Abstract
Background
Obstetric referrals thrive on rapid transfer of information and data, and effective communication in order to reduce delays in receiving of quality care once the woman reaches the ...facility. We explored health care workers’ perception of the feasibility and acceptance of WhatsApp messaging technology to facilitate obstetric referrals in selected health facilities in rural Ghana.
Methods
The study used a qualitative research method and adheres to the interpretivist ideology. This study was conducted in the Sene East District (SED) and Sene West District (SWD) in the Bono East region of Ghana. Sixteen healthcare facilities were sampled. In-depth interviews and focused group discussions were conducted. QSR NVivo-12 for data management and analysis. Collaizzi's descriptive phenomenological technique of analysis was used to analyse the data.
Results
From the analysis, three main themes emerged. The themes included the HCWs’ perceptions of the feasibility of WhatsApp messaging technology (sub: optimist and pessimist perspectives), challenges to the acceptance of WhatsApp messaging technology (sub: challenge with getting data, network challenges, and risk of platform used for unintended purposes), and the HCWs’ perceptions of the acceptance of WhatsApp messaging technology (sub: easy communication and information sharing, improvement in quality of service, and tracking referred clients’ compliance).
Conclusion
We conclude that the implementation of WhatsApp messaging technology in obstetric referral is feasible and acceptable to HCWs in rural healthcare facilities in Ghana. To promote the acceptance and use of WhatsApp messaging technology in obstetric referrals, there is a need to build the capacity of HCWs and provide a working guideline to regulate the platform. The government and its partners must consider providing internet data and airtime, as well as dedicated phones to support the implementation of the use of WhatsApp messaging technology in promoting effective obstetric referral.
Schistosomiasis control in sub-Saharan Africa is enacted primarily through preventive chemotherapy. Predictive models can play an important role in filling knowledge gaps in the distribution of the ...disease and help guide the allocation of limited resources. Previous modeling approaches have used localized cross-sectional survey data and environmental data typically collected at a discrete point in time. In this analysis, 8 years (2008–2015) of monthly schistosomiasis cases reported into Ghana’s national surveillance system were used to assess temporal and spatial relationships between disease rates and three remotely sensed environmental variables: land surface temperature (LST), normalized difference vegetation index (NDVI), and accumulated precipitation (AP). Furthermore, the analysis was stratified by three major and nine minor climate zones, defined using a new climate classification method. Results showed a downward trend in reported disease rates (~ 1% per month) for all climate zones. Seasonality was present in the north with two peaks (March and September), and in the middle of the country with a single peak (July). Lowest disease rates were observed in December/January across climate zones. Seasonal patterns in the environmental variables and their associations with reported schistosomiasis infection rates varied across climate zones. Precipitation consistently demonstrated a positive association with disease outcome, with a 1-cm increase in rainfall contributing a 0.3–1.6% increase in monthly reported schistosomiasis infection rates. Generally, surveillance of neglected tropical diseases (NTDs) in low-income countries continues to suffer from data quality issues. However, with systematic improvements, our approach demonstrates a way for health departments to use routine surveillance data in combination with publicly available remote sensing data to analyze disease patterns with wide geographic coverage and varying levels of spatial and temporal aggregation.
Abstract Introduction Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in ...low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly. Methods Consensus on trauma care audit filters was built between twenty panellists using a Delphi technique with four anonymous, iterative surveys designed to elicit: (i) trauma care processes to be measured; (ii) important features of audit filters for the district-level hospital setting; and (iii) potentially useful filters. Filters were ranked on a scale from 0 to 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8. Results Panellists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1 – 0.58; Round 2 – 0.66; Round 3 – 0.76; and Round 4 – 0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage – vital signs are recorded within 15 min of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation – a large bore IV was placed within 15 min of patient arrival; referral – if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. Conclusion This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs, the collection and reporting of prospective trauma care audit filters may be an important step towards improving care for the injured at district-level hospitals in LMICs.
To examine the feasibility and effectiveness of community-based maternal mortality surveillance in rural Ghana, where most information on maternal deaths usually comes from retrospective surveys and ...hospital records.
In 2013, community-based surveillance volunteers used a modified reproductive age mortality survey (RAMOS 4+2) to interview family members of women of reproductive age (13-49 years) who died in Bosomtwe district in the previous five years. The survey comprised four yes-no questions and two supplementary questions. Verbal autopsies were done if there was a positive answer to at least one yes-no question. A mortality review committee established the cause of death.
