Assessment of socio demographic factors on termination of pregnancy in Ghana.

AIM: Assessing the socio-demographic factors on termination of pregnancy in Ghana. DESIGN: Cross-sectional study, using data source from the Demographic Health Survey (DHS). METHODS: Data pooled from the most recent DHS conducted in Ghana, with variables of interest with rural and urban population coverage. A systematic search of the literature was performed using PubMed, Google Scholar and Elsevier PubMed for the secondary data. Descriptive and logistic regression analysis was performed using Python Pandas' software to estimate the independent effects of the socio-demographic factors on termination of pregnancy in Ghana. RESULTS: Reported using odds and adjusted OR AOR at 95% confidence level and statistical significance at a p-value of (p > 0.05). Age, place of residence, occupation, currently pregnant, woman's individual sample weight, completeness of current pregnancy, living children + current pregnancy, ethnicity and number of living children significantly predicted the outcome variable. PATIENT OR PUBLIC CONTRIBUTION: Nurses have an important role to play in providing support, education and counselling to people, and must be equipped with the knowledge and skills (including non-judgmental and compassionate care) necessary to provide care that is sensitive to the diverse needs of people from different socio-demographic backgrounds.

Low birth weight, household socio-economic status, water and sanitation are associated with stunting and wasting among children aged 6-23 months: Results from a national survey in Ghana.

BACKGROUND: Stunting and wasting are key public health problems in Ghana that are significantly linked with mortality and morbidity risk among children. However, information on their associated factors using nationally representative data is scanty in Ghana. This study investigated the influence of Infant and Young Child Feeding (IYCF) indicators, socio-demographic and economic related factors, and water and sanitation on stunting and wasting, using nationally representative data in Ghana. METHODS: This is a secondary data analysis of the most recent (2017/2018) Ghana Multi-Indicator Cluster Survey (MICS) datasets. The multi-indicator cluster survey is a national cross-sectional household survey with rich data on women of reproductive age and children under the age of five. The survey used a two-stage sampling method in the selection of respondents and a computer-assisted personal interviewing technique to administer structured questionnaires from October 2017 to January 2018. The present study involved 2529 mother-child pairs, with their children aged 6 to 23 months. We used the Complex Sample procedures in SPSS, adjusting for clustering and stratification effects. In a bivariate logistic regression, variables with P-values ≤ 0.05 were included in a backward multivariate logistic regression to identify the significant factors associated with stunting and wasting. RESULTS: The mean age of children was 14.32 ± 0.14 months, with slightly more being males (50.4%). About 12% and 16% of the children were wasted and stunted, respectively. There were 39.4%, 25.9%, and 13.7% of children who, respectively, satisfied the minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). None of the IYCF indicators was significantly associated with stunting or wasting in the multivariate analysis but low socio-economic status, low birth weight, being a male child and unimproved toilet facilities were significantly associated with both wasting and stunting. CONCLUSION: Our findings suggest that aside from the pre-natal period, in certain contexts, household factors such as low socio-economic status and poor water and sanitation, may be stronger predictors of undernutrition. A combination of nutrition-specific and nutrition-sensitive interventions including the pre-natal period to simultaneously address the multiple determinants of undernutrition need strengthening.

Economic and social determinants of health care utilization during the first wave of COVID-19 pandemic among adults in Ghana: a population-based cross-sectional study.

BACKGROUND: The COVID-19 pandemic had socioeconomic effects in Africa. This study assessed the social and economic determinants of healthcare utilization during the first wave of COVID-19 among adults in Ghana. METHODS: Information about individuals residing in Ghana was derived from a survey conducted across multiple countries, aiming to evaluate the impact of the COVID-19 pandemic on the mental health and overall well-being of adults aged 18 and above. The dependent variable for the study was healthcare utilization (categorized as low or high). The independent variables were economic (such as financial loss, job loss, diminished wages, investment/retirement setbacks, and non-refunded travel cancellations) and social (including food scarcity, loss of financial support sources, housing instability, challenges affording food, clothing, shelter, electricity, utilities, and increased caregiving responsibilities for partners) determinants of health. A multinomial logistic regression was conducted to identify factors associated with healthcare utilization after adjusting for confounders (age, gender, access to medical insurance, COVID-19 status, educational background, employment, and marital status of the participants). RESULTS: The analysis included 364 responses. Individuals who encountered a loss of financial support (AOR: 9.58; 95% CI: 3.44-26.73; p < 0.001), a decrease or loss of wages (AOR: 7.44, 95% CI: 3.05-18.16, p < 0.001), experienced investment or retirement setbacks (AOR: 10.69, 95% CI: 2.60-43.88, p = 0.001), and expressed concerns about potential food shortages (AOR: 6.85, 95% CI: 2.49-18.84, p < 0.001) exhibited significantly higher odds of low healthcare utilization during the initial phase of the pandemic. Contrastingly, participants facing challenges in paying for basic needs demonstrated lower odds of low healthcare utilization compared to those who found it easy to cover basic expenses (AOR: 0.19, 95% CI: 0.06-0.67, p = 0.001). CONCLUSION: Economic and social factors were associated with low healthcare utilization in Ghana during the first wave of the pandemic. Investment or retirement loss and financial support loss during the pandemic had the largest effect on healthcare utilization. Further research is needed to understand the connection between concerns about food shortages, welfare losses during pandemics and healthcare utilization during pandemics in Ghana.

