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1.
BMJ Open ; 12(1): e052752, 2022 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-34992110

RESUMO

OBJECTIVES: It has been suggested that ethnic minorities have been disproportionally affected by the COVID-19. We aimed to determine whether prevalence and correlates of past SARS-CoV-2 exposure varied between six ethnic groups in Amsterdam, the Netherlands. DESIGN, SETTING, PARTICIPANTS: Participants aged 25-79 years enrolled in the Healthy Life in an Urban Setting population-based prospective cohort (n=16 889) were randomly selected within ethnic groups and invited to participate in a cross-sectional COVID-19 seroprevalence substudy. OUTCOME MEASURES: We tested participants for SARS-CoV-2-specific antibodies and collected information on SARS-CoV-2 exposures. We estimated prevalence and correlates of SARS-CoV-2 exposure within ethnic groups using survey-weighted logistic regression adjusting for age, sex and calendar time. RESULTS: Between 24 June and 9 October 2020, we included 2497 participants. Adjusted SARS-CoV-2 seroprevalence was comparable between ethnic Dutch (24/498; 5.1%, 95% CI 2.8% to 7.4%), South-Asian Surinamese (22/451; 4.9%, 95% CI 2.2% to 7.7%), African Surinamese (22/400; 8.3%, 95% CI 3.1% to 13.6%), Turkish (30/408; 7.9%, 95% CI 4.4% to 11.4%) and Moroccan (32/391; 7.2%, 95% CI 4.2% to 10.1%) participants, but higher among Ghanaians (95/327; 26.3%, 95% CI 18.5% to 34.0%). 57.1% of SARS-CoV-2-positive participants did not suspect or were unsure of being infected, which was lowest in African Surinamese (18.2%) and highest in Ghanaians (90.5%). Correlates of SARS-CoV-2 exposure varied across ethnic groups, while the most common correlate was having a household member suspected of infection. In Ghanaians, seropositivity was associated with older age, larger household sizes, living with small children, leaving home to work and attending religious services. CONCLUSIONS: No remarkable differences in SARS-CoV-2 seroprevalence were observed between the largest ethnic groups in Amsterdam after the first wave of infections. The higher infection seroprevalence observed among Ghanaians, which passed mostly unnoticed, warrants wider prevention efforts and opportunities for non-symptom-based testing.


Assuntos
COVID-19 , SARS-CoV-2 , Idoso , Criança , Estudos Transversais , Gana , Humanos , Países Baixos/epidemiologia , Prevalência , Estudos Prospectivos , Estudos Soroepidemiológicos
2.
Environ Monit Assess ; 194(2): 60, 2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34993649

RESUMO

The Accra Plain of Ghana is experiencing rapid urbanization, but there is scant information on its impact on local biodiversity. We assessed the changes in land use/land cover of the Accra Plain since 1991 and evaluated how the observed changes have influenced local small mammals in forest fragments. We applied supervised classification and intensity analysis time-series Landsat imagery data to assess land use/land cover changes between 1991 and 2017. Small mammals were surveyed in two forest fragments, the Pinkwae and Adumanya forests from June 2019 to January 2020, using capture-mark-recapture technique. We compared our data with baseline data gathered in 1991-1992, when large areas of the city remained mostly undeveloped. Our data revealed that the urban area has increased by 832%, while the forest area declined by 85% between 1991 and 2017. The Pinkwae and Adumanya forests, which covered 120 and 1.5 ha, respectively, in 1991 have each been reduced to < 1 ha. We found changes in the small mammal species composition in the forest fragments, but not species richness due to species turnover. Grammomys poensis and Dephomys defua are first records for the Accra Plain. Our data suggested that small forest fragments within the urbanizing landscape are important for maintaining the local small mammal species. For the conservation of local small mammals in urbanizing landscapes, it is important to maintain the greatest possible number of small forest fragments and establish policies that prevent forest remnants from being further depleted.


Assuntos
Conservação dos Recursos Naturais , Urbanização , Animais , Biodiversidade , Ecossistema , Monitoramento Ambiental , Florestas , Gana , Mamíferos
3.
BMC Health Serv Res ; 22(1): 32, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34986828

RESUMO

BACKGROUND: The Ghanaian government has implemented interventions that integrate traditional medicine (TM) into its national health system in response to the high prevalence of TM use. However, empirical evidence of the experiences of service users and the practice of integrated health in Ghana is scanty. Therefore, this study explored the experiences of people with TM integration into the formal health system in Ashanti region using an adapted TM integration framework. METHODS: A sequential explanatory mixed methods study design comprising survey administration and in-depth interviews for data collection was utilised to address the research objective. Framework analysis was used in analysing the qualitative data and for triangulation of results. RESULTS: Participants were aware of licensing and training of TM practitioners in a science-based university in Ghana. However, knowledge of the existence of TM units in selected hospitals in the region was minimal. Integration knowledge was largely influenced by sex, marital status, household size and residential status, where males and urban dwellers were more familiar with the process than females and rural dwellers. Low patronage of integrated health services in the region was attributable to weak cross referrals. However, service users who had engaged with the integrated system recounted a satisfactory outcome. CONCLUSION: Service users' unfamiliarity with the presence of integrated facilities in Ghana could be an impediment to the practice of integrated healthcare. Sensitisation of the public about the practice of an integrated system could refine the Ghanaian integrated system. Regular evaluation of patient satisfaction and outcome measures might also serve as an effective strategy for improving health services delivery since evaluation is becoming an important component of health service design and implementation. There is the need for future studies to focus on exploring the perceptions and experiences of health practitioners and hospital administrators regarding the practice of integrated health in Ghana.


