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Doku A, Tuglo LS, Boima V, Agyekum F, Aovare P, Ali Abdulai M, Godi A, Peters RJG, Agyemang C. Prevalence of Cardiovascular Disease and Risk Factors in Ghana: A Systematic Review and Meta-analysis. Glob Heart 2024; 19:21. [PMID: 38404614 PMCID: PMC10885824 DOI: 10.5334/gh.1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
Background The increasing cardiovascular disease (CVD) burden threatens the global population as the major cause of disability and premature death. Data are scarce on the magnitude of CVD among the population in West Africa, particularly in Ghana. This study examined the available scientific evidence to determine the pooled prevalence (PP) of CVD and risk factors in Ghana. Methods We searched electronic databases such as PubMed, Google Scholar, the Cochrane Library, Science Direct and Africa Journal Online databases to identify literature published from the start of the indexing of the database to 10th February 2023. All articles published in the English language that assessed the prevalence of CVD or reported on CVD in Ghana were included. Two authors independently performed the study selection, assessed the risk of bias, extracted the data and checked by the third author. The effect sizes and pooled odds ratio (POR) were determined using the random-effects DerSimonian-Laird (DL) model. Result Sixteen studies with 58912 participants from 1954 to 2022 were included in the meta-analysis. Six studies out of 16 reported more than one prevalence of CVD, giving a total of 59 estimates for PP. The PP of CVD in the general population in Ghana was 10.34% (95% Cl: [8.48, 12.20]; l2 99.54%, p < 0.001). Based on the subgroup analysis, the prevalence of CVD was higher in hospital-based settings at 10.74% (95%, confidence interval [Cl]: 8.69, 12.79) than in community-based settings at 5.04% (95% Cl: 2.54, 7.53). The risk factors were male gender (pooled odds ratio [POR]: 1.66; 95% CI: 1.02, 2.70), old age (POR: 1.32; 95% CI: 1.21, 1.45), unemployment (POR: 2.62; 95% CI: 1.33, 5.16), diabetes (POR: 2.79; 95% CI: 1.62, 4.81) and hypertension (POR: 3.41; 95% CI: 1.75, 6.66). Conclusion The prevalence of CVD was high in Ghana. Urgent interventions are needed for the prevention and management of the high burden of CVD and its risk factors.
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Affiliation(s)
- Alfred Doku
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
- National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Lawrence Sena Tuglo
- Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
- Department of Epidemiology, School of Public Health, Nantong University, 9 Seyuan Road, Nantong, Jiangsu, China
| | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
| | - Francis Agyekum
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Pearl Aovare
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, P.O Box 200, Kintampo-B/E, Ghana
| | - Anthony Godi
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ron J. G. Peters
- Department of Cardiology, University Amsterdam Medical Center, University of Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
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Abdulai MA, Mevissen FEF, Marien V, Ruiter RAC, Owusu-Agyei S, Asante KP, Bos AER. A qualitative analysis of factors influencing the implementation of antiretroviral treatment adherence policy in Ghana: stakeholders perspective. Health Res Policy Syst 2023; 21:54. [PMID: 37316935 DOI: 10.1186/s12961-023-01010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 05/20/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The Joint United Nations Programme on HIV/AIDS launched the 90-90-90 initiative. Failure to meet the target reflects the difficulties in successfully implementing HIV treatment policy. There are research gaps in exploring personal and external factors influencing HIV treatment in Ghana. To fill this gap, we explored individual and environmental (interpersonal, community and structural) factors influencing stakeholders' HIV treatment policy implementation in Ghana. METHODS Fifteen qualitative semi-structured in-depth interviews were conducted among representatives in different management positions at hospitals, health directorates, the Ghana AIDS Commission, the National AIDS and STI control program, and the National Association of People Living with HIV. RESULTS Using thematic analysis, the findings suggest that individual and environmental factors such as attitude towards policy, awareness of HIV treatment policy, training received on policy implementation, difficulties related to patient factors, alternate sources of HIV care, inefficient policy decision-making, monitoring and evaluation of HIV treatment policy, lack of HIV treatment policy implementation training, poor availability of logistics, policy and guidelines, infrastructure, organization of training, and staff availability may hinder successful HIV treatment policy implementation. CONCLUSION Several individual and environmental (interpersonal, community and structural) factors seem to influence HIV treatment policy implementation. To ensure successful policy implementation stakeholders need to receive training on new policies, availability of sufficient supplies of material resources, inclusive decision-making, receive supportive monitoring of policy implementation, and oversight.
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Affiliation(s)
- Martha Ali Abdulai
- Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, P.O Box, 200, Kintampo-Bono East Region, Ghana.
