Effects of a community-level intervention on maternal health care utilization in a resource-poor setting of Northern Ghana.

BACKGROUND: This study aimed to assess the effects of health education and community-level participatory interventions at the community level and the use of community maternal health promoters on the utilization of maternal health care services in poor rural settings of northern Ghana. METHODS: A randomized controlled survey design was conducted from June 2019 to July 2020 in two rural districts of northern Ghana. A multistage cluster sampling technique was used to select the participants. Data were collected from a repeated cross-sectional household survey. Descriptive analysis, bivariate and covariates adjusted simple logistic regression analyses were performed using STATA version 16 statistical software. RESULTS: At post-intervention, the two groups differed significantly in terms of ANC (p = 0.001), skilled delivery (SD) (p = 0.003), and PNC (p < 0.0001). Women who received health education on obstetric danger signs had improved knowledge by 50% at the end of the study. Women who received the health education intervention (HEI) on practices related to ANC and skilled delivery had increased odds to utilize ANC (AOR = 4.18; 95% CI = 2.48-7.04) and SD (AOR = 3.90; 95% CI = 1.83-8.29) services. Institutional delivery and PNC attendance for at least four times significantly increased from 88.5 to 97.5% (p < 0.0001), and 77.3-96.7% (p < 0.0001) respectively at postintervention. Women who had received the HEI were significantly more likely to have good knowledge about obstetric danger signs (AOR = 10.17; 95% CI = 6.59-15.69), and BPCR (AOR = 2.10; 95% CI = 1.36-3.24). Women who had obtained tertiary education were significantly more likely to make at least four visits to ANC (AOR = 2.38; 95% CI = 0.09-1.67). CONCLUSIONS: This study suggests that the use of health education and participatory sessions led by community-based facilitators could be a potentially effective intervention to improve the knowledge of women about obstetric danger signs and encourage the uptake of maternity care services in resource-poor settings of Ghana.

On-site personal protective equipment signage and use by road construction workers in Ghana: a comparative study of foreign- and locally-owned companies.

BACKGROUND: Road construction work has specific risks and safety issues which have not been adequately addressed in most low- and middle-income countries, especially Africa. The objective of this study was to determine the prevalence of personal protective equipment (PPE) use during road construction activities by workers in foreign- owned against locally-owned road construction companies in Ghana. METHODS: An institution-based cross-sectional survey was undertaken during January - March, 2020 to study 389 road construction workers who were actively working on site. They were unobtrusively observed to capture whether or not they wore the appropriate PPE at the time of the survey. The PPE of interest were: hard hat, goggles, shoes, nose masks, hearing protection, gloves and reflective vests/apparel. On-site posted PPE signage was also checked. RESULTS: Majority of workers were males (96.9%) and labourers (53.5%). Similar numbers of workers in locally-owned (195) and foreign-owned (194) companies were studied. Use of PPE varied considerably by type: shoes (78.7%), reflective vest (44.5%), gloves (30.6%), hard hat (27.0%), nose mask (17.2%), goggles (11.3%) and hearing protection (10.8%). For all types of PPE, use was higher for workers in foreign-owned companies compared with locally-owned companies: goggles (Odds ratio [OR] 55.2), hearing protection (OR 52.0), gloves (OR 23.7), hard hat (OR 20.2), nose mask (OR 17.8), reflective vest (OR 5.3) and shoes (OR 4.1), (p<0.001 for all ORs). No site had any signage to promote PPE use. CONCLUSIONS: Majority of workers used shoes. Less than half of workers used other types of PPE and use of some types (goggles and hearing protection) was minimal. Workers in foreign-owned companies were significantly more likely to use all the seven types of PPE than locally-owned companies. Although there is still room for improvement in foreign-owned companies, locally-owned companies should be able to attain similar PPE use to that in foreign-owned companies. Necessary PPE should be provided and site supervisors should encourage workers to wear PPE when on site.

Predictors of Seat-Belt Use among Bus Passengers in Ghana: An Application of the Theory of Planned Behaviour and Health Belief Model.