Assuntos
Prestação Integrada de Cuidados de Saúde , Administradores Hospitalares , Feminino , Gana , Instalações de Saúde , Humanos , Masculino , Medicina Tradicional
4.
Artigo em Inglês | MEDLINE | ID: mdl-35010786

RESUMO

OBJECTIVES: There is paucity of data on determinants of length of COVID-19 admissions and long COVID, an emerging long-term sequel of COVID-19, in Ghana. Therefore, this study identified these determinants and discussed their policy implications. METHOD: Data of 2334 patients seen at the main COVID-19 treatment centre in Ghana were analysed in this study. Their characteristics, such as age, education level and comorbidities, were examined as explanatory variables. The dependent variables were length of COVID-19 hospitalisations and long COVID. Negative binomial and binary logistic regressions were fitted to investigate the determinants. RESULT: The regression analyses showed that, on average, COVID-19 patients with hypertension and diabetes mellitus spent almost 2 days longer in hospital (p = 0.00, 95% CI = 1.42-2.33) and had 4 times the odds of long COVID (95% CI = 1.61-10.85, p = 0.003) compared to those with no comorbidities. In addition, the odds of long COVID decreased with increasing patient's education level (primary OR = 0.73, p = 0.02; secondary/vocational OR = 0.26, p = 0.02; tertiary education OR = 0.23, p = 0.12). CONCLUSION: The presence of hypertension and diabetes mellitus determined both length of hospitalisation and long COVID among patients with COVID-19 in Ghana. COVID-19 prevention and management policies should therefore consider these factors.


Assuntos
COVID-19 , COVID-19/complicações , COVID-19/tratamento farmacológico , Estudos Transversais , Gana/epidemiologia , Humanos , Tempo de Internação , SARS-CoV-2
5.
Accid Anal Prev ; 165: 106517, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34896907

RESUMO

Despite the countless benefits derived from motorcycle usage, it has become a significant public health concern, particularly in developing countries, due to the plateauing number of fatal/serious injuries associated with them. Although it has been well documented that the frequency and fatality rates of intersection-related motorcycle crashes are high, little research efforts have been made to explore the contributory factors influencing motorcycle-involved crashes at these locations. Interestingly, no study has investigated the latent patterns and chains of factors that simultaneously contribute to the injury severity sustained by motorcycle crash casualties at intersections under different traffic control conditions in developing countries. Since motorcycles are mostly used as taxis in developing countries, it is imperative to consider the injury severity sustained by all crash casualties in the motorcycle safety analysis. This study bridges the research gap by employing a plausible data mining tool to explore hidden rules associated with motorcycle crash casualty injury severity outcomes at both signalized and non-signalized intersections in Ghana's most densely populated region, Accra, using three-year crash data spanning 2016-2018. Besides, a binary logit regression model was also employed to explore the impact of crash factors on casualty severity outcomes using the same dataset. The results from both analysis techniques were consistent; however, the data mining technique provided chains of factors which provided additional insights into the groups of factors that collectively influence the casualty injury severity outcomes. From the rule discovery results, while full license status, daytime/daylight, and shoulder presence increased the risk of fatal injuries at signalized intersections, factors such as inattentiveness, good road surface, nighttime, shoulder absence, and young rider were highly likely to increase casualty fatalities at non-signalized intersections. By controlling all or some of these risk factors, the level of injury severity on the roadways could be reduced. Based on the findings, we provide enforcement, education, and engineering-based recommendations to help improve motorcycle safety.


Assuntos
Motocicletas , Ferimentos e Lesões , Acidentes de Trânsito , Mineração de Dados , Gana/epidemiologia , Humanos , Modelos Logísticos , Ferimentos e Lesões/epidemiologia
6.
Sci Total Environ ; 803: 149959, 2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-34487907

