Department of Social and Behavioural Sciences

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    Burnout, Metabolic Syndrome And Risk Of Cardiovascular Diseases Among Health Workers In Accra, Ghana
    (University Of Ghana, 2021-09) Konlan, K.D.
    Background: In sub-Saharan Africa (SSA), an epidemiological transition has caused cardiovascular diseases (CVDs) to overtake communicable diseases and this presents a double-barreled challenge to the under-resourced health system. Health workers are critical in reversing this twofold burden of diseases. The corona virus disease 2019 (COVID-19) pandemic has increased the workload of health workers predisposing them to additional job-related burnout. Burnout among health workers increases their risk of CVDs. However, there is a paucity of data about the link between burnout syndrome and CVDs among health workers in Ghana. Aim: This study aimed to examine burnout, metabolic syndrome and risk of cardiovascular diseases among health workers in Accra, Ghana. Methodology: A cross-sectional study was conducted among 1,264 health workers recruited from three public hospitals in Accra. The participants were sampled using a proportionate stratified sampling technique and completed a questionnaire that collected socio-demographic, job-profile, lifestyle, resilience and burnout information. In addition, each participant’s anthropometric and hemodynamic indices were measured. Furthermore, five milliliters of blood was obtained for analysis of fasting plasma glucose, lipids and cortisol. Descriptive, bivariate and multivariable logistic and ordinal regression analyses were employed to examine the associations between independent and dependent variables. Data analyses were conducted with the aid of Stata 15.0. Results: The prevalence of burnout was 20.57%. Burnout was significantly associated with the job profile factors except job support and control (p < 0.05). Also, the prevalence of MetS was 41.85%. Burnout was significantly associated with hypercortisolemia and MetS as well as ten-year risk of CVDs (p<0.001). Specifically, for a one unit increase in overall burnout, the odds of experiencing metabolic syndrome was increased by 19.78 times (AOR=19.78, 95% CI: 12.69-30.83) as compared to those without burnout. Similarly, for a one unit increase in burnout, the odds of experiencing a high ten-year risk of CVDs increased by 2.07 times (AOR=2.07; 95% CI: 1.73-2.40). Conclusion: There is high prevalence of burnout among health workers in Accra particularly during the COVID-19 pandemic. Workers at the primary level of healthcare and those on night shifts are most likely to experience burnout. Burnout is significantly associated with MetS and an increased ten-year risk of CVDs. It is recommended that the Ghana Health Service should undertake health systemic changes to decrease challenges of night shifts and at primary care facilities. Furthermore, the Ministry of Health needs a Staff Medicare Policy to help reduce disease-related turnovers.
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    Intra-Family Communication and Reproductive Health Decision Making in the Volta Region of Ghana
    (University of Ghana, 2012-10) Aglobitse, D.M.
    At the centre of Ghanaian society is the institution of family. Sustained through a series of kinship, networks and marriages, the family is acknowledged as the bedrock of all social life where critical tasks including nurturing are organised. According to Segrin and Flora (2005), very few, if any, relationships are more important, salient, long lasting, and central to people's well-being than their family relationships. Although these relationships are often de fined by genes and in stitutionalised ceremonies such as marriage, they are built, maintained, and destroyed by communication (or its absence). Therefore. Communication in the family setting is critical, as it is the bedrock of human social relationships. Additionally, a variety of fa mil y-factors at the household and individual level exist that may have direct influence on poverty and health. The principal objective of the study was to identify some of the determinants of reproductive health decision making as well as the determinants of intra- family communication or discuss ion about reproductive health issues. Structured interviews were administered to a sample of 1.080 respondents representing a total of 360 households from six districts in the Volta Region of Ghana, namely Ho, Krachi , Kadjebi , Hohoe, Ketu and Akatsi. Two focus group discussions (with one peri-urban and one rural community) for each district and two Key Informant Interview (KII) per district were also held at the same stud y sites. The Statistical Package for the Social Sciences (S PSS) version 17 was used to analyse the data. Regression techniques were used to assess the effects of education and income on family discussion at one stage and family discuss ion and reproductive health usage at another stage. Responses and discussions from FGD and KII were transcribed and data analyzed based on the objectives of this study. Results of the analysis indicate that educational level is significantly related to all the elements of reproductive health examined. Income and education were positively correlated with family discuss ions about reproductive health issues such that higher income and higher educational level , were associated with greater likelihood of family discussions, and family discuss ion or intra-family communication was also positively correlated with reproductive health usage. Types of settlement (urban or rural) were only associated with family discussion about maternal health such that urban dwellers were more likely to engage in maternal health discussions than rural dwellers. Results also indicated that mass media. Health workers, friends, and schools were the major sources of information about reproductive health issues. Young people and adults did not differ in their response pattern. This study recommends further research to assess whether comprehensive sexual and reproductive health communication within families facilitates adolescents ' health care utilization. Examination of how intra-family communication quality and content are related to service use is needed to understand adolescents ' sexual and reproductive health knowledge and needs.
