How can malaria rapid diagnostic tests achieve their potential? A qualitative study of a trial at health facilities in Ghana.

BACKGROUND: Rapid diagnostic tests (RDTs) for malaria are at the early stages of introduction across malaria endemic countries. This is central to efforts to decrease malaria overdiagnosis and the consequent overuse of valuable anti-malarials and underdiagnosis of alternative causes of fever. Evidence of the effect of introducing RDTs on the overprescription of anti-malarials is mixed. A recent trial in rural health facilities in Ghana reduced overprescription of anti-malarials, but found that 45.5% patients who tested negative with RDTs were still prescribed an anti-malarial. METHODS: A qualitative study of this trial was conducted, using in-depth interviews with a purposive sample of health workers involved in the trial, ranging from those who continued to prescribe anti-malarials to most patients with negative RDT results to those who largely restricted anti-malarials to patients with positive RDT results. Interviews explored the experiences of using RDTs and their results amongst trial participants. RESULTS: Meanings of RDTs were constructed by health workers through participation with the tests themselves as well as through interactions with colleagues, patients and the research team. These different modes of participation with the tests and their results led to a change in practice for some health workers, and reinforced existing practice for others. Many of the characteristics of RDTs were found to be inherently conducive to change, but the limited support from purveyors, lack of system antecedents for change and limited system readiness for change were apparent in the analysis. CONCLUSIONS: When introduced with a limited supporting package, RDTs were variously interpreted and used, reflecting how health workers had learnt how to use RDT results through participation. To build confidence of health workers in the face of negative RDT results, a supporting package should include local preparation for the innovation; unambiguous guidelines; training in alternative causes of disease; regular support for health workers to meet as communities of practice; interventions that address negotiation of health worker-patient relationships and encourage self-reflection of practice; feedback systems for results of quality control of RDTs; feedback systems of the results of their practice with RDTs; and RDT augmentation such as a technical and/or clinical troubleshooting resource

FEEDBACK METHODS IN VOCATIONAL EDUCATION AND TRAINING FOR SUPPORTING STUDENTS WITH LEARNING DISABILITIES AND/ DIFFICULTIES IN LEARNING: A LITERATURE REVIEW

Purpose: Feedback is considered to motivate students and enhance their learning. In Vocational Education and Training (VET) and workplace settings, feedback methods have been implemented to ensure a better connection between teaching and learning. However, to date, not much seems to be known about feedback methods used on students with learning disabilities/difficulties in VET. This literature review study examines the current feedback methods and outcomes among students with disabilities and/or difficulties in learning in vocational education, training, and workplace settings. Methods: For this purpose, ERIC, PubMed, Scopus, ProQuest, Google Scholar, and Web of Sciences were used to identify relevant literature between 2015 and 2022. The review was conducted following the PRISMA-P guidelines. Amongst the studies identified, four studies met the inclusion criteria to be included in the study. The feedback methods identified in the studies include videotaped feedback dialogues between students and teachers, video modelling with video feedback interventions, peer feedback through collaborative writing activities, and a combined peer-teacher feedback method. Findings: The results showed that students received feedback from peers, teachers, and instructors in vocational education and training schools and workplace settings. The feedback, such as communication, reflection, and practical learning capabilities, assisted these students with their working lives. It significantly impacted their learning capacity, enhanced their persistence, increased their perceived abilities, enabled them to understand their learning development better, and improved their performance as they acquired new skills by doing tasks. Conclusion: Generally, the feedback methods were perceived as supportive, constructive, and motivating, prompting reflection and inspiring performance. Notwithstanding, more research on feedback methods and their outcomes on students with learning disabilities/difficulties in vocational education and workplace settings is needed. This must be in conjunction with research on how these same students experience/perceive the feedback methods used on them. This will enable new measures to facilitate the effective transition from school to employment for this category of VET students.   Article visualizations

The effect of reducing the direct cost of care on health service utilization and health outcomes in Ghana : a randomized controlled trial

