Knowledge and use of art therapy for mental health treatment among clinical psychologists.

BACKGROUND: Art therapy allows people to express feelings about any subject through creative work. It is beneficial for people who feel out of touch with their emotions. In Ghana, little is known about art therapy as a therapeutic tool. Herbal treatment, biomedical and faith healing practices are the most common treatment options for mental health. This research aimed to provide new insights into clinical psychologists on their knowledge and use of art therapy in treating clients and identified the enablers and barriers in this therapeutic intervention. METHOD: Twenty-one clinical psychologists were sampled using the snowball sampling method. They were interviewed over the phone using a semi-structured interview guide which was developed based on the predefined study objectives. Thematic analysis was employed to analyze the data resulting in three central thematic areas. RESULTS: Twelve of the clinical psychologists were females and eight were male, with an age range between twenty-five to fifty years. The major themes identified were knowledge of art therapy, the use of art therapy and enablers and barriers in using art therapy. The study revealed that clinical psychologists had limited knowledge of art therapy mainly due to lack of training. With the use of art therapy, the participants revealed that they had used some form of art therapy before and they perceived art therapy to be effective on their clients however, they demonstrated low confidence in using it. Practitioner training and the availability of art therapy-related resources were identified as both facilitators and hindrances to the use of art therapy. CONCLUSION: Clinical Psychologists are cognizant of art therapy albeit they have limited knowledge. Therefore, training in how to use art therapy and the availability of resources to facilitate art therapy can be provided for Clinical Psychologists by the Ghana Mental Health Authority.

Prevalence and predictors of diarrhea among children under five in Ghana.

BACKGROUND: Globally, childhood diarrhea is a major public health concern. Despite numerous interventions that have been put in place to reduce its incidence over the years, childhood diarrhea remains a problem and is the fourth leading cause of child mortality in Ghana. This study examined the predictors of diarrhea among children under the age of five in Ghana. METHODS: Data from the 2014 Ghana Demographic and Health survey, a cross-sectional survey, was used for the purpose of this study. A total of 2,547 children under the age of five were included in this study. Logistic regression analysis was performed to establish the factors associated with childhood diarrhea and ascertain explanatory variables. RESULTS: The prevalence of diarrhea was 11.7%. Male children (13.4%) and those living in rural areas (12%), particularly in the Brong Ahafo region (17%) recorded the highest prevalence of diarrhea. Children aged 6 to 35 months of age, maternal age and education, sex of children and region of residence were the predictors of diarrhea among children under the age of five years in this study. CONCLUSION: To lessen the prevalence of diarrhea among children under five in Ghana, existing interventions must be evaluated in the context of the predictors identified. Based on observations deduced from this study, the Ministry of Health, Ghana Health Service and other health regulatory agencies should intensify monitoring and awareness in the various regions, particularly in the transition and savannah zones on the causes, risk factors, and methods of preventing diarrhea in children under five. Various stakeholders including government and non-governmental organizations should take into account the predictors of diarrhea identified in the design of interventions to effectively reduce morbidity and mortality associated with childhood diarrhea.

Strategies to increase rural maternal utilization of skilled health personnel for childbirth delivery in low- and middle-income countries: a narrative review.