Demographic and socio-economic factors affecting bed net ownership, usage, and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities.

BACKGROUND: The most cost-effective malaria prevention and control strategy is the use of a bed net. However, several factors affect the ownership and usage of bed nets among the adult population. Hence, this study aimed to examine socio-demographic factors affecting bed net ownership, usage and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities. METHODS: This hospital-based cross-sectional study was conducted, between January and September 2021, at Bremang Seventh-Day Adventist Hospital, Suame Municipal, Ashanti Region and Sunyani Municipal Hospital, Sunyani, Bono Region, Ghana. Structured questionnaires were administered to a total of 550 participants to ascertain their ownership and usage of the bed nets. Afterwards, finger prick blood samples were collected for malaria microscopy. Crude and adjusted prevalence ratios (PR) and their respective 95% CIs were calculated, using Poisson regression with robust standard errors, to show associated variables in bivariate and multivariate analyses respectively. R software (version 4.1.1) was used to perform all statistical analyses. RESULTS: About 53.3% (n = 293) of participants owned at least one-bed net but only 21.5% (n = 118) slept under it the previous night. Those married were 2.0 (95% CI: 1.6 - 2.5) and 2.4 (95% CI: 1.6 - 3.5) times more likely to own and use a bed net respectively than those who never married. Also, pregnant women were 1.3 (95% CI: 1.1 - 1.6) and 1.8 (95% CI: 1.3 - 2.5) times more likely to own and use a bed net respectively than non-pregnant. Even though income levels were not associated with bed net ownership and usage, students were 0.4 (95% CI: 0.2 - 0.6) and 0.2 (95% CI: 0.1 - 0.5) times less likely to own and use bed net respectively compared to formally employed persons. The overall malaria prevalence rate was 7.8%. Malaria-negative patients were 1.6 (95% CI: 1.2 - 2.0) and 2.4 (95% CI: 1.4 - 4.1) times more likely to own and use bed nets respectively than malaria positive. Patients with tertiary education recorded the lowest malaria prevalence (3.5%, n = 4). None of those with a monthly income > $300 recorded a case of malaria. On the contrary, majority 83%, n/N = 25/30) of the malaria-positive patients earned ≤ $150. CONCLUSION: The National Malaria Control Program should conduct comprehensive mapping of all urban population segments before launching mass bed net distribution campaigns, taking into account demographic and socioeconomic factors to enhance bed net utilization and reduce malaria prevalence.

Antimicrobial stewardship capacity and antibiotic utilisation practices in the Cape Coast Teaching Hospital, Ghana: A point prevalence survey study.

INTRODUCTION: Antimicrobial resistance (AMR) is a global threat that necessitates coordinated strategies to improve antibiotic prescribing and reduce AMR. A key activity is ascertaining current prescribing patterns in hospitals to identify targets for quality improvement programmes. METHODS: The World Health Organisation point prevalence survey methodology was used to assess antibiotic prescribing in the Cape Coast Teaching Hospital. All core variables identified by the methodology were recorded. RESULTS: A total of 78.8% (82/104) patients were prescribed at least one antibiotic, with the majority from adult surgical wards (52.14%). Significantly longer hospital stays were associated with patients who underwent surgery (p = 0.0423). "Access" antibiotics dominated total prescriptions (63.8%, 132/207) with ceftriaxone, cefuroxime, and ciprofloxacin being the most prescribed "Watch" antibiotics. The most common indications were for medical prophylaxis (59.8%, 49/82) and surgical prophylaxis (46.3%, 38/82). Over one-third of surgical prophylaxis (34.2%, 13/38) indications extended beyond one day. There was moderate documentation of reasons for antibiotic treatment in patient notes (65.9%, 54/82), and targeted therapy after samples were taken for antimicrobial susceptibility testing (41.7%, 10/24). Guideline compliance was low (25%) where available. CONCLUSIONS: There was high use of antibiotics within the hospital which needs addressing. Identified quality targets include developing surgical prophylaxis guidelines, reviewing "Watch" antibiotic prescribing, and assessing antibiotic durations for patients on two or more antibiotics. Organizational-level deficiencies were also identified that need addressing to help instigate ASPs. These can be addressed by developing local prescribing protocols and antibiotic stewardship policies in this hospital and wider in Ghana and across Africa.

