Browsing by Author "Nimako, B.A."
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Item Concurrent Chronic Conditions in Adult Patients of the Medical Out-Patient Clinic of the Tema General Hospital(University of Ghana, 2012-07) Nimako, B.A.; Sackey, S.O.Chronic conditions are a significant source of disease burden in Ghana including The Tema General Hospital (TGH). When concurrent in an individual, the outcomes are poorer. Yet medical research, preventive and clinical services are focused on single disease entities. The few studies conducted have predominantly been in developed countries and the elderly. This research determined the prevalence, distribution and socio-demographic risk factors of concurrent chronic conditions in our setting, to inform appropriate prevention and clinical care planning and practices. A cross-sectional study was conducted in adult patients of the medical clinic of the main OPD of TGH from 21 st May to 8 th June 2012. Consecutive patients were sampled and interviewed using a structured questionnaire to collect data on socio- demographic characteristics and medical history. Medical diagnoses were extracted from the medical records. Concurrent chronic condition was defined as the presence of two or more of 13 pre-selected conditions in an individual, and its association with a range of socio-demographic characteristics was determined using multivariate logistic regression. Of the 1,399 records analysed, 38.8% (95% CI: 36.3 – 41.4) had concurrent chronic conditions. As much as 48.6% of the persons with concurrent chronic conditions were young adults (18-59 years). The most common combination of conditions was diabetes mellitus and hypertension. Age, sex and a family history of chronic condition were independently associated with concurrent chronic conditions. Of these, age was the most significant; compared with the referent age group of 18 – 39 years, the adjusted odds for people aged 60 years and above was higher (OR =15.82 ,95% CI:10.66- 23.48, p <0.0001). Notably, the increasing prevalence observed with increasing age plateaus at a prevalence of about 60% by age 57 years. This study shows that concurrent chronic conditions are common in adult attendants of the medical clinic of the main OPD of the TGH. The most common combination was the pair of hypertension-diabetes mellitus and confirmed increasing age, female sex and a family history of a chronic condition as independent risk factors for concurrent chronic conditions. These prompt the need for research, medical education, prevention and clinical care plans on concurrent chronic conditions.Item Measuring Health Systems Strength and Its Impact: Experiences from the African Health Initiative(BMC Health Services Research, 2017-12) Sherr, K.; Fernandes, Q.; Kanté, A.M.; Bawah, A.; Condo, J.; Mutale, W.; Hingora, A.; Mboya, D.; Exavery, A.; Tani, K.; Manzi, F.; Pemba, S.; Phillips, J.; Kante, A.M.; Ramsey, K.; Baynes, C.; Awoonor-Williams, J.K.; Nimako, B.A.; Kanlisi, N.; Jackson, E.F.; Sheff, M.C.; Kyei, P.; Asuming, P.O.; Biney, A.,; Chilengi, R.; Ayles, H.; Mwanza, M.; Chirwa, C.; Stringer, J.; Mulenga, M.; Musatwe, D.; Chisala, M.; Lemba, M.; Drobac, P.; Rwabukwisi, F.C.; Hirschhorn, L.R.; Binagwaho, A.; Gupta, N.; Nkikabahizi, F.; Manzi, A.; Farmer, D.B.; Hedt-Gauthier, B.; Cuembelo, F.; Michel, C.; Gimbel, S.; Wagenaar, B.; Henley, C.; Kariaganis, M.; Manuel, J.L.; Napua, M.; Pio, A.Background: Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. This manuscript reflects on the experience of establishing an evaluation framework to measure health systems strength, and associate measures with health outcomes, as part of this Initiative. Methods: Using the World Health Organization's health systems building block framework, the Partnerships present novel approaches to measure health systems building blocks and summarize data across and within building blocks to facilitate analytic procedures. Three Partnerships developed summary measures spanning the building blocks using principal component analysis (Ghana and Tanzania) or the balanced scorecard (Zambia). Other Partnerships developed summary measures to simplify multiple indicators within individual building blocks, including health information systems (Mozambique), and service delivery (Rwanda). At the end of the project intervention period, one to two key informants from each Partnership's leadership team were asked to list - in rank order - the importance of the six building blocks in relation to their intervention. Results: Though