Challenges of rural women living with obstetric fistula: A phenomenological study.

BACKGROUND: Obstetric fistula is a devastating complication caused by a prolonged and obstructed labor. It is estimated that about 2 million girls and women continue to live with obstetric fistula while between 50,000-100,000 women worldwide develop obstetric fistula each year. This condition continues to persist and remains a major problem in Ghana and other developing countries. AIM: To explore the challenges and post-surgery integration needs among rural women living with obstetric fistula. METHOD: A critical exploratory research methodology based on phenomenology was used to conduct in-depth one-on-one interviews. A non-probability and purposive sampling were done to identify thirty-six (36) women between the ages of 25 and 65. The interviews were recorded electronically and transcribed verbatim. A systematic analysis of data was then done to identify and categorize emerging themes. RESULTS: The results from the study showed that those who lived with obstetric fistulae experienced psychosocial, physical and economic challenges. Dominant among the psychological challenges identified were disruptions in social relations, divorce and loss of baby through neonatal death. Physical challenges include rashes and sores, foot drop, incontinence of urine. Economically, these women lost their source of livelihood and were heavily dependent on other family members. Support from family was also found to be key towards the post-surgery integration of the women. CONCLUSION: Obstetric fistula is a dilapidating condition that needs to be addressed at the micro, mezzo and macro level. Based on the findings of the study, recommendations were made to improve emergency obstetric care for women especially for women living in rural communities.

Antibiotic-Resistant Bacteria and Resistance Genes in Isolates from Ghanaian Drinking Water Sources.

The control of infectious diseases is seriously threatened by the increase in the number of microorganisms resistant to antimicrobial agents. Antibiotic-resistant bacteria have also been identified in the water environment. A field study was performed sampling drinking water sources in seven districts of southern Ghana targeting boreholes, dams, hand-dug wells, and streams during baseflow conditions. Bacteria were isolated (N = 110) from a total of 67 water samples to investigate their antimicrobial susceptibility and to determine their carriage of select antibiotic resistance genes. Bacterial identification was performed using conventional selective media methods and the analytical profile index (API) method. Antibiotic susceptibility tests were carried out using the Kirby-Bauer method. Results indicated that all water sources tested were of poor quality based on the presence of fecal indicator organisms. The most commonly occurring bacterium isolated from water was Klebsiella spp. (N = 24, 21.8%), followed by E. coli (N = 23, 20.9%). Gram-negative bacteria isolates were most commonly resistant to cefuroxime (24.5%), while the Gram-positives were most commonly resistant to meropenem (21.3%). The highest rates of bacterial resistances to more than one antibiotic were observed in Klebsiella spp. (30.0%) followed by E. coli (27.8%). PCR was used to detect the presence of a select antibiotic resistance genes in the Gram-negative isolates. The presence of bla NDM-1, sull, tet(O), and tet(W) were observed in isolates from all water sources. In contrast, ermF was not detected in any of the Gram-negative isolates from any water source. Most (28.7%) of the resistance genes were observed in E. coli isolates. Reducing microbial contamination of the various water sources is needed to protect public health and to ensure the sustainability of this resource. This further calls for education of the citizenry.

Correlates of household waste management in Ghana: implications for public health.

Household waste management is a challenge in Accra, Ghana, due to increasing urbanization and unscrupulous dumping of garbage. The aim of this study was to determine the correlates of household waste management as well as their implications for public health. The study employed a descriptive, cross-sectional design with self-administered questionnaires to assess household waste management in Accra, Ghana. The study was conducted from September 1, 2019 to February 28, 2020. Our findings showed that rubber waste types were the most generated (26%) among respondents in their various households, followed by tin (19%) and plastic (16%). Majority (50.5%) of the respondents disposed of waste collected in public bins. However, about half of the respondents dumped waste through illegal or unauthorized means. About three out of four respondents (72.9%) indicated that improper management of garbage could affect the health of household members while 81.1% reported willing to participate in waste management in their neighborhoods. Females were more likely to be willing to participate in waste management compared to their male counterparts (p = 0.001). It is recommended that stakeholders and policy makers should focus on education for the citizenry on waste management behaviors. In addition, they should have increased access to waste collection services; since the public health implication of dumping anywhere could cause flooding, choke gutters, and lead to epidemic of cholera and vector borne diseases like malaria and dysentery.

