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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    Health service utilization and direct healthcare costs associated with obesity in older adult population in Ghana
    (Health Policy and Planning, 2020-03) Aikins, M.; Lartey, S.T.; de Graaff, B.; Magnussen, C.G.; Boateng, G.O.; Minicuci, N.; Kowal, P.; Si, L.; Palmer, A.J.
    Obesity is a major risk factor for many chronic diseases and disabilities, with severe implications on morbidity and mortality among older adults. With an increasing prevalence of obesity among older adults in Ghana, it has become necessary to develop cost-effective strategies for its management and prevention. However, developing such strategies is challenging as body mass index (BMI)-specific utilization and costs required for cost-effectiveness analysis are not available in this population. Therefore, this study examines the associations between health services utilization as well as direct healthcare costs and overweight (BMI ≥25.00 and <30.00 kg/m2) and obesity (BMI ≥30.00 kg/m2) among older adults in Ghana. Data were used from a nationally representative, multistage sample of 3350 people aged 50+ years from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE; 2014/15). Health service utilization was measured by the number of health facility visits over a 12-month period. Direct costs (2017 US dollars) included out-of-pocket payments and the National Health Insurance Scheme (NHIS) claims. Associations between utilization and BMI were examined using multivariable zero-inflated negative binomial regressions; and between costs and BMI using multivariable two-part regressions. Twenty-three percent were overweight and 13% were obese. Compared with normal-weight participants, overweight and obesity were associated with 75% and 159% more inpatient admissions, respectively. Obesity was also associated with 53% additional outpatient visits. One in five of the overweight and obese population had at least one chronic disease, and having chronic disease was associated with increased outpatient utilization. The average per person total costs for overweight was $78 and obesity was $132 compared with $35 for normal weight. The NHIS bore approximately 60% of the average total costs per person expended in 2014/15. Overweight and obese groups had significantly higher total direct healthcare costs burden of $121 million compared with $64 million for normal weight in the entire older adult Ghanaian population. Compared with normal weight, the total costs per person associated with overweight increased by 73% and more than doubled for obesity. Even though the total prevalence of overweight and obesity was about half of that of normal weight, the sum of their cost burden was almost doubled. Implementing weight reduction measures could reduce health service utilization and costs in this population.
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    Suicide in ghana: How could the community-based health planning and service (chps) effectively contribute to its prevention?
    (Iran J Public Health, 2019-11) Aikins, M.; Assan, A.; Takian, A.
    Suicide and suicide attempts are significant global public health challenge. Among the most com-mon means of suicide worldwide are pesticide self-poisoning, hanging and firearm use. Regard-ing methods of suicide, studies have identified strong association between suicidal behavior and mental disorders –especially depression and alco-hol use disorders. Further, many suicide cases happen spontaneously due to inabilities to handle life stress which emerge from financial difficul-ties, break-ups from relationships, chronic pain and illness or loss
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    Knowledge and satisfaction of health insurance clients: a cross-sectional study in a tertiary hospital in Ghana
    (Journal of Public Health, 2019-11) Aikins, M.; Nsiah-Boateng, E.; Asenso-Boadi, F.; Andoh-Adjei, F.
    Aim This study assesses client knowledge of, and satisfaction with services under the National Health Insurance Scheme (NHIS) in a tertiary healthcare facility. Subject and methods A cross-sectional exit interview was conducted at the Korle-Bu Teaching Hospital in the Greater Accra region of Ghana. Respondents were classified into various groups based on the number of positive responses obtained for knowledge and satisfaction measures on a 5-point Likert scale. Descriptive statistics and multivariate logistic regression analyses were conducted to test and measure associations between client characteristics, their knowledge of the NHIS, and satisfaction with services. Results Two hundred and four clients participated in the study, representing a 97% response rate. Seventy-nine clients (39%) had more knowledge of the NHIS, 115 (56%) were more satisfied with NHIS services, and 200 (98%) were more satisfied with healthcare services. Factors including education and years of enrolment were significantly associated with more knowledge of the NHIS. Similarly, knowledge of the NHIS, number of living children, and years of enrolment strongly correlated with more satisfaction with NHIS services. However, being a returning patient was strongly related with less knowledge of the NHIS and less satisfaction with NHIS services. Conclusion Clients have less knowledge of the NHIS and are fairly satisfied with its services overall. However, they are more satisfied with healthcare provider services. More education and sensitization are necessary to increase knowledge and improve satisfaction and enrolment.
