Browsing by Author "Kushitor, M."
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Item Building cardiovascular disease competence in an urban poor Ghanaian community: A social psychology of participation approach(Journal of Community & Applied Social Psychology, 2020-01-08) Aikins, A.D-G.; Kushitor, M.; Kushitor, S.B.; Sanuade, O.; Asante, P.Y.; Sakyi, L.This paper describes conceptual, methodological, and practical insights from a longitudinal social psychological project that aims to build cardiovascular disease (CVD) competence in a poor community in Accra, Ghana's capital. Informed by a social psychology of participation approach, mixed method data included qualitative interviews and household surveys from over 500 community members, including people living with diabetes, hypertension, and stroke, their caregivers, health care providers, and GIS mapping of pluralistic health systems, food vending sites, bars, and physical activity spaces. Data analysis was informed by the diagnosis-psychosocial intervention-reflexivity framework proposed by Guareschi and Jovchelovitch. The community had a high prevalence of CVD and risk factors, and CVD knowledge was cognitive polyphasic. The environment was obesogenic, alcohol promoting, and medically pluralistic. These factors shaped CVD experiences and eclectic treatment seeking behaviours. Psychosocial interventions included establishing a self-help group and community screening and education. Applying the “AIDS-competent communities” model proposed by Campbell and colleagues we outline the psychosocial features of CVD competence that are relatively easy to implement, albeit with funds and labour, and those that are difficult. We offer a reflexive analysis of four challenges that future activities will address: social protection, increasing men's participation, connecting national health policy to community needs, and sustaining the project.Item Chronic non-communicable diseases and the challenge of universal health coverage: Insights from community-based cardiovascular disease research in urban poor communities in Accra, Ghana(BMC Public Health, 2014-06) De-Graft Aikins, A.; Kushitor, M.; Koram, K.; Gyamfi, S.; Ogedegbe, G.Background: The rising burden of chronic non-communicable diseases in low and middle income countries has major implications on the ability of these countries to achieve universal health coverage. In this paper we discuss the impact of cardiovascular diseases (CVD) on primary healthcare services in urban poor communities in Accra, Ghana. Methods. We review the evidence on the evolution of universal health coverage in Ghana and the central role of the community-based health planning services (CHPS) programme and the National Health Insurance Scheme in primary health care. We present preliminary findings from a study on community CVD knowledge, experiences, responses and access to services. Results: The rising burden of NCDs in Ghana will affect the achievement of universal health coverage, particularly in urban areas. There is a significant unmet need for CVD care in the study communities. The provision of primary healthcare services for CVD is not accessible, equitable or responsive to the needs of target communities. Conclusions: We consider these findings in the context of the primary healthcare system and discuss the challenges and opportunities for strengthening health systems in low and middle-income countries. © 2014 de-Graft Aikins et al; licensee BioMed Central Ltd.Item Community perceptions of universal health coverage in eight districts of the Northern and Volta regions of Ghana(Global Health Action, 2020-02-03) Biney, A.; Wright, K.J.; Kushitor, M.; Awoonor-Williams, J.K.; Bawah, A.A.; Phillips, J.F.Background: Ever since Ghana embraced the 1978 Alma-Ata Declaration, it has consigned priority to achieving ‘Health for All.’ The Community-based Health Planning and Services (CHPS) Initiative was established to close gaps in geographic access to services and health equity. CHPS is Ghana’s flagship Universal Health Coverage (UHC) Initiative and will soon completely cover the country with community-located services. Objectives: This paper aims to identify community perceptions of gaps in CHPS maternal and child health services that detract from its UHC goals and to elicit advice on how the contribution of CHPS to UHC can be improved. Method: Three dimensions of access to CHPS care were investigated: geographic, social, and financial. Focus group data were collected in 40 sessions conducted in eight communities located in two districts each of the Northern and Volta Regions. Groups were comprised of 327 participants representing four types of potential clientele: mothers and fathers of children under 5, young men and young women ages 15–24. Results: Posting trained primary health-care nurses to community locations as a means of improving primary health-care access is emphatically supported by focus group participants, even in localities where CHPS is not yet functioning. Despite this consensus, comments on CHPS activities suggest that CHPS services are often compromised by cultural, financial, and familial constraints to women’s health-seeking autonomy and by programmatic lapses constrain implementation of key components of care. Respondents seek improvements in the quality of care, community engagement activities, expansion of the range of services to include emergency referral services, and enhancement of clinical health insurance coverage to include preventive health services. Conclusion: Improving geographic and financial access to CHPS facilities is essential to UHC, but responding to community need for improved outreach, and service quality is equivalently critical to achieving this goal.Item Evaluating health service coverage in Ghana’s Volta Region using a modified Tanahashi model(Global Health Action, 2020-03-16) Bawah, A.A.; Sheff, M.C.; Asuming, P.O.; Kyei, P.; Kushitor, M.; Phillips, J.F.; Kachur, S.P.Background: The United Nations 2030 Sustainable Development Goals have reaffirmed the international community’s commitment to maternal, newborn, and child health, with further investments in achieving quality essential service coverage and financial protection for all. Objective: Using a modified version of the 1978 Tanahashi model as an analytical framework for measuring and assessing health service coverage, this paper aims to examine the system of care at the community level in Ghana’s Volta Region to highlight the continued reforms needed to achieve Universal Health Coverage. Methods: The Tanahashi model