RESUMO

Small-scale irrigation has gained momentum in recent years as one of the development priorities in Sub-Saharan Africa. However, farmer-led irrigation is often informal with little support from extension services and a paucity of data on land suitability for irrigation. To map the spatial explicit suitability for dry season small-scale irrigation, we developed a method using an ensemble of boosted regression trees, random forest, and maximum entropy machine learning models for the Upper East Region of Ghana. Both biophysical predictors including surface and groundwater availability, climate, topography and soil properties, and socio-economic predictors which represent demography and infrastructure development such as accessibility to cities and proximity to roads were considered. We assessed that 179,584 ± 49,853 ha is suitable for dry-season small-scale irrigation development when only biophysical variables are considered, and 158,470 ± 27,222 ha when socio-economic variables are included alongside the biophysical predictors, representing 77-89% of the current rainfed-croplands. Travel time to cities, accessibility to small reservoirs, exchangeable sodium percentage, surface runoff that can be potentially stored in reservoirs, population density, proximity to roads, and elevation percentile were the top predictors of small-scale irrigation suitability. These results suggested that the availability of water alone is not a sufficient indicator for area suitability for small-scale irrigation. This calls for strategic road infrastructure development and an improvement in the support to farmers for market accessibility. The suitability for small-scale irrigation should be put in the local context of market availability, demographic indicators, and infrastructure development.


Assuntos
Clima , Solo , Fazendeiros , Gana , Humanos , Aprendizado de Máquina
7.
J Oncol Pharm Pract ; 28(1): 64-73, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33430692

RESUMO

INTRODUCTION: Though there are controversies, cancer screening has been suggested to decrease mortality. Over the years, the most accessible primary healthcare provider; the community pharmacist, has developed an interest in being part of cancer screening activities and prevention of a wide range of other non-communicable diseases. To achieve this, community pharmacists need a working knowledge of the basic screening test and recommendations. Also, it's important to acknowledge the barriers that may prevent the implementation of cancer-screening efforts at the community pharmacy. This study aims to determine the knowledge and barriers to cancer screening among Ghanaian community pharmacists. METHODOLOGY: Knowledge and barriers to cancer screening was assessed using an online questionnaire in 435 community pharmacists. Descriptive statistics and Pearson's chi-squared tests were used to analyze the data. RESULTS: The reliability and validity assessment of the questionnaire after data collection revealed a Cronbach's alpha value of 0.82 for knowledge on cancer screening. The SD and mean age of study participants were 2.48 ± 20.08. Only 25.7% of the participants had good knowledge. The most identified barrier was the lack of established guidelines (60.9%). There was no association between participants' demographics and their knowledge scores. CONCLUSIONS: Community pharmacists can potentially have a large impact on early detection of cancer through screening. However, they have to improve their knowledge on general screening guidelines and be aware of available educational resources to increase their knowledge. It is also important for all stakeholders to come together to establish local screening modalities and recommendations for the country.


Assuntos
Serviços Comunitários de Farmácia , Neoplasias , Atitude do Pessoal de Saúde , Detecção Precoce de Câncer , Gana , Humanos , Neoplasias/diagnóstico , Neoplasias/prevenção & controle , Farmacêuticos , Papel Profissional , Reprodutibilidade dos Testes , Inquéritos e Questionários
8.
PLoS One ; 16(12): e0261455, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34936668

RESUMO

AIMS: To assess the determinants of glycaemic control among patients with Type 2 diabetes mellitus (T2DM) presenting at the Greater Accra Regional Hospital, Ghana. METHODS: The study employed semi-structured questionnaires and review of clinical records of patients 16 years and above with Type 2 Diabetes. RESULTS: The mean age of participants was 56.6 ± 13.8 years, with majority (71.6%) being females. A total of 161 (59.4%) of patients had poor glycaemic control (HbA1c ≥8.1%; 95% CI: 53.6 to 65.3%). Poor glycaemic control was significantly associated with high body mass index of the patient (AOR 13.22; 95% CI: 1.95 to 89.80), having only elementary education (AOR 5.22, 95% CI 2.12-12.86, p<0.0001) and being on insulin therapy (AOR 2.88; 95% CI: 1.05 to 7.88). On the other hand, seldom coffee intake (AOR: 0.27; 95% CI: 0.11 to 0.64), high physical activity (AOR 1.57, 95% CI 1.06-2.35, p = 0.025) and having a cardiovascular disease (AOR: 0.15; 95% CI: 0.05 to 0.46) appeared to positively influence glycaemic control. Self-monitoring of blood glucose and diet interventions did not appear to influence glycaemic control. CONCLUSIONS: The study results showing that a high proportion of patients attending the Diabetes Clinic with uncontrolled diabetes has serious implications for the management of T2DM diabetes as it suggests that current hospital-based treatment measures are less effective. Comprehensive management of T2DM targeting all the key factors identified in this study and incorporating a multispectral collaborative effort based on holistic approach, combined with non-pharmacological components are strongly warranted.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Controle Glicêmico , Adulto , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Dietoterapia , Gerenciamento Clínico , Exercício Físico , Feminino , Gana/epidemiologia , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Malar J ; 20(1): 478, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930267