there were differences across Partnerships, service delivery and information systems were reported to be the most common focus of interventions, followed by health workforce and leadership and governance. Medical products, vaccines and technologies, and health financing, were the building blocks reported to be of lower focus. Conclusion: The African Health Initiative experience furthers the science of evaluation for health systems strengthening, highlighting areas for further methodological development - including the development of valid, feasible measures sensitive to interventions in multiple contexts (particularly in leadership and governance) and describing interactions across building blocks; in developing summary statistics to facilitate testing intervention effects on health systems and associations with health status; and designing appropriate analytic models for complex, multi-level open health systems.Item Multimorbidity of chronic diseases among adult patients presenting to an inner-city clinic in Ghana(2013-11-26) Nimako, B.A.; Baiden, F.; Sackey, S.O.; Binka, F.Abstract Background Very little is known about multimorbidity and chronic diseases in low and middle income countries, particularly Sub-Saharan Africa, and more information is needed to guide the process of adapting the health systems in these countries to respond adequately to the increasing burden of chronic diseases. We conducted a hospital-based survey in an urban setting in Ghana to determine the prevalence of multimorbidity and its associated risk factors among adult patients presenting to an inner city clinic. Methods Between May and June 2012, we interviewed adult patients (aged 18 years and above) attending a routine outpatient clinic at an inner-city hospital in Accra using a structured questionnaire. We supplemented the information obtained from the interviews with information obtained from respondents’ health records. We used logistic regression analyses to explore the risk factors for multimorbidity. Results We interviewed 1,527 patients and retrieved matching medical records for 1,399 (91.6%). The median age of participants was 52.1 years (37–64 years). While the prevalence of multimorbidity was 38.8%, around half (48.6%) of the patients with multimorbidity were aged between 18–59 years old. The most common combination of conditions was hypertension and diabetes mellitus (36.6%), hypertension and musculoskeletal conditions (19.9%), and hypertension and other cardiovascular conditions (11.4%). Compared with patients aged 18–39 years, those aged 40–49 years (OR 4.68, 95% CI: 2.98–7.34), 50–59 years (OR 12.48, 95% CI: 8.23–18.92) and 60 years or older (OR 15.80, 95% CI: 10.66–23.42) were increasingly likely to present with multimorbidity. While men were less likely to present with multimorbidity, (OR 0.71, 95% CI: 0.45–0.94, p = 0.015), having a family history of any chronic disease was predictive of multimorbidity (OR 1.43, 95% CI: 1.03–1.68, p = 0.027). Conclusions Multimorbidity is a significant problem in this population. By identifying the risk factors for multimorbidity, the results of the present study provide further evidence for informing future policies aimed at improving clinical case management, health education and medical training in Ghana.Item Research Capacity Building Integrated into PHIT Projects: Leveraging Research and Research Funding to Build National Capacity(BMC Health Services Research, 2017-12) Hedt-Gauthier, B.L.; Chilengi, R.; Jackson, E.; Michel, C.; Napua, M.; Odhiambo, J.; Bawah, A.; Hingora, A.; Mboya, D.; Exavery, A.; Tani, K.; Manzi, F.; Pemba, S.; Phillips, J.; Kante, A.M.; Ramsey, K.; Baynes, C.; Awoonor-Williams, J.K.; Nimako, B.A.; Kanlisi, N.; Jackson, E.F.; Sheff, M.C.; Kyei, P.; Asuming, P.O.; Biney, A.; Ayles, H.; Mwanza, M.; Chirwa, C.; Stringer, J.; Mulenga, M.; Musatwe, D.; Chisala, M.; Lemba, M.; Mutale, W.; Drobac, P.; Cyamatare Rwabukwisi, F.; Hirschhorn, L.R.; Binagwaho, A.; Gupta, N.; Nkikabahizi, F.; Manzi, A.; Condo, J.; Farmer, D.B.; Sherr, K.; Cuembelo, F.; Michel, C.; Gimbel, S.; Wagenaar, B.; Henley, C.; Kariaganis, M.; Manuel, J.L.; Pio, A.ackground: Inadequate research capacity impedes the development of evidence-based health programming in sub-Saharan Africa. However, funding for research capacity building (RCB) is often insufficient and restricted, limiting institutions' ability to address current RCB needs. The Doris Duke Charitable Foundation's African Health Initiative (AHI) funded Population Health Implementation and