AFTER CHILDBIRTH, WHAT NEXT?

By: Patience Anokye, Head of Medical Research Team

Of all the things most women desire in the world, child-bearing is a priority because only that proves their womanhood especially in Africa.

Having a child, however, is just one part of the story: ensuring the full growth of the newborn baby and helping the mother to regain her energy when both are discharged from hospital is where most new mothers get problems.

According to best practices, a lactating mother needs to eat nourishing meals with a lot of body-building foods as well as fruits and green vegetables that contain essential minerals such as iron and vitamins.

This is to build up her strength in order to be fit and also to help produce breast milk for the baby. Foods rich in iron will help to replace the blood lost during labour. Mothers who do not eat well balanced diet after delivery lose body weight and become lean over a period of prolonged lactation.

Apart from the nutrition aspect, best practices say after delivery, mothers must regularly wash their female organ with lukewarm water with edible salt added to it and must also sit on warm water. This would help prevent an offensive odour and general discharge.

Mothers who have just had a baby need sufficient sleep and rest to help keep up a good supply of breast milk. Studies have shown that it is not good for a lactating mother to lift heavy things and engage in tedious work until her womb and birth passage return to their normal state.

Moreover, it takes six or more weeks before new mothers overstretched muscles return to normal. Hence, they need postnatal exercises to help their muscles and ligaments regain their natural strength.

Nevertheless, care of the new born is also crucial. Midwives and health workers maintain that breast milk is the ideal food for the newly born baby. Breast feeding should be started the same day the baby is born.

Experience in most countries have shown that most babies thrive well and show adequate growth in the first four to six months of life on their mothers' milk.

The various nutrients in mothers' breast milk are balanced for optimum growth of the baby and also contain several substances which act in combination as defense mechanism against infection.

Nevertheless, it is also essential to keep the breast and nipples clean. For example, mothers should keep their nails clean and short and must not touch their nipples with unwashed hands or wipe them with anything like a handkerchief. This is to prevent germs from entering the baby's mouth.

Infection is one of the dangers to babies so hand-washing before handling babies and after changing napkins as well as feeding are essential.

Babies' napkins and plastic pants need to be changed as soon as they are soiled and be washed daily to avoid an unpleasant odour. When wet napkins are left on babies for too long especially under plastic pants, they could cause sore buttocks (sore buttocks begin as a reddened area).

It is good to use bibs for babies. If worn at feeding times, they keep babies' dress neat, but plastic bibs are not advisable because they can blow over to cover babies face and let them suffocate. Although an expectant mother takes pride in her baby's dresses, it is important for her to consider warmth, comfort, style and fabrics when selecting clothes for her baby.

For example, babies must be kept warm without causing undue perspiration, irritation of their skin or clothes which hinder their movement.

Babies clothing should also not interfere with their desire to wriggle and kick; because health workers are of the view that movements of babies stimulate the circulation of blood, absorption of food as well as developing the muscles in readiness for sitting, standing and walking.

Furthermore, care should be taken when handling, dressing or bathing babies. Since new born babies have weak spines, necks and muscles, mothers must always support the heads and spine of their babies properly. Most mothers unfasten the back of the dresses of young babies while they hold them in a sitting posture. Experts maintain that it is advisable to turn babies over and lay them face down on the lap when dressing them.

The care of babies' skin is equally important. Because the texture of babies' skin are so fine, they are easily irritated, and it is better to use good and quality baby soaps, creams and powders for them to prevent irritation of their skin.

Apart from all the care that needs to be given babies in the house it is also very important for mothers to seek medical advice from the nearest hospitals on the type of foods to give the babies as they grow.

Mothers should also send their babies to medical centres for the treatment and dressing of their cords and for immunization against diseases.

My name is Patience Anokye, a health practitioner, and by the time I leave this world, it must be better than I found it.

 

REDUCING INTERCITY BUS TRAVELS IN GHANA: AN IMPLICATION FOR A ROBUST TRANSPORT POLICY

Transport is a fundamental part of every nation’s economy, allowing people to travel to and from work, and ensuring that goods and services are effectively delivered. Intercity bus service thus plays a critical role in transporting residents, especially people who do not have cars, cannot drive, or choose not to drive.

