONCLUSIONS

These findings show how important it is to move education for nutrition care beyond the simple acquisition of knowledge. They show how educational interventions embedded within systems of healthcare can improve patients' health by helping health students and professionals to appreciate the importance of delivering nutrition care and feel competent to deliver it.

Knowledge, attitudes and determinants of exclusive breastfeeding practice among Ghanaian rural lactating mothers

Background

The practice of exclusive breastfeeding (EBF) is influenced by maternal knowledge and attitudes as well as socio-demographic and cultural factors. This study assessed knowledge, attitudes and practice of EBF among rural lactating mothers with infants aged 0–6 months. Factors associated to the practice of EBF were also investigated.

Methods

This cross-sectional study was conducted among 190 rural lactating mothers with infants aged 0–6 months seeking postnatal care at a health centre in Ghana. All data was collected using a questionnaire that contained both closed and open ended questions.

Results

About 26 % (n = 50) of the mothers were unable to correctly define EBF. The majority (92.6 %, n = 176) of the mothers said they felt good to EBF for 6 months, to breastfed on demand (99.5 %, n = 189) and did not have difficulties EBF (90 %, n = 171). Despite the generally positive attitude towards EBF, 42 % (n = 79) of the mothers did not EBF their babies. These mothers did not practice EBF because they misunderstood certain signs of the child to mean wanting to eat food or drink water, regarded breastmilk to be inadequate to meet the nutritional needs of the child and misunderstood healthcare professionals’ EBF advice. Higher maternal education was associated with higher likelihood of EBF (OR 3.5; 95 % CI 1.6, 7.7; p = 0.002). Mothers whose babies were younger than 3 months were more likely to EBF (OR 12.0; 95 % CI 4.4, 32.5; p < 0.001) than those having babies aged ≥ 3 months. Furthermore, higher knowledge of EBF was associated with the likelihood of EBF (OR 5.9; 95 % CI 2.6, 13.3; p < 0.001).

Conclusion

Mothers’ knowledge and attitudes towards EBF were favourable but practice of EBF was suboptimal. This study adds additional evidence that knowledge of EBF, child’s age and maternal level of education are important determinants of the practice of EBF. Beyond dissemination of health messages, healthcare professionals should pay more counselling attention to less educated mothers, and also older children’s caregivers.

The perceived usefulness of community based education and service (COBES) regarding students' rural workplace choices

BACKGROUND

Community Based Education and Service (COBES) are those learning activities that make use of the community as a learning environment. COBES exposes students to the public and primary health care needs of rural communities. The purpose of this study was to investigate students' perceived usefulness of COBES and its potential effect on their choice of career specialty and willingness to work in rural areas.

METHOD

A mixed method cross sectional study design using semi-structured interviews, questionnaires, and focus group discussions were used for health facility staff, faculty and students and community members.

RESULTS

One hundred and seventy questionnaires were administered to students and 134 were returned (78.8% response rate). The majority (59.7%) of students were male. Almost 45% of the students indicated that COBES will have an influence on their choice of career specialty. An almost equal number (44%) said COBES will not have an influence on their choice of career specialty. However, 60.3% of the students perceived that COBES could influence their practice location. More males (64.7%, n = 44) than females (57.8%, n = 26) were likely to indicate that COBES will influence their practice location but the differences were statistically insignificant (p = 0.553). The majority of students, who stated that COBES could influence their practice location, said that COBES may influence them to choose to practice in the rural area and that exposure to different disease conditions among different population groups may influence them in their career choice. Other stakeholders held similar views. Qualitative data supported the finding that COBES could influence medical students' choice of specialty and their practice location.

CONCLUSION

Medical students' 'perceptions of the influence of COBES on their choice of career specialty were varied. However, most of the students felt that COBES could influence them to practice in rural locations.

Self-reported receipt of healthcare professional's weight management counselling is associated with self-reported weight management behaviours of type 2 diabetes mellitus patients

BACKGROUND

Weight loss has been shown to influence the health outcomes of type 2 diabetes patients. Providing weight management counselling to diabetes patients may help them adopt appropriate weight management behaviours to lose weight. This study determined the association between self-reported receipt of healthcare professional's weight management counselling and the weight management behaviours of type 2 diabetes patients.