Trends of risk factors associated with childhood stunting and anaemia in Ghana: evidence from the Demographic Health Survey and Multiple Indicator Cluster Survey (2003-2017).

OBJECTIVE: This study investigated the trend of effect estimates of the key risk factors of childhood stunting and anaemia between 2003 and 2017. DESIGN: A secondary analysis of the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data for the Ghanaian population between 2003 and 2017. Associations of selected socio-demographic (child age and gender; maternal age and education), economic (household wealth), environmental, dietary (minimum dietary diversity and iodine use) and health system (place of delivery and vaccination) factors were explored using the Poisson regression model. Trend analysis was explored using a fitted linear regression line on a time series plot. SETTING: Ghana. PARTICIPANTS: Children under 5 years. RESULTS: The results showed a reduction in the prevalence of stunting and anaemia over the 15-year duration. These health outcomes were found to be negatively associated with a wide array of socio-demographic (child age and gender, maternal age and education, residency), economic (household wealth), dietary (iodised salt use) and health service (place of delivery and vaccination) factors; however, the most consistent statistically significant association was observed between child's age and belonging to the poor wealth quintile. CONCLUSION: In order to prevent these indicators of child malnutrition, key consideration must be given to the early developmental stages of life. Child health policies must focus on addressing the key contextual factors of child malnutrition.

Entomological risk assessment for transmission of arboviral diseases by Aedes mosquitoes in a domestic and forest site in Accra, Ghana.

Dengue, Zika and chikungunya are Aedes-borne viral diseases that have become great global health concerns in the past years. Several countries in Africa have reported outbreaks of these diseases and despite Ghana sharing borders with some of these countries, such outbreaks are yet to be detected. Viral RNA and antibodies against dengue serotype-2 have recently been reported among individuals in some localities in the regional capital of Ghana. This is an indication of a possible silent transmission ongoing in the population. This study, therefore, investigated the entomological transmission risk of dengue, Zika and chikungunya viruses in a forest and domestic population in the Greater Accra Region, Ghana. All stages of the Aedes mosquito (egg, larvae, pupae and adults) were collected around homes and in the forest area for estimation of risk indices. All eggs were hatched and reared to larvae or adults for morphological identification together with larvae and adults collected from the field. The forest population had higher species richness with 7 Aedes species. The predominant species of Aedes mosquitoes identified from both sites was Aedes aegypti (98%). Aedes albopictus, an important arbovirus vector, was identified only in the peri-domestic population at a prevalence of 1.5%, significantly higher than previously reported. All risk indices were above the WHO threshold except the House Index for the domestic site which was moderate (19.8). The forest population recorded higher Positive Ovitrap (34.2% vs 26.6%) and Container (67.9% vs 36.8%) Indices than the peri-domestic population. Although none of the mosquito pools showed the presence of dengue, chikungunya or Zika viruses, all entomological risk indicators showed that both sites had a high potential arboviral disease transmission risk should any of these viruses be introduced. Continuous surveillance is recommended in these and other sites in the Metropolis to properly map transmission risk areas to inform outbreak preparedness strategies.

A log-binomial Bayesian geoadditive semiparametric analysis of geographical inequalities in caesarean births in Ghana.

BACKGROUND: Caesarean section is a clinical intervention aimed to save the lives of women and their newborns. In Ghana, studies have reported inequalities in use among women of different socioeconomic backgrounds. However, geographical differentials at the district level where health interventions are implemented, have not been systematically studied. This study examined geographical inequalities in caesarean births at the district level in Ghana. The study investigated how pregnancy complications and birth risks, access to health care and affluence correlate with geographical inequalities in caesarean section uptake. METHODS: The data for the analysis was derived from the 2017 Ghana Maternal Health Survey. The log-binomial Bayesian Geoadditive Semiparametric regression technique was used to examine the extent of geographical clustering in caesarean births at the district level and their spatial correlates. RESULTS: In Ghana, 16.0% (95% CI = 15.3, 16.8) of births were via caesarean section. Geospatial analysis revealed a strong spatial dependence in caesarean births, with a clear north-south divide. Low frequencies of caesarean births were observed among districts in the northern part of the country, while those in the south had high frequencies. The predominant factor associated with the spatial differentials was affluence rather than pregnancy complications and birth risk and access to care. CONCLUSIONS: Strong geographical inequalities in caesarean births exist in Ghana. Targeted and locally relevant interventions including health education and policy support are required at the district level to address the overuse and underuse of caesarean sections, to correspond to the World Health Organisation recommended optimal threshold of 10% to 15%.

