'Digitising health protection schemes in Ghana': An enquiry into factors associated with the use of a mobile phone-based health insurance contribution payment system among tertiary students.

In 2018, Ghana's National Health Insurance Scheme (NHIS) introduced a mobile money payment system for membership renewal and premium payments to enhance enrolment and retention rates. However, the adoption of such innovations depends on various factors, including personal traits and public perceptions. This study aims to explore the determinants of NHIS membership renewal and premium payment via the mobile renewal system. Conducted at Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana, the study used a survey design to gather data from 951 KNUST students. Employing logistic regression analysis, the study identified key factors influencing the use of the NHIS mobile renewal service. The findings revealed that individuals aged 19-21, 25-27 or above 27, without mobile money accounts, and those with no history of online purchases were less likely to adopt the mobile renewal system (P < .05). Conversely, those perceiving the system as useful and easy to use were more likely to utilise it for NHIS membership renewal (P < .05). In conclusion, policymakers should prioritise system quality, accessibility, perceived ease of use, and usefulness to facilitate the adoption and usage of the NHIS mobile payment system. These findings contribute valuable insights for enhancing the effectiveness of health insurance innovations.

Differences in physical and mental health symptoms among residents living near municipal solid waste sites: a cross sectional study in the Ashanti Region, Ghana.

OBJECTIVE: Physical and mental health concerns and symptoms, including sleep problems, low mood, extreme tiredness, and appetite loss are prevalent among people living near waste sites. This research examines differences in health symptoms among residents living near municipal solid waste sites in the Ashanti Region, Ghana. METHODS: The study used cross-sectional data from 827 residents living near three municipal waste sites, including Besease, Asokore, and Dompoase sites in the Ashanti Region, Ghana. Descriptive statistics, Pearson's chi-square, and binary logistic regressions were performed to examine the differences and associations between the variables. RESULTS: Health symptoms, including sleep problems/insomnia, frequent extreme tiredness, low mood, loss of appetite, stress, anxiety, and depression, were reported by the majority of the participants. Residents near open dumpsites (Besease and Asokore) exhibit significantly higher likelihoods of experiencing various health symptoms such as extreme fatigue, depression, psychological disorders, thinking and concentration problems, low mood, loss of appetite, and anxiety compared to those near the engineered Oti landfill in Dompoase. CONCLUSION: While emphasizing the importance of proper landfill design and management in Ghana, this study underscores the need for further longitudinal and clinical investigations. Clinically establishing the link between dumpsites and health symptoms is imperative for informed public health interventions and policy decisions aimed at mitigating the potential adverse health effects of landfills on residents' well-being.

Association between breakfast skipping and psychosomatic symptoms among Canadian adolescents.

This cross-sectional study aimed to examine the mediating roles of gender and substance use in the influence of breakfast skipping on psychosomatic symptoms. The study used data among a nationally-representative sample of 2855 Canadian adolescents who participated in the 2018 Health Behavior in School-aged Children (HBSC) survey. Sequential logistic regressions were used to estimate the associations between breakfast skipping and psychosomatic symptoms. Path analysis using a non-parametric bootstrapping technique tested the hypothesized mediating roles. Results showed that adolescents who skipped breakfast were 2.55 times more likely to report higher psychosomatic symptoms compared to non-breakfast skippers (AOR = 2.55; 95% CI = 1.75-3.82). The bootstrapping mediation models showed that breakfast skipping indirectly influenced psychosomatic symptoms through substance use and gender, accounting for 18.47% ( ß = 0.0052, Boots 95% CI = 0.0025, 0.00730) and 10.70% ( ß = 0.0091, Boots 95% CI = 0.0052, 0.0125), respectively, of the total effect. Our findings have important implications for targeted public and mental health interventions to address both breakfast skipping and psychosomatic symptoms among adolescents.  Conclusion: The study compellingly underscores the significance of incorporating gender-specific factors and substance use in understanding the correlation between breakfast skipping and psychosomatic symptoms. These insights hold importance for tailoring public health interventions to alleviate the prevalence of psychosomatic symptoms among adolescents by actively addressing breakfast skipping. What is Known: • Breakfast is considered the most important meal of the day due to its role in providing the brain with the energy necessary to enhance cognitive functions. • Adolescents commonly exhibit a prevalent lifestyle behaviour of skipping breakfast. What is New: • This study provides robust evidence supporting the association between breakfast skipping and elevated psychosomatic symptoms in adolescents. • Gender and substance use mediate this association, offering novel insights into the complex interplay that contributes to psychosomatic symptoms among this demographic group. • Longitudinal research is needed to unravel causal relationships and illuminate the underlying mechanisms of this intricate connection.