METHODS

This cross-sectional study was conducted among 378 type 2 diabetes mellitus patients seeking care from two hospitals. Using a questionnaire, participants' weight management behaviours were assessed as well as receipt of healthcare professional's weight management counselling.

RESULTS

Half (51.3 %) of the participants reported receipt of healthcare professional's weight management counselling in the last 12 months. Half of the participants ever tried to lose weight. Fewer than half of the participants reported modifying their dietary habits (45.5 %) or engaging in exercise (48.7 %) to lose weight. Those who reported receipt of weight management counselling were more likely to report ever trying to lose weight (AOR 43.0, 95 % CI 23.0-81.6; p < 0.001), modifying their dietary habits (AOR 22.5, 95 % CI 13.0-39.19; p < 0.001), and engaging in exercise (AOR 13.0, 95 % CI 7.8-21.7; p < 0.001) to lose weight.

CONCLUSION

Participants engaged in varied weight management behaviours. Receipt of health care professionals' weight management counselling was associated to participants' reported participation in weight management behaviours. Weight management counselling from health care professionals may support the adoption of weight management behaviours in type 2 diabetes mellitus patients.

The effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in rural communities in Ghana

BACKGROUND

Career choices and placements of healthcare professionals in rural areas are a major problem worldwide, and their recruitment and retention to these areas have become a challenge to the health sector. The purpose of this study was to investigate the effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in a rural area.

METHOD

This cross sectional survey was conducted among 56 pioneering graduates that followed a Problem Based Learning/Community Based Education and Service (PBL/COBES) curriculum. Using a mixed methods approach, open-and closed-ended questionnaire was administered to 56 graduates. Cross tabulation using Chi-square test were used to compare findings of the quantitative data. All qualitative data analysis was performed using the principles of primary, secondary and tertiary coding.

RESULTS

All 56 graduates answered and returned the questionnaire giving a 100 % response rate. 57.1 % (32) of them were male. Majority of them lived in towns (41.1 %) and cities (50 %) prior to medical school. A significant number of graduates (53.6 %,) from the cities, without any female or male predominance said COBES had influenced their choice of specialty. Again, a significant proportion of graduates from the towns (60.9 %,) and cities (67.8 %,), indicated that COBES had influenced them to work in the rural area. However, there was no significant difference between males and females from the towns and cities regarding the influence of COBES to work in the rural area. Qualitative data supported the finding that COBES will influence graduates willingness to work in the rural area

CONCLUSION

The majority of graduates from the towns and cities in Ghana, with a male predominance, indicated that COBES may have influenced their choice of specialty and willingness to practice in the rural areas despite their town or city based upbringing.

Adiposity, hypertension and weight management behaviours in Ghanaian type 2 diabetes mellitus patients aged 20-70 years

OBJECTIVE

This study assessed the prevalence of general and abdominal obesity and hypertension as well the weight management behaviours of type 2 diabetes mellitus patients.

METHODS

It included 378 diabetes patients seeking care from two hospitals in Ghana. Standard methods and tools were used to assess participants' weight, height, waist circumference (WC), blood pressure (BP) and fasting plasma glucose (FPG). Weight management behaviours were measured using a questionnaire.

RESULTS

The prevalence of general obesity, abdominal obesity and hypertension was 20.1%, 46.6% and 67.7% respectively. Abdominal obesity was more likely in participants who: skipped breakfast, engaged in exercise to lose weight and were generally overweight/obese. General overweight and obesity was more likely in participants who: reported receipt of weight management counselling, engaged in exercise to lose weight, had a weight management plan/goal, and were abdominally obese. Hypertension was less likely in participants who had: no formal education, diabetes for ≥5 years and modified their dietary habits to lose weight but more likely in those who skipped breakfast.

CONCLUSION

Abdominal obesity, general overweight/obesity, and hypertension were frequent in this sample and were influenced by weight management behaviours.

