Administrative Regions Of Ghana Research Articles

Caregivers’ Experience of Supporting Deaf Adults with Mental Health Disorders in Ghana

Background: Caregivers play a crucial role in the support and management of individuals experiencing mental health disorders; however, there is a paucity of research concerning the experiences of caregivers of deaf persons diagnosed with any form of mental disorder in Ghana. This study aims to explore the lived experiences of these caregivers, with a particular focus on their perceptions of mental health, available support systems, challenges encountered, and the consequent impact on familial relationships while supporting this underserved population. Method: This qualitative study engaged eleven family caregivers of deaf adults diagnosed with a mental health disorders made up of ten females and one male aged 45–68 years, recruited across four of the sixteen administrative regions in Ghana. Utilizing a semi-structured interview guide, face-to-face interviews were conducted to gather in-depth narratives from the participants. Results: Thematic analysis of the data revealed several key themes, including the awareness and understanding of mental health disorders, availability and accessibility of mental health support services and training, dynamics of psychosocial and familial relationships, and the multifaceted challenges faced in caregiving for individuals with mental health disorders. Conclusion: The findings underscored an urgent need for the development of a specialized caregiving manual tailored for caregivers of deaf individuals experiencing mental health disorders. This study advocates for policymakers to prioritize the creation of such resources to enhance care delivery and improve overall mental health outcomes for this vulnerable population.

MHealth knowledge and usage in maternal healthcare delivery: perspectives and experiences of healthcare practitioners in Ghana

ObjectivesThis study explored the knowledge and experiences of health practitioners regarding the use of mobile health (mHealth) for maternal healthcare delivery.DesignUnderpinned by the Unified Theory of Acceptance and Use of...

Leveraging local health system resources to address quality healthcare gaps in sub-Saharan African: lessons from the SafeCare quality improvement programme in Ghana

IntroductionIn low- and-middle-income-countries (LMICs) like Ghana, universal access to quality healthcare remains a mirage and this undermines achievement of sustainable development goal (SDG) 3. The SafeCare Quality Improvement (QI) programme is an initiative of PharmAccess Foundation, a Netherlands-based non-governmental organisation (NGO). In 2009 SafeCare QI programme was launched in Ghana to help address gaps in healthcare quality standards, leveraging existing local resources. Over 600 private and public healthcare facilities are currently enrolled in the programme and is being adopted for nation-wide rollout by government of Ghana and implementing partners.ObjectiveThis paper explored views and experiences of frontline health staff and policy makers on the SafeCare quality improvement programme in Ghana and how local resources were leveraged in its implementation.MethodologyDesign/setting: The evaluation was conducted in 53 private and public healthcare facilities from seven administrative regions of Ghana across the coastal, middle, and northern geopolitical belts. The regions are Ashanti (n = 12), Bono East (n = 8), Bono (n = 3), Greater Accra (n = 12), Oti (n = 4), Savannah (n = 8) and Western (n = 9).Sampling: Quota and purposive sampling techniques were used to sample the healthcare facilities in accordance with the study eligibility criteria. Total of 45 focus group discussions (FGDs) and 47 individual in-depth interviews (IDIs) were conducted among frontline staff and policy makers from government and private local partner institutions.Analysis: Group and individual interviews were audio recorded, transcribed verbatim and thematic content analysis done using Nvivo (version 12.0) software.FindingsOverall, participants perceived the relevance and benefits of the SafeCare programme to be "very satisfactory" while the programme impact, rollout process and success were perceived to be "satisfactory". Quality healthcare standards were perceived to have improved in beneficiary health facilities due to participation in the SafeCare programme. Patient satisfaction, service utilisation and revenue generation in healthcare facilities were also attributed to the SafeCare programme. Proposals were made for harmonisation of existing QI assessment tools to mitigate duplications. Agreed data sharing protocols and interoperability with existing national database were also recommended to promote sustainability. Finally, low staff motivation, high workload, lack of financial and material resources were cited as potential impediments to full compliance with the SafeCare QI standards by healthcare facilities enrolled in the programme.ConclusionsSafeCare QI programme has contributed to QI and adherence to patient safety standards in Ghana. Sustainability is however dependent on continuous government commitment as the programme gets adopted as a national QI programme. Overlaps in content of QI assessment tools ought to be addressed to promote efficiency without compromising quality standards. The SafeCare programme demonstrates that health systems in LMICs have the potential to attain acceptable quality healthcare standards when they take advantage of existing local resources, including private-public partnership (PPP) and peer-learning opportunities.