On the other hand, it has also been argued by some transport economists that intercity transit can have various costs, many of which tend to be overlooked or undervalued (Armstrong-Wright, 1993; Litman, 2016). For instance, Litman argues that traffic congestion, pollution imposed on non-users and accident risk imposed by transit vehicles are usually caused by intercity bus travels. Transport infrastructure of many nations are now coming under significant and multiple pressures due to urbanization, rising global populations and environmental challenges. It is estimated that about 3 million people move into cities every week and that soon there will be nearly 2 billion cars in use in the world, placing pressure on already stretched transport infrastructures.

In Ghana, cities perform several higher order functions; hence people commute to these cities daily to engage in all forms of activities. As a result, large volumes of intercity buses use the National highways (N routes) daily. However, the increasing number of buses on these corridors (N routes) can be seen to have several disadvantages. These shortcomings are made manifest through long queues and waiting time at bus terminals, long journey time, high bus fares, road accidents, traffic congestion, deterioration of road surface, rising maintenance cost of vehicles, high fuel consumption and adverse environmental effects (including CO₂ emissions).

In spite of the foregoing challenges, it appears very little has been done to tackle the shortcomings in a comprehensive manner. Mulligan (2014) has stated that the efforts are usually concerned with expanding road infrastructure. This has often come at the expense of public transport services and severely congested roads have been the result.

An alternative solution worth considering is the role of Information and Communications Technology (ICT) in reducing intercity bus travel. Empirical studies conducted by ANOKS Research have confirmed that many intercity bus travel purposes could be reduced through the use of ICT. Shrivastava (2012) alludes to this assertion by stating that ICT could play a vital role in bringing the vision for convenient, joined up, multi-modal sustainable mobility to reality. For instance, ICT can facilitate travel demand reduction through video-conferencing and telepresence systems, net meetings, voice over internet protocol systems such as Skype and Hotmail messenger which now include video facilities, facilities to enable home or remote working (including work hubs), shopping ordered from and delivered to homes, and even via synthetic environments.

ICT should therefore be seen as an enabling tool within a wider transport policy framework designed to create sustainable travel behaviours. There should therefore be an evolution of a more ICT oriented and comprehensive approach adopted to formulate transport policies generally aimed at solving urban transport problems.

My name is Kofi Anokye, a development enthusiast, and by the time I leave this world, it must be better than I found it. Brains, not natural resources, develop a nation!

THE NON-USE OF FOOTBRIDGES IN AFRICA: MOVING THE DEBATE FROM PROBLEMS TO SOLUTIONS

INTRODUCTION:

One of the most salient aspects of Africa is its unfortunate traffic situation and the reasons are numerous and diverse (Sabet, 2013). According to Asian Development Bank (2011), accompanying the increase in Africa’s population has been a rise in the number of vehicles on the road. Unfortunately, transport infrastructure has failed to keep up with this dramatic growth; and perhaps more importantly, the existing infrastructure is often poorly planned or introduced after development occurs. The rapid increase in the number of motor vehicles on highways has created a major social problem - the loss of lives through road accidents. The appalling human misery and the serious economic loss caused by road accidents along highways demand the attention and calls for a solution to the problem. 

 

Road accidents claim many lives every year and most of these accidents involve pedestrians. This finding is supported by Sabet (2013) that in low to middle income countries in particular, pedestrians and cyclists account for the major proportion of road traffic injuries. The effect of the high number of pedestrian injuries in low to middle income countries includes not only the physical consequences of disablement and death, but also carries a psychosocial burden of trauma for both the victims and their families (Peden et al., 2004). Moreover, the economic impact on a broader societal level clearly identifies pedestrian injury as a serious public health concern and intervention in this area as a major challenge.

These road accidents can be lessened by providing pedestrian crossing facilities coupled with strict enforcement to ensure that the facilities are put into use in addition to creating public awareness through civic education. In this regard, a contributing factor in facilitating the flow of pedestrian movement is creating over/underpass. Pedestrian bridges (footbridges) can address real or perceived safety issues and can represent one of the most important elements of a community’s non-motorized transportation network (Manjanja, 2013).

