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1.
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
2.
Hum Resour Health ; 19(1): 136, 2021 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-34742301

RESUMO

BACKGROUND: Health care workers (HCWs) are among the high-risk groups in contracting and dying from COVID-19. World Health Organization estimates that over 10,000 HCWs in Africa have been infected with COVID-19 making it a significant occupational health hazard to HCWs. In Ghana, over 100 HCWs have already been infected and dozen others died from the virus. Acceptability and uptake of the COVID-19 vaccine is therefore critical to promote health and safety of HCWs as the country battles out of a third wave of the pandemic. OBJECTIVE: The study sought to ascertain the correlates of HCWs likelihood of participating in a COVID-19 vaccine trial and accepting the vaccine when given the opportunity. METHODS: The study was a web-based cross-sectional survey among HCWs (n = 1605) in all sixteen (16) administrative regions in Ghana. Data were analyzed with STATA statistical analysis software (version 14). Chi-square (X2) and Fisher's exact tests were used to test for differences in categorical variables; bivariate probit regression analysis with Average Marginal Effect (AME) was employed to ascertain the determinants of HCWs' likelihood of participating in a COVID-19 vaccine trial and taking the vaccine. RESULTS: It was found that 48% of HCWs will participate in a COVID-19 vaccine trial when given the opportunity; 70% will accept the COVID-19 vaccine; younger HCWs (AME = 0.28, SE = 0.16, p < 0.1), non-Christians (AME = 21, SE = 0.09, p < 0.05) and those who worked in faith-based health facilities (AME = 18, SE = 0.07, p < 0.05) were more likely to participate in a COVID-19 vaccine trial. Female HCWs (AME = - 11, SE = 0.04, p < 0.05) and those with lower educational qualification were less likely to accept a COVID-19 vaccine (AME = - 0.16, SE = 0.08, p < 0.1). Reasons cited for unwillingness to participate in a COVID-19 vaccine trial or uptake the vaccine were mainly fear, safety concerns, mistrust, uncertainty, spiritual and religious beliefs. CONCLUSIONS: Acceptance of the COVID-19 vaccine appear to be high among HCWs; conversely, willingness to volunteer for the vaccine trial was low. Continuous targeted and integrated public health education for HCWs will enhance vaccine acceptability to promote safety and population health in the global south as Ghana intensifies efforts to produce COVID-19 vaccines locally.


Assuntos
COVID-19 , Vacinas , Vacinas contra COVID-19 , Estudos Transversais , Feminino , Gana , Pessoal de Saúde , Promoção da Saúde , Humanos , SARS-CoV-2
3.
BMC Health Serv Res ; 21(1): 1223, 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34763699

RESUMO

BACKGROUND: The Community-based Health Planning and Services (CHPS) is a national health reform programme that provides healthcare at the doorsteps of rural community members, particularly, women and children. It seeks to reduce health inequalities and promote equity of health outcomes. The study explored implementation and utilization challenges of the CHPS programme in the Northern Region of Ghana. METHODS: This was an observational study that employed qualitative methods to interview key informants covering relevant stakeholders. The study was guided by the systems theory. In all, 30 in-depth interviews were conducted involving 8 community health officers, 8 community volunteers, and 14 women receiving postnatal care in four (4) CHPS zones in the Yendi Municipality. The data were thematically analysed using Atlas.ti.v.7 software and manual coding system. RESULTS: The participants reported poor clinical attendance including delays in seeking health care, low antenatal and postnatal care visits. The barriers of the CHPS utilization include lack of transportation, poor road network, cultural beliefs (e.g. taboos of certain foods), proof of women's faithfulness to their husbands and absence of health workers. Other challenges were poor communication networks during emergencies, and inaccessibility of ambulance service. In seeking health care, insured members of the national health insurance scheme (NHIS) still pay for services that are covered by the NHIS. We found that the CHPS compounds lack the capacity to sterilize some of their equipment, lack of incentives for Community Health Officers and Community Health Volunteers and inadequate infrastructures such as potable water and electricity. The study also observed poor coordination of interventions, inadequate equipment and poor community engagement as setbacks to the progress of the CHPS policy. CONCLUSIONS: Clinical attendance, timing and number of antenatal and postnatal care visits, remain major concerns for the CHPS programme in the study setting. The CHPS barriers include transportation, poor road network, cost of referrals, cultural beliefs, inadequate equipment, lack of incentives and poor community engagement. There is an urgent need to address these challenges to improve the utilization of CHPS compounds and to contribute to achieving the sustainable development goals.


