A systematic review of academic performance of Children with Disabilities (CWDs) in inclusive education schools in Low and Middle-Income Countries (LMICs)

Globally it is estimated that about 150 million children are living with disabilities. Inclusive education inspires the participation of all students in the learning process in the same classroom. However, it is really difficult to find thorough, credible accounts of disabled children's access to education, enrolment, attendance, and results. This review evaluated academic performance, including access to school, enrolment, attendance, and results of Children with disabilities (CWD) in LMICs. In reporting this systematic review, the researchers followed the recommended Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting standards. The authors conducted searches using Science Direct, PubMed, Scopus, and Google Scholar electronic databases. The study's major findings indicate that CWDs in inclusive schools perform poorly academically compared to their non-disabled peers. Consequently, the researchers recommend more primary research to evaluate the academic performance of CWDs and the progress of inclusive education in LMICs.

The knowledge level of nurses managing critically-ill and injured patients in Ashanti Region of Ghana

Background

Shortages in the right cadres of human resources to manage health emergencies remain an acute problem especially in low- and middle-income countries. Efforts to address this challenge are dependent on the knowledge and competency of emergency nurses. We sought to determine the knowledge level of nurses in emergency management in the Ashanti Region of Ghana.

Methods

We used a cross-sectional, quantitative approach to evaluate knowledge about emergency care among 408 nurses working in wards and emergency units in 11 randomly selected district hospitals (6 public and 5 faith-based). Participants were purposively selected and examined on knowledge level using a structured questionnaire. The inclusion criteria were different cadres of nurses who had spent at least 6 months in the selected hospitals.

Results

Four hundred and eight nurses participated. Most were general nurses (73.1 %) or mid-wives (14.4 %), with few specialised in emergency nursing (3.9 %) or critical care nursing (1.6 %). Mean percentage correct on an objective 20 question test on emergency care was 59.8 %. Few (35.6 %) nurses felt that they had adequate knowledge to manage emergencies. Around half (52.5 %) had received training in managing critically ill and injured patients through continuing professional development and 46.6 % felt prepared to work at emergency units. But few (34.7 %) reported having adequate logistics to manage emergencies and fewer (32.2 %) had time off to access training opportunities. Predictors of reporting adequate knowledge to manage emergencies included: having received training in managing critically ill and injured patients (p<.002), feeling prepared to work at emergency units (p<.001), and having adequate logistics to manage emergencies (p<.001).

Conclusion

Most nurses did not feel that they had adequate knowledge to manage emergencies. This study has identified increased availability of continuing professional development on emergency care for nurses as a priority in Ghana.

The perception of healthcare workers of People with Disabilities presenting for care at peri-urban health facilities in Ghana

Healthcare provider attitudes and perceptions of disability may influence the delivery of comprehensive quality care to patients with disabilities. The study was conducted to ascertain healthcare providers' perspectives on access to healthcare by disabled people in a peri-urban district of Ghana. We employed a qualitative approach and selected participants using the purposive sampling technique. Qualitative data were collected from 28 healthcare providers through face-to-face interviews using an interview guide. Data let thematic an alysis was employed to tease out the findings through categorisation and the main themes have been presented as findings with specific quotations to support them. We found that people with disabilities who visited healthcare facilities were perceived as individuals who are stressed up, selfish and inconsiderate, violent, having low self-esteem and also difficult to communicate with. This could affect the interactions between healthcare providers and people with disabilities who visit the facility and subsequently the quality of service provided. It is recommended that the Ministry of Education, Ministry of Health and the Ghana Health Service work closely with the various educational institutions to train healthcare professionals to improve their knowledge on disability issues to improve service delivery.

