Browsing by Author "Agyemang, S.A."

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Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates
(2020) Baral, R.; Nonvignon, J.; Agyemang, S.A.; et al.
Background: Numerous studies have reported the economic burden of childhood diarrhea in low- and middle income countries (LMICs). Yet, empirical data on the cost of diarrheal illness is sparse, particularly in LMICs. In this study we review the existing literature on the cost of childhood diarrhea in LMICs and generate comparable estimates of cost of diarrhea across 137 LMICs. Methods: The systematic literature review included all articles reporting cost estimates of diarrhea illness and treatment from LMICs published between January 2006 and July 2018. To generate country-specific costs, we used service delivery unit costs from the World Health Organization’s Choosing Interventions that are Cost-Effective (WHO–CHOICE database). Non-medical costs were calculated using the ratio between direct medical and direct non-medical costs, derived from the literature review. Indirect costs (lost wages to caregivers) were calculated by multiplying the average GDP per capita per day by the average number of days lost to illness identified from the literature. All cost estimates are reported in 2015 USD. We also generated estimates using the IHME’s service delivery unit costs to explore input sensitivity on modelled cost estimates. Results: We identified 25 articles with 64 data points on either direct or indirect cost of diarrhoeal illness in children aged < 5 years in 20 LMICs. Of the 64 data points, 17 were on the cost of outpatient care, 28 were on the cost of inpatient care, and 19 were unspecified. The average cost of illness was US$36.56 (median $15.73; range $4.30 – $145.47) per outpatient episode and $159.90 (median $85.85; range $41.01 – $538.33) per inpatient episode. Direct medical costs accounted for 79% (83% for inpatient and 74% for outpatient) of the total direct costs. Our modelled estimates, across all 137 countries, averaged (weighted) $52.16 (median $47.56; range $8.81 – $201.91) per outpatient episode and $216.36 (median $177.20; range $23.77 –$1225.36) per inpatient episode. In the 12 countries with primary data, there was reasonable agreement between our modelled estimates and the reported data (Pearson’s correlation coefficient = .75). Conclusion: Our modelled estimates generally correspond to estimates observed in the literature, with a few exceptions. These estimates can serve as useful inputs for planning and prioritizing appropriate health interventions for childhood diarrheal diseases in LMICs in the absence of empirical data
Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates
(BMC Public Health, 2020-05-05) Nonvignon, J.; Baral, R.; Debellut, F.; Agyemang, S.A.; Clark, A.; Pecenka, C.
Background Numerous studies have reported the economic burden of childhood diarrhea in low- and middle-income countries (LMICs). Yet, empirical data on the cost of diarrheal illness is sparse, particularly in LMICs. In this study we review the existing literature on the cost of childhood diarrhea in LMICs and generate comparable estimates of cost of diarrhea across 137 LMICs. Methods The systematic literature review included all articles reporting cost estimates of diarrhea illness and treatment from LMICs published between January 2006 and July 2018. To generate country-specific costs, we used service delivery unit costs from the World Health Organization’s Choosing Interventions that are Cost-Effective (WHO–CHOICE database). Non-medical costs were calculated using the ratio between direct medical and direct non-medical costs, derived from the literature review. Indirect costs (lost wages to caregivers) were calculated by multiplying the average GDP per capita per day by the average number of days lost to illness identified from the literature. All cost estimates are reported in 2015 USD. We also generated estimates using the IHME’s service delivery unit costs to explore input sensitivity on modelled cost estimates. Results We identified 25 articles with 64 data points on either direct or indirect cost of diarrhoeal illness in children aged < 5 years in 20 LMICs. Of the 64 data points, 17 were on the cost of outpatient care, 28 were on the cost of inpatient care, and 19 were unspecified. The average cost of illness was US$36.56 (median $15.73; range $4.30 – $145.47) per outpatient episode and $159.90 (median $85.85; range $41.01 – $538.33) per inpatient episode. Direct medical costs accounted for 79% (83% for inpatient and 74% for outpatient) of the total direct costs. Our modelled estimates, across all 137 countries, averaged (weighted) $52.16 (median $47.56; range $8.81 – $201.91) per outpatient episode and $216.36 (median $177.20; range $23.77 –$1225.36) per inpatient episode. In the 12 countries with primary data, there was reasonable agreement between our modelled estimates and the reported data (Pearson’s correlation coefficient = .75). Conclusion Our modelled estimates generally correspond to estimates observed in the literature, with a few exceptions. These estimates can serve as useful inputs for planning and prioritizing appropriate health interventions for childhood diarrheal diseases in LMICs in the absence of empirical data.