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    Maternal Health Care Utilization through Community-based Initiatives in Periurban Accra
    (University of Ghana, 2018-07) Nwameme, A.U.
    Background: The availability of skilled care during pregnancy, childbirth, and the postpartum period ensures the best chances of delivering a healthy infant with no complication to the mother. Huge disparities in health exist between urban and rural dwellers but recent research has shown that the urban poor sometimes have worse maternal health outcomes than rural dwellers. Community-based interventions have been shown to foster interactions between pregnant women and health care providers and can go a long way in mitigating the adverse effects of urban poverty on maternal health. This study aimed to highlight how such initiatives are able to improve maternal health care utilization in a peri-urban settlement in Accra. Methodology: This research was a cross-sectional study employing quantitative and qualitative methods of data collection and analysis. Four hundred and forty-one (441) women who delivered in the past 18 months were randomly sampled from two subdistricts of the Ga East Municipality for participation in the survey. The purposive sampling technique was then used to sample participants for the Focus Group Discussions and the In-depth Interviews. Five (5) FGDs (n=35) were conducted amongst mothers in the community depending on place of delivery (21), and with the Community Health Officers (14), whilst nine (9) IDIs were conducted with formal and informal health care providers in the communities. Analysis of the quantitative data was done using STATA l3c and univariable, bivariable and multi variable logistic analysis were carried out with p-value of <0.05 seen as significant. The qualitative data were audio-recorded, transcribed verbatim and thematic analysis was done using the NVivo 11c software. Results: Socio-demographic characteristics such as employment (p=<0.01), autonomy (p=<0.001), and satisfaction with Antenatal Care service provision (p=<0.001) were found to be the main determinants of adequate ANC utilization. In addition, employment (p=<0.05), decision making (by males) (p=<0.001), having had obstetric complications (p=<0.001) and having ever been visited by a CHO (p=<0.01) emerged as determinants of Postnatal Care utilization in a timely manner. Barriers to maternal health care utilization include financial and time constraints, lack of public health care facilities within the communities, poor service provision at health care facilities, fear of having a Caesarean section, and cultural practices, causing women to access care from private facilities and Traditional Birth Attendant centres. There was no effect on ANC and SBA service utilization due to CHO home visits, but surprisingly, these visits reduced the likelihood of timely PNC service utilization (aOR=0.62, 95% CI=0.40-0.95). Mother Support Groups did not have any significant effect on ANC, SBA or PNC utilization. Public-private health care partnerships were weak and are dodged by lack of synchronism and high attrition rate of Mother Support Group volunteers. Conclusion: Although majority of women in these peri-urban communities availed themselves of ANC, SBA and PNC services, a substantial number of them utilized these services inadequately, and in an untimely manner. In addition, community-based activities of formal and informal health care providers had a mixed effect on maternal health care utilization and collaborations between them faced challenges requiring a clear cut protocol to guide these partnerships.