Psychometric properties of the dundee ready educational environment measure in a sample of Ghanaian Medical Students

BACKGROUND

The Dundee Ready Educational Environment Measure (DREEM) has been widely accepted and recognized for the assessment of the educational environment in a variety of health professions education programs. Concerns regarding the psychometric properties of the DREEM have been raised. This study evaluated the psychometric properties of the DREEM in a sample of Ghanaian medical students following a problem-based learning curriculum.

METHODS

A sample of 234 second to fourth year medical students of the University for Development Studies, School of Medicine and Health Sciences were invited to complete the DREEM questionnaire. Psychometric measures employed included Cronbach's alpha analysis, confirmatory factor analysis and principal component analysis with varimax rotation.

RESULTS

The internal consistency for the overall DREEM was 0.92. Apart from two subscales that had Cronbach's alpha values < 0.70, the remainder had values ranging from 0.73 - 0.78. Confirmatory factor analysis did not support the original five factor structure of the DREEM. Large significant correlation coefficients were found between the five factors raising concerns about the independency of the individual subscales. Exploratory factor analysis suggested various factor solutions ranging from 4 to 14 factors. The four factor structure was interpretable and was maintained. All of the four factors achieved eigenvalues > 1, and in total they accounted for 37.6% of the variance. Alpha values for the subscales of the new four factor structure ranged from 0.618 - 0.915.

DISCUSSION

The overall internal consistency of the DREEM was found to be excellent. The internal consistency of the individual subscales was variable, as two subscales had alpha values < 0.70 and the remainder exceeding 0.70. The original five factor structure of the DREEM was not supported. Exploratory factor analysis suggested a four factor solution as a possible alternative to the five factor structure of the DREEM.

Demographic, dietary and physical activity predictors of general and abdominal obesity among university students: a cross-sectional study

BACKGROUND

Obesity has become a disease of global public health concern in both developing and developed countries. We investigated the influence of socio-demographic, dietary habits and physical activity levels on general and abdominal obesity among a sample of university students in Ghana.

METHODS

This cross-sectional study was carried out among a sample of 552 students attending the University for Development Studies, School of Medicine and Health Sciences, Tamale, Ghana. Demographic characteristics were assessed using questionnaire. Dietary habits were measured by means of food frequency questionnaires. Anthropometric measurements were done using appropriate methods. Physical activity levels were measured using the World Health Organization (WHO) global physical activity questionnaire. Spearman's nonparametric correlation coefficient and multinomial logistic regression analysis were used to investigate the determinants of general and abdominal obesity.

RESULTS

The prevalence of general overweight/obesity (25.8 % vs. 5.9 %) and abdominal obesity (40.9 % vs. 0.8 %) was higher in female students than in male students. General overweight/obesity was less likely in students who engaged in vigorous physical activity (Adjusted Odds Ratio (AOR) = 0.3, 95 % CI = 0.1 - 0.7, p = 0.004), but more likely in students who consumed fruits and vegetables > 3 days per week (AOR = 2.6, 95 % CI = 1.2 - 5.4, p = 0.015). Abdominal obesity was also less likely in male students (AOR = 0.0, 95 % CI = 0.0 - 0.5, p = 0.017) but more likely in students who consumed roots and tubers > 3 times per week (AOR = 8.0, 95 % CI = 2.2 - 10.1, p = 0.017) and in those who consumed alcoholic and non-alcoholic beverages > 3 times per week (AOR = 8.2, 95 % CI = 2.2 - 31.1, p = 0.002).

CONCLUSION

Demographic factors, dietary habits and physical activity levels were found to be associated to general overweight/obesity and abdominal obesity. General overweight/obesity was associated to the consumption of fruits and vegetables > 3 times a week. The consumption of roots and tubers > 3 times per week and alcoholic and non-alcohol beverages > 3 times a week was associated to abdominal obesity. Engagement in vigorous physical activity and being male were negatively associated to general overweight/obesity and abdominal obesity respectively. Promotion of active lifestyles in young adults should be encouraged.

Awareness, use and associated factors of emergency contraceptive pills among women of reproductive age (15-49 years) in Tamale, Ghana

BACKGROUND

Emergency contraceptive pills (ECPs) are one of the means by which women can use after intercourse to prevent pregnancy. ECPs can be used to reduce the prevalence of unwanted pregnancies and unsafe abortions. This study investigated awareness and use of ECPs among reproductive age (15-49 years) women in Tamale, Ghana. Factors associated with the use of ECPs were also investigated.