Assuntos
Reforma dos Serviços de Saúde , Planejamento em Saúde , Serviços de Saúde Comunitária , Atenção à Saúde , Feminino , Gana , Humanos , Gravidez
4.
BMC Health Serv Res ; 21(1): 1209, 2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34749726

RESUMO

BACKGROUND: E-Learning solutions are increasingly being advocated to augment existing traditional teaching and learning efforts in health training institutions. Unfortunately, these emerging technologies rarely focus on health sciences education within the context of public universities, hence the need for this study. This project evaluated experiences of healthcare trainees with a pilot e-Learning project (SMART e-Learning project) initiated in one of Ghana's public universities in 2017. The study used a mixed methods cross-sectional approach among 363 healthcare trainees. Data collection was between 17th October, 2019 to 3rd December, 2019. Data was analysed descriptively and test for variable differences done using Pearson Chi-square and Fisher's Exact for categorical variables. Wilcoxon Mann-Whitney test was used to test for differences in the Likert scale items. Additionally, rotated varimax factor analysis was performed for the health trainees' rated satisfaction factors. RESULTS: Out of 446 respondents who consented to participate in the study, 363 responses were complete and valid, representing a response rate of 81 %. Most frequently used e-learning facilities by healthcare trainees were: writing interim assessments (IAs) (82 %) while the least used function was live chating with faculty (5 %). Challenges associated with the e-learning pilot project were: limited workspace in the pilot computer laboratory (33 %), slow internet/intranet speed (29 %) and limited capacity of teaching and ICT staff to support users (28 %). CONCLUSIONS: There is the need to engage relevant stakeholders at the University, ministries of health and education through policy dialogues to develop statutory e-Learning guidelines for health educational institutions of higher learning to complement existing traditional teaching and learning approaches.


Assuntos
Instrução por Computador , Atenção à Saúde , Gana , Humanos , Projetos Piloto , Políticas , Tecnologia
5.
BMC Health Serv Res ; 21(1): 1190, 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34732179

RESUMO

BACKGROUND: Midwives face direct and indirect barriers in their workplaces that have negative consequences on their ability to provide quality care to women and neonates, however, they still carry on with their duties. This study aimed at investigating the coping strategies that Ghanaian midwives adopt to be able to complete their work. METHODS: Glaserian Grounded theory was used in this study. Data were collected through non-participant observations and semi-structured interviews. The study participants included 29 midwives who worked in labour/birthing environments and a pharmacist, a social worker, a national Health Insurance Scheme manager and a health services manager. FINDINGS: The midwives' motivation due to their strong desire to save the lives of women and neonates and their strong affection for the midwifery profession was identified to help them cope with the barriers that they faced in their workplaces. The midwives' motivation was found to spur actions such as improvising, taking control of the birthing process and the birthing environment and the maintenance of social and professional networks to help them to complete their duties. CONCLUSION: Ghanaian midwives face myriad barriers in their workplaces; however, they are able to adopt coping strategies that enable them to complete their duties. The provision of care resources for maternity services in the country will reduce the barriers that the midwives face and improve the quality of maternal and neonatal care. In the short term however, pre and post midwifery educational programmes should focus on developing resilience in the midwifery workforce to help midwives cope more effectively with the challenges that they face in their workplaces.


Assuntos
Tocologia , Enfermeiras Obstétricas , Adaptação Psicológica , Feminino , Gana , Teoria Fundamentada , Humanos , Recém-Nascido , Gravidez , Pesquisa Qualitativa
6.
Artigo em Inglês | MEDLINE | ID: mdl-34769719

RESUMO

The government of Ghana has been piloting traditional medicine (TM) integration in 17 health facilities across the country. However, the nature of current practice of integrated healthcare has not been thoroughly explored. This paper sought to explore the experiences and recommendations of orthodox health practitioners and hospital administrators in the Ashanti region regarding the practice of integrated healthcare in Ghana. The study adopted a qualitative, phenomenological approach involving 22 interviews. Purposive sampling technique was used in selecting study participants. Framework analysis was used to draw on the experiences of participants relating to TM integration. Participants were knowledgeable about the existence of integrated health facilities and stated that TM integration has created options in health services. However, participants deemed the integrated system ineffective and attributed the inefficiency to poor processing and certification of TM products, opposition of medical doctors to TM usage, absence of a protocol to guide the integration process, and inadequate publicity. Professional training of TM practitioners and inclusion of TM in medical school curriculum could improve collaboration between the health practitioners. Future research should focus on assessing the opinions and involvements of TM practitioners regarding the integration of traditional therapies into national health systems.