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    The Role of Divination in Health Seeking Practices in the Talensi-Nabdam District of Northern Ghana
    (University of Ghana, 2014-02) Azongo, T.B.; Adongo, P.B.; Pappoe, M.; Tetteh, E.; Gyapong, M.
    In spite of the available modern technologies for dealing with ill-health, many people continue to resort to divination in the search for therapy. The persistence of the practice of divination in health seeking suggests that there is a considerable use derived from its practice. Against this background this study was conducted to assess the extent to which divination influences health-seeking behaviour as people utilise modern healthcare facilities in the Talensi-Nabdam district in Northern Ghana, findings of which could provide clues to some barriers to healthcare delivery and utilization in Ghana at large. A mixed-method approach involving Focus Group Discussions with community elders, in- depth interviews with practicing diviners and experienced healthcare practitioners, and a community survey using a questionnaire was used. Analysis involved triangulation of both the qualitative and quantitative data. Qualitative data was analysed by importing verbatim transcripts of all interviews and discussions into Nvivo-7 software, while quantitative analyses involved logistic regression procedures, using Stata-10 software. The use of divination in health seeking was found to be significantly correlated with age, sex, marital status, number of wives possessed by men, number of children, level of education and religious affiliation. Findings also suggest that on the pathway between symptoms recognition and therapy options divination is often employed to pin down supernatural and other causes of misfortunes and ill-health and to determine the appropriate patterns of resort. Patients with such diseases as burns, boils, anthrax, and snakebites tend to consult diviners first as they believe these conditions are of spiritual or supernatural origin. Diviners don’t consider themselves as healers, but rather consider themselves merely as custodians of the spiritual conduits by which people can find out the causes of ill-health and other misfortunes from the spiritual and ancestral world in order to determine the course of action. The findings have implications for healthcare service and utilization: delays in seeking and utilising modern healthcare services and the tendency for patients asking for “discharge against medical advice” to enable alternative treatment at home, as well as reasons for treatment failures at modern healthcare facilities. It is proposed that a bio-psycho-social-spiritual model should be integrated into clinical care of patients at modern healthcare facilities especially in diagnostic interviews and treatment regimes of patients. Collaboration between the Ghana Health Service and diviners together with other magico-religious healthcare practitioners could facilitate incorporation of this model into medical and nursing training curricular.
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    The Role of Workplace Hiv Focal Persons’ in Hiv and Aids Education and Service Delivery: A Study of the Focal Person in Enterprises in Accra, Ghana
    (University of Ghana, 2015-07) Ofori-Asumadu, A.K.; Adongo, P.B.; Ahorlu, C.; University of Ghana,College of Health Sciences, School of Public Health, Department of Social and Behavioural Sciences
    ABSTRACT People living with HIV and AIDS are likely to experience stigmatization and ostracism when they open up about their sero-status at work. The HIV Focal Point is a system where a staff member, referred to as a focal person is assigned to deliver HIV related services. It offers distinct opportunities and advantages as a key delivery point for HIV prevention, treatment and care programme for specific groups of people. Yet, many programmes do not explain the operational issues concerning it. The study examined the formation and operation of workplace HIV focal persons and the influence of their services on the workforce. Methods: A descriptive study using a mix methods approach. The quantitative aspect employed a survey with close ended questions administered to 428 workplace respondents. The qualitative aspect used open-ended and semi-structured interview guides for five Focus Group Discussions and fifteen in-depth/Key Informant Interviews. Qualitative data was analysed by coding and condensation of data; identification of significant text and recording and grouping of emerging themes whilst quantitative data was analysed using the Statistical Package for the Social Sciences (SPSS) version 16. Results: The results indicate that there was no evidence of a standard criteria for the selection of focal persons. The focal person selection process varied among enterprises: the selection were at times made in cognisance of government policy; by reasons unknown to workers; or by default appointment, if health workers were present in the enterprises’ clinics. The roles and responsibilities of the HIV focal person was not a construct of their job description and specification but