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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    Community perceptions of enrolment of indigents into the National Health Insurance Scheme in Ghana: a case study of the Livelihood Empowerment against Poverty Programme
    (Global Health Research and Policy, 2022) Akweongo, P.; Voetagbe, V.; Tediosi, T.; Gadeka, D.D.; Salari, S.; Aikins, M.
    Background: The Livelihood Empowerment against Poverty (LEAP) programme in Ghana as part of its benefciary programme, identifes the poor/indigents for exemptions from premium payments in the National Health Insurance Scheme (NHIS). This paper sought to understand community perceptions of enrolling the poor in the NHIS through LEAP in order to inform policy. Methods: The study adopted a descriptive cross-sectional study design by using a qualitative approach. The study was conducted in three geographical regions of Ghana: Greater Accra, Brong-Ahafo and Northern region represent ing the three ecological zones of Ghana between October 2017 and February 2018. The study population included community members, health workers, NHIS staf and social welfare ofcers/social development ofcers. Eighty-one in-depth interviews and 23 Focus Group Discussions were conducted across the three regions. Data were analysed thematically and verbatim quotes from participants were used to support the views of participants. Results: The study shows that participants were aware of the existence of LEAP and its benefts. There was, however, a general belief that the process of LEAP had been politicized and therefore favours only people who were sympa thizers of the ruling government as they got enrolled into the NHIS. Participants held the view that the process of selecting benefciaries lacked transparency, thus, they were not satisfed with the selection process. However, the study shows the ability of the community to identify the poor. The study reports varying concepts of poverty and its identifcation across the three ecological zones of Ghana. Conclusion: There is a general perception of politicization and lack of transparency of the selection of the poor into the NHIS through the LEAP programme in Ghana. Community-based approaches in the selection of the indigent are recommended to safeguard the NHIS-LEAP benefciary process.
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    Insured clients out-of-pocket payments for health care under the national health insurance scheme in Ghana
    (BMC Health Services Research, 2021) Akweongo, P.; Aikins, M.; Wyss, K.; Salari, P.; Tediosi, F.
    Background: In 2003, Ghana implemented a National Health Insurance Scheme (NHIS) designed to promote universal health coverage and equitable access to health care. The scheme has largely been successful, yet it is confronted with many challenges threatening its sustainability. Out-of-pocket payments (OOP) by insured clients is one of such challenges of the scheme. This study sought to examine the types of services OOP charges are made for by insured clients and how much insured clients pay out-of-pocket. Methods: This was a descriptive cross-sectional health facility survey. A total of 2066 respondents were interviewed using structured questionnaires at the point of health care exit in the Ashanti, Northern and Central regions of Ghana. Health facilities of different levels were selected from 3 districts in each of the three regions. Data were collected between April and June 2018. Using Epidata and STATA Version 13.1 data analyses were done using multiple logistic regression and simple descriptive statistics and the results presented as proportions and means. Results: Of all the survey respondents 49.7% reported paying out-of-pocket for out-patient care while 46.9% of the insured clients paid out-of-pocket. Forty-two percent of the insured poorest quintile also paid out-of-pocket. Insured clients paid for consultation (75%) and drugs (63.2%) while 34.9% purchased drugs outside the health facility they visited. The unavailability of drugs (67.9%) and drugs not covered by the NHIS (20.8%) at the health facility led to outof- pocket payments. On average, patients paid GHS33.00 (USD6.6) out-of-pocket. Compared to the Ashanti region, patients living in the Northern region were 74% less at odds to pay out-of-pocket for health care. Conclusion and recommendation: Insured clients of Ghana’s NHIS seeking health care in accredited health facilities make out-of-pocket payments for consultation and drugs that are covered by the scheme. The out-of-pocket payments are largely attributed to unavailability of drugs at the facilities while the consultation fees are charged to meet the administrative costs of services. These charges occur in disadvantaged regions and in all health facilities. The high reliance on out-of-pocket payments can impede Ghana’s progress towards achieving Universal Health Coverage and the Sustainable Development Goal 3, seeking to end poverty and reduce inequalities. In order to build trust and confidence in the NHIS there is the need to eliminate out-of-pocket payments for consultation and medicines by insured clients.
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    Injuries and their related household costs in a tertiary hospital in Ghana
    (African Journal of Emergency Medicine, 2020-05-26) Blankson, P.K.; Nonvignon, N.; 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.
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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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    Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana
    (Plos One, 2020-01-22) Aikins, M.; Heerdegen, A.C.S.; Amon, S.; Agyemang, S.A.; Wyss, K.
    Introduction District health managers play a pivotal role in the delivery of basic health services in many countries, including Ghana, as they are responsible for converting inputs and resources such as, staff, supplies and equipment into effective services that are responsive to population needs. Weak management capacity among local health managers has been suggested as a major obstacle for responsive health service delivery. However, evidence on district health managers’ competencies and its association with health system performance is scarce. Aim To examine managerial capacity among district health managers and its association with health system performance in six districts in the Eastern Region of Ghana. Methods Fifty-nine district health managers’ in six different performing districts in the Eastern Region of Ghana completed a self-administered questionnaire measuring their management competencies and skills. In addition, the participants provided information on their socio-demographic background; previous management experience and training; the extent of available management support systems, and the dynamics within their district health management teams. A non-parametric one-way analysis was applied to test the association between management capacity and district performance, which was measured by 17 health indicators. Results Shortcomings within different aspects of district management were identified, however there were no significant differences observed in the availability of support systems, characteristics and qualifications of district health managers across the different performing districts. Overall management capacity among district health managers were significantly higher in high performing districts compared with lower performing districts (p = 0.02). Furthermore, district health managers in better performing districts reported a higher extent of teamwork (p = 0.02), communication within their teams (p<0.01) and organizational commitment (p<0.01) compared with lower performing districts. Conclusion The findings demonstrate individual and institutional capacity needs, and highlights the importance of developing management competencies and skills as well as positive team dynamics among health managers at district level.
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    Routine medical and dental examinations: a case study of adults in Tema community 20 in Ghana
    (INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION, 2019-12-02) Agyemang, S.A.; Danquah, E.P.B.; Amon, S.; Aikins, M.
    Routine medical and dental examinations are important and effective measures in the prevention of diseases and promotion of good health. A cross-sectional quantitative study was conducted among adult residents in Community 20, Tema. The study randomly sampled 216 adults aged over 18 years. These participants were interviewed after informed consent was obtained. Sociodemographic factors associated with routine medical and dental examinations were determined using multivariable logistic regression analysis. Weighted mean was used to determine the level of perceived importance of medical and dental examination. A total of 68.1% and 31.9% of the adults have ever undergone routine medical and dental examination, respectively. Personal reasons constituted 35.4% for medical examination and 55.1% for dental examination. Medical and dental examinations encourage adults to be health conscious was ranked highest with a weighted mean of 3.78. Routine medical and dental examinations were higher among adults over 50 years, males, higher educated adults, higher income earners and the unmarried. Most of the adults indicated that medical and dental examinations were very important. Routine medical and dental examinations encourage adults to be health conscious. Routine medical and dental examinations were higher among adults over 50 years. Public health education programs should educate and encourage the general public especially among the younger population to undergo routine medical and dental examinations annually
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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