Factors influencing attendance to immunization sessions for children in a rural district of Ghana.

Improving immunization coverage is vital to promoting child health and reducing childhood diseases and deaths. In spite of being actively promoted as a major public health intervention for national development since the late 1970s, immunization coverage in Ghana remains low. We investigated factors that influence attendance to immunization sessions in the Komenda-Edina-Eguafo-Abrem District of Ghana. The major factors hindering attendance were poor knowledge about immunization, lack of suitable venues and furniture at outreach clinics, financial difficulties, long waiting times, transport difficulties, poorly motivated service providers and weak intersectoral collaboration. The timing of immunization sessions, length of prior notice to the community, attitude of service providers and fear of side-effects generally did not deter attendance.

PIP: Although childhood immunization has been a major national development goal in Ghana since the late 1970s, coverage rates remain low. In 1992, coverage for the third dose of diphtheria-pertussis-tetanus (DPT) was 43% for children under 12 months of age. The present study, conducted in August 1993, used focus group discussions and interviews with 469 mothers of children under 2 years of age, 17 service providers, and 10 heads of health-related sectors, to investigate factors influencing attendance to immunization sessions in Ghana's Komenda-Edina-Eguafo-Abrem District. 73% of mothers reported they attended child welfare clinics regularly. The main factors motivating mothers to attend were the perceived benefits of immunization for disease prevention, its impact on socioeconomic development, the relatively low cost of disease prevention, and the need for vaccination cards for school entry. The major factors hindering attendance were poor knowledge about immunization, lack of suitable venues and furniture at outreach clinics, financial difficulties, long waiting times, transportation problems, poorly motivated service providers, and weak intersectoral collaboration. The timing of immunization sessions, length of advance notice to the community, attitude of service providers, and fear of side effects generally did not deter attendance. Attention to the obstacles to compliance with childhood immunization schedules is essential if Ghana is to achieve the goal of 80% coverage by the year 2000.

The availability and cost of antibiotics for treating PID in the Central Region of Ghana and implications for compliance with national treatment guidelines.

The availability and cost of antibiotics for treating pelvic inflammatory disease (PID) were assessed in 17 drug-dispensing outlets in 5 districts of the Central Region, Ghana. The outlets included the dispensaries of 2 regional and 4 district hospitals, 4 privately-owned pharmacies and 7 chemical seller shops. The most common antibiotics available, including co-trimoxazole, metronidazole, benzylpenicillin, amoxycillin, chloramphenicol and gentamicin, were also the lowest-priced drugs. Conversely, the most expensive antibiotics including ceftriaxone, ciprofloxacin, cefuroxime and spectinomycin, were also the least commonly available. Recommended anti-gonococcal antibiotics (ciprofloxacin, ceftriaxone) may not be prescribed if they are not available in the districts.

PIP: This paper assessed the availability and cost of antibiotics used for treating pelvic inflammatory disease in 17 drug-dispensing outlets in five districts of the Central Region, Ghana. The outlets included the dispensaries of 2 regional and 4 district hospitals, 4 privately owned pharmacies, and 7 chemical seller shops. The most common antibiotics available, including cotrimoxazole, metronidazole, benzylpenicillin, amoxycillin, chloramphenicol, and gentamicin, were also the lowest priced drugs. In contrast, the most expensive antibiotics, including ceftriaxone, ciprofloxacin, cefuroxime, and spectinomycin, were also the least commonly available. Recommended anti-gonococcal antibiotics (ciprofloxacin, ceftriaxone) may not be prescribed if they are not available in the districts.

The management of pelvic inflammatory disease in the Central Region of Ghana is not standardized.

We evaluated the management of pelvic inflammatory disease (PID) in 2 regional level hospitals and 4 district hospitals of the Central Region of Ghana. We retrospectively reviewed 208 case notes of inpatients clinically diagnosed with PID and interviewed 25 clinicians at these hospitals. Overall, 20 antibiotics were prescribed in 62 different regimens. Between 9 and 26 antibiotic regimens were prescribed in each hospital. Metronidazole, gentamicin, amoxycillin, ampicillin, benzylpenicillin and tetracycline were frequently prescribed while the recommended anti-gonococcal antibiotics, ciprofloxacin and ceftriaxone, were rarely prescribed. The commonest regimens were prescribed for a shorter duration than recommended. Condom promotion, partner notification and management were scarcely or never undertaken. Fifty-six per cent of clinicians had never seen the national treatment guidelines; 32% had received in-service training in STD case management. The findings provide the basis for improving the management of PID in the Central Region of Ghana.