RESUMO

BACKGROUND: The novel anti-malarial cipargamin (KAE609) has potent, rapid activity against Plasmodium falciparum. Transient asymptomatic liver function test elevations were previously observed in cipargamin-treated subjects in two trials: one in malaria patients in Asia and one in volunteers with experimentally induced malaria. In this study, the hepatic safety of cipargamin given as single doses of 10 to 150 mg and 10 to 50 mg once daily for 3 days was assessed. Efficacy results, frequency of treatment-emerging mutations in the atp4 gene and pharmacokinetics have been published elsewhere. Further, the R561H mutation in the k13 gene, which confers artemisinin-resistance, was associated with delayed parasite clearance following treatment with artemether-lumefantrine in Rwanda in this study. This was also the first study with cipargamin to be conducted in patients in sub-Saharan Africa. METHODS: This was a Phase II, multicentre, randomized, open-label, dose-escalation trial in adults with uncomplicated falciparum malaria in five sub-Saharan countries, using artemether-lumefantrine as control. The primary endpoint was ≥ 2 Common Terminology Criteria for Adverse Events (CTCAE) Grade increase from baseline in alanine aminotransferase (ALT) or aspartate transaminase (AST) during the 4-week trial. RESULTS: Overall, 2/135 patients treated with cipargamin had ≥ 2 CTCAE Grade increases from baseline in ALT or AST compared to 2/51 artemether-lumefantrine patients, with no significant difference between any cipargamin treatment group and the control group. Cipargamin exposure was comparable to or higher than those in previous studies. Hepatic adverse events and general safety and tolerability were similar for all cipargamin doses and artemether-lumefantrine. Cipargamin was well tolerated with no safety concerns. CONCLUSIONS: This active-controlled, dose escalation study was a detailed assessment of the hepatic safety of cipargamin, across a wide range of doses, in patients with uncomplicated falciparum malaria. Comparison with previous cipargamin trials requires caution as no clear conclusion can be drawn as to whether hepatic safety and potential immunity to malaria would differ with ethnicity, patient age and or geography. Previous concerns regarding hepatic safety may have been confounded by factors including malaria itself, whether natural or experimental infection, and should not limit the further development of cipargamin. Trial registration ClinicalTrials.gov number: NCT03334747 (7 Nov 2017), other study ID CKAE609A2202.


Assuntos
Antimaláricos/efeitos adversos , Indóis/efeitos adversos , Fígado/efeitos dos fármacos , Compostos de Espiro/efeitos adversos , Adulto , Relação Dose-Resposta a Droga , Feminino , Gabão , Gana , Humanos , Masculino , Mali , Pessoa de Meia-Idade , Ruanda , Uganda , Adulto Jovem
10.
Inquiry ; 58: 469580211067479, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34935554

RESUMO

To assess the prevalence and factors associated with psychological distress (PD) and Medical Laboratory Professionals (MLPs) involvement in COVID-19-related duties. This study adopted an online cross-sectional, nationally stratified survey among 473 MLPs using Google Form with a designated link; Depression, anxiety, and stress scale-21 (DASS-21) was used to measure depression, anxiety, and stress (secondary outcome). We employed generalized Negative Binomial (NBR) and Poisson regression analytical approach to our study outcomes. All analyses were performed using Stata 16, and P-value≤.05 deemed significant. The overall DASS-21 score ranged from asymptomatic psychological distress to severe symptomatic PD. The prevalence of depression, anxiety, and stress were 9.1 [95%CI=6.8-12.0], 17.8 [95%CI=14.6-21.5], and 7.5 [95%CI=5.4-10.1], respectively. The result evinced a high and significant association; the univariate NBR predicted a significant increase of PD score by 12% and 18% among participants who were involved in one and two or more COVID-19-related duties, respectively, (ß[95%CI] = .12 [.05-.18] and .18 [.10-.26], respectively). A binary outcome predicted approximately 2-folds of overall psychological distress among participants involved in two or more COVID-19-related duties compared with non-involvement (adjusted Prevalence Ratio [95%CI]= 2.34 [1.12-4.85]). For depression, anxiety, and stress symptoms, both univariate and multivariate data analyses evinced a higher disadvantage among MLP involved in COVID-19-related duties. We observed a high tendency of experiencing significant psychological distress amongst MLP involved in COVID-19-related duties. Experience of psychological distress increased with deeper involvement in COVID-19-related activities. Psychological support should be extended to MLPs to limit the effect of these negative emotions on their cognitive and social behavior as well as job performance.


Assuntos
COVID-19 , Angústia Psicológica , Estudos Transversais , Depressão/epidemiologia , Gana/epidemiologia , Humanos , Laboratórios , SARS-CoV-2 , Inquéritos e Questionários
11.
Ann Glob Health ; 87(1): 121, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34900621

