Browsing by Author "Kotoh, A.M."
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Item Associated factors of diet quality among people living with HIV/AIDS in Ghana(BMC Nutrition, 2024) Abdulai, K.; Torpey, T.; Kotoh, A.M.; Laar, A.Introduction : Nutrition is a very important element of a comprehensive care for people living with HIV/AIDS (PLHIV), especially in resource-constrained settings where malnutrition and food insecurity are common. Dietary diversity is a useful indication of nutritional adequacy (diet quality) in people of all ages. An optimally diverse diet strengthens the body’s immune system. Objective This study aimed to assess diet quality and its associated factors among PLHIV. Methods A facility-based cross-sectional study design was employed to select 440 PLHIV from two hospitals in the Eastern Region of Ghana. Dietary intakes were determined using 24-hour recall. A stadiometer and bioimpedance analysis machine were used to obtain anthropometric and body composition data. Diet quality was assessed using FAO’s individual dietary diversity score (IDDS) as a proxy. SPSS version 20 was used for analysis. Odds ratios and ordinal logistic regression were used to identify factors associated with diet quality among the PLHIV. P-value was set at 0.05. Results Most of the PLHIV (73%) consumed from ‘Starchy staple” food group. Less than 20% of the study sample consumed ‘Fruits’ and ‘Vegetables’ (17% and 14% respectively) a day before the survey. The mean IDDS was 4.11 (SD=1.29). Overall, most of the PLHIV (56%) had medium IDDS which is equivalent to “diet needing improvement’, 14% had higher IDDS (good diet), whiles about 31% of the participants actually had poor diet (lower IDDS). Associated factors of diet quality were age (AOR=0.966: 95%CI: 0.936–0.997: p=0.031), married (AOR=4.634: 95%CI: 1.329– 16.157: p=0.0016), separated (AOR=0.0203: 95%CI: .036–0.994: p=0.049), and daily meal frequency (AOR=0.441: 95%CI: .478–1.948: p=0.020). Overall, the model accounts for about 20% of the variation in diet quality of the participants (pseudo-R square=0.196). Conclusion This study demonstrates that most of the PLHIV did not consume good diet which may have an implication on their immune system, which is already under attack by HIV, and probably emerging infections. Age, marital status, and meal frequency were the variables that predicted diet quality among the study participants.Item Barriers and facilitators to the implementation of a community-based hypertension improvement project in Ghana: a qualitative study of ComHIP(BMC Health Services Research, 2020-01-30) Laar, A.K.; Adler, A.J.; Kotoh, A.M.; Legido-Quigley, H.; Perel, P.; Lamptey, P.; Lange, I.L.Background: Globally, hypertension is a leading cause of cardiovascular disease and mortality, with the majority of deaths occurring in low- and middle-income countries. Because the burden of hypertension is increasing in low resource settings with restricted infrastructure, it is imperative that new models for hypertension care are realised. One such model is the Community-based Hypertension Improvement Project (ComHIP) which employs a community-based method of task-shifting for managing hypertension. This study is a qualitative analysis of the barriers and facilitators of the main components of ComHIP. Methods: We purposively selected 55 informants for semi-structured interviews or focus group discussions, which were carried out bythree trained local researchers in Krobo, Twi or English. Informants included patients enrolled in ComHIP, health care providers and Licensed Chemical Sellers trained by ComHIP, and Ghana Health Service employees. Data were analysed using a multi-step thematic analysis. Results: While results of the effectiveness of the intervention are pending, overall, patients and nurses reported positive experiences within ComHIP, and found that it helped enable them to manage their hypertension. Healthcare providers appreciated the additional training, but had some gaps in their knowledge. Ghana Health Service employees were cautiously optimistic about the programme, but expressed some worries about the sustainability of the programme. Many informants expressed concerns over the inability of community nurses and workers to dispense anti-hypertensives, due to legal restrictions. Conclusions: The WHO recommends task-sharing as a technique for managing chronic conditions such as hypertension in resource constrained settings. ComHIP presents an example of a task-sharing programme with a high level of acceptability to all participants. Going forward, we recommend greater levels of communication and dialogue to allow community-based health workers to be allowed to dispense anti-hypertensives.Item Beliefs about children and the psychosocial implications of infertility on individuals seeking assisted fertilization in Ghana(Reproductive BioMedicine