Survey results were available for 357 women of reproductive age who died in the district. A positive response to at least one yes-no question was recorded for respondents reporting on the deaths of 132 women. These women had either a maternal death or died within one year of termination of pregnancy. Review of 108 available verbal autopsies found that 64 women had a maternal or late maternal death and 36 died of causes unrelated to childbearing. The most common causes of death were haemorrhage (15) and abortion (14). The resulting maternal mortality ratio was 357 per 100 000 live births, compared with 128 per 100 000 live births derived from hospital records.
The community-based mortality survey was effective for ascertaining maternal deaths and identified many deaths not included in hospital records. National surveys could provide the information needed to end preventable maternal mortality by 2030.
Metodos En 2013, los voluntarios del seguimiento de ambito comunitario utilizaron una encuesta sobre mortalidad en edad reproductiva (RAMOS 4+2) para entrevistar a miembros de familias de mujeres en ...edad reproductiva (13-49 anos) que fallecieron en el distrito de Bosomtwe durante los cinco anos anteriores. La encuesta estaba formada por preguntas de si y no y dos preguntas adicionales. Se realizaron autopsias verbales en caso de que se respondiera de forma afirmativa al menos a una pregunta de si y no. Un comite de revision de mortalidad establecio la causa de la muerte.
INTRODUCTIONCOVID-19 is a global pandemic seen in modern times. The clinical characteristics, treatment regimen and duration of hospitalization of COVID-19 patients remain unclear in Ghana. METHODSwe ...retrospectively reviewed the secondary data of 307 discharged COVID-19 patients to characterize their demographics, clinical symptoms, treatment regimen given and duration of hospitalization. RESULTSthe mean age and temperature of the patients were 37.9 years and 36.3°C, respectively. The majority (85.7%) of the cases reviewed were asymptomatic; for those presenting with symptoms, the main ones were cough (50%), fever (29.6%), headache (27.3%), and sore throat (22.7%). Comorbidities were present in 25.1% of the patients; the popularly reported comorbidities were hypertension (71.4%), asthma (7.8%) and diabetes (6.5%). The average duration of hospitalization was 13.8 days, and the duration of hospitalization for patients managed with azithromycin + chloroquine (AZ+CQ) was 10.4 days, followed closely by those managed with hydroxychloroquine (HCQ) only, 11.0 days. There was longer duration of hospitalization among patients who received AZ only compared to patients receiving AZ + CQ (3.24 ± 1.10 days, p=0.037; 95% CI 0.11, 6.37). Linear regression analysis showed that the duration of hospitalization for patients who received AZ only was 2.7 days, which was higher than that of patients who received AZ+CQ and HCQ only (95% CI 0.44, 4.93; p=0.019). CONCLUSIONin this cohort of COVID-19 patients, the common symptoms were cough, fever, headache, and sore throat. The use of AZ+CQ or HCQ only as a therapy for managing COVID-19 patients shortened the duration of hospitalization.
To assess anemia prevalence and identify associated parameters in children <3 years of age in a rural area of Ghana.
Univariate and multivariate logistic regression of cross-sectional survey results ...from 861 children aged <3 years attending routine immunization services in Berekum district.
Anemia prevalence was 73.1%; most were either mildly (31.2%) or moderately (38.7%) affected. Risk factors for anemia (hemoglobin < 11.0 g/dl) in multivariate analysis were malaria parasitemia and male sex; these factors and younger age were associated with anemia severity. A partial defect in glucose-6-phosphate dehydrogenase was associated with decreased severity. Height-for-age, but not weight-for-age, was associated with anemia and its severity.
Malaria parasitemia was strongly associated with anemia and its severity, suggesting that malaria control may be the most effective way to reduce the burden of anemia in rural Ghanaian children.
Maternal mortality from postpartum hemorrhage remains high globally, in large part because women give birth in rural communities where unskilled (traditional birth attendants) provide care for ...delivering mothers. Traditional attendants are neither trained nor equipped to recognize or manage postpartum hemorrhage as a life-threatening emergent condition. Recommended treatment includes using uterotonic agents and physical manipulation to aid uterine contraction. In resource-limited areas where Obstetric first aid may be the only care option, physical methods such as bimanual uterine compression are easily taught, highly practical and if performed correctly, highly effective. A simulator with objective performance feedback was designed to teach skilled and unskilled birth attendants to perform the technique.
