12 research outputs found
Informal workers’ access to health care services: findings from a qualitative study in the Kassena-Nankana districts of Northern Ghana
Background
Over the past two decades, employment in the informal sector has grown rapidly in all regions including low and middle-income countries. In the developing countries, between 50 and 75% of workers are employed in the informal sector. In Ghana, more than 80% of the total working population is working in the informal sector. They are largely self-employed persons such as farmers, traders, food processors, artisans, craft-workers among others. The persistent problem in advancing efforts to address health vulnerabilities of informal workers is lack of systematic data. Therefore, this study explored factors affecting informal workers access to health care services in Northern Ghana.
Method
The study used qualitative methodology where focus group discussions and in-depth interviews were conducted. Purposive sampling technique was used to select participants for the interviews. The interviews were transcribed and coded into emergent themes using Nvivo 10 software before thematic content analysis.
Results
Study participants held the view that factors such as poverty, time spent at the health facility seeking for health care, unpleasant attitude of health providers towards clients affected their access to health care services. They perceived that poor organization and operations of the current health system and poor health care services provided under the national health insurance scheme affected access to health care services according to study participants. However, sale of assets, family support, borrowed money from friends and occasional employer support were the copying strategies used by informal workers to finance their health care needs.
Conclusion
Most of the population in Ghana are engaged in informal employment hence their contribution to the economy is very important. Therefore, efforts needed to be made by all stakeholders to address these challenges in order to help improve on access to health care services to all patients particularly the most vulnerable groups in society
Effect of specificity of health expenditure questions in the measurement of out-of-pocket health expenditure: evidence from field experimental study in Ghana
Background: The effect of number of health items on out-of- pockets (OOPs) has been identified as a source of bias in measuring OOPs. Evidence comes mostly from cross-sectional comparison of different survey instruments to collect data on OOPs. Very few studies have attempted to validate these questionnaires, or distinguish bias arising from the comprehensiveness of the OOPs list versus specificity of OOPs questions. Objectives: This study aims to estimate biases arising from the specificity of OOPs questions by comparing provider and household's information. Methods: A generic questionnaire to collect data on household's OOPs was developed following the nomenclature proposed in division 6 of the classification of household final consumption 2018. The four categories within such division are used to set the comprehensiveness of the OOPs list, the specificity within each category was tailored to the design of the nationally representative living standard survey in Ghana where a field experiment was conducted to test the validity of different versions. Households were randomised to 11, 44 or 56 health items. Using data from provider records as the gold standard, we compared the mean positive OOPs, and estimated the mean ratio and variability in the ratio of household expenditures to provider data for the individual households using the Bland-Altman method of assessing agreement. Findings: We found evidence of a difference in the overall mean ratio in the specificity for OOPs in inpatient care and medications. Within each of these two categories, a more detailed disaggregation yielded lower OOPs estimates than less detailed ones. The level of agreement between household and provider OOPs also decreased with increasing specificity of health items. Conclusion: Our findings suggest that, for inpatient care and medications, systematically decomposing OOPs categories into finer subclasses tend to produce lower OOPs estimates. Less detailed items produced more accurate and reliable OOPs estimates in the context of a rural setting
Socio-economic and demographic determinants of under-five mortality in rural northern Ghana
Background: In spite of global decline in under-five mortality, the goal of achieving MDG 4 still remains largely unattained in low and middle income countries as the year 2015 closes-in. To accelerate the pace of mortality decline, proven interventions with high impact need to be implemented to help achieve the goal of drastically reducing childhood mortality. This paper explores the association between socio-economic and demographic factors and under-five mortality in an impoverished region in rural northern Ghana.
Methods: We used survey data on 3975 women aged 15–49 who have ever given birth. First, chi-square test was used to test the association of social, economic and demographic characteristics of mothers with the experience of under-five death. Subsequently, we ran a logistic regression model to estimate the relative association of factors that influence childhood mortality after excluding variables that were not significant at the bivariate level.
