Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study.

BACKGROUND: Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. OBJECTIVE: This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. METHODS: A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers' contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. RESULTS: A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. CONCLUSIONS: The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle.

Health-seeking experiences of women with obstetric fistula: a qualitative study at two fistula centres in Ghana.

OBJECTIVES: The study explored the health-seeking experiences of women with obstetric fistula from the onset of the condition until surgical treatment was obtained. It also describes their interactions with health staff and traditional healers. DESIGN: Exploratory, descriptive qualitative study. SETTING: Two secondary-level health facilities in the northern and central regions of Ghana; data collection took place in 2018-2019. PARTICIPANTS: A purposive sample of 37 women who had experienced fistula resulting from childbirth and were awaiting fistula repair at the two fistula centres in Ghana was obtained. DATA ANALYSIS: Thematic analysis was used to analyse the data. RESULTS: Health-seeking experiences and behaviours of women with obstetric fistula were identified. Six major themes were generated: attribution and perceptions of fistula; competing alternatives/multiple sources of care; limited awareness and access to care; financial barriers; psychosocial challenges, and abuse by healers. The results indicate that the health-seeking experiences of women with obstetric fistula were characterised by long delays in care-seeking. The major themes and subthemes are presented with quotes from participants. CONCLUSION: The women experienced winding pathways of treatment-seeking due to lack of awareness and incorrect attribution. The major barriers to health-seeking included poverty, challenges with transportation and inadequate repair centres. Increased awareness of obstetric fistula and access to repair centres could shorten the suffering women go through while awaiting fistula treatment. Improved awareness of obstetric fistula and establishment of more fistula centres would be beneficial.

Socioeconomic factors associated with the number of children ever born by married Ghanaian females: a cross-sectional analysis.

OBJECTIVE: Most studies in Ghana on determinants of children ever born (CEB) are often conducted among all females of reproductive age and do not adequately report patterns among married females. Considering the importance of marriage to fertility in the Ghanaian context, this study seeks to explore the association of socioeconomic characteristics of married Ghanaian women with CEB. DESIGN: Data from the 2017 Ghana Maternal Health Survey were used. Three separate models were considered: linear regression model using CEB and two logistic regression models. Bivariate and multivariate analyses were considered for all models. SETTING: The study was conducted in all 10 administrative regions of Ghana. PARTICIPANTS: Married females aged between 15 and 49 years. PRIMARY AND SECONDARY OUTCOME MEASURES: Socioeconomic factors associated with married females' CEB. RESULTS: In all three models, place of residence, zone, wealth index, age, age at marriage, media exposure, level of education, number of abortions and age at first sex were all significantly (p<0.05) associated with CEB. Married females with higher education had lower odds of one or more births and lower odds of giving birth to three or more children. Also, married females from households with the highest wealth index had fewer CEB, lower odds of one or more births and lower odds of giving birth to three or more children. CONCLUSION: Socioeconomic characteristics of married females in Ghana, including education and wealth status had a significant influence on the number of CEBs. We recommend governments' intervention to help bridge the gaps in access to education and income-generating opportunities. The mass media must be used to propagate and counsel married females on the potential of high fertility and its consequences.

An integrative literature review on the impact of COVID-19 on maternal and child health in Africa.

Africa has the highest rates of maternal deaths globally which have been linked to poorly functioning health care systems. The pandemic revealed already known weaknesses in the health systems in Africa, such as workforce shortages, lack of equipment and resources. The aim of this paper is to review the published literature on the impact of the COVID-19 pandemic on maternal and child health in Africa. The integrative review process delineated by Whittemore and Knafl (2005) was used to meet the study aims. The literature search of Ovid Medline, CINAHL, PubMed, WHO, Google and Google scholar, Africa journals online, MIDIRS was limited to publications between March 2020 and May 2022. All the studies went through the PRISMA stages, and 179 full text papers screened for eligibility, 36 papers met inclusion criteria. Of the studies, 6 were qualitative, 25 quantitative studies, and 5 mixed methods. Thematic analysis according to the methods of Braun and Clark (2006) were used to synthesize the data. From the search the six themes that emerged include: effects of lockdown measures, COVID concerns and psychological stress, reduced attendance at antenatal care, childhood vaccination, reduced facility-based births, and increase maternal and child mortality. A review of the literature revealed the following policy issues: The need for government to develop robust response mechanism to public health emergencies that negatively affect maternal and child health issues and devise health policies to mitigate negative effects of lockdown. In times of pandemic there is need to maintain special access for both antenatal care and child delivery services and limit a shift to use of untrained birth attendants to reduce maternal and neonatal deaths. These could be achieved by soliciting investments from various sectors to provide high-quality care that ensures sustainability to all layers of the population.