RESUMO

Background: Cardiovascular disease (CVD) is a growing burden in low- and middle-income countries. Ghana seeks to address this problem by task-shifting CVD diagnosis and management to nurses. The Community-Based Health Planning and Services (CHPS) initiative offers maternal and pediatric health care throughout Ghana but faces barriers to providing CVD care. We employed in-depth interviews to identify solutions to constraints in CVD care to develop a nurse-led CVD intervention in two districts of Ghana's Upper East Region. Objective: This study sought to identify non-physician-led interventions for the screening and treatment of cardiovascular disease to incorporate into Ghana's current primary health care structure. Methods: Using a qualitative descriptive design, we conducted 31 semistructured interviews of community health officers (CHOs) and supervising subdistrict officers (SDOs) at CHPS community facilities. Summative content analysis revealed the most common intervention ideas and endorsements by the participants. Findings: Providers endorsed three interventions: increasing community CVD knowledge and engagement, increasing nonphysician prescribing abilities, and ensuring provider access to medical and transportation equipment. Providers suggested community leaders and volunteers should convey CVD knowledge, marshaling established gathering practices to educate communities and formulate action plans. Providers requested lectures paired with experiential learning to improve their prescribing confidence. Providers recommended revising reimbursement and equipment procurement processes for expediting access to necessary supplies. Conclusions: Frontline CHPS primary care providers believe CVD care is feasible. They recommended a three-pronged intervention that combines community outreach, provider training, and logistical support, thereby expanding task-shifting beyond hypertension to include other CVD risk factors. This model could be replicable elsewhere.


Assuntos
Doenças Cardiovasculares , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Criança , Gana , Humanos , Papel do Profissional de Enfermagem , Atenção Primária à Saúde , População Rural
12.
PLoS One ; 16(12): e0261974, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34972184

RESUMO

INTRODUCTION: Obstetric intensive care unit admission (ICU) suggests severe morbidity. However, there is no available data on the subject in Ghana. This retrospective review was conducted to determine the indications for obstetric ICU admission, their outcomes and factors influencing these outcomes to aid continuous quality improvement in obstetric care. METHODS: This was a retrospective review conducted in a tertiary hospital in Ghana. Data on participant characteristics including age and whether participant was intubated were collected from patient records for all obstetric ICU admissions from 1st January 2010 to 31st December 2019. Descriptive statistics were presented as frequencies, proportions and charts. Hazard ratios were generated for relations between obstetric ICU admission outcome and participant characteristics. A p-value <0.05 was deemed statistically significant. RESULTS: There were 443 obstetric ICU admissions over the review period making up 25.7% of all ICU admissions. The commonest indications for obstetric ICU admissions were hypertensive disorders of pregnancy (70.4%, n = 312/443), hemorrhage (14.4%, n = 64/443) and sepsis (9.3%, n = 41/443). The case fatality rates for hypertension, hemorrhage, and sepsis were 17.6%, 37.5%, and 63.4% respectively. The obstetric ICU mortality rate was 26% (115/443) over the review period. Age ≥25 years and a need for mechanical ventilation carried increased mortality risks following ICU admission while surgery in the index pregnancy was associated with a reduced risk of death. CONCLUSION: Hypertension, haemorrhage and sepsis are the leading indications for obstetric ICU admissions. Thus, preeclampsia screening and prevention, as well as intensifying antenatal education on the danger signs of pregnancy can minimize obstetric complications. The establishment of an obstetric HDU in CCTH and the strengthening of communication between specialists and the healthcare providers in the lower facilities, are also essential for improved pregnancy outcomes. Further studies are needed to better appreciate the wider issues underlying obstetric ICU admission outcomes. PLAIN LANGUAGE SUMMARY: This was a review of the reasons for admitting severely-ill pregnant women and women who had delivered within the past 42 days to the intensive care unit (ICU), the admission outcomes and risk factors associated with ICU mortality in a tertiary hospital in a low-resource country. High blood pressure and its complications, bleeding and severe infections were observed as the three most significant reasons for ICU admissions in decreasing order of significance. Pre-existing medical conditions and those arising as a result of, or aggravated by pregnancy; obstructed labour and post-operative monitoring were the other reasons for ICU admission over the study period. Overall, 26% of the admitted patients died at the ICU and maternal age of at least 25 years and the need for intubation were identified as risk factors for ICU deaths. Attention must be paid to high blood pressure during pregnancy.


Assuntos
Cuidados Críticos/métodos , Unidades de Terapia Intensiva , Obstetrícia/métodos , Admissão do Paciente , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Adolescente , Adulto , Feminino , Gana/epidemiologia , Hemorragia/terapia , Humanos , Hipertensão/terapia , Pessoa de Meia-Idade , Mortalidade , Pobreza , Gravidez , Modelos de Riscos Proporcionais , Respiração Artificial , Estudos Retrospectivos , Sepse/terapia , Centros de Atenção Terciária/organização & administração , Resultado do Tratamento , Adulto Jovem
13.
Health Res Policy Syst ; 19(1): 145, 2021 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-34895235