evaluates health system coverage through five key measures that reflect different stages along the service provision continuum: availability of services; accessibility; initial contact with the health system; continued utilization; and quality coverage. Data from cross-sectional household and health facility surveys were used in this study. Immunization and antenatal care services were selected as tracer interventions to serve as proxies to assess systems bottlenecks. Results: Financial access and quality coverage were identified as the biggest bottlenecks for both tracer indicators. Financial accessibility, measured by enrollment in Ghana’s National Health Insurance Scheme was poor with 16.94% presenting valid membership cards. Childhood immunization was high but dropped modestly from 93.8% at initial contact to 76.7% quality coverage. For antenatal care, estimates ranged from 65.9% at initial visit to 25.1% quality coverage. Conclusion: Results highlight the difficulty in achieving high levels of quality service coverage and the large variations that exist within services provided at the primary care level. While vertical investments have been prioritized to benefit specific health services, a comprehensive systems approach to primary health care needs to be further strengthened to reach Ghana’s Universal Health Coverage objectives.Item Hypertension awareness, treatment and control in Ghana: a cross-sectional study(Ethnicity and Health, 2018-02) Sanuade, O.A.; Awuah, R.B.; Kushitor, M.Objective: This study assessed the rates of hypertension awareness, treatment and control as well as the socio-economic and demographic correlates in Ghana. Methods: This was a cross-sectional study. We used wave 1 of the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) conducted between 2007and 2008. The sample was 5526 respondents aged 18 years and above. Descriptive statistics were used to describe the characteristics of the respondents and binary logistic regression was used to determine the correlates of hypertension awareness, treatment and control. Results: The hypertension prevalence was 58.9%. About 19.0% of the individuals living with hypertension were aware of their hypertension; 67.6% of those who were aware of their hypertension were treating the condition, and; 11.6% of those who were on treatment had their hypertension controlled. Age, place of residence, level of education, employment status, ethnicity, and religion were associated with hypertension awareness and treatment. None of the factors was associated with hypertension control. Conclusion: Our study suggests high hypertension prevalence in Ghana, with low rates of awareness, treatment and control. Socio-economic and demographic factors are essential correlates of hypertension awareness and treatment in Ghana. The findings indicate the need to develop pragmatic intervention approaches such as rigorous education programs and use of the task-shifting system, in addressing hypertension and issues related to it.Item Methods women use for induced abortion and sources of services: insights from poor urban settlements of Accra, Ghana(BMC Women’s Health, 2021) Agula, C.; Henry, E.G.; Asuming, P.O.; Agyei‑Asabere, C.; Kushitor, M.; Canning, D.; Shah, I.; Bawah, A.A.Background: Increasing access to safe abortion methods is crucial for improving women’s health. Understanding patterns of service use is important for identifying areas for improvement. Limited evidence is available in Ghana on factors associated with the type of method used to induce abortion. This paper examined the methods and sources of services used for abortion by women living in poor urban settings of Accra. Methods: Data are from a survey that was conducted in 2018 among 1233 women aged 16–44 years who reported ever having had an induced abortion. We estimated a multinomial logistic regression model to examine factors asso‑ ciated with the type of abortion methods women used. We further generated descriptive statistics for the source of abortion services. Results: About 50% women used surgical procedures for their last abortion, 28% used medication abortion (MA), 12% used other pills, 3% used injection, and 7% used non-medical methods. However, nearly half (46%) of the women who terminated a pregnancy within the year preceding the survey used medication abortion (MA), 32% used surgical procedures, while 5% used non-medical methods. Women who terminated a pregnancy within three years preced‑ ing the survey had a 60% lower chance of using surgical procedures if they did not use MA compared to those who terminated a pregnancy more than 3 years before the survey (Relative Risk Ratio [RRR] 0.4; 95% CI 0.3–0.5). The vast majority (74%) of women who used MA obtained services from pharmacies. Conclusions: The use of MA pills to terminate pregnancies has increased in recent years in Ghana and these pills are mostly accessed from pharmacies. This suggests a need for a review of the national guidelines to include pharmacists and chemists in the provision of MA services.Item Research on Ageing in Ghana from the 1950s to 2016: A bibliography and commentary(University of Wisconsin Press, 2016) de-Graft Aikins, A.; Kushitor, M.; Sanuade, O.; Dakey, S.; Dovie, D.; Kwabena-Adade, J.This bibliography tracks research conducted on aging in Ghana from the 1950s to the present and aims to document the state of knowledge on aging research to inform future research, policies, and interventions. The bibliography has been developed as a companion to the Ghana Studies special section themed “Aging in Ghana: Addressing the Multifaceted Needs of Older Ghanaians.” We searched eight databases for research on aging and the elderly on Ghana, as well as three local journals, citation lists of authoritative texts, and the University of Ghana graduate theses database. We identified 115 eligible publications from nine disciplines: anthropology, demography/population studies, economics, medicine/medical sciences (physiology, psychiatry), psychology, public health/epidemiology, sociology, social policy and social work. Research focused on six empirical areas: demographic profiles and patterns of aging; the health status of older Ghanaians; care and support for older Ghanaians; roles and responsibilities of older Ghanaians; social representations of aging and social responses to older Ghanaians; and socio-economic status, social and financial protection, and other forms of support for older people. We present preliminary thematic notes on the empirical studies and discuss future trends in research on aging in Ghana.