Abbreviations: NHIS, National Health Insurance Scheme; UHC, universal health coverage Provenance: Not commissioned; part of a Collection; externally peer reviewed This paper is part of the PLOS ...Universal Health Coverage Collection. Universal Health Coverage: The Policy Context Since 2003, the Government of Ghana has been implementing the National Health Insurance Scheme (NHIS) as the main strategy to progressively bridge financial access barriers and provide a social risk protection system 1.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
IMPORTANCE: Conditions that can be treated by surgery comprise more than 16% of the global disease burden. However, 5 billion people do not have access to essential surgical care. An estimated 90% of ...the 87 million disability-adjusted life-years incurred by surgical conditions could be averted by providing access to timely and safe surgery in low-income and middle-income countries. Population-level spatial access to essential surgery in Ghana is not known. OBJECTIVES: To assess the performance of bellwether procedures (ie, open fracture repair, emergency laparotomy, and cesarean section) as a proxy for performing essential surgery more broadly, to map population-level spatial access to essential surgery, and to identify first-level referral hospitals that would most improve access to essential surgery if strengthened in Ghana. DESIGN, SETTING, AND PARTICIPANTS: Population-based study among all households and public and private not-for-profit hospitals in Ghana. Households were represented by georeferenced census data. First-level and second-level referral hospitals managed by the Ministry of Health and all tertiary hospitals were included. Surgical data were collected from January 1 to December 31, 2014. MAIN OUTCOMES AND MEASURES: All procedures performed at first-level referral hospitals in Ghana in 2014 were used to sort each facility into 1 of the following 3 hospital groups: those without capability to perform all 3 bellwether procedures, those that performed 1 to 11 of each procedure, and those that performed at least 12 of each procedure. Candidates for targeted capability improvement were identified by cost-distance and network analysis. RESULTS: Of 155 first-level referral hospitals managed by the Ghana Health Service and the Christian Health Association of Ghana, 123 (79.4%) reported surgical data. Ninety-five (77.2%) did not have the capability in 2014 to perform all 3 bellwether procedures, 24 (19.5%) performed 1 to 11 of each bellwether procedure, and 4 (3.3%) performed at least 12. The essential surgical procedure rate was greater in bellwether procedure–capable first-level referral hospitals than in noncapable hospitals (median, 638; interquartile range, 440-1418 vs 360; interquartile range, 0-896 procedures per 100 000 population; P = .03). Population-level spatial access within 2 hours to a hospital that performed 1 to 11 and at least 12 of each bellwether procedure was 83.2% (uncertainty interval UI, 82.2%-83.4%) and 71.4% (UI, 64.4%-75.0%), respectively. Five hospitals were identified for targeted capability improvement. CONCLUSIONS AND RELEVANCE: Almost 30% of Ghanaians cannot access essential surgery within 2 hours. Bellwether capability is a useful metric for essential surgery more broadly. Similar strategic planning exercises might be useful for other low-income and middle-income countries aiming to improve access to essential surgery.
Sub-Saharan African countries, including Ghana, are known hotspots for fine particulate matter air pollution (PM2.5) and stillbirths but lacked epidemiologic evidence. We investigated the association ...between PM2.5 and stillbirth in Ghana. District-level stillbirth data were obtained from the Ghana Health Service for all 260 local districts from 2012 to 2019 for a total of 5,229,338 births, including 81,611 stillbirths. Spatiotemporal datasets, including satellite-derived PM2.5, temperature, population density, and gross domestic product were linked with the birth data. We applied a variant difference-in-differences design with conditional quasi-Poisson regression to estimate the risk of stillbirth associated with annual PM2.5 concentrations. We adjusted for relevant environmental and sociodemographic factors and performed subgroup analyses by population density and household air pollution. The average district-level annual stillbirth incidence was 29 (standard deviation = 55) per 1000 births. The annual average PM2.5 concentration was 59.97 μg/m3 (standard deviation = 9.75). Every 10 μg/m3 increment in annual average PM2.5 was associated with a 3% risk of stillbirth (RR); 1.03 (95% CI: 0.97, 1.09) for all-source PM2.5 and 2% risk each for anthropogenic (RR = 1.02, 95% CI: 0.96, 1.07) and natural (RR = 1.02, 95% CI: 0.94, 1.11) sources. The association was higher for moderate or high subgroup, relative to low subgroup and higher in natural than anthropogenic sources of PM2.5 exposures. Thus, there was some evidence for an adverse association between PM2.5 exposure and stillbirth but estimates were less precise. Given that the district-level variation may be underpowered, stronger risk is expected in future high-quality individual-level longitudinal cohort studies in Ghana.