Unemployment Duration and Its Covariates: Evidence From Selected Regions in Ghana

This study examines individual-specific covariates of unemployment duration, with evidence from four administrative regions of Ghana. It employs primary data and semi-parametric Cox regression and Cox proportional hazard models, underpinned by job search and human capital theories. This study is distinct from other unemployment-related studies in Ghana in that it highlights how individual characteristics affect their employability and unemployment spells. The study concludes that age, locality, social networks, alternative income sources, migration, and education are significant factors influencing unemployment duration in Ghana. Also, migration status and education are jointly associated with shorter unemployment duration. The study encourages young people to take up voluntary services and other forms of industry attachments to build labor market experience. Again, the government should develop and implement a policy on industrial attachment and internship programs for tertiary students. Individuals should build and effectively utilize their social networks. Individuals who receive financial support while unemployed should leverage such income to intensify their job search efforts and activities. Moreover, individuals should take advantage of the opportunities created in the educational sector to upgrade their educational levels. The study further encourages job seekers with higher education to migrate as part of their job search efforts and activities. The study sets the springboard for further studies to be conducted on employment duration in Ghana but using longitudinal data and national survey data.

Assessing the impact of climate variability on maize yields in the different regions of Ghana-A machine learning perspective.

Climate variability has become one of the most pressing issues of our time, affecting various aspects of the environment, including the agriculture sector. This study examines the impact of climate variability on Ghana's maize yield for all agro-ecological zones and administrative regions in Ghana using annual data from 1992 to 2019. The study also employs the stacking ensemble learning model (SELM) in predicting the maize yield in the different regions taking random forest (RF), support vector machine (SVM), gradient boosting (GB), decision tree (DT), and linear regression (LR) as base models. The findings of the study reveal that maize production in the regions of Ghana is inconsistent, with some regions having high variability. All the climate variables considered have positive impact on maize yield, with a lesser variability of temperature in the Guinea savanna zones and a higher temperature variability in the Volta Region. Carbon dioxide (CO2) also plays a significant role in predicting maize yield across all regions of Ghana. Among the machine learning models utilized, the stacking ensemble model consistently performed better in many regions such as in the Western, Upper East, Upper West, and Greater Accra regions. These findings are important in understanding the impact of climate variability on the yield of maize in Ghana, highlighting regional disparities in maize yield in the country, and highlighting the need for advanced techniques for forecasting, which are important for further investigation and interventions for agricultural planning and decision-making on food security in Ghana.

Frontline health workers’ experiences of providing care for people living with non-communicable diseases during the COVID-19 pandemic in Ghana: a qualitative study

BackgroundThe COVID-19 pandemic has significantly impacted frontline health workers. However, a neglected dimension of this discourse was the extent to which the pandemic impacted frontline healthcare workers providing non-communicable diseases...

Ghanaian Journalists and The Spread of Rumors During the Covid19 Pandemic: Views from Five Regions