RESUMO

BACKGROUND: Effective payment mechanisms for healthcare are critical to the quality of care and the efficiency and responsiveness of health systems to meet specific population health needs. Since its inception, Ghana's National Health Insurance Scheme (NHIS) has adopted fee-for-service, diagnostic-related groups and capitation methods, which have contributed to provider reimbursement delays, rising costs and poor quality of care rendered to the scheme's clients. The aim of this study was to explore stakeholder perceptions of the feasibility of value-based payment (VBP) for healthcare in Ghana. Value-based payment refers to a system whereby healthcare providers are paid for the value of services rendered to patients instead of the volume of services. METHODS: This study employed a cross-sectional qualitative design. National-level stakeholders were purposively selected for in-depth interviews. The participants included policy-makers (n = 4), implementers (n = 5), public health insurers (n = 3), public and private healthcare providers (n = 7) and civil society organization officers (n = 1). Interviews were audio-recorded and transcribed. Data analysis was performed using both deductive and inductive thematic analysis. The data were analysed using QSR NVivo 12 software. RESULTS: Generally, participants perceived VBP to be feasible if certain supporting systems were in place and potential implementation constraints were addressed. Although the concept of VBP was widely accepted, study participants reported that efficient resource management, provider motivation incentives and community empowerment were required to align VBP to the Ghanaian context. Weak electronic information systems and underdeveloped healthcare infrastructure were seen as challenges to the integration of VBP into the Ghanaian health system. Therefore, improvement of existing systems beyond healthcare, including public education, politics, data, finance, regulation, planning, infrastructure and stakeholder attitudes towards VBP, will affect the overall feasibility of VBP in Ghana. CONCLUSION: Value-based payment could be a feasible policy option for the NHIS in Ghana if potential implementation challenges such as limited financial and human resources and underdeveloped health system infrastructure are addressed. Governmental support and provider capacity-building are therefore essential for VBP implementation in Ghana. Future feasibility and acceptability studies will need to consider community and patient perspectives.


Assuntos
Atenção à Saúde , Programas Nacionais de Saúde , Estudos Transversais , Gana , Instalações de Saúde , Humanos
14.
PLoS One ; 16(12): e0261192, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34914742

RESUMO

BACKGROUND: The insecticide treated bed net (ITN) has been proven for malaria control. Evidence from systematic review also suggests benefits of ITN roll out in reducing the incidence of cutaneous leishmaniasis (CL) and other vector borne diseases. METHODS: Using a community-based cross-sectional study design, ITN use, factors associated with non-use of ITNs, and occurrence of sand flies were investigated in three communities with reported cases of CL in the Oti region of Ghana. RESULTS: A total of 587 households comprising 189 (32.2%), 200 (34.1%), and 198 (33.7%) households from Ashiabre, Keri, and Sibi Hilltop communities with de facto population of 3639 participated in this study. The proportion of households that owned at least one ITN was 97.1%. The number of households having at least one ITN for every two members was 386 (65.8%) and 3159 (86.8%) household population had access to ITN. The household population that slept in ITN the night before this survey was 2370 (65.1%). Lack of household access to ITN (AOR = 1.80; CI: 1.31, 2.47), having a family size of more than 10 members (AOR = 2.53; CI: 1.20, 4.24), having more than 10 rooms for sleeping in a household (AOR = 10.18; CI: 1.28, 81.00), having 2-4 screened windows (AOR = 1.49; CI: 1.00, 2.20), and having 8-10 screened windows (AOR = 3.57; CI: 1.25, 10.17) were significantly associated with increased odds of not sleeping in ITN the night before the survey. A total of 193 female sand flies were trapped from various locations within the study communities. CONCLUSIONS: Factors associated with ITN non-use such as lack of household access to ITN should be incorporated into future efforts to improve ITN use. Species of sand flies and their potential vectorial role in the study communities should also be investigated.


Assuntos
Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Leishmania/isolamento & purificação , Leishmaniose Cutânea/epidemiologia , Malária/complicações , Controle de Mosquitos/métodos , Mosquitos Vetores/parasitologia , Psychodidae/parasitologia , Adulto , Idoso , Animais , Estudos Transversais , Características da Família , Feminino , Gana/epidemiologia , Humanos , Leishmaniose Cutânea/parasitologia , Malária/parasitologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2021 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-34958186

RESUMO

PURPOSE: Over the past two decades, Community-Based Health Planning and Services (CHPS) has been a pragmatic strategy towards universal Primary Health Care (PHC) in Ghana. However, the ability and capacity of these facilities to deliver quality primary health care remain an illusion as they are still crumbling in myriad challenges. These challenges are translated to the poor-quality services provision and low community utilization of CHPS facilities. The study presents a comparative analysis of three communities in the Kassena-Nankana East Municipality, Ghana. DESIGN/METHODOLOGY/APPROACH: Using a mixed-method research design, the study gathered and analysed data from 110 households, three community health officers (CHOs) and three community leaders using semi-structured questionnaires and interview guides. FINDINGS: The findings indicated that the facilities do not have the requisite inputs such as drugs and supplies, logistics, appropriate health personnel, good infrastructure, funding support necessary to deliver quality and appropriate healthcare services that meet the health needs of the communities. For the CHPS to realize their full potentials as PHC facilities, it is required that the needed inputs such as logistics, drugs and appropriate staff are in place to facilitate the activities of CHOs. RESEARCH LIMITATIONS/IMPLICATIONS: Due to the limited number of participants and selection of the study communities, the results may generalization. Also, the researchers acknowledged the inability to interview the district level health officials and the Kassena-Nankana Municipal Assembly during the field visits. This could have provided in-depth knowledge on the findings of this research as well as the validation of the results from the communities' perspective. Several attempts were made to contact and interview district-level authorities which proven futile due to the unavailability of targeted respondents. This resulted in limiting the studies at the community level. However, this limitation does not disprove the findings of this study. PRACTICAL IMPLICATIONS: The article implications for planning primary health care strategies include a keen assessment of community health needs and institutional management of primary health care facilities, equip PHC facilities with adequate resources such as drugs and appropriate staffing to provide the health needs of the communities. ORIGINALITY/VALUE: The paper fulfils the gap in the literature by providing empirical data on how the challenges of primary health care facilities affected the provision of high quality service and how this can affect community's use of the facilities.


