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Item A cross-sector approach to explore socio-ecological associations with treatment engagement behaviours in Northern Ghana(Journal of Cancer Policy, 2024-07-14) Tuck,C.; Gray,L.; Suraj,H.; Timtoni,A.R.I.; Tampuri,A.R.; Aryeetey,R.; Braimah,A.B.; Akparibo,R.; Cooper,R.Background: Cancer presents a growing global burden, not least in African countries such as Ghana where high cancer treatment dropouts has been identified due to numerous social, cultural and financial reasons. There is little understanding regarding patterns of treatment access behaviour, especially in Northern Ghana, which this study was designed to explore. Methods: Through cross-sector collaboration, we extracted and clinically validated cancer patient records available in the Tamale Teaching Hospital. These were analysed descriptively and through multi-variate logistic regression. A treatment mapping process was also applied to highlight challenges in data collection. Multiple imputation with chained equations was conducted for high levels of missing data. Sensitivity analysis was applied to assess the impact of missing data. Results: Treatment drop-out was high even when uncertainty due to missing data was accounted for, and only 27 % of patients completely engaged with treatment. High drop-out was found for all cancers including those covered by the Ghana National Health Insurance scheme. Multi-variate logistic regression revealed that social, health condition and systemic factors influence treatment engagement until completion. High missing data was observed for liver, ovarian, colorectal, gastric, bladder, oesophageal and head and neck and skin cancers, and soft tissue sarcomas, which limited model fitting. Conclusion: Treatment drop-out is a critical issue in Northern Ghana. There was high missing data due to the dynamic, complex and decentralised treatment pathway. Future studies are needed to understand the complex challenges in data recording. Policy summary: Treatment drop out is a pertinent issue that policy makers should look to address. Further discussion with stakeholders involved in cancer treatment and data collection is required to better understand challenges to routine data collection in the local setting. This will allow policy to be designed to cater for the impact of multiple intersecting health and social factors on treatment completion.Item Adverse Events Following Immunization With Newly Introduced Covid-19 Vaccine For Persons Who Have Received At Least One Dose, Awutu Senya East Municipality, Central Region, Ghana(University of Ghana, 2021-12) Buabeng, R.O.Introduction: Vaccines are a critical public health tool in the fight against the COVID-19 pandemic. COVISHIELD, a recombinant simian adenovirus-based COVID-19 vaccine, had been granted emergency use authorization in Ghana. Because the vaccine’s early phase trials were not conducted in Ghanaians, no adverse events following immunization (AEFIs) linked to the vaccination had been identified among Ghanaians prior to the vaccine’s deployment on March 2, 2021. This study aimed to assess the AEFIs of COVISHIELD in the Awutu Senya East Municipality (ASEM). Methods: A prospective observational follow-up study was conducted from August to October 2021 among vaccinees aged 18 years and above. Those who consented were enrolled and subsequently followed up for adverse events within 24 hours and on days 7, 21, and 56 after the immunization. Participants were recruited from all 5 sub-municipalities in ASEM. Data was collected through face-to-face administration of questionnaires to participants at the point of enrolment. Follow-ups were done post-vaccination via telephone calls. Adverse events were coded using the Medical Dictionary for Regulatory Activities (MedDRA 23). According to the Division of AIDS (DAIDS Version 2.1), adverse events were assessed for severity. Data was input into Excel, cleaned, and exported to STATA I/C 16 (Stata Corp LLC, Texas, USA) for analysis. Cumulative AEFI incidence was described across sociodemographic study participant variables. A 95% confidence interval was also determined for the cumulative incidence of AEFIs across participant characteristics. Pearson's chi-square test was performed to assess the relationship between AEFIs and socio-demographic factors. Approval was granted for the conduct of the study on 2nd August 2021 by the Ghana Health Service Ethics Committee. Results: The overall incidence of AEFIs among the 550 vaccinees who were followed for 56 days was 16.7% (92/550). The incidence was higher in the younger age group. The AEFIs experienced were more severe among participants 60 years and older than in the younger group. Most participants (71.7% [66/92]) who experienced AEFIs had only one event and the AEFIs experienced were mostly Grade 1 – mild (77.2% [71/92]), and Grade 2 – moderate (20.7% [19/92]) severity. No serious AEFIs were reported. More than half (52.2% [48/92]) of those who developed AEFIs observed them by the next day after the vaccination. AEFIs resolved at a median time of 2 days from onset. Asthenia (32.6% [30/92]) was the commonest AEFI, followed by headache (28.3% [26/92]), body pain (18.5% [17/92]), pyrexia (17.4% [16/92]), and injection site pain (17.4% [16/92]). The risk of AEFI incidence among the younger age group (those aged 18 to 29 years and 30 to 39 years) had 4 times increased risk of AEFI compared to older ones (those aged 70 years and over). Also, the risk of AEFI incidence was 56% higher among females than in males. Conclusion: The incidence of AEFIs among the