BACKGROUND: Skilled attendance at birth is considered key to accomplishing Sustainable Development Goal (SDG) 3.1 aimed at reducing maternal mortality. Many maternal deaths can be prevented if a woman receives care by skilled health personnel. Maternal utilization of skilled health delivery services in rural areas in low- and middle-income countries is 70% compared to 90% in urban areas. Previous studies have found community-based interventions may increase rural maternal uptake of skilled health delivery services, but evidence is lacking on which strategies are most effective. OBJECTIVE: To review the effectiveness of community-based strategies to increase rural maternal utilization of skilled health personnel for childbirth delivery in low-and middle-income countries. METHODS: We conducted a narrative review. PubMed, CINAHL, Cochrane Library, and PsycINFO databases were searched for articles from database inception through 13 November 2019. Key search terms were pre-determined. Information was extracted on studies meeting our inclusion criteria: cluster and randomized trials, rural setting, reproductive aged women, community engagement, low- and middle-income countries. Studies were considered effective if statistically significant (p < 0.05). A narrative synthesis was conducted. RESULTS: Ten cluster randomized trials out of 5,895 candidate citations met the inclusion criteria. Strategies included home-based visits, women's groups, and combined approaches. Out of the ten articles, only three studies were found to significantly increase maternal uptake of skilled health personnel for delivery, and each used a different strategy. The results are inconclusive as to which strategies are most effective. Limitations of this review include heterogeneity and generalizability of studies. CONCLUSIONS: This research suggests that different strategies may be effective at improving maternal utilization of skilled health personnel for delivery in certain rural settings while ineffective in others. More research is warranted to better understand the context in which strategies may be effective and under what conditions.

Surveying and mapping breast cancer services in Ghana: a cross-sectional pilot study in the Eastern Region.

OBJECTIVES: Define the services available for the care of breast cancer at hospitals in the Eastern Region of Ghana, identify areas of the region with limited access to care through geospatial mapping, and test a novel survey instrument in anticipation of a nationwide scale up of the study. DESIGN: A cross-sectional, facility-based survey study. SETTING: This study was conducted at 33 of the 34 hospitals in the Eastern Region of Ghana from March 2020 to May 2020. PARTICIPANTS: The 33 hospitals surveyed represented 97% of all hospitals in the region. This included private, government, quasi-government and faith-based organisation owned hospitals. RESULTS: Sixteen hospitals (82%) surveyed provided basic screening services, 11 (33%) provided pathological diagnosis and 3 (9%) provided those services in addition to basic surgical care.53%, 64% and 78% of the population lived within 10 km, 25 km and 45 km of screening, diagnostic and treatment services respectively. Limited chemotherapy was available at two hospitals (6%), endocrine therapy at one hospital (3%) and radiotherapy was not available. Twenty-nine hospitals (88%) employed a general practitioner and 13 (39%) employed a surgeon. Oncology specialists, pathology personnel and a plastic surgeon were only available in one hospital (3%) in the Eastern Region. CONCLUSIONS: Although 16 hospitals (82%) provided screening, only half the population lived within reasonable distance of these services. Few hospitals offered diagnosis and surgical services, but 64% and 78% of the population lived within a reasonable distance of these hospitals. Geospatial analysis suggested two priorities to cost-effectively expand breast cancer services: (1) increase the number of health facilities providing screening services and (2) centralise basic imaging, pathological and surgical services at targeted hospitals.

Assessment of clinical outcome and health insurance coverage among patients with breast cancer.

Breast cancer is a global health concern in terms of morbidity and mortality. Risksharing mechanisms such as health insurance provide resources and promote access to healthcare. The aim of the study was to assess the relationship between health insurance coverage and clinical outcome of breast cancer patients. The study employed retrospective design involving the use of secondary data from the patients diagnosed with breast cancer. Between the period of 2015 to 2019, 250 patients' records were reviewed from a sample size of 300 patients over 5 year patients' follow-up period. A descriptive and Kaplan Meier survival analysis was performed to determine the patients' survival rate. Seventy-two percent of the patients had health insurance cover at the time of diagnosis. Insurance status was found to be significantly associated with survival (p-values= 0.036). Insurance cover had 1.42 hazard ratio (p=0.036, 95% CI: 1.023-1.980). Patients with health insurance coverage at the time of diagnosis had a higher survival rate. No significant association was found among the demographic characteristics and the patients' clinical outcomes.

Sexual and reproductive health of adolescents in schools for people with disabilities.

