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Spencer SA, Adipa FE, Baker T, Crawford AM, Dark P, Dula D, Gordon SB, Hamilton DO, Huluka DK, Khalid K, Lakoh S, Limbani F, Rylance J, Sawe HR, Simiyu I, Waweru-Siika W, Worrall E, Morton B. A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive Care Med 2023; 49:772-784. [PMID: 37428213 PMCID: PMC10354139 DOI: 10.1007/s00134-023-07136-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to "ensure the timely and effective delivery of life-saving health care services to those in need". In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or "building blocks": (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings.
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Affiliation(s)
- Stephen A Spencer
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Tim Baker
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Queen Marys University of London, London, UK
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Paul Dark
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
| | - Dingase Dula
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Oliver Hamilton
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Karima Khalid
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Felix Limbani
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Jamie Rylance
- Health Care Readiness Unit, World Health Organisation, Geneva, Switzerland
| | - Hendry R Sawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ibrahim Simiyu
- Liverpool School of Tropical Medicine, Liverpool, UK
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Eve Worrall
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ben Morton
- Liverpool School of Tropical Medicine, Liverpool, UK.
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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Avoka JA, Dun-Dery EJ, Seidu I, Abou ANE, Twene P, Tandoh IO, Dun-Dery F. Time series analysis of the relationship between diarrhea in children and Rota 2 vaccine in the Fanteakwa District of the eastern region of Ghana. BMC Pediatr 2021; 21:88. [PMID: 33607970 PMCID: PMC7893935 DOI: 10.1186/s12887-021-02540-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Rotavirus is considered the main causal factor of severe gastroenteritis among infants and children globally. The association with severe rotavirus infection is mostly worse among the least developed countries, mainly due to inadequate access to medical care and poverty. This study was conducted to determine the seasonal effects in respect of diarrhea cases in children, the association between diarrhea cases and Rota2 vaccine in the Fanteakwa District of the Eastern Region of Ghana. METHODS The study compares monthly diarrhea cases against children vaccinated with Rota2 extracted from DHIMS2 spanning May 2012 to December 2017 in Fanteakwa District. A univariate association between diarrhea cases and children vaccinated with Rota 2 was conducted using the R-software version 3.4.4 with the use of forecast, tseries and TSAPred. Pearson Correlation coefficient was also computed between monthly diarrhea cases and Rota 2 as well as lagged values of Rota 2 and Diarrhea cases. RESULTS The study shows that February recorded the highest average number of diarrhea cases (172) over the period 2012 to 2017 with a standard deviation of 59. However, a one-way analysis of variance shows a significant difference amongst the monthly averages with an F-statistic of 0.042 and P-value of 0.064. It is observed that the correlations between each of the Rota2 doses and the lagged cases are positive, showing higher Rota2 doses a month ago ((Xt - 1),0.346 to 0.735), two months ago ((Xt - 2),0.383 to 0.746), three months ago ((Xt - 3), 0.330 to 0.737) and four months ago ((Xt - 4), 0.236 to 0.723) are associated with lower diarrhea cases. The results also show that an increase in the previous two month's Rota2 figures by 100 is associated with a significant decrease in the currently expected diarrhea cases by approximately 36. CONCLUSION Seasonal variations exist in the occurrence of diarrhea in children, with January recording the highest number of diarrhea cases (172). There is a relationship between episodes of diarrhea in children and Rota2 (p-value = 0.064); thus, the more children are vaccinated with Rota2, the less diarrhea cases are recorded. Diarrhea cases in Fanteakwa district are generally low, except 2013 and 2016 where the cases are higher than the rest of the other years.
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Affiliation(s)
- James Atampiiga Avoka
- Ghana Health Service, Birim Central Municipal Health Directorate, Box 429, Akim Oda, Ghana
| | - Elvis J. Dun-Dery
- Department of Population and Health Research, Research Web Africa, Box 233, Sunyani, Ghana
| | - Issah Seidu
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Armel N. E. Abou
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Paul Twene
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Isaac Obeng Tandoh
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Frederick Dun-Dery
- Disease Control in Disadvantaged Populations, Heidelberg Institute of Global Health, Medical Faculty, Ruprecht-Karls Universität, Heidelberg, Germany
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Amankwah O, Weng-Wai C, Mohammed AH. Modelling the Mediating Effect of Health Care Healing Environment on Core Health Care Delivery and Patient Satisfaction in Ghana. ENVIRONMENTAL HEALTH INSIGHTS 2019; 13:1178630219852115. [PMID: 31217690 PMCID: PMC6560799 DOI: 10.1177/1178630219852115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/26/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The multifaceted nature of health care delivery has led to the need to incorporate strategies that will help to enhance performance and maintain the quality of the health care environment. However, even though dedicated health care staffs contribute to patients' satisfaction of health care delivery, the health care environment must ensure the safety and well-being of patients. Like most developing countries, many public hospitals in Ghana are faced with challenges in the area of health care healing environment. Therefore, this article investigates the mediating effect of health care healing environment between health care core business and patients' satisfaction. METHOD This is a cross-sectional study involving adult patients of Komfo Anokye Teaching Hospital, Tamale Teaching Hospital, and Cape Coast Teaching Hospital in Ghana. A questionnaire survey based on the 'A Staff and Patient Environment Calibration Toolkit (ASPECT)' dimensions and health care core service dimensions was used to collect data from 622 patients. SmartPLS was used to analyse the data collected. RESULTS The findings of the study show that the quality of health care healing environment mediates the relationship between patients' satisfaction and all of the constructs under the core health care delivery. CONCLUSION Stakeholders of the Ghanaian health care sector should take initiatives to constantly improve the quality of health care healing environment as it has an influence on patient satisfaction of the overall core health care delivery.