Determinants of safety climate at primary care level in Ghana, Malawi and Uganda: a cross-sectional study across 138 selected primary healthcare facilities
(Human Resource for Health, 2021) Vallières, F.; Mubiri, P.; Agyemang, S.A.; Amon, S.; Gerold, J.; Martineau, T.; Nolan, N.; O’Byrne, T.; Sanudi, L.; Sengooba, F.; Prytherch, H.
Background: Safety climate is an essential component of achieving Universal Health Coverage, with several organi sational, unit or team-level, and individual health worker factors identifed as infuencing safety climate. Few studies however, have investigated how these factors contribute to safety climate within health care settings in low- and middle-income countries (LMICs). The current study examines the relationship between key organisational, unit and individual-level factors and safety climate across primary health care centres in Ghana, Malawi and Uganda. Methods: A cross-sectional, self-administered survey was conducted across 138 primary health care facilities in nine districts across Uganda, Ghana and Malawi. In total, 760 primary health workers completed the questionnaire. The relationships between individual (sex, job satisfaction), unit (teamwork climate, supportive supervision), organisa tional-level (district managerial support) and safety climate were tested using structural equation modelling (SEM) procedures. Post hoc analyses were also carried out to explore these relationships within each country. Results: Our model including all countries explained 55% of the variance in safety climate. In this model, safety climate was most strongly associated with teamwork (β=0.56, p<0.001), supportive supervision (β=0.34, p<0.001), and district managerial support (β=0.29, p<0.001). In Ghana, safety climate was positively associated with job satis faction (β=0.30, p<0.05), teamwork (β=0.46, p<0.001), and supportive supervision (β=0.21, p<0.05), whereby the model explained 43% of the variance in safety climate. In Uganda, the total variance explained by the model was 64%, with teamwork (β=0.56, p<0.001), supportive supervision (β=0.43, p<0.001), and perceived district managerial sup port (β=0.35, p<0.001) all found to be positively associated with climate. In Malawi, the total variance explained by the model was 63%, with teamwork (β=0.39, p=0.005) and supportive supervision (β=0.27, p=0.023) signifcantly and positively associated with safety climate. Discussion/conclusions: Our fndings highlight the importance of unit-level factors—and in specifc, teamwork and supportive supervision—as particularly important contributors to perceptions of safety climate among primary health workers in LMICs. Implications for practice are discussed.
Economic burden of caregiving for persons with severe mental illness in sub-Saharan Africa: A systematic review
(PLoS ONE, 2018-08) Addo, R.; Agyemang, S.A.; Tozan, Y.; Nonvignon, J.
Background Over the past two decades, the focus of mental health care has shifted from institutionalisation to community-based programs and short hospital stays. This change means that there is an increased role for caregivers, mostly family members, in managing persons with mental illness. Although there is evidence to support the benefits of deinstitutionalisation of mental health care, there are also indications of substantial burden experienced by caregivers; the evidence of which is limited in sub-Saharan Africa. However, knowledge of the nature and extent of this burden can inform the planning of mental health services that will not only benefit patients, but also caregivers and households. Objective To systematically review the available evidence on the economic burden of severe mental illness on primary family caregivers in sub-Saharan Africa. Methods A comprehensive search was conducted in Pubmed, CINAHL, Econlit and Web of Science with no date limitations up to September 2016 using keywords such as "burden", "cost of illness" and "economic burden" to identify relevant published literature. Articles were appraised using a standardised data extraction tool covering themes such as physical, psychological and socioeconomic burden. Results Seven papers were included in the review. Caregivers were mostly family members with a mean age of 46.34, female and unemployed. Five out of seven studies (71%) estimated the full economic burden of severe mental illness on caregivers. The remainder of studies just described the caregiver burden. All seven papers reported moderate to severe caregiver burden characterised by financial constraint, productivity loss and lost employment. The caregiver’s level of income and employment status, severity of patient's condition and duration of mental illness were reported to negatively affect the economic burden experienced by caregivers. Conclusion There is paucity of studies reporting the burden of severe mental illness on caregivers in sub-Saharan Africa. Further research is needed to present the nature and extent of this burden to inform service planning and policymaking.