METHODS

This cross sectional study was conducted among 200 women of reproductive age (15-49 years) in Tamale, Ghana. Data on socio-demographic variables, awareness and usage of ECPs were assessed by means of a previously validated questionnaire. Univariate and multivariate logistic regression analyses were performed to identify factors associated with the use of ECPs.

RESULTS

Awareness level of ECPs were found to be 69.0% (n = 138); 42.8% (n = 59) got the awareness from a health worker, 31.8% (n = 44) from the radio/TV and 25.4% (n = 35) from family members/friends. Eighty-five percent (n = 117) knew the correct time-frame for an effective use of ECP to prevent pregnancy. Forty percent (39.9%, n = 55) of the participants who had awareness have ever used ECPs. Factors that were found to be associated with the use of ECPs were; participants who said ECPs were affordable (AOR = 6.1, 95% CI = 2.51-10.40, p = 0.001), available (AOR 2.1, 95% CI = 0.61-6.01, p = 0.001), cultural (AOR = 3.5, 95% CI = 1.01-10.15, p = 0.011) and religious unacceptable (AOR = 4.0, 95% CI = 1.02-10.0, p = 0.005).

CONCLUSION

A relatively high level of awareness and usage of ECPs was found. Factors that were associated with the use of ECPs were availability and affordability. Cultural and religious unacceptability did not hinder the use of ECPs. Health authorities should continue to make ECPs available to women of reproductive age.

Prevalence, components and associated demographic and lifestyle factors of the metabolic syndrome in type 2 diabetes mellitus

BACKGROUND

Adults with the metabolic syndrome (MetS) are twice as likely to die from and three times as likely to have a heart attack or stroke compared with people without the syndrome. About 70-80% of type 2 diabetes mellitus (type 2 DM) patients are diagnosed with the MetS. Investigating the occurrence of the MetS in type 2 DM patients is critical for cardiovascular disease prevention. We evaluated the prevalence and components of the MetS and its associated clinical and demographic factors in a Ghanaian adult population with DM 2.

METHODS

This cross-sectional study was conducted among 200 previously diagnosed type 2 DM patients receiving care from an outpatient clinic of the Tamale Teaching Hospital, Ghana. Anthropometric measurements of waist circumference (cm), weight (Kg) and height (m) were measured appropriately. Clinical data were obtained from the personal health record files of the participants. MetS was defined according to the International Diabetes Federation criteria.

RESULTS

The prevalence of MetS was 24.0% (n=48). The prevalence was higher in women (27.3%, n= 42) compared to men (13.0%, n=6). The commonest occurring components of the MetS included abdominal obesity (77.0%) and elevated FPG (77.0%) denoting uncontrolled diabetes. The prevalence of elevated BP was found to be 44.0%(n=88) and was higher in men (56.5%) than in women (40.3%). Factors that were found to be associated to the MetS were being overweight/obese (Crude OR = 2.9, 95% CI = 1.43 - 5.90, p=0.004), ever tried to lose weight (Crude OR = 2.5, 95% CI = 1.24 - 4.94, p=0.015) and having diabetes for over 5 years (Crude OR = 11.3, 95% CI = 5.26 - 24.08, p<0.001). Other factors that were associated to the MetS were current smokers (Crude OR = 6.8, 95% CI = 1.21- 38.49, p=0.030) and alcohol drinkers (Crude OR = 3.1, 95% CI = 1.23 - 7.65, p=0.018).

CONCLUSION

A comparatively low prevalence of the MetS was found. More females than males had the MetS. Uncontrolled diabetes and abdominal obesity were prevalent. The factors identified by our univariate logistic regression model were not significant predictors of the MetS in our multivariate model.

Medical students' achievement on the Bachelor of Medicine, Bachelor of Surgery/Chirurgery Final Part I and II licensing examination: a comparison of students in problem-based learning, community-based education and service, and conventional curricula in Ghana

PURPOSE

Problem-based learning is an established method of teaching and learning in medical education. However, its impact on students' achievement on examinations is varied and inconsistent. We compared the levels of achievement on the Bachelor of Medicine, Bachelor of Surgery/Chirurgery (MB ChB) Part I and II licensing examination of students in problem-based learning, community-based education and service (PBL/COBES), and conventional curricula.