Results: Factors that significantly predict under-five mortality included mothers’ educational level, presence of co-wives, age and marital status. Mothers who have achieved primary or junior high school education were 45% less likely to experience under-five death than mothers with no formal education at all (OR = 0.55, p < 0.001). Monogamous women were 22% less likely to experience under-five deaths than mothers in polygamous marriages (OR = 0.78, p = 0.01). Similarly, mothers who were between the ages of 35 and 49 were about eleven times more likely to experience under-five deaths than those below the age of 20 years (OR = 11.44, p < 0.001). Also, women who were married had a 27% less likelihood (OR = 0.73, p = 0.01) of experiencing an under-five death than those who were single, divorced or widowed.
Conclusion: Taken independently, maternal education, age, marital status and presence of co-wives are associated with childhood mortality. The relationship of these indicators with women’s autonomy, health seeking behavior, and other factors that affect child survival merit further investigation so that interventions could be designed to foster reductions in child mortality by considering the needs and welfare of women including the need for female education, autonomy and socioeconomic well-being
Descriptive epidemiology of anaemia among pregnant women initiating antenatal care in rural Northern Ghana
Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana.; The aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits.; The study was conducted in the Navrongo War Memorial Hospital, a secondary referral facility in the Kassena-Nankana district in rural northern Ghana.; A retrospective analysis of antenatal clinic records of pregnant women collected from January to December 2014. All pregnant women initiating antenatal clinic, who had initial haemoglobin (Hb) levels measured, were included in the study. Logistic regression analyses were carried out to determine factors associated with anaemia at the initiation of ANC.; We analysed data from 506 women with median Hb of 11.1 g/dL (IQR 7.31-13.8). The median gestational age at booking was 14 weeks (5-36 weeks). The prevalence of anaemia was 42.7%, with 95% confidence interval (CI) [38.4-47.1], and was high among teenage mothers (52% [34.9-67.8]), mothers who booked in the third trimester (55% [33.6-74.7]) and grand multiparous women (58% [30.7-81.6]). Factors associated with anaemia included grand multiparity (odds ratio [OR] = 1.94 with 95% CI [1.58-2.46]), booking during the third trimester (OR = 2.06 [1.78-2.21]) and mother who were underweight compared to those with normal weight (OR = 3.17 [1.19-8.32]).; Burden of anaemia in pregnancy is still high in rural northern Ghana. We advocate further strengthening of the primary health care system to improve early access to ANC delivery
Trends and risk factors associated with stillbirths: a case study of the Navrongo War Memorial Hospital in Northern Ghana
Maternal and Child health remains at the core of global health priorities transcending the Millennium Development Goals into the current era of Sustainable Development Goals. Most low and middle-income countries including Ghana are yet to achieve the required levels of reduction in child and maternal mortality. This paper analysed the trends and the associated risk factors of stillbirths in a district hospital located in an impoverished and remote region of Ghana.; Retrospective hospital maternal records on all deliveries conducted in the Navrongo War Memorial hospital from 2003-2013 were retrieved and analysed. Descriptive and inferential statistics were used to summarise trends in stillbirths while the generalized linear estimation logistic regression is used to determine socio-demographic, maternal and neonatal factors associated with stillbirths.; A total of 16,670 deliveries were analysed over the study period. Stillbirth rate was 3.4% of all births. There was an overall decline in stillbirth rate over the study period as stillbirths declined from 4.2% in 2003 to 2.1% in 2013. Female neonates were less likely to be stillborn (Adjusted Odds ratio = 0.62 and 95%CI [0.46, 0.84]; p = 0.002) compared to male neonates; neonates with low birth weight (4.02 [2.92, 5.53]) and extreme low birth weight (18.9 [10.9, 32.4]) were at a higher risk of still birth (p<0.001). Mothers who had undergone Female Genital Mutilation had 47% (1.47 [1.04, 2.09]) increase odds of having a stillbirth compared to non FGM mothers (p = 0.031). Mothers giving birth for the first time also had a 40% increase odds of having a stillbirth compared to those who had more than one previous births (p = 0.037).; Despite the modest reduction in stillbirth rates over the study period, it is evident from the results that stillbirth rate is still relatively high. Primiparous women and preterm deliveries leading to low birth weight are identified factors that result in increased stillbirths. Efforts aimed at impacting on stillbirths should include the elimination of outmoded cultural practices such as FGM
Evaluating alternative approaches for improving the measurement of household Out-of-pocket health expenditure: The Indepth-Network household out-of-pocket health expenditure (iHOPE) experimental study in Ghana