BACKGROUND: Seat-belt use is effective in preventing traffic fatalities and injuries yet its use is not universal. This study sought to determine the predictors of self-reported seat-belt use among bus passengers in Ghana based on the theory of planned behaviour and health belief model. METHODS: A quantitative cross-sectional study design with 633 randomly selected intercity bus passengers was conducted using a structured questionnaire in Kumasi, Ghana. The resulting data were analysed using SPSS version 23.0. Ordinal regression was employed to determine the predictors of self-reported seat-belt use. RESULTS: Majority of the respondents were male (61.5%) with a mean age of 32.2 (SD = 11.6). A third (33.0%) reported that they always wear their seat-belt as bus passengers. The results indicated that intention (OR = 1.49, 95% CI = 1.21-1.84, p = 0.001), subjective norm (OR = 1.57, 95% CI = 1.15-2.13, p = 0.004) and perceived behavioural control (OR = 1.53; 95% CI = 1.21-1.92, p = 0.001) variables from the theory of planned behaviour were significant independent predictors of seat-belt use. Among the health belief model variables, perceived severity (OR = 1.57, 95% CI = 1.15-2.16, p = 0.005) and perceived barriers (OR = 0.52, 95% CI = 0.39-0.67, p = 0.001) were the only significant independent predictors of self-reported seat-belt use. CONCLUSION: The findings suggest that intention, subjective norm, perceived behavioural control, perceived severity and perceived barriers play an important role in determining bus passengers' seat-belt use behaviour. Road safety programmes to increase seat-belt use will gain from giving serious attention to these factors in the design and implementation of such programmes.

Barriers to the enforcement of mandatory seat belt laws in Ghana: an exploratory study.

Road traffic accidents claim millions of lives every year across the world. Fortunately, effective safety and preventive measures such as routine maintenance of vehicles and roads and the use of seat belts exist. Yet, authorities in some countries fail to enforce laws on these measures. One of the barriers to compliance with traffic laws is poor enforcement. Using a cross-sectional study design, we explored the barriers to the enforcement of mandatory seat belt laws in Ghana. We employed an open-ended key informant interview guide to interview 26 staff of the Motor Traffic and Transport Department of the Ghana Police Service, National Road Safety Authority and the Driver and Vehicle Licensing Authority. The interviews which lasted between 30 and 45 min per session were analysed through a thematic approach facilitated by ATLAS.ti. The findings showed that the barriers to the enforcement of seat belt laws mentioned by the participants were institutional factors (inadequate resources and logistics and inability to enforce vehicle safety standards) political factors (external interference and lack of consensus on seat belt law implementation) and human factors (poor public attitudes and non- recognition of road safety as both individual and collective responsibility). The enforcement of road safety laws could be enhanced by adequately resourcing officers, addressing external interference of police duties and empowering officers to perform their duties without fear or favour. These findings are also useful in continuous public education and enhanced enforcement of the seat belt laws.

Prevalence and associated factors of occupational injuries in an industrial city in Ghana.

BACKGROUND: Workers are exposed to workplace hazards which increase their risk of occupational injury. Data on occupational injuries and associated factors are important for planning and informing national policy regarding workplace health and safety. This study sought to estimate the prevalence and factors associated with occupational injuries among workers in an industrial city in Ghana. METHODS: A community-based cross-sectional survey was conducted among 459 workers in the Tema industrial enclave in Ghana from 22nd December 2020 to 27th February 2021. Participants were recruited using a two-stage sampling technique. Eight communities were randomly selected from twenty-five communities in the first stage while households in each community were randomly selected in the second stage. Data on socio-demographic characteristics, occupational health and safety and occupational injuries were collected. Logistic regression was used to examine the relationship between occupational injuries and associated factors. RESULTS: The mean age of the workers was 33.9 (±6.8) years with a range of 21-53 while over 18.1% of them were working at the Port and Harbour. The prevalence of occupational injury among the workers in the preceding twelve months was 64.7%. The mechanism of injury was mainly the use of working tools (45.8%) and hot surfaces, substances or chemicals (14.1%). Being a casual staff (AOR: 2.26, 95%CI: 1.04-4.92), working at Port and Harbour (AOR: 3.77, 95%CI: 1.70-8.39), no health and safety training (AOR: 2.18, 95%CI: 1.08-4.39), dissatisfaction with health and safety measures (AOR: 4.31, 95%CI: 2.12-8.78) and tertiary education (AOR: 0.03, 95%CI: 0.01-0.10) were significantly associated with occupational injuries. CONCLUSION: The prevalence of occupational injuries in this study was high. Promoting machine tools' safety, health and safety training, and satisfaction with health and safety measures through rewarding workers who do not sustain injuries could be key to employees' health and safety.

