The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana.

Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.

Assessing health-related quality of life and clinical outcomes of patients with diabetes accessing healthcare in two public hospitals in south-eastern Ghana: a cross-sectional descriptive study.

BACKGROUND: Diabetes is a significant contributor to kidney failure, heart attack, strokes, lower limb amputation, blindness, and other complications that negatively impact health-related quality of life (HRQOL). This study assessed the HRQOL and clinical outcomes of patients with diabetes accessing healthcare in south-eastern Ghana. METHODS: This was a hospital-based cross-sectional descriptive study conducted in the Ho Municipal and Ho Teaching Hospitals in Ghana among patients with type 2 diabetes who were seeking healthcare at both hospitals for at least 12 months. Systematic random sampling technique was used to select 310 respondents out of the total sample size of 326 patients with type 2 diabetes and data were collected using diabetes-39 questionnaire. The data were analysed using STATA 16.0. Socio-demographic and clinical variables were expressed as frequencies and percentages. Differences between proportions were tested using Chi-square to identify predictors of poor HRQOL and Pearson correlation for association. The p < 0.05 was considered significant. RESULTS: Out of 310 respondents, 171 (55.0%) had poor HRQOL. The predictors of poor HRQOL were age (p < 0.008), education (p < 0.028), employment (p < 0.001), residence (p < 0.01), duration of diabetes (p < 0.002), diabetes education (p < 0.001), BMI (p < 0.005), and glycaemic control (p < 0.001). Energy and mobility (63.2%), anxiety and worry (53.9%), and diabetes control (49.6%) dimensions were the most prevalent of poor HRQOL. Diabetes education, complications, being diabetic for 16 years and above, earning income, resident in rural area, being married, being pensioner and national Service Personnel, and diabetes comorbidities were significantly associated with HRQOL. CONCLUSIONS: More than half of the respondents had poor HRQOL. Clinical and public health efforts should focus on effective control and screening measures for the individual patients and general population.

Biopsychosocial analysis of antibiotic use for the prevention or management of COVID-19 infections: A scoping review.

BACKGROUND: The novelty and complexity of the COVID-19 pandemic has resulted in various coping mechanisms adopted by individuals as a means of averting the perceived fatalities of the pandemic. The use of antibiotics in the management of COVID-19 is clinically recommended under specific conditions. However, there are increasing trends of non-adherence to the recommended criteria resulting in the unwarranted use of antibiotics as an adaptative approach to the ongoing pandemic. OBJECTIVE: The objective was to identify and classify factors associated with the unwarranted use of antibiotics in the management of COVID-19 from published literature and the perspectives of key stakeholders along a Biopsychosocial model. METHODS: Literature was searched in the following databases: PubMed/MEDLINE, Scopus, Embase and Google Scholar for studies published between 31st December 2019 and 31st January 2022. The Arskey and O'Malley framework modified by Levac in the six-stage methodological process was adopted for this review and included: a) identification of research questions, b) identification of relevant research articles, c) selection of studies, d) data charting and synthesis, e) summary, discussion and analysis, and f) stakeholder consultations. RESULTS: Out of 10,252 records identified from all sources, 12 studies were selected for inclusion in this scoping review. The selected articles reflected both antibiotic use and COVID-19 whilst capturing the biological (medical) and psychosocial perspectives. Most of the studies reported the overuse or abuse of Azithromycin especially in hospital settings. Common themes across the review and stakeholder consultations included fear, anxiety, media influences and deficits in public knowledge. CONCLUSION: The findings of the study highlight the complexity of antibiotic control especially in the context of a pandemic. The identified determinants of antibiotic use provide the necessary framework to simulate health emergencies and be better positioned in the future through the development of targeted and comprehensive policies on antibiotic stewardship.

Post-Traumatic Growth and Resilience among Hospitalized COVID-19 Survivors: A Gendered Analysis.