and Society Online, 2021) Kyei, J.M.; Manu, A.; Kotoh, A.M.; Adjei, C.A.; Ankomah, A.Infertility presents challenges to individuals and couples, particularly in Sub-Saharan Africa. This study aimed to docu ment beliefs about childbearing/children and the psychosocial implications of infertility in individuals seeking assisted fertilization in the Ghanaian context. The study had an exploratory descriptive qualitative design. Six males and 12 females were recruited pur posefully from five private fertility centres in the Greater Accra Region. Face-to-face interviews were performed. In Ghanaian soci ety, couples and individuals with infertility who are seeking assisted fertilization consider having biological children to be important. The quest to have children was broadly centred on the associated benefits of being a parent, including societal recognition, the role of family inheritance, and support. The inability of participants to have biological children was found to have a negative effect on their psychological and social well-being. Anxiety, worry, hopelessness, stigma and suicidal ideations were some of the effects iden tified. It is recommended that those seeking assisted fertilization should be supported through counselling to minimize the potential negative effects of childlessnessItem Challenges experienced by clients undergoing assisted reproductive technology in Ghana: An exploratory descriptive study(International Federation of Gynecology and Obstetrics, 2020-04-17) Kyei, J.M.; Manu, A.; Kotoh, A.M.; Meherali, S.; Ankomah, A.Objective: To explore the experiences of clients accessing assisted reproductive technology (ART) services in selected health facilities in Greater Accra, Ghana. Methods: An exploratory, descriptive, qualitative design using a purposive sampling technique was employed. Overall, 12 women and six men participated in the study. In-depth interviews were conducted using a semi-structured interview guide. The Braun and Clarke (2006) procedure for data analysis was followed. Data collection spanned 9 months (January to October 2017). Results: Five major challenges were identified that were commonly experienced by our participants at every phase of the ART treatment, including the high cost of ART treatment, the long distance to treatment centers, drug treatment challenges, disturbances in daily routine and work, and anxiety about pregnancy outcome. Conclusion: Given the emotional and psychological challenges reported by the participants in the present study, an integration of counseling units in the ART centers is recommended, manned by qualified personnel such as clinical psychologists and counselors to support clients at every stage of the treatment. Also, given the high cost of ART services, as reflected in the participants’ views, it is recommended that private health insurance companies fund some aspect of ART services, such as laboratory investigations and medications.Item Community concepts of poverty: An application to premium exemptions in Ghana's National Health Insurance Scheme(Globalization and Health, 2013-03) Aryeetey, G.C.; Jehu-Appiah, C.; Kotoh, A.M.; Spaan, E.; Arhinful, D.K.; Baltussen, R.; van der Geest, S.; Agyepong, I.A.Background: Poverty is multi dimensional. Beyond the quantitative and tangible issues related to inadequate income it also has equally important social, more intangible and difficult if not impossible to quantify dimensions. In 2009, we explored these social and relativist dimension of poverty in five communities in the South of Ghana with differing socio economic characteristics to inform the development and implementation of policies and programs to identify and target the poor for premium exemptions under Ghana's National Health Insurance Scheme.Methods: We employed participatory wealth ranking (PWR) a qualitative tool for the exploration of community concepts, identification and ranking of households into socioeconomic groups. Key informants within the community ranked households into wealth categories after discussing in detail concepts and indicators of poverty.Results: Community defined indicators of poverty covered themes related to type of employment, educational attainment of children, food availability, physical appearance, housing conditions, asset ownership, health seeking behavior, social exclusion and marginalization. The poverty indicators discussed shared commonalities but contrasted in the patterns of ranking per community.Conclusion: The in-depth nature of the PWR process precludes it from being used for identification of the poor on a large national scale in a program such as the NHIS. However, PWR can provide valuable qualitative input to enrich discussions, development and implementation of policies, programs and tools for large scale interventions and targeting of the poor for social welfare programs such as premium