BackgroundPoor maternal health delivery in developing countries results in more than half a million maternal deaths during pregnancy, childbirth or within a few weeks of delivery. This is partly due to unavailability and low utilization of maternal healthcare services in limited-resource settings. The aim of this study was to investigate the access and utilization of maternal healthcare in Amansie-West district in the Ashanti Region of Ghana.MethodsAn analytical cross-sectional study, involving 720 pregnant women systematically sampled from antenatal clinics in five sub-districts was conducted from February to May 2015 in the Amansie-West district. Data on participants’ socio-economic characteristics, knowledge level and access and utilization of maternal health care services were collected with a structured questionnaire. Odds ratios were estimated to describe the association between explanatory variables and maternal healthcare using generalized estimating equations (GEE).Results68.5, 83.6 and 33.6% of the women had > 3 antenatal care visits, utilized skilled delivery and postnatal care services respectively. The mothers’ knowledge level of pregnancy emergencies and newborn danger signs was low. Socio-economic characteristics and healthcare access influenced the utilization of maternal healthcare. Compared to the lowest wealth quintile, being in the highest wealth quintile was associated with higher odds of receiving postnatal care (adjusted odds ratio [aOR]; 95%CI: 2.84; 1.63, 4.94). Use of health facility as a main source of healthcare was also associated with higher odds of antenatal care and skilled delivery.ConclusionThis study demonstrates suboptimal access and utilization of maternal healthcare in rural districts of Ghana, which are influenced by socio-economic characteristics of pregnant mothers. This suggests the need for tailored intervention to improve maternal healthcare utilization for mothers in this and other similar settings.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2159-5) contains supplementary material, which is available to authorized users.

BackgroundObstetric referrals, otherwise known as maternal referrals constitute an eminent component of emergency care, and key to ensuring safe delivery and reducing maternal and child mortalities. The efficiency of Obstetric referral systems is however marred by the lack of accessible transportation and socio-economic disparities in access to healthcare. This study evaluated the role of socio-economic factors, perception and transport availability in honouring Obstetric referrals from remote areas to referral centres.MethodsThis was a cross-sectional study, involving 720 confirmed pregnant women randomly sampled from five (5) sub-districts in the Amansie west district in Ghana, from February to May 2015. Data were collected through structured questionnaire using face-to-face interviewing and analyzed using STATA 11.0 for windows. Logistic regression models were fitted to determine the influence of socio-demographic characteristics and pregnancy history on obstetric referrals.ResultsAbout 21.7 % of the women studied honoured referral by a community health worker to the next level of care. Some of the pregnant women however refused referrals to the next level due to lack of money (58 %) and lack of transport (17 %). A higher household wealth quintile increased the odds of being referred and honouring referral as compared to those in the lowest wealth quintile. Women who perceived their disease conditions as emergencies and severe were also more likely to honour obstetric referrals (OR = 2.3; 95 % CI = 1.3, 3.9).ConclusionClients’ perceptions about severity of health condition and low income remain barriers to seeking healthcare and disincentives to honour obstetric referrals in a setting with inequitable access to healthcare. Implementing social interventions could improve the situation and help attain maternal health targets in deprived areas.

BackgroundIn Ghana it is estimated that 1.2% of HIV infections occur in young people aged 15-24 but the representation in our clinics is small. Adherence to treatment, appointment keeping and knowledge of HIV status remains a challenge. Disclosure has been shown to result in better adherence to therapy, good clinical outcomes, psychological adjustment and reduction in the risk of HIV transmission when the young person becomes sexually active. A baseline study was conducted to ascertain if adolescents and young adults knew their HIV status and their knowledge on HIV. Informed consent and assent were obtained from willing participants. Self-administered questionnaires on general knowledge of HIV, HIV treatment and disclosure were collected and analyzed.ResultsThirty-four young persons participated in the study. The mean age was 16.9 ± SD 2.5 and 62% (21/32) were female. All of them were still in school. Eighty-five percent were aware that young people their age could fall sick, 91% had heard of HIV, 70% knew someone with HIV and 45% thought that adolescents were not at risk of HIV. On modes of HIV transmission, 66.7% knew HIV was transmitted through sex and 63.6% knew about mother to child transmission. Fifty three percent (18/34) knew their HIV status, 50% (17/34) were on antiretroviral and 35% (6/17) of them admitted to missing ARV doses. One person who said he was HIV negative and another who did not know his status were both on ARVs.ConclusionDisclosure of HIV status to adolescents and young people is dependent on a complex mix of factors and most practitioners recommend an age and developmentally appropriate disclosure. Thus it is highly individualized. The knowledge and awareness of HIV was 91% compared to 97% of adults in the most recent Ghana Demographic and Health Survey however only about two thirds had acceptable in depth knowledge on HIV. Only half knew their HIV status which was not the best considering their ages. There is the need to strengthen education to young persons with HIV, support adhere to ARVs for better outcomes and assist care givers to disclose HIV status to them.

A277the Sample Czar nonprofit-focused panel or All Global online consumer panel. Patients were U.S., aged ≥ 18, with no prior biologic experience. Only patients that responded consistently with non-contradictory responses were included in this analysis. 170 patients responded consistently to preference questions and 169 patients responded consistently to openness questions. In order to compare physician responses about their patient population vs. patient responses, population samples for both were derived using bootstrapping statistical techniques (responses were randomly over sampled 10,000 times with replacement).A stratified-analysis of responses of Minority patients vs White/Undetermined patients was conducted. Student t-tests were used to calculate p-values. Only results displaying p-values were significant. Results: OPENNESS: Physicians significantly overestimated patients openness to biologics in general, (85.46% vs 74.61% respectively, p< .0001) but, underestimated patients openness to Intravenous (IV) MOA (55.97% vs. 63.96% respectively). Minority patients (N= 42) showed greater openness to biologics (92.90%), to IV MOA (83.32%), and SQ MOA (90.52%) compared to White/ Undetermined patients (68.44%, 57.45%, 59.77% respectively N= 127). PREFERENCE: Overall physicians significantly underestimated patients' preference to IV MOA (22.07% vs 24.35% respectively, p< .0001) and SQ MOA (48.84% vs 54.69 respectively p< .0001). Minority patients (N= 27) had greater preference for IV MOA (59.23%), and a lower preference to SQ MOA (40.77%) compared to White/Undetermined (39.25%, 57.24% respectively N= 143). ConClusions: The results from this study suggest differences between minority and white/undetermined patients' openness and preferences to biologics and biologic MOA highlighting the importance of cultural factors in shared decision making.

without a time limit from inception to June 2019. Inclusion criteria were: studies published in English or Arabic, and conducted in Saudi Arabia. Results: thirty tow studies of 67 published studies met the inclusion criteria which conducted in Saudi Arabia. Observational cross-national was the manly methods used to investigate selfmedication practice in the selected studies. Seven of these Studies were conducted in Riyad. Non-steroidal anti-inflammatory drugs, antibiotic, vitamins are the most common medicines that involved in the self-medication practice in Saudi. Conclusions: Self-medication practice is common among patients in Saudi Arabia. Special attention should be given to educating the public and health care providers on which illnesses for which they can seek self-medication without the advice of a healthcare provider, and responsible governmental and nongovernmental organizations should work hard to ensure the rational use of medication