Problematic social media use and overweight/obesity: explanatory pathway analysis of 124 667 in-school adolescents in 39 high-income countries.

BACKGROUND: The relationship between adolescent problematic social media use (PSMU) and overweight/obesity and the potential explanatory pathways for this association are unclear. This study (1) examined the relationship between PSMU and overweight/obesity and (2) evaluated potential explanatory pathways for this association. METHODS: The data used in this study came from the 2018 Health Behaviour in School-aged Children (HBSC) survey. A sample of 124 667 in-school adolescents from 39 high-income countries was analysed. Sequential logistic regressions were used to estimate the association between PSMU and overweight/obesity. Pathway analysis using a non-parametric bootstrapping technique tested the hypothesized mediating roles. RESULTS: The multivariable logistic regressions indicated that higher problematic social media users were 1.11 times more likely to be overweight/obese compared with those who reported low PSMU (AOR = 1.11; 95% CI = 1.05-1.18). Our bootstrapping mediation analyses showed that PSMU indirectly influenced overweight/obesity through breakfast skipping, life satisfaction, family communication, self-rated health, and physical activity, accounting for 19.8% (ß = 0.0068, Boots 95% CI = 0.0056-0.0074), 15.1% (ß = 0.0050, Boots 95% CI = 0.0046-0.0056), 9.2% (ß = 0.0031, Boots 95% CI = 0.0024-0.0038), 7.8% (ß = 0.0024, Boots 95% CI = 0.001-0.004), and 5.2% (ß = 0.0017, Boots 95% CI = 0.0014-0.0023), respectively, of the total effect. CONCLUSION: To the best of our knowledge, this is the first study that used nationally representative data from multiple countries in high-income countries to examine the association between PSMU and overweight/obesity and potential explanatory pathways among school-going adolescents. This finding has important implications for public health interventions to reduce overweight/obesity rates among young people.

Staying in or out? COVID-19-induced healthcare utilization avoidance and associated socio-demographic factors in rural India.

BACKGROUND: Although evidence on healthcare utilization avoidance during COVID-19 pandemic is emerging, such knowledge is limited in rural settings. An effective policy to the COVID-19 shocks and stresses in rural settings require empirical evidence to inform the design of health policies and programmes. To help overcome this evidence gap and also contribute to policy decisions, this study aimed at examining COVID-19-induced healthcare utilization avoidance and associated factors in rural India. METHODS: This study used the third-round data from the COVID-19-Related Shocks in Rural India survey conducted between 20-24 September, 2020 across six states. The outcome variable considered in this study was COVID-19-induced healthcare utilization avoidance. Multivariable Binary Logistic Regression Model via Multiple Imputation was used to assess the factors influencing COVID-19-induced healthcare utilization avoidance. RESULTS: Data on 4,682 respondents were used in the study. Of this, the prevalence of COVID-19-induced healthcare utilization avoidance was 15.5% in rural India across the six states. After adjusting for relevant covariates, participants from the Bihar State have significantly higher likelihood of COVID-19-induced healthcare utilization avoidance compared to those from the Andhra Pradesh. Also, participants whose educational level exceeds high school, those who use government hospital/clinic, engage in daily wage labour in agriculture have significantly higher odds of COVID-19-induced healthcare utilization avoidance compared to their counterparts. CONCLUSION: Our study revealed that state of residence, type of health facility used, primary work activity and educational level were associated with COVID-19-induced healthcare utilization avoidance in rural India. The findings suggest that policy makers and public health authorities need to formulate policies and design interventions that acknowledge socioeconomic and demographic factors that influence healthcare use avoidance.