Socio-economic factors associated with adolescent pregnancy and motherhood: Analysis of the 2017 Ghana maternal health survey.

BACKGROUND: Adolescent pregnancy and motherhood have been linked to several factors stemming from social, cultural and to a large extent economic issues. This study examined the socio-economic factors associated with adolescent pregnancy and motherhood in Ghana. DESIGN: This was a secondary analysis of the 2017 Ghana Maternal Health Survey, which was a nationally representative cross-sectional survey. Data from 4785 adolescents aged between 15-19 years were included in the analysis. Adolescent pregnancy was defined as adolescents who have ever been pregnant, whiles adolescent motherhood was defined as adolescents who have ever given birth. Weighted logistic regression was used to assess the association between the socio-economic variables and adolescent pregnancy and motherhood. RESULTS: Of the 25062 women aged between 15 and 49 years included in the 2017 maternal health survey, 4785 (19.1%) were adolescents between 15-19 years. Adolescent pregnancy was reported in 14.6% (CI:13.2% -16.1%) of the respondents, whereas 11.8% (CI: 10.5% -13.1%) of the respondents had ever given birth. In the multivariate regression analysis, zone (p<0.001), wealth index (p<0.001), age (p<0.001), marital status (p<0.001) and level of education (p<0.001) were all significantly associated with adolescent pregnancy and motherhood. The odds of pregnancy and motherhood were significantly higher in the Middle and Coastal zones (p<0.001), and among older adolescents (p<0.001). However, the odds of pregnancy and motherhood was significantly lower among adolescents from households with the highest wealth index (p<0.001), among those who were never married (p<0.001) and among adolescents who had secondary/higher education (p<0.001). CONCLUSION: Several socio-economic variables including education, household wealth, marital status and zone of residence were significantly associated with adolescent pregnancy and adolescent motherhood. Sexual and reproductive health education should be intensified among these populations. Adolescent friendly corners should be made available and accessible to all adolescents in Ghana irrespective of where they live or their age.

Exploring the myths surrounding the COVID-19 vaccines in Africa: the study to investigate their impacts on acceptance using online survey and social media.

Purpose: The coronavirus disease 2019 (COVID-19) vaccine is the key to getting out of the pandemic. However, acceptance of the vaccine has been affected by false information and rumors, which have kept people from getting the shot since it was rolled out. Materials and Methods: This study aimed to investigate the various misconceptions surfaced about the COVID-19 vaccines in Africa. We performed an online survey using an anonymous questionnaire to reach out to African respondents by social media and all possible online platforms such as Facebook, WhatsApp, Instagram, Twitter, YouTube, and so forth. The web-based questionnaires about the myths surrounding the vaccines were extracted from nonscientific information, unproven statements, social media posts, news reports, and people's concerns about the safety of the COVID-19 vaccines. Participants indicated their level of agreement with each statement. Results: A total of 2,500 people responded to the online survey in Africa. The two common myths that respondents agreed with were that "since vaccines for COVID-19 have been developed, we can make vaccines for the common cold, human immunodeficiency viruses, and other diseases" (n=892, 35.7%) and that "researchers rushed the development of the COVID-19 vaccines; therefore, it is not very effective, safe and cannot be trusted" (n=595, 23.8%). The range of respondents who neither agreed nor disagreed with these myths was 12.4%-33.0%. The majority (1,931, 77.2%) indicated disagreement with the statement "after getting the COVID-19 vaccine, one can stop wearing a mask as well as taking safety precautions." Conclusion: Myths surrounding the COVID-19 vaccines have impact on acceptance. Exploring them helps public health authorities in Africa dispel them and provide accurate information to promote vaccination campaigns, education, and acceptance.

Demographic disparities in unimproved drinking water and sanitation in Ghana: a nationally representative cross-sectional study.

OBJECTIVE: The government of Ghana has targeted universal access to safe drinking water by 2025 and elimination of open defecation by year 2030. This study explored the use of unimproved drinking water and unimproved sanitation and assessed their association with demographic factors. DESIGN: This was a secondary data analysis of the 2017 Ghana Maternal Health Survey, a nationally representative cross-sectional survey. Open defecation households were mapped to show regional differences. Weighted logistic regression was used to assess the association of demographic variables with use of unimproved drinking water and unimproved toilet facilities. SETTING: Ghana. PARTICIPANTS: A total of 26 324 households were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Use of unimproved drinking water and unimproved toilet facilities. RESULTS: Out of the 26 324 households, 8.9% used unimproved drinking water while 81.6% used unimproved sanitation. Open defecation was practised by 15.2% of Ghanaian households, with a prevalence of 58.8%, 6.7% and 12.5% in the Northern, Middle and Coastal zones, respectively. In the multivariate analysis, rural households (p<0.001), households with more than five members (p<0.001), households with heads less than 25 years (p=0.018), male-headed households (p<0.001) and household heads with no/low level of education (p<0.001) were significantly associated with drinking unimproved water. Also, rural households (p=0.002), households in the Northern zone (p<0.001), single-member households (p<0.001), households with heads less than 25 years (p<0.001) and household heads with no/low level of education (p<0.001) were significantly associated with using unimproved toilet facilities. CONCLUSION: The target of universal access to safe drinking water by 2025 and elimination of open defecation by 2030 seems impossible to be achieved if appropriate measures are not implemented. We recommend that state authorities, health partners and non-governmental organisations support local-level sanitation plans and strategies.