Assuntos
Administradores Hospitalares , Medicina Tradicional , Atenção à Saúde , Gana , Humanos , Percepção , Pesquisa Qualitativa
7.
Environ Monit Assess ; 193(11): 715, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34637024

RESUMO

Artisanal small-scale mining has been part of Ghana's history, but recent public outcry on the devastating impacts of the phenomenon on water bodies, due to expansion in the sector, has led to clamp downs by various governments on the activity. This has called for evaluation of the water quality of the South-western Rivers System, which are small-scale mining endemic areas. Thirty-five river samples were collected in July 2018 and were analyzed for physico-chemical parameters using procedures outlined in the Standard Methods for the Examination of Water and Wastewaters. The results revealed that the rivers are polluted with Fe and Cu, accompanied by very high levels of turbidity (mean = 488 NTU) and total suspended solids (TSS) (mean = 382 mg/L). NH3-N, PO4-P, BOD, and DO levels indicated mild pollution in the waters. Pollution of the rivers is attributable to impacts of artisanal small-scale mining, surface run-off as a result of high intensity rainfall, anthropogenic (indiscriminate waste disposal) and geogenic factors such as dissolution of minerals from the soil zone. It was observed that, if not strictly regulated, turbidity and TSS levels arising mainly from illegal small-scale mining activities could lead to shutdowns of a number of Ghana Water Company Limited treatment plants, leading to water supply challenges in the study area.


Assuntos
Rios , Poluentes Químicos da Água , Monitoramento Ambiental , Gana , Poluentes Químicos da Água/análise , Qualidade da Água
8.
BMC Public Health ; 21(1): 1930, 2021 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-34689732

RESUMO

BACKGROUND: Violence has severe and long-lasting negative consequences for children's and adolescents' well-being and psychosocial functioning, thereby also hampering communities' and societies' economic growth. Positive attitudes towards violence and the lack of access to alternative non-violent strategies are likely to contribute to the high levels of teachers' ongoing use of violence against children in sub-Saharan African countries. Notwithstanding, there are currently very few school-level interventions to reduce violence by teachers that a) have been scientifically evaluated and b) that focus both on changing attitudes towards violence and on equipping teachers with non-violent discipline strategies. Thus, the present study tests the effectiveness of the preventative intervention Interaction Competencies with Children - for Teachers (ICC-T) in primary and secondary schools in Tanzania, Uganda, and Ghana. METHODS: The study is a multi-site cluster randomized controlled trial with schools (clusters) as level of randomization and three data assessment points: baseline assessment prior to the intervention, the first follow-up assessment 6 months after the intervention and the second follow-up assessment 18 months after the intervention. Multi-stage random sampling will be applied to select a total number of 72 schools (24 per country). Schools will be randomly allocated to the intervention and the control condition after baseline. At each school, 40 students (stratified by gender) in the third year of primary school or in the first year of secondary/junior high school and all teachers (expected average number: 20) will be recruited. Thus, the final sample will comprise 2880 students and at least 1440 teachers. Data will be collected using structured clinical interviews. Primary outcome measures are student- and teacher-reported physical and emotional violence by teachers in the past week. Secondary outcome measures include children's emotional and behavioral problems, quality of life, cognitive functioning, academic performance, school attendance and social competence. Data will be analyzed using multilevel analyses. DISCUSSION: This study aims to provide further evidence for the effectiveness of ICC-T to reduce teacher violence and to improve children's functioning (i.e., mental health, well-being, academic performance) across educational settings, societies and cultures. TRIAL REGISTRATION: The trial was registered at clinicaltrials.org under the ClinicalTrials.gov identifier NCT04948580 on July 2, 2021.