METHODS

In 2014, we analyzed the MB ChB Final Part I and II licensing examination results of students in three classes (2004, 2005, and 2006) of the School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana. Ninety-three students in the 2004 and 2005 cohorts followed a conventional curriculum, and 82 students in the 2006 cohort followed a PBL/COBES curriculum. Using appropriate statistical tools, the analysis compared individual discipline scores and the proportions of students who received distinction/credit/pass grades among the classes.

RESULTS

The PBL students had significantly higher mean and median scores than the conventional students in Obstetrics and Gynecology, Internal Medicine, Community Health and Family Medicine, Surgery, and Psychiatry, but not in Child Health and Pediatrics. Also, a significantly (P=0.0010) higher percentage, 95.1% (n=78), of the PBL students passed all the disciplines, compared to 79.6% (n=74) of the conventional students.

CONCLUSION

The PBL students significantly performed better in all the disciplines except child health and pediatrics, where the conventional students scored higher. These findings demonstrate that the benefits of the PBL/COBES curriculum are tangible and should be fostered.

Distorted self-perceived weight status and underestimation of weight status in diabetes mellitus type 2 patients

OBJECTIVES

Diabetes mellitus type 2 (DM 2) patients' self-perception of their weight status is very critical in diabetes care. We sought to investigate perception of weight status in a sample of 200 DM 2 patients attending an outpatient clinic at a Teaching Hospital and compared it with their BMI-measured weight status, with a focus on underestimation of their weight status. Factors associated with underestimation of weight status in this sample were also explored.

METHODS

Using a cross-sectional design, anthropometric and clinical variables were assessed using appropriate tools. Questionnaires were used to collect socio-demographic data and self-perception of weight status. Self-perceived weight status was compared to BMI-measured weight status by cross-tabulation, Kappa statistics of agreement and χ2 for trend analysis. Both univariate and multiple logistic regression analysis were conducted to identify factors associated with underestimation of weight status.

RESULTS

The prevalence of general overweight/obesity and abdominal obesity was 32.0% (n = 64) and 58.0% (n = 116) respectively. Generally, 58.0% (n = 116) of the participants had a distorted weight perceived weight status in which 77.6% (n = 90) underestimated their weight status. Factors associated with underestimation of weight status were being overweight/obese (AOR = 22.9, 95% CI = 8.30-63.07, p<0.001), not married (AOR = 3.7, 95% CI = 1.50-9.17, p = 0.005) and never tried to lose weight (AOR = 6.9, 95% CI = 2.35-19.97, p<0.001). Participants aged over 40 years and those being hyperglycaemic were not significantly associated to underestimation of weight status.

CONCLUSION

We found a substantial discordance between BMI-measured and self-perceived weight status. Factors that were associated with underestimation of weight status were being; overweight/obese, not married and never tried to lose weight. Diabetes patients should be provided with information about weight guidelines.

Prevalence of obesity and systemic hypertension among diabetes mellitus patients attending an out-patient diabetes clinic in a Ghanaian Teaching Hospital

AIMS

Diabetes Mellitus is now a prevalent disease in both developed and developing countries. Overweight/obesity and hypertension are potential modifiable risk factors for diabetes mellitus and persist during the course of the disease. This study was aimed at reporting the prevalence of overweight/obesity and systemic hypertension and their association to blood glucose levels in persons with diabetes mellitus attending a diabetic clinic in Ghanaian Teaching Hospital.

MATERIALS AND METHODS

This cross-sectional study was conducted among 100 previously diagnosed diabetes mellitus patients attending a diabetic clinic at the Tamale Teaching Hospital, Ghana. Anthropometric variables of age, weight and height were measured with appropriate instruments, computed into BMI and classified according to WHO classifications. Systolic and diastolic blood pressures were measured by an appropriate instrument and classified by WHO standards. Fasting plasma glucose levels of the study participants were recorded from their personal health folder. All data was analysed by GraphPad prism version 5.