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Fraukje E F Mevissen
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Public Health, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Veerle Marien
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Seth Owusu-Agyei
- Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, P.O Box, 200, Kintampo-Bono East Region, Ghana
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | - Kwaku Poku Asante
- Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, P.O Box, 200, Kintampo-Bono East Region, Ghana
| | - Arjan E R Bos
- Faculty of Psychology, Open University, PO Box 2960, 6401 DL, Heerlen, The Netherlands
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Ali Abdulai M, E.F Mevissen F, Kramer A, Boitelet Z, Poku Asante K, Owusu-Agyei S, Ruiter RA, E.R Bos A. A qualitative analysis of factors influencing healthcare providers’ behaviour toward persons living with HIV in Ghana. International Journal of Africa Nursing Sciences 2023. [DOI: 10.1016/j.ijans.2023.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Janssen J, Afari-Asiedu S, Monnier A, Abdulai MA, Tawiah T, Wertheim H, Baltussen R, Asante KP. Exploring the economic impact of inappropriate antibiotic use: the case of upper respiratory tract infections in Ghana. Antimicrob Resist Infect Control 2022; 11:53. [PMID: 35365210 PMCID: PMC8973739 DOI: 10.1186/s13756-022-01096-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/17/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Antibiotic consumption is increasing worldwide, particularly in low and middle-income countries (LMICs). Access to lifesaving antibiotics in LMICs is crucial while minimising inappropriate use. Studies assessing the economic impact of inappropriate antibiotic use in LMICs are lacking. We explored the economic impact of inappropriate antibiotic use using the example of upper respiratory tract infections (URIs) in Ghana, as part of the ABACUS (AntiBiotic ACcess and USe) project. METHODS A top-down, retrospective economic impact analysis of inappropriate antibiotic use for URIs was conducted. Two inappropriate antibiotic use situations were considered: (1) URIs treated with antibiotics, against recommendations from clinical guidelines; and (2) URIs that should have been treated with antibiotics according to clinical guidelines, but were not. The analysis included data collected in Ghana during the ABACUS project (household surveys and exit-interviews among consumers buying antibiotics), scientific literature and stakeholder consultations. Included cost types related to health care seeking behaviour for URIs. Additionally, cost saving projections were computed based on potential effects of future interventions that improve antibiotic use. RESULTS Health care costs related to inappropriate antibiotic use for URIs were estimated to be around 20 million (M) USD annually, including 18 M USD for situation 1 and 2 M USD for situation 2. Travel costs and lost income due to travel, together, were estimated to be around 44 M USD for situation 1 and 18 M USD for situation 2. Possible health care cost savings range from 2 to 12 M USD for situation 1 and from 0.2 to 1 M USD for situation 2. CONCLUSIONS This study indicates that inappropriate antibiotic use leads to substantial economic costs in a LMIC setting that could have been prevented. We recommend investment in novel strategies to counter these unnecessary expenditures. As the projections indicate, this may result in considerable cost reductions. By tackling inappropriate use, progress can be made in combatting antibiotic resistance.
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Affiliation(s)
- Jip Janssen
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Samuel Afari-Asiedu
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Annelie Monnier
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Theresa Tawiah
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Heiman Wertheim
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Rob Baltussen
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
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Afari-Asiedu S, Abdulai MA, Tostmann A, Boamah-Kaali E, Asante KP, Wertheim HF, Hulscher M. Interventions to improve dispensing of antibiotics at the community level in low and middle income countries: A systematic review. J Glob Antimicrob Resist 2022; 29:259-274. [PMID: 35342021 DOI: 10.1016/j.jgar.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Inappropriate antibiotic dispensing is one of the key drivers of antibiotic resistance. This review documents the effectiveness of interventions aimed at improving antibiotic dispensing practices at the community level by drug dispensers in low and middle income countries (LMIC). METHODS We conducted a systematic search in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science (November 11, 2019). Studies were included if they reported data on the outcome measure: appropriate dispensing of medicine including antibiotics. The effectiveness of studies was assessed based on quantitative results reported in the studies included. RESULTS A total of 1158 papers were screened. Thirteen studies from Asia (6), Africa (5), South America (one) and one study from both Africa and Asia were included in this review. Nine (69.2%) studies reported significant effectiveness of interventions on all or more than 50% of antibiotic related outcomes. Cochrane Effective Practice and Organization of Care interventions frequently applied were educational meetings (9/13), distribution of educational materials (7/13), educational outreach meetings (7/13), reminders (6/13), local consensus processes (6/13), distribution of supplies (6/14) and clinical practice guidelines (4/14), Nine studies reported on stakeholder involvement. CONCLUSION This review shows that it is possible to improve antibiotic dispensing practices at the community level in LMIC. Stakeholders' involvement was key in the design and implementation of interventions.
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Affiliation(s)
- Samuel Afari-Asiedu
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana; Radboud University Medical Center, Center for Infectious Diseases Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Microbiology, Nijmegen, The Netherlands.
