Data Accuracy and Completeness of Monthly Midwifery Returns Indicators of Ejisu Juaben Health Directorate of Ghana

The broad range of activities contained in the provision of Primary Health Care (PHC) places a burden on providers to make optimal use of limited resources to achieve maximal health benefit to the population served. All too often, ad hoc decisions and personal preferences guide PHC resource allocations, making accountability for results impossible. Problems constraining Routine Health Information System (RHIS) performance in low-income countries include: poor data quality; limited use of available information; weaknesses in how data are analyzed and poor RHIS management practices. This study sought to investigate these constraints. A non-experimental before and after study involving bassline assessment of data accuracy and completeness, application of innovative strategies such as mentoring and coaching of Health Information Officers in data quality improvement process. Coincidentally, the intervention improved both data accuracy and completeness performance significantly among the participating facilities. The outstanding performance may be attributed to management's new orientation and growing interest towards quality data. Engaging frontline staff in data quality improvement work and provision of regular feedback leads to improvement in data accuracy and completeness. This has implications for decision-making and resource allocation, especially in low-income countries, where the routine health information management system relies heavily on paper work

Preparedness for Use of Health Information for Planning and Decision Making: A Study of Health Facilities in the Kumasi Metropolis, Ghana

Background: Providing the right quality information system promotes effective and efficient ways of using scarce resources through proper planning and decision-making. This however depends on availability of infrastructure and adequate staff training on use of health information.Methods: This cross-sectional study was conducted among health facilities in the Kumasi metropolis and data was collected from June to September 2011. The study involved 323 health staffs, recruited from among1162 health workers from public, private, quasi and mission health facilities and the Metro Health Directorate in four of the ten sub-metros across the Kumasi metropolis. Data was analysed with STATA 11 software. Results: More than 50% had received training on HI among all the facilities. Comparatively, training on HIS was lower in the public hospitals. Training on HI and relevance the training had significant associations with the use of HI (p<0.001). Respondents who had never had training on HI were less likely to use HI for planning and decision-making as compared to those who had ever had training (OR=0.086; 95% CI=0.03, 0.25). Although most facilities had available logistics for storage, processing and using health information, not all were functioning. Challenges associated with use of HI included inaccurate data, low knowledge on IT, unreliable information, inconsistent data, improper documentation and power cut offs. Conclusion: Use of health information remains critical to making evidenced based decision-making. Improving health training and the requisite logistics could improve use of HI among health staffs. Keywords: health information, planning, Kumasi metropolis, training, logistics, preparednes

Using Quality Improvement Process to Enhance Health Staff Confidence and Competence in Health Information System Tasks in the Ejisu Juaben Municipal Health Directorate, Ghana

Routine Health Information is faced with huge challenges which reduce its decision making and planning yields. The objective of the study was 1) to undertake competency gap analysis of health staff’s performance in routine health information tasks, 2) implement quality improvement process training module, 3) to measure the improvement in the competency level of health staff in performing RHIS tasks after application of Quality Improvement Process principles. A quasi-experimental, uncontrolled before and after study was conducted in 18 health facilities in the Ejisu Juaben Municipal Health Directorate, Ghana. The study involved assessment of competency level and training of 141 staff using Data Quality Improvement Process (DQIP) training module over a twelve-month period. RHIS task competence was measured by a pencil and paper test that measured the ability of respondents to perform calculations, and to interpret and use RHIS results, based on the same indicators as used dimension of confidence level. The study found huge competency gaps among staff amidst high confidence in undertaking RHIS tasks while their performance of these tasks scored objectively, yielded low average scores of improvements in competency gaps; data analysis (-36.9%: +3.6%), data interpretation (-42.2%: +9.8%) and use of data (-44.6%: +2.6%) in the baseline and endline evaluations respectively. The study concludes that Quality Improvement Process (QIP) centred training drives the effectiveness of staff competency in performing RHIS tasks, but not necessarily their confidence level

Prevalence and knowledge of hypertension among people living in rural communities in Ghana: a mixed method study

