Research Articles

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A research article reports the results of original research, assesses its contribution to the body of knowledge in a given area, and is published in a peer-reviewed scholarly journal. The faculty publications through published and on-going articles/researches are captured in this community

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    Exploring barriers to accessing physiotherapy services for stroke patients at Tema general hospital, Ghana
    (Archives of Physiotherapy, 2017) Nketia-Kyere, M.; Aryeetey, G.C.; Nonvignon, J.; Aikins, M.
    Background: Physiotherapy has been shown to reduce the risk of disability among stroke patients. Poor adherence to physiotherapy can negatively affect outcomes and healthcare cost. However, very little is known about barriers especially to physiotherapy services in Ghana. The objective of this study was to assess the barriers to physiotherapy services for stroke patients at Tema General Hospital (TGH). The individual/personal and health system barriers to physiotherapy services at TGH were determined. Method: A cross-sectional study design was employed. A simple random sampling technique was used to recruit 207 respondents for a face-to-face interview. Interviewer-administered questionnaires were used to collect data on individual/personal barriers of respondents to physiotherapy services and were described using the Likert’s scale. Health system barriers were assessed using a self-structured questionnaire which had section under the following heading: human factors, physiotherapy modalities, physical barriers and material/equipment factors. The time spent waiting for physiotherapy and attitude of physiotherapist towards patients; physiotherapy modality such as electrotherapy, exercise therapy and massage therapy among others were some of the indices measured. Respondents’ adherence to Medication was assessed with the Morisky 8-item medication adherence questionnaire. Data were entered and analysed using Epi info 7 and STATA 12.0. Associations between the variables were determined using a chi-square test and logistic regression model was used to test the strength of associations between the independent and the dependent variables. The level of statistical significance was set at p < 0.05. Results: The results showed that majority (76.3%) of the respondents had economic barrier as their main individual/ personal barrier to physiotherapy services. For medication adherence level, patients with low medication adherence level were about 21 times the odds of defaulting on accessing physiotherapy services five times or more as compared to those with medium adherence level (OR 20.63, 95% CI 8.96, 42.97). It was concluded in the study that individual/ personal barriers of stroke patients were the significant barriers to accessing physiotherapy services at Tema General Hospital.
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    Economic Analysis of Health Inequality Among the Elderly in Ghana
    (Journal of Population Ageing, 2020) Fonta, C.L.; Nonvignon, J.; Aikins, M.; Nonvignon, J.; Aryeetey, G.C.
    In Ghana, the ageing population is growing at a fast pace amidst challenging socioeconomic environment. As such, the health of elderly persons in Ghana is of emerging concern and of high priority to the Government. In this study, we seek to measure health inequality among elderly persons in Ghana to determine its existence and explore the factors driving it. Data for the study were drawn from the World Health Organization (WHO)‘s Study on Global Ageing and Adult Health (SAGE Wave 1) and analyzed using STATA and a Distributive Analysis Stata Package (DASP) installed in STATA. Health inequality was measured using concentration curves and concentration index (CI). Furthermore, a regression-based approach was used to determine factors associated with health inequality and their estimated contributions to health inequality. The CI for poor SRH was −0.059 indicating greatest poor health among the poor. The highest contributors to health inequality were presence of at least a chronic condition (63.4%), followed by the age group 70 years and above (26.6%), being single (13.9%), poor (3.9%) and uneducated (0.3%). The probability of reporting poor health was higher with increasing age (Coeff = 0.27, p < 0.05), having at least a chronic condition (Coeff = 0.34, p < 0.05), being single (Coeff = 0.14, p < 0.05) and being poor (Coeff = 0.17, p < 0.05). The results show that health inequality exists among the elderly in Ghana and that poor health was greatest among the poor. Socioeconomic, demographic and health related factors are associated with health inequality.
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    Characterization of functional disability among older adults in Ghana: A multi-level analysis of the study on global ageing and adult health (SAGE) Wave II
    (PLOS ONE, 2022) Darkwah, K.A.; Iddi, S.; Nonvignon, J.; Aikins, M.