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana
| | - Alma Tostmann
- Radboud University Medical Center, Center for Infectious Diseases Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Microbiology, Nijmegen, The Netherlands
| | - Ellen Boamah-Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana
| | - Heiman Fl Wertheim
- Radboud University Medical Center, Center for Infectious Diseases Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Microbiology, Nijmegen, The Netherlands
| | - Marlies Hulscher
- Radboud University Medical Center, Center for Infectious Diseases Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands
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Abdulai MA, Marable JK, Wadus A, Asante KP. A qualitative analysis of factors influencing health-seeking behavior of people living with HIV, hypertension and diabetes in an urban area of Ghana. Journal of Multimorbidity and Comorbidity 2022; 12:26335565221092664. [PMID: 35586035 PMCID: PMC9106310 DOI: 10.1177/26335565221092664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Non-communicable diseases are rising globally and lower-middle-income countries are now facing a double-burden of communicable and non-communicable diseases like hypertension and diabetes. Patients with HIV/AIDS are at increased risk of developing hypertension and diabetes. Understanding how this double-burden influences persons living with HIV health-seeking behavior (HSB) is critical to identifying successful interventions and policies. To explore the factors that influence the health-seeking behavior of HIV patients with hypertension and diabetes in an urban setting of Ghana, we undertook a qualitative study consisting of sixteen in-depth interviews (five healthcare providers [HCP] and eleven patients); all recruited from Antiretroviral Therapy (ART) clinics in the Techiman South Municipality of Ghana. Interview questions were designed to explore cognitive, affective, social, and environmental factors that influence an individual’s decision-making process and behavior. All interviews were audio-recorded, transcribed, and analyzed thematically. Participants raised unique challenges while seeking treatment services for HIV, hypertension, and diabetes. Frequent appointments, increased pill burden, food restrictions, alternate sources of care (herbalist and pastors), and negative psychological wellbeing were some of the challenges noted for seeking treatment services. Challenges with the health facility, including separate clinic days for comorbid conditions, high costs of medications and transportation, and long waiting hours were also cited as influencing health-seeking behavior. Results indicate greater challenges for HIV patients living with hypertension and diabetes in accessing treatment services. Understanding this is critical to removing barriers and making treatment more accessible. Further integration of treatment for hypertension and diabetes into HIV care is essential to ensuring patient engagement in continuous care.
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Affiliation(s)
- Martha Ali Abdulai
- Kintampo Health Research Centre, Research and Development Division, Ghana
| | - Julian K Marable
- Department of Global Health, Georgetown University, Washington, DC, USA
| | - Awudu Wadus
- Kintampo Health Research Centre, Research and Development Division, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana
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7
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Afari-Asiedu S, Hulscher M, Abdulai MA, Boamah-Kaali E, Wertheim HFL, Asante KP. Stakeholders' perspectives on training over the counter medicine sellers and Community-based Health Planning and Services facilities to dispense antibiotics in Ghana. J Pharm Policy Pract 2021; 14:62. [PMID: 34294159 PMCID: PMC8299568 DOI: 10.1186/s40545-021-00349-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Dispensing of antibiotics by over the counter medicine sellers (OTCMS) is a major driver of inappropriate use and resistance in low and middle income countries. Recent studies in Ghana revealed the need to consider training OTCMS and Community-based Health Planning and Services (CHPS)/health posts to dispense some antibiotics. Feasibility of training OTCMS and CHPS to dispense some antibiotics was explored in this study. Methods This was an explorative study involving 10 in-depth interviews (IDIs) among staff of Ghana health services (GHS), pharmacy council and the association of OTCMS at the district and regional levels. Next, findings were presented to the Ghana Antimicrobial Resistance (AMR) platform for further discussions at the national level. Five IDIs were also performed among selected members of the AMR platform as a follow-up on emerging issues. Data were thematically analysed and presented as narratives with quotes to support the findings. Results Two opposing views were found in our study. Leadership of OTCMS and GHS staff at the district health directorate supported the suggestion that OTCMS and CHPS should be trained to dispense specific antibiotics because they are already dispensing them. The leadership of OTCMS explained that some of their members are experienced and could be trained to improve their practices. In contrast, participants from pharmacy council, GHS in the region and national AMR platform generally alluded that OTCMS and CHPS should not be trained to dispense antibiotics because their level of education is inadequate. GHS personnel from the region further explained that training OTCMS could further compromise inappropriate antibiotic use in the context of already weak regulation enforcement. GHS and pharmacy council in the region rather suggested that OTCMS and CHPS should focus on public health education on disease prevention and appropriate antibiotic use. Conclusions There is general lack of consensus among stakeholders on whether OTCMS and CHPS should be trained to dispense specific antibiotics. Further stakeholder engagement is required to carefully consider this suggestion as views on feasibility differ. Ministries of health and healthcare agencies in Ghana and LMIC should improve access to approved health services to improve antibiotic use in rural settings.