exemption for health care. © 2013 Aryeetey et al; licensee BioMed Central Ltd.Item Community concepts of poverty: an application to premium exemptions in Ghana¿s National Health Insurance Scheme(2013-03-14) Aryeetey, G.C.; Jehu-Appiah, C.; Kotoh, A.M.; Spaan, E.; Arhinful, D.K.; Baltussen, R.; Van Der Geest, S.; Agyepong, I.A.Abstract Background Poverty is multi dimensional. Beyond the quantitative and tangible issues related to inadequate income it also has equally important social, more intangible and difficult if not impossible to quantify dimensions. In 2009, we explored these social and relativist dimension of poverty in five communities in the South of Ghana with differing socio economic characteristics to inform the development and implementation of policies and programs to identify and target the poor for premium exemptions under Ghana’s National Health Insurance Scheme. Methods We employed participatory wealth ranking (PWR) a qualitative tool for the exploration of community concepts, identification and ranking of households into socioeconomic groups. Key informants within the community ranked households into wealth categories after discussing in detail concepts and indicators of poverty. Results Community defined indicators of poverty covered themes related to type of employment, educational attainment of children, food availability, physical appearance, housing conditions, asset ownership, health seeking behavior, social exclusion and marginalization. The poverty indicators discussed shared commonalities but contrasted in the patterns of ranking per community. Conclusion The in-depth nature of the PWR process precludes it from being used for identification of the poor on a large national scale in a program such as the NHIS. However, PWR can provide valuable qualitative input to enrich discussions, development and implementation of policies, programs and tools for large scale interventions and targeting of the poor for social welfare programs such as premium exemption for health care.Item Determinants of Antenatal Care First Trimester Initiation and their Effects in Place of Delivery in the Builsa South District of the Upper East Region(University of Ghana, 2016-07) Boah, M.; Kotoh, A.M.; University of Ghana, College of Health Sciences School of Public HealthThe importance of antenatal care and skilled-birth attendant at delivery in the reduction of maternal morbidity and mortality are key components of the safe motherhood initiative. Despite the introduction of strategies to promote early antenatal care attendance and delivery in health facilities by skilled attendants, women in the Builsa South district initiate antenatal care late. The purpose of this study is to explore the determinants of antenatal care first trimester initiation and how they affect the place where the woman delivers. A population based cross sectional study was conducted in June 2016 among four hundred and thirty-one women in childbearing age who delivered in the past six months preceding the survey. Both quantitative and qualitative methods were used in data collection. Four focus discussions were conducted. The study was approved by Ethics Review Committee of the Ghana Health Service. Quantitative data were analyzed using STATA version 13. Pearson Chi- square test was used to identify statistically significant association in a bivariate analysis. A multivariate logistic regression was used to estimate the strength of association between the independent variables and the outcome variables. In the qualitative method, discussions were recorded and transcribed verbatim. Thematic analysis was used for the analysis. The study found 98.8% of the respondents used antenatal care at least once in their recent pregnancy. However, many booked after the first trimester of pregnancy and 68 percent attained four and more visits before delivery. Prevalence of health facility delivery was 62.7 percent. Unaware of delivery onset and no complications with previous delivery were the major causes of home delivery. Maternal age, highest educational attainment, parity, occupation, and having a valid health insurance during pregnancy were significantly associated with the timing of the first antenatal care visit in the bivariate analysis. In the multivariate analysis, level of educational attainment was identified as the determinant of antenatal care initiation which had a statistically significant association (p<0.05) with place of delivery. The frequently mentioned reasons for late booking from the discussions were unplanned pregnancy and waiting to confirm pregnancy status. The findings suggest that there is urgent need to advocate for and invest in the education of the female child since this promotes better maternal health seeking behaviour and can contribute to reducing maternal morbidity and mortality. The qualitative results also