Predictors of stress and associated factors among healthcare workers in Western Ghana.

Healthcare professionals are the most vulnerable to stress among all occupational groups due to the nature of their work environment. The aim of this study is to determine the level of stress and associated factors among healthcare workers in Western Ghana. The study employed a cross-sectional design with self-administered questionnaires. The results show that 69.5% of the respondents were stressed. Prevalence of stress was higher among female respondents than males. We found that 40.4 % of respondents intend to change work as a result of stress faced at their work places. Respondents aged 56≥ were more (3.16) likely to be stressed than those in the other age groups. We found a significant association between age, marital status, workload and educational background and stress levels among the respondents. The management of these healthcare institutions and their stakeholders must adopt strategies to help health workers cope with the stress they encounter.

Knowledge, Attitude, and Adaptation to Climate Change in Ghana.

Climate change is a serious challenge to human existence. It threatens efforts towards the attainment of sustainable development goals and aggravates conditions that lead to health inequities and inequalities for vulnerable populations. The study aimed to investigate knowledge and adaptation to climate change among people in Ghana. A nationally representative survey of Ghanaian adults (N = 674) was conducted from August 1, 2019, to December 31, 2019. Results showed that 43.9% of the respondents understood the meaning of climate change. Respondents perceived the causes of climate change to include burning of fossil fuel, deforestation, natural events such as ocean currents, carbon emission from vehicles and industries, agricultural emissions of nitrous oxide from fertilizers, and an act of God. About 53.1% and 41% of the male and female respondents, respectively, had an encounter with climate change-induced natural disasters. About two out of five respondents (43%) were either afraid or confused about climate change. Distilled or maintained public drainage from waste (30.2%) and clearing drains (25.6%) was the leading adaptation strategies towards climate change-induced natural disasters. Training (30.1%), national radio (27.7%), and television (19.1%) were the preferred leading methods for receipt of global warming information. These findings provide useful insights for policy directions. The government of Ghana and other stakeholders should develop a communication strategy to increase and sustain publicity and education on climate change to the citizenry.

Food Safety Practices among Postnatal Mothers in Western Ghana.

Food safety has become a global issue due to the morbidity and mortality associated with it, particularly in developing countries. The objective of this community-based study is to examine food safety practices and its associated factors among postnatal mothers in the Western Region of Ghana. A cross-sectional survey study was conducted from August 1 2019 to January 31, 2020 from which data was obtained from the postnatal mothers (N = 300). The data was analysed using SPSS v.23. The findings suggest that majority (86%) of the respondents exhibited good food handling practices. Also, 66.3% and 91.7% of the respondents exhibited good food preparation and proper storage practices, respectively. Results also revealed that the odds of performing good handling practice among respondents within the age group of 36-45 years were five times higher compared to those within the age group of 18-25 years [OR = 4.92 (95% CI: 1.44-16.86), p = 0.011]. Moreover, respondents who had tertiary education qualifications were more likely to have proper food handling practices compared to those with primary education [OR = 0.27 (95% CI: 0.09-0.71), p = 0.009]. These findings provide useful insights for policy directions. The government of Ghana and other stakeholders should develop a communication strategy to increase and sustain publicity and education on food safety particularly to postnatal mothers and the citizenry in general.

An Assessment of Public Knowledge and Potential Health Impacts of Global Warming in Ghana.