Ghana: health system review 2021

 

A health system review provides a detailed description of a health care system and of reform and policy initiatives in progress or under development. The health system review of Ghana serves as an effort to also assess the system's performance towards the attainment of universal health coverage (UHC). A workshop was organized in 2018 to develop a template for writing the health system review of Ghana. This serves as a pilot study to test the feasibility of using a template somewhat like that of the WHO European Observatory on Health Systems and Policies for writing health system reviews of African countries. The health system review of Ghana is the first to be written for an African country modelled after the HiT reviews by the European Observatory. One key characteristics of the health system of Ghana is the introduction and reform of the national health insurance scheme (NHIS) in 2003 and 2012 respectively. About 40% of the population are enrolled and 60% enrolled are exempted from premium payments. Ghana has since 2010 scaled-up a national telemedicine programme, becoming one of the first adopters and innovators in Africa to integrate digital health technologies into mainstream health care system. Since 2018, Ghana has implemented the NHIS mobile renewal service, which allows payment of health insurance coverage using mobile money technologies. Ghana is one of the first countries to introduce a nationwide health insurance in Africa. The NHIS is one significant effort towards health systems strengthening and achieving UHC. Enrolment in in the NHIS contributes to better access to health care and improved financial protection. However, not only is population coverage low, but there is a serious concern about the system's financial sustainability. A promising approach is to improve the mobile-money based intervention through the high mobile-phone penetration rates in Ghana to enable more effective household saving arrangements towards UHC.

Key messages

Ghana presents important lessons, including the introduction of a national health insurance. This contributes to better access to health care and improved financial protection. Ghana is exploiting the use of mobile phone technologies and has become one of the first adopters and innovators in Africa to integrate digital health technologies into mainstream health care system.

Predictors of adverse birth outcomes among pregnant adolescents in Ashanti Region, Ghana

Adolescent pregnancy is associated with adverse birth outcomes. However, the determinants of these outcomes are understudied. The present study sought to identify the predictors of adverse birth outcomes among pregnant adolescents in Ghana. In this prospective health centre-based study, 416 pregnant adolescents, aged 13-19 years old, were followed, and 270 birth outcomes were evaluated. We collected data on socio-demographic variables, eating behaviour, household hunger scale (HHS), lived poverty index (LPI) and compliance to antenatal interventions. The prevalence of low birth weight (LBW) and preterm births (PTB) were 15⋅2 and 12⋅5 %, respectively. Pregnant adolescents with no formal education (AOR 9⋅0; P = 0⋅004; 95 % CI 2⋅1, 39⋅8), those who experienced illness (AOR 3⋅0; P = 0⋅011; 95 % CI 1⋅3, 7⋅0), those who experienced hunger (OR 2⋅9; P = 0⋅010; 95 % CI 1⋅3, 6⋅5) and those with high LPI (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅2, 5⋅3) presented increased odds of delivering preterm babies compared with those who have had secondary education, did not experience any illness, were not hungry or having low LPI, respectively. Pregnant adolescents who used insecticide-treated net (ITN) (AOR 0⋅4; P = 0⋅013; 95 % CI 0⋅2, 0⋅9) presented reduced odds LBW children; while those who experienced illness (AOR 2⋅7; P = 0⋅020; 95 % CI 1⋅2, 6⋅0), poorer pregnant adolescents (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅1, 4⋅8) and those who experienced hunger (AOR 3⋅0; P = 0⋅028; 95 % CI 1⋅1, 8⋅1) presented increased odds of LBW children compared with those who used ITN, were not ill, were not poor or did not experience hunger. Adverse birth outcomes were associated with ANC compliance and socioeconomic factors of the pregnant adolescents. Hence, strengthening antenatal uptake and compliance by pregnant adolescents, promoting their livelihood and socioeconomic status, and interventions to prevent teenage pregnancies are strongly recommended.

Predictors of adverse birth outcomes among pregnant adolescents in Ashanti Region, Ghana