Aim: To improve malaria control in children less than five years of age. Objectives: To assess the impact of reducing the direct cost of health care on utilization of health services and morbidity associated with malaria among children under 5 years old. Primary objective To compare the prevalence of anaemia (Hb<8g/dl) among children six to fifty-nine months of age, from households with and without improved financial access. Secondary objectives included: To compare the health service utilization rate among children from households with or without improved financial access; to compare household all-cause mortality between the trial arms, to examine primary and major secondary outcomes by socio-economic status of households, to compare outcomes among children from self-enrolled and trial-enrolled households; and to document community knowledge and attitudes on user fees. Methods: 2332 households containing 2757 children less than 5 years of age in Dangme West, Ghana were randomised either to be enrolled into a pre-payment scheme operating allowing free access to primary care, including drugs or to a control which paid user fees for their health care as pertained normally. These included 138 households, comprising 165 children, who had enrolled in the pre-payment scheme prior to the closure of the registration window were included in the study as an observational arm. 2 Results: 2194 households comprising 2592 children were allocated randomly into control and intervention groups. 138 households, comprising 165 children had themselves enrolled in the pre-payment scheme. At baseline, the two randomised groups were the same, but the group who self-enrolled were significantly less poor and had better health outcome measures. Introducing free primary healthcare significantly altered the healthcare seeking behaviour of households, with those randomly allocated to the intervention arm using formal healthcare more (95% Cl 1.04-1.20; p=O.OOI) and home treatment and chemical sellers less than those in the control group. This did not, however, lead to any measurable difference in any of the health outcomes at the end of the six-month trial period. For the primary outcome of moderate anaemia there was no difference seen OR 1.05 (0.66-1.67). Conclusions: This study suggests that reducing the direct cost of health care has a significant impact on healthcare-seeking behaviour but cannot, on its own, be assumed to have an impact on health outcomeEThOS - Electronic Theses Online ServiceGBUnited Kingdo

Factors influencing choice of care seeking for acute fever comparing private chemical shops with health centres and hospitals in Ghana: A study using case-control methodology

An anonymised dataset containing information on demographic, socio-economic and health seeking behaviour for 600 patients who attended chemical sellers and health centres in Dangme West District, Ghana. It was collected using structured questionnaire between November 2012 and January 2013 as part of a case-control study to examine patient's treatment seeking practices

Changes in the availability and affordability of subsidised artemisinin combination therapy in the private drug retail sector in rural Ghana: before and after the introduction of the AMFm subsidy.

BACKGROUND: Most people with febrile illness are treated in the private drug retail sector. Ghana was among nine countries piloting the Global Fund Affordable Medicines Facility - malaria (AMFm). AMFm aimed to: increase artemisinin combination therapy (ACT) affordability; increase ACT availability; increase ACT use; and 'crowd out' artemisinin monotherapies. METHODS: Three censuses were carried out 2 months before (2010), 2 months after and 2.5 years after (2013) the first co-paid ACTs to assess changes in antimalarial (AM) availability and price in private retail shops in a Ghanaian rural district to assess the sustainability of the initial gains. Supply, stock-out and cost were explored. RESULTS: Of 62 shops in the district, 56 participated with 398, 388 and 442 brands of AMs in the shops during the 3 censuses. The proportion of ACTs increased over the period while monotherapies reduced. Herbal-based AM preparations comprised 40-45% of AMs in stock with minimal variation over the period. ACTs were the most sold AM type for all ages but overall buying and selling prices of Quality Assured-ACTs increased by 40-100%. CONCLUSIONS: Initial gains in ACT availability were sustained, but not improved on 2.5 years after AMFm. Widespread availability of unproven herbal medicines is a concern; AMFm had little impact on this

"I would have to sell things in order to get the money":A qualitative exploration of willingness to pay for the RTS,S/AS01 malaria vaccine in the Volta region, Ghana

BACKGROUND: Malaria morbidity and mortality remain a challenge in Ghana. A promising childhood vaccine is being piloted in Ghana, however with the loss of its low-income status, Ghana is losing associated donor co-funding. User fees have been considered an alternative financing method, so this study utilised qualitative methods and explored caregivers’ willingness to pay for the malaria vaccine (RTS,S/AS01) to inform future service provision. METHODS: The study design was cross-sectional. Twenty in-depth interviews were conducted between February 2020 and March 2020 amongst a purposive sample of caregivers of RTS,S/AS01 eligible children, in the Volta region, Ghana. Interviews were audio-recorded and transcribed into English Language. Thematic analysis followed, using NVIVO12 to organise this data. RESULTS: Caregivers could distinguish between RTS,S/AS01 and routine vaccines and were willing to pay median GH₵5 (US$0.94), interquartile range GH₵3.75–5 (US$0.71–0.94) per dose of RTS,S/AS01. The maximum amount participants were willing to pay per dose was GH₵10 (US$1.88), interquartile range GH₵6–10 (US$1.13–1.88). Caregivers mentioned that they would work more to cover this cost because they were happy with services rendered to them during the RTS,S/AS01 pilot phase, and preferred vaccines over vector control measures. The results suggest that a willingness to pay was based on beliefs that the vaccine is fully effective. Although no participant declared that they would be unwilling to pay hypothetical user fees, there were still widespread concerns about affordability, with the majority feeling that the government should be responsible to pay for RTS,S/AS01. CONCLUSIONS: Participants expressed a willingness to pay due to an appreciation of vaccines, shaped by personal experiences with immunisations and disease. Participants’ average income was lower than the national average, potentially affecting the perceived affordability of RTS,S/AS01. Because of the belief that RTS,S/AS01 is fully effective, caregivers may pay less attention to other preventative measures, thus unintentionally undermining malaria vector control

Factors influencing choice of care-seeking for acute fever comparing private chemical shops with health centres and hospitals in Ghana: a study using case-control methodology.