participants in the Awutu Senya East Municipal was relatively low. The events were generally mild and they disappeared quickly without hospitalization. It is, therefore, recommended that the general public get vaccinated through the national COVID-19 vaccination roll-out organized by the Expanded Program on Immunization.Item Depression, Anxiety And Stress Symptoms Among Healthcare Workers Who Recovered From Covid-19 Infection In Selected Healthcare Facilities In The Accra Metropolis(University of Ghana, 2022-07) Esiape, R.Background: The Coronavirus pandemic is causing devastating effects worldwide. While very few studies have shown the effect the pandemic has on the psychological well-being of people, these studies have focused largely on the general human population, neglecting healthcare workers who are at the frontline of the fight against Covid-19. Thus, studies that examine how these pandemic and associated factors affect psychological well-being of healthcare workers who recovered from Covid-19 infection, particularly in a developing country such as Ghana is important for managers to establish or strengthen support systems for these workers. Aim: This study sought to investigate the psychological disorders of heath care workers (HCWs) who recovered from COVID-19 infection in selected healthcare facilities in the Accra Metropolitan area. Method: This study was a cross-sectional one. A standardized questionnaire was used to take information from 120 healthcare professionals at five selected healthcare facilities in the Accra Metropolitan Area of the Greater Accra Region. Multiple logistic regression analysis was conducted to examine factors that were associated with the development of depression, anxiety and stress (psychological disorders). Additionally, test of proportions was conducted to compare psychological experiences among vaccinated and unvaccinated groups. Results: The results of this study show that the prevalence of healthcare workers who survived COVID-19 infection in the study with depressive, anxiety and stress symptoms were 20.8%, 28.3% and 29.1% respectively. Sex, age, marital status, parity average monthly income and having co-morbidities were found to be significantly associated with depressive symptoms, while sex, age, marital status and persistent symptoms of COVID-19 disease were significantly associated with anxiety symptoms. Additionally, sex, marital status, average monthly income and persist symptoms of COVID-19 disease were the factors associated with stress symptoms. Further, healthcare workers who were unvaccinated were more likely to develop anxiety (p<0.05) compared to the vaccinated group but there was no statistically significant association between vaccination status and the development of depression and stress (p>0.05). Conclusion: This study has revealed that the proportion of healthcare workers with depressive, anxiety and stress symptoms was high. This has serious implications on health care delivery in the country. Therefore, consensus efforts should be made by the Ministry of Health and Ghana Health Service to provide mental health support and services for healthcare workers who recover from COVID-19.Item Health Seeking Behaviour And Quality Of Life Among Older Adults In The La-Nkwantanang Madina Municipality(University of Ghana, 2022-06) Apau, S.A.Background: It is projected that 21.1% of the world’s population will be aged 60 years or older by 2050 with 80% of them living in low-and-middle income countries. Aging is a desired process accompanied with health-related challenges and disabilities, which affect the quality of life of the older adults. The health challenges associated with aging require regular health care service utilization. Health seeking behaviour is the act of deciding to seek or not to seek care from qualified medical personnel when not feeling well. This study examined factors associated with health seeking behaviour and quality of life of older adults in the La-Nkwantanang Madina Municipal Area. Objective: The main objective of this study is to examine factors associated with health seeking behaviour and quality of life of older adults in the La-Nkwantanang Madina Municipal Area. Methods: A descriptive cross-sectional study design was employed to examine health seeking behavior and quality of life among older adults aged 60 years and above in the La-Nkwantanang Madina Municipal Area. A multi-stage sampling technique was employed to select participants for the study. Data on quality of life was collected using EQ-5D questionnaire, a standardized measure of health status developed by the EuroQol Group. Face-to-face interviews were carried out among the participants. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 20. Univariate analysis was performed; chi-square test of association done at the bivariate level and logistic regression analysis was done to determine predictors of good health seeking behaviour. Results: A total of 465 older adults were interviewed. The average age of respondents in this study was 76.97±11.38 years old. The majority 371 (80%) were staying with relatives; either their children 205 (55.3%) or partners/spouses 128 (34.5%). Most of them 341 (73.5%) have subscribed to the National Health Insurance Scheme (NHIS) sought care from public health facilities. More than half, 243(52.4%) of the adults sought regular medical check-up. Only 69 (14.9%) resort to self-medication. Respondents between 80-89 years old have 1.6 times the odds of having regular medical check-up compared to those aged 60-69 years old. Education (Χ2=29.967, p<0.001), staying with a relative (Χ2=27.793, p<0.001), profession (Χ2=27.184, p<0.001), receiving income (Χ2=5. 