Assessment of prevalence, predictors, reasons and regulations of substance smoking among children in Ghana.

BACKGROUND: In Ghana, it is against the law for children to smoke. Nevertheless, a portion of children in the country do smoke. However, there is a paucity of research on young smokers in Ghana and other sub-Saharan African nations. This study, therefore, investigated the prevalence of smoking, the kinds of substances children smoke, predictors of smoking, reasons for and factors that lead children to smoke, and regulation of smoking among children in Ghana. METHODS: In total, 5024 children aged 8-17 were studied using a cross-sectional convergent parallel mixed method. Descriptive statistics, Person's Chi-square test, Fisher Exact test, and binary logistic regression were used to analyse the quantitative data. In contrast, thematic analysis was used to analyse the qualitative data. RESULTS: The results showed that 3.2% of children had ever smoked. Male children smoked more often than female children. The prevalence of cigarette, marijuana, and shisha smoking was 78.3%, 18%, and 3.7%, respectively. While more male children than female children smoked cigarettes and marijuana, more female children than male children used shisha. Children mainly smoked for fun and due to group culture. In addition, children were influenced by friends; parents, family members, and neighbours who smoke; curiosity; and advertisements and videos to initiate smoking. Despite the availability of regulations and laws regulating tobacco products in public places, tobacco advertisement, promotion, and sale to persons under 18, children are still smoking. CONCLUSIONS: Children who have ever engaged in smoking reported using cigarettes, marijuana, and shisha. Policymakers urgently need to strategise and strengthen their policies, programmes, and interventions to address smoking among children.

Fifty years of hemodialysis in Ghana-current status, utilization and cost of dialysis services.

BACKGROUND: Kidney failure is common in Ghana. Haemodialysis (HD) is the most common treatment modality for survival. Although, HD has been available in Ghana for 50 years, the majority of patients who develop kidney failure cannot access it. We describe the state of HD, dialysis prevalence, its utilization and cost of HD after fifty years of dialysis initiation in Ghana. METHODS: A situational assessment of HDs centres in Ghana was conducted by surveying nephrologists, doctors, nurses and other health care professionals in HD centres from August to October 2022. We assessed the density of HD centres, number of HD machines, prevalence of nephrologists, number of patients receiving HD treatment and the cost of dialysis in private and government facilities in Ghana. RESULTS: There are 51 HD centres located in 9 of the 16 regions of Ghana. Of these, only 40 centres are functioning, as 11 had shut down or are yet to operate. Of the functioning centres most (n = 26, 65%) are in the Greater Accra region serving 17.7% of the population and 7(17.5%) in the Ashanti region serving 17.5% of the population in Ghana. The rest of the seven regions have one centre each. The private sector has twice as many HD centers (n = 27, 67.5%) as the public sector (n = 13,32.5%). There are 299 HD machines yielding 9.7 HD machines per million population (pmp) with a median of 6 (IQR 4-10) machines per centre. Ghana has 0.44 nephrologists pmp. Currently, 1195 patients receive HD, giving a prevalence of 38.8 patients pmp with 609(50.9%) in the private sector. The mean cost of HD session is US $53.9 ± 8.8 in Ghana. CONCLUSION: There are gross inequities in the regional distribution of HD centres in Ghana, with a low HD prevalence and nephrology workforce despite a high burden of CKD. The cost of haemodialysis remains prohibitive and mainly paid out-of-pocket limiting its utilization.

Residential status and household wealth disparities in modern contraceptives use among women in Ghana: a cross-sectional analysis.