BACKGROUND: Several public health interventions to improve management of patients with fever are largely focused on the public sector yet a high proportion of patients seek care outside the formal healthcare sector. Few studies have provided information on the determinants of utilization of the private sector as against formal public sector. Understanding the differences between those who attend public and private health institutions, and their pathway to care, has significant practical implications. The chemical shop is an important source of care for acute fever in Ghana. METHODS: Case-control methodology was used to identify factors associated with seeking care for fever in the Dangme West District, Ghana. People presenting to health centres, or hospital outpatients, with a history or current fever were compared to counterparts from the same community with fever visiting a chemical shop. RESULTS: Of 600 patients, 150 each, were recruited from the district hospital and two health centres, respectively, and 300 controls from 51 chemical shops. Overall, 103 (17.2 %) patients tested slide positive for malaria. Specifically, 13.7 % (41/300) of chemical shop patients, 30.7 % (46/150) health centre and 10.7 % (16/150) hospital patients were slide positive. While it was the first option for care for 92.7 % (278/300) chemical shop patients, 42.7 % (64/150) of health centre patients first sought care from a chemical shop. More health centre patients (61.3 %; 92/150) presented with fever after more than 3 days than chemical shop patients (27.7 %; 83/300) [AOR = 0.19; p < 0.001 CI 0.11-0.30]. Although the hospital was the first option for 83.3 % (125/150) of hospital patients, most (63.3 %; 95/150) patients arrived there over 3 days after their symptoms begun. Proximity was significantly associated with utilization of each source of care. Education, but not other socioeconomic or demographic factors were significantly associated with chemical shop use. CONCLUSIONS: The private drug retail sector is the first option for the majority of patients, including poorer patients, with fever in this setting. Most patients with fever arrive at chemical shops with less delay and fewer signs of severity than at public health facilities. Improving chemical shop skills is a good opportunity to diagnose, treat or refer people with fever early

COVID-19 vaccine hesitancy among the adult population in Ghana:evidence from a pre-vaccination rollout survey

Background: Coronavirus disease 2019 (COVID-19) has already claimed over four million lives globally and over 800 deaths in Ghana. The COVID-19 vaccine is a key intervention towards containing the pandemic. Over three billion doses of the vaccine have already been administered globally and over 800,000 doses administered in Ghana, representing less than 5% vaccination coverage. Fear, uncertainty, conspiracy theories and safety concerns remain important threats to, a successful rollout of the vaccine if not managed well.Objective: Ascertain the predictors of citizens’ probability of participating in a COVID-19 vaccine trial and subsequently accept the vaccine when given the opportunity.Methodology: The study was an online nation-wide survey among community members (n = 1556) from 18th September to 23rd October, 2020 in the 16 regions in Ghana. Binary probit regression analysis with marginal effect estimations was employed to ascertain the predictors of community members’ willingness to participate in a COVID-19 vaccine trial and uptake the vaccine.Results: Approximately 60% of respondents said they will not participate in a COVID-19 vaccine trial; 65% will take the vaccine, while 69% will recommend it to others. Willingness to voluntarily participate in COVID-19 vaccine trial, uptake the vaccine and advise others to do same was higher among adults aged 18–48 years, the unmarried and males (p &lt; 0.05). Significant predictors of unwillingness to participate in the COVID-19 vaccine trial and uptake of the vaccine are: married persons, females, Muslims, older persons, residents of less urbanised regions and persons with lower or no formal education (p &lt; 0.05). Predominant reasons cited for unwillingness to participate in a COVID-19 vaccine trial and take the vaccine included fear, safety concerns, lack of trust in state institutions, uncertainty, political connotations, spiritual and religious beliefs.Conclusion: The probability of accepting COVID-19 vaccine among the adult population in Ghana is high but the country should not get complacent because fear, safety and mistrust are important concerns that have the potential to entrench vaccine hesitancy. COVID-19 vaccine rollout campaigns should be targeted and cognisant of the key predictors of citizens’ perceptions of the vaccine. These lessons when considered will promote Ghana’s efforts towards vaccinating at least 20 million people to attain herd immunity