Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya = 50%, Ghana = 53%) and poor data concordance between child registers and facility tally sheets (Kenya = 0%, Ghana = 3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.

Challenges associated with coronavirus disease (COVID-19)-related self-quarantine in Ghana: lessons for future self-quarantine interventions.

Introduction: self-quarantine was one of the key public health interventions in halting the spread of the coronavirus disease (COVID-19) in Ghana. Despite its success, self-quarantine was bridled with challenges across the country, including in the Eastern Region. Consequently, it was pertinent to ascertain these challenges to inform future self-quarantine interventions in the region and the country. The study aimed to ascertain challenges faced by COVID-19 self-quarantined persons in the Eastern Region of Ghana to inform future policies on self-quarantine in the region and the country in general. Methods: thirty-five (35) participants were interviewed in both Twi and English. Following the thematic content analysis approach, Atlas. ti software was used to analyse the data. Relevant quotes were extracted from the transcripts to back the various sub-themes in presenting the results. Results: three global themes emerged from the analyses: socio-economic challenges of self-quarantine (lack of access to essential goods and services, loss of income, and poor housing conditions), health-related challenges (sedentary lifestyle, non-supply of essential personal protective equipment such as face masks, development of oedema and weight gain), and psychological challenges (loneliness, boredom, and anxiety). Conclusion: COVID-19-related challenges self-quarantined persons faced in the Eastern Region of Ghana were multifaceted, ranging from socio-economic, and health to psychological ones. Consequently, emergency preparedness for future pandemic control using self-quarantine as a tool should bring on board various stakeholders to ensure challenges identified in this study are holistically addressed and do not recur.

Factors associated with COVID-19 knowledge among Ghanaians: A national survey.

BACKGROUND: Adequate knowledge about COVID-19 in a population may be relevant in the fight to control its spread among the populace. Thus, the aim of this study was to assess the factors associated with real knowledge of COVID-19 among Ghanaians to promote effective dissemination of appropriate information aimed at containing the spread. METHODS: A cross-sectional online survey and computer assisted telephone interviews (CATI) was conducted among Ghanaians aged 18 years and above across the 260 districts of Ghana. The survey assessed the level of knowledge of COVID-19 and its associated factors and compared differences between perceived and real knowledge. One district health promotion officer per district was trained for the data collection. Participants were recruited via use of phone directories of both organized and non-organized local district groups. Phone calls were made to randomly selected phone contacts to schedule options for participation in the study. We used multivariable logistic regression to investigate the associated factors of COVID-19 knowledge among respondents. RESULTS: Of the 2,721 participants who completed the survey, the majority (99.3%) were aware of the existence of the COVID-19 outbreak, had good knowledge on infection prevention (87.0%) and rated their knowledge about COVID-19 as good (81.7%). Factors associated with COVID-19 knowledge were: age ≥56 years (aOR = 0.5; CI: 0.3-0.8; p = 0.002), tertiary education (aOR = 1.8; CI: 1.2-2.6; p = 0.003), residing in Greater Accra region (aOR = 2.0; CI: 1.1-3.6; p = 0.019), not infected with the novel coronavirus (aOR = 1.5; Cl: 1.0-2.1; p = 0.045), knowing an infected person (aOR = 3.5; CI = 1.5-7.9; p = 0.003), good practice of effective preventive measures (aOR = 1.2: Cl: 1.1-1.5: 0.008), not misinformed (aOR = 0.7; Cl: 0.5-0.9; 0.015), and perceiving spreading speed of the virus as slow (aOR = 0.7; Cl: 0.5-0.9; 0.007). CONCLUSION: The study found good knowledge regarding COVID-19, control measures, and preventive strategies. The Ghana Health Service should continuously provide accurate information to educate the media and citizens to prevent misinformation, which is vital in stopping the spread of the COVID-19 virus.

Breastfeeding and weaning practices among mothers in Ghana: A population-based cross-sectional study.