Assuntos
Qualidade de Vida , Violência , Adolescente , Criança , Gana , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Serviços de Saúde Escolar , Professores Escolares , Instituições Acadêmicas , Tanzânia , Uganda
9.
PLoS One ; 16(10): e0258543, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34695137

RESUMO

BACKGROUND: Inactivation or mutation of the tumour suppressor gene p53 or its regulator mouse double minute 2 (MDM2) is the commonest event in breast cancer. These altered genes usually express abnormally high levels of their proteins in many carcinomas. The phenotypic expression of p53 and MDM2 in breast cancer cases in our setting is not known. This study investigated the expression of the tumour suppressor protein p53 and its regulator MDM2, using immunohistochemistry in a Ghana breast cancer cohort. METHOD: A 9-year retrospective cross-sectional study on archived tissue blocks-formalin fixed paraffin embedded tissue (FFPE) was carried out. Demographic data were abstracted. Based on complete clinical data and availability of FFPE archived blocks 203 cases were selected for tissue micro array (TMA) construction. The TMA sections were subjected to immunohistochemistry (IHC) (ER, PR, HER2, p53, and MDM2). Expression of p53 and MDM2 were related to grade and molecular subtypes. RESULTS: The age ranged from 17 to 92 years (mean = 49.34 ± 13.74). Most of the cases were high grade; grade II (34.9%) and grade III (55.7%). Fifty-four percent of the cases were triple negative. Invasive ductal carcinoma no special type was the commonest histotype (87.1%). Thirty-six percent (36%) of the cases expressed p53. Significant associations were found between p53 overexpression and histological grade (p = 0.034), triple negative (p = 0.0333) and luminal B (p<0.01) tumors. Most cases (93.1%) were negative for MDM2 expression. Significant association was found between MDM2 and HER2 over-expression as well as Ki-67. There was no significant positive correlation between MDM2 and p53 co-expression (p>0.05). CONCLUSION: The elevated level of p53 expression in the aggressive breast cancer phenotypes (high histological grade and triple negative) in our cohort suggest that P53 elevation may be a poor prognostic marker in our setting. High expression of MDM2 in our cohort with high Ki67; also in cases with Her2/neu overexpression known with predictable poor prognosis in the absence of target therapy suggest MDM2 may be associated with aggressive biological behaviour in our breast cancer cases. The non-significant association of p53 and MDM2 expression in the same cases as also documented by previous studies suggest independent genetic pathway in tumourigenesis.


Assuntos
Neoplasias da Mama , Adulto , Idoso , Feminino , Gana , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Proteína Supressora de Tumor p53
10.
Pan Afr Med J ; 38: 18, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34650649

RESUMO

Infection prevention and control (IPC) measures remain crucial to breaking transmission of the virus in the wake of inconclusive efforts underway to find an effective vaccine and treatment. While acknowledging that many lessons evolve as the pandemic unfolds, an initial understanding and recognition of the complexities that surround IPC policy implementation and adherence is vital for effective control of on-going pandemic in particular and to inform national IPC policies beyond the epi-curve. This short communication therefore seeks to unravel initial thoughts, themes and concepts that have unfolded in the implementation of IPC policies and guidelines in the context of the ongoing outbreak response in Ghana. A rapid desk review was done. Reflexive journals, field notes, observations and workshop experiences were compiled and overlapped with authors' experience as a member of the COVID-19 national response team for Infection Prevention and Control (IPC). Thematic content analysis was then used to categorize the lessons into common themes. While aligning with global strategies, the concept of 'looking within' for initial solutions and strengths have proven useful for a public health emergency response in Ghana. Future IPC policies must inculcate perspectives from the politics and economics of IPC practices and employ varieties of multidisciplinary approaches required to broaden the scope of IPC practice.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Pandemias/prevenção & controle , Gana , Humanos , Controle de Infecções , Gestão da Informação , Desenvolvimento de Pessoal
11.
Environ Monit Assess ; 193(11): 748, 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34694510

RESUMO

In this study, descriptive statistics, correlation matrix, multiple regression model, and geostatistical models were used to assess the contamination of groundwater with respect to trace elements in the Lower Tano river basin, Ghana, West Africa. A total number of 48 boreholes drilled across the basin with depths ranging from 18 to 60 m were used as data sources in this study. The results of the descriptive statistics showed that the average lead, iron, and aluminium concentrations exceeded the WHO permissible limits of 0.3 mg/L, 0.01 mg/L, and 0.2 mg/L respectively. Furthermore, copper, chromium, aluminium, zinc, manganese, nickel, iron, arsenic, electrical conductivity, and total dissolved solids were found to be extreme and highly positively skewed. Even though significant correlations exist among some variables, the statistical results showed that the quality of the boreholes drilled across the basin was mainly originating from geogenic and anthropogenic sources. In addition, each pair of correlated physical parameters and trace elements in the drilled boreholes were predicted using multiple regression models. Likewise, geostatistical modelling was used to assess the spatial analysis of each pair of correlated physical parameters and trace elements in the drilled boreholes. The cross-validation results revealed kriging model, as the most precise model for the spatial distribution maps for the correlated physical parameters, and correlated trace elements concentration in the boreholes drilled across the study region. The semivariogram models showed that most of the correlated physical parameters and correlated trace elements were weak moderately and strongly spatially dependent, suggesting fewer agronomic influences. The results of the spatial analysis were consistent with the multiple regression model and the Pearson correlation matrix.