PIP: An evaluation of the clinical management of pelvic inflammatory disease (PID) conducted in 1997 at two regional and four district hospitals in Ghana's Central Region revealed vast procedural inconsistencies and errors. The analysis was based on a review of the case notes of 208 women hospitalized with PID in 1996 and interviews with 25 hospital clinicians. 19 clinicians (76%) treated their PID patients empirically since laboratory facilities were unavailable or expensive. Overall, 20 antibiotics were prescribed in 62 different regimens. A mean of 2.9 antibiotics was prescribed per patient. Metronidazole, gentamicin, amoxycillin, ampicillin, benzylpenicillin, and tetracycline were the most frequently supplied antibiotics, while the recommended antigonococcal antibiotics ciprofloxacin and ceftriaxone were rarely offered. Moreover, regimens were prescribed for shorter durations (average, 7 days) than recommended. Condom promotion, partner notification, and partner treatment were rarely offered. Only 99 women (48%) were scheduled for a follow-up visit after hospital discharge. 56% of clinicians were unaware of national PID treatment guidelines and only 32% had received in-service training in sexually transmitted disease management. These findings indicate an urgent need for standardization of PID case management, a greater emphasis on partner notification and condom promotion, and more widespread distribution of and in-service training on the national PID guidelines.

Survey of antibiotic prescribing pattern in government health facilities of the Wassa west district of Ghana.

Antibiotic prescribing patterns was studied from 700 retrospective outpatient clinical records from seven government health facilities in the Wassa West district of Ghana. Prescribing patterns were compared between the district hospital and six health centres. The percentage of patients receiving one or more antibiotics was significantly more at the health centres(60.7%) than at the hospital(41.0%) (chi 2 = 13.6; p < 0.001). The average number of antibiotics prescribed per patient was 1.4 and 1.1 respectively. The commonest antibiotics prescribed were procaine penicillin, cotrimoxazole, benzylpenicillin, metronidazole and amoxycillin. Malaria, upper respiratory infections, soft tissue infections and diarrhoeal diseases were the commonest indications for antibiotic use. Factors such as the availability of diagnostic facilities, type of prescriber, lack of refresher training and patient demand were considered to significantly influence antibiotic prescribing.

Susceptibility of urinary tract bacteria to antibiotics in Cape Coast, Ghana.

A total of 857 urine specimens were received at the Cape Coast Central Hospital between 1993 and 1995 for microscopy, culture and sensitivity. Of these, 225 (26.2%) yielded significant bacterial growth. Twelve organisms were isolated with Escherichia coli, coliforms and Klebsiella species accounting for about 79% of all bacterial isolates. Over 76% of isolates were resistant to cotrimoxazole, ampicillin and tetracycline. However, over 81% were sensitive to cefuroxime, gentamicin, nalidixic acid and nitrofurantoin. Except for cefuroxime, the sensitivity of isolates to all antibiotics tested were generally lower in 1995 than in 1993. A decreasing trend in the antibiotic sensitivity of E. coli over the three-year period was observed.

Epidemiology of measles in the Central Region of Ghana: a five-year case review in three district hospitals.

OBJECTIVE: As part of a national accelerated campaign to eliminate measles, we conducted a study, to define the epidemiology of measles in the Central Region. DESIGN: A descriptive survey was carried out on retrospective cases of measles. SETTING: Patients were drawn from the three district hospitals (Assin, Asikuma and Winneba Hospitals) with the highest number of reported cases in the region. SUBJECTS: Records of outpatient and inpatient measles patients attending the selected health facilities between 1996 and 2000. Data on reported measles cases in all health facilities in the three study, districts were also analysed. MAIN OUTCOME MEASURES: The distribution of measles cases in person (age and sex), time (weekly, or monthly, trends) and place (residence), the relative frequency, of cases, and the outcome of treatment. RESULTS: There was an overall decline in reported cases of measles between 1996 and 2000 both in absolute terms and relative to other diseases. Females constituted 48%-52% of the reported 1508 cases in the hospitals. The median age of patients was 36 months. Eleven percent of cases were aged under nine months; 66% under five years and 96% under 15 years. With some minor variations between districts, the highest and lowest transmission occurred in March and September respectively. Within hospitals, there were sporadic outbreaks with up to 34 weekly cases. CONCLUSION: In Ghana, children aged nine months to 14 years could be appropriately targeted for supplementary, measles immunization campaigns. The best period for the campaigns is during the low transmission months of August to October. Retrospective surveillance can expediently inform decisions about the timing and target age groups for such campaigns.