BACKGROUND: Children need good nutrition to develop proper immune mechanisms and psychosocial maturity, but malnutrition can affect their ability to realize this. Apart from the national demographic and health survey, which is carried out every 5 years, there have not been enough documented studies on child breastfeeding and weaning practices of caregivers in the Volta Region. We, therefore, examined child breastfeeding and weaning practices of mothers in the Volta Region of Ghana. METHODS: A sub-national survey method was adopted and a semi-structured questionnaire was used to collect data from 396 mothers and their children. Descriptive and inferential statistics comprising frequency, percentage, chi-square, and logistic regression were employed in analysing the data. We defined exclusive breastfeeding as given only breast milk to an infant from a mother or a wet nurse for six months of life except drops or syrups consisting of vitamins, minerals, supplements, or medicines on medical advice, and prolonged breastfeeding as breastfeeding up to 24 months of age. RESULTS: The prevalence of exclusive breastfeeding (EBF) was 43.7%. Mothers constituting 61.1% started breastfeeding within an hour of giving birth. In addition to breast milk, 5.1% gave fluids to their children on the first day of birth. About 66.4% started complementary feeding at 6 months, 22.0% breastfed for 24 months or beyond, while 40.4% fed their children on-demand. Child's age (AOR: 0.23, 95% CI:0.12-0.43, p<0.0001), prolonged breastfeeding (AOR: 0.41, 95%CI: 0.12-0.87, p = 0.001), mother's religion (AOR: 3.92, 95%CI: 1.23-12.61, p = 0.021), feeding practices counselled on (AOR: 1.72, 95%CI: 1.96-3.09, p = 0.023), mother ever heard about EBF (AOR: 0.43, 95%CI: 1.45-2.41, p = 0.039), child being fed from the bottle with a nipple (AOR: 1.53, 95%CI: 1.94-2.48, p = 0.003), and age at which complementary feeding was started (AOR: 17.43, 95%CI: 3.47-87.55, p = 0.008) were statistically associated with EBF. CONCLUSION: Breastfeeding education has been ongoing for decades, yet there are still gaps in the breastfeeding practices of mothers. To accelerate progress towards attainment of the sustainable development goal 3 of ensuring healthy lives and promoting well-being for all at all ages by the year 2030, we recommend innovative policies that include extensive public education to improve upon the breastfeeding and weaning practices of mothers.

Prevalence and predictors of depression, anxiety, and stress among adults in Ghana: A community-based cross-sectional study.

INTRODUCTION: Over the past two decades, there have been several global interventions including the Sustainable Development Goals (SDGs), aimed at improving health outcomes. Despite efforts by countries to achieve the SDG targets, mental health challenges remain major public health concerns globally. We examined the prevalence and predictors of depression, anxiety, and stress as well as the comorbidities of these mental health issues among adults. MATERIALS AND METHODS: This was a community-based cross-sectional study conducted among 2456 adults in four districts of the Volta Region of Ghana using data from the UHAS-Yonsei University Partnership Project. We analysed the data using frequency, percentage, mean, standard deviation, correlation, and binary logistic regression. RESULTS: Overall, 51.8% of the participants had at least one of the mental health issues examined. The prevalence of a mental health issue was 25.2%, 53.3%, and 9.7% for depression, anxiety, and stress respectively. Participants constituting 8.3% experienced all three mental health issues as comorbidities. Participants' level of formal education and income significantly predicted depression, anxiety, and stress respectively at the multivariable level. Adults with a tertiary level of education were, for instance, 68% (AOR = 0.32, 95%CI = 0.15-0.66), 65% (AOR = 0.35, 95%CI = 0.17-0.73), and 50% (AOR = 0.50, 95%CI = 0.33-0.76) less likely to experience depression, anxiety, and stress, respectively compared with those who had no formal education. CONCLUSION: The majority of our study participants either experienced depression, anxiety, or stress. There were quite high comorbidities of the mental health issues among the adult population. To accelerate progress towards the achievement of SDG 3.4 target of promoting mental health and wellbeing for all by the year 2030, there is a need for effective implementation of the country's 2012 Mental Health Act which makes provisions for the establishment of a Mental Health Fund. This could improve the financial circumstances of indigenes as income has been realised in the present study as an important factor influencing depression, anxiety, and stress among the adult population.

Hepatitis B Knowledge, Testing, and Vaccination History among Undergraduate Public Health Students in Ghana.

