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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Item Socio-economic differences in cost of pregnancy-related health services in the peri-urban Accra, Ghana(Journal of Public Health, 2014) Aikins, M.; Aryeetey, R.; Dako-Gyeke, P.; et al.Background Financial and physical barriers are known to limit access to maternal health services in developing countries. These limitations are often compounded by the low socio-economic status of women. This study examined socio-economic differences in health services costs incurred by pregnant women. Methods A cross-sectional cost survey of 300 women who had delivered a live birth in the last 12 months was undertaken. Results Majority of the women were aged between 20 and 39 years. About 63% of the women claimed they were registrants of the National Health Insurance Scheme (NHIS). However, only 64% of them provided valid NHIS identification cards. There were relatively more insured women in the rich quintiles (44%) compared with insured women in the poor quintiles (33%). Generally, women who were in the rich quintile incurred the highest average medical and non-medical costs, spent the highest time before service provision, and lost the highest average incomes. Conclusions Women's socio-economic differences play a critical role in access to health services. We recommend that awareness campaigns on the NHIS must be intensified. The Ghana Health Services through its Community-based Health Planning Service should carefully structure its home visits to cover education on pregnancy-related health services.Item Pathways Utilized For Antenatal Health Seeking Among Women In The Ga East District, Ghana(Ghana Medical Journal, 2015) Aryeetey, R.N.O.; Aikins, M.; Dako-Gyeke, P.; Adongo, P.B.Background: Ghana’s maternal mortality ratio has been declining over the last two decades but at a rather slow pace. Poor access to effective maternity care is identified as one of the key challenges of maternity care. The current study mapped out the pathways to pregnancy care seeking among urban-dwelling adult women in a peri-urban district located in the Greater Accra region of Ghana. Methods: A total of 300 women who had a live birth in the last 12 months participated in a community-based survey. They answered questions on care-seeking behavior related to their last pregnancy. A multivariate A logistic regression model was used to identify factors associated with multiple care-seeking behavior. Results: Almost all women in the survey (98%) reported accessing skilled antenatal care (ANC) from a bio-medical provider, although 35% began ANC later than the first trimester. About 45% of women simultaneously utilized both ANC and alternative care providers (ACP) including traditional birth attendants, herbalists, and spiritualists. A complex pathway to antenatal care seeking behavior involving shuttling between providers was observed. Controlling for household wealth, household size, and age, seeking care from multiple providers concurrently were associated with residence in Kwabenya sub-district OR=2.13 (95% CI: 1.28, 3.55) and previous abortion OR=2.08 (95% CI: 1.11, 3.91) Conclusions: Urban-dwelling women in Ga East Dis trict seek antenatal care concurrently from multiple sources. Health system interventions must seek ways to integrate alternative care providers into the existing biomedical health care system.Item Capacity for optimal performance of healthcare supply chain functions: competency, structural and resource gaps in the Northern Region of Ghana(Journal of Health Organization and Management, 2020) Atinga, R.A.; Dery, S.; Katongole, S.P.; Aikins, M.Purpose – The study drew on capacity framework around the individual, organisational, health system and wider context to explore gaps in health supply chain (HSC) workers capacity and competency to perform supply chain (SC) functions and the lessons for workforce development. Design/methodology/approach – A mixed-method study was conducted across the Northern Region of Ghana. Qualitative data were collected from in-depth interviews with 34 key SC managers at the regional, district and facility levels. A semi-structured questionnaire was administered through the RedCap mobile app to 233 core HSC workers and non-core workers (clinicians with additional responsibilities in SC). Data were managed and analysed inductively and deductively for themes. Findings – Weak knowledge and competency in SC functions attributed to poor training exposure and organisational support for capacity building, undermined the capacity to perform basic SC functions, especially by the non-core category. The policy and regulatory environment of the HSC marketplace were described as fluid and with complexity of demands. Both worker categories, therefore, requested functional, technical, managerial and customer care competencies to anticipate and manage complexities. Structural characteristics of the health system giving narrow decision space to HSC workers cascaded the capacity for innovation and initiative and promoted frustrations among mid-level managers. Infrastructural deficits and shortfalls in operational resources scaled back the capacity to efficiently manage inventory and ensure that commodities reach clients in good qualityItem 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 An Exploratory Study of Physical Activity and Over Weighti Two Senior High Schools in The Accra Metropolis(GHANA MEDICAL JOURNAL, 2013) Nyawornota, V.K.; Aryeetey, R.; Bosomprah, S.; Aikins, M.Background: Overweight and physical inactivity are major risk factors for non-communicable diseases. However, little evidence on physical activity, and overweight exists to support intervention in specific sub-populations including adolescents in low-income settings like Ghana. This study aimed at estimating overweight and determining the pattern and level of physical activity among senior high school students in the Accra Metropolis. Methods: A cross-sectional study was conducted in the Accra Metropolis, among senior high school students, ages 15 to 19 years. Participants were selected using a two-stage cluster sampling technique. Structured ques tionnaire and anthropometric measurement were em ployed to gather information for the study. Students were considered as overweight if their Body Mass In dex (BMI) ≥ +1SD, and obese if BMI ≥ +2SD. Results: Out of 444 students, 17% were classified as engaging in low level physical activity, 49% in moder ate activity, and 34% in high level of physical activity. Much of the activity in boys was recreational while among girls, was due to domestic chores. The preva lence of overweight was 11.7%. Overweight preva lence was higher among female students (15.6%) com pared to 4.5% in males. Furthermore the risk of over weight was lower among students who engaged in high physical activity than those engaged in low activity. Overweight was independently associated with physi cal activity (p=0.01), sex (p=0.001) and age (p=0.01), after controlling for age sex and physical activity and diet. Conclusion: Majority of students in the study engaged in moderate to high physical activity. The prevalence of overweight was 11.7%. Physical activity was sig nificantly related to overweight among students in the study.Item 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.Item 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.Item 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 challengeItem 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.Item 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.