Determining the potential of mobilephone-based health interventions in Kumasi, Ghana

Background: Numerous reviews have reported generally positive outcomes of mobile phone-based health (mHealth) interventions in the sub-Saharan African countries, especially for people with non-communicable diseases. At the same time, the mHealth landscape is burdened by a lack of sustainability. A recently published review has identified several context factors that influence the successful implementation of mHealth. Therefore, the aim is to use these contextual factors to assess the potential for mHealth in a particular clinical setting.Design: The study used a cross-sectional, descriptive design.Setting: The clinical setting of the study was the ‘Komfo Anokye Teaching Hospital’ in Kumasi, Ghana.Participants: 150 patients attending the diabetes clinic were surveyed.Main outcome measures: Context factors that influence the perceived usefulness and ease of use of mHealth.Results: The survey revealed that patients at the diabetes centre had a positive attitude towards mobile phones, but also a low familiarity. Whereas patients faced several access barriers to care, most enabling resources for the successfuland sustainable implementation of mHealth interventions such as access to mobile phones and electricity were available.Conclusions: There is a high potential for mHealth in the setting of the diabetes clinic in Kumasi, Ghana.Keywords: Ghana, mHealth, Diabetes, potentialFunding: None Declare

Effects of combined decision-support and performance-based incentives on reported client satisfaction with maternal health services in primary facilities: A quasi-experimental study in the Upper East Region of Ghana.

BACKGROUND: Computerized decision-support systems (CDSS) and performance-based incentives (PBIs) have potential to contribute to client satisfaction with health services. However, rigorous evidence is lacking on the effectiveness of these strategies in lower-income countries such as Ghana. This study aimed to determine the effect of a combined CDSS-PBI intervention on client satisfaction with maternal health services in primary facilities in the Upper East Region of Ghana. METHODS: We employed a quasi-experimental controlled baseline and endline design to assess the effect of the combined interventions on client satisfaction with maternal health services, measured by quantitative pre/post-test client satisfaction survey. Our analysis used difference-in-difference logistic regression, controlling for potential covariates, to compare variables across intervention and comparison facilities at baseline and endline. RESULTS: The combined CDSS-PBI intervention was associated with increased or unchanged client satisfaction with all maternal health services compared at endline. Antenatal client difference-in-difference of mean satisfaction scores were significant at endline for intervention (n = 378) and comparison (n = 362) healthcare facilities for overall satisfaction (DiD 0.058, p = 0.014), perception of providers' technical performance (DiD = 0.142; p = 0.006), client-provider interaction (DiD = 0.152; p = 0.001), and provider availability (DiD = 0.173; p = 0.001). Delivery client difference-in-difference of satisfaction scores were significant at endline for intervention (n = 318) and comparison (n = 240) healthcare facilities for overall satisfaction with delivery services (DiD = 0.072; p = 0.02) and client-provider interaction (DiD = 0.146; p = 0.02). However, mean overall satisfaction actually reduced slightly in intervention facilities, while DiD for technical performance and provider availability were not significant. CONCLUSION: This combined CDSS-PBI intervention was associated with greater antenatal and delivery client satisfaction with some aspects of maternity services within two years of implementation. It could be expanded elsewhere if funds allow, though further research is still required to assess cost-effectiveness and long-term effects on client satisfaction and maternal health outcomes

The role of packaged water in meeting global targets on improved water access

Packaged water (as either refill, bottled, or sachet water) has become an important element of water security in many low- and middle-income countries, owing to poor reliability and lack of piped water infrastructure. However, over time and across countries, the Demographic and Health Surveys monitoring program has inconsistently classified packaged water components as either improved or unimproved. Using data collected as part of the Performance Monitoring and Accountability 2020 (PMA2020) surveys on water options in nine study geographies across eight countries, we identified five geographies where packaged water constituted one of several options for 5% or more of users. In this study, four scenarios were designed in which packaged water components were variously classified as either improved or unimproved. Unimproved water use was highest in scenarios where sachet or refill water was classified as an unimproved source. Across the four scenarios, the difference in the use of unimproved water as the main option was highest (65%) in Nigeria (Lagos). That difference increased to 78% when considering all regular options. The development of these scenarios highlights the importance of classifying a source as improved or unimproved in the overall metric that indicates progress at national and international levels.IS

High-risk water and sanitation practices: evidence of underreporting from eight countries

Water and sanitation indicators in the erstwhile Millennium Development Goals (MDGs) failed to capture high-risk practices such as unimproved water consumption and open defecation undertaken on a regular basis. In conjunction with local partners, we used a mobile platform to implement representative randomized household surveys in eight countries across Asia and Africa (n=245,054) to quantify the presence and magnitude of such underreporting. Our study identified the use of high-risk practices as a regular option to be greater than their use as the main option. Across the study areas, this consistent underreporting amounted to 26 million (unimproved water) and 50 million (open defecation) people not being targeted for suitable policy interventions. A deeper analysis of Ghana shows poor and rural households are more likely to engage in high-risk practices. Current metrics inflate water and sanitation progress, and need to be adapted for the complex world we live in

Effects of computerized decision support on maternal and neonatal health-worker performance in the context of combined implementation with performance-based incentivisation in Upper East Region, Ghana: a qualitative study of professional perspectives