810, p=0.016), subscribing to some health insurance (Χ2=32.974, p<0.001) were significantly associated with positive health seeking behaviour. Adults with health insurance were 8.4 times more likely to go for regular medical check-up than those who were not insured (AOR=8.4, CI: 2.398-29.502). Participants without health insurance were 73% less likely to go for regular medical check-ups than those who have. Older adults who do not receive support from their family members were 59% times less likely to go for regular medical check-ups compared to those who receive support. Older adults who received support from their family members were (AOR=4.3, CI: 1.489-12.441) times more likely to go for regular medical check-up than those without family support. Conclusion: Older adults in the municipality are conscious of their health care needs. More than half of them sought regular medical check-up from public health facilities. Very few resort to self-medication. Families should support the elderly while government enrol them into the NHIS to enable them seeking health care regularly.Item Prevalence And Determinants Of Self-Medication Practices For Covid-19 Prevention Among Public Transport Drivers In La Nkantanang Madina Municipal District(University of Ghana, 2022-04) Forson, R.A.Background: The COVID-19 pandemic is abrupt and has unprecedentedly affected millions of people worldwide. Practices such as proper wearing of face mask, social distancing among other prevention interventions are some recommended mitigating measures. There is an increasing concern about self-medication and consequently, there is a need to respond to self-medicating practice among vulnerable populations such as drivers. The study therefore sought to investigate the prevalence of self-medication practices for COVID-prevention among public transport drivers in La Nkwantanang Madina Municipal District. Methods: The study was a cross-sectional survey using a multistage sampling technique. The data was collected using a semi-structured and pre-tested questionnaire through a face-to-face interview. Further, data was captured using Kobo-Collect and exported to Stata 16 for analysis. Means, standard deviation, proportions, and frequencies were used to summarize continuous and categorical variables. A Chi-square and logistic regression models were used to determine association between independent and dependent variables. A p-value of <0.05 was considered significant statistically. Results: The mean age of the respondents was 35.52. Majority, 243 (66.6%) of the drivers had no alternate occupation. Overall, prevalence of self-medication in the past 2 months to prevent COVID-19 was 9.3% (95% CI: 0.02-0.10). Factors mainly associated with self-medication were a previous experience with COVID-19 symptoms [OR= 6.35(95% CI:3.04 – 13.27); p=<0.001] and presence of a chronic disease [OR=3.32(95% CI: 1.53 – 7.23); p=0.02]. The drugs most commonly used by the drivers to self-medicate were Vitamin C (55%), Ibuprofen (27.5%), Zinc (15%) and Amoxicillin (12.5%). The most predominating herbal product used to prevent COVID-19 was the leaf of the Neem tree (29%). Conclusion: The prevalence of self-medication for COVID-19 prevention among public transport drivers in La-Nkwantanang Madina Municipal District was low. Medicines commonly used by public transport drivers were well known by respondents are easily available on the open market at less expensive rates and so respondents can afford them. It is therefore vital to embark on educational campaigns and strict legislative measures in relation to the dispensing of drugs from private pharmacies and chemical shops and facilitate access to health facilities among other important interventions that may cause a behavior change among respondents.Item Factors Influencing The Interest Of House Officers And Medical Officers In Anaesthesiology Specialty At The Korle-Bu Teaching Hospital(University of Ghana, 2022-03) Seppey, S. A.Introduction: Anaesthesiology is the medical specialty which deals with the pharmacological, physiological, and clinical aspects of anaesthesia, a state of temporary loss of wakefulness or sensation, which is induced for medical purposes. Over the years, the field has failed to attract an adequate number of doctors into its practice though an integral part of the practice of medicine. Aim of The Study: The study assessed the factors affecting the interest of house officers and medical officers in anaesthesiology as a prospective field of specialisation. Methods: The study employed a quantitative research design, in which questionnaires were administered to 192 House officers and medical officers from 5 Departments (Surgery, Medicine, Paediatrics, Obstetrics & Gynaecology and Anaesthesia). The doctors were selected using the stratified random sampling technique. STATA 16 was used to process and analyze the data gathered from the respondents. Descriptive statistics (percentages, means and frequencies) and inferential statistics (chi square and logistic regression) were used for data analysis. Results: Doctors generally had a good perception about anaesthesiology. Also, duration of a specialty, rotation during clinical clerkship and ability to have a controlled lifestyle were some of the factors that influence the interest of doctors in anaesthesiology as a prospective field of specialization. In line with this, respondents between the ages of 25 to 29 years were more likely as compared to those who were less than 25 years