Background: Knowledge and understanding of hypertension and its associated health risks remain inadequate despite increasing trend of hypertension prevalence. This study was conducted to assess the prevalence, knowledge and perceptions of hypertension in rural communities in Ghana.Methods: A mixed method study involving 534 subjects was employed. Data was collected in six communities from May to December 2014 with structured questionnaires and interview guides. A logistic regression analysis was conducted to estimate the influence of the socio-demographic factors on knowledge of hypertension. Qualitative data was thematically analyzed.Results: The mean systolic blood pressure (BP) was higher in men than women (127.42mmHg versus 124.42mmHg). The proportion of hypertensives was 21.4% and was higher among men in all age categories. Knowledge on some risk factors of hypertension was extremely low. Having formal education was associated with higher odds of knowledge of hypertension (Adjusted odds ratio [AOR]; 95% confidence interval [CI]=2.28; 1.25-4.16). Several misconceptions such as the use of agro-chemicals, fertilizers and excess vitamins  were identified as causes of hypertension.Conclusion: This study demonstrates an increased prevalence of hypertension, knowledge gaps and misconceptions surrounding hypertension in rural communities in Ghana. This evidence is useful in streamlining interventional programmes aimed at improving knowledge and prevention of hypertension.Keywords: Hypertension, knowledge, prevalence, rural communities, Ghana, blood pressure

Knowledge of Health Information for Healthcare Decision Making: A Cross Sectional Study of Health Staff in Kumasi Metropolis, Ghana

Health information collected and analyzed by health staff is the backbone for decision-making. Health staff’s Knowledge and understanding influence their usage of health information for health care planning and decision-making. This study assessed the knowledge and understanding of health information among health staffs in the Ashanti region, Ghana. This cross-sectional study was conducted from June to September 2011. The study involved 323 health staffs who were sampled from among1162 health workers from public, private, quasi and mission health facilities and the Metro Health Directorate in four of the ten sub-metros across the Kumasi metropolis. Data was analysed with STATA 11 software. The study outcome indicates a high level of knowledge of health information among health staffs in the Kumasi metropolis with 77% having comprehensive knowledge on HI (measured by correct responses of the statements to tease out knowledge). Awareness was however low among staff of quasi facilities. Staffs knowledge of health information was influenced by their academic qualification, profession and training on health information. Lack of awareness and training on health information discouraged the use of HI among health staffs (OR=0.02 and 0.08 respectively). Health information remains critical to making evidenced based decision-making. Improving the knowledge and understanding of health staffs will go a long way to increase the use of health information for planning and decision-making. Keywords: Health information, planning, Kumasi metropolis, knowledge, decision makin

Determinants of viral load non-suppression among people living with HIV on antiretroviral therapy in Kumasi, Ghana

Objectives: To determine the rate and factors associated with viral load non-suppression among adults living with HIV/AIDS on active anti-retroviral therapy (ART).Design: A retrospective cross-sectional studySetting: Three ART clinics in Kumasi, GhanaParticipants: All HIV-infected adults who were ≥18 years and on active ART for 12 months and whose viral loadnhad been estimated were included.Main outcome measure: Unsuppressed viral load among patients on ARTResults: In all, 483 HIV patients were included in the study, with 369 (76.4%) achieving viral load suppression. Gender, educational level, comorbidity status, and duration on ART were independently associated with viral nonsuppression (p < 0.05).Conclusions: This study has revealed that the rate of viral suppression in the study area is lower than the UNAIDS 90% target. The findings have implications on designing new and stemming up implementation of existing interventions to improve the rate of viral suppression among patients in the study area. It is also necessary that more of such studies are replicated in other parts of the country to identify risk factors for virological failure among patients on ART

Determinants of Antenatal Healthcare Utilisation by Pregnant Women in Third Trimester in Peri-Urban Ghana

Access to quality healthcare still remains a major challenge in the efforts at reversing maternal morbidity and mortality. Despite the availability of established maternal health interventions, the health of the expectant mother and the unborn child remains poor due to low utilisation of interventions. The study examined the socioeconomic determinants of antenatal care utilisation in peri-urban Ghana using pregnant women who are in their third trimester. Two-stage sampling technique was used to sample 200 pregnant women who were in their third trimester from the District Health Information Management System software. Well-structured questionnaire was the instrument used to collect data from respondents. Descriptive statistics and inferential statistics including binary logit regression model were used to analyse the data with the help of SPSS and STATA software. The results showed varying utilisation levels of ANC. From the regression result, age, household size, and occupational status were identified as the important socioeconomic determinants of antenatal care utilisation among the respondents. The important system factors which influence antenatal care utilisation by the respondents are distance to ANC, quality of service, and service satisfaction. The study concludes that socioeconomic and health system factors are important determinants of antenatal care utilisation. Stepping up of interventions aimed at improving the socioeconomic status and addressing health system and proximity challenges could be helpful in improving antenatal care utilisation by pregnant women in Ghana

Prevalence and knowledge of hypertension among people living in rural communities in Ghana: a mixed method study