Display omitted
•This is the first known country-specific study in Africa on PM2.5 and stillbirth.•Applied variant difference-in-differences design for PM2.5 and stillbirth in Ghana.•Found small positive associations between long-term PM2.5 exposure and stillbirth.•Higher associations in population density and household air pollution subgroups.•Relatively high risk in vulnerable subgroups exposed to natural PM2.5.
Global campaigns to control HIV, tuberculosis, malaria, and vaccine-preventable illnesses showed that large-scale impact can be achieved by using additional international financing to support ...selected, evidence-based, high-impact investment areas and to catalyse domestic resource mobilisation. Building on this paradigm, we make the case for targeting additional international funding for selected high-impact investments in primary health care. We have identified and costed a set of concrete, evidence-based investments that donors could support, which would be expected to have major impacts at an affordable cost. These investments are in: (1) individuals and communities empowered to engage in health decision making, (2) a new model of people-centred primary care, and (3) next generation community health workers. These three areas would be supported by strengthening two cross-cutting elements of national systems. The first is the digital tools and data that support facility, district, and national managers to improve processes, quality of care, and accountability across primary health care. The second is the educational, training, and supervisory systems needed to improve the quality of care. We estimate that with an additional international investment of between US$1·87 billion in a low-investment scenario and $3·85 billion in a high-investment scenario annually over the next 3 years, the international community could support the scale-up of this evidence-based package of investments in the 59 low-income and middle-income countries that are eligible for external financing from the World Bank Group's International Development Association.
During the 1990s, researchers at the Navrongo Health Research Centre in northern Ghana developed a highly successful community health program. The keystone of the Navrongo approach was the deployment ...of nurses termed community health officers to village locations. A trial showed that, compared to areas relying on existing services alone, the approach reduced child mortality by half, maternal mortality by 40%, and fertility by nearly a birth - from a total fertility rate of 5.5 in only five years. In 2000, the government of Ghana launched a national program called Community-based Health Planning and Services (CHPS) to scale up the Navrongo model. However, CHPS scale-up has been slow in districts located outside of the Upper East Region, where the "Navrongo Experiment" was first carried out. This paper describes the Ghana Essential Health Intervention Project (GEHIP), a plausibility trial of strategies for strengthening CHPS, especially in the areas of maternal and newborn health, and generating the political will to scale up the program with strategies that are faithful to the original design.
GEHIP improves the CHPS model by 1) extending the range and quality of services for newborns; 2) training community volunteers to conduct the World Health Organization service regimen known as integrated management of childhood illness (IMCI); 3) simplifying the collection of health management information and ensuring its use for decision making; 4) enabling community health nurses to manage emergencies, particularly obstetric complications and refer cases without delay; 5) adding $0.85 per capita annually to district budgets and marshalling grassroots political commitment to financing CHPS implementation; and 6) strengthening CHPS leadership at all levels of the system.
GEHIP impact is assessed by conducting baseline and endline survey research and computing the Heckman "difference in difference" test for under-5 mortality in three intervention districts relative to four comparison districts for core indicators of health status and survival rates. To elucidate results, hierarchical child survival hazard models will be estimated that incorporate measures of health system strength as survival determinants, adjusting for the potentially confounding effects of parental and household characteristics. Qualitative systems appraisal procedures will be used to monitor and explain GEHIP implementation innovations, constraints, and progress.
By demonstrating practical means of strengthening a real-world health system while monitoring costs and assessing maternal and child survival impact, GEHIP is expected to contribute to national health policy, planning, and resource allocation that will be needed to accelerate progress with the Millennium Development Goals.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
This study explores sociodemographic and health factors associated with hospitalizing diabetes mellitus (DM) patients and estimates the number of future hospitalizations for DM in ...Ghana.
Methods
We conducted a secondary analysis using nationally representative patient hospitalization data provided by the Ghana Health Service and projected population counts from the Ghana Statistical Service. Data were stratified by year, age, sex and region. We employed Poisson regression to determine associations between sociodemographic and health factors and hospitalization rates of DM patients. Using projected population counts, the number of DM-related hospitalizations for 2018 through 2032 were predicted. We analysed 39 846 DM records from nearly three million hospitalizations over a 6-y period (2012–2017).
Results
Most hospitalized DM patients were elderly, female and from the Eastern Region. The hospitalization rate for DM was higher among patients ages 75–79 y (rate ratio RR 23.7 95% confidence interval {CI} 18.6 to 30.3) compared with those ages 25–29 y, females compared with males (RR 1.9 95% CI 1.4 to 2.5) and the Eastern Region compared with the Greater Accra Region (RR 1.9 95% CI 1.7 to 2.2). The predicted number of DM hospitalizations in 2022 was 11 202, in 2027 it was 12 414 and in 2032 it was 13 651.