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Affiliation(s)
- Samuel Afari-Asiedu
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service , Kintampo, Bono East Region, Ghana. .,Radboudumc Center for Infectious Diseases , Radboud University Medical Center, Nijmegen, The Netherlands. .,Radboud Institute for Health Sciences, Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Marlies Hulscher
- Radboudumc Center for Infectious Diseases , Radboud University Medical Center, Nijmegen, The Netherlands.,Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service , Kintampo, Bono East Region, Ghana
| | - Ellen Boamah-Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service , Kintampo, Bono East Region, Ghana
| | - Heiman F L Wertheim
- Radboudumc Center for Infectious Diseases , Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service , Kintampo, Bono East Region, Ghana
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Abdulai MA, Mevissen FEF, Ruiter RAC, Owusu‐Agyei S, Asante KP, Bos AER. A qualitative analysis of factors influencing antiretroviral adherence among persons living with
HIV
in Ghana. Community & Applied Soc Psy 2021. [DOI: 10.1002/casp.2551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Martha Ali Abdulai
- Kintampo Health Research Centre, Ghana Health Service Kintampo Ghana
- Department of Work and Social Psychology Maastricht University Maastricht The Netherlands
| | - Fraukje E. F. Mevissen
- Department of Work and Social Psychology Maastricht University Maastricht The Netherlands
| | - Robert A. C. Ruiter
- Department of Work and Social Psychology Maastricht University Maastricht The Netherlands
| | - Seth Owusu‐Agyei
- Kintampo Health Research Centre, Ghana Health Service Kintampo Ghana
- Institute of Health Research University of Health and Allied Sciences Ho Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service Kintampo Ghana
| | - Arjan E. R. Bos
- Faculty of Psychology Open University Heerlen The Netherlands
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Do NTT, Vu HTL, Nguyen CTK, Punpuing S, Khan WA, Gyapong M, Asante KP, Munguambe K, Gómez-Olivé FX, John-Langba J, Tran TK, Sunpuwan M, Sevene E, Nguyen HH, Ho PD, Matin MA, Ahmed S, Karim MM, Cambaco O, Afari-Asiedu S, Boamah-Kaali E, Abdulai MA, Williams J, Asiamah S, Amankwah G, Agyekum MP, Wagner F, Ariana P, Sigauque B, Tollman S, van Doorn HR, Sankoh O, Kinsman J, Wertheim HFL. Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach. Lancet Glob Health 2021; 9:e610-e619. [PMID: 33713630 PMCID: PMC8050200 DOI: 10.1016/s2214-109x(21)00024-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices. METHODS We did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016-Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions. FINDINGS Vietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia. INTERPRETATION Contextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance. FUNDING Wellcome Trust and Volkswagen Foundation.
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Affiliation(s)
- Nga T T Do
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Huong T L Vu
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Chuc T K Nguyen
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | | | - Khatia Munguambe
- Manhiça Health Research Centre, Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - F Xavier Gómez-Olivé
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Johannes John-Langba
- School of Applied Human Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Toan K Tran
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Malee Sunpuwan
- Institute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand
| | - Esperanca Sevene
- Manhiça Health Research Centre, Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Hanh H Nguyen
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Phuc D Ho
- Institute of Mathematics, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | | | - Sabeena Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Olga Cambaco
- Manhiça Health Research Centre, Manhiça, Mozambique
| | | | | | | | | | | | | | | | - Fezile Wagner
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Proochista Ariana
- Nuffied Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Stephen Tollman
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Nuffied Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Osman Sankoh
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Statistics Sierra Leone, Freetown, Sierra Leone; University Secretariat, Njala University, Njala, Sierra Leone; Heidelberg Institute for Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Heiman F L Wertheim
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands.
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Afari-Asiedu S, Hulscher M, Abdulai MA, Boamah-Kaali E, Asante KP, Wertheim HFL. Every medicine is medicine; exploring inappropriate antibiotic use at the community level in rural Ghana. BMC Public Health 2020; 20:1103. [PMID: 32664902 PMCID: PMC7359511 DOI: 10.1186/s12889-020-09204-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/05/2020] [Indexed: 11/14/2022] Open
Abstract
Background Inappropriate antibiotic use is an important driver of antibiotic resistance. This study sought to explore inappropriate antibiotic use and confusing antibiotics with other medicines in Ghana using ethnomethodology research approach. Methods This was an explorative study involving 15 in-depth interviews among health professionals and private dispensers and eight focus group discussions among 55 community members. Qualitative data were coded using Nvivo 12, thematically analysed and presented as narratives with quotes to support the findings. Results Self-medication was common and antibiotics were used to treat specific diseases but respondents were not aware these were ‘antibiotics’. Various antibiotics were used for indications that in principle do not require systemic antibiotics, like stomach ache and sores on the body. Antibiotics, in particular tetracycline and metronidazole, were poured into “akpeteshie” (local gin) to treat hernia and perceived stomach sores (stomach ulcer). These practices were copied/learnt from various sources like over-the-counter medicine sellers, family, friends, radio/television, drug peddlers, pharmacies and doctors. Medicines in capsules were referred to as ‘topaye’ or ‘abombelt’ in Twi (local dialect) and perceived to treat pain associated with diseases. Antibiotics in capsules were described with colours which appeared confusing as some capsules with different drugs in them have similar colours. Conclusion Inappropriate antibiotic use were influenced by general lack of knowledge on antibiotics and identification of antibiotics by colours of capsules which leads to confusion and could lead to inappropriate antibiotic use. There is the need for public health education on appropriate antibiotic use and standardization of appearance of antibiotics and other drugs to optimize use.