to be interested in anesthesiology specialisation [(cOR =4.364; 95% CI =1.202-15.838), (aOR =3.241, 95% CI =1.103-14.72)]. Again, respondents who had practiced medicine for 2 to 4 years were more likely as compared to those who had practiced medicine for less than 2 years to be interested in anaesthesiology specialisation [(cOR =2.143; 95% CI =1.072-4.286), (aOR =1.567, 95% CI =1.013-3.245)]. Conclusion: There is a good perception of medical officers and house officers about anaesthesiology. Likewise, factors such as the duration and level of exposure to the specialty during clinical clerkship and the ability to have a controlled lifestyle and future job prospects are significant in influencing the interest in anesthesiology specialisation. Recommendations: Senior anaesthesiologists and medical schools need to improve the profile of the discipline, by changing the misconceptions attached to it and enhance its appeal to doctors. This can be done by dispelling the notion that anaesthesiology is a risky and dangerous profession during lectures in the medical schoolsItem Multidrug-Resistant Bloodstream Organism Infection At The Neonatal Intensive Care Unit In The Greater Accra Regional Hospital In Ghana(University Of Ghana, 2022) Yeboah, A.OBackground: Antimicrobial drugs since their inception have improved contemporary medicine. Blood stream infections (BSIs) are a significant source of morbidity and mortality among the neonatal population in hospitalized settings with a penchant for Low and middle-income countries (LMICs). Data on newborn BSIs showing Multidrug resistance (MDR) using a mixed technique approach are few. As a result, it has become critical to identify and analyze the scope of this hidden health problem in a vulnerable and at-risk population in order to raise awareness and prompt action. The general objective was to assess the multidrug resistant-organism infections in Neonatal Intensive care unit (NICU) in Greater Accra Regional Hospital in Ghana. Methods: The study was conducted using a mixed method research design at a tertiary level in a neonatal intensive care unit (NICU) in Greater Accra Regional Hospital (GARH), Ghana. All blood cultures taken for newborns admitted to the NICU within the period of 1st June 2020 to 31st May 2021were included. Multidrug resistance (MDR) in BSI rates were analysed, and the effect of antimicrobial resistance (AMR) on outcomes and duration of hospitalization were analysed. Participants in the qualitative study were Neonatal ICU nurses, Microbiologists, and Laboratory technicians. The sampling approach used for interviewing health workers was convenience sampling in view of the tight work scheduled of many of the qualified respondents. All interviews were conducted in the facility with prior notice to the participants. Data was analyzed into proportions as per total sample size. Analyzed data, together with interview findings, together forming quantitative and qualitative data, were compared with the University of Ghana http://ugspace.ug.edu.gh vi secondary data extracted to answer the proposed research questions. P values <0.05 were considered significant. Results: Of 1,043 blood culture samples taken from neonates in the NICU, 195 cultured Multidrug resistant organisms (MDROs). Overall incidence of MDR BSI was 18.7% (195/1043). The predominantly isolated pathogenic organism was Klebsiella spp 31.2% (61/195) and Staphylococcus aureus 20.5% (40/195). Additionally, 38 coagulase negative Staphylococci were isolates. Among the Klebsiella spp resistance to ampicillin, cefotaxime and gentamicin was 72.1%, 39.3% and 52.4%, respectively, while carbapenem resistance was 10.4%. Mortality among neonates with MDR BSI was 26.2% (51/195). Results also indicated that knowledge of MDROs amongst Health care workers and control measures to curtail their development and spread were very general and lacked. Qualitative results also indicated that public education and sensitization at the community level as well as providing a framework and guidelines for antimicrobial stewardship at the facility level is a basic and urgent need in the management of MDR. Conclusion: This study corroborates existing literature, reiterating the urgent need for intervention. The empirical regimen in the setting of low- and middle-income countries such as Ghana is unlikely to lead to advancement substantial enough to improve outcomes associated with MDR BSI. The required improvement would require advancements in various medical fields including improvement in clinical microbiological services.Item Health Behaviour Of Pregnant Women Towards The Pregnancy School In The Greater Accra Regional Hospital(University of Ghana, 2021-09) Egyir, S.C.Antenatal care is viewed as an important point of contact between health workers and women and an opportunity for provision of health education including how to detect pregnancy complications and development of a birth plan to ensure safe delivery at a health facility. Quality antenatal care and education given to pregnant women during antenatal visits could be used as one of the measures to curb maternal mortality since these somewhat preventable maternal deaths have hugely been attributed to the lack of quality contacts between the pregnant women and the professional caregiver. Owing to the fact that little has been done over the years on the health behaviour of pregnant women towards the pregnancy school, the study therefore explored the health behaviour of pregnant women towards the pregnancy school in the Greater Accra Regional Hospital using the theory of Information