Hesitant or not: A cross-sectional study of socio-demographics, conspiracy theories, trust in public health information, social capital and vaccine hesitancy among older adults in Ghana.

Vaccination is an effective strategy to reduce the coronavirus disease 2019 (COVID-19) burden, but its effectiveness hinges on timely vaccine uptake. Addressing concerns among vaccine-hesitant individuals is critical to preventing the immunization program from failing. This study analyzes the determinants of vaccine hesitance among older adults (aged 50 years and older) in Ghana. We adopted a cross-sectional survey with a quantitative approach that accessed data from 400 older adults from the Accra and Kumasi metropolitan areas using purposive and snowball sampling techniques. Multivariate logistic regressions were used to estimate the socio-demographic, social capital, conspiracy theories about COVID-19, and public health information factors associated with vaccine hesitance within the sample. The study found that only minority (5%) of respondents had been vaccinated, with 79% indicating willingness to be vaccinated. The study found that females (AOR: 0.734, CI: 0.019-0.036, p = .027) and those who have retired (AOR: 0.861, CI: 0.003-0.028, p = .034) were significantly less likely to engage in COVID-19 vaccine hesitance. Furthermore, the study revealed that participants who trust public health information (AOR: 0.065, CI: 0.022-0.049, p = .031) and have social capital (AOR: 0.886, CI: 0.017-0.032, p = .001) were significantly less likely to present COVID-19 vaccine hesitance. Finally, participants who believe in conspiracy theories about COVID-19 and vaccines (AOR: 3.167, CI: 1.021-2.043, p = .004) were significantly more likely to engage in COVID-19 vaccine hesitance. Efforts to convey vaccination benefits and address issues through evidence-based information are needed to strengthen and preserve the public's trust in vaccines in Ghana.

System, institutional, and client-level factors associated with formal healthcare utilisation among older adults with low income under a social protection scheme in Ghana.

BACKGROUND: In sub-Saharan African context, effect of system, institutional and client-level factors on formal healthcare utilisation among older adults with low income, especially those under a social protection scheme (called Livelihood Empowerment against Poverty [LEAP] programme) is least explored in the literature. However, an adequate understanding of how these factors contribute to formal healthcare utilisation among older adults who are classified as poor (in terms of low income) is important to inform health policy decisions. The aim of this study, therefore, was to examine the contributions of system, institutional and client-level factors in formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana. METHODS: Data associated with this study were obtained from an Ageing, Health, Lifestyle and Health Services survey conducted between 1 and 20 June 2018 (N = 200) in the Atwima Nwabiagya Municipal and Atwima Nwabiagya North District of Ghana. Multivariable logistic regressions were used to determine system, institutional and client-level factors associated with formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana. The significance of the test was set at a probability value of 0.05 or below. RESULTS: The study revealed that participants who relied on the LEAP programme and/or health insurance subscription to cater for their healthcare expenses (AOR: 11.934, CI: 1.151-123.777), those whose family/caregivers decided on when and where to use formal healthcare (AOR:12.409; CI: 2.198-70.076) and those who did not encounter communication problem with healthcare providers (AOR: 1.358; CI: 1.074-3.737) were significantly more likely to utilise formal healthcare services compared with their counterparts. The study further found that participants who perceived the attitude of healthcare providers as poor (AOR: 0.889; CI: 0.24-0.931) and those who spent 20-40 minutes at the healthcare facility were significantly less likely to utilise formal healthcare services compared with their counterparts (AOR: 0.070; CI: 0.006-0.195). CONCLUSION: Our findings suggest that reducing waiting time at healthcare facilities, improving social protection and/or health insurance schemes, improving patient-doctor communication and promoting attitudinal change programmes (such as orientations and supportive supervision) for healthcare providers may help to facilitate the use of needed formal healthcare services by older adults with low income in Ghana.

Determinants of national health insurance enrolment among people at risk of statelessness in the Awutu Senya East Municipality and Gomoa East District of Ghana.

