Determinants of the type of health care sought for symptoms of Acute respiratory infection in children: analysis of Ghana demographic and health surveys.

BACKGROUND: Globally, acute respiratory infection (ARI) is a leading cause of infant and childhood morbidity and mortality. Currently, it is estimated that 50 million cases of childhood ARI are untreated. In this study, we identified determinants of the type of treatment sought for symptoms of childhood acute respiratory infection (ARI), including non-treatment, amongst a nationally representative sample of children under five years in Ghana. METHODS: In total, 1 544 children were studied by a secondary analysis of pooled survey data from the 1993, 1998, 2003, 2008, and 2014 Ghana Demographic and Health Surveys (GDHS). Cross-tabulations, chi-square, multinomial logistic regression, and Bayesian hierarchical spatial logistic regression analyses were used to identify relationships between the type of treatment sought and maternal socio-economic and household characteristics. RESULTS: Seeking medical care was significantly associated with child age (RRR= 1.928, 95 % CI 1.276 - 2.915), maternal employment status (RRR = 1.815, 95 % CI 1.202 - 2.740), maternal health insurance status, (RRR = 2.618, 95 % CI 1.801 - 3.989), children belonging to middle (RRR = 2.186, 95 % CI 1.473 - 3.243), richer (RRR = 1.908, 95 % CI 1.145 - 3.180) and richest households (RRR = 2.456, 95 % CI 1.363 - 4.424) and the 1998 survey period (RRR = 0.426, 95 % CI 0.240 - 7.58). Seeking self-care or visiting a traditional healer was significantly associated with maternal educational status (RRR = 0.000, 95 % CI 0.000 - 0.000), and the 1998 (RRR= 0.330, 95 % CI 0.142 - 0.765), 2003 (RRR= 0.195, 95 % CI 0.071 - 0.535), 2008 (RRR= 0.216, 95 % CI 0.068 - 0.685) and 2014 (RRR= 0.230, 95 % CI 0.081 - 0.657) GDHS periods. The probability that the odds ratio of using medical care exceeded 1 was higher for mothers/caregivers in the Western, Ashanti, Upper West, and Volta regions. CONCLUSIONS: Government policies that are aimed at encouraging medical care-seeking for children with ARI may yield positive results by focusing on improving maternal incomes, maternal NHIS enrolment, and maternal household characteristics. Improving maternal education could be a positive step towards addressing challenges with self-care or traditional healing amongst children with ARI.

Determinants of Unsafe Plastic Waste Disposal among Households in the Tamale Metropolitan Area, Ghana.

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.

WaSH CQI: Applying continuous quality improvement methods to water service delivery in four districts of rural northern Ghana.

Continuous, safely managed water is critical to health and development, but rural service delivery faces complex challenges in low- and middle-income countries (LMICs). We report the first application of continuous quality improvement (CQI) methods to improve the microbial quality of household water for consumption (HWC) and the functionality of water sources in four rural districts of northern Ghana. We further report on the impacts of interventions developed through these methods. A local CQI team was formed and trained in CQI methods. Baseline data were collected and analyzed to identify determinants of service delivery problems and microbial safety. The CQI team randomized communities, developed an improvement package, iteratively piloted it in intervention communities, and used uptake survey data to refine the package. The final improvement package comprised safe water storage containers, refresher training for community WaSH committees and replacement of missing maintenance tools. This package significantly reduced contamination of HWC (p<0.01), and significant reduction in contamination persisted two years after implementation. Repair times in both intervention and control arms decreased relative to baseline (p<0.05), but differences between intervention and control arms were not significant at endline. Further work is needed to build on the gains in household water quality observed in this work, sustain and scale these improvements, and explore applications of CQI to other aspects of water supply and sanitation.

Carrying water may be a major contributor to disability from musculoskeletal disorders in low income countries: a cross-sectional survey in South Africa, Ghana and Vietnam.

BACKGROUND: The Sustainable Development Goals include commitments to end poverty, and promote education for all, gender equality, the availability of water and decent work for all. An important constraint is the fact that each day, many millions of women and children, and much less frequently men, carry their household's water home from off-plot sources. The burden of fetching water exacerbates gender inequality by keeping women out of education and paid employment. Despite speculation about the potential health impacts of fetching water, there is very little empirical evidence. We report the first large study of the health impacts of carrying water on women and children. METHODS: A cross-sectional survey was conducted in South Africa, Ghana and Vietnam during 2012. It investigated water carrying methods and health status. Because areas of self-reported pain were correlated we undertook factor analysis of sites of reported pain, to interpret patterns of pain reporting. Regression analysis using Generalised Estimating Equations (GEE) investigated water carrying as a risk factor for general health and self-reported pain. RESULTS: People who previously carried water had increased relative risk of reporting pain in the hands (risk ratio RR 3.62, 95% confidence interval CI 1.34 to 9.75) and upper back (RR 2.27, 95% CI 1.17 to 4.40), as did people who currently carry water (RR hand pain 3.11, 95% CI 1.34 to 7.23; RR upper back pain 2.16, 95% CI 1.25 to 3.73). The factor analysis results indicate that factor 1, 'axial compression', which is correlated with pain in the head and upper back, chest/ribs, hands, feet and abdomen/stomach, is associated with currently (0.30, 95% CI 0.17 to 0.43) or previously (0.21, 95% CI 0.01 to 0.42) carrying water. Factor 2, 'soft tissue strain', which is correlated with pain in the neck, shoulders/arms, lower back and hips/pelvis or legs, is marginally negatively associated with currently (-0.18, 95% CI -0.32 to -0.04) carrying water. The factor 'axial compression' was more strongly associated with carrying water containers on the head. CONCLUSIONS: Participants who reported a history of current or past water carrying more frequently reported pain in locations most likely to be associated with sustained spinal axial compression in the cervical region. Given the fact that cervical spinal conditions are globally one of the more common causes of disability, our findings suggest that water carrying, especially by head loading is a major contributing factor in musculoskeletal disease burden in low income countries. Our findings support the proposed indicator for monitoring SDG6.1: "Percentage of population using safely managed drinking water services at home."