Background: Knowledge and understanding of hypertension and its associated health risks remain inadequate despite increasing trend of hypertension prevalence. This study was conducted to assess the prevalence, knowledge and perceptions of hypertension in rural communities in Ghana. Methods: A mixed method study involving 534 subjects was employed. Data was collected in six communities from May to December 2014 with structured questionnaires and interview guides. A logistic regression analysis was conducted to estimate the influence of the socio-demographic factors on knowledge of hypertension. Qualitative data was thematically analyzed. Results: The mean systolic blood pressure (BP) was higher in men than women (127.42mmHg versus 124.42mmHg). The proportion of hypertensives was 21.4% and was higher among men in all age categories. Knowledge on some risk factors of hypertension was extremely low. Having formal education was associated with higher odds of knowledge of hypertension (Adjusted odds ratio [AOR]; 95% confidence interval [CI]=2.28; 1.25-4.16). Several misconceptions such as the use of agro-chemicals, fertilizers and excess vitamins were identified as causes of hypertension. Conclusion: This study demonstrates an increased prevalence of hypertension, knowledge gaps and misconceptions surrounding hypertension in rural communities in Ghana. This evidence is useful in streamlining interventional programmes aimed at improving knowledge and prevention of hypertension

Household cost of chronic kidney disease care among patients presenting at Komfo Anokye Teaching Hospital, Ghana

Background: Chronic kidney disease (CKD) has a major effect on global health, both as a direct cause of morbidity and mortality and as a risk factor for cardiovascular disease. This study was carried out to determine the household cost of CKD care among patients receiving treatment at a tertiary healthcare facility in Ghana. Methods: This was a cross-sectional study conducted over a period of three months. The estimated household cost of CKD care was made up of direct and indirect cost of treating the condition. The direct cost was divided into direct medical cost and direct non-medical cost. The direct medical cost included cost of medication, outpatient consultations, cost of dialysis, diagnostic investigations (including laboratory investigations), and ultrasound and computed tomography requests. The direct non-medical cost included cost of feeding and transportation. The indirect cost was based on the total time lost to productivity. Results: A total of 224 patients were included in the study. The mean ±SD age of the patients was 49.62 ±15.37 years. The overall average monthly cost of CKD care for the 224 patients was GH₵ (US$) 1,121.42 (198.63), making up of 87.70% direct cost and 12.30% indirect cost. The cost incurred by CKD patients on dialysis was significantly higher and almost four times higher than that of the end stage non-dialysis CKD patients

Feasibility and acceptability of ACT for the community case management of malaria in urban settings in five African sites

<p>Abstract</p> <p>Background</p> <p>The community case management of malaria (CCMm) is now an established route for distribution of artemisinin-based combination therapy (ACT) in rural areas, but the feasibility and acceptability of the approach through community medicine distributors (CMD) in urban areas has not been explored. It is estimated that in 15 years time 50% of the African population will live in urban areas and transmission of the malaria parasite occurs in these densely populated areas.</p> <p>Methods</p> <p>Pre- and post-implementation studies were conducted in five African cities: Ghana, Burkina Faso, Ethiopia and Malawi. CMDs were trained to educate caregivers, diagnose and treat malaria cases in < 5-year olds with ACT. Household surveys, focus group discussions and in-depth interviews were used to evaluate impact.</p> <p>Results</p> <p>Qualitative findings: In all sites, interviews revealed that caregivers' knowledge of malaria signs and symptoms improved after the intervention. Preference for CMDs as preferred providers for malaria increased in all sites.</p> <p>Quantitative findings: 9001 children with an episode of fever were treated by 199 CMDs in the five study sites. Results from the CHWs registers show that of these, 6974 were treated with an ACT and 6933 (99%) were prescribed the correct dose for their age. Fifty-four percent of the 3,025 children for which information about the promptness of treatment was available were treated within 24 hours from the onset of symptoms.</p> <p>From the household survey 3700 children were identified who had an episode of fever during the preceding two weeks. 1480 (40%) of them sought treatment from a CMD and 1213 of them (82%) had received an ACT. Of these, 1123 (92.6%) were administered the ACT for the correct number of doses and days; 773 of the 1118 (69.1%) children for which information about the promptness of treatment was available were treated within 24 hours from onset of symptoms, and 768 (68.7%) were treated promptly and correctly.</p> <p>Conclusions</p> <p>The concept of CCMm in an urban environment was positive, and caregivers were generally satisfied with the services. Quality of services delivered by CMDs and adherence by caregivers are similar to those seen in rural CCMm settings. The proportion of cases seen by CMDs, however, tended to be lower than was generally seen in rural CCMm. Urban CCMm is feasible, but it struggles against other sources of established healthcare providers. Innovation is required by everyone to make it viable.</p