According to Hasan and Napiah (2014), accidents between pedestrians and vehicles were studied in terms of minimizing conflict between these two modes while maintaining the continuous free motor traffic flow and the safety environment for pedestrians who are the most vulnerable road users. Therefore, the classic approach to pedestrian safety improvements is the separation from vehicles either by space or time. A way to achieve that is by grade separation built either above or below the street level. Accordingly, such physical changes to the environment can significantly decrease the rate of pedestrian-vehicle crashes (Retting et al., 2003).

Pedestrian bridges are provided at locations where high vehicle speeds and heavy traffic volumes take place, where there are hazardous pedestrian crossing conditions like in areas where there are few or no gaps in the traffic stream, conflicts between motorists and pedestrians and in locations where large numbers of school children cross busy streets. The construction of footbridges at hazardous road locations is gradually increasing in Africa. In countries such as Ghana, Kenya and Tanzania, governments have provided a considerable number of footbridges on various major highways so as to ensure safe crossing of pedestrians and to reduce existing pedestrians and vehicular conflicts.

SITUATIONAL ANALYSIS:

In the words of Hasan and Napiah (2014), footbridge is one of the safest pedestrian crossing facilities, yet most often pedestrian do not use it, and prefer to cross the road on the surface. International research in low to middle income countries have shown that pedestrian safety interventions are underutilised. Despite the high number of pedestrian deaths and the construction of a number of footbridges in African countries such as Ghana, Kenya, South Africa and Tanzania, pedestrians in these countries still opt to risk their lives in crossing the roads (Ojo et al., 2022; Hassan et al., 2020). 

It is indicated by Zegeer (2002) that if a pedestrian can find more direct route and same or less time to cross at street level, the usage of the footbridge will be decreased, and the risk probability will be increased. Manjanja (2013) has explained that the non-use of footbridges is among the major reasons for mishaps on the city streets. And yet despite the severity of the problem, traffic laws go largely unenforced, creating an environment whereby drivers and pedestrians can act without concern for legal consequences. 

SUMMARY OF FINDINGS FROM CASE STUDIES:

     This section looks at key findings on footbridge facility in some selected African countries including Kenya, Tanzania, Ghana and South Africa.

     (1) The new approaches of urban and transportation planning are being aimed to facilitate pedestrian movement and improve the quality of spaces denoted specifically to pedestrians recently. 

     (2) Footbridges are popular but often ineffective. The footbridge as a facility is to separate pedestrian from motor vehicle traffic. Though theoretically true, but in practice this rarely occurs for several reasons such as:  

     (i) Bridges are so expensive, and cannot be built at most locations where pedestrians may prefer to cross.

     (ii) Many pedestrians will not walk extra distance in their trip, and because of the accessible ramps which will increase the distance, they will cross at grade level. 

     (3) Despite the high number of fatalities, despite the obvious risks, and despite conclusive evidence of the problem, pedestrians might not take even simple steps that are fully within their control to improve their safety. 

     (4) The structural design of the footbridge has a great effect on the usage of it; therefore, it should comply with the recommended standards designs. The main factors hindering the effective usage of the facility include security, time constraints, tiredness, dizziness, inadequate facilities to support disabled, aged people and the sick. 

     (5) Some pedestrians preferred signalized crossing to bridges and underpasses and that was mainly because of the ascending and descending movements required on these facilities and the effort involved in climbing a grade which is resulted from the vertical dimension of the stairs slope. 

      (6) In Kenya, there has been fencing along sides of the street or in the median for several hundred feet on either side of the grade-separated crossing to raise the efficiency of the usage. The existence of the fence on both sides of the street plays an important role in preventing pedestrians from jaywalking, especially if it is built in continually shape with no spaces, and for long and convenient distance. 

     (7) Studies contend that the decision to use a pedestrian bridge is not so much the product of risk  assessments or probabilities, but of simple habit. From this perspective, those that have used a  footbridge in the past are more likely to use it in the future and those who cross the street dangerously in today are more likely to do the same tomorrow.  As such, past behaviour will be the best predictor of footbridge use. 

     (8) Footbridges are generally made to provide pedestrians a safe route to cross roads. However, the occurrences of accidents and jaywalking in Kenya, Tanzania, Ghana and South Africa prove that footbridges are underutilized by pedestrians in these countries.