Conclusions
Females and older patients are more at risk to be hospitalized, therefore these groups need special surveillance with targeted public health education aimed at behavioural changes.
Abstract only
Food processing ameliorates food security; however its role in food contamination has been debated. In Ghana, corn and tomato mills use milling parts fabricated by local blacksmiths ...whose activities are often not regulated. The possibility of milling process as a source of contamination in food systems has not been readily available. We aimed to measure contamination levels of Al and Fe in milled maize and tomatoes. Six corn mills and four tomato mills were randomly selected in Tamale metropolis for collection of twenty samples before and after milling for quantification of Al and Fe by spectrophotometer (HACH DR/2800) and Atomic Absorption Spectrometry (AA‐6300 SHIMADZU). Contamination of Al by the processing ranged from 0.1 – 8.3 mg/kg maize, and 0.2‐7.7 mg/kg for tomatoes samples. Fe contamination ranged from 0.6‐72.6 mg/kg maize and 23.2‐500.4 mg/kg tomatoes, indicating that milling introduces contamination. Mean Al concentration in the milled foods is above the PTWI (1mg/kg/week) established by the WHO/FAO (2007). Fe intake may exceed the upper safe intake when more than 105g milled maize or 34.4g milled tomatoes are consumed a day habitually. We observed that grinding mills are a source of Al and Fe contamination of milled foods especially tomato mills. Adequate regulation of the work of blacksmiths and grinding mill operation is needed to safe guard the safety of the general public in Northern Ghana.
Background. The COVID-19 pandemic and government-led interventions to tackle it have had life-changing effects on vulnerable populations, especially rural and urban slum dwellers in developing ...countries. This ethnographic study explored how the Ghanaian government’s management of COVID-19, socio-cultural factors, infrastructural challenges, and poverty influenced community perceptions, attitudes, and observance of COVID-19 prevention measures in Ghana. Methods. The study employed focused ethnography using in-depth interviews (IDIs), focus group discussions (FGDs), and nonparticipant observations to collect data from an urban slum and a rural community as well as from government officials, from October 2020 to January 2021. The data were triangulated and analyzed thematically with the support of qualitative software NVivo 12. All ethical procedures were followed. Results. The Ghanaian government’s strategy of communicating COVID-19-related information to the public, health-related factors such as health facilities failing to follow standard procedures in testing and tracing persons who came into contact with COVID-19-positive cases, poverty, and lack of social amenities contributed to the poor observance of COVID-19 preventive measures. In addition, the government’s relaxation of COVID-19 restrictions, community and family values, beliefs, and misconceptions contributed to the poor observance of COVID-19 preventive measures. Nevertheless, some aspects of the government’s intervention measures and support to communities with COVID-19 prevention items, support from nongovernmental organizations (NGOs), and high knowledge of COVID-19 and its devastating effects contributed to positive attitudes and observance of COVID-19 preventive measures. Conclusion. There is a need for the government to use the existing community structures to engage vulnerable communities so that their concerns are factored into interventions to ensure that appropriate interventions are designed to suit the context. Moreover, the government needs to invest in social amenities in deprived communities. Finally, the government has to be consistent with the information it shares with the public to enhance trust relations.
Regular pelvic examinations and health care visits are important preventative measures for maintaining maternal health. However, in rural settings within the least developed countries, poor travel ...conditions, lack of resources, social constraints, lack of educational opportunities, and economic limitations make it difficult for women to receive proper healthcare during pregnancy. The goal of this design project is to diminish the barrier of transportation to secondary and tertiary healthcare facilities and services by developing a portable gynecological examination table for use by Community-based Health Planning and Services (CHPS) workers in the Sene District, Ghana. Design for global health is a topic of increasing importance and places new constraints on the engineering design process. Throughout the design process, Ghanaian and American clinicians were interviewed in order to obtain user requirements for the initial prototype. These requirements were translated into engineering specifications, and brainstorming and functional decomposition were performed in order to generate solution concepts. In agreement with the engineering specifications and the outcomes of quality function deployment (QFD) and Pugh charts, a portable gynecological examination table prototype was designed that 1) supports a weight of 142 kg while only weighing 10 kg, 2) can be folded into a 17.8×50.8×50.8 cm3 volume enabling transportation by backpack, 3) costs less than $100, 4) can be cleaned with bleach, and 5) has three adjustable back angles of 0, 30, and 60 degrees. This prototype was fabricated and then evaluated in Ghana, brought back to the UNIVERSITY, and redesigned. The redesigned prototype was evaluated to meet the specifications for table weight, support weight, ability to be cleaned, and durability in a laboratory testing. The table was then returned to Ghana, where acceptance of the design and its usability were assessed by interviewing and surveying midwives, physicians, and mothers.
PDF
