Browsing by Author "Aryeetey, G."
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Item Caregivers’ Perceptions of Quality of Care for Patients with Schizophrenia at Pantang Hospital, Accra(University of Ghana, 2015-09) Ofoedu, O.P.; Aryeetey, G.; University of Ghana, Masters College of Health, Sciences School of Public HealthMental healthcare in Ghana, is slowly picking up with records of schizophrenia prevailing the most. This usually long-term mental illness, requires care within and outside of the health facility. Unlike physical health where patients’ perspective of health service received is a measure of quality of care, mental health though adopting methods from physical health research is slightly different. The shift from patients with schizophrenia unto their caregivers in the assessment of quality of care in this study is based on the patient advocacy role performed as a function of a caregiver. This study assesses the quality of care received by patients with schizophrenia in Pantang hospital by the following quality of care indicators: (1) Waiting time, (2) Staff attitude, (3) Communication clarity (4) Facility cleanliness without leaving out the expectations of health service delivery of these healthcare recipients. The study used a purposive method of sampling to recruit potential respondents. Digitally-recorded in-depth interviews were conducted to obtain the needed information with the aid of an interview guide. Data was thematically analysed using MS Excel Matrix and identified themes were summarised in interpretable tables. The findings on quality of care received were good but for the long waiting time that seemed a setback in all of these, though overall satisfaction of healthcare recipients in the study was satisfactory. The expectations of caregivers were very relatable issues such as the need to access mental health services through the National Health Insurance Scheme, provision of more mental health facilities to boost access and the aching desire to be seen by very few doctors throughout the long period of reviews in a bid to curb the menace of stigmatization that lurks around, leaving room for improvement through policy formulation, training and proper personnel management in Ghana’s mental health clime.Item Efficiency, equity and feasibility of strategies to identify the poor: An application to premium exemptions under National Health Insurance in Ghana(Health Policy, 2010-05) Jehu-Appiah, C.; Aryeetey, G.; Spaan, E.; Agyepong, I.; Baltussen, R.Objectives: This paper outlines the potential strategies to identify the poor, and assesses their feasibility, efficiency and equity. Analyses are illustrated for the case of premium exemptions under National Health Insurance (NHI) in Ghana. Methods: A literature search in Medline search was performed to identify strategies to identify the poor. Models were developed including information on demography and poverty, and costs and errors of in- and exclusion of these strategies in two regions in Ghana. Results: Proxy means testing (PMT), participatory welfare ranking (PWR), and geographic targeting (GT) are potentially useful strategies to identify the poor, and vary in terms of their efficiency, equity and feasibility. Costs to exempt one poor individual range between US$11.63 and US$66.67, and strategies may exclude up to 25% of the poor. Feasibility of strategies is dependent on their aptness in rural/urban settings, and administrative capacity to implement. A decision framework summarizes the above information to guide policy making. Conclusions: We recommend PMT as an optimal strategy in relative low poverty incidence urbanized settings, PWR as an optimal strategy in relative low poverty incidence rural settings, and GT as an optimal strategy in high incidence poverty settings. This paper holds important lessons not only for NHI in Ghana but also for other countries implementing exemption policies. © 2009 Elsevier Ireland Ltd.Item Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?(Social Science and Medicine, 2011-01) Jehu-Appiah, C.; Aryeetey, G.; Spaan, E.; de Hoop, T.; Agyepong, I.; Baltussen, R.To improve equity in the provision of health care and provide risk protection to poor households, low-income countries are increasingly moving to social health insurance. Using data from a household survey of 3301 households conducted in 2009 this study aims to evaluate equity in enrollment in the National Health Insurance Scheme (NHIS) in Ghana and assess determinants of demand across socio-economic groups. Specifically by looking at how different predisposing (age, gender, education, occupation, family size, marital status, peer pressure and health beliefs etc) enabling (income, place of residence) need (health status) and social factors (perceptions) affect household decision to enrol and remain in the NHIS. Equity in enrollment is assessed by comparing