Economic Cost and Quality of Life of Family Caregivers of Schizophrenic Patients Attending Psychiatric Hospitals in Ghana
(BMC Health Services Research, 2017-11) Opoku-Boateng, Y.N.; Kretchy, I.A.; Aryeetey, G.C.; Dwomoh, D.; Decker, S.; Agyemang, S.A.; Tozan, Y.; Aikins, M.; Nonvignon, J.
Background Low and middle income countries face many challenges in meeting their populations’ mental health care needs. Though family caregiving is crucial to the management of severe mental health disabilities, such as schizophrenia, the economic costs borne by family caregivers often go unnoticed. In this study, we estimated the household economic costs of schizophrenia and quality of life of family caregivers in Ghana. Methods We used a cost of illness analysis approach. Quality of life (QoL) was assessed using the abridged WHO Quality of Life (WHOQOL-BREF) tool. Cross-sectional data were collected from 442 caregivers of patients diagnosed with schizophrenia at least six months prior to the study and who received consultation in any of the three psychiatric hospitals in Ghana. Economic costs were categorized as direct costs (including medical and non-medical costs of seeking care), indirect costs (productivity losses to caregivers) and intangible costs (non-monetary costs such as stigma and pain). Direct costs included costs of medical supplies, consultations, and travel. Indirect costs were estimated as value of productive time lost (in hours) to primary caregivers. Intangible costs were assessed using the Zarit Burden Interview (ZBI). We employed multiple regression models to assess the covariates of costs, caregiver burden, and QoL. Results Total monthly cost to caregivers was US$ 273.28, on average. Key drivers of direct costs were medications (50%) and transportation (27%). Direct costs per caregiver represented 31% of the reported monthly earnings. Mean caregiver burden (measured by the ZBI) was 16.95 on a scale of 0–48, with 49% of caregivers reporting high burden. Mean QoL of caregivers was 28.2 (range: 19.6–34.8) out of 100. Better educated caregivers reported lower indirect costs and better QoL. Caregivers with higher severity of depression, anxiety and stress reported higher caregiver burden and lower QoL. Males reported better QoL. Conclusions These findings highlight the high household burden of caregiving for people living with schizophrenia in low income settings. Results underscore the need for policies and programs to support caregivers.
Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana
(Plos One, 2020-01-22) Aikins, M.; Heerdegen, A.C.S.; Amon, S.; Agyemang, S.A.; Wyss, K.
Introduction District health managers play a pivotal role in the delivery of basic health services in many countries, including Ghana, as they are responsible for converting inputs and resources such as, staff, supplies and equipment into effective services that are responsive to population needs. Weak management capacity among local health managers has been suggested as a major obstacle for responsive health service delivery. However, evidence on district health managers’ competencies and its association with health system performance is scarce. Aim To examine managerial capacity among district health managers and its association with health system performance in six districts in the Eastern Region of Ghana. Methods Fifty-nine district health managers’ in six different performing districts in the Eastern Region of Ghana completed a self-administered questionnaire measuring their management competencies and skills. In addition, the participants provided information on their socio-demographic background; previous management experience and training; the extent of available management support systems, and the dynamics within their district health management teams. A non-parametric one-way analysis was applied to test the association between management capacity and district performance, which was measured by 17 health indicators. Results Shortcomings within different aspects of district management were identified, however there were no significant differences observed in the availability of support systems, characteristics and qualifications of district health managers across the different performing districts. Overall management capacity among district health managers were significantly higher in high performing districts compared with lower performing districts (p = 0.02). Furthermore, district health managers in better performing districts reported a higher extent of teamwork (p = 0.02), communication within their teams (p<0.01) and organizational commitment (p<0.01) compared with lower performing districts. Conclusion The findings demonstrate individual and institutional capacity needs, and highlights the importance of developing management competencies and skills as well as positive team dynamics among health managers at district level.