BACKGROUND: Modern contraceptive refers to "a product or medical procedure that interferes with reproduction from acts of sexual intercourse". The aim of this study was to assess the relationship between residential status and wealth quintile, and modern contraceptive use among women in Ghana. METHODS: We examined residential status and wealth quintile on contraceptive use analysing the 2006, 2011 and 2018 Multiple Indicator Cluster Surveys datasets. A sample of 30,665 women in their reproductive ages (15-49 years) were enrolled in the surveys across Ghana. STATA version 13 was used to process and analyse the data. It examined socioeconomic and demographic characteristics, assessed modern contraceptive use prevalence among women, and used logistic regression models to determine predictors. The results were presented in odds ratio and adjusted odds ratio with 95% confidence intervals. All statistical tests were measured with p < 0.05. RESULTS: In the three survey years, the highest prevalence of modern contraceptive usage was observed in 2011 (27.16%). The odds of using modern contraceptive increased by 19% in rural places (AOR = 1.19; 95% CI = 1.097-1.284) compared to urban places. The likelihood of women in second (AOR = 1.17; 95% CI = 1.065-1.289), middle (AOR = 1.24; 95% CI = 1.118-1.385), and fourth (AOR = 1.25; 95% CI = 1.113-1.403) wealth quintile using contraceptives increased compared to those of low wealth quintile. With the interactive terms, rural-second (AOR = 1.38; 95% CI = 1.042-1.830), rural-middle (AOR = 1.45; 95% CI = 1.084-1.933), rural-fourth (AOR = 1.52; 95% CI = 1.128-2.059), and rural-high (AOR = 1.42; 95% CI = 1.019-1.973) were more likely to use contraceptives compared to urban-low women. Despite lower odds, women of the age groups 20-24 (AOR = 2.33; 95% CI = 2.054-2.637), cohabitaing (AOR = 1.07; 95% CI = 0.981-1.173), secondary or higher education (AOR = 1.55; 95% CI = 1.385-1.736), Central (AOR = 1.48; 95% CI = 1.296-1.682) and Eastern (AOR = 1.48; 95% CI = 1.289-1.695) regions significantly predicted modern contraceptive use. CONCLUSION: Modern contraceptive use in Ghana is low. Women in rural-rich categories are more likely to use modern contraceptives. Background factors such as age, marital status, educational attainment, and previous child experiences predict modern contraceptive use. It is recommended for the intensification of contraceptive awareness and utilization for all reproductive age women, regardless of education, marriage, or wealth.

Evaluation of treatment patterns, healthcare resource utilization and cost of illness for sickle cell disease in Ghana: a private medical insurance claims database study.

BACKGROUND: Sickle cell disease (SCD) is a major public health concern in sub-Saharan Africa, accounting for nearly 75% of the global disease burden. The current analysis evaluated patient characteristics, treatment patterns, healthcare resource utilization (HCRU) and associated costs in patients with SCD based on a Private Medical Insurance Database in Ghana. METHODS: This retrospective longitudinal cohort study was conducted using an e-claims database from Ghana (01 January 2015 to 31 March 2021). Patients were stratified by age (0 month to < 2 years, ≥ 2 years to ˂6 years, ≥ 6 years to < 12 years, ≥ 12 years to < 16 years; ≥16 years), vaso-occlusive crisis (VOC) (< 1, ≥ 1 to < 3, and ≥ 3 per year), and continuous enrolment. Study outcomes related to patient characteristics, comorbidities, treatment pattern, HCRU were evaluated for pre- and post-index period (index period was between July 2015 to March 2020). Descriptive analysis was used to analyse different study variables. RESULTS: The study included 2,863 patients (mean age: 20.1 years; Min age: 0; Max age: 83; females 56.1%). Overall, 52.2% (n = 1,495) of SCD patients were ≥ 16 years and 17.0% (n = 486) were in the ≥ 2 to ˂6-years age group. The majority of patients aged ≥ 16 years (62.5%) in the database did not have reported VOC episodes, 35.9% of patients had 1 to 3 VOCs per year and 1.5% had ≥ 3 VOCs per year during the follow-up period. Consultation-based prevalence of SCD was 0.5% [95% confidence interval (CI): 0-1.3%] - 1.4% [CI: 0.6-2.2%]. Malaria, upper respiratory tract infection (URTI) and sepsis were the common complications of SCD. Analgesics were the most frequently prescribed medications followed by anti-infectives, hematinics, and antimalarials. Hydroxyurea, a routine standard of care for SCD was under-utilized. SCD patients had median cost incurred for consultation/hospital services of $11.3 (Interquartile range [IQR] $6.2 - $27.2). For patients with VOC, maximum median cost was incurred for medications ($10.9 [IQR $5.0-$32.6]). Overall median healthcare cost was highest for individuals with ≥ 3 VOCs per year during the follow-up period ($166.8 [IQR $70.3-$223.5]). CONCLUSION: In this retrospective private insurance claims database analysis, SCD imposes a significant healthcare burden, especially in patients with VOC. There is a need for reimbursed treatment options that could reduce the long-term burden associated with SCD and VOC.