emanated from their respective company’s HIV and AIDS policies. Focal persons’ saw themselves as ill-equipped for their role and this inadequacy was both operational and logistical. In instances where the focal person did not have a health background, there were also technical knowledge deficits. Using the parameters of ‘comprehensive HIV knowledge’, for example, knowledge of content of HIV policies; condom use and HIV risk perception as a proxy for measuring the influence of focal person exposure on the workforce, exposed workers reported significantly higher ‘comprehensive HIV knowledge’. When parameters were compared between exposed and non-exposed workers, knowledge of the content of HIV and AIDS policies was 64.5%:0%; condoms use was 65%:24.8%; perception of a moderate to small risk of acquiring HIV was 100%:76% with 24% of non-exposed workers reporting no risk at all in comparison with none among the exposed. Stigmatizing behaviour was also significantly reduced in the exposed workers in contrast to the non-exposed (68.7%:7%) Conclusion: Workplace HIV focal persons influenced positively HIV behaviour outcomes of workers and the availability of HIV services at the workplace. Workplace HIV focal persons assured the availability of HIV services at the workplace and the ability of workers to respond positively to HIV. It is therefore recommended to scale up and institutionalize the focal person services; expand services to include other diseases of public health importance; incentivize private sector with tax rebates to support the position through monies thus saved; mainstream the focal person’s job description within the public /civil service and private sector and enjoin (charge) government to enforce a minimum standard for the operations of focal persons.
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    Socio-Cultural Factors Associated With Buruli Ulcer Management In The Obom Sub-District Of The Ga South Municipality Of Ghana
    (University of Ghana, 2015-03) Koka, E.
    This study was conducted with three specific objectives: to describe community knowledge and perception about Buruli ulcer and wound management; determine health seeking behaviour for Buruli ulcer by community members and determine cultural and local acceptability of wound management at the clinic and community. The study was conducted in the Obom sub-district of the Ga South Municipality of Ghana. This was a mixed method study employing qualitative and quantitative techniques for data collection. Interviews and Focus Group Discussions were conducted with some selected community elders, traditional healers, Buruli ulcer patients and some patient caretakers in selected communities. Fifty five (55) in-depth interviews were conducted and groups of 8 community elders (Ga, Ewe and Akan) were each selected for focus group discussions in the study area. There were therefore a total of three focus group discussions that were done. Observations were also done on Buruli ulcer patients to document how they integrate local and modern wound management practices in the day to day handling of their wounds. Survey questionnaires were also used to collect data. Content analysis was done after thematic coding of the qualitative data whiles for the quantitative data; Epi-Info 7 was used to perform basic frequencies to measure the level of knowledge, perceptions and treatment seeking behaviour of Buruli ulcer in the endemic communities. Findings from the study revealed a high level (95.3%) of knowledge about Buruli ulcer in the selected endemic communities. Local names of Buruli ulcer vary by the local languages (Ga, Ewe and Akan) spoken by communities. However, the various local names have common meanings and interpretations for Buruli ulcer disease. Findings revealed varied perceptions of community members about Buruli ulcer and the infected. Some respondents perceived Buruli ulcer patients as people who have been bewitched, people who are witches/wizards while others perceived them as people who did not take good care of themselves and got infected. It came to light that most respondents (41.0%) would resort to self-medication as their first treatment option when infected with Buruli ulcer disease. However, it was also found that, cultural practices and beliefs significantly affected the patients' wound care and treatment seeking behaviour. It came up that there were two categories of wounds depending on their causes. Those caused by charms or spirits and required the attention of traditional healers, while those not caused by charm should be treated either at home or at the health facility. Various materials were used for such wound dressing and these included urine and concoctions made of charcoal and gun powder. There is the need for community education to make a strong case for early reporting to avoid ulcers or at least severe ones reporting at the biomedical facilities. It is pertinent for both Buruli ulcer endemic community members and clinicians to be educated to understand each other‘s expectations regarding wound care, as local beliefs could significantly impact wound care and treatment outcomes.