BACKGROUND: Hepatitis B virus (HBV) infection is a serious public health problem in many parts of the world. The risk of acquiring the infection through exposure to blood, semen, and other bodily fluids is highest among health care workers (HCW) including trainees. Ghana is considered a high risk country for HBV; however little is known about the knowledge and prevention practices of the infection in the country. This study assessed the knowledge, testing, and vaccination history of HBV and their related factors among undergraduate public health students of University of Health and Allied Sciences in Ghana. METHODS: A cross-sectional study was conducted among 226 students using a pretested questionnaire to assess Hepatitis B knowledge, testing, and vaccination history of the students. We performed logistic regression analysis to examine the relationship between Hepatitis B testing and vaccination history and participants' characteristics. Data was analysed using Stata Version 12. RESULTS: Majority 169 (73.9%) of the 226 participants studied had moderate knowledge regarding HBV infection. About half 114 (50.4%) of them had never been tested for HBV infection, and 100 (44.2%) had received at least a single dose of Hepatitis B vaccine. The completed vaccination rate among the students was 30.5%. Students in their 2nd year (Adjusted Odds Ratio [AOR]: 3.13; 95% Confidence Interval [CI]: 1.13, 7.52; p<0.011) and those with moderate (AOR: 4.76; 95% CI; 1.35, 16.82; P=0.015) and good (AOR: 5.40; 95% CI: 1.31, 22.36; P=0.020) level of knowledge were more likely to be tested for HBV. With regard to vaccination, females (AOR: 1.85; 95%CI: 1.04-3.29; P=0.037) and regular students (AOR: 0.37; 95%CI: 0.19, 0.70; p=0.002) were associated with receiving the full dose of Hepatitis B vaccine. CONCLUSION: This study highlights the urgent need for continued health education on HBV infection and strategies that ensure that health trainees are screened and fully vaccinated against the infection to prevent potential future exposure to the virus. The students' representative council can organize free HBV testing and vaccination for all fresh students.

Effective Vaccine Management: The Case of a Rural District in Ghana.

BACKGROUND: The Effective Vaccine Management (EVM) initiative provides the platform needed to monitor and assess the vaccine supply chain system to identify strengths and weaknesses of the system at all levels to enhance the development of improvement plan to strengthen the system. This valuation was carried out in the Tolon District of the Northern Region, Ghana. METHODS: A descriptive valuation of vaccine management was carried out in six vaccine stores in the Tolon District of Northern Ghana. We employed World Health Organization (WHO) assessment tools and procedures which consisted of desk reviews and interviews of cold chain managers to assess vaccine management practices in the district. Five out of the nine global assessment criteria were assessed and a minimum target level required for all criteria to meet the WHO standard was 80%. RESULTS: None of the facilities assessed met the WHO benchmark of 80% for all but one criteria assessed. With regards to temperature control, the scores ranged from 42% at Kasuliyili CHPS Centre to 77% at the district store with an average district score of 60%. Stock management ranged between 11% at Wantugu Health Centre and 75% at Nyankpala Health Centre with district average score of 32%. Effective vaccine distribution scores ranged between 13% at Kasuliyili CHPS and 46% at Nyankpala Health Centre with an average district score of 27%. Only Nyankpala Health Centre had an acceptable score of 84% for vaccine management, whereas the lowest score for this indicator was 5% at Tolon Health Centre store with district average score of 53%. Information management and supportive functions scores ranged from 0% at Tolon Health Centre to 26% at the district store with the district average score of 16%. Nineteen (90.5%) of vaccine users had poor knowledge regarding temperature control and vaccine distribution. CONCLUSION: Effective vaccine management knowledge and practices are poor at Tonlon district and calls for urgent and pragmatic approaches such as training and re-training of vaccine users at all levels.

Low tuberculosis case detection: a community and health facility based study of contributory factors in the Nkwanta South district of Ghana.

BACKGROUND: Tuberculosis (TB) continues to pose a major public health problem globally. In Ghana, the national TB case detection rate is 81 %; however, some districts are not able to meet their case detection targets. This study was therefore carried out in the Nkwanta South district to identify possible factors contributing to low TB case detection. METHODS: A cross sectional descriptive study involving the review of outpatients records for the year 2012 was conducted. Data on cough for 2 weeks or more duration, age, sex, area of residence and sputum smear examination were extracted. A community-based survey involving household contacts of TB patients and community based volunteers was also carried out. Data collected in the community included knowledge of TB status of relatives, level of socialization with TB patients and signs and symptoms of TB disease. Descriptive statistics including cross-tabulations were used to identify possible factors contributing to low TB case detection. RESULTS: A total of 932 patients out of 3987 reported coughing for 2 weeks or more (23.4 %; 932/3987). Out of that, only 24.6 % (230/932) had sputum smear microscopy done, yielding 57 (24.8 %) positive cases. Five out of the 57 positive cases were found not registered for the initiation of treatment leading to a false primary default rate of 8.8 % per year. Eighty-five percent of the contacts were able to mention persistent cough as a sign/symptom of TB with 80.4 % indicating that TB can be cured. Only 10 % of health facilities provided diagnostic services in the district with only 25 % of staff having had training in TB management. CONCLUSION: The study identified some factors (weak record review systems, inadequate diagnostic centres, lack of trained persons and some level of stigma at the community level) that could be contributing to low TB case detection in the Nkwanta South district.