Department of Health Policy, Planning and Management
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Item Household cost of road traffic accident-related injuries: A case study of St. Joseph Hospital, Koforidua in Ghana(Heliyon, 2024-08-12) Amenuveve,P.K.; Dzidzornu,D.O.; Owusu,R.; Bawua,S.A.Road traffic accidents (RTAs) are a prominent contributor to both mortality and morbidity, particularly affecting individuals aged 5–29 years. Road traffic Injuries impose substantial physical and economic burden on individuals, households, and governments, particularly in African nations. Thus, our study focuses on assessing the economic cost of road traffic accidents within the context of St. Joseph Hospital, Koforidua. A cross-sectional survey was conducted at the Emergency Unit of the St. Joseph Hospital with a sample size of 291 patients. A patient perspective was used in costing the management of RTAs. Data was descriptively analyzed with Microsoft Excel with means and standard deviations estimated for direct, indirect, and intangible costs to the patient. Total direct and indirect cost of road traffic accidents were approximately GHS1,973,801.28 (US$164,483.44) and GHS520,309.46 (US$43,359.12) respectively which represents 79.1 % and 20.9 % of the total cost. The annual average economic cost for all cases was GHS8,570.83 (US $714.24). Intangible costs were also found to be high, with 54.2 % patients rating their RTA burden to be between mild to moderate, 10.8 % as moderate to severe and 1.4 % as severe. RTA cost burden is huge for all households. Uninsured patients bear significantly higher costs than insured patients. Intangible costs were also high, prompting the need to provide psychological care to RTA victims and their families. Concerted efforts should be directed at strict enforcement, training, improvement of road infrastructure and legislation to reduce or curb road traffic accidents in LMICs.Item Assessment of the quality of life of COVID-19 recovered patients at the Ghana Infectious Disease Centre(PLoS ONE, 2024) Amedewonu, E.A.; Aryeetey, G.C.; Godi, A.; Sackeyfio, J.; Dai-Kosi, A. D.Background The Coronavirus Disease (COVID-19), initially thought to be a respiratory disease, is now known to affect multiple organ systems with variable presentation and devastating or fatal complications. Despite the large numbers of people who have suffered this disease globally, the mid- to long-term impact of COVID-19 on a person’s general well-being and physical function has not been fully investigated in Ghana. Aim This study sought to determine the Quality of Life (QoL) and associated factors among Gha naian patients following clinical recovery from COVID-19 infection. Methods This was a cross-sectional quantitative study involving 150 COVID-19 recovered patients attending the review clinic of the Ghana Infectious Disease Centre. Quality of life was esti mated using the EuroQol Group Association five-domain, five-level questionnaire (EQ-5D 5L) while participants’ overall health status was measured on a visual analogue scale (EQ VAS): a scale ranging from 0 (worst health) to 100 (best health). Kruskal-Wallis tests were used to assess differences in domain and overall QoL scores while quantile regression was used to determine demographic and clinical factors associated with QoL scores. Results The mean QoL from the EQ-5D-5L assessment tool was (81.5 ± 12.0) %, while the self reported QoL from the EQ-VAS tool (75.6 ± 22.0) %. Persistence of symptoms after 30 days was significantly associated with EQ-5D-5L QoL (Adjusted median difference [95% CI] = -9.40 [-14.19, -4.61], p<0.001) while access to rehabilitative centres was significantly associated with EQ-VAS QoL (Adjusted median difference [95% CI] = -29.60 [-48.92, -10.29], p = 0.003). Conclusion Quality of life was relatively good among the COVID-19 recovered patients. Persistence of symptoms and access to rehabilitative centres significantly predicted one’s QoL.Item Does health insurance mitigate the economic impact of negative health outcomes? Evidence from Ghana’s National Health Insurance Scheme(Journal of Social and Economic Development, 2023) Novignon, J.; Nonvignon, J.; Arthur, E.; et al.In many developing countries, financial risk protection for health is under-developed and negative health outcomes can be impoverishing. In this study, we sought to investigate the impact of negative health outcomes on household welfare and the role of public health insurance to mitigate this impact. We used data from the seventh round of the Ghana Living Standards Survey (GLSS). To address the potentially non-random nature of the