INTRODUCTION: Persons with disabilities have the same sexual and reproductive health (SRH) needs as the abled people but they often face barriers to SRH information and services which are necessary for healthy and safe relationships, protection from HIV and other sexually transmitted infections (STIs). This study sought to access the SRH services among adolescents with disabilities in four Special Needs Schools in Ghana. METHODS: The study adopted a cross-sectional study design with a quantitative approach to data collection between the months of January to March, 2018. A structured and pretested questionnaire was used to collect data from adolescents with disabilities from selected schools in Ghana. Both descriptive and inferential statistics were performed using chi-square test and multivariate logistic regression. RESULTS: Majority of participants had hearing disability (52.1%). The average age at menarche among females was 13 years whiles the age at which puberty was attained among boys was 14 years. School teachers were the major source of information on SRH for the respondents (63.7%) followed by parents (12.2%). A majority (67.1%) of respondents had good knowledge of SRH. Factors which were significantly associated with knowledge level were age (p=0.026), religion (p=0.034), sources of information (p<0.001), guardians (p=0.049). CONCLUSION: The majority of participants had good knowledge of SRH, although their knowledge of contraceptive and access were poor. Only condoms were mostly known. There is the need for increased awareness on the availability of other contraceptives methods and the removal of barriers to contraceptive methods.

Risk factors for loss to follow-up in human immunodeficiency virus care in the Greater Accra Regional Hospital in Ghana: a retrospective cohort study.

BACKGROUND: Loss of human immunodeficiency virus (HIV)-positive patients to follow-up increases HIV-related morbidity and mortality. This study identified the factors associated with loss to follow-up (LTFU) in an urban health facility in Ghana. METHODS: A 12-y retrospective study was conducted using routinely collected data from the National Acquired Immune Deficiency Syndrome (AIDS) Control Programme (NACP) on persons living with HIV/AIDS (PLWHA) who initiated antiretroviral therapy (ART) from 2006 to 2017 at the Greater Accra Regional Hospital. Convenience sampling was used to select the study area. All gathered data were exported to Stata 14 statistical software for analysis. RESULTS: A total of 4330 PLWHA initiated ART between January 2006 and December 2017. Of these, 1166 (26.9%) were lost to follow-up over the 12-y period. The factors associated with LTFU included being a Muslim (adjusted hazard ratio [aHR] 1.31 [95% confidence interval {CI} 1.05 to 1.65]), having CD4 <250 cells/ml (aHR 1.45 [95% CI 1.21 to 1.76]) and completing adherence counselling (aHR 1.58 [95% CI 1.31 to 1.92]). Having other sources of health care funding and disclosure of one's disease status were found to be protective (aHR 0.74 [95% CI 0.58 to 0.94] and 0.80 [95% CI 0.65 to 0.98], respectively). CONCLUSIONS: Some of the determinants of LTFU in the hospital are comparable to those found in other parts of Africa and could be addressed using existing interventions.

Safety Culture and Perioperative Quality at the Volta River Authority Hospital in Akosombo, Ghana.

BACKGROUND: The Volta River Authority Hospital (VRAH) is a district hospital associated with a large public works project in Akosombo, Ghana, that has developed a reputation for high-quality care. We hypothesized that this stems from a culture of safety and standardized processes typical of high-risk engineering environments. To investigate this, we evaluated staff and patient perceptions of safety and quality, as well as perioperative process variability. MATERIALS AND METHODS: The Safety Attitudes Questionnaire (SAQ) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys were used to evaluate staff and patient perceptions of safety. Perioperative general surgery and obstetrical procedure observations generated process maps, which were analyzed for variability and waste. RESULTS: Thirty-one SAQs were administered. 83% of workers held a positive perception of teamwork, and 77.4% held a positive perception of safety culture. Fifteen HCAHPS surveys of surgical inpatients showed a median hospital rating of 10 [IQR 8.5-10] on a ten-point scale. 90% gave maximal scores for pain management and 84.4% for nurse communication. Ten general surgery and obstetrical procedures were observed for which process map analysis was notable for no consistent waste steps and 100% adherence to the World Health Organization Safe Surgery Checklist. CONCLUSIONS: Surveys suggest an institutional commitment to safety with strong teamwork culture and patient communication. Perioperative process mapping supports this culture, with low levels of variability and waste, and is useful for evaluating standardization of care. VRAH demonstrates the feasibility of delivering high standards of perioperative care in a low-resource setting.