Training (PHIT) partnership projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania and Zambia) to implement health systems strengthening initiatives inclusive of RCB. Methods: Using Cooke's framework for RCB, RCB activity leaders from each country reported on RCB priorities, activities, program metrics, ongoing challenges and solutions. These were synthesized by the authorship team, identifying common challenges and lessons learned. Results: For most countries, each of the RCB domains from Cooke's framework was a high priority. In about half of the countries, domain specific activities happened prior to PHIT. During PHIT, specific RCB activities varied across countries. However, all five countries used AHI funding to improve research administrative support and infrastructure, implement research trainings and support mentorship activities and research dissemination. While outcomes data were not systematically collected, countries reported holding 54 research trainings, forming 56 mentor-mentee relationships, training 201 individuals and awarding 22 PhD and Masters-level scholarships. Over the 5 years, 116 manuscripts were developed. Of the 59 manuscripts published in peer-reviewed journals, 29 had national first authors and 18 had national senior authors. Trainees participated in 99 conferences and projects held 37 forums with policy makers to facilitate research translation into policy. Conclusion: All five PHIT projects strongly reported an increase in RCB activities and commended the Doris Duke Charitable Foundation for prioritizing RCB, funding RCB at adequate levels and time frames and for allowing flexibility in funding so that each project could implement activities according to their trainees' needs. As a result, many common challenges for RCB, such as adequate resources and local and international institutional support, were not identified as major challenges for these projects. Overall recommendations are for funders to provide adequate and flexible funding for RCB activities and for institutions to offer a spectrum of RCB activities to enable continued growth, provide adequate mentorship for trainees and systematically monitor RCB activities.Item What do you do with success? the science of scaling up a health systems strengthening intervention in Ghana(BioMed Central Ltd., 2018) Phillips, J.F.; Awoonor-Williams, J.K.; Bawah, A.A.; Nimako, B.A.; Kanlisi, N.S.; Sheff, M.C.; Asuming, P.O.; Kyei, P.E.; Biney, A.; Jackson, E.F.Background: The completion of an implementation research project typically signals the end of research. In contrast, the Ghana Health Service has embraced a continuous process of evidence-based programming, wherein each research episode is followed by action and a new program of research that monitors and guides the utilization of lessons learned. This paper reviews the objectives and design of the most recent phase in this process, known as a National Program for Strengthening the Implementation of the Community-based Health Planning and Services (CHPS) Initiative in Ghana (CHPS+). Methods: A mixed method evaluation strategy has been launched involving: i) baseline and endline randomized sample surveys with 247 clusters dispersed in 14 districts of the Northern and Volta Regions to assess the difference in difference effect of stepped wedge differential cluster exposure to CHPS+ activities on childhood survival, ii) a monitoring system to assess the association of changes in service system readiness with CHPS+ interventions, and iii) a program of qualitative systems appraisal to gauge stakeholder perceptions of systems problems, reactions to interventions, and perceptions of change. Integrated survey and monitoring data will permit multi-level longitudinal models of impact; longitudinal QSA data will provide data on the implementation process. Discussion: A process of exchanges, team interaction, and catalytic financing has accelerated the expansion of community-based primary health care in Ghana's Upper East Region (UER). Using two Northern and two Volta Region districts, the UER systems learning concept will be transferred to counterpart districts where a program of team-based peer training will be instituted. A mixed method research system will be used to assess the impact of this transfer of innovation in collaboration with national and regional program management. This arrangement will generate embedded science that optimizes prospects that results will contribute to national CHPS reform policies and action. © 2018 The Author(s).