Geographic disparities in the time to under-five mortality in Ghana.

Globally, there has been tremendous advancement in medicine and child healthcare with increased life expectancy. That notwithstanding, the risk of under-five mortality ─ children dying before their fifth birthday remains relatively high in countries in Sub-Saharan Africa such as Ghana. In Ghana, under-five mortality remains a major public health problem that requires significant policy interventions. Using data from the 2017 Maternal Health Survey (n = 4785), we examined the geographic disparities in the time to under-five mortality in Ghana. The Kaplan Meier estimator showed significant (Log-rank: p< 0.001) rural-urban differences in the time to under-five mortality in Ghana. A disaggregated cox proportional hazards analysis showed that despite wide consensus that children in urban areas have a high survival rate, children in urban areas in northern regions of Ghana, especially the Upper West (HR = 4.40, p < 0.05) and Upper East (HR = 5.37, p < 0.01) Regions were significantly at increased risk of dying before the age of five compared to children in urban areas in the Greater Accra Region. A rural-urban comparison showed that children born in rural areas in all the other regions of Ghana were at a higher risk of dying before the age of five when compared to their counterparts in the rural areas of Greater Accra Region. Other factors such as sex of child, mothers' age and use of the internet, number of household members, ethnicity and household wealth were significantly associated with the timing of under-five mortality in Ghana. Healthcare policies and programs such as immunizations and affordable child healthcare services should be prioritized especially in rural areas of regions with a high risk of child mortality. Also, there is a need to improve healthcare delivery in urban areas, particularly in northern Ghana, where deplorable healthcare service infrastructure and delivery coupled with high poverty rates put children at risk of dying before their fifth birthday.

Relationships among causal factors influencing mine accidents using structural equation modelling.

Accidents occur due to a series of interactions between deficiencies within the various levels of a sociotechnical system. Quantifying the relationship between upper and lower levels helps develop accident countermeasures focusing on significant organisational latent conditions. This study explores the relationship between the causal factors of accidents within Ghanaian mines using SEM. Data obtained from the analysis of incident reports using HFACS-GMI were quantified to enable its use in the SEM software, as SEM calculations cannot be done using a 0/1 description. The study also tests five hypotheses, including the basic assumption of the HFACS model. The case study results showed that organisational factors significantly influence workplace/individual conditions; upper causal categories do not only influence adjacent immediate lower causal categories, and partial correlations exist between causal categories with a particular level. Based on the SEM model from LISERL, an accident causation path diagram was developed. The diagram reveals that leadership flaws, the technological environment and adverse physiological/mental states were the mediating factors in accident causation within the mines. The operational process has a prominent position in the organisational factors tier and is an essential factor in the entire accident system. Therefore, accident countermeasures should be directed to addressing operational deficiencies.

A multilevel and multicenter assessment of health care system capacity to manage cardiovascular diseases in Africa: a baseline study of the Ghana Heart Initiative.

INTRODUCTION: Cardiovascular diseases (CVD) remain the leading cause of death worldwide, with over 70% of these deaths occurring in low- and middle-income regions such as Africa. However, most countries in Africa do not have the capacity to manage CVD. The Ghana Heart Initiative has been an ongoing national program since 2018, aimed at improving CVD care and thus reducing the death rates of these diseases in Ghana. This study therefore aimed at assessing the impact of this initiative by identifying, at baseline, the gaps in the management of CVDs within the health system to develop robust measures to bolster CVD management and care in Ghana. METHODS: This study employed a cross-sectional study design and was conducted from November 2019 to March 2020 in 44 health facilities in the Greater Accra region. The assessment covered CVD management, equipment availability, knowledge of health workers in CVD and others including the CVD management support system, availability of CVD management guidelines and CVD/NCD indicators in the District Health Information Management System (DHIMS2). RESULTS: The baseline data showed a total of 85,612 outpatient attendants over the period in the study facilities, 70% were women and 364(0.4%) were newly diagnosed with hypertension. A total of 83% of the newly diagnosed hypertensives were put on treatment, 56.3% (171) continued treatment during the study period and less than 10% (5%) had their blood pressure controlled at the end of the study (in March 2020). Other gaps identified included suboptimal health worker knowledge in CVD management (mean score of 69.0 ± 13.0, p < 0.05), lack of equipment for prompt CVD emergency diagnosis, poor management and monitoring of CVD care across all levels of health care, lack of standardized protocol on CVD management, and limited number of indicators on CVD in the National Database (i.e., DHIMS2) for CVD monitoring. CONCLUSION: This study shows that there are gaps in CVD care and therefore, there is a need to address such gaps to improve the capacity of the health system to effectively manage CVDs in Ghana.

Thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus patients in Ghana: A comparative cross-sectional study.

INTRODUCTION: Thyroid disorders and diabetes mellitus coexist and are prevalent endocrinopathies among adult population. Thyroid dysfunction contributes to metabolic imbalances, increase beta-cell apoptosis and glucose intolerance. There is paucity of data and contradicting findings on how thyroid dysfunction influence glycaemic control. Therefore, we evaluated thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus (T2DM) patients in Ghana. METHODS: A comparative cross-sectional study was conducted among 192 T2DM patients from Effia Nkwanta Regional Hospital. Three consecutive monthly fasting plasma glucose (FBG) and glycated haemoglobin (HbA1c) were analysed and the results were classified as, moderate hyperglycaemia (MH) (FBG = 6.1-12.0 mmol/L, HbA1c < 7%), severe hyperglycaemia (SH) (FBG ≥ 12.1 mmol/L, HbA1c > 7%) and good glycaemic controls (GC) (FBG = 4.1-6.0 mmol/L, HbA1c < 7%). Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4), body mass index (BMI) and other clinical parameters were measured. Data analysis was done using R language version 4.0.2 and p < .05 was considered statistically significant. RESULTS: There were no significant differences in age (years) between patients in the various glycaemic groups (p = .9053). The overall prevalence of thyroid disorders was 7.8% among T2DM patients. The prevalence of thyroid disorders was higher in patients with SH (11.7%) followed by those with MH (7.5%) and then those with GC (5.4%). Serum levels of TSH and FT3/FT4 ratio were significantly lower in T2DM patients with SH compared to those with MH and the GC (p < .0001). However, FT4 was significantly higher in SH patients compared to the good glycaemic controls (p < .01). The first tertiles of TSH [aOR = 10.51, 95% CI (4.04-17.36), p < .0001] and FT3 [aOR = 2.77, 95% CI (1.11-6.92), p = .0290] were significantly and independently associated with increased odds of hyperglycaemia. CONCLUSION: The prevalence of thyroid dysfunction is high in T2DM and increases with hyperglycaemia. Reduced TSH and T3 may worsen glycaemic control. Periodic monitoring of thyroid function should be incorporated into management guidelines among T2DM patients in Ghana.

Assessment of knowledge and socioeconomic status of caregivers of children with malnutrition at a district hospital in Ghana.

Background: Malnutrition is a significant public health problem and is a major cause of morbidity and mortality in children. Aims: To assess knowledge and socioeconomic status of caregivers of children under 5 years with malnutrition at a district hospital in Ghana. Methods: Case Report forms were used to gather data in a cross-sectional study which was carried out among 189 caregivers and their children aged from zero to fifty-nine months at the Out-Patient Department clinic. Results: Most (80.95%) children had marasmus. Sixty-two point four-two percent had severe wasting, while 35.45% had mild stunting. The rest, 21.69% had moderate stunting; while only 2.12% severe stunting. Almost all caregivers (94.71%) had heard of exclusive breast feeding as a good feeding practice but only 58.20% practiced it. Most caregivers (68.26%) had no education or only up to basic level, p=0.035. The average number of children per family was 4.8 per household (SD: 1.69) with majority of them (64.55%) having 4-6 children per family and 13.23% of them had more than 7 children per family, p=0.009. More than a third (37.04%) of the caregivers earned less than a hundred Ghana cedis (GhC 100 [US$ 19] per month and 50.26% of them earned between GhC 101 (US$ 19) and GhC 500 (US$ 96) per month. Conclusion: Lower level of caregivers' education and large family size were risk factors for developing malnutrition among children.

Health insurance coverage among women of reproductive age in rural Ghana: policy and equity implications.