To evaluate the impact of simulation-based training on the ability of birth attendants to correctly perform bimanual compression in response to postpartum hemorrhage from uterine atony.
Simulation-based training was conducted for skilled (
N
=
111) and unskilled birth attendants (
N
=
14) at two regional (Kumasi, Tamale) and two district (Savelugu, Sene) medical centers in Ghana. Training was evaluated using Kirkpatrick's 4-level model.
All participants significantly increased their bimanual uterine compression skills after training (
p
=
0.000). There were no significant differences between 2-week delayed post-test performances indicating retention (
p
=
0.52). Applied behavioral and clinical outcomes were reported for 9 months from a subset of birth attendants in Sene District: 425 births, 13 postpartum hemorrhages were reported without concomitant maternal mortality.
The results of this study suggest that simulation-based training for skilled and unskilled birth attendants to perform bi-manual uterine compression as postpartum hemorrhage Obstetric first aid leads to improved applied procedural skills. Results from a smaller subset of the sample suggest that these skills could potentially lead to improved clinical outcomes and additional study is merited.
Recent reports have highlighted that expanding access to health care is ineffective at meeting the goal of universal health coverage if the care offered does not meet a minimum level of quality. ...Health care facilities nearest to patient's homes that are perceived to offer inadequate or inappropriate care are frequently bypassed in favor of more distant private or tertiary-level hospital facilities that are perceived to offer higher-quality care.
To estimate the frequency with which women in Ghana bypass the nearest primary health care facility and describe patient experiences, costs, and other factors associated with this choice.
This nationally representative survey study was conducted in 2017 and included 4203 households to identify women in Ghana aged 15 to 49 years (ie, reproductive age) who sought primary care within the last 6 months. Women who sought care within the past 6 months were included in the study. Data were analyzed from 2018 to 2019.
Bypass was defined as a woman's report that she sought care at a health facility other than the nearest facility.
Sociodemographic characteristics, reasons why women sought care, reasons why women bypassed their nearest facility, ratings for responsiveness of care, patient experience, and out-of-pocket costs. All numbers and percentages were survey-weighted to account for survey design.
A total of 4289 women met initial eligibility criteria, and 4207 women (98.1%) completed the interview. A total of 1993 women reported having sough health care in the past 6 months, and after excluding those who were ineligible and survey weighting, the total sample included 1946 women. Among these, 629 women (32.3%) reported bypassing their nearest facilities for primary care. Women who bypassed their nearest facilities, compared with women who did not, were more likely to visit a private facility (152 women 24.5% vs 202 women 15.6%) and borrow money to pay for their care (151 women 24.0% vs 234 women 17.8%). After adjusting for covariates, women who bypassed reported paying a mean of 107.2 (95% CI, 79.1-135.4) Ghanaian Cedis (US $18.50 95% CI, $13.65-$23.36) for their care, compared with a mean of 58.6 (95% CI, 28.1-89.2) Ghanaian Cedis (US $10.11 95% CI, $4.85-15.35) for women who did not bypass (P = .006). Women who bypassed cited clinician competence (136 women 34.3%) and availability of supplies (93 women 23.4%) as the most important factors in choosing a health facility.
The findings of this survey study suggest that bypassing the nearest health care facility was common among women in Ghana and that available services at lower levels of primary care are not meeting the needs of a large proportion of women. Among the benefits women perceived from bypassing were clinician competence and availability of supplies. These data provide insights to policy makers regarding potential gaps in service delivery and may help to guide primary health care improvement efforts.
Abstract Objective To investigate the identification of maternal deaths at the community level using the reproductive age mortality survey (RAMOS) in all households in which a women of reproductive ...age (WRA) died and to determine the most concise subset of questions for identifying a pregnancy-related death for further investigation. Methods A full RAMOS survey was conducted with the families of 46 deceased WRA who died between 2005 and July 2009 and was compared with the cause of death confirmed by the maternal mortality review committee to establish the number of maternal mortalities. The positive predictive value (PPV) of each RAMOS question for identifying a maternal death was determined. Results Compared with years of voluntary reporting, active surveillance for maternal deaths doubled their identification. In addition, 4 questions from the full RAMOS have the highest PPV for a maternal death including the question: "Was she pregnant within the last 6 weeks?" which had a 100% PPV and a 100% negative predictive value. Conclusion Active identification of maternal mortality at the community level by using a 4-question modified RAMOS that is systematically administered in the local language by health workers can increase understanding of the extent of maternal mortality in rural Ghana.
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