Sexual and reproductive health of adolescents in schools for people with disabilities

Introduction: persons with disabilities have the same sexual and reproductive health (SRH) needs as the abled people but they often face barriers to SRH information and services which are necessary for healthy and safe relationships, protection from HIV and other sexually transmitted infections (STIs). This study sought to access the SRH services among adolescents with disabilities in four Special Needs Schools in Ghana. Methods: the study adopted a cross-sectional study design with a quantitative approach to data collection between the months of January to March, 2018. A structured and pretested questionnaire was used to collect data from adolescents with disabilities from selected schools in Ghana. Both descriptive and inferential statistics were performed using chi-square test and multivariate logistic regression.Results: majority of participants had hearing disability (52.1%). The average age at menarche among females was 13 years whiles the age at which puberty was attained among boys was 14 years. School teachers were the major source of information on SRH for the respondents (63.7%) followed by parents (12.2%). A majority (67.1%) of respondents had good knowledge of SRH. Factors which were significantly associated with knowledge level were age (p=0.026), religion (p=0.034), sources of information (p<0.001), guardians (p=0.049).Conclusion: the majority of participants had good knowledge of SRH, although their knowledge of contraceptive and access were poor. Only condoms were mostly known. There is the need for increased awareness on the availability of other contraceptives methods and the removal of barriers to contraceptive methods

Social Deterministic Factors to Participation in the National Health Insurance Scheme in the Context of Rural Ghanaian Setting.

The primary purpose of this study is to identify predictors of complete household enrollment into the National Health Insurance Scheme (NHIS) among inhabitants of the Barekese sub-district in the Ashanti Region of Ghana. Heads of households in 20 communities from the Barekuma Collaborative Community Project site were interviewed to gather data on demographic, socioeconomic status (SES) indicators and complete household subscription in the NHIS. Logistic regression model was used to predict enrollment in the NHIS. Of the 3228 heads of households interviewed, 60 percent reported having all members of their respective households enrolled in the NHIS. Residents in the classified Middle and High SES brackets had 1.47 (95% CI: 1.21-1.77) and 1.66 (95% CI: 1.27-2.16) times higher odds, respectively, of complete household enrollment compared to their counterparts in the Low SES category. The odds of enrolling in the program tend to increase progressively with the highest level of education attained by the head of the family unit. Eight years after the introduction of the national health insurance policy in Ghana, the reported subscription rate for complete households was about 60 percent in the 20 rural communities that participated in the study. This finding calls for the need to step up further national strategies that will help increase enrollment coverage, especially among the poor and less educated in the rural communities.

Spatial Analysis of Factors Associated with Household Subscription to the National Health Insurance Scheme in Rural Ghana.

The use of health insurance schemes in financing healthcare delivery and to minimize the poverty gap is gaining considerable recognition among the least developed and resource challenged countries around the world. With the implementation of the socialized health insurance scheme, Ghana has taken the lead in Sub-Saharan Africa and now working out further strategies to gain universal coverage among her citizenry. The primary goal of this study is to explore the spatial relationship between the residential homes and demographic features of the people in the Barekese subdistrict in Ghana on the probability to enroll the entire household unit in the National Health Insurance Scheme (NHIS). Household level data were gathered from 20 communities on the enrollment status into the NHIS alongside demographic and socioeconomic indicators and the spatial location of every household that participated in the study. Kulldorff's purely spatial scan statistic was used to detect geographic clusters of areas with participatory households that have either higher or lower enrollment patterns in the insurance program. Logistic regression models on selected demographic and socioeconomic indicators were built to predict the effect on the odds of enrolling an entire household membership in the NHIS. Three clusters significantly stood out to have either high or low enrollment patterns in the health insurance program taking into accounts the number of households in those sub-zones of the study region. Households in the Cluster 1 insurance group have very high travel expenses compared to their counterparts in the other idenfied clusters. Travel cost and time to the NHIS registration center to enroll in the program were both significant predictors to participation in the program when controlling for cluster effect. Residents in the High socioeconomic group have about 1.66 [95% CI: 1.27-2.17] times the odds to enroll complete households in the insurance program compared to their counterparts in the Low socioeconomic group. The study demonstrated the use of spatial analytical tools to identify clusters of household enrollment pattern in the NHIS among residents in rural Ghana. In the face of limited resources, policy makers can therefore use the findings as guideline to strategically channel interventions to areas of most need. Furthermore, these analyses can be repeated annually to assess progress on improving insurance coverage.