 

RECOMMENDATIONS:

     Based on the findings of the study, the following solutions have been provided to enhance and sustain footbridge usage by pedestrians. 

     (1) Adopt user-friendly designs for the benefit of all persons (pedestrians). Thus, footbridges should be user friendly. The criteria for user friendliness are:

• The design of footbridges should be modified to accommodate the disabled, aged people, the sick and cycle traffic.
•  Footbridges should be free from all commercial and other activities.
• All footbridges should be free of any billboard or ads of any form.
• Good access to footbridges is a must. Good access means convenient approach to the footbridges without any encumbrance. For example, an appropriate location for a footbridge should be near a bus stop. Location consideration should be a priority.
• Footbridges should be aesthetically beautiful and well maintained.
• Footbridges should have security lighting for pedestrians.
• There should be police patrol during the night especially for the covered footbridges. 

      (2) Fencing the road dividers and the footpath are the effective method to direct the pedestrians towards the footbridges. Fencing the road dividers and awareness campaigns for the pedestrians and vehicles operators should be promoted to ensure safe road crossing.

     (3) Public education and awareness campaign for use of footbridges should be organized. Education and public relation program must be conveyed to people so that they are aware of current law enforcement on footbridge uses.

     (4) Pedestrian safety measures must take cognisance of the local context of perceived and real crime, poverty and increased urbanisation and adopt a multidimensional approach. The focus on educational interventions must widen to include engineering measures that recognise pedestrians as significant road users.

     (5) City authorities must pay attention on building footbridges that not only serve the real needs but encourage the use by pedestrians. Feasibility studies should focus on pedestrians’ behavioural characteristics and attitudes in order to determine the right, safe and efficient footbridge designs and locations.

CONCLUSION:

The study concludes that much remains to be done on footbridges in their construction technology so as to attract more pedestrians and cyclists to use the facility effectively. The study envisages that the use rate is likely to improve if safety benefits and convenience of using the footbridge without considerable time loss are clearly visible to pedestrians. On the other hand, the challenge of getting pedestrians to use footbridges will fail when there is absence of sustained planning, improved infrastructure, enforcement and educational efforts.

 

REFERENCES:

Asian Development Bank (2011). Sector assessment: Transport. Country Partnership Strategy: Bangladesh 2011-2015. Asian Development Bank.

Hasan, R. A., and Napiah, M. B. (2014). The Effect of Structure and Street Characteristics on the Footbridge Usage. Journal of Applied Science and Agriculture, 9(21) Special 2014, Pages: 52-59.

Hasan, R., Oviedo-Trespalacios, O., Napiah, M. (2020). An intercept study of footbridge users and non-users in Malaysia. Transportation Research Part F: Traffic Psychology and Behaviour, 73, 66–79. doi:10.1016/j.trf.2020.05.011. 

Manjanja, R.A. (2013). Non-Usage of Pedestrian Footbridges in Kenya: The Case of Uthiru Pedestrian Footbridge on Waiyaki Way. School of Engineering of University of Nairobi.

Ojo, T. K., Appiah, A. B., Obiri-Yeboah, A., Adebanji, A. O., Donkor, P., Mock, C. (2020). An intercept survey of the use and non-use of footbridges in Ghana. Case Studies on Transport Policy. https://doi.org/10.1016/j.cstp.2022.05.016.

Peden M., McGee, K., and Sharma, G. (2002). The injury chart book: A graphical overview of the global burden of injuries. Geneva, World Health Organization.

Retting, R.A., S.A. Ferguson, and A.T. Mccartt (2003). A review of evidence-based traffic engineering measures designed to reduce pedestrian-motor vehicle crashes. American Journal of Public Health, 93: 1456-1463.

Sabet, D.M. (2013). Fear Is Not Enough: Testing the impact of risk on pedestrian behaviour in Dhaka, Bangladesh. Center for Enterprise Society.

Zegeer, C. S. (2002). Pedestrian Facilities Users Guide: Providing Safety and Mibility-Publication No. FHWA-RD-01-102. New York, U.S. Department of Transport, Federal Highway Administration.