suggest that though maternal health services are free for women who deliver in health facilities, there are other hidden costs like the inability to afford Dettol, soap, bleach, and rubber sheets required for delivery which serve as barriers to health facility delivery. Health care providers can identify potential women who will most likely deliver at home using the routinely collected data on the women during antenatal care. Women found to be at risk of home delivery can be supported throughout pregnancy to encourage them to deliver in health facilities with skilled-birth attendants.Item Experiences Related to Modern Contraceptive Use among Fishermen and their Partners in the Accra Metropolis(University of Ghana, 2016-07) Aniteye, H.A.; Kotoh, A.M.; University of Ghana, College of Health Sciences School of Public HealthContraceptive use has been studied globally and in sub-Saharan Africa. Evidence abounds in the literature concerning high knowledge of contraceptives and low use for various reasons. This study used a qualitative design to explore the experiences related to modern contraceptive use among fishermen and their partners in the Accra Metropolitan Area. Focus group discussions and in-depth interviews were held with purposively selected fishermen, their leaders and partners between 15-59 years. Thematic content analysis was used to analyze the data. Eight major themes and 21 sub-themes emerged from the data. The key findings included participants‟ high knowledge of contraceptives and minimal use attributable to a multiplicity of factors including myths and fallacies, entrenched cultural beliefs relating to pronatalism, religious beliefs and beliefs concerning moral decadence on the part of women. Knowledge about female condom and permanent contraception was low among men and women; a few men had a strong aversion for permanent contraception. Most participants could not connect condom use with the prevention of sexually transmitted infection (STI). The men who used condom complained bitterly of lack of sensitivity during coitus. Emergency contraception was known by a few but wrongly utilized. In conclusion, although the fishermen and their partners had knowledge about contraceptives, the overarching reasons for non-use were some entrenched beliefs, attitudes they had developed towards contraception and erroneous ideas from oral tradition. It is recommended that behavioural change communication be reinforced by Community Health Nurses working in the fishing community coupled with community-based distribution of free condoms. Also, family planning could be highly subsidized to defray some cost borne by users.Item Factors That Influence Enrolment and Retention in Ghana’ National Health Insurance Scheme(International Journal of Health Policy and Management, 2018-05) Kotoh, A.M.; Aryeetey, G.C.; Van Der Geest, S.Background: The government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2004 with the goal of achieving universal coverage within 5 years. Evidence, however, shows that expanding NHIS coverage and especially retaining members have remained a challenge. A multilevel perspective was employed as a conceptual framework and methodological tool to examine why enrolment and retention in the NHIS remains low. Methods: A household survey was conducted after 20 months educational and promotional activities aimed at improving enrolment and retention rates in 15 communities in the Central and Eastern Regions (ERs) of Ghana. Observation, indepth interviews and informal conversations were used to collect qualitative data. Forty key informants (community members, health providers and district health insurance schemes’ [DHISs] staff) purposely selected from two casestudy communities in the Central Region (CR) were interviewed. Several community members, health providers and DHISs’ staff were also engaged in informal conversations in the other five communities in the region. Also, four staff of the Ministry of Health (MoH), Ghana Health Service (GHS) and National Health Insurance Authority (NHIA) were engaged in in-depth interviews. Descriptive statistics was used to analyse quantitative data. Qualitative data was analysed using thematic content analysis. Results: The results show that factors that influence enrolment and retention in the NHIS are multi-dimensional and cut across all stakeholders. People enrolled and renewed their membership because of NHIS’ benefits and health providers’ positive behaviour. Barriers to enrolment and retention included: poverty, traditional risk-sharing arrangements influence people to enrol or renew their membership only when they need healthcare, dissatisfaction about health providers’ behaviour and service delivery challenges. Conclusion: Given the multi-dimensional nature of barriers to enrolment and retention, we suggest that the NHIA should engage DHISs, health providers