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Affiliation(s)
- Samuel Afari-Asiedu
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Bono East Region, Ghana. .,Radboud University Medical Centre, Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Nijmegen, Netherlands.
| | - Marlies Hulscher
- Radboud University Medical Center/Scientific Center for Quality of Healthcare, Radboud University, Nijmegen, Netherlands
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Bono East Region, Ghana.,Department of work and psychology, Maastricht University, Maastricht, Netherlands
| | - Ellen Boamah-Kaali
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Bono East Region, Ghana.,Department of work and psychology, Maastricht University, Maastricht, Netherlands
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Bono East Region, Ghana
| | - Heiman F L Wertheim
- Radboud University Medical Centre, Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Nijmegen, Netherlands
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11
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Afari-Asiedu S, Oppong FB, Tostmann A, Ali Abdulai M, Boamah-Kaali E, Gyaase S, Agyei O, Kinsman J, Hulscher M, Wertheim HFL, Asante KP. Determinants of Inappropriate Antibiotics Use in Rural Central Ghana Using a Mixed Methods Approach. Front Public Health 2020; 8:90. [PMID: 32266200 PMCID: PMC7105730 DOI: 10.3389/fpubh.2020.00090] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/04/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The consequences of antibiotic resistance are projected to be most severe in low and middle income countries with high infectious disease burden. This study examined determinants of inappropriate antibiotic use at the community level in rural Ghana. Methods: An observational study involving qualitative and quantitative methods was conducted between July, 2016 and September, 2018 in Ghana. Two household surveys were conducted at two time points (2017 and 2018) among 1,100 randomly selected households over 1 year. The surveys focused on antibiotic use episodes in the past month. Four in-depth interviews and two focus group discussions were performed to further explain the survey results. Determinants of inappropriate antibiotic use were assessed using a mixed effect logistic regression analysis (multilevel analysis) to account for the clustered nature of data. We defined inappropriate antibiotic use as either use without prescription, not completing treatment course or non-adherence to instruction for use. Qualitative data were thematically analyzed. Results: A total of 1,100 households was enrolled in which antibiotics were used in 585 (53.2%) households in the month prior to the surveys. A total of 676 (21.2%) participants out of 3,193 members from the 585 reportedly used antibiotics for 761 episodes of illness. Out of the 761 antibiotic use episodes, 659 (86.6%) were used inappropriately. Paying for healthcare without health insurance (Odds Ratio (OR): 2.10, 95% CI: 1.1–7.4, p-value: 0.026), not seeking healthcare from health centers (OR: 2.4, 95% CI: 1.2–5.0, p-value: 0.018), or pharmacies (OR: 4.6, 95% CI: 1.7–13.0, p-value: 0.003) were significantly associated with inappropriate antibiotic use. Socio-demographic characteristics were not significantly associated with inappropriate antibiotic use. However, the qualitative study described the influence of cost of medicines on inappropriate antibiotic use. It also revealed that antibiotic users with low socioeconomic status purchased antibiotics in installments which, could facilitate inappropriate use. Conclusion: Inappropriate antibiotic use was high and influenced by out-of-pocket payment for healthcare, seeking healthcare outside health centers, pharmacies, and buying antibiotics in installments due to cost. To improve appropriate antibiotic use, there is the need for ministry of health and healthcare agencies in Ghana to enhance healthcare access and healthcare insurance, and to provide affordable antibiotics.
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Affiliation(s)
- Samuel Afari-Asiedu
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.,Radboud University Medical Center, Institute for Health Sciences, Nijmegen, Netherlands
| | | | - Alma Tostmann
- Radboud University Medical Center, Institute for Health Sciences, Nijmegen, Netherlands.,Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| | | | | | - Stephaney Gyaase
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Oscar Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Marlies Hulscher
- Radboud University Medical Center, Institute for Health Sciences, Nijmegen, Netherlands
| | - Heiman F L Wertheim
- Radboud University Medical Center, Institute for Health Sciences, Nijmegen, Netherlands.,Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
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12
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Agbokey F, Dwommoh R, Tawiah T, Ae-Ngibise KA, Mujtaba MN, Carrion D, Ali Abdulai M, Afari-Asiedu S, Owusu-Agyei S, Asante KP, Jack DW. Determining the Enablers and Barriers for the Adoption of Clean Cookstoves in the Middle Belt of Ghana-A Qualitative Study. Int J Environ Res Public Health 2019; 16:E1207. [PMID: 30987276 PMCID: PMC6480161 DOI: 10.3390/ijerph16071207] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/15/2019] [Accepted: 03/20/2019] [Indexed: 12/02/2022]
Abstract
Despite its benefits and espousal in developed counties, the adoption of clean cookstoves is reportedly low in less developed countries, especially in Sub-Saharan Africa. This qualitative study aimed at exploring and documenting the enablers and barriers for adoption of clean cookstove in the middle belt of Ghana. The findings showed convenience of clean cookstove use, reduced firewood usage, less smoke emission and associated health problems resulting from indoor air pollution and time for firewood gathering and cooking, good smell and taste of food as enabling factors for clean cookstove adoption. Factors such as safety, financial constraint (cost), non-availability of spare parts on the open market to replace faulty stove accessories, stove size and household size were the potential barriers to clean cookstove adoption. These findings help us to understand the factors promoting and inhibiting the adoption of clean cook stoves, especially in rural settings.