BACKGROUND: This paper investigates the factors influencing the decision to enrol in Ghana's National Health Insurance Scheme (NHIS) among people at risk of statelessness, with emphasis on the individual's demographic and socioeconomic factors.  METHODS: The study used data from a cross-sectional household survey undertaken in the Awutu Senya East Municipality and Gomoa East District of Ghana's Central Region between March 9 and June 26, 2021, on healthcare utilization culture among people at risk of statelessness. Descriptive statistics and binary logistic regression were used in analysing data from a sample of 384 people at risk of statelessness.  RESULTS: The results reveal that about 51% of the at-risk population have ever enrolled while 48% of the respondents were enrolled on the NHIS at the time of the survey (active members). The majority of the enrolled members acquired their membership through self-payment of the enrolment fee. Additionally, respondents aged 26-35 had higher odds of enrolling, whiles those within 56-65 years had lower odds of enrolling in health insurance. Also, persons who are married and have a high school education or an equivalent qualification were more likely to enrol, while persons with no employment were less likely to enrol. CONCLUSION: According to the paper, while the gap in coverage between rich and poor, married and single appears to have narrowed, these factors continue to determine NHIS coverage among people at risk of statelessness. The same is true for education. Efforts must be increased to ensure equal access to healthcare financing interventions for better access to health services.

Self-reported symptoms of ocular allergy and its comorbid factors among residents living near a landfill site in Ghana.

Residents close to landfill sites may be exposed to long-term emitted toxic compounds that may have effects on their eyes. The aim of this study was to determine the prevalence of symptomatic ocular allergy and its comorbid factors among residents living near a landfill site in Ghana. An exploratory cross-sectional design involving 400 inhabitants living around a landfill site was employed. The prevalence of symptomatic ocular allergy was 59.3%. In a bivariate analysis, comorbid conditions including respiratory disease, coughing, flu, cholera, skin disease, diarrhoea, and hypertension predicted symptomatic ocular allergy. However, only cholera remained a significant predictor of symptomatic ocular allergy in the multivariate analysis. Symptomatic ocular allergy was high among inhabitants around the landfill site in Ghana. While proper design and management of landfills in Ghana is crucial, further longitudinal and clinical studies are required to clinically establish the link between landfill and ocular allergy.

Is illegal mining socio-politically entrenched? An opinion piece of the interaction between formal politics and chief dominance in mineral governance, and its influence on fighting Galamsey in Ghana.

Gold mining has been the backbone of Ghana's development since pre-colonial times. It has been essential in revenue mobilisation and the provision of employment to many people. However, in recent times the sector has received severe public backlash due to its inability to effect appropriate socioeconomic change; and the consequential destruction to forests, croplands and water bodies that has accompanied the livelihood activity. While the need to curb this menace has been hyper-crucial in recent times, these attempts have failed cyclically. This paper argues that the deep-seated linkages between different power actors such as politicians and chiefs/kings are the driving forces thwarting the fight against the menace. Recently, constructive criticisms from the public have rejuvenated the fight against galamsey, however, the modalities of the fight and socio-political power relations have jointly militated against the effectiveness of the fight. It is particularly argued that policymakers should rather take advantage of the evolved nature of the political landscape of Ghana, where politicians sometimes negotiate with chiefs/kings for political expediency during elections. This can be achieved by motivating chiefs/king's to become principal "galamsey-fighters". In the meantime, the authors also suggest that the confiscated excavators from the mining sites which are usually burnt should be stopped and rather sold to generate capital for reclaiming the lands.

[Husbands' involvement in antenatal-related care in the Bosomtwe District of Ghana: inquiry into the facilitators and barriers]. / Implication des maris dans les soins anténatals: enquête sur les facilitateurs et les barrières: Cas des habitants de Bosomtwe au Ghana.