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    Secondary analysis of snake bite data in the Western Region of Ghana: 2006-2010
    (Ghana Medical Journal, 2016-06) Mensah, E.K.; Karikari, K.; Aikins, M.; Vanotoo, L.; Sackey, S.; Ohuabunwo, C.; Wurapa, F.; Sifah, T.K.; Afari, E.
    Background: A snake bite is an injury caused by a bite from a snake, often resulting in puncture wounds, amputations and sometimes envenomation. Envenoming resulting from snake bite is a particularly important public health problem in rural areas of tropical and sub-tropical countries in Africa. This paper reports the incidence of snake bites and its associated mortality in the Western Region of Ghana. Method: The study was a descriptive cross-sectional review of 2006 - 2010 snake bite secondary data generated by the Western Regional Health Information Office in Ghana. Data was extracted from the District Health Information Management System (DHIMS) database. Data was managed and analyzed using SPSS Version 16.0. Univariate analyses were expressed as percentages and graphs. Results: The year 2009 recorded the highest incidence of Snake bites in the Western Region with Juabeso district recording the highest incidence of snake bites over the study period. Over the period about 55% of the incidence was between 50 – 100 per 100,000 population. The total number of snake bites recorded in the region for the period was 7,275, of which 52% (3,776) were males. About 60% of the patients were of the age group 15-49 years. A total of 12 reported snake bite deaths were recorded, of which 67% were men. This study recommends to the Districts Health Directorates in the Western Region to regularly organize community education on snake bite and the use of protective clothing by the farmers.
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    What are the Technical and Allocative Efficiencies of Public Health Centres in Ghana?
    (Ghana Medical Journal, 2008-12) Akazili, J.; Adjuik, M.; Chatio, S.; Kanyomse, E.; Hodgson, A.; Aikins, M.; Gyapong, J.
    Introduction: Health systems in developing countries including Ghana are faced with critical resource constraints in pursuing the goal of improving the health status of the population. The constrained ability to adequately meet health care needs is exacerbated by inefficiency in the health care systems, especially within public health centres. Methods: The study used Data Envelopment Analysis (DEA) method, to calculate the technical and allocative efficiency of 113 randomly sampled health centres. A logistic regression model was also applied on whether a health centre was technically efficient or not to determine the factors that significantly influence the efficiency of health centres. Findings: The findings showed that 78% of health centres were technically inefficient and so were using resources that they did not actually need. Eight-eight percent were also allocatively inefficient. The overall efficiency, (product of the technical and allocative efficiency), was also calculated and over 90% of the health centres were inefficient. The results of a logistic regression analysis show that newer health centres and those which receive incentives were more likely to be technically efficient compared to older health centres and those who did receive incentives. Conclusion: The results broadly point to grave inefficiency in the health care delivery system of the health centres and that lots of resources could be saved if measures were put in place to curb the waste. Incentives to health centres were found to be major motivating factors to the promotion of efficiency.
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    Financial Viability of District Mutual Health Insurance Schemes of Lawra and Sissala East Districts, Upper West Region, Ghana
    (Ghana Medical Journal, 2010-12) Yevutsey, S.K.; Aikins, M.
    Introduction: The National Health Insurance Act, passed in 2003 mandates the National Health Insurance Authority to, in conjunction with the district assemblies establish district mutual health insurance scheme (DMHIS) governed by semi-autonomous boards in all ten regions. Since its implementation, unsubstantiated reports indicate increasing health care and administra-tive costs of the various DMHIS across the country without any corresponding increase in the premium level. We sought to assess the financial viability of the DMHIS in Lawra (LDMHIS) and Sissala East (SEDMHIS) districts, Upper West Region of Ghana. Methods: Cost analysis of revenue and expenditure of LDMHIS and SEDMHIS from 2004 to 2007 was used to estimate the revenue, expenditure, administrative cost, expense, claims and combined ratios. Results: The scheme‟s major sources of revenue were funds from NHIA on behalf of exempted group and the formal sector employees and premium collected from the informal sector. Other sources of revenue were significant at the beginning and became almost negli-gible at the end of 2007. At the end of 2005, adminis-trative cost was higher than medical claims. By the end of 2007, it has reduced to 34.3% and 15.7% of the total expenditure of the SEDMHIS and LDMHIS respec-tively. The combined ratios decreased from 2.27 and 1.17 in 2005 to 0.74 and 0.95 in 2007 for SEDMHIS and LDMHIS respectively. Conclusion: Continuous NHIA support, increasing coverage of the scheme and a corresponding reduction in administrative cost would increase revenue. If this is sustained, the schemes could be financially viable in the long term.