Adolescent pregnancy is associated with adverse birth outcomes. However, the determinants of these outcomes are understudied. The present study sought to identify the predictors of adverse birth outcomes among pregnant adolescents in Ghana. In this prospective health centre-based study, 416 pregnant adolescents, aged 13-19 years old, were followed, and 270 birth outcomes were evaluated. We collected data on socio-demographic variables, eating behaviour, household hunger scale (HHS), lived poverty index (LPI) and compliance to antenatal interventions. The prevalence of low birth weight (LBW) and preterm births (PTB) were 15⋅2 and 12⋅5 %, respectively. Pregnant adolescents with no formal education (AOR 9⋅0; P = 0⋅004; 95 % CI 2⋅1, 39⋅8), those who experienced illness (AOR 3⋅0; P = 0⋅011; 95 % CI 1⋅3, 7⋅0), those who experienced hunger (OR 2⋅9; P = 0⋅010; 95 % CI 1⋅3, 6⋅5) and those with high LPI (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅2, 5⋅3) presented increased odds of delivering preterm babies compared with those who have had secondary education, did not experience any illness, were not hungry or having low LPI, respectively. Pregnant adolescents who used insecticide-treated net (ITN) (AOR 0⋅4; P = 0⋅013; 95 % CI 0⋅2, 0⋅9) presented reduced odds LBW children; while those who experienced illness (AOR 2⋅7; P = 0⋅020; 95 % CI 1⋅2, 6⋅0), poorer pregnant adolescents (OR 2⋅5; P = 0⋅014; 95 % CI 1⋅1, 4⋅8) and those who experienced hunger (AOR 3⋅0; P = 0⋅028; 95 % CI 1⋅1, 8⋅1) presented increased odds of LBW children compared with those who used ITN, were not ill, were not poor or did not experience hunger. Adverse birth outcomes were associated with ANC compliance and socioeconomic factors of the pregnant adolescents. Hence, strengthening antenatal uptake and compliance by pregnant adolescents, promoting their livelihood and socioeconomic status, and interventions to prevent teenage pregnancies are strongly recommended.

Mobile phone use among commercial drivers in Ghana: An important threat to road safety

Background

Ghana passed a law in 2012 banning the use of mobile phones while driving. However, data on compliance to the law has been lacking.

Objective

To examine factors associated with mobile phone use while driving among Ghanaian commercial drivers.

Methods

A survey was conducted among 627 commercial drivers (98.0% response rate). Bivariate and multivariate logistic regressions were performed to determine how a priori covariates influenced commercial drivers' use of phones while driving. The covariates included driver age, education, driving route distance, driving under the influence (DUI), and knowledge that phone use during driving causes distraction.

Results

Respondents were aware of the law (94.7%) but compliance was low (38%). Drivers who did not believe that cell phone use contributed to crash risk were more likely to report distracted driving (AOR 2.02,95%CI 1.05-3.9). Drivers who had completed primary (AOR 4.49,95%CI 1.14-17.78) or at least senior high school (AOR 6.89,95%CI 1.5-31.59) had increased odds of using the phone while driving, compared to those having no formal education. Drivers with 6-10 years (AOR 2.00,95%CI 1.00-3.98) or >10 years driving experience (AOR 2.87,95%CI 1.24-6.62) were more likely to report distracted driving compared to those with ≤5 years' experience. Drivers who travelled longer distances were more likely to report distracted driving (AOR 2.41,95%CI 1.23-4.71). Those who had never engaged in DUI were less likely to use the phone while driving (AOR 0.06,95%CI 0.01-0.43).

Conclusion

Future prevention efforts for distracted driving in Ghana will require targeted distracted driving enforcement and education for commercial drivers and their passengers.

Funding

This study was funded, in part, by a grant (D43-TW007267) from the Fogarty International Center, US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Perspectives in musculoskeletal injury management by traditional bone setters in Ashanti, Ghana

Background

The popularity of the services of traditional bone setters (TBS) in Ghana as an alternative health care requires exploration and documentation of the perspectives of providers and users.

Objective

To explore and document the perspectives of providers and users of the services of TBS in the management of musculoskeletal injuries in the Ashanti region, Ghana.

Methods

From the social constructivist and qualitative approach, in-depth interviews were used to explore the perspectives of eight TBS and 16 users of their services, selected purposively through snowballing. Thematic content analysis (TCA) was employed.

Results

High recovery rate, warm reception, prompt attention, and the relatively lower charges, are reported to motivate the patronage of the services of TBS for the management of fractures in the legs, arms, ribs, joint bones dislocations, waist and spinal cord problems. The TBS combined traditional and orthodox procedures, using plant and animal-based materials, beliefs, spirituality (God-given) and physical therapy in the management of musculoskeletal injuries. No adverse experience was reported by either the providers or users of the traditional management methods.

