Global Health Security Index not a proven surrogate for health systems capacity to respond to pandemics: The case of COVID-19.

INTRODUCTION: Global Health Security borders on prevention, detection and response to public health threats like the novel coronavirus disease 2019 (COVID-19). Global Health Security Index (GHSI) of 2019 and 2021 revealed the world remains ill-prepared to deal with future pandemics, evident in the historic impact of COVID-19 on countries. As at 7th December 2022, COVID-19 has infected over 600 million people and claimed over six million lives, mostly in countries with higher GHSI scores. OBJECTIVE: Determine whether the GHSI scores of countries have a correlation with COVID-19 cases, deaths and vaccination coverage, while adjusting for country level dynamics. METHODS: This paper utilizes GHSI database of 195 countries. Data consists of 171 questions grouped into 37 indicators across six overarching categories on health security and COVID-19. Multivariate multiple regression analysis with robust standard errors was conducted to test the hypothesis that high GHSI ratings do not guarantee better COVID-19 outcomes like cases, deaths and vaccination coverage. Also, avplots STATA command was used to check outliers with potential negative effect on outcome and predictor variables. RESULTS: Global average GHSI score for all 195 countries was 38.9. United States of America recorded the highest GHSI score of 75.9 but also recorded one of the highest COVID-19 cases and deaths; Somalia recorded the worst GHSI score of 16.0 and one of the lowest COVID-19 cases and deaths. High GHSI scores did not associate positively with reduction in COVID-19 cases (Coef=157133.4, p-value=0.009, [95%CI 39728.64 274538.15]) and deaths (Coef=1405.804, p-value=0.047, [95%CI 18.1 2793.508]). However, high GHSI ratings associated with increases in persons fully vaccinated per 100 population (Coef=0.572, p-value=0.000, [95%CI.272.873]). CONCLUSION: It appears the world might still not be adequately prepared for the next major pandemic, if the narrative remains unchanged. Countries that recorded higher GHSI scores, counter-intuitively, recorded higher COVID-19 cases and deaths. Countries need to invest more in interventions towards attaining Universal Health Coverage (UHC) including integrated health systems and formidable primary health care to enhance preparedness and response to pandemics.

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.

Assessing the preparedness and feasibility of an e-learning pilot project for university level health trainees in Ghana: a cross-sectional descriptive survey.

BACKGROUND: Ghana is challenged with shortage of critical human resources for health particularly nurses and midwives in rural hard-to-reach communities. This shortage potentially hinders efforts towards attaining universal access to basic healthcare. More importantly, poor quality of pre-service training for health trainees has the potential to worsen this predicament. There is therefore the need to leverage emerging digital innovations like e-learning to complement existing efforts. This study was conducted several months before the outbreak of COVID-19 to investigate the preparedness, acceptability and feasibility e-learning innovation for nursing and midwifery trainees. METHODS: The study is a cross-sectional descriptive survey involving nursing and midwifery students (n = 233) in one of Ghana's public universities, located in the Volta region of Ghana. Simple random sampling technique was used to collect responses from eligible respondents using a structured questionnaire. Descriptive statistical analysis was done using STATA software (version 12.0). RESULTS: It was found that nearly 100% of respondents owned smartphones that were used mostly for learning purposes including sharing of academic information. Over 70% of respondents particularly used social media, social networking applications and internet searches for learning purposes. Health trainees were however constrained by low bandwidth and lack of seamless internet connectivity within their learning environments to maximize the full benefits of these e-learning opportunities. CONCLUSION: Respondents were predominantly prepared for an e-learning pilot project. These feability findings suggest e-learning is a huge potential that can be used to augment existing approaches for pre-service training of health trainees in Ghana, when implementation threats are sufficiently addressed. Compelling findings of this study are therefore timely to inform evidence-based policy decisions on innovative digitial solutions for pre-service training of health workforce even as the world adapts to the "new normal" situation induced by COVID-19.

Implementation of the policy protocol for management of surgical and non-surgical wounds in selected public health facilities in Ghana: An analytic case study.

BACKGROUND: It is estimated that millions of patients are affected by healthcare associated infections (HAIs) each year. In Ghana, high prevalence of HAIs in relation to non-surgical (also called contaminated wounds) and surgical wounds (also called sterile wounds) is largely attributed to poor adherence to policy protocols for wound management by frontline clinical staff especially nurses. OBJECTIVE: Investigate the extent to which nursing staff adhere to the policy protocol for management of non-surgical and surgical wounds in selected public health facilities in Ghana. METHODOLOGY: This is an analytic case study among nursing staff (n = 140) in three government facilities in the Volta region of Ghana. Subjective and objective performance scores of staff on adherence proxies were compared using the Wilcoxon Signed-rank test, and univariate ordered logistic regression analysis used to predict staff likelihood of adherence to policy protocols on non-surgical and surgical wound management. FINDINGS: Overall, staff self-rated themselves higher on subjective performance proxies relative to their objective scores (p<0.05). Staff with more years of work experience did not translate into a higher likelihood of adhering to standard protocol on wound management (Coef. = -0.49, CI = -0.93-0.05, p = 0.036). Being a senior nursing officer relative to lower nursing ranks increased staff likelihood of complying particularly with standard policy protocol for management of non-surgical wounds (Coef. 5.27, CI = 0.59 9.95, p = 0.027). CONCLUSION: There is the need for accelerated in-service training for staff on standard protocols for wound management coupled with supportive supervisions. Staff adherence to standard quality care protocols should be a pre-requisite for licensing of health facilities by regulatory bodies like Health Facilities Regulatory Agency and National Health Insurance Authority.

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

BACKGROUND: Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. PURPOSE: To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. METHODS: This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. RESULTS: Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. CONCLUSION: There is the need to intensify client education and balanced commitment to technical and perceived quality improvement efforts. This will help enhance client confidence in Ghana's healthcare system, stimulate active participation in the national health insurance, increase healthcare utilization and ultimately improve public health outcomes.