The literature on behavioral outcomes associated with the COVID-19 pandemic is inundated with mental health burdens such as depression and stress disorders. The current study investigated gender invariance on resilience and post-traumatic growth (PTG) as positive psychological changes associated with the COVID-19 pandemic. A total of 381 survivors of the COVID-19 infection completed measurements of resilience, PTG, violence and stigma experience, and mental health problems like post-traumatic stress disorder (PTSD). The data were analyzed using descriptive statistics, correlation, multivariate regression, and a latent profile analysis. The results revealed that more than half of the participants had high scores on resilience (53.6%) and PTG (60.9%). The positive psychological changes, although independent of each other, were moderated by gender, and influenced by the negative experiences of participants such as stigma, violence, and PTSD. Latent profile analyses revealed three classes of participants, two of which were characterized by high scores on mental health problems and PTG. The clusters were invariant across gender. Surviving COVID-19 contributed to resilience and PTG. These can be targeted for intervention programs to mitigate the mental health burden occasioned by the pandemic.

A comparative analysis of pattern and attitude towards self-medication among pharmacy and non-pharmacy students in University of Ghana.

Introduction: self-medication involves the use of medicines without the input of health professionals. Available studies are not entirely conclusive on self-medication among health science versus non-health science university students. The current study therefore sought to investigate relevant aspects of self-medication among pharmacy and non-pharmacy students. Methods: this quantitative cross-sectional research was conducted among undergraduate pharmacy and non-pharmacy students of the University of Ghana from October 1st 2019 to December 6th 2019. Using a questionnaire, interviews were conducted to assess the pattern and attitude towards self-medication among respondents within the last 2 months. Results: a total of 337 (163 pharmacy and 174 non-pharmacy) students filled and completed questionnaires. The prevalence of self-medication was 55.2% for pharmacy and 51.1% for non-pharmacy students. Both pharmacy and non-pharmacy students were either accepting or ambivalent towards self-medication. Painkillers were the major class of medications that were self-medicated by both pharmacy (38.5%) and non-pharmacy students (30.7%). The most common reason for self-medication among pharmacy (62.2%) and non-pharmacy (56.2%) students was the need for rapid relief from an illness. Majority of the participants who were self-medicated (27.6% among non-pharmacy and 36.8% among pharmacy students) demonstrated ambivalent attitude towards self-medication. An increase in the study level reduced the likelihood of self-medication in both pharmacy and non-pharmacy students: OR=0.442, CI = 0.266-0.736 for pharmacy students and OR=0.671, CI = 0.456-0.987 for non-pharmacy students. Conclusion: self-medication is common students of the University of Ghana. Prevalence of self-medication was higher among pharmacy students than non-pharmacy students. This study provides data for targeted education and sensitisation of self-medication among university students.

The impact of antimicrobial resistance awareness interventions involving schoolchildren, development of an animation and parents engagements: a pilot study.

BACKGROUND: Antimicrobial resistance (AMR) is a global health challenge, particularly in low- and middle-income countries where antibiotics are widely available to consumers, leading to their misuse. However, AMR educational interventions for engaging parents of schoolchildren are mainly lacking in Sub-Saharan Africa. This study aimed to assess the potential of AMR animation and schoolchildren in influencing parents' AMR knowledge, attitudes, and beliefs. METHODS: Parents of schoolchildren aged 11-15 years in Tema, a city in Ghana, watched and discussed an AMR animation designed with ideas from the schoolchildren's top stories and picture drawings. The children from two schools were first engaged with AMR lessons, with one school using storytelling, the other school using picture drawing, and none serving as a control. The children were then asked to discuss the lessons with their parents. Baseline surveys of parents of randomly selected children were conducted to assess AMR knowledge, attitudes and beliefs before engaging the students and parents, and immediately after the parents participated in viewing and discussing the animation. McNemar and t-tests were used to assess changes in AMR knowledge, attitudes and beliefs. RESULTS: Parents who participated in the animation event, and whose schoolchildren were in the storytelling intervention school had significantly improved knowledge regarding the statement "Antibiotics will cure any infection" (p = 0.021, χ2 = 0.711; 88% vs 50%) between baseline and endline. However, these parents also had statistically significant decreased scores regarding the statement "Antibiotics do not kill our good bacteria" (p = 0.021, χ2 = 1.042; 71.4% vs 40%) between baseline and endline. There was no significant effect on any statement among parents whose children were in the picture drawing school. However, t-test results combining the statements as composite scores showed statistically significant difference in only the attitude construct among parents whose children participated in storytelling intervention (p = 0.043) or picture drawing intervention (p = 0.019). There were no statistically significant changes in knowledge and beliefs constructs. CONCLUSIONS: This study shows that interventions involving schoolchildren with parents engagements and AMR animation could influence parents' AMR attitudes. The intervention could also positively or negatively impact parents' AMR knowledge. Modifications of the interventions may be needed for tackling AMR.