RESULTS

In general, 7.0% of the participants were underweight and 32.0% were overweight or obese. The mean±SD weight, height and BMI of the participants were 67.53±13.32, 1.68±0.12 and 24.18±5.32. Twenty-one percent of the studied participants were hypertensive. Mean±SD fasting plasma glucose of 7.94±2.82 was observed among the diabetic patients. As the prevalence of hyperglycaemia was higher among patients aged ≤40 years (88.9% vs. 75.8%), normoglycaemia (11.1% vs. 24.2%) was higher among those over 40 years. The differences were not significant. The prevalence of hyperglycaemia was significantly higher in participants with overweight/obese (0.0% vs. 41.6%, p<0.0001) than those with underweight (26.1% vs. 1.3%, p=0.0005) and normal weight (73.9% vs. 57.1%, p=0.2228).

CONCLUSION

A high prevalence of overweight/obesity and systemic hypertension was found. Hyperglycaemia was more prevalent among overweight/obese participants.

Lifestyle risk factors of general and abdominal obesity in students of the school of medicine and health science of the university of development studies, tamale, ghana

This study evaluated the prevalence of general and abdominal obesity among students of the University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS), Tamale, Ghana. Also, lifestyle risk factors for the two obesity indices were investigated. This study was conducted among a sample of 646 students. Anthropometric measures of weight, height, and waist circumference were appropriately assessed. The prevalence of general and abdominal obesity was 1.9% and 4.2%, respectively. Risk factors of general obesity were being female (crude OR = 6.9, 95% CI = 1.85-25.80, P = 0.0021), engaging in light PA (OR = 12.45, 95% CI = 2.96-52.41, P = 0.0006), being aged 28-37 years (OR = 5.37, 95% CI = 1.39-20.68, P = 0.0329), nonintake of coffee (OR = 4.1, 95% CI = 1.10-15.28, P = 0.0357), being married (OR = 5.7, 95% CI = 1.48-22.02, P = 0.0286), and being abdominally obese (OR = 02.7, 95% CI = 25.61-11.60, P < 0.0001). Risk factors for abdominal obesity were being female, being married, having general obesity, and nonintake of coffee. Abdominal obesity was more prevalent than general obesity. Risk factors included being female, married, and generally obese and nonintake of coffee.

Assessing the reliability and validity of the Revised Two Factor Study Process Questionnaire (R-SPQ2F) in Ghanaian medical students

PURPOSE

We investigated the validity and reliability of the Revised Two Factor Study Process Questionnaire (R-SPQ2F) in preclinical students in Ghana.

METHODS

The R-SPQ2F was administered to 189 preclinical students of the University for Development Studies, School of Medicine and Health Sciences. Both descriptive and inferential statistics with Cronbach's alpha test and factor analysis were done.

RESULTS

The mean age of the students was 22.69± 0.18years, 60.8% (n=115) were males and 42.3% (n=80) were in their second year of medical training. The students had higher mean deep approach scores (31.23±7.19) than that of surface approach scores (22.62±6.48). Findings of the R-SPQ2F gave credence to a solution of two-factors indicating deep and surface approaches accounting for 49.80% and 33.57%, respectively, of the variance. The scales of deep approach (Cronbach's alpha, 0.80) and surface approach (Cronbach's alpha, 0.76) and their subscales demonstrated an internal consistency that was good. The factorial validity was comparable to other studies.

CONCLUSION

Our study confirms the construct validity and internal consistency of the R-SPQ2F for measuring approaches to learning in Ghanaian preclinical students. Deep approach was the most dominant learning approach among the students. The questionnaire can be used to measure students' approaches to learning in Ghana and in other African countries.

Distorted self-perceived weight status and its associated factors among civil servants in Tamale, Ghana: a cross-sectional study

Background

Obesity has been described as an epidemic and a major public health concern globally. Distorted self-perceived weight status can negatively impact an individual’s decision to lose weight as well as adoption of healthful weight management attitudes. This study described self-perceived weight status among adults working in civil service departments in Tamale, Ghana, and compared it to their classification based on WHR. It also examined associations of distorted self-perceived weight status with weight loss attitudes, socio-demographic variables and knowledge levels on the health effects of overweight and obesity.