A 1-day survey of drug prescribing patterns in the District General Hospital of the Wassa West District of Ghana.

A 1-day prevalence survey of the drug prescribing patterns for 45 in-patients of the Tarkwa Government Hospital was undertaken in November 1995. An average of 3.6 drugs were prescribed per patient. The commonest prescribed drugs were paracetamol, chloroquine, amoxycillin, gentamicin and ampicillin. Of 162 drug items prescribed, 93.2% were on the national Essential Drugs List (EDL) and 61.1% were prescribed by their generic names. Over 60% of the patients received one or more injectable drugs or antibiotics. The use of injectable drugs on the wards ranged from nil on the male surgical ward to 90.9% on the male medical ward. The most frequently prescribed injectable drugs were gentamicin, ampicillin, chloroquine, benzylpenicillin, dextrose and pethidine. The main indications for antibiotic use were post-Caesarean delivery, pneumonia, accidents, abscesses and meningitis. The findings provide the basis for monitoring drug prescribing patterns and for evaluating any interventions to improve prescribing behaviour and the treatment of diseases.

An audit of prescribing practices in health care facilities of the Wassa West district of Ghana.

While many health districts recognise that irrational prescribing leads to wastage of drugs, few monitor prescribing practices. We investigated drug use in government health facilities in the Wassa West district of Ghana. Retrospective prescribing data were obtained from 700 outpatients' clinical record cards in 7 government health facilities in the district. Prescribing patterns were significantly worse in the health centres than in the district hospital in terms of polypharmacy, use of injectable drugs and antibiotics. Overall, 4.8 drugs were prescribed per patient, 97% of drugs were on the national essential drugs list and 65% of drugs were prescribed by their generic names. Antibiotics and injectable drugs were prescribed for 60% and 80% patients respectively. The observed patterns were related to the cadre of prescribers, availability of diagnostic facilities, participation in recent refresher training and patient demand. Measures to improve prescribing practices are discussed.

A comprehensive review of the policy and programmatic response to chronic non-communicable disease in Ghana.

INTRODUCTION: Chronic non-communicable diseases (NCDs) in Ghana have caused significant illness and death in Ghana for many years. Yet, until recently, they have been neglected and not considered a health priority. This paper reviews the national policy and programme response to chronic NCDs over the period 1992 to 2009. METHODS: Unpublished reports, documents, relevant files of the Ghana Health Service (GHS) were examined to assess programmatic response to chronic NCDs. Literature was searched to locate published articles on the epidemiology of chronic NCDs in Ghana. The websites of various local and international health institutions were also searched for relevant articles. RESULTS: Several policy and programme initiatives have been pursued with limited success. A national control programme has been established, NCDs are currently a national policy priority, draft tobacco control legislation prepared, public education campaigns on healthy lifestyles, instituted cervical cancer screening and a national health insurance system to reducing medical costs of chronic NCD care. Major challenges include inefficient programme management, low funding, little political interest, low community awareness, high cost of drugs and absence of structured screening programmes. Emerging opportunities include improving political will, government's funding of a national cancer screening programme; basic and operational research; and using funds from well-resourced health programmes for overall health system strengthening. CONCLUSIONS: Although Ghana has recently determined to emphasise healthy lifestyles and environment as a major health policy for the prevention and control of chronic NCDs, low funding and weak governance have hindered the effective and speedy implementation of proposed interventions.

Syndromic management of sexually transmitted diseases: is it rational or scientific?

Control of sexually transmitted diseases improves the reproductive and sexual health of afflicted individuals and lowers the community burden of HIV. Preventing STDs or their complications requires health education, condom promotion and effective case management. Clinical diagnosis is frequently incorrect while laboratory-confirmed aetiological diagnosis is expensive. In resource-poor countries which lack trained personnel and laboratory facilities, syndromic management remains a rational approach to STD care. Although the approach is simplistic in design, its successful implementation requires regular monitoring and evaluation of protocols as well as supervision and training of clinicians.