Assuntos
Água Subterrânea , Poluentes Químicos da Água , Monitoramento Ambiental , Gana , Rios , Poluentes Químicos da Água/análise
12.
BMC Health Serv Res ; 21(1): 1056, 2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34610842

RESUMO

INTRODUCTION: Malaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-SP) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana. Yet, the high ANC attendance is not commensurate with the uptake of these interventions, with missed opportunities to deliver the interventions. This study sought to assess the health system factors affecting access and delivery of IPTp-SP and ITN as defined by the Ghana Malaria Policy Guideline to eligible pregnant women attending ANC clinic sessions. METHODS: A quantitative cross-sectional study was conducted in the Volta Region of Ghana, with data collected across three levels of health care delivery facilities, including hospitals, health centres and Community-Based Health Planning Service (CHPS) compounds. Data collection included structured observation checklists to document the communication and interaction between the ANC health staff and pregnant women. Additionally, structured questionnaires were used to elicit information on cadre, trainings attended, knowledge and delivery practices of health workers on IPTp-SP and ITN. Stata 16 was used for data analysis, and a defined delivery algorithm was used to compute appropriate and inappropriate delivery practices, using the Ghana policy directive as a guide. Predictors of appropriate delivery were determined using logistic regression analysis. RESULTS: Approximately 97% of the 680 ANC observations had complete information for analysis. Of these, 78% (511/657) were eligible for IPTp-SP after excluding women who have less than 16 weeks of gestation, G6PD deficient, malaria positive and have taken 5 doses of IPTp-SP prior to day of observation. Appropriate delivery of IPTp-SP was 76% (390/511). Despite the availability of SP, 15% (75/511) of all eligible women were not offered the medication and 37% (44/119) of inappropriate delivery was recorded during periods of stock out. ITNs were appropriately delivered to 59% (139) out of 237 eligible women. Thirty-two percent (77/237) of eligible women, mostly continuing ANC clients, were not given ITN despite stock availability. CONCLUSIONS: IPTp-SP was appropriately delivered to most of the eligible pregnant women compared to ITN. While stock out of both intervention could account for inappropriate delivery, despite stock availability, IPTp-SP and ITN were not delivered to some eligible women.


Assuntos
Antimaláricos , Malária , Antimaláricos/uso terapêutico , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Malária/tratamento farmacológico , Malária/epidemiologia , Malária/prevenção & controle , Gravidez , Gestantes , Estados Unidos
13.
Pan Afr Med J ; 39: 222, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34630834

RESUMO

Introduction: irrational or inappropriate prescribing of antibiotics is a major problem in healthcare and leads to antibiotic resistance. There is the need to understand the prescribing patterns and antibiotic stewardship in health facilities to support appropriate antibiotic use. A study was carried out to evaluate prescribing pattern of antibiotics at the Ghana Police Hospital using National Standard Treatment Guidelines (STG) and World Health Organization (WHO) prescribing indicators. Methods: a cross-sectional descriptive study was conducted at the Ghana Police Hospital. Data on prescriptions of antibiotics for both out-patients and in-patients was collected between December 2019 and March 2020. A pretested self-designed tool was used for data collection. All sampled prescriptions were assessed for appropriateness using the STG of 2017 and WHO "AWaRe" classification. The criteria used in assessment included dose, frequency, duration of treatment and choice of antibiotic prescribed for disease condition. Descriptive statistics were used in data analysis. Results: a total of 184 patient prescriptions (286 antibiotics) were included in this study. Results showed that antibiotics were mostly prescribed for dental and dental-related conditions (20.7%) and obstetric post-delivery prophylaxis (18.1%). Appropriateness of indicators for antibiotics prescribed assessed ranged between 89.2% to 97.6%. The most frequently prescribed antibiotics were metronidazole (25.9%), amoxicillin with clavulanic acid (22.0%), amoxicillin (16.4%) and ciprofloxacin (10.1%). Based on WHO "AWaRe" classification, the "access" group of antibiotics (74%) was the most prescribed, followed by "watch" group (24%). There were no antibiotics prescribed from the "reserve" group of antibiotics and another 2% that was not part of AwaRe classification. Conclusion: study revealed that the level of appropriateness for prescribing indicators assessed was relatively high and majority of prescribed antibiotics were from the "access" and "watch" group. These observations suggest responsible prescribing of antibiotics at the Ghana Police Hospital and effective antibiotic stewardship should be sustained and improved.