Verbal autopsy: an analysis of the common causes of childhood death in the Barekese sub-district of Ghana.

The availability of mortality data for any society plays an essential role in health monitoring and evaluation, as well as in the design of health interventions. However, most resource-poor countries such as Ghana have no reliable vital registration system. In these instances, verbal autopsy (VA) may be used as an alternative method to gather mortality data. In rural Ghana, the research team utilized a VA questionnaire to interview caretakers who were present with a child under the age of five prior to death. The data was given to two physicians who independently assigned the most probable cause of death for the child. A third, blinded physician analyzed the data in the cases where the first two physicians disagreed. When there was agreement between physicians, this was assigned as the cause of death for the individual child. During the study period, we recorded 118 deaths from 92 households. Twenty-nine (24.6%) were neonatal deaths with the leading causes of death being neonatal sepsis, birth asphyxia and pneumonia. The remaining 89 (75.4%) were post-neonatal deaths with the most common causes of death being pneumonia, malaria and malnutrition. While 63/118 (53.4%) deaths occurred in the home, there is no statistically significant relationship between the location of the home and the time of travel to the nearest health facility (P=0.132). VA is an important epidemiological tool for obtaining mortality data in communities that lack reliable vital registration systems. Improvement in health care is necessary to address the large number of deaths occurring in the home.

Verbal Autopsy: an Analysis of the Common Causes of Childhood Death in the Barekese Sub-District of Ghana

The availability of mortality data for any society plays an essential role in health monitoring and evaluation; as well as in the design of health interventions. However; most resource-poor countries such as Ghana have no reliable vital registration system. In these instances; verbal autopsy (VA) may be used as an alternative method to gather mortality data. In rural Ghana; the research team utilized a VA questionnaire to interview caretakers who were present with a child under the age of five prior to death. The data was given to two physicians who independently assigned the most probable cause of death for the child. A third; blinded physician analyzed the data in the cases where the first two physicians disagreed. When there was agreement between physicians; this was assigned as the cause of death for the individual child. During the study period; we recorded 118 deaths from 92 households. Twenty-nine (24.6) were neonatal deaths with the leading causes of death being neonatal sepsis; birth asphyxia and pneumonia. The remaining 89 (75.4) were post-neonatal deaths with the most common causes of death being pneumonia; malaria and malnutrition. While 63/118 (53.4) deaths occurred in the home; there is no statistically significant relationship between the location of the home and the time of travel to the nearest health facility (P=0.132). VA is an important epidemiological tool for obtaining mortality data in communities that lack reliable vital registration systems. Improvement in health care is necessary to address the large number of deaths occurring in the home

Evaluating international collaboration: differential perceptions of partnership in a CBPR project in Ghana.

Practitioners of community-based participatory research (CBPR) must overcome numerous barriers in order to include research participants as equal partners in decision-making. The decision-making processes of stakeholders (including research participants) of one international CBPR project based in the middle belt of Ghana were analyzed through qualitative focus group and interview data, as well as direct observation of formal meetings. Using modified grounded theory to interpret our data, we find that despite the intentions of extracommunity stakeholders, ordinary community members do not experience full ownership of the governance of the research enterprise. We conclude that organizational philosophy, cultural expectations, and environmental context can help to explain differential perceptions of stakeholders and function as barriers to full partnership.