    Background Functional disability is a common public health problem that affects the health and quality of life of older adults. This causes them to be highly dependent on other members of their fam ily, receive home care, or to be institutionalized. Although functional disability has been widely studied in developed country settings, very limited studies have focused on age related functional disability in sub-Saharan Africa, and in particular Ghana. The purpose of this study is to assess various factors associated with the difficulties in performing basic and instrumental activities of daily living among older adults in Ghana. Methods This cross-sectional study used data on 1610 older adults aged 50 years and above from the Study on Global Ageing and Adult Health (SAGE) survey Wave II conducted in Ghana. Nine standard functioning difficulty tools of WHODAS II was used for the analysis. The WHODAS II offers continuous summary scores with higher scores showing higher disability, and vice versa. A multi-level regression model was used to identify individual and household level risk factors linked to the functional disability of older adults. Results Female older adults (53.7%) reported having functional disability. The mean functional dis ability among older adults aged 50 years and above was 5.2 (± 5.9). Results indicated that older adults who are females, aged 70 years and above, and had three or more chronic con ditions had a higher functional disability. Also, older adults who have adequate fruit intake and belong to wealthier households were found to have a lower functional disability. Conclusions The study reveals that functional disability among older adults is frequent in Ghana and is associated with having three or more chronic conditions and being overweight/obese. Pre vention of functional disability in old age in Ghana is therefore a matter of great social and economic concern, which calls for coordinate efforts across the board to mitigate this public health challenge
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    Responses to donor proliferation in Ghana’s health sector: a qualitative case study
    (Bull World Health Organ, 2015) Pallas, S.W.; Nonvignon, J.; Aikins, M.; Ruger, J.P.
    Objective To investigate how donors and government agencies responded to a proliferation of donors providing aid to Ghana’s health sector between 1995 and 2012. Methods We interviewed 39 key informants from donor agencies, central government and nongovernmental organizations in Accra. These respondents were purposively selected to provide local and international views from the three types of institutions. Data collected from the respondents were compared with relevant documentary materials – e.g. reports and media articles – collected during interviews and through online research. Findings Ghana’s response to donor proliferation included creation of a sector-wide approach, a shift to sector budget support, the institutionalization of a Health Sector Working Group and anticipation of donor withdrawal following the country’s change from low income to lower-middle income status. Key themes included the importance of leadership and political support, the internalization of norms for harmonization, alignment and ownership, tension between the different methods used to improve aid effectiveness, and a shift to a unidirectional accountability paradigm for health-sector performance. Conclusion In 1995–2012, the country’s central government and donors responded to donor proliferation in health-sector aid by promoting harmonization and alignment. This response was motivated by Ghana’s need for foreign aid, constraints on the capacity of governmental human resources and inefficiencies created by donor proliferation. Although this decreased the government’s transaction costs, it also increased the donors’ coordination costs and reduced the government’s negotiation options. Harmonization and alignment measures may have prompted donors to return to stand-alone projects to increase accountability and identification with beneficial impacts of projects.
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    Injuries and their related household costs in a tertiary hospital in Ghana
    (African Journal of Emergency Medicine, 2020) Blankson, P-K.; Nonvignon, J.; Aryeetey, G.; Aikins, M.
    Introduction: Injuries remain a leading cause of death in many developing countries, accounting for more deaths than HIV, tuberculosis, and malaria combined. This study set out to determine the associated patient costs of reported injury cases at the Accident and Emergency Department of the Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana. Method: A cross-sectional retrospective Cost-of-Illness study of 301 sampled patients was undertaken, following a review of injured patients' records from January–December 2016. Direct cost, (consisting of consultation, surgery, medicines, transportation, property damage, food and consumables) was estimated. Indirect cost was calculated using the Human capital approach. Intangible cost was assessed using Likert scale analysis. The overall household cost, average cost of various injuries and intangible costs were determined. Results: The total annual household cost of injuries to patients who attended KBTH was US$11,327,461.96, of which 82% was the direct cost. The average household cost of injuries was US$ 1276.15. All injuries recorded some level of high intangible cost but was exceptional for burns. Conclusion: Injured patients incur high direct treatment cost in all aetiology, with generally high intangible cost as well. It is therefore imperative that injury prevention strategies be prioritized in national health policies, while broader discussions continue on sustainable health financing of injury management.
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    Capacity building for implementation research: a methodology for advancing health research and practice
    (Health Research Policy and Systems, 2020-06-01) Dako-Gyeke, P.; Asampong, E.; Afari, E.; Launois, P.; Ackumey, M.; Opoku-Mensah, K.; Dery, S.; Akweongo, P.; Nonvignon, J.; Aikins, M.