COVID-19 vaccines development in Africa: a review of current situation and existing challenges of vaccine production.

Following the development of the coronavirus disease 2019 (COVID-19) vaccines and the launching of vaccination, the World Health Organization has reported that the African Continent is lagging in the race to vaccinate its population against the deadly virus. The Continent has received a limited number of vaccines, implying that vaccine production needs to be scaled up in Africa. In this review, we summarize the current situation concerning COVID-19 vaccine development in Africa, progress made, challenges faced in vaccine development over the years and potential strategies that will harness vaccine production success.

COVID-19 vaccination in pregnancy: A review of maternal and infant benefits.

Pregnant women with COVID-19 are more likely to be admitted to the intensive care unit and their babies born prematurely. Clinical trials excluded pregnant women from the vaccine and safety data were limited. However, an increasing number of studies have demonstrated the safety and immunogenicity of the COVID-19 vaccines for pregnant women and their babies including evidence of maternal transfer of antibodies. In addition to these benefits, the vaccines are proved to be effective for both the pregnant women and infants. The current evidence supports the safety, immunogenicity of the COVID-19 vaccine and its effectiveness in reducing the theoretical risk of the infection among pregnant women and their infants. This review summarizes the recent data on the beneficial effects of COVID-19 immunization on both the pregnant mother and infant.

Increasing COVID-19 vaccine acceptance among the general population while maintaining autonomy.

The accelerated dissemination of coronavirus disease, its effects on the general public and healthcare system have been unparalleled. COVID-19 vaccination is critical for reducing the alarming incidence of the infection, promoting herd immunity, preventing associated mortality and morbidity, and maintaining public health and safety. Through the development of COVID-19 vaccines, many people are keen to protect themselves against the virus; however, the willingness for vaccination especially in Africa, is far below what is required to stop the ongoing COVID-19 pandemic. As a result, there is an immediate need to implement plans aimed at increasing population vaccine willingness. The slippery slope is whether sanctions, bans and restriction should be imposed on hesitant persons, since transmission of the epidemic can be prevented through stringent enforcement of the control barriers, while eradicating the disease would necessitate vaccination. This commentary provides recommendations about how to increase population vaccine acceptance while maintaining autonomy.

Knowledge, risk perception and preparedness towards coronavirus disease-2019 (COVID-19) outbreak among Ghanaians: a quick online cross-sectional survey.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is recognized as global pandemic, affecting more than 300,000 worldwide. Ghana joined the international community by confirming first two COVID-19 cases on March 12, 2020. The study aimed to assess the public knowledge, risk perception and preparedness to respond the COVID-19 in the early stage of the outbreak in Ghana. METHODS: A cross-sectional study was conducted to collect information from Ghanaian during the early stage of the outbreak from 12th to 20th March 2020. Electronic based questionnaire was developed to collected information on the public knowledge, risk perceptions and preparedness to respond the COVID-19. All people who were aged 18 years and over were invited to participate in the study. RESULTS: A total of 350 participants were recruited into the analysis; 56% were males, with the majority of the study population aged between 18-30 years (61.4%), single (68.9%) and attained tertiary education (95.1%). Regarding COVID-19, 62.7% had "good" knowledge about the outbreak, 68.3% had a high risk of contracting the COVID-19 infection and 81.4% had a moderate preparedness skill to prevent and control the disease. Internet (77.1%) was the major sources of information. Knowledge of COVID-19 was significantly associated with education (p<0.001), age (p=0.018), employment (p=0.011) and health-related occupation (P=0.001) but only religion was associated with risk perception. CONCLUSION: Though overall public knowledge was good, disparity exist among the least educated population, there was high risk perceptions and moderate preparedness skill to respond to COVID-19 among our study population. We recommend that educational campaigns through timely online update on COVID-19, van mobilization and mass media broadcasting should target all groups including those in the rural communities.