BACKGROUND: Globally, health insurance has been identified as a key component of healthcare financing. The implementation of health insurance policies in low and middle-income countries has led to a significant increase in access to healthcare services in these countries. This study assessed health insurance coverage and its associated factors among women of reproductive age living in rural Ghana. METHODS: This study used a nationally representative data from the 2017/2018 Ghana Multiple Indicator Cluster Survey (GMICS) and included 7340 rural women aged 15-49 years. Bivariate and multivariable logistic regression models were developed to assess the association between the explanatory and the outcome variable. Statistical significance was considered at p = 0.05. RESULTS: The overall prevalence of health insurance coverage among rural women in Ghana was 51.9%. Women with secondary (aOR = 1.72, 95% CI: 1.38-2.14) and higher education (aOR = 4.57, 95% CI: 2.66-7.84) were more likely to have health insurance coverage than those who had no formal education. Women who frequently listened to radio (aOR = 1.146, 95% CI: 1.01-1.30) were more likely to have health insurance coverage than those who did not. Women who had a child (aOR = 1.81, 95% CI: 1.50-2.17), two children (aOR = 1.59, 95% CI: 1.27-1.98), three children (aOR = 1.41, 95% CI: 1.10-1.80), and five children (aOR = 1.36, 95% CI: 1.03-1.79) were more likely to have health insurance coverage than those who had not given birth. Women who were pregnant (aOR = 3.52, 95% CI: 2.83-4.38) at the time of the survey, and women within the richest households (aOR = 3.89, 95% CI: 2.97-5.10) were more likely to have health insurance coverage compared to their other counterparts. Women in the Volta region (aOR = 1.36, 95% CI: 1.02-1.81), Brong Ahafo region (aOR = 2.82, 95% CI: 2.20-3.60), Northern region (aOR = 1.32, 95% CI: 1.02-1.70), Upper East region (aOR = 2.13, 95% CI: 1.63-2.80) and Upper West region (aOR = 1.56, 95% CI: 1.20-2.03) were more likely to have health insurance coverage than those in the Western region. CONCLUSION: Although more than half of women were covered by health insurance, a significant percentage of them were uninsured, highlighting the need for prompt policy actions to improve coverage levels for insurance. It was found that educational level, listening to radio, parity, pregnancy status, wealth quintile, and region of residence were factors associated with health insurance coverage. We recommend better targeting and prioritization of vulnerability in rural areas and initiate policies that improve literacy and community participation for insurance programs. Further studies to establish health policy measures and context specific barriers using experimental designs for health insurance enrolments are required.

Responding to Africa's burden of disease: accelerating progress.

Although Africa is home to about 14% of the global population (1.14 billion people), it is growing three times faster than the global average [1]. The continent carries a high burden of disease, but there has been real progress in eradication, elimination, and control since 2015. Examples are the eradication of wild polio in 2020 [2] and the eradication or elimination of neglected tropical diseases, such as dracunculiasis in Kenya in 2018; Human African trypanosomiasis in Togo in 2022; and trachoma in Togo, Gambia, Ghana, and Malawi in 2022 [3]. New HIV infections reduced by 44% in 2021 compared to 2010 [4], and in 2021 the African region passed the 2020 milestone of the End TB Strategy, with a 22% reduction in new infections compared with 2015 [5].

Infant and young child feeding practices and associated socioeconomic and demographic factors among children aged 6-23 months in Ghana: Findings from Ghana Multiple Indicator Cluster Survey, 2017-2018.

BACKGROUND: Association between poor infant and young child feeding (IYCF) practices and malnutrition in infants and young children (IYC) is well established. Furthermore, appropriate IYCF practices are important during the first 1,000 days of life to ensure optimal health and development. Understanding IYCF practices and associated socioeconomic and demographic factors will inform interventions to achieve the UN 2030 Sustainable Development Goal (SDG) target to end malnutrition in all forms. OBJECTIVE: This study estimates the prevalence of Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF), and Minimum Acceptable Diet (MAD), and examines their association with socioeconomic and demographic characteristics among children aged 6-23 months in Ghana. METHOD: We used data from the Ghana Multiple Indicator Cluster Survey 6 (GMICS6) conducted in 2017-18. Participants were recruited through multi-stage stratified cluster sampling. Information on caregiver's self-reported breastfeeding status and 24-hour dietary recall of foods IYC were fed with were collected through face-to-face interviews. We estimated the prevalence of MDD, MMF and MAD with a 95% confidence interval (CI). We investigated the socioeconomic and demographic determinants of MDD, MMF and MAD using univariate and multivariable logistic regression analyses. FINDINGS: Among 2,585 IYC aged 6-23 months, MDD, MMF and MAD were estimated as 25.46%, 32.82% and 11.72% respectively. Age of the IYC, educational status of the mothers/primary caregivers, and resident regions were found to have positive associations with MDD, MMF and MAD. In addition, the richest household wealth index and urban area of residence were found to have significant positive associations with MDD. CONCLUSION: We report a low prevalence of MDD, MMF and MAD. Efforts to improve IYCF practices among children aged 6-23 months in Ghana should focus on multi-sectorial approaches including increasing access to formal education, income-generating activities and addressing regional and rural-urban inequity.