Global warming is a serious threat to human existence. The relatively higher level of global warming in recent times poses higher health risks to humans, both directly and indirectly. The aim of the study was to investigate public knowledge of global warming and its effects on human health. A nationally representative survey of Ghanaian adults (N = 1130) was conducted from November 1, 2018 to February 28, 2019. Results show that 84.4% of the respondents understood the meaning of global warming. Respondents' perceived causes of global warming include natural processes, deforestation, act of the gods, burning of fossil fuel, and carbon dioxide (CO2) emission from vehicles and industries. The majority of the respondents (83.4%) indicated that global warming has an impact on human health, while 8.5% indicated that it does not. Majority (78.6%) of the respondents are willing to support efforts to reduce the intensity of global warming. Television (19.1%) and social media (18.6%) were the leading preferred methods for receipt of global warming information. These findings provide useful insights for policy directions. The Government of Ghana and other stakeholders in health should develop a communication strategy to increase and sustain publicity and education of the citizenry on global warming.

Microbial Air Quality in Neighborhoods near Landfill Sites: Implications for Public Health.

Air pollution has been a major challenge worldwide particularly in the developing world. Improper waste disposal and management may result in microbial air pollution. In advanced countries, landfill sites are far from neighborhoods; however, the opposite is observed for landfill sites in the developing world. In Accra, some landfill sites are 100 meters from neighborhoods. The aim of this study was to assess the microbial air quality and associated environmental health hazards of landfill sites in selected districts in the Greater Accra Region of Ghana. A random sampling method was employed to select sampling sites across the dry and wet seasons from landfills and their corresponding neighborhoods. Results obtained showed a higher total count (CFU/m3) of bacteria and fungi in the air at the landfill sites than neighborhoods. Statistically significant variation (p < 0.05) in bacterial and fungal concentrations over two seasons was found for both landfills and neighborhoods. However, bacterial concentrations were significantly higher than fungal concentrations (p < 0.05) across seasons for all locations. Staphylococcus epidermidis was the highest (15.6 %) occurring microbe at both landfill sites and neighborhoods. This was followed by Staphylococcus aureus (12.7%). Other bacteria and fungi of public health importance such as Pseudomonas aeruginosa, Escherichia coli, Aspergillus flavus, and Aspergillus niger were also isolated from the study sites, above the WHO recommended levels. In conclusion, the landfill waste disposal and its close proximity to neighborhoods as observed in this study pose a potential environmental health risk, with dire implications for public health and safety. The government must enact and implement policies to regulate waste management and to ensure public safety.

Escherichia coli as a Tool for Disease Risk Assessment of Drinking Water Sources.

Many diseases have been associated with poor drinking water quality including diseases caused by diarrheagenic pathogens, especially in developing countries where access to a consistent water supply is a problem. The objective of the study was to evaluate the health risks associated with the sources of drinking water in the Dangme West District of Ghana using E. coli as a measurement tool, aiming at ascertaining the paths leading to contamination of the water sources. A total of 464 water samples were obtained for analysis. Sampling covered a year across the dry and wet seasons in Ghana. Water samples were obtained from groundwater and surface water sources. E. coli counts were determined using the most probable number method (MPN). Disease risk assessment was carried out using the WHO drinking water risk assessment guidelines. Generally, the study revealed significantly higher E. coli counts in the wet season than in the dry season. Among the water samples analyzed, surface water, especially from the dams, was found to pose the highest disease risk as compared to the other water sources. Samples from groundwater sources, especially boreholes, posed the lowest disease risk. In conclusion, observations from the study implied that most water sources in the study district are highly polluted with bacteria pathogens beyond recommended safety guidelines. The main causes of faecal contamination in these water sources were purported to be anthropogenic. Therefore, there is a need to formulate a policy aimed at managing and improving rural water sources.

Evaluation of heat stress impacts and adaptations: perspectives from smallholder rural farmers in Bawku East of Northern Ghana.