    Background Implementation research is increasingly being recognised as an important discipline seeking to maximise the benefits of evidence-based interventions. Although capacity-building efforts are ongoing, there has been limited attention on the contextual and health system peculiarities in low- and middle-income countries. Moreover, given the challenges encountered during the implementation of health interventions, the field of implementation research requires a creative attempt to build expertise for health researchers and practitioners simultaneously. With support from the Special Programme for Research and Training in Tropical Diseases, we have developed an implementation research short course that targets both researchers and practitioners. This paper seeks to explain the course development processes and report on training evaluations, highlighting its relevance for inter-institutional and inter-regional capacity strengthening. Methods The development of the implementation research course curriculum was categorised into four phases, namely the formation of a core curriculum development team, course content development, internal reviews and pilot, and external reviews and evaluations. Five modules were developed covering Introduction to implementation research, Methods in implementation research, Ethics and quality management in implementation research, Community and stakeholder engagement, and Dissemination in implementation research. Course evaluations were conducted using developed tools measuring participants’ reactions and learning. Results From 2016 to 2018, the IR curriculum has been used to train a total of 165 researchers and practitioners predominantly from African countries, the majority of whom are males (57%) and researchers/academics (79.4%). Participants generally gave positive ratings (e.g. integration of concepts) for their reactions to the training. Under ‘learnings’, participants indicated improvement in their knowledge in areas such as identification of implementation research problems and questions. Conclusion The approach for training both researchers and practitioners offers a dynamic opportunity for the acquisition and sharing of knowledge for both categories of learners. This approach was crucial in demonstrating a key characteristic of implementation research (e.g. multidisciplinary) practically evident during the training sessions. Using such a model to effectively train participants from various low- and middle-income countries shows the opportunities this training curriculum offers as a capacity-building tool.
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    Economic Burden of Motorcycle Accidents in Northern Ghana
    (Ghana medical journal, 2011-12) Kudebong, M.; Wurapa, F.; Nonvignon, J.; Norman, I.; Awoonor-Williams, J.K.; Aikins, M.
    Background: Motorcycles are the most popular means of transportation in northern Ghana, and their accidents are major causes of out-patient attendance and admis-sions in the Bolgatanga Municipality. Objective: This paper estimates the economic burden of motorcycle accidents in the Bolgatanga Municipality in Northern Ghana. Design: Retrospective cross-sectional cost study. Methods: Data were collected from Drivers and Vehi-cle Licensing Authority, the Police, health facilities and motorcycle accident victims. Both quantitative and qualitative approaches were used for data collection. Cost analysis was based on the standard road accident cost conceptual framework. Results: Ninety-eight percent of vehicles registered in the municipality in 2004 – 2008 were motorcycles. The motorcycles were significantly more than the cars reg-istered. The economic burden of motorcycle accidents was estimated to be about US$1.2 million, of which, 52% were accident-related costs (i.e. property damage and administration) and 48% casualty-related costs (i.e. medical costs, out-of-pocket expenses, lost labour out-puts, intangible costs and funeral expenses). Most mo-torcycle accident victims were in their productive ages and were males. Only a third of the motorcycles were insured. Majority of the riders (71%) did not possess valid driving license and would want to avoid the po-lice. Main motorcycle injuries were head injuries, frac-tures, lacerations and contusions. Majority of the acci-dents were caused by lack of formal motorcycle riding training, abuse of alcohol, unrestrained animals and donkey carts. Conclusion: Motorcycle accidents could be reduced through law enforcement, continuous mass education and helmet use.
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    Sociodemographic determinants of health insurance enrolment and dropout in urban district of Ghana: a cross-sectional study
    (Health Economics Review, 2019-06-27) Nonvignon, J.; Nsiah-Boateng, E.; Aryeetey, G.C.; Salari, P.; Tediosi, F.; Akweongo, P.; Aikins, M.
    Background: Earlier studies have found significant associations between sociodemographic factors and enrolment in the National Health Insurance Scheme (NHIS) in Ghana. These studies were mainly household surveys in relatively rural areas with high incidence of poverty. To expand the scope of existing evidence, this paper examines policy design factors associated with enrolment and dropout of the scheme in an urban poor district using routine secondary data. Methods: This study is a cross-sectional quantitative analysis of 2014–2016 NHIS enrolment data of the Ashiedu Keteke district office. Descriptive and multivariate logistic regression analyses were performed to examine sociodemographic factors associated with NHIS enrolment and dropout. Results: A total of 215,724 individuals enrolled in the NHIS over the period under study, of which 98,232 (46%) were new members. About 41% of existing members in 2014 dropped out of the NHIS in 2015 and 53% of those in 2015 dropped out in 2016. The indigents (core poor) are significantly more likely to enrol and to drop out of the NHIS. However, the males, informal sector employees, social security and national insurance trust (SSNIT) contributors, and the aged (70+ years) are significantly less likely to enrol in the NHIS but more likely to retain coverage. Conclusions: A considerable number of members are dropping out of the NHIS. The indigents in particular, are increasingly enrolling in and dropping out of the NHIS whilst the males, informal sector employees, SSNIT contributors and the aged are not enrolling as expected but increasingly retaining coverage. Policy reforms to ensuring continued growth towards realization of universal health coverage should take these factors into consideration.