Coping strategies and resilience among patients with hypertension in Ghana.

Background: Hypertension is associated with high morbidity and mortality and this has been linked to poor treatment and control rates. To optimize drug treatment, patient-centered strategies such as coping, resilience, and adherence to medication may improve control rates and decrease the morbidity and mortality associated with hypertension. This study, therefore, assessed coping skills and resilience among patients with hypertension in Ghana. Methods: A cross-sectional study was conducted at Korle Bu Teaching Hospital. 224 consented patients with a diagnosis of hypertension were consecutively selected from the outpatient clinic. Questionnaires comprising socio-demographic characteristics, clinical parameters, Adult Resilience Measure, and the Africultural Coping Systems Inventory were administered. Data were analyzed using Stata version 16.1 and significance level was set at p-value of ≤ 0.05. Results: The mean age of participants was 62.03 ± 11.40 years and the majority were female (63%). The overall coping strategy mean score was 43.13 ± 13.57. For resilience, median relational and personal resilience (PR) scores were 32 (IQR-7) and 39 (IQR-9), respectively. Increased systolic BP significantly increases the overall coping strategy score. Collective coping strategy and systolic BP significantly increased coping scores (95%CI = 0.05-3.69 vs. 95%CI = 0.58-5.31). Overall coping strategy significantly increased personal and relational resilience (RR) domain scores by 0.004 (95%CI = 0.002-0.01) and 0.005 (95%CI = 0.003-0.006) units, respectively. This study demonstrated that Cognitive and emotional debriefing coping strategy was mostly used by patients with hypertension. Conclusion: Coping strategies had a positive and significant correlation with personal and RR, specifically collective and cognitive debriefing had a significant positive association with resilience among study participants. There is a need to actively put in measures that can improve the coping strategies and resilience among patients with hypertension to adjust to the long-term nature of the illness and treatment as this will promote better treatment outcomes.

Perceptions of a mobile phone-based approach to promote medication adherence: A cross-sectional application of the technology acceptance model.

Background: In several African and Asian countries, callers to mobile phones sometimes hear a song or message in place of the typical ringing sound. This application, called caller tunes, may offer a unique opportunity to promote medication adherence that is yet to be explored. Objectives: Assess the application of the technology acceptance model to a potential caller tunes approach designed to enhance medication adherence, with a specific focus on the interrelationships of perceived ease of use, perceived usefulness, cost, and intention. Methods: Data from a cross-sectional sample of 996 adult mobile phone users in Ghana, approximately half of whom were current caller tunes users, was examined using exploratory factor analysis for scale evaluation and structural equation modeling to assess associations among perceived ease of use, perceived usefulness, and cost on intention to use mobile phone caller tunes to promote medication adherence. Results: Consistent with the technology acceptance model, intention to use the caller tunes as a means of enhancing medication adherence was higher among those who viewed the application positively in terms of ease of use and usefulness. Among those who were already caller tunes users, availability as a free download was also associated with more positive intentions. Conclusion: The present study provides preliminary evidence in support of caller tunes as a novel strategy to promote medication adherence. Future studies interested in using this approach would be advised to consider factors such as participants' current use of caller tunes, age, availability as a free download, and perceptions of ease of use and perceived usefulness of the approach as potential moderators of study outcomes.

Factors that influence the intention to use mobile phone caller tunes for patient reporting of adverse drug reactions: a qualitative study.