Conclusion

With plant and animal-based materials, TBS are observed to combine traditional and orthodox procedures to confidently manage musculoskeletal injuries to the satisfaction of their highly motivated patrons. Although over 60% of the TBS attribute the healing power behind their practice to God, the rest do not discount the role of spiritual therapy. Further studies expanded to include the perspectives of non-users of the services of the TBS will authenticate the findings of this study.

A review of population-based studies on hypertension in Ghana

BACKGROUND

Hypertension is becoming a common health problem worldwide with increasing life expectancy and increasing prevalence of risk factors. Epidemiological data on hypertension in Ghana is necessary to guide policy and develop effective interventions.

METHODS

A review of population-based studies on hypertension in Ghana was conducted by a search of the PUBMED database, supplemented by a manual search of bibliographies of the identified articles and through the Ghana Medical Journal. A single reviewer extracted data using standard data collection forms.

RESULTS

Eleven studies published on hypertension with surveys conducted between 1973 and 2009 were identified. The prevalence of hypertension was higher in urban than rural areas in studies that covered both types of area and increased with increasing age (prevalence ranging from 19.3% in rural to 54.6% in urban areas). Factors associated with high blood pressure included increasing body mass index, increased salt consumption, family history of hypertension and excessive alcohol intake. The levels of hypertension detection, treatment and control were generally low (control rates ranged from 1.7% to 12.7%).

CONCLUSION

An increased burden of hypertension should be expected in Ghana as life expectancy increases and with rapid urbanisation. Without adequate detection and control, this will translate into a higher incidence of stroke and other adverse health outcomes for which hypertension is an established risk factor. Prevention and control of hypertension in Ghana is thus imperative and any delays in instituting preventive measures would most likely pose a greater challenge on the already overburdened health system.

Stroke in Ashanti region of Ghana

OBJECTIVE

To determine the morbidity and mortality in adult in-patients with stroke admitted to the Komfo Anokye Teaching Hospital (KATH).

METHODS

A retrospective study of in-patients with stroke admitted to the KATH, from January 2006 to december 2007 was undertaken. Data from admission and discharge registers were analysed to determine stroke morbidity and mortality.

RESULTS

Stroke constituted 9.1% of total medical adult admissions and 13.2% of all medical adult deaths within the period under review. The mean age of stroke patients was 63.7 (95% ci=62.8, 64.57) years. Males were younger than females. The overall male to female ratio was 1:0.96, and the age-adjusted risk of death from stroke was slightly lower for females than males (relative risk= 0.88; 95% ci=0.79, 1.02, p=0.08). The stroke case fatality rate was 5.7% at 24 hours, 32.7% at 7 days, and 43.2% at 28 days.

CONCLUSION

Stroke constitutes a significant cause of morbidity and mortality in Ghana. Major efforts are needed in the prevention and treatment of stroke. Population-based health education programs and appropriate public health policy need to be developed. This will require a multidisciplinary approach of key players with a strong political commitment. There is also a clear need for further studies on this topic including, for example, an assessment of care and quality of life after discharge from hospital. The outcomes of these studies will provide important information for the prevention efforts.

Pregnant women and alcohol use in the Bosomtwe district of the Ashanti region-Ghana

Drinking alcohol in pregnancy is a serious public health concern worldwide. This study sought to determine the magnitude and socio-demograhic characteristics of pregnant women attending Antenatal clinic in the Bosomtwe district, Ghana who drank alcohol and to assess their general knowledge about the effects of alcohol in pregnancy. The study, a descriptive cross-sectional, was conducted in all the ten health facilities providing reproductive health care with a sample size of 397 pregnant women using structured questionnaires. The findings of the study were that 20.4% of pregnant women drank alcohol. The 25-29 year group 26 (34.0%), married 50 (61.7%) and Junior High School Educated 37 (45.7%) as well as Christians 69 (85.0%) and traders 28 (34.6%) drank most. Majority 77 (33.5%) heard about the detrimental effects of alcohol at Antenatal Clinics (ANC). The District Health Management Team (DHMT) should strengthen health education on alcohol at ANC and through the radio as well as the DHMT collaborating with the Ghana Education Service to embark on education of school pupils and students on the harmful effects of alcohol in pregnancy.