Assuntos
Serviços de Saúde Comunitária , Planejamento em Saúde , Gana , Humanos , Atenção Primária à Saúde , Qualidade da Assistência à Saúde
16.
PLoS One ; 16(12): e0261849, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34962960

RESUMO

BACKGROUND: Tuberculosis (TB) and COVID-19 pandemics are both diseases of public health threat globally. Both diseases are caused by pathogens that infect mainly the respiratory system, and are involved in airborne transmission; they also share some clinical signs and symptoms. We, therefore, took advantage of collected sputum samples at the early stage of COVID-19 outbreak in Ghana to conduct differential diagnoses of long-standing endemic respiratory illness, particularly tuberculosis. METHODOLOGY: Sputum samples collected through the enhanced national surveys from suspected COVID-19 patients and contact tracing cases were analyzed for TB. The sputum samples were processed using Cepheid's GeneXpert MTB/RIF assay in pools of 4 samples to determine the presence of Mycobacterium tuberculosis complex. Positive pools were then decoupled and analyzed individually. Details of positive TB samples were forwarded to the NTP for appropriate case management. RESULTS: Seven-hundred and seventy-four sputum samples were analyzed for Mycobacterium tuberculosis in both suspected COVID-19 cases (679/774, 87.7%) and their contacts (95/774, 12.3%). A total of 111 (14.3%) were diagnosed with SARS CoV-2 infection and six (0.8%) out of the 774 individuals tested positive for pulmonary tuberculosis: five (83.3%) males and one female (16.7%). Drug susceptibility analysis identified 1 (16.7%) rifampicin-resistant tuberculosis case. Out of the six TB positive cases, 2 (33.3%) tested positive for COVID-19 indicating a coinfection. Stratifying by demography, three out of the six (50%) were from the Ayawaso West District. All positive cases received appropriate treatment at the respective sub-district according to the national guidelines. CONCLUSION: Our findings highlight the need for differential diagnosis among COVID-19 suspected cases and regular active TB surveillance in TB endemic settings.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Coinfecção/diagnóstico , Coinfecção/epidemiologia , Mycobacterium tuberculosis/genética , Pandemias/prevenção & controle , SARS-CoV-2/genética , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , Antibióticos Antituberculose/farmacologia , COVID-19/prevenção & controle , COVID-19/virologia , Coinfecção/virologia , Diagnóstico Diferencial , Farmacorresistência Bacteriana/efeitos dos fármacos , Feminino , Gana/epidemiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/efeitos dos fármacos , Rifampina/farmacologia , Escarro/microbiologia , Tuberculose Pulmonar/microbiologia
17.
BMC Pregnancy Childbirth ; 21(1): 850, 2021 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-34969366

RESUMO

BACKGROUND: Equitable access to skilled birth attendance during delivery is vital for reducing global maternal deaths to 70 deaths per 100, 000 to achieve the Sustainable Development Goals (SDGs) by 2030. Although several initiatives have been implemented to reduce maternal mortality in Ghana, inequalities in access to skilled birth attendance during delivery still exist among women of different socioeconomic groups. This study assesses the socioeconomic inequalities in access and use of skilled birth attendants during delivery in Ghana. METHODS: Research was conducted through literature reviews and document reviews, and a secondary data analysis of the 2014 Ghana Demographic and Health Survey (GDHS), a nationally representative survey. A total of 1305 women aged 15-49 years, who had a live birth the year before to the survey in the presence of a skilled birth attendant were analysed using concentration indices and curves. The indices were further decomposed to identify the major socioeconomic factors contributing most to the inequalities. RESULTS: The results found that access to skilled birth attendants was more among women from rich households showing a pro-rich utilization. The decomposition analysis revealed that household wealth index, educational level of both mother and husband/partner, area of residence and mother's health insurance coverage were the major contributing factors to socioeconomic inequalities in accessing skilled birth attendants during child delivery among Ghanaian women. CONCLUSION: This study confirms that a mother's socioeconomic status is vital to reducing maternal deaths. Therefore, it is worthy to focus attention on policy interventions to reduce the observed inequalities as revealed in the study.