Out of pocket health payment (OOPs) has been identified by System of Health Accounts (SHA) as the largest source of health care financing in most low and middle-income countries. This means that most low and middle-income countries will rely on user fees and co-payments to generate revenue, rationalize the use of services, contain health systems costs or improve health system efficiency and service quality. However, the accurate measurement of OOPs has been challenged by several limitations which are attributed to both sampling and non-sampling errors when OOPs are estimated from household surveys, the primary source of information in LICs and LMICs. The incorrect measurement of OOPs can undermine the credibility of current health spending estimates, an otherwise important indicator for tracking UHC, hence there is the need to address these limitations and improve the measurement of OOPs. In this current study, new modules on household health utilization and expenditure were developed by repurposing the existing Ghana Living Standards Survey instrument and further validating these new tools with a ‘gold standard’ (provider data) with the aim of proposing alternative approaches capable of producing reliable data for estimating OOPs in the context of National Health Accounts and for the purpose of monitoring financial protection in health. This was achieved by specifically answering questions on; the structure of the instrument (Type of instrument and overall structure of health expenditure questions), the optimal recall period, the optimal number of items(specificity) and to also share some key lessons, challenges and recommendations in implementing a large validation study in a resource-poor setting
Using community-driven solutions to improve maternal and neonatal outcomes in rural northern Ghana: the PREMAND Project
Background: Community interventions are often created by researchers, non-profit organisations, or other community outsiders and launched in communities with minimal input from the community members themselves. In addition, these are often blanket interventions, or generic programming offered across varied communities that do not take into account the unique needs of each community. The PREventing Maternal And Neonatal Death (PREMAND) project in rural northern Ghana hypothesised that the root causes of maternal and neonatal deaths and near-misses would vary based on each community's unique geographic, social, and cultural factors, and that interventions to address these issues should be driven by the community members and tailored to their specific needs.
Methods: PREMAND is a three-phase project beginning with sociocultural audits of near-misses and verbal and social autopsies of deaths of mothers and babies in four districts in Ghana. Semi-structured qualitative interviews about each event are also conducted and transcribed. Data are then mapped to demonstrate where clusters of events are located and to determine which five communities are experiencing the highest numbers of deaths and near-deaths. Lastly, data and maps generated by PREMAND are presented to community leaders and elders through large community meetings. Communities are provided with small seed grants (US$2000) to generate their own solutions based on the data presented and their own experiences as experts on their own communities.
Findings: The community intervention stage is still underway, but preliminary results indicate that all five identified communities have planned unique interventions, and two of the communities have completed their interventions. One community plumbed water to a local health facility where deliveries occur, and another purchased and retrofitted a motor ambulance for emergency transport. All of the communities have committed to putting forth their own funds so that they can undertake bigger projects than seed money will allow.
Interpretation: Preliminary results from the community intervention phase demonstrate that, when provided with basic information about the problem and a small amount of resources to develop their own solutions, community members are motivated to enact change, develop unique solutions specific to their own needs, and even contribute their own time and funds to improve their communities.
Funding: USAID Ghana
Socio-demographic determinants of low birth weight: Evidence from the Kassena-Nankana districts of the Upper East Region of Ghana.
OBJECTIVE:To examine the social, economic and demographic factors that determine low birth weight in the two Kassena Nankana districts of the Upper East region of Ghana. METHODS:Cross-sectional data was collected from January 2009 to December 2011 using the Navrongo Health and Demographic Surveillance System which monitors routine health and demographic outcomes in the study area. Data on foetal characteristics such as birth weight, and sex and maternal age, parity, maternal education, marital status, ethnicity, religious affiliation and socio-economic characteristics were collected and described. Tests of means, proportions and Chi-squares are employed in bivariate analysis, and adjusted logistic regression models fitted to control for potential confounding variables. All tests were two-sided and test of significance was set at p-value of < 0.05. RESULTS:There were 8,263 live births (44.9% females) with an overall average birth weight of 2.85 kg (2.9 kg for males and 2.8 kg for females). The average maternal age was 28 years, median parity 2, maternal literacy rate was about 70% and 83% of mothers were married. The prevalence of low birth weight was 13.8% 95%CI [13.10, 14.6] and more in female babies than in males (15.5% vs 12.2%; p<0.0001). Determinants of low birth-weight after controlling for confounding factors were sex of neonate (OR = 1.32, 95%CI [1.14,1.52]; p<0.0001), maternal age (p = 0.004), and mothers who are not married (OR = 1.44 [1.19, 1.74]; p<0.0001). CONCLUSION:Female neonates in this population were likely to present with low birth weight and maternal factors such as younger age, lower socio-economic status and single parenthood were major determinants of low birth weight. Effective and adequate antenatal care should therefore target women with these risk factors
Investigating the effect of recall period on estimates of inpatient out-of-pocket expenditure from household surveys in Vietnam.