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Affiliation(s)
- Francis Agbokey
- Kintampo Health Research Centre, Post Office Box 200, Kintampo, Brong Ahafo Region, Ghana.
| | - Rebecca Dwommoh
- Kintampo Health Research Centre, Post Office Box 200, Kintampo, Brong Ahafo Region, Ghana.
| | - Theresa Tawiah
- Kintampo Health Research Centre, Post Office Box 200, Kintampo, Brong Ahafo Region, Ghana.
| | | | - Mohammed Nuhu Mujtaba
- Kintampo Health Research Centre, Post Office Box 200, Kintampo, Brong Ahafo Region, Ghana.
| | - Daniel Carrion
- Mailman School of Public Health, Columbia University, Department of Environmental Health Sciences, New York, NY 10032, USA.
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Post Office Box 200, Kintampo, Brong Ahafo Region, Ghana.
| | - Samuel Afari-Asiedu
- Kintampo Health Research Centre, Post Office Box 200, Kintampo, Brong Ahafo Region, Ghana.
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Post Office Box 200, Kintampo, Brong Ahafo Region, Ghana.
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana.
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Post Office Box 200, Kintampo, Brong Ahafo Region, Ghana.
| | - Darby W Jack
- Mailman School of Public Health, Columbia University, Department of Environmental Health Sciences, New York, NY 10032, USA.
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13
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Abdulai MA, Afari-Asiedu S, Carrion D, Ae-Ngibise KA, Gyaase S, Mohammed M, Agyei O, Boamah-Kaali E, Tawiah T, Dwommoh R, Agbokey F, Owusu-Agyei S, Asante KP, Jack D. Experiences with the Mass Distribution of LPG Stoves in Rural Communities of Ghana. Ecohealth 2018; 15:757-767. [PMID: 30232662 PMCID: PMC7366325 DOI: 10.1007/s10393-018-1369-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 05/20/2023]
Abstract
Household air pollution (HAP) is a leading cause of morbidity and mortality worldwide. To limit HAP exposure and environmental degradation from biomass fuel use, the Government of Ghana promotes liquefied petroleum gas (LPG) use in rural Ghana via the Rural LPG program (RLP). We assessed the experiences of the RLP in 2015, 2 years after its launch. A mixed methods approach was used involving Focus Group Discussions (19) and in-depth interviews (25). In addition, a survey questionnaire was administered to elicit socio-demographic characteristics, household cooking practices and stove use patterns of 200 randomly selected respondents. At about 9 months after LPG acquisition, < 5% of LPG beneficiaries used their stoves. Some of the reasons ascribed to the low usage of the LPG cookstoves were financial constraints, distance to LPG filling point and fear of burns. Community members appreciate the convenience of using LPG. Our results underscore a need for innovative funding mechanisms contextualized within an overall economic empowerment of rural folks to encourage sustained LPG use. It emphasizes the need for innovative accessibility interventions. This could include establishing new LPG filling stations in RLP beneficiary districts to overcome the barriers to sustained LPG use.
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Affiliation(s)
- Martha Ali Abdulai
- Kintampo Health Research Centre (KHRC), P. O. Box 200, Kintampo-B/A, Ghana
| | | | | | | | - Stephaney Gyaase
- Kintampo Health Research Centre (KHRC), P. O. Box 200, Kintampo-B/A, Ghana
| | - Mujtaba Mohammed
- Kintampo Health Research Centre (KHRC), P. O. Box 200, Kintampo-B/A, Ghana
| | - Oscar Agyei
- Kintampo Health Research Centre (KHRC), P. O. Box 200, Kintampo-B/A, Ghana
| | - Ellen Boamah-Kaali
- Kintampo Health Research Centre (KHRC), P. O. Box 200, Kintampo-B/A, Ghana
| | - Theresa Tawiah
- Kintampo Health Research Centre (KHRC), P. O. Box 200, Kintampo-B/A, Ghana
| | - Rebecca Dwommoh
- Kintampo Health Research Centre (KHRC), P. O. Box 200, Kintampo-B/A, Ghana
| | - Francis Agbokey
- Kintampo Health Research Centre (KHRC), P. O. Box 200, Kintampo-B/A, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre (KHRC), P. O. Box 200, Kintampo-B/A, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre (KHRC), P. O. Box 200, Kintampo-B/A, Ghana.