health insurance scheme, the Lewbel instrumental variable estimation technique was used. The results suggest that more days of illness lead to fewer hours of labour supply and this result was statistically significant across all specifications. We found evidence of a heterogeneous impact of negative health outcomes through health insurance coverage on hours of labour supply for the full sample. We also find that for rural dwellers and informal sector workers, days of illness reduced labour supply, while the impact was relatively less with health insurance coverage. The findings call for policies that focus on reforming the NHIS to ensure effectiveness and achieve its primary objectives of removing financial barriers to health care in Ghana.Item The epidemiological and economic burden of diabetes in Ghana: A scoping review to inform health technology assessmen(Plos Global Public Health, 2024) Kazibwe, J.; Owusu, R.; Gulbi, G.; et al.Diabetes remains one of the four major causes of morbidity and mortality globally among non-communicable diseases (NCDs. It is predicted to increase in sub–Saharan Africa by over 50% by 2045. The aim of this study is to identify, map and estimate the burden of diabetes in Ghana, which is essential for optimising NCD country policy and understanding exist ing knowledge gaps to guide future research in this area. We followed the Arksey and O’Malley framework for scoping reviews. We searched electronic databases including Medline, Embase, Web of Science, Scopus, Cochrane and African Index Medicus following a systematic search strategy. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews was followed when reporting the results. A total of 36 studies were found to fulfil the inclusion criteria. The reported prevalence of diabetes at the national level in Ghana ranged between 2.80%– 3.95%. At the regional level, the Western region reported the highest prevalence of diabetes: 39.80%, followed by Ashanti region (25.20%) and Central region at 24.60%. The prevalence of diabetes was generally higher in women in comparison to men. Urban areas were found to have a higher prevalence of diabetes than rural areas. The mean annual financial cost of managing one diabetic case at the outpatient clinic was estimated at GHS 540.35 (2021 US $194.09). There was a paucity of evidence on the overall economic burden and the regional prevalence burden. Ghana is faced with a considerable burden of diabetes which varies by region and setting (urban/rural). There is an urgent need for effective and efficient interventions to prevent the anticipated elevation in burden of disease through the utilisation of existing evidence and proven priority-setting tools like Health Technology Assessment (HTA)Item The Relationship Between Climate Change, Globalization And Non-Communicable Diseases In Africa: A Systematic Review(PLOS ONE, 2024) Siiba, A.; Baatiema, L.; Kangmennaang, J.; Luginaah, I.Climate change and non-communicable diseases (NCDs) are considered the 21st Century’s major health and development challenges. Both pose a disproportionate burden on low- and middle-income countries that are unprepared to cope with their synergistic effects. These two challenges pose risks for achieving many of the sustainable development goals (SDGs) and are both impacted by globalization through different pathways. While there are important insights on how climate change and or globalization impact NCDs in the general literature, comprehensive research that explores the influence of climate change and or globalization on NCDs is limited, particularly in the context of Africa. This review documents the pathways through which climate change and or globalization influence NCDs in Africa. We conducted a comprehensive literature search in eight electronic databases—Web of Science, PubMed, Scopus, Global Health Library, Science Direct, Medline, ProQuest, and Google Scholar. A total of 13864 studies were identified. Studies that were identified from more than one of the databases was automatically removed as a duplicate (n = 9649). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), guidelines, a total of 27 studies were eventually included in the final review. We found that the impacts of climate change and or globalization on NCDs act through three potential pathways: reduction in food production and nutrition, urbanization and transformation of food systems. Our review contributes to the existing literature by providing insights into the impact of climate change and or globalization on human health. We believe that our findings will help enlighten policy makers working on these pathways to facilitate the development of effective policy and public health interventions to mitigate the effects of climate change and globalization on the rising burden of NCDs and goal 3 of the SDG, in particular.Item A new scale to assess health-facility level management: the development and validation of the facility management scale in Ghana, Uganda, and Malawi(BMC Health Services Research, 2024) Aikins, M.; Mubiri, P.; Ssengooba, F.Background The increased recognition of governance, leadership, and management as determinants of health system performance has prompted calls for research focusing on the nature, quality, and measurement of this key health system building block. In low- or middle-income contexts (LMIC), where facility-level management and performance remain a challenge, valid tools to measure management have the potential to boost performance and accelerate improvements. We, therefore, sought to develop a Facility-level Management Scale (FMS) and test its reliability in the psychometric properties in three African contexts. Methods The FMS was administered to 881 health workers in; Ghana (n=287; 32.6%), Malawi (n=66; 7.5%) and Uganda (n=528; 59.9%). Half of the sample data was randomly subjected to exploratory factor analysis (EFA) and Monte Carlo Parallel Component Analysis to explore the FMS’ latent structure. The construct validity of this structure was then tested on the remaining half of the sample using confirmatory factor analysis (CFA). The FMS’ convergent and divergent validity, as well as internal consistency, were also tested. Results Findings from the EFA and Monte Carlo PCA suggested the retention of three factors (labelled ‘Supportive Management’, ‘Resource Management’ and ‘Time management’). The 3-factor solution explained 51% of the variance in perceived facility management. These results were supported by the results of the CFA (N=381; χ2=256.8, df=61, p<0.001; CFI=0.94; TLI=0.92; RMSEA [95% CI]=0.065 [0.057–0.074]; SRMR=0.047). Conclusion The FMS is an open-access, short, easy-to-administer scale that can be used to assess how health workers perceive facility-level management in LMICs. When used as a regular monitoring tool, the FMS can identify key strengths or challenges pertaining to time, resources, and supportive management functions at the health facility levelItem Prevalence of fever and its associated risk factors among patients hospitalised with coronavirus disease 2019 (COVID-19) at the Eastern Regional Hospital, Koforidua, Ghana(Plos One, 2024) Bashir, M.A.; Awoonor-Williams, J.K.; Amponsah-Manu, F.;Background In Ghana, temperature check at various points of entry was adopted as a means of screening people for coronavirus disease 2019 without taking into consideration data on the local prevalence of fever associated with the disease. Our objective was to assess fever prevalence and its associated risk factors among patients hospitalised with coronavirus disease 2019 at the Eastern Regional Hospital, Koforidua in Ghana. Methods We reviewed medical records of 301 coronavirus disease 2019 patients who were admitted at the Eastern Regional Hospital, Koforidua between May 5, 2020, and August 31, 2021. Data collected on a pre-designed extraction sheet was processed, entered and analysed using Microsoft excel 2019 and Stata/IC version 16.1 software. Prevalence of fever was estimated and a multivariable logistic regression model was fitted to establish risk factors associated with fever among hospitalised coronavirus disease 2019 patients. A relationship was accepted to be significant at 5% level of significance. Results The prevalence of fever among hospitalised coronavirus disease 2019 patients was 21.6% (95% CI, 17.1%-26.7%). Risk factors associated with fever were age group [0–19 years (AOR, 5.75; 95% CI, 1.46–22.68; p = 0.013); 20–39 years (AOR, 3.22; 95% CI, 1.42–7.29; p = 0.005)], comorbidity (AOR, 2.18; 95% CI, 1.04–4.59; p = 0.040), and disease severity [moderate (AOR, 3.89; 95% CI, 1.44–10.49; p = 0.007); severe (AOR, 4.08; 95% CI, 1.36– 12.21; p = 0.012); critical (AOR, 4.85; 95% CI, 1.03–22.85; p = 0.046)]. Conclusions The prevalence of fever was low among hospitalised coronavirus disease 2019 patients at the Eastern Regional Hospital, Koforidua. However, there was an increasing risk of fever as the disease severity progresses. Fever screening may be utilised better in disease of higher severity; it should not be used alone especially in mild disease.Item The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana(GLOBAL HEALTH ACTION, 2024) Lulea, S.A.; Arhinful, D.; Awuah, R.; et al.Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual awareness Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed-methods study that aims to understand diabetes in the Ga Mashie area of Accra and identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.Item Maternal health care utilization following the implementation of the free maternal health care policy in Ghana: analysis of Ghana demographic and health surveys 2008–2014(BMC Health Services Research, 2024) Adane, F.; Azaare, J.; Hushie, M.; et alBackground In July 2008, Ghana introduced a ‘free’ maternal health care policy (FMHCP) through the national health insurance scheme (NHIS) to provide comprehensive antenatal, delivery and post-natal care services to pregnant women. In this study, we evaluated the ‘free’ policy impact on antenatal care uptake and facility-level delivery utilization since the policy inception. Methods The study used two rounds of repeated cross-sectional data from the Ghana Demographic and Health Survey (GDHS, 2008–2014) and constructed exposure variable of the FMHCP using mothers’ national health insurance status as a proxy variable and another group of mothers who did not subscribe to the policy. We then generated the propensity scores of the two groups, ex-post, and matched them to determine the impact of the ‘free’ maternal health care policy as an intervention on antenatal care uptake and facility-level delivery utilization, using probit and logit models. Results Antenatal care uptake and facility-level delivery utilization increased by 8 and 13 percentage points difference, observed coefficients; 0.08; CI: 95% [0.06–0.10]; p < 0.001 and 0.13; CI: 95% [0.11–0.15], p < 0.001, respectively. Pregnant women were 1.97 times more likely to make four plus [a WHO recommended number of visits at the time] antenatal care visits and 1.87 times more likely to give birth in a health care facility of any level in Ghana between 2008 and 2104; aOR = 1.97; CI: 95% [1.61–2.4]; p < 0.001 and aOR = 1.87; CI: 95% [1.57–2.23]; p < 0.001, respectively. Conclusions Antenatal care uptake and facility-level delivery utilization improved significantly in Ghana indicating a positive impact of the FMHCP on maternal health care utilization in Ghana since its implementation.Item Assessing Forest Species Diversity in Ghana’s Tropical Forest Using PlanetScope Data(Remote Sensing, 2024) Njomaba, E.; Ofori, J.N.; Aikins, B.E.; et al.This study utilized a remotely sensed dataset with a high spatial resolution of 3 m to predict species diversity in the Bobiri Forest Reserve (BFR), a moist semi-deciduous tropical forest in Ghana. We conducted a field campaign of tree species measurements to achieve this objective for species diversity estimation. Thirty-five field plots of 50 m × 20 m were established, and the most dominant tree species within the forest were identified. Other measurements, such as diameter at breast height (DBH ≥ 5 cm), tree height, and each plot’s GPS coordinates, were recorded. The following species diversity indices were estimated from the field measurements: Shannon–Wiener (H′ ), Simpson diversity index (D2 ), species richness (S), and species evenness (J ′ ). The PlanetScope surface reflectance data at 3 m spatial resolution was acquired and preprocessed for species diversity prediction. The spectral/pixel information of all bands, except the coastal band, was extracted for further processing. Vegetation indices (VIs) (NDVI—normalized difference vegetation index, EVI—enhanced vegetation index, SRI—simple ratio index, SAVI—soil adjusted vegetation index, and NDRE—normalized difference red edge index) were also calculated from the spectral bands and their pixel value extracted. A correlation analysis was then performed between the spectral bands and VIs with the species diversity index. The results showed that spectral bands 6 (red) and 2 (blue) significantly correlated with the two main species diversity indices (S and H′ ) due to their influence on vegetation properties, such as canopy biomass and leaf chlorophyll content. Furthermore, we conducted a stepwise regression analysis to investigate the most important spectral bands to consider when estimating species diversity from the PlanetScope satellite data. Like the correlation results, bands 6 (red) and 2 (blue) were the most important bands to be considered for predicting species diversity. The model equations from the stepwise regression were used to predict tree species diversity. Overall, the study’s findings emphasize the relevance of remotely sensed data in assessing the ecological condition of protected areas, a tool for decision-making in biodiversity conservation.