BACKGROUND: Computerized decision support systems (CDSS) and performance-based incentives (PBIs) can improve health-worker performance. However, there is minimal evidence on the combined effects of these interventions or perceived effects among maternal and child healthcare providers in low-resource settings. We thus aimed to explore the perceptions of maternal and child healthcare providers of CDSS support in the context of a combined CDSS-PBI intervention on performance in twelve primary care facilities in Ghana's Upper East Region. METHODS: We conducted a qualitative study drawing on semi-structured key informant interviews with 24 nurses and midwives, 12 health facility managers, and 6 district-level staff familiar with the intervention. We analysed data thematically using deductive and inductive coding in NVivo 10 software. RESULTS: Interviewees suggested the combined CDSS-PBI intervention improved their performance, through enhancing knowledge of maternal health issues, facilitating diagnoses and prescribing, prompting actions for complications, and improving management. Some interviewees reported improved morbidity and mortality. However, challenges described in patient care included CDSS software inflexibility (e.g. requiring administration of only one intermittent preventive malaria treatment to pregnant women), faulty electronic partograph leading to unnecessary referrals, increased workload for nurses and midwives who still had to complete facility forms, and power fluctuations affecting software. CONCLUSION: Combining CDSS and PBI interventions has potential to improve maternal and child healthcare provision in low-income settings. However, user perspectives and context must be considered, along with allowance for revisions, when designing and implementing CDSS and PBIs interventions

Questionnaire for women’s satisfaction survey on antenatal care

Questionnaire for women’s satisfaction survey on antenatal care

Facteurs liés à l'avortement déclenché chez les femmes à Hohoe, Ghana

In Hohoe, Ghana, induced abortion is the second highest cause of hospital admissions. We aimed to describe factors influencing induced abortion among 408 randomly selected women aged 15-49 years. 21% of the women had had an abortion; of those, 36% said they did not want to disrupt their education or employment; 66% of the abortions were performed by doctors. Bivariate logistic regression showed that compared with women with secondary education, women with basic education (OR = 0.31, 95% CI: 0.18-0.54) and uneducated women (OR = 0.24, 95% CI: 0.07-0.70) were significantly less likely to have had an abortion. Women who were married (OR = 1.83, 95% CI: 1.10-3.04), peri-urban residents (OR = 1.88, 95% CI: 0.95-3.94), and women with formal employment (OR = 2.22, 95% CI: 0.86-5.45) were more likely to have had an abortion. Stakeholders should improve access to effective contraception to lower the chance of needing an abortion and target education programmes at those with unmet need for contraceptionA Hohoe, au Ghana, l'avortement déclenché constitue la deuxième cause principale des admissions hospitalières. Nous avions comme objectif de décrire les facteurs qui influent sur l'avortement déclenché chez 408 femmes âgées de 15 à 49 ans qui ont été sélectionnées au hasard. Vingt-et-un pourcent des femmes ont eu un avortement ; parmi elles, 36% ont dit qu'elles ne voulaient pas interrompre leur éducation ou leur emploi ; 66% des avortements ont été réalisé par les médecins. La régression logistique bi variable a révélé que par rapport aux femmes qui ont fait l'étude secondaire, les femmes qui ont une éducation de base (OR=0,31, 95% CI : 018-0,54) et les femmes illettrées (OR=0,24, 95% CI : 0,07-0,70) avaient sensiblement moins la chance d'avoir un avortement. Les femmes mariées (OR=1,83, 95% CI : 1,10-3,04), les habitants péri- urbains (OR=1,88, 95%CI : 0,95-3,94) et les femmes qui ont des emplois formels (OR=2,22, 95% CI :0,86-5,45) avaient plus la chance d'avoir eu un avortement. Il faut que les intéressés améliorent la contraception effective pour réduire la possibilité de demander un avortement et de viser des programmes d'éducation pour celles qui ont des besoins pour la contraception qui n'ont pas été satisfait

Anthropometric measurements: options for identifying low birth weight newborns in Kumasi, Ghana.

BackgroundIn Ghana, 32% of deliveries take place outside a health facility, and birth weight is not measured. Low birth weight (LBW) newborns who are at increased risk of death and disability, are not identified; 13%-14% of newborns in Ghana are LBW. We aimed at determining whether alternative anthropometrics could be used to identify LBW newborns when weighing scales are not available to measure birth weight.MethodsWe studied 973 mother and newborn pairs at the Komfo Anokye Teaching and the Suntreso Government hospitals between November 2011 and October 2012. We used standard techniques to record anthropometric measurements of newborns within 24 hours of birth; low birth weight was defined as birth weight ResultsOne-fifth (21.7%) of newborns weighed less than 2.5 kg. Among LBW newborns, the following measurements had the highest correlations with birth weight: chest circumference (r = 0.69), mid-upper arm circumference (r = 0.68) and calf circumference (r = 0.66); the areas under the curves of these three measurements demonstrated the highest accuracy in determining LBW newborns. Chest, mid-upper arm and calf circumferences at cut-off values of ≤ 29.8 cm, ≤ 9.4 cm and ≤ 9.5 cm respectively, had the best combination of maximum sensitivity, specificity and predictive values for identifying newborns with LBW.ConclusionsAnthropometric measurements, such as the chest circumference, mid-upper arm circumference and calf circumference, offer an opportunity for the identification of and subsequent support for LBW newborns in settings in Ghana, where birth weights are not measured by standardized weighing scales