enrollment between consumption quintiles. Determinants of enrolling in and dropping out from NHIS are assessed using a multinomial logit model after using PCA to evaluate respondent's perceptions relating to schemes, providers and community health 'beliefs and attitudes'. We find evidence of inequity in enrollment in the NHIS and significant differences in determinants of current and previous enrollment across socio-economic quintiles. Both current and previous enrollment is influenced by predisposing, enabling and social factors. There are, however, clear differences in determinants of enrollment between the rich and the poor. Policy makers need to recognize that extending enrollment will require recognition of all these complex factors in their design of interventions to stimulate enrollment. © 2010 Elsevier Ltd.Item Estimation of packaged water consumption and associated plastic waste production from household budget surveys(Environmental Research Letters, 2017-07) Wardrop, N.A.; Dzodzomenyo, M.; Aryeetey, G.; Hill, A.G.; Bain, R.E.S.; Wright, J.Packaged water consumption is growing in low- and middle-income countries, but the magnitude of this phenomenon and its environmental consequences remain unclear. This study aims to quantify both the volumes of packaged water consumed relative to household water requirements and associated plastic waste generated for three West African case study countries. Data from household expenditure surveys for Ghana, Nigeria and Liberia were used to estimate the volumes of packaged water consumed and thereby quantify plastic waste generated in households with and without solid waste disposal facilities. In Ghana, Nigeria and Liberia respectively, 11.3 (95% confidence interval: 10.3-12.4), 10.1 (7.5-12.5), and 0.38 (0.31-0.45) Ml day-1 of sachet water were consumed. This generated over 28 000 tonnes yr-1 of plastic waste, of which 20%, 63% and 57% was among households lacking formal waste disposal facilities in Ghana, Nigeria and Liberia respectively. Reported packaged water consumption provided sufficient water to meet daily household drinking-water requirements for 8.4%, less than 1% and 1.6% of households in Ghana, Nigeria and Liberia respectively. These findings quantify packaged water's contribution to household water needs in our study countries, particularly Ghana, but indicate significant subsequent environmental repercussions. © 2017 IOP Publishing Ltd.Item HIV/AIDS-related stigma and HIV test uptake in Ghana: Evidence from the 2008 demographic and health survey(Etude de la Population Africaine, 2014) Novignon, J.; Novignon, N.; Aryeetey, G.; Nonvignon, J.The study examined the association between HIV test uptake and socioeconomic characteristics of individuals, including HIV-related stigma behaviours. The study also investigated the socioeconomic determinants of HIV-related stigma in Ghana. Cross tabulations and logistic regression techniques were applied to data from the 2008 Ghana Demographic and Health Survey. The results showed significantly low HIV test uptake and some level of HIV-related stigma prevalence in Ghana. Higher wealth status, educational attainment and HIV-related stigma were significant determinants of HIV test uptake. Aside wealth status and education, rural place of residence and religious affiliation were positive and significant determinants of HIV-related stigma. The findings call for comprehensive HIV education including treatment, prevention and care. Legislations to discourage stigma and improve HIV-testing will be critical policy steps in the right direction. © 2014, Union for African Population Studies. All rights reserved.Item Household perceptions and their implications for enrolment in the National Health Insurance Scheme in Ghana(Health Policy and Planning, 2012-05) Jehu-Appiah, C.; Aryeetey, G.; Agyepong, I.; Spaan, E.; Baltussen, R.Objective This paper identifies, ranks and compares perceptions of insured and uninsured households in Ghana on health care providers (quality of care, service delivery adequacy, staff attitudes), health insurance schemes (price, benefits and convenience) and community attributes (health 'beliefs and attitudes' and peer pressure). In addition, it explores the association of these perceptions with household decisions to voluntarily enrol and remain in insurance schemes.Methods First, data from a household survey of 3301 households and 13865 individuals were analysed using principal component analysis to evaluate respondents' perceptions. Second, percentages of maximum attainable scores were computed for each cluster of perception factors to rank them according to their relative importance. Third, a multinomial logistic regression was run to determine the association of identified perceptions on enrolment.Results Our study demonstrates that scheme factors have the strongest association with voluntary enrolment and retention