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14
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Asante KP, Afari-Asiedu S, Abdulai MA, Dalaba MA, Carrión D, Dickinson KL, Abeka AN, Sarpong K, Jack DW. Ghana's Rural Liquefied Petroleum Gas Program Scale Up: A case study. Energy Sustain Dev 2018; 46:94-102. [PMID: 32489234 PMCID: PMC7266102 DOI: 10.1016/j.esd.2018.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND The Government of Ghana launched the Rural LPG (RLP) promotion program in 2013 as part of its efforts to reduce fuelwood consumption. The aim of the RLP is to contribute to Ghana's overarching goal to provide LPG access to 50% of Ghana's population by 2020. The RLP has not announced long-term program objectives. However, in the interim the RLP targeted a cumulative total of 170,000 LPG cookstoves to rural households by the end of 2017. As of November 2017, 149,500 rural households had received the LPG cook stoves. Our case study documents Ghana's experiences to date with LPG scale up. METHODS We carried out a desktop review/document analysis of literature on the RLP. Each document was reviewed for information related to the elements of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework as it pertained to LPG promotion and adoption. In-depth interviews were held among key stakeholders in Ghana. Previously collected data from a field evaluation of the RLP was also assessed. FINDINGS Generally, our evaluation suggests that the current form of the RLP is not achieving its stated goal. Our evaluation of the RLP in five rural communities showed that about 58% of households had never refilled their LPG cylinders nine months after the initial delivery of a filled cylinder. Only 8% still used their LPG at 18 months post distribution. Cost and distance to LPG filling stations were the main reasons for low LPG use. Beneficiaries did not exclusively use their LPG even at the initial stages when all of them had LPG in their cylinders. Ghana is currently undergoing transitions in the LPG sector including a change from the current private cylinder ownership model to a cylinder recirculation model for the distribution of LPG. There was no evidence of a well-documented implementation framework for the RLP. CONCLUSION Fuel cost, poor LPG access, and an inadequate implementation framework hinder the RLP implementation.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health, P.O Box 200, Kintampo, Ghana
| | | | - Martha Ali Abdulai
- Kintampo Health Research Centre, Ghana Health, P.O Box 200, Kintampo, Ghana
| | | | - Daniel Carrión
- Department of Environmental Health Sciences, Columbia University (CU), USA
| | | | - Ali Nuhu Abeka
- Ghana Ministry of Energy, P.O Box SD40, Cantonment, Accra
| | | | - Darby W Jack
- Department of Environmental Health Sciences, Columbia University (CU), USA
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15
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Afari-Asiedu S, Asante KP, Senah K, Abdulai MA, Afranie S, Mahama E, Anane EA, Abukari M, Darko ML, Febir LG, Owusu-Agyei S. Volunteering for Health Services in the Middle Part of Ghana: In Whose Interest? Int J Health Policy Manag 2018; 7:836-846. [PMID: 30316232 PMCID: PMC6186480 DOI: 10.15171/ijhpm.2018.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/15/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In many developing countries like Ghana, community volunteers assist in the provision of certain health services to rural and hard-to-reach communities. This study examined factors that influence the motivation and retention of community-based volunteers supporting with work on health-related activities at the community level in Ghana. METHODS Using a sequential mixed-method design, a cross-sectional survey was carried out among 205 selected community-based volunteers in Kintampo North Municipality (KNM) and Kintampo South District (KSD) of Ghana between December, 2014 and February, 2015. Qualitative interviews, including 12 in-depth interviews (IDIs) among health workers and community opinion leaders and 2 focus group discussion (FGD) sessions with volunteers were conducted. RESULTS Personal interest (32.7%) and community leaders' selection of volunteers (30.2%) were key initial reasons for volunteering. Monetary incentives such as allowance for extra duty (88.8%) and per diem (49.3%) and non-monetary incentives such as T-shirts/bags (45.4 %), food during training (52.7%), community recognition, social prestige and preferential treatment at health facilities were the facilitators of volunteers' retention. There was a weak evidence (P=.051) to suggest that per diem for their travels is a reason for volunteers' satisfaction. CONCLUSION Community-based volunteers' motivation and retention were influenced by their personal interest in the form of recognition by community members and health workers, community leaders' selection and other nonmonetary incentives. Volunteers were motivated by extra-duty allowance but not per diems paid for accommodation and feeding when they travel. Organizations that engage community volunteers are encouraged to strengthen the selection of volunteers in collaboration with community leaders, and to provide both non-monetary and monetary incentives to motivate volunteers.