Across the tropical developing countries, smallholder farmers are confronted with various climate related risks that hinge on agricultural activities. Climate change is predicted to impact smallholder farmers and their livelihood, especially within and beyond this century. Several studies have examined the impact of drought and rainfall on smallholder farmers as climate change impact assessment. However, there is limited information on impacts and coping strategies of poor farmers to heat exposure at household and farm level in tropical developing countries. As global temperature is predicted to increase with robust impacts on farmers in African region due to poverty and low adaptive capacity, this study evaluates how farmers in Bawku East of Northern Ghana experience the impacts of heat stress and how they cope with it both at the household level and on the field of cultivation. Using household survey and focus group discussion, the authors elicited impacts and responses of heat exposure from 308 resident farmers in three selected farming communities in Bawku East to gauge their vulnerability to heat exposure. Even though farmers have various impacts and coping strategies to heat exposure, these are ineffective to prevent them from heat related morbidity and mortality at both household and farm level. The study recommends the need for government led intervention to assist farmers in their effort to cope with heat stress as global temperatures will exacerbate heat stress impacts on small holder farmers especially in African region.

Burnout among Healthcare Professionals in Ghana: A Critical Assessment.

Health workers are prone to burnout, which can have an adverse effect on their person and the patients to whom care is offered. The goal of this paper was to assess the levels of burnout experienced by healthcare workers in Accra, Ghana. The study was conducted using the cross-sectional study design. Questionnaires were used to obtain data from 365 respondents who worked in 12 major healthcare facilities. Data obtained were analyzed with SPSS version 23. Majority of the respondents were females (56.7%) as against males (43.3%). The total score for all burnout variables among health worker groups ranged from good (71.50%), alarming (12.60%), acute crisis (6.02%), and burnout (9.90%). Among the health worker groups, nurses had the highest percentage score values for all burnout variables. There was an association between burnout and these sociodemographic characteristics: age (p < 0.001), gender (p = 0.003), educational qualification (p < 0.001), occupation (p < 0.001), years of work experience (p < 0.001), marital status (p < 0.001), and parenthood (having children) (p < 0.001). It is recommended that measures should be put in place in Ghanaian hospitals to assess stress and burnout levels to ensure people who are going through such situations are properly cared and supported.

Healthcare waste management in Ghanaian hospitals: Associated public health and environmental challenges.

Healthcare waste generation is an integral part of healthcare operations. Improper healthcare waste management and disposal can be detrimental to humans and the environment. The objective of this paper is to investigate the healthcare waste management practices, aiming to provide needed data to inform policy decisions. The study was conducted using a cross-sectional study. Quantitative data was obtained from 497 respondents who worked in 25 major healthcare facilities. Data was analyzed using (SPSS) version 23.0. Results indicated that 52.4% of respondents had knowledge about healthcare waste management. However, only 12% of the respondents were open to training in healthcare/biomedical waste management. Less than half of the respondent (47.5%) practiced waste segregation at the sources of generation. There were significantly more healthcare waste disposal materials available (P = 0.001) in private than government and quasi-government hospitals. Based on the major findings of the study, we recommend that adequate training as well as Personal Protective Equipment (PPE's) should be provided to healthcare professionals to improve healthcare waste management. Complacence in adhering to Healthcare waste disposal guideline must be addressed.

Knowledge, Attitudes, and Perceptions of Air Pollution in Accra, Ghana: A Critical Survey.

Air pollution has been a major challenge worldwide particularly in the developing world. It has dire implications for human health. Understanding the knowledge and behaviour of the populace is key to the development and implementation of necessary intervention programmes. The aim of this study was to assess the knowledge, attitudes, and perceptions of air pollution in the Accra, Ghana. The study employed a cross-sectional design to obtain quantitative data form 1404 respondents, and the results were analysed with SPSS version 23. There were more (54.1%) female respondents than males (45.9%) in the study. The majority (70.5%) of the respondents were aware of the haze (air pollution) and its adverse effects on health. There was however a significant relationship between the sociodemographics and air pollution awareness (P = 0.01). There was also a correlation between residents' age, educational level, length of stay, marital status, and knowledge/awareness rate of air pollution (P < 0.05). Although the majority of the respondents are aware of air pollution and its relationship to their health, rates of awareness were low in some demographic groups like the elderly and the less educated. Therefore, nondiscriminatory policies should be formed toward the education and guidance of people to become knowledgeable about air pollution and related health challenges. Most of the residents admitted improving air quality is the responsibility of every citizen. The government should utilize this to form collaborative measure with the citizens for a more effective control of air pollution.