Prevalence and determinants of occupational injuries among emergency medical technicians in Northern Ghana.

BACKGROUND: Emergency Medical Technicians (EMTs) are the primary providers of prehospital emergency medical services. The operations of EMTs increase their risks of being exposed to occupational injuries. However, there is a paucity of data on the prevalence of occupational injuries among EMTs in sub-Saharan Africa. This study, therefore, sought to estimate the prevalence and determinants of occupational injuries among EMTs in the northern part of Ghana. METHODS: A cross-sectional study was conducted among 154 randomly recruited EMTs in the northern part of Ghana. A pre-tested structured questionnaire was used to collect data on participants' demographic characteristics, facility-related factors, personal protective equipment use, and occupational injuries. Binary and multivariate logistic regression analyses with a backward stepwise approach were used to examine the determinants of occupational injuries among EMTs. RESULTS: In the 12 months preceding data collection, the prevalence of occupational injuries among EMTs was 38.6%. Bruises (51.8%), and sprains/strains (14.3%) were the major types of injuries reported among the EMTs. The key determinants of occupational injury among EMTs were male sex (AOR: 3.39, 95%CI: 1.41-8.17), an absence of a health and safety committee at the workplace (AOR: 3.92, 95%CI: 1.63-9.43), absence of health and safety policy at the workplace (AOR: 2.76, 95%CI: 1.26-6.04) and dissatisfaction with health and safety measures at the workplace (AOR: 2.51, 95%CI: 1.10-5.71). CONCLUSION: In the twelve months before to the data collection for this study, the prevalence of occupational injuries among EMTs of the Ghana National Ambulance Service was high. The creation of health and safety committees, the creation of health and safety rules, and the strengthening of current health and safety procedures for EMTs are all possible ways to lessen this.

Reporting on road traffic injury: content analysis of injuries and prevention opportunities in Ghanaian newspapers.

In order to analyse traffic injury reporting in Ghanaian newspapers and identify opportunities for improving road safety, the content of 240 articles on road traffic injury was reviewed from 2005 to 2006 editions of two state-owned and two privately owned newspapers. The articles comprised reports on vehicle crashes (37%), commentaries (33%), informational pieces (12%), reports on pedestrian injury (10%), and editorials (8%). There was little coverage of pedestrian injuries, which account for half of the traffic fatalities in Ghana, but only 22% of newspaper reports. Only two articles reported on seatbelt use. Reporting patterns were similar between public and private papers, but private papers more commonly recommended government action (50%) than did public papers (32%, p=0.006). It is concluded that Ghanaian papers provide detailed coverage of traffic injury. Areas for improvement include pedestrian injury and attention to preventable risk factors such as road risk factors, seatbelt use, speed control, and alcohol use.

Road Traffic and Other Unintentional Injuries Among Travelers to Developing Countries.

Injuries result in nearly 6 million deaths and incur 52 million disability-adjusted life-years annually, making up 15% of the global disease burden. More than 90% of this burden occurs in low- and middle-income countries. Given this burden, it is not unexpected that injuries are the leading cause of death among travelers to low- and middle-income countries, namely, from road traffic crashes and drowning. Therefore, pretravel advice regarding foreseeable dangers and how to avoid them may significantly mitigate injury risk, such as wearing seatbelts, helmets, and personal flotation devices when appropriate; responsibly consuming alcohol; and closely supervising children.