Assuntos
Antibacterianos/administração & dosagem , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Gestão de Antimicrobianos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Gana , Hospitais , Humanos , Prescrição Inadequada/estatística & dados numéricos , Lactente , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Padrões de Prática Médica/normas , Indicadores de Qualidade em Assistência à Saúde , Adulto Jovem
14.
J Environ Public Health ; 2021: 9974029, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34659424

RESUMO

Background: The global discourse on plastic waste generation and disposal has over the last two decades, gained traction with the aid of research-based evidence. Though observed globally, the situation is quickly deteriorating in developing countries such as Ghana. In Ghana and Africa as a whole, rapidly increasing population and rural to urban migration have been cited as factors that exacerbate the existing struggles with plastic pollution. This study aimed at identifying the determinants of unsafe plastic waste disposal among households. Methods: The study was carried out in three communities in Tamale in the Northern Region of Ghana. Data were collected from 270 randomly selected households through household surveys, key informant interviews, and direct field observations. Results: The study revealed that the majority (63.3%) of the total respondents used and disposed of their plastic waste "unsafely." The analysis showed that the education level and household wealth were significant determinants of unsafe plastic disposal. Conclusion: The study concludes that challenges of plastic waste management are not limited to economic, technical, and institutional factors, but social factors such as human behavior are key aspects of waste management that need attention. The study, therefore, recommends strict enforcement of sanitation by-laws, promotion of education, and provision of alternatives to plastics that will minimize the need for importing and manufacturing plastics, as potential steps towards addressing unsafe disposal of plastics in the domestic environment.


Assuntos
Plásticos , Eliminação de Resíduos , Gerenciamento de Resíduos , Características da Família , Gana , Humanos , Eliminação de Resíduos/normas , Segurança , Gerenciamento de Resíduos/normas
15.
PLoS One ; 16(10): e0258164, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34714857

RESUMO

This paper uses publicly available data and various statistical models to estimate the basic reproduction number (R0) and other disease parameters for Ghana's early COVID-19 pandemic outbreak. We also test the effectiveness of government imposition of public health measures to reduce the risk of transmission and impact of the pandemic, especially in the early phase. R0 is estimated from the statistical model as 3.21 using a 0.147 estimated growth rate [95% C.I.: 0.137-0.157] and a 15-day time to recovery after COVID-19 infection. This estimate of the initial R0 is consistent with others reported in the literature from other parts of Africa, China and Europe. Our results also indicate that COVID-19 transmission reduced consistently in Ghana after the imposition of public health interventions-such as border restrictions, intra-city movement, quarantine and isolation-during the first phase of the pandemic from March to May 2020. However, the time-dependent reproduction number (Rt) beyond mid-May 2020 does not represent the true situation, given that there was not a consistent testing regime in place. This is also confirmed by our Jack-knife bootstrap estimates which show that the positivity rate over-estimates the true incidence rate from mid-May 2020. Given concerns about virus mutations, delays in vaccination and a possible new wave of the pandemic, there is a need for systematic testing of a representative sample of the population to monitor the reproduction number. There is also an urgent need to increase the availability of testing for the general population to enable early detection, isolation and treatment of infected individuals to reduce progression to severe disease and mortality.