Assuntos
Parto Obstétrico , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Serviços de Saúde Materna , Parto , Adolescente , Adulto , Feminino , Gana , Humanos , Pessoa de Meia-Idade , Tocologia , Modelos Estatísticos , Gravidez , Fatores Socioeconômicos , Adulto Jovem
18.
Afr J AIDS Res ; 20(4): 270-276, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34905452

RESUMO

With the introduction of antiretroviral therapy (ART), many HIV-infected children are growing into adolescence and adulthood. A facility-based cross-sectional study was conducted at the Fevers Unit of one of the teaching hospitals in Ghana. The Morisky Medication Adherence Scale (MMAS-8) and pill count were used to assess adherence, while measured viral load levels of participants were used to assess viral suppression. The rate of viral suppression (<400 copies/ml) was 68.2%. Participants with high MMAS-8 scores were 8.4 times more likely to be virally suppressed compared to those with low MMAS-8 scores (OR = 8.4, p = 0.003, 95% CI: 2.11-33.48). The commonest reason for missing doses of their antiretroviral drugs (ARVs) was forgetfulness. Efforts must be made by all stakeholders involved in HIV care to engage adolescents and young adults living with HIV (AYALHIV) on personal and/or group levels to help identify and improve particular ART adherence issues so as to increase viral suppression rates.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Criança , Estudos Transversais , Gana/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Adesão à Medicação , Centros de Atenção Terciária , Carga Viral , Adulto Jovem
19.
Pan Afr Med J ; 40: 96, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34909084

RESUMO

Introduction: urogenital schistosomiasis affects school-aged children with impacts on health, growth, and cognitive development. Basic schools along active water bodies have a possibility of a high infection among the children. Methods: we performed a school-based cross-sectional assessment of urogenital schistosomiasis among children in four selected rural communities along major rivers in the central region of Ghana. Three hundred and nine (309) basic school children class 1 to junior high school (JHS) 3 were recruited. Sociodemographic data and information on behavioral influences were collected with a structured written questionnaire. Laboratory examinations were conducted on fresh urine samples. Descriptive statistics and cross-tabulations with measures of association between variables, adjusted and unadjusted logistic regression analysis were performed on measured variables. Results: we recorded a 10.4% prevalence of urogenital schistosomiasis. Schools in communities along the Kakum river recorded the highest disease burden (65.6%). The odds of infection among pupils who engage in irrigation activities were 4 folds more than those who do not engage in irrigation activities (adjusted odds ratio (aOR) (95%CI): 4.3 (1.6-12.1), P-value=0.005). Pupils of caregivers who resort to self-medication using local herbal concoctions had 14-fold more odds of infection compared to those who visit the health facility (aOR (95%CI): 14.4 (1.4-143.1), P-value=0.006). Conclusion: poor health-seeking behaviors and lack of access to health facilities influenced the disease proportion among the children in these endemic communities.


Assuntos
Rios , Esquistossomose Urinária , Animais , Criança , Estudos Transversais , Gana/epidemiologia , Humanos , Prevalência , Fatores de Risco , Schistosoma haematobium , Esquistossomose Urinária/epidemiologia , Instituições Acadêmicas
20.
Pan Afr Med J ; 40: 131, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34909099

RESUMO

Introduction: globally about 5.4 million people are affected by snakebite annually leading to 2.7 million cases of snakebite envenoming and 81,000-138,000 deaths. In sub-Saharan Africa, the burden of disease caused by snakebite is often underestimated despite its status as a category A neglected tropical disease. We reviewed snakebite data to determine the magnitude of snakebite by person, place, and time in the Volta and Oti Regions of Ghana. Methods: we conducted a descriptive secondary data analysis using snakebite data from 2014-2018 extracted from the District Health Information and Management Systems (DHIMS 2) database. Data were analyzed descriptively by person, place, and time using summary statistics and results were presented in proportions and graphs. Missed outbreaks were determined through calculation of cumulative sum (CUSUM 2). Results: a total of 2,973 cases of snakebites were reported over the 5 years of which 1675 (56.3%) were males. Majority 867 (29.2%) of snakebite victims were between 20-34 years of age with recorded 5-year average incidence of 24 snakebite cases per 100,000. Nkwanta North District recorded the highest cases 499 (16.8%) with most of the snakebite cases 2,411 (81%) recorded in the rainy season. Overall, there was a decreasing trend of snakebites and four missed snakebite outbreaks occurred during the period. No snakebite death was recorded. Conclusion: a 5-year average snakebite incidence of 24 cases per 100,000 persons was recorded and Nkwanta North District recorded the highest cases with peaks occurring in rainy and harvesting seasons. Four outbreaks were missed. There is a need to conduct periodic data analysis for effective intervention programs.


Assuntos
Mordeduras de Serpentes , Antivenenos , Gana/epidemiologia , Humanos , Incidência , Masculino , Estações do Ano , Mordeduras de Serpentes/epidemiologia
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