BACKGROUND: This paper explored the facilitators and barriers to husbands' involvement in antenatal-related care in the Bosomtwe District of Ghana from the perspectives of husbands, pregnant women with and without delivery experience, nursing mothers, midwives and traditional birth attendants. METHODS: The study relied on the qualitative research design to collect and analyse data on the facilitators and barriers to husbands' involvement in antenatal-related care. The unit of analysis was made up of 36 participants-husbands (14), pregnant women with delivery experience and, nursing mothers (8), pregnant women without delivery experience (6), male and female midwives (6) and traditional birth attendants (2) who were purposively selected. The study's data was gathered using in-depth interviews and analysed through the content approach. RESULTS: Various economic [work and time constraint], cultural [the association of childbearing and its allied duties to women] and health-system factors [lack of antenatal services targeted at husbands and health professionals' attitude] hinder husbands' active participation in antenatal care. Despite these, some husbands participated in antenatal care owing to the importance they accord to the health and safety of their wives and the foetus; changing gender roles and preferential treatments received by their wives at antenatal clinics [as a result of the involvement of their husbands in prenatal care]. CONCLUSION: The implementation of alternative strategies, like, couple counselling, prolonging operating times of health centres to accommodate working men are recommended to provide a more accommodative and attractive avenue for husbands to support their wives during pregnancy. These efforts must be reinforced by the entire society through modifying the "ill-held view" that pregnancy and childcare is the sole duty of a woman.

The involvement of males [husbands] in antenatal-related care is noted to have significant impacts on the wellbeing of pregnant women and lessen burden of pregnancy, delivery and childcare. In this study, we examined the opinions of some stakeholders in the space of pregnancy and childcare [husbands, pregnant women with delivery experience, nursing mothers, midwives and traditional birth attendants], regarding the involvement of husbands in antenatal-related care. The study was conducted in the Bosomtwe District of Ghana, West Africa.The participants were asked to narrate experiences of husbands' involvement in pregnancy-related care, in addition to the barriers and facilitators of such engagement processes. A total of 36 participants were involved in the study. The narrative approach was used to report the findings.It was found that male's involvement in antenatal-related care is minimal in the study area. Factors such as limited time due to economic activities and the responsibility of providing financial resources for the wellbeing of the family and cultural factors in the form of childbearing being a responsibility of women deterred husbands from antenatal-related care. Again, absence of services that target males also served as a barrier. That notwithstanding, the importance attached by husbands to the health and safety of their wives and the foetus, the changing gender roles and preferential treatments given to pregnant women who are accompanied by their husbands facilitated males involvement.In conclusion, the study has implications for male-friendly antenatal care services development and continuous effort to undo the "cultural-ills" of male's involvement in pregnancy care in Ghana.

An integrative review on individual determinants of enrolment in National Health Insurance Scheme among older adults in Ghana.

BACKGROUND: We conducted an integrative review in an attempt to methodically and systematically understand the individual (personal factors) that influence National Health Insurance Scheme [NHIS] enrolment among older adults aged 50 years and above. The study was premised on evidence pointing to a state of little or no change in the enrolment rates [especially among older adults], which contrasts with the initial euphoria that greeted the launch of the scheme - which culminated in high enrolment rates. METHODS: The integrative literature review was conducted to synthesise the available evidence on individual determinants of NHIS among older adults. The methodological approach of the integrative literature review follows a five-stage interdependent and interconnected procedure of problem identification, literature search, data evaluation, data analysis and results presentation. Studies that met the inclusion criteria were peer-reviewed articles published in the English Language, from January 2010 to July 2020 and have Ghana as its setting or study area. The Andersen's Behavioural Model was used to categorize the predictor variables. RESULTS: Predisposing factors [gender, age, level of education and marital status], enabling factors [income] and need factors [health conditions or health attributes of older adults] were identified as individual predictors of NHIS enrolment among older adults. The findings support argument of Andersen's Behavioural Model [where predisposing, enabling and need factors are considered as individual determinants of health behaviour]. CONCLUSIONS: The findings call for policy reforms that take into account the aforementioned individual predictors of NHIS enrolment, especially among the aged.

COVID-19 and the marginalized: an opinion piece on further measures to address COVID-19 in prisons in Sub-Saharan Africa.