This qualitative study examines the role of Ghanaian journalists in disseminating rumors, misinformation, and disinformation during the Covid19 pandemic. Additionally, the study investigates how this information was transmitted and spread among journalists, as well as the motivating factors behind their actions. The participants in the study were purposely selected from five administrative regions of Ghana that had a lower uptake of COVID-19 vaccines, as classified by the Ghana Health Services. The findings of the study indicate that journalists played a significant role in spreading disinformation during the COVID-19 pandemic in Ghana. The interviewees in this study attributed this to various reasons, such as parochial and partisan interests, lack of information, deliberate attempts to force verification, and pressure associated with the job. The study concludes that the involvement of journalists in the spread of rumors about the COVID-19 pandemic and related issues can be attributed to the liberalized nature of the media space in Ghana with its excessive commercialization and rush for breaking news. This competition for news has led many journalists to neglect due diligence and professional ethics in sourcing and disseminating information to the public. This study highlights the need for policymakers to establish effective measures for regulating the ethics and standards of journalism in line with the relevant constitutional provisions and democratic practice

Whose public, whose goods? Generations of patients and visions of fairness in Ghanaian health.

Since Ghana's independence in 1957, the country has seen an ebb and flow of reforms intended to expand and fund state healthcare, informed by diverse notions of affordability and adequate provision. Cycles of attempted health reforms have emerged from disparate political and economic ideologies, themselves a product of broader global histories and specific national experiences. Based on group interviews with people across most administrative regions of Ghana, this paper examines how the formative historical experiences of different generations gives rise to a multiplicity of understandings of what constitutes a 'fair' distribution of national health resources. It discusses the forms and contents of arguments that people of different ages raised in both rural and urban settings in the course of the study - with particular reference to the operation of Ghana's current National Health Insurance Scheme, and in light of their perceptions of the justice or injustice of present day healthcare in relation to earlier periods.

The precarity of internal migration of youth in Ghana: exploitative employment and livelihood insecurity

ABSTRACT This paper ascertains whether young internal migrants are prone to poverty and livelihood insecurity and become victims of exploitative employment when compared to the non-migrant youth population in Ghana. This study employs econometrics analysis using the Ghana Living Standards Survey 6 (2012) and 7 (2017), with a sample size of 15,000 households, and ethnographic interviews to assess the determinants of livelihood security, exploitation, and abuse. Our analysis focuses on youth in four administrative regions in Ghana with the highest number of internal migrants. The study found that young internal migrants are often engaged in unstable, noncontract, abusive, and exploitative employment.

A Social-Ecological Study of Perceptions and Determinants of Sexual Enhancement Drug Use among Men and Women in Ghana.

The use and sale of sexual enhancement drugs (particularly unapproved aphrodisiacs) have become a public health concern in Ghana and many other sub-Saharan African countries. While most studies have examined this phenomenon from the level of individual perspectives, this study investigates the multi-dimensional and multi-level factors (e.g., individual characteristics and behaviours, interpersonal factors, community norms and practices, institutional and public policy factors) that influence attitudes, perceptions, and use of aphrodisiacs among men and women in Ghana. Using a concurrent mixed-method design, we derived the data from a semi-structured interview and cross-sectional survey conducted across five administrative regions in Ghana. Interpretative phenomenological analysis and logistic regression techniques were used to analyse the qualitative and quantitative (survey) data, respectively. Approximately 12.6% of participants (17.6% among males and 7.2% among females) had used an aphrodisiac in the six months prior to the study. Approximately 23.4% of the participants had more than one partner during the same period. Among men, being religious (B = −0.238, p < 0.05) and having multiple sexual partners (B = 0.481, p < 0.01) were positively associated with the use of aphrodisiacs. For women, being employed (B = −1.539, p < 0.01), engaging in physical activities (exercising) (B = −0.658, p < 0.05), having good health (B = 0.869, p < 0.05), having multiple sexual partners (B = 1.191, p < 0.01), and taking alcohol (B = 1.041, p < 0.01) were associated with use of aphrodisiacs. Although many participants had used aphrodisiacs, women, in particular, held unfavourable views about the drugs due to perceived negative health implications for themselves and their partners. The findings also show that community-level factors (e.g., social norms and expectations), interpersonal factors (e.g., expectations of partners and friends), public policy (e.g., drug-related regulations), and organisational/institutional factors (e.g., health system arrangements about access and use of drugs) were critical to the sale and use of aphrodisiacs among both men and women in Ghana. A multi-level analysis of the use of sexual enhancement drugs among men and women is crucial to formulating social and public health policies that aim to improve public knowledge of these drugs, reduce uncontrolled production, and protect population health and well-being.