and other stakeholders to develop and implement intervention activities to eliminate corruption, shortage of drugs in health facilities and enforce the compulsory enrolment stated in the NHIS policy to move the scheme towards universal coverage.Item Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders(BMC Health Services Research, 2019-10-15) Laar, A.K.; Adler, A.J.; Kotoh, A.M.; Legido-Quigley, H.; Lange, I.L.; Perel, P.; Lamptey, P.Background: Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognized as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. Methods: A total of 55 informants – comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policymakers – were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after giving informed consent. Results: Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, and the benefits, as well as drawbacks, of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers – increasing providers’ knowledge on hypertension and patients’ awareness of same- there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence and the phenomenon of medical pluralism in Ghana were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and similarly designed programmes. Conclusions: This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.Item Knowledge, perceptions and ever use of modern contraception among women in the ga east district, ghana.(2010-12-14) Aryeetey, R.; Kotoh, A.M.; Hindin, M.J.A survey of 332 women, ages 15-49 years, was carried out in the Ga East district of Ghana to identify community knowledge, perceptions, and factors associated with ever using modern family planning (FP). Knowledge of modern FP was almost universal (97 percent) although knowledge of more than three methods was 56 percent. About 60 percent of all and 65 percent of married respondents reported ever use of a modern method. Among ever users, 82 percent thought contraceptives were effective for birth control. However, one-third did not consider modern FP safe. About 20 percent indicated their male partner as a barrier, and 65 percent of users reported at least one side effect. In a multivariate model that controlled for age, education, religion, and occupation, being married remained significantly associated (OR = 2.14; p=0.01) with ever use of a modern contraceptive method. Interventions are needed to address service- and knowledge-related barriers to use.Item Modeling clinical and non‑clinical determinants of intrapartum stillbirths in singletons in six public hospitals in theGreater Accra Region ofGhana: a case–control study(Scientifc Reports, 2023) Vanotoo, L.; Dwomoh, D.; Laar, A.; Kotoh, A.M.; Adanu, R.The Greater Accra Region (GAR) of Ghana records 2000 stillbirths annually and 40% of them occur intrapartum. An understanding of the contributing factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. This study identified determinants of intrapartum stillbirths in GAR. A retrospective 1:2 unmatched case–control study was conducted in six public hospitals in the Greater Accra Region of Ghana. A multivariable binary logistic regression model was used to quantify the effect of exposures on intrapartum stillbirth. The area under the receiver operating characteristics curve and the Brier scores were used to screen potential risk factors and assess the predictive performance of the regression models. The following maternal factors increased the odds of intrapartum stillbirths: pregnancy-induced hypertension (PIH) [adjusted Odds Ratio; aOR= 3.72, 95% CI:1.71–8.10, p < 0.001]; antepartum haemorrhage (APH) [aOR= 3.28, 95% CI: 1.33–8.10, p < 0.05] and premature rupture of membranes (PROM) [aOR= 3.36, 95% CI: 1.20–9.40, p < 0.05]. Improved management of PIH, APH, PROM, and preterm delivery will reduce intrapartum stillbirth. Hospitals should improve on the quality of monitoring women during labor. Auditing of intrapartum stillbirths should be mandatory for all hospitals and Ghana Health Service should include fetal autopsy in stillbirth auditing to identify other causes of fetal deaths. Interventions to reduce intrapartum stillbirth must combine maternal, fetal and service delivery factors to make them effective.Item “No visible signs of pregnancy, no sickness, no antenatal care”: Initiation of antenatal care in a rural district in Northern Ghana(BMC Public Health, 2019-07-30) Kotoh, A.M.; Boah, M.Background Attending antenatal care (ANC) early contribute to better birth outcomes. Studies have shown that many pregnant women in Sub-Saharan Africa do not initiate ANC early (i.e. in the first trimester). This study determined the gestational age of pregnancy at first ANC attendance. It also explored factors that influence initiation of ANC. Methods This cross-sectional study, conducted in Ghana, used mixed methods to collect data from women aged 15–45 years who delivered 6 months prior to the