Assuntos
COVID-19 , Pandemias/prevenção & controle , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Gana/epidemiologia , Humanos , Modelos Estatísticos , Saúde Pública , Quarentena
16.
Nutrients ; 13(10)2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34684616

RESUMO

Urbanisation in Ghana could be negatively impacting the state of food security, especially in economically vulnerable groups. Food supply, safety, and quality are all aspects of food security which could be impacted. We conducted a scoping literature review to understand the nature and magnitude of evidence available on the urban food security situation in Ghana. A literature search was conducted in Medline, CINAHL, Embase, Global Health, Scopus, Web of Science, Africa Wide Information and Google Scholar to identify relevant peer-reviewed and grey literature. 45 studies, mainly cross-sectional surveys/food samples analysis, met the inclusion criteria. The majority of studies were concentrated in the Greater Accra Region (n = 24). Most studies focused on food safety and quality (n = 31). Studies on supply and stability were, however, scarce. Qualitative research methods were uncommon in the included studies. The existing literature on food security are concentrated in two regions: The Greater Accra and Ashanti regions. Future studies exploring food security in urban Ghana should focus on exploring the lived experiences and perceptions of food insecurity and food stability by urban-dwellers using qualitative methods. The evidence suggesting that the safety/quality of foods sold in Ghanaian markets is poor should be a concern to consumers and policy makers.


Assuntos
Segurança Alimentar , Cidades , Alimentos , Inocuidade dos Alimentos , Abastecimento de Alimentos , Gana , Humanos
17.
BMC Health Serv Res ; 21(1): 1104, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654428

RESUMO

BACKGROUND: Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana. METHODS: We utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision. RESULTS: Less than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity. DISCUSSION: Overall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care. CONCLUSIONS: SAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care.


Assuntos
Aborto Induzido , Assistência ao Convalescente , Estudos Transversais , Feminino , Gana , Instalações de Saúde , Humanos , Gravidez
18.
Reprod Health ; 18(1): 206, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654455

RESUMO

BACKGROUND: There is evidence that women with disabilities (WWDs) experience the most difficulty accessing and using sexual and reproductive health and rights (SRHRs) services and information worldwide. However, there are currently no workable interventions to reach WWDs with essential SRHR services. This study aims to test the effect of an integrated health facility and individual-level intervention on access to SRHRs information and services among sexually active WWDs aged 15-49 years in Ghana. METHODS: A quasi-experimental study design with four arms will be implemented in four districts in the Northern region of Ghana to test the effect of three inter-related interventions. The inventions are (1) capacity building in disability-centred SRHRs information and service delivery for healthcare providers, (2) support for WWDs to access disability-unfriendly healthcare infrastructure, and (3) one-on-one regular SRHRs education, information provision, and referral. The first two interventions are at the health-facility level while the third one is at the individual/family level. The first arm of the experiment will expose eligible WWDs to all three interventions. In the second arm, WWDs will be exposed to only the two-health facility-level interventions. The third arm will expose WWDs to only the individual level intervention. The forth arm will constitute the control group. A total of 680 (170 in each arm) sexually active women with physical disability and visual impairments will take part in the study over a period of 12 months. To assess the effect of the interventions on key study outcomes (i.e. awareness about, and use of modern contraceptive, ANC attendance, and skilled delivery among parous women), pre- and post-intervention surveys will be conducted. Difference-in-Difference analysis will be used to examine the effect of each intervention in comparison to the control group, while controlling for confounders. Cost-effectiveness analyses will also be conducted on the three-intervention arms vis a vis changes in key outcome measures to identify which of the three interventions is likely to yield greater impact with lower costs. DISCUSSION: Lack of access to SRHRs information and services for WWDs is not only a violation of their right to appropriate and quality SRH care but could also undermine efforts to achieve equitable healthcare access as envisaged under SDG 3. This research is expected to generate evidence to inform local health programmes to increase access to SRHRs among WWDs by strengthening local health system capacity to provide disability-sensitive SRHRs services. Trial registration Name of the registry: Pan African Clinical Trials Registry (PACTR). Trial ID: 14591. Date of registration: 02/01/2020. URL of trial registry record: https://pactr.samrc.ac.za/Researcher/TrialRegister.aspx?TrialID=14591.


Assuntos
Pessoas com Deficiência , Serviços de Saúde Reprodutiva , Feminino , Gana , Instalações de Saúde , Acesso aos Serviços de Saúde , Humanos
19.
BMC Health Serv Res ; 21(1): 1110, 2021 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-34656125