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Affiliation(s)
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Kodjo Senah
- Department of Sociology, School of Social Science, University of Ghana, Accra, Ghana
| | | | - Stephen Afranie
- Department of Sociology, School of Social Science, University of Ghana, Accra, Ghana
| | - Emmanuel Mahama
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | | | - Mahama Abukari
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Martin Luther Darko
- Department of Sociology, School of Social Science, University of Ghana, Accra, Ghana
| | - Lawrence G. Febir
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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16
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Asante KP, Boamah EA, Abdulai MA, Buabeng KO, Mahama E, Dzabeng F, Gavor E, Annan EA, Owusu-Agyei S, Gyansa-Lutterodt M. Knowledge of antibiotic resistance and antibiotic prescription practices among prescribers in the Brong Ahafo Region of Ghana; a cross-sectional study. BMC Health Serv Res 2017. [PMID: 28633631 PMCID: PMC5477684 DOI: 10.1186/s12913-017-2365-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Antibiotic resistance (ABR) has become a major public health challenge in most parts of the world including Ghana and is a major threat to gain in bacterial disease control. The role of prescribers in the control of antibiotics is identified as crucial in developing interventions to control ABR. To guide policy recommendations on ABR, a study was carried out among prescribers to identify gaps in their knowledge of ABR and to document their prescription practices. Method A cross-sectional survey was conducted among prescribers from both public and private facilities in the Brong Ahafo Region of Ghana using both quantitative and qualitative methods in 2014. Results Three hundred and seventy nine prescribers participated in the quantitative study and a subset of 33 participated in in-depth interviews. Majority (50.0%) of the prescribers interviewed were nurses. Most (51.0%) of the prescribers were located in hospitals. Knowledge of ABR was high among all the prescribers. About 80.0% percent of all prescribers agreed that the antibiotics that are currently used could lose its efficacy in future. There is no singular formal source of information on antibiotic resistance. The prescribers held a strong perception that antibiotic resistance is imminent though their knowledge on various resistant bacterial strains was limited. Prescribers attributed ABR burden to factors such as poor prescription practices and limited ABR control measures. The prescription practices of the prescribers vary but were mostly inappropriate among the lower cadre. Conclusion The knowledge of ABR is high among prescribers. There is however a gap in the knowledge and perception of optimal antibiotic prescription practices among prescribers. There is the need for a formal source of information on ABR to support prescriber’s antibiotic prescription practices. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2365-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana.
| | - Ellen Abrafi Boamah
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana
| | - Kwame Ohene Buabeng
- Faculty of Pharmacy & Pharmaceutical Services, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Mahama
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana
| | - Francis Dzabeng
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana
| | - Edith Gavor
- Ghana National Drugs Programme, Ministry of Health, Accra, Ghana
| | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana
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Abdulai MA, Baiden F, Adjei G, Owusu-Agyei S. Low level of Hepatitis B knowledge and awareness among pregnant women in the Kintampo North Municipality: Implications for effective disease control. Ghana Med J 2016. [DOI: 10.4314/gmj.v50i3.7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Over 2 billion people are infected with Hepatitis B virus (HBV) and about 240 million are chronic carriers of the virus. Chronic HBV infection is an important cause of liver cancer. The infectivity of HBV is hundred times higher than the HIV virus yet it receives comparatively little attention in public health. The study assessed knowledge and awareness of HBV among pregnant women in the Kintampo Municipality of Ghana.Methods: A cross-sectional survey was conducted among pregnant women attending antenatal clinic in two facilities between September 2010 and November 2010. We performed analysis to determine factors associated with hepatitis B awareness.Results: Forty-one percent of the 504 women were aware of hepatitis B viral infection, 33.5% of the women were able to correctly mention the transmission routes of Hepatitis B. The radio was the most (42%) mentioned source of information on HBV and the least source of information were places of worship (2.7%).After adjusting for other factors, level of education; SSS/SHS and above OR=4.2, P<00.1, 95% CI (2.5, 7.0) and occupation (Civil servant/Student); OR= 3.8, P00.1, 95% CI (1.7, 8.5) were the important predictors of Hepatitis B awareness.Conclusion: There is a low level of knowledge and awareness of HBV among pregnant women in this municipality. This could potentially hamper effective HBV prevention and control in Ghana. Education on hepatitis B need to be included in health promotion activities.Funding: The study was funded by KHRC Director’s small grant Initiative.Keywords: Hepatitis B, knowledge, awareness, women, Ghana
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Abdulai MA, Baiden F, Adjei G, Owusu-Agyei S. Low level of Hepatitis B knowledge and awareness among pregnant women in the Kintampo North Municipality: implications for effective disease control. Ghana Med J 2016; 50:157-162. [PMID: 27752190 PMCID: PMC5044795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Over 2 billion people are infected with Hepatitis B virus (HBV) and about 240 million are chronic carriers of the virus. Chronic HBV infection is an important cause of liver cancer. The infectivity of HBV is hundred times higher than the HIV virus yet it receives comparatively little attention in public health. The study assessed knowledge and awareness of HBV among pregnant women in the Kintampo Municipality of Ghana. METHODS A cross-sectional survey was conducted among pregnant women attending antenatal clinic in two facilities between September 2010 and November 2010. We performed analysis to determine factors associated with hepatitis B awareness. RESULTS Forty-one percent of the 504 women were aware of hepatitis B viral infection, 33.5% of the women were able to correctly mention the transmission routes of Hepatitis B. The radio was the most (42%) mentioned source of information on HBV and the least source of information were places of worship (2.7%).After adjusting for other factors, level of education; SSS/SHS and above OR=4.2, P<00.1, 95% CI (2.5, 7.0) and occupation (Civil servant/Student); OR= 3.8, P00.1, 95% CI (1.7, 8.5) were the important predictors of Hepatitis B awareness. CONCLUSION There is a low level of knowledge and awareness of HBV among pregnant women in this municipality. This could potentially hamper effective HBV prevention and control in Ghana. Education on hepatitis B need to be included in health promotion activities. FUNDING The study was funded by KHRC Director's small grant Initiative.
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Affiliation(s)
| | - Frank Baiden
- Ensign College of Public Health Kpong, E/R, Ghana
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