An assessment of house-hold solid waste management in a large Ghanaian district.

The importance of waste management cannot be overemphasized. Improper waste management and disposal has rippling effect on the environment and human health. The aim of this study is to assess solid waste management among household in a large Ghanaians district. Multi-stage sampling technique comprising a cluster, simple random sampling, and systematic sampling techniques were used to select 600 respondents for the study. Data was analyzed using (SPSS) version 23.0. Results indicates that communal waste collection bins were far from households as confirmed by the majority (57.3%) of the respondents. The majority (56.5%) of the households walked a distance of 11-15 min before reaching the refuse site. The study found that the number of waste collection point in the community were few (1-3 collection bins) as confirmed by majority (92.2%) of the respondents. The distance from the center of the community to the final waste disposal site covered 1-2 h journey. There was a significant relationship between the number of waste disposal sites in the community and the average distance (in kilometers one way) from the city center to a disposing site. In conclusion, the study found that communal waste collection bins were far from households; number of waste collection point in the community were few. This indicates that the distance from the center of the community to the final waste disposal site covered 1-2 h journey. Based on the major findings of the study, we recommend that district assembly should provide waste collection bins to every household to ensure that residents do not dispose their housrhold waste indiscriminately. District by-laws should be strengthened to ensure proper household waste disposal at all districts in Ghana.

Trends in patients' overall satisfaction with healthcare delivery in Accra, Ghana.

BACKGROUND: Patient satisfaction represents a key marker for the quality of healthcare delivery and is critical for smooth functioning of the healthcare system. AIM: The aim of this study was to determine the levels of patient satisfaction with the quality of care they receive, and thus identify the key factors that influence patients' overall satisfaction with healthcare. SETTING: The study was conducted across seven healthcare facilities in Greater Accra region. METHODS: The study employed a cross-sectional design to obtain data from 417 respondents between 01 November 2017 and 31 January 2018. Patient satisfaction within the context and setting of this study refers to the extent to which patients are happy with the healthcare services they receive. Statistical analysis was performed using Statistical Package for the social Sciences (SPSS) version 23. RESULTS: Female patients constituted 66.7% of the respondents, while 33.3% were male patients. Most of the participants had health insurance coverage (95.2%). Overall, 69.5% of the patients were satisfied with the level of care, 29.3% were somewhat satisfied and 1.2% were not satisfied. Female patients (86.0%) were more satisfied with the level of care they received compared to male patients (61.9%). Majority of the female patients (87.8%) indicated that they were treated with courtesy and respect. However, more than a half (51.8%) of male patients indicated they were not treated with courtesy and respect. Patient satisfaction negatively correlated with social status and age of the patients. CONCLUSION: Measurement of patients' satisfaction is important for healthcare delivery. It was clear from this study that there is still a gap in improving and managing patients' satisfaction and expectation. All stakeholders must get involved to ensure timely and satisfactory healthcare delivery to all patients.

Self-Assessment of Hygiene Practices towards Predictive and Preventive Medicine Intervention: A Case Study of University Students in Ghana.

INTRODUCTION: Personal hygiene is essential to the current paradigm shift towards predictive, preventive, and personalized medicine, which enables the prediction and prevention of infectious disease outbreaks. OBJECTIVE: The aim of this paper was to evaluate the personal hygiene practices among university students aiming at providing a basis for preventive and predictive medical interventions and to make future efforts improve target interventions for young people. METHODS: The study was conducted using a cross-sectional study. Validated instruments that related personal hygiene practices were used to obtain quantitative data from 412 tertiary students from seven universities in Accra, Ghana. The resulting data were analyzed with IBM-SPSS, version 23. RESULTS: There were more female respondents (54.4%) in the study than male respondents (45.6%). Respondents between the age group of 19-24 years constituted majority (59.7%) of the respondents in the study. Respondents from urban areas exhibited good hygiene practice compared to those from urban residences. There was a significant association between residence and hygiene practice (χ 2=17.8, P≤0.001). We also observed that those respondents within the upper class in society had a poor hygiene practice, compared to the Lower Class and Middle Class respondents. Lack of education (63.1%) was observed as the main barrier to personal hygiene among the respondents. Future of the society depends on the health of its youth. CONCLUSION: A significant number of students are not actively practicing good hygiene. There is a need for deployment of preventive medicine interventions targeted at young people. It calls for improvement in methods of hygiene education for young people in tertiary institutions and the inclusion of hygiene in school curricula.