RESUMO

BACKGROUND: Tuberculosis screening of people living with HIV (PLHIV) - an intervention to reduce the burden of TB among PLHIV - is being implemented at HIV clinics in Ghana since 2007, but TB screening coverage remains low. Facility adherence to intervention guidelines may be a factor but is missing in implementation science literature. This study assesses the level of HIV clinic adherence to the guidelines and related facility characteristics in selected district hospitals in Ghana. METHODS: This cross-sectional study was conducted in all 27 district hospitals with HIV clinics, X-ray and geneXpert machines in Ghana. These hospitals are in 27 districts representing about 27% of the 100 district hospitals with HIV clinics in Ghana. A data collection tool with 18-items (maximum score of 29) was developed from the TB/HIV collaborative guidelines to assess facility adherence to four interrelated components of the TB screening programme as stated in the guidelines: intensive TB case-finding among PLHIV (ITCF), Isoniazid preventive therapy initiation (IPT), TB infection control (TIC), and programme review meetings (PRM). Data were collected through record review and interviews with 27 key informants from each hospital. Adherence scores per component were summed to determine an overall adherence score per facility and summarized using medians and converted to proportions. Facility characteristics were assessed and compared across facilities with high (above median) versus low (below median) overall adherence scores, using nonparametric test statistics. RESULTS: From the 27 key interviews and facility records reviewed, the median adherence scores for ITCF, IPT, TIC, and PRM components were 85.7% (IQR: 85.5-100.0), 0% (IQR: 0-66.7), 33.3% (IQR: 33.3-50.0), and 90.0% (IQR: 70.0-90.0), respectively. The overall median adherence score was 62.1% (IQR: 58.6-65.1), and 17 clinics (63%) with overall adherence score above the median were categorized as high adherence. Compared to low adherence facilities, high adherence facilities had statistically significant lower PLHIV clinic attendees per month (256 (IQR: 60-904) vs. 900 (IQR: 609-2622); p = 0.042), and lower HIV provider workloads (28.6 (IQR: 8.6-113) vs. 90 (IQR: 66.7-263.5); p = 0.046), and most had screening guidelines (76%, p < 0.01) and questionnaire (80%, p < 0.01) available on-site. CONCLUSION: PRM had highest score while the IPT component had the lowest score. Almost a third of the facilities implemented the TB screening programme activities with a high level of adherence to the guidelines. We suggest to ensure adherence to all four components, reducing staff workloads and making TB screening questionnaires and guidelines available on-site would increase facility adherence to the intervention and ultimately achieve intervention targets.


Assuntos
Infecções por HIV , Tuberculose , Antituberculosos/uso terapêutico , Estudos Transversais , Gana/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Isoniazida , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia
20.
BMC Infect Dis ; 21(1): 1047, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627168

RESUMO

BACKGROUND: In Ghana, Balantidium coli (B. coli) has been identified in vegetables and in pigs, although there is a paucity of data regarding human balantidiosis. This study sought to assess human B. coli infection in Ghana, factors associated with the infection as well as its association with haematological and biochemical parameters. METHODS: Two pig rearing communities in the Ga West Municipality, Ghana, were involved in this study. Stool and blood samples were collected from pig farmers and their exposed household members as well as relevant information on potential associated factors. Eosin-saline wet preparation was done on the same day of stool samples were collected while formol ether concentration technique was performed later. Haematological, biochemical parameters and serum electrolytes were determined using Celltac MEK-6500 K, PKL-125 biochemical analyser, and FT-320 electrolyte analyser, respectively. RESULTS: The overall prevalence of balantidiosis was 10.4 %, significantly higher among farmers (21.7 %) than in exposed household members (5.8 %) (x2 = 17.8, p = 0.000025). Of the 43 infected individuals, 20.9 % were co-infected with either Entamoeba histolytica, Giardia lamblia, or Schistosoma mansoni. In B. coli infection, mild to moderate anaemia together with a reduction in levels of platelet, albumin and, sodium, chloride, and bicarbonate ions were observed. However, white blood cells were significantly elevated in infected states. Poor farming practices such as free-range systems, improper disposal of pig faeces, lack of use of protective farming clothing, and unavailability of dedicated farming clothing were found to be associated with B. coli infection status. Finally, frequent diarrhea (OR = 12.30, p = 0.006) with occult blood (OR = 25.94, p < 0.0001) were found to be predictors of B. coli infection. CONCLUSIONS: Human balantidiosis is endemic in Ga West Municipality, Ghana. Individuals living closed to pig rearing communities presenting with frequent diarrhea with occult blood in stool should be screened and treated for balantidiosis to mitigate the clinical consequences of the infection.


Assuntos
Balantidíase , Entamoeba histolytica , Animais , Gana/epidemiologia , Humanos , Prevalência , Fatores de Risco , Suínos
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