study. Crosstabs, chi-square test and logistic regression were used to analyse quantitative data. Also, 33 participants were engaged in focus group discussions (FGDs). Thematic content analysis was used to develop themes from the data. Results Of the 431 participants, 8.9, 8, 25.4, 45.3 and 10.7% started ANC in the first, second, third, fourth and fifth months of pregnancy respectively. Formal education, employment and number of living children were predictors of initiating ANC early; by 12 weeks of gestation. Women who attained primary, junior high, secondary education and above had 5.6, 57.5 and 163.2 higher odds respectively of initiating ANC in the first trimester compared to women with no education (p ≤ 0.05). Women with two, three and four to nine living children were 4.1, 3 and 3.5 times respectively more likely to access ANC early compared to primigravidae women. However, women with five or more children and primigravidae women are more likely to initiate ANC late; after 12 weeks gestation. The FGD data also show that most of the participants initiated ANC late. Two themes: visible signs of pregnancy and or sickness influence ANC attendance in the first trimester. The themes that explain late initiation of ANC are: healthy, do not value the benefits of early ANC attendance, desire to avoid embarrassment associated with the pregnancy, unplanned pregnancy, indirect cost of accessing ANC and traditional rites and practices.Item The Influence of Male Support during Antenatal Care on the Place of Delivery in the Offinso South Municipality of the Ashanti Region, Ghana(2016-07) Kuurdong, S.; Kotoh, A.M.; University of Ghana, College of Health Sciences, School of Public HealthIn Ghana and other countries of the developing world, men are very influential in deciding whether their partners visit the antenatal clinic (ANC) or not or they deliver in a health facility or not. Generally, there is a high ANC coverage in Offinso and Ghana at large. But as a result of lack of male support during ANC, some pregnant women are not able to deliver at health facilities. This necessitated the conduct of this study to explore the influence of male support during ANC on the place of delivery. The main aim of this study is to find out how male support influence the place of delivery. The study assessed the level of male support, factors influencing male support and the influence of male support on the place of delivery. A cross sectional study design was employed to conduct this study in two hospitals and a health center in the Offinso South Municipality of the Ashanti Region of Ghana. A structured questionnaire with closed and open ended questions was administered to a total of 426 respondents (213 couples) aged between 15 to 49 years old. The data was analyzed using STATA 13.1 The majority of male and female respondents were aged 25-34 and 20-29 years respectively. The results of this study suggest that more than 80% of both males and their partners reported that the level of male support during ANC was high. Level of knowledge about ANC, economic factors, cultural factors of the males and time spent at the ANC showed some association with male support, but it was statistically not significant. Both males and their partners reported that 95% of all deliveries occurred in health facilities. There was no association between male support and the place of delivery. The findings show a high level of male support and high health facility deliveries.Item Womens’ experiences of living with obstetric fistula in Ghana–time for the establishment of a fistula centre of excellence(Midwifery, 2019-12-13) Kotoh, A.M.; Mantey, R.; Barry, M.; Redington, W.Objective: To explore the experiences of women living with Obstetric Fistula in Ghana. Design: A descriptive qualitative design involving face-to-face semi-structured interviews following in- stitutional ethical approval. Setting: Urban and rural setting in the Mfantseman Municipal Area (MMA) in the Central Region (CR) of Ghana Participants: A purposive sample of thirty- two women who had experienced obstetric fistula (OBF) Findings: Three core themes emerged and these were i) Women’s perceptions of OBF, ii) Experiences of women living with OBF iii) Coping strategies of women living with OBF Conclusion and implications for practice: There is a need for a multi-agency coordinated approach to the treatment and management of OBF in Ghana. The findings support the need for a dedicated specialist fistula centre to treat women and to meet the educational needs of health care professionals with strate- gies to prevent as well as support women with OBF. The hub and spoke organisation design for health care systems has proved beneficial in other health settings providing a level of quality that would not be possible otherwise. It is time to end the suffering of women living with obstetric fistula