BACKGROUND: Patient reporting of adverse drug reactions (ADRs) is low in low- and middle-income countries, in part because of poor awareness to report. With the increase in mobile subscription, mobile phones can be used as a platform to disseminate information on ADRs. The aim of this study was to qualitatively assess the potential of using mobile phone caller tunes (the message or sound the caller hears before the receiver answers the call) to encourage patient reporting of ADRs. METHODS: A total of 38 key informant interviews and 12 focus group discussions (57 participants in groups of 4-5) were conducted in Accra, Ghana. The transcripts were analysed using key constructs of the Technology Acceptance Model (TAM) including perceived usefulness, perceived ease of use, and behavioural intention to use caller tunes for patient reporting of ADRs. RESULTS: Respondents mentioned lack of knowledge on reporting ADRs, and their willingness to use mobile phone caller tunes to promote patient reporting of ADRs. Many respondents pointed out how ADRs usually led to discontinuity in medication use, usually without consultation with health professionals. Caller tunes were regarded an innovative, accessible and convenient platform to disseminate information on ADRs. Most respondents intended to use caller tunes with drug safety information to promote ADR reporting, particularly to help their friends and family members. Simplicity of the message, use of songs or messages in local languages and price of downloading the caller tunes were important considerations. CONCLUSION: There is a need for the creation and testing of caller tunes on ADRs in Ghana to promote patient or consumer reporting of ADRs. Further studies are needed to assess factors that could influence the creation and use of caller tunes to disseminate information on drug safety.

Analgesic effects of a hydro-ethanolic whole plant extract of Synedrella nodiflora (L.) Gaertn in paclitaxel-induced neuropathic pain in rats.

BACKGROUND: Synedrella nodiflora is used by traditional healers in Ghana for the management of epilepsy and pain. The hydro-ethanolic extract of the whole plant has demonstrated antinociceptive effect in various animal models of pain. This study investigated the potential benefit of the hydro-ethanolic extract in a rat model of paclitaxel-induced neuropathic pain. METHODS: Neuropathy was induced in rats by a continuous intraperitoneal administration of paclitaxel (2 mg/kg) for 5 days. Baseline latencies to thermal pain were recorded before the first injection of paclitaxel and during the 5 day induction period. Following the induction, the rats in designated treatment group were treated with the hydro-ethanolic extract (100, 300 and 1000 mg/kg, p.o) or pregabalin (10, 30 and 100 mg/kg) or vehicle (distilled water) and their responses to thermal hyperalgesia measured every 30 for a total period of 3 h. RESULTS: There was a significant difference between the baseline reaction latency and what was observed on the 5th day of the induction of neuropathy. Two days after the induction of neuropathy, the extract and pregabalin significantly and dose-dependently produced antinociceptive effect during the 3-h test period. CONCLUSION: The hydro-ethanolic extract of the whole plant of Synedrella nodiflora possess analgesic effect in paclitaxel-induced neuropathy in rats.

Locus of control and anti-hypertensive medication adherence in Ghana.

INTRODUCTION: Medication non-adherence is a major public health problem in Ghana. Locus of control (LoC) may influence adherence to medication. In this study we examine the association between locus orientation and adherence to hypertensive medication among adult patients. We also take into account the role of medication side effects. METHODS: We conducted a hospital-based cross-sectional study involving two tertiary hospitals in southern and northern Ghana. Data were collected from 400 hypertensive patients using a structured questionnaire. We gathered information on patient's sociodemographic characteristics, health LoC, side effects of anti-hypertensive medication and adherence to anti-hypertensive medication. RESULTS: Participants exhibited features of mixed LoC (both internal and external) usually referred to as bi-local expectancy. However, orientation was skewed towards external LoC. Females were marginally more likely than males to have an internal LoC. Education was associated with a greater likelihood of internal LoC. While most patients (93.3%) poorly adhered to antihypertensive medications, logistic regression model revealed that non-adherence was significantly associated with low internal LoC, medication side effects and the combined effect of medication side effects and external LoC. CONCLUSION: Medication non-adherence, experiences of medication side effects and LoC are associated. Multifaceted intervention programmes highlighting personality characteristics like LoC may improve anti-hypertensive medication adherence.