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 METHODS: Unpublished reports, documents, relevant files of the Ghana Health Service (GHS) were examined to assess programmatic response to chronic NCDs.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.

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.

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.

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.

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.

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.