National health insurance accreditation pattern among private healthcare providers in Ghana
(Archives of Public Health, 2017) Lamptey, A.A.; Nsiah-Boateng, E.; Agyemang, S.A.; Aikins, M.
Background: Healthcare providers' accreditation is one of the standard means of assuring quality services. This paper examines the pattern of National Health Insurance Scheme accreditation results among private healthcare providers in Ghana. Methods: A cross-sectional quantitative analysis of administrative data from seven National Health Insurance Scheme healthcare provider accreditation surveys over the 2009-2012 period. Data on private healthcare providers that applied for formal accreditation between the study period were retrieved from the NHIS accreditation database using a checklist. Proportions were used to examine pattern of private healthcare provider accreditation results by region, type of care provider, and grade. Results: Overall, 1600 healthcare providers applied for accreditation over the study years, of which 1252 (78%) passed and were accredited. Majority of healthcare providers that passed the healthcare facility assessment were in Ashanti, Greater Accra, and Western regions, and were significantly higher than those in the other regions. Among the healthcare providers that passed the assessment, pharmacies (22%) and clinics (18%) constituted the largest groups, and were significantly higher than the other types of healthcare providers. Similarly, among those that passed, majority (62%) obtained grade C and D, representing a score of 50-59% and 60-69%, respectively, and were significantly higher than those that obtained the top three grades of A+ (90-100%), A (80-89%) and B (70-79%). Conclusions: Majority of healthcare providers accredited to provide services to the insured are concentrated in three regions of the country, and are mainly pharmacies and clinics. Moreover, substantial proportion of the healthcare providers obtain average scores of the healthcare facility assessment, an indication that these care providers fall below the National Health Insurance Scheme applicable-predetermined standards. © 2017 The Author(s).
Psychological burden and caregiver-reported non-adherence to psychotropic medications among patients with schizophrenia
(Psychiatry Research, 2018-01) Kretchy, I.A.; Osafo, J.; Agyemang, S.A.; Appiah, B.; Nonvignon, J.
The study examined the association between psychological distress, caregiving burden and caregiver-reported medication adherence in 444 informal family caregivers of patients with schizophrenia. Participants were assessed on the Depression, Anxiety Stress Scale, Zarit Burden Interview and the Medication Adherence Report Scale. Caregivers reported a non-adherence rate of 54.5% among patients with schizophrenia. Poor adherence to antipsychotics was significantly associated with caregiver burden (p < 0.01) and experience of anxiety (p < 0.0001). The burden of caregiving should be considered during the assessment of adherence. The findings suggest a need for culturally appropriate interventions that improve antipsychotic adherence of outpatients with schizophrenia with specific attention to the burden of the caregiver.
Routine medical and dental examinations: a case study of adults in Tema community 20 in Ghana
(INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION, 2019-12-02) Agyemang, S.A.; Danquah, E.P.B.; Amon, S.; Aikins, M.
Routine medical and dental examinations are important and effective measures in the prevention of diseases and promotion of good health. A cross-sectional quantitative study was conducted among adult residents in Community 20, Tema. The study randomly sampled 216 adults aged over 18 years. These participants were interviewed after informed consent was obtained. Sociodemographic factors associated with routine medical and dental examinations were determined using multivariable logistic regression analysis. Weighted mean was used to determine the level of perceived importance of medical and dental examination. A total of 68.1% and 31.9% of the adults have ever undergone routine medical and dental examination, respectively. Personal reasons constituted 35.4% for medical examination and 55.1% for dental examination. Medical and dental examinations encourage adults to be health conscious was ranked highest with a weighted mean of 3.78. Routine medical and dental examinations were higher among adults over 50 years, males, higher educated adults, higher income earners and the unmarried. Most of the adults indicated that medical and dental examinations were very important. Routine medical and dental examinations encourage adults to be health conscious. Routine medical and dental examinations were higher among adults over 50 years. Public health education programs should educate and encourage the general public especially among the younger population to undergo routine medical and dental examinations annually