decisions in the National Health Insurance Scheme (NHIS). Specifically these relate to benefits, convenience and price of NHIS. At the same time, while households had positive perceptions with regards to technical quality of care, benefits of NHIS, convenience of NHIS administration and had appropriate community health beliefs and attitudes, they were negative about the price of NHIS, provider attitudes and peer pressure. The uninsured were more negative than the insured about benefits, convenience and price of NHIS.Conclusions Perceptions related to providers, schemes and community attributes play an important role, albeit to a varying extent in household decisions to voluntarily enrol and remain enrolled in insurance schemes. Scheme factors are of key importance. Policy makers need to recognize household perceptions as potential barriers or enablers to enrolment and invest in understanding them in their design of interventions to stimulate enrolment. © The Author 2011; all rights reserved.Item Injuries and their related household costs in a tertiary hospital in Ghana(African Journal of Emergency Medicine, 2020) Blankson, P-K.; Nonvignon, J.; Aryeetey, G.; Aikins, M.Introduction: Injuries remain a leading cause of death in many developing countries, accounting for more deaths than HIV, tuberculosis, and malaria combined. This study set out to determine the associated patient costs of reported injury cases at the Accident and Emergency Department of the Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana. Method: A cross-sectional retrospective Cost-of-Illness study of 301 sampled patients was undertaken, following a review of injured patients' records from January–December 2016. Direct cost, (consisting of consultation, surgery, medicines, transportation, property damage, food and consumables) was estimated. Indirect cost was calculated using the Human capital approach. Intangible cost was assessed using Likert scale analysis. The overall household cost, average cost of various injuries and intangible costs were determined. Results: The total annual household cost of injuries to patients who attended KBTH was US$11,327,461.96, of which 82% was the direct cost. The average household cost of injuries was US$ 1276.15. All injuries recorded some level of high intangible cost but was exceptional for burns. Conclusion: Injured patients incur high direct treatment cost in all aetiology, with generally high intangible cost as well. It is therefore imperative that injury prevention strategies be prioritized in national health policies, while broader discussions continue on sustainable health financing of injury management.Item Injuries and their related household costs in a tertiary hospital in Ghana(African Journal of Emergency Medicine, 2020-05-26) Blankson, P.K.; Nonvignon, N.; Aryeetey, G.; Aikins, M.Introduction Injuries remain a leading cause of death in many developing countries, accounting for more deaths than HIV, tuberculosis, and malaria combined. This study set out to determine the associated patient costs of reported injury cases at the Accident and Emergency Department of the Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana. Method A cross-sectional retrospective Cost-of-Illness study of 301 sampled patients was undertaken, following a review of injured patients' records from January–December 2016. Direct cost, (consisting of consultation, surgery, medicines, transportation, property damage, food and consumables) was estimated. Indirect cost was calculated using the Human capital approach. Intangible cost was assessed using Likert scale analysis. The overall household cost, average cost of various injuries and intangible costs were determined. Results The total annual household cost of injuries to patients who attended KBTH was US$11,327,461.96, of which 82% was the direct cost. The average household cost of injuries was US$ 1276.15. All injuries recorded some level of high intangible cost but was exceptional for burns.Item Livestock ownership and microbial contamination of drinking-water: Evidence from nationally representative household surveys in Ghana, Nepal and Bangladesh(International Journal of Hygiene and Environmental Health, 2018-01) Wardrop, N.A.; Hill, A.G.; Dzodzomenyo, M.; Aryeetey, G.; Wright, J.A.Background Current priorities for diarrhoeal disease prevention include use of sanitation and safe water. There have been few attempts to quantify the importance of animal faeces in drinking-water contamination, despite the presence of potentially water-borne zoonotic pathogens in animal faeces. Objectives This study aimed to quantify the relationship between livestock ownership and point-of-consumption drinking-water contamination. Methods Data from nationally representative household surveys in Nepal, Bangladesh, and Ghana, each with associated water quality assessments, were used. Multinomial regression