Out-of-pocket payments (OOPs), direct payments by households or individuals for healthcare are part of the health financing landscape. Data on OOPs is needed to monitor progress in financial risk protection, and the evaluation of health financing policies. In low-and-middle-income countries, estimates of OOPs rely heavily on self-reported data from household surveys. These surveys require respondents to recall events in the past and can suffer from recall biases. This study investigates the effect of recall period on the agreement of the amount and timing of inpatient OOPs between household reports and provider records in Bavi, Vietnam. We recruited 1397 households for interview using records from the district hospital. The households were interviewed with identical questionnaires except that the recall period was either 12 or 6 months. We linked household with provider data and excluded medicine costs from both household and provider OOPs since they could be purchased outside the hospital. We estimated the effect of recall period on the overall mean and variability of ratios of household to hospital reported OOPs using the Bland-Altman approach for method comparison. We estimated the effect of recall period on whether a transaction was recalled correctly in expenditure and time using multinomial regression. The households reported higher amounts of OOPs than did the hospital for both recall periods. There was no evidence of an effect of recall period on the mean of the ratios of household- to hospital-reported OOPs, although the confidence intervals are not inconsistent with previous studies indicating higher OOPs for shorter recall periods. The geometric mean ratio for the 6-month period was estimated to be a multiple of 1.4 (95% CI 0.9, 2.1) times that of the 12-month period. Similarly, there was no evidence of an effect of recall period on the risk of reporting lower or higher amounts than provider OOPs. The occurrence and timing of inpatient stays generally recalled well, with 70% remembered in the correct month declining slightly over time. Respondents for the 6-month recall period had a significantly lower risk of failing to report the event (RR 0.8 (0.7, 1.0)). The results suggest the best recall period may depend on whether the purpose of a survey is for the recall of the timing of events, in which case the 6 month period may be better, or the amounts of OOPs, where there was no significant difference and the provider records are not a gold standard but the 12 month period had a tendency to be in closer agreement with the provider OOPs
Prevalence and adverse obstetric outcomes of female genital mutilation among women in rural Northern Ghana
Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and results in adverse pregnancy outcomes among affected women. This paper assessed the prevalence and effects of FGM on pregnancy outcomes in a rural Ghanaian setting.; We analyzed 9306 delivery records between 2003 and 2013 from the Navrongo War Memorial Hospital. Multivariable logistic regression analyses were used to determine the effects of FGM on pregnancy outcomes such as stillbirth, birth weight, postpartum haemorrhage, caesarean and instrumental delivery. We also assessed differences in the duration of stay in the hospital by FGM status.; A greater proportion of mothers with FGM (24.7%) were older than 35 years compared with those without FGM (7.6%). FGM declined progressively from 28.4% in 2003 to 0.6% in 2013. Mothers with FGM were nearly twice as likely to have caesarean delivery (adjusted odds ratios = 1.85 with 95%CI [1.72, 1.99]) and stillbirths (1.60 [1.21, 2.11]) compared with those without. Similarly, they had a 4-fold increased risk of post-partum haemorrhage (4.69 [3.74, 5.88]) and more than 2-fold risk lacerations/episiotomy (2.57 [1.86, 3.21]) during delivery. Average duration of stay in the hospital was higher for mothers with FGM from 2003 to 2007.; Despite significant decline in prevalence of FGM, adverse obstetric outcomes are still high among affected women. Increased public health education of circumcised women on these outcomes would help improve institutional deliveries and heighten awareness and prompt clinical decisions among healthcare workers. Further scale-up of community level interventions are required to completely eliminate FGM