Methods

This cross-sectional study was undertaken from January 2011 to July 2011 among a sample of 186 civil servants living in Tamale. Out of the sample, 121 were men and 65 were women. Participants’ self-perceived weight status, socio-demographic and weight loss attitudes were assessed by means of a 10-item questionnaire. Participants’ waist and hip circumferences were measured with appropriate tools and computed into waist hip ratio (WHR) and classified based on WHO classifications.

Results

More than 80% of the participants were aged below 40 years. Generally, 56.5% (n = 105) participants had normal weight and 31.2% (n = 58) were centrally obese. The proportion of participants being centrally obese was higher in women compared to men (p < 0.0001). Forty four percent of the studied population had a distorted self-perceived weight status. Less than10% of participants self-perceived themselves as overweight/obese, in which over 47% were, in fact, overweight/obese as measured by WHR. Factors associated with distorted self-perceived weight status were being overweight/obese (Crude OR = 97.3; (35.8-264.6; p < 0.0001), aged < 40 years (Crude OR = 2.8; 95% CI = 1.3-6.5; p = 0.0102) and having inadequate knowledge on the health effects of overweight/obesity (Crude OR = 3.7; CI = 1.3-11.0; p = 0.0114). Weight loss attitudes and methods used to lose weight were not significantly associated to self-perceived weight status and WHR measured weight status.

Conclusions

Self-perceived and WHR measured weight status of participants did not conform. Distorted self-perceived weight status was not associated to weight loss attitudes but to being overweight/obese, being younger (<40 years) and having inadequate knowledge on the health effects of overweight/obesity. Educating people on accurate weight perception and the health effects of overweight/obesity should be considered in designing public health strategies to curb the rising prevalence of overweight/obesity and other non-communicable diseases in Ghana.

Topiramate: a new safe and effective antiepileptic

Twenty patients of either sex, with refractory partial epilepsy with or without secondary generalisation were entered in an open label study to evaluate the efficacy and safety of topiramate in them. Topiramate was used as an adjunctive therapy with an initial starting dose of 50 mg/day. The dose was then titrated upwards with increments of 50 mg per week, till a time the most effective and the best tolerated dose was reached. This most effective/tolerated dose was then continued for 6 months. Of the 17 patients entering the maintenance phase, 4 patients (24%) became seizure free, while a total of 14 patients (83%) out of 17 cases responded with a reduction in monthly seizures rate by 50% or more. Mean reduction of 68.9% was observed in monthly seizure rate during the maintenance phase. The median effective dose of topiramate was 600 mg per day. Five patients dropped out of the study due to adverse events such as anxiety, aggressiveness, rash, lethargy, etc. The central nervous system (CNS) related side effects such as dizziness, headache, and tremor were reported, which are commonly seen with other presently available antiepileptics like carbamazepine, phenytoin sodium, sodium valproate, etc, as well. Most adverse events, however, were mild and transient and did not interfere with the day to day activity of the patients. Topiramate was not associated with any abnormality in laboratory or neurological examination findings. The excellent response with topiramate therapy in Indian patients, uncontrolled with the available antiepileptics, as well as its good safety profile endorse the international efficacious and safe image of topiramate.

Risperidone in schizophrenia

Efficacy and safety of new antipsychotic agent-risperidone was evaluated in the confirmed schizophrenic patients of either sex, over 15 years of age. Of the 30 patients who entered the study, 27 completed the trial as per the protocol and only 3 dropped out, one was lost to follow up, the other was an uncooperative patient who pulled out of the trial due to moderate side effects while one patients withdrew the consent at his own free will. The significant improvements were seen in the broad range of symptoms of schizophrenia at various time points in the trial. The significant beneficial effect on negative symptoms was particularly obvious. The drug was well tolerated by most patients, and side effects, when reported, were mild. Even the extrapyramidal symptoms reported could be easily controlled with oral trihexyphenidyl hydrochloride. The exhaustive extrapyramidal symptom rating scale also did not show any worsening during risperidone therapy. The efficacy and safety profile of novel antipsychotic drug risperidone makes it a useful therapeutic agent in the broad range of patients with schizophrenia.