adjusting for confounders was applied to assess the relationship between livestock ownership and the level of drinking-water contamination with E. coli. Results Ownership of five or more large livestock (e.g. cattle) was significantly associated with drinking-water contamination in Ghana (RRR = 7.9, 95% CI = 1.6 to 38.9 for medium levels of contamination with 1–31cfu/100 ml; RRR = 5.2, 95% CI = 1.1–24.5 for high levels of contamination with >31cfu/100 ml) and Bangladesh (RRR = 2.4, 95% CI = 1.3–4.5 for medium levels of contamination; non-significant for high levels of contamination). Ownership of eight or more poultry (chickens, guinea fowl, ducks or turkeys) was associated with drinking-water contamination in Bangladesh (RRR = 1.5, 95% CI = 1.1–2.0 for medium levels of contamination, non-significant for high levels of contamination). Conclusions These results suggest that livestock ownership is a significant risk factor for the contamination of drinking-water at the point of consumption. This indicates that addressing human sanitation without consideration of faecal contamination from livestock sources will not be sufficient to prevent drinking-water contamination. © 2017 The AuthorsItem Sachet water quality and product registration: A cross-sectional study in Accra, Ghana(Journal of Water and Health, 2018-05) Dzodzomenyo, M.; Fink, G.; Dotse-Gborgbortsi, W.; Wardrop, N.; Aryeetey, G.; Coleman, N.; Hill, A.; Wright, J.Objectives: To assess the extent to which packaged water producers follow product registration procedures and to assess the relationship between product registration and drinking water quality in Accra, Ghana. Methods: Following preliminary analysis of a national water quality survey, 118 packaged sachet water samples were collected by sampling all brands sold by 66 vendors. A sample of vendors were selected from two high income and two low-income areas of Accra, Ghana. Sachet packaging and labelling details were recorded and compared to a regulatory database to assess product registration. All samples were weighed and tested for faecal indicator bacteria and selected physico-chemical parameters. Results: Product registration numbers and brand names could be matched to regulatory records for 77 out of 118 sachets (65.2%). All samples tested were compliant with national water quality standards for faecal indicator bacteria and nitrate. Brand registration was not associated with any of the quality indicators considered Conclusion: The results of this study suggest that whilst a substantial proportion of sachet water is sold without formal product registration, the microbial quality of the unlicensed water is consistently high in Accra, Ghana. Further examination of regulatory enforcement and monitoring will be needed to ensure sustained high water quality over time.Item Socioeconomic-related inequalities in child malnutrition: evidence from the Ghana multiple indicator cluster survey(Health Econ Rev., 2015-11) Novignon, J.; Aboagye, E.; Agyemang, O.S.; Aryeetey, G.Background Malnutrition is a prevalent public health concern in Ghana. While studies have identified factors that influence child malnutrition and related inequalities in Ghana, very little efforts have been made to decompose these inequalities across various household characteristics. This study examined the influence of socioeconomic factors on inequality in child malnutrition using a decomposition approach. Go to: Methods The study employed cross section data from the 2011 Multiple Indicator Cluster Survey (MICS). Analysis was done at three levels: First, concentration curves were constructed to explore the nature of inequality in child malnutrition. Secondly, concentration indices were computed to quantify the magnitude of inequality. Thirdly, decomposition analysis was conducted to determine the role of mother’s education and health insurance coverage in inequality of child malnutrition. Go to: Results The concentration curves showed that there exists a pro-poor inequality in child malnutrition measured by stunting and wasting. The concentration indices of these measures indicated that the magnitude of inequality was higher and significant at 1 % for weight-for-age (WAZ) (−0.1641), relative to height-for-age (HAZ) (−0.1613). The decomposition analyses show that whilst mother’s education contributed about 13 and 11 % to inequality in HAZ, it contributed about 18.9 and 11.8 % to inequality in WAZ for primary and secondary or above education attainments, respectively. Finally, health insurance contributed about 1.91 and 1.03 % to inequality in HAZ and WAZ, respectively. Go to: Conclusion The results suggest that there is the need to encourage critical policies directed towards improving female literacy in the country. The existence of a functional health insurance system and increasing universal coverage are recommended to mitigate child malnutrition.