PURPOSE: This paper examines prison services and how they can be managed to uphold COVID-19 prevention etiquettes, in light of the contemporary rise in COVID-19 cases across the sub-Saharan Africa continent and the world at large. DESIGN/METHODOLOGY/APPROACH: An extensive review of existing literature on COVID-19 was conducted to ascertain the nature of the pandemic in prisons in sub-Saharan Africa. FINDINGS: In line with empirical observations, the paper recommends regular disinfection of prisons and correctional facilities on the sub-continent. Again, there is the need for countries to resort to alternative punitive measures other than imprisonment, to curb the issue of overcrowding in prisons. Furthermore, there is the need for national governments to build ultramodern prison facilities, which would make room for emergency situations, as well as make provision for any future rise in the number of inmates while, at the same time, meeting fundamental needs as peculiar to prisoners. Finally, medical units in prisons need to be well-equipped against contemporary rise in COVID-19 cases. ORIGINALITY/VALUE: The authors hereby declare that this submission is their handmade which has not been submitted to any other journal outlet.

Removing barriers to healthcare through an intercultural healthcare system: Focus group evidence.

OBJECTIVE: Barriers to healthcare in Ghana are multifaceted. Many people, including patients and providers, face them at different levels. To address these barriers, there is a need to explore the role of an intercultural healthcare system. This paper explores and provides the first evidence on ways through which an intercultural healthcare system can reduce the sociocultural and economic barriers to healthcare in Ghana. METHODS: Focus group discussions with 35 participants comprising 17 healthcare users, 11 formal healthcare providers and 7 alternative healthcare providers were conducted to gather data. Thematic analyses were performed on the transcribed data and presented based on a posteriori inductive reduction approach. RESULTS: Findings reveal that an intercultural healthcare system in Ghana can help reduce barriers to healthcare, especially cultural, social and economic barriers, by fostering an enhanced relationship between culture and healthcare, promoting affordable healthcare and promoting effective communication between healthcare providers and users. Weak institutional support, lack of strong political will and commitment, lack of training to meet standards of practice, poor registration and regulatory measures, and lack of universal acceptance inhibit implementation of an intercultural healthcare system in Ghana. CONCLUSION: The support for intercultural healthcare system and the agreement on its perceived ability to reduce social, cultural and economic healthcare barriers for service users offer an opportunity for policymakers to demonstrate a stronger political will and improved commitment for effective education and training, enforcement of regulatory measures, inclusion of intercultural healthcare in medical school curricula across the country, and community engagement.

"With tramadol, I ride like a Jaguar": a qualitative study of motivations for non-medical purpose tramadol use among commercial vehicle operators in Kumasi, Ghana.

BACKGROUND: The misuse of tramadol has become a major aspect of the wider substance use challenge in recent years and is evolving into a health crisis at an alarming rate. However, literature on motivations for non-medical purpose tramadol use among commercial vehicle operators remains inadequate. The aim of this study was to document the motivations for non-medical purposes tramadol use in Kumasi. Such an understanding could inform policy direction to regulate non-medical purposes tramadol use in Ghana. METHODS: We conducted this exploratory qualitative study with 23 purposively selected commercial vehicle drivers (15) and assistants (8) in Kumasi, Ghana. Data for the study were collected through in-depth face-to-face interviews between June 2018 and March 2019. Using a thematic analytical approach, the interviews were coded and analysed. RESULTS: Multiple motivations for non-medical purposes tramadol use were found including those related to: (1) sexual; (2) psychological; (3) physical; and (4) economic factors. Participants also reported three main inter-linking categories of perceived tramadol adverse effects: (1) physical; (2) psychological; and (3) social effects. Although participants indicated no plans for stopping their non-medical use of tramadol any time soon, strong willingness was voiced for supporting officials in finding and dealing with non-medical purpose tramadol sellers. CONCLUSION: Non-medical purposes tramadol use was associated with a confluence of factors, ranging from enhanced sexual performance to economic reasons. Based on the findings of the study and the dependence and addictive potentials of tramadol, there is the need for psychoeducational programmes for persons who misuse tramadol and enhancement of operational capacities of regulatory agencies.