Trends in patients' overall satisfaction with healthcare delivery in Accra, Ghana

Background: Patient satisfaction represents a key marker for the quality of healthcare delivery and is critical for smooth functioning of the healthcare system. Aim: The aim of this study was to determine the levels of patient satisfaction with the quality of care they receive, and thus identify the key factors that influence patients' overall satisfaction with healthcare. Setting: The study was conducted across seven healthcare facilities in Greater Accra region. Methods: The study employed a cross-sectional design to obtain data from 417 respondents between 01 November 2017 and 31 January 2018. Patient satisfaction within the context and setting of this study refers to the extent to which patients are happy with the healthcare services they receive. Statistical analysis was performed using Statistical Package for the social Sciences (SPSS) version 23. Results: Female patients constituted 66.7% of the respondents, while 33.3% were male patients. Most of the participants had health insurance coverage (95.2%). Overall, 69.5% of the patients were satisfied with the level of care, 29.3% were somewhat satisfied and 1.2% were not satisfied. Female patients (86.0%) were more satisfied with the level of care they received compared to male patients (61.9%). Majority of the female patients (87.8%) indicated that they were treated with courtesy and respect. However, more than a half (51.8%) of male patients indicated they were not treated with courtesy and respect. Patient satisfaction negatively correlated with social status and age of the patients. Conclusion: Measurement of patients' satisfaction is important for healthcare delivery. It was clear from this study that there is still a gap in improving and managing patients' satisfaction and expectation. All stakeholders must get involved to ensure timely and satisfactory healthcare delivery to all patients

Prevalence of Multidrug-Resistant Escherichia coli Isolated from Drinking Water Sources.

The control of infectious diseases is badly endangered by the rise in the number of microorganisms that are resistant to antimicrobial agents. This is because infections caused by resistant microorganisms often fail to respond to conventional treatment, resulting in prolonged illness and greater risk of death. Antimicrobial-resistant bacteria are also present in various water sources. This study therefore sought to document the microbiological quality and antibiograms of bacterial isolates (E. coli strains) from six different water sources in order to determine their safety for human consumption and to provide updated antibiotic data for pragmatic treatment of patients. Bacteria isolation and identification was done using API and conventional methods. Antibiotic susceptibility testing was conducted using the Kirby-Bauer method. Results obtained indicated that all the water sources tested were of poor quality. Bacteria isolated included E. coli, Enterobacter spp., Klebsiella spp., Salmonella typhi, Streptococcus spp., Proteus vulgaris, Vibrio cholera, Shigella spp., Pseudomonas aeruginosa, and Enterococcus faecalis. The prevalence of multidrug-resistant E. coli was 49.48%. E. coli isolates showed high resistance patterns to the tested antibiotics. They were most resistant to penicillin (32.99%), cefuroxime (28.87%), erythromycin (23.71%), and tetracycline (21.45%). In contrast, they were susceptible to nitrofurantoin (93.8%), cefotaxime and amikacin (91.75%), gentamicin (90.7%), nalidixic acid (89.65%), ciprofloxacin (74.2%), chloramphenicol (69.07%), pipemidic acid (65.97%), and cefuroxime (52.58%). Sixty-three percent (63%) of the multidrug-resistant E. coli strains recorded a multiple antibiotic resistance (MAR) index value >0.2. The susceptible antibiotics, especially the nitrofurantoin, are hence recommended in the practical treatment of waterborne bacterial diseases.