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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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    Hospital All-Risk Emergency Preparedness in Ghana
    (Ghana medical journal, 2012-03) Norman, I.D.; Aikins, M.; Binka, F.N.; Nyarko, K.M.
    Objective: This paper assessed the emergency preparedness programs of health facilities for all-risks but focused on Road Traffic Accidents, (RTA) resulting in surge demand. It adopted W. H. O checklist covering hospital preparedness, equipment, manpower and surge capacity planning as best practices for the mitigation of public health emergencies. Method: This is a cross-sectional study of purposively selected health facilities. The method used consisted of site visit, questionnaire survey, literature and internet review. The W. H. O. standard for emergency preparedness of health facilities was used to evaluate and assess the nation’s hospitals surge capacity programs. The study was conducted between March-June, 2010. A total of 22 district and regional health facilities including teaching hospitals participated in the study. All 10 regions of the country were covered. Result: These were: (1) many of the nation’s hospitals were not prepared for large RTA’s resulting in surge demands, and did not possess general emergency preparedness programs. (2) The hospitals’ respective abilities to handle large scale RTA’s were compromised by the lack of competent medical and allied health personnel and adequate supplies. Discussion: The inadequacies of the hospital system in responding to emergencies raise serious public health concerns. The biggest challenge facing the hospitals in their emergency intervention is the lack of preemergency and emergency preparedness plans as well as the coordination of the hospitals response mechanisms. Conclusion: The paper ended with recommendations on how the nation’s hospitals and their supervisory agencies could improve emergency preparedness.
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    Improving Medical Records Filing in a Municipal Hospital in Ghana
    (Ghana medical journal, 2012-09) Teviu, E.A.A.; Aikins, M.; Abdulai, T.I.; Sackey, S.; Boni, P.; Afari, E.; Wurapa, F.
    Background: Medical records are kept in the interest of both the patient and clinician. Proper filing of patient’s medical records ensures easy retrieval and contributes to decreased patient waiting time at the hospital and continuity of care. This paper reports on an intervention study to address the issue of misfiling and multiple patient folders in a health facility. Design: Intervention study. Setting: Municipal Hospital, Goaso, Asunafo North District, Brong Ahafo Region, Ghana. Methods: Methods employed for data collection were records review, direct observation and tracking of folders. Interventions instituted were staff durbars, advocacy and communication, consultations, in-service trainings, procurement and monitoring. Factors contributing to issuance of multiple folders and misfiling were determined. Proportion of multiple folders was estimated. Results: Results revealed direct and indirect factors contributing to issuance of multiple patient folders and misfiling. Interventions and monitoring reduce acquisition of numerous medical folders per patient and misfiling. After the intervention, there was significant reduction in the use of multiple folders (i.e., overall 97% reduction) and a high usage of single patient medical folders (i.e., 99%). Conclusion: In conclusion, a defined medical records filing system with adequate training, logistics and regular monitoring and supervision minimises issuance of multiple folders and misfiling.
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    Challenges in provider payment under the Ghana National Health Insurance Scheme: a case study of claims management in two districts
    (Ghana medical journal, 2012-12) Sodzi-Tettey, S.; Aikins, M.; Awoonor-Williams, J.K.; Agyepong, I.A.
    In 2004, Ghana started implementing a National Health Insurance Scheme (NHIS) to remove cost as a barrier to quality healthcare. Providers were initially paid by fee – for - service. In May 2008, this changed to paying providers by a combination of Ghana - Diagnostic Related Groupings (G-DRGs) for services and fee – for - service for medicines through the claims process. Objective: The study evaluated the claims management processes for two District MHIS in the Upper East Region of Ghana. Methods: Retrospective review of secondary claims data (2008) and a prospective observation of claims management (2009) were undertaken. Qualitative and quantitative approaches were used for primary data collection using interview guides and checklists. The reimbursements rates and value of rejected claims were calculated and compared for both districts using the z test. The null hypothesis was that no differences existed in parameters measured. Findings: Claims processes in both districts were similar and predominantly manual. There were administrative capacity, technical, human resource and working environment challenges contributing to delays in claims submission by providers and vetting and payment by schemes. Both Schemes rejected less than 1% of all claims submitted. Significant differences were observed between the Total Reimbursement Rates (TRR) and the Total Timely Reimbursement Rates (TTRR) for both schemes. For TRR, 89% and 86% were recorded for Kassena Nankana and Builsa Schemes respectively while for TTRR, 45% and 28% were recorded respectively. Conclusion: Ghana’s NHIS needs to reform its provider payment and claims submission and processing systems to ensure simpler and faster processes. Computerization and investment to improve the capacity to administer for both purchasers and providers will be key in any reform.