Motivation-Behavioural-Skill model to guide the research. A qualitative explorative approach was employed. Data were collected from Greater Accra Regional hospital using a purposive sampling method. Fourteen (14) participants who consisted of three (3) pregnant and eleven (11) postpartum women who consented to participate in the study were interviewed face to face using a semi structured interview guide which lasted for 30-45minutes. Data were analysed thematically. Four (4) main themes and eighteen (18) subthemes were formulated from the constructs of the IMB model and the objectives of the study. The results of the study emphasized that, the participants found the information given at the classes to be very useful and had concerns with the time frame of the classes. The findings suggest that although the pregnancy school is a good initiative all stakeholders should support in order to improve it. Future research should focus on the information needs of the husbands and partners attending pregnancy schools.Item Male Involvement In Family Planning: Perspective Of Men In The Bawku West District(University of Ghana, 2022-08) Sulley, R.R.Background: An efficient way of managing fertility is through the practice of family planning. Low fertility results in slower population growth. Family planning has long been recognized as an efficient intervention in public health, extremely cost-effective in reducing the burden of disease on maternal and child health. Male involvement in family planning is not a new discovery to the field of public health. Even though contraceptive prevalence rate is high, 32% of women in the district wants to take up more methods. The women in Bawku West District are unable to assess family planning because male partners are not involved. This is a major public health concern and needs further investigation. Methods: The study was a qualitative study using a phenomenology approach. Data were collected using focus group discussion and in-depth interviews. The study participant was made up of married and cohabiting men aged 18 to 59 years living in the Bawku West District. Purposive sampling technique was employed for the selection of participants. Two sub districts were chosen (1 urban and 1 rural, for fair distribution of participants) and the nature of the phenomenon examined among them. Interviews were audio-recorded, and the tape were transcribed verbatim and the resulting texts analysed using thematic analysis. Results: Out of the 51 men that took part in the study, majority were young men between the ages of 18 to 32 years. Findings from the study revealed that health service factors such as accessible, distance to health facility and cost are major factors that deter men from participating in family planning services The study also revealed that though men were more knowledgeable about family planning and its methods did not reflect in their participation in family planning services in the district. Conclusion: Though men in the Bawku West district had appreciable knowledge on family planning, they are unwilling to practice it because of sociocultural, individual characteristics and health service factors. The study recommends that there should be variety of methods for men to choose from.Item Emergency Contraceptive Use Among Female Students At The Ghana Institute Of Journalism(University of Ghana, 2022-10) Effah, R.A.P.Introduction: Emergency contraceptives prevent pregnancy after unprotected intercourse including sexual assault. Unwanted pregnancy as well as the health issues that are associated with it including maternal and infant mortality can be mitigated with the proper use of emergency contraceptives. Unsafe abortions could also be avoided with adequate knowledge and the correct use of emergency contraceptives. Many university students engage in a variety of risky sexual behaviour that sometimes results in unwanted pregnancies. Aim: To determine the use of emergency oral contraceptives among female students at the Ghana Institute of Journalism Methods: A descriptive cross-sectional survey was employed in the study with 348 females interviewed using self-administered questionnaires. The students were selected from three faculties through multistage sampling. Stata IC version 16 was used to analyse the data. Frequencies and percentages were used to describe the characteristics of the respondents. Pearson’s chi-square test was used to assess the association between the emergency contraceptive use and the independent variables of interest. Logistics regression was also used to estimate the crude and adjusted odds ratios. Results: Findings of the research showed that out of 348 respondents, 68.1% had ever heard of emergency contraceptives with majority having low knowledge of emergency contraceptives. The number of participants who had ever had sex were 228 and out of this number 80.7% had ever used emergency contraceptives. The barriers to the use of ECs included fear of being seen by friends, acquaintances and parents, dreading side effects, religious opposition, and embarrassment to buy from health workers. Being in an intimate relationship and having multiple casual partners was associated with use of ECs. (AOR: 3.19, 95% CI: 2.97-9.78, p=0.005) and (AOR: 1.43, 95% CI: 1.52-5.98, p=0.018) respectively. Conclusion: Majority of the females had heard of emergency contraceptives but only few had adequate knowledge of its correct use. There should be inter-sectoral collaboration between the Ministry of Health and the Ministry of Education to ensure students are correctly informed about emergency contraceptives.