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Affiliation(s)
- Oti Amankwah
- Faculty of Built Environment and Surveying, Department of Real Estate, Universiti Teknologi Malaysia, Skudai, Malaysia
- Faculty of Built and Natural Environment, Department of Estate Management, Kumasi Technical University, Kumasi, Ghana
| | - Choong Weng-Wai
- Faculty of Built Environment and Surveying, Department of Real Estate, Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Abdul Hakim Mohammed
- Faculty of Built Environment and Surveying, Department of Real Estate, Universiti Teknologi Malaysia, Skudai, Malaysia
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Christmals CD, Gross J, Aziato L, Armstrong SJ. The State of Nursing Research in Ghana: An Integrative Literature Review. SAGE Open Nurs 2018; 4:2377960818783820. [PMID: 33415196 PMCID: PMC7774359 DOI: 10.1177/2377960818783820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/10/2018] [Accepted: 04/07/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION For nursing practice to be responsive to the needs of patients, it must be driven by contextual research evidence. To guide institutional and national nursing research policy, there is need to determine the quantity and quality of nursing research in Ghana. PURPOSE The purpose of this integrative literature review was to quantify, critically evaluate, and describe nursing research publication in Ghana from January 2007 to December 2016 with regard to the country's research capacity to sustain evidence-based practice. RESULTS Sixty (60) out of 749 articles identified from EBSCOhost, ProQuest, PubMed, Science Direct, Scopus, Wiley Online Library, and Google Scholar using three keywords (nursing, health, and Ghana) were included. A total of 60,778 human subjects were used in these studies. There were more quantitative (28) studies than qualitative (23) studies. These studies recorded 219 authors from 120 institutions, 55 of which were outside Ghana. Forty-five percent of the articles were published in journals with impact factor. There was a steady increase in publication in Ghana over the decade. A majority of the studies published in education were in curriculum implementation and evaluation. CONCLUSIONS The increasing number of peer-reviewed nursing research publications in Ghana and the curriculum implementation and evaluation in Ghana signified an increasing capacity of the country to implement and sustain evidence-based practice. RECOMMENDATIONS It is recommended that regular research be conducted to evaluate the responsiveness to old and new nursing programs in Ghana.
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Affiliation(s)
- Christmal D. Christmals
- Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Department of Nursing Education, School of Therapeutic Sciences, University of Witwatersrand, Johannesburg South Africa
| | - Janet Gross
- Morehead State University, KY, USA
- Global Health Services Partnership, US Peace Corps, Liberia
| | - Lydia Aziato
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Accra, Ghana
| | - Susan J. Armstrong
- Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Yarney L, Atinga RA. Patients’ perspectives of emergency care quality and priorities for care improvement. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2017. [DOI: 10.1108/ijhg-12-2016-0055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Studies have examined strategies implemented to strengthen quality of emergency care in healthcare provider institutions in Ghana. But few studies have focused on what determines quality of emergency care from the patient’s perspective. The purpose of this paper is to fill that gap by examining factors salient to gauging quality of emergency care and priority areas for care improvement.
Design/methodology/approach
Cross-sectional data were collected from patients admitted in emergency units of public hospitals in two regions: Greater Accra and Central Regions. A structured questionnaire designed with inputs from emergency medicine physicians and patients was used to collect data from 381 patients. Principal component analysis (PCA) and logistic regression models were computed to respectively determine salient measures of emergency care quality and their association with patient overall perceived quality of emergency care.
Findings
Using the PCA, four factors (social and relational care, attentive prehospitalised care, ward quality and privacy and medical supplies) were derived as salient measures of emergency care quality. All the factors derived had statistically significant association with patient overall perception of quality.
Originality/value
Emergency care quality improvement strategies that incorporate the dimensions identified can produce effective therapeutic outcomes.
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