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    Predictors of self-reported health among the elderly in Ghana: A cross sectional study
    (BMC Geriatrics, 2017) Fonta, C.L.; Nonvignon, J.; Aikins, M.; Nwosu, E.; Aryeetey, G.C.
    Background: Self-reported health is a widely used measure of health status across individuals. As the ageing population increases, the health of the elderly also becomes of growing concern. The elderly go through life facing social, economic and financial hardships. These hardships are known to affect the health status of people as they age. The purpose of this study is to assess social and health related factors of self-reported health among the elderly in Ghana. Methods: A multivariate regression analysis in form of a binary and ordinal logistic regression were used to determine the association between socioeconomic, demographic and health related factors, on self-reported health. The data used for this study was drawn from the World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE) Wave 1. Results: In total, out of 2613 respondent, 579 (20.1%) rated their health status as poor and 2034 (79.9%) as good. The results showed that the odds of reporting poor health was 2.5 times higher among the old-old compared to the young old. The elderly with one or more than one chronic condition had the odds of 1.6 times and 2 times respectively, of reporting poor health. Engaging in mild to moderate exercise increased the chances of reporting poor health by 1.8 times. The elderly who had never worked in a lifetime were 2 times more likely to report poor health. In the same way, residents of Eastern and Western parts of Ghana were 2 times more likely to report poor health compared to those in the Upper West region. Respondents with functional limitations and disabilities were 3.6 times and 2.4 times respectively, more likely to report poor health. On the other hand, the odds of reporting poor health was 29, 36 and 27% less among respondents in the highest income quintiles, former users of tobacco and those satisfied with certain aspects of life respectively. Also, current alcohol users were 41% less likely to report poor health. Conclusion: The health status of the elderly is to an extent determined by the circumstances in which they are born, grow and live. The findings suggest that addressing social issues faced by individuals in youthful age will go a long way to achieving good health in the future. People with physical limitations and disabilities are most vulnerable to unmet healthcare needs and support system from government, policy makers and family. © 2017 The Author(s).
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    Economic Cost and Quality of Life of Family Caregivers of Schizophrenic Patients Attending Psychiatric Hospitals in Ghana
    (BMC Health Services Research, 2017-11) Opoku-Boateng, Y.N.; Kretchy, I.A.; Aryeetey, G.C.; Dwomoh, D.; Decker, S.; Agyemang, S.A.; Tozan, Y.; Aikins, M.; Nonvignon, J.
    Background Low and middle income countries face many challenges in meeting their populations’ mental health care needs. Though family caregiving is crucial to the management of severe mental health disabilities, such as schizophrenia, the economic costs borne by family caregivers often go unnoticed. In this study, we estimated the household economic costs of schizophrenia and quality of life of family caregivers in Ghana. Methods We used a cost of illness analysis approach. Quality of life (QoL) was assessed using the abridged WHO Quality of Life (WHOQOL-BREF) tool. Cross-sectional data were collected from 442 caregivers of patients diagnosed with schizophrenia at least six months prior to the study and who received consultation in any of the three psychiatric hospitals in Ghana. Economic costs were categorized as direct costs (including medical and non-medical costs of seeking care), indirect costs (productivity losses to caregivers) and intangible costs (non-monetary costs such as stigma and pain). Direct costs included costs of medical supplies, consultations, and travel. Indirect costs were estimated as value of productive time lost (in hours) to primary caregivers. Intangible costs were assessed using the Zarit Burden Interview (ZBI). We employed multiple regression models to assess the covariates of costs, caregiver burden, and QoL. Results Total monthly cost to caregivers was US$ 273.28, on average. Key drivers of direct costs were medications (50%) and transportation (27%). Direct costs per caregiver represented 31% of the reported monthly earnings. Mean caregiver burden (measured by the ZBI) was 16.95 on a scale of 0–48, with 49% of caregivers reporting high burden. Mean QoL of caregivers was 28.2 (range: 19.6–34.8) out of 100. Better educated caregivers reported lower indirect costs and better QoL. Caregivers with higher severity of depression, anxiety and stress reported higher caregiver burden and lower QoL. Males reported better QoL. Conclusions These findings highlight the high household burden of caregiving for people living with schizophrenia in low income settings. Results underscore the need for policies and programs to support caregivers.