‘I Am on a Family Planning Program, but I Have Not Told My Husband’: Contraceptive Decision-Making of Child Brides in Ghana

This study explores the factors that influence child bride’s decision making, either independently or jointly on modern contraceptive use in Ghana. The findings of this study are based on qualitative data collected through in-depth interviews with 15 child brides aged 15–24 years from four administrative regions in Ghana. It was observed that knowing about contraceptives, quality of the knowledge, attitude and sociocultural influences affected child brides’ decision to use contraception. Thus, autonomy in decision making requires first, making the decision to access contraceptives and secondly, whether the decision can be implemented alone or with permission or in consultation with their spouses. It can be concluded from this study that child brides are not always as vulnerable and unable to exercise agency as is sometimes suggested because they sometimes used contraceptives without informing their partners although there is the possibility of a negative backlash from their partners when it is known.

Health Behaviors and Health Literacy: Questing the Role of Weak Social Ties Among Older Persons in Rural and Urban Ghana.

BackgroundOlder persons are one of the most vulnerable groups as regards low health literacy. However, little is known about the extent of limitations and multi-faceted nature of their health literacy, such as its characteristics and social and geographical dimensions. Additionally, most existing studies have predominantly treated health literacy as a risk factor of health and wellbeing of older persons as opposed to an outcome that must be pursued.ObjectivesThis study investigated the moderating role of weak social ties (bridging social capital) in the relationship between health behaviors, such as smoking, alcohol intake, voluntary body check-up and physical exercise, and health literacy among older persons in rural and urban Ghana.MethodsData was drawn from a cross-sectional survey comprising 522 respondents across five administrative regions in Ghana. Ordinary Least Squares regression technique was used to analyse the data.ResultsOlder persons in urban areas had higher health literacy [Mean/Standard deviation (SD) = 9.1/4.1 vs. 10.1/4.2] as well as higher bridging social capital (Mean/SD = 2.0/1.2 vs. 1.6/0.9) than their rural counterparts. Bridging social capital was negatively associated with the health literacy of urban residents (B = −0.997, p < 0.01). We found evidence that smoking (B = −0.787, p < 0.05) and undertaking physical activities (B = 0.812, p < 0.01) were associated with health literacy of older persons in rural areas. Having voluntary body check-ups (B = 0.155, p < 0.01) was associated with health literacy in urban areas. Bridging social capital negatively moderated the association of smoking with health literacy in rural areas (B = −5.032, p < 0.01), but it instead positively modified the relationship between alcohol intake and health literacy in urban areas (B = 0.185, p < 0.05).ConclusionFor policymakers and practitioners aiming to promote older persons' health literacy as a public health asset at individual and community levels, an important starting point to achieving such goals is to understand the fundamental indicators (e.g., health behaviors) and the role that social and geographical factors play in shaping their health literacy.

Impact of Actual Use Behavior of Healthcare Wearable Devices on Quality of Life: A Cross-Sectional Survey of People with Dementia and Their Caregivers in Ghana.

The increasing prevalence of dementia has necessitated the introduction and use of healthcare wearable devices to augment the healthcare services delivered to people with dementia (PWDs). Unfortunately, evidence on user feedback and the real impact of the actual use of these devices on the quality of life of PWDs has not been fully explored, especially in the context of developing countries. This study, therefore, seeks to evaluate the impact of actual use behavior (AUB) of healthcare wearable devices on the quality of life (QoL) of PWDs in Ghana by using constructs from the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) model and the SF-36 quality of life instrument. Data were collected from people with dementia and, in some cases, caregivers (acting as proxies) in three administrative regions of Ghana using structured questionnaires. Of the 420 questionnaires distributed, 356 were returned, giving a response rate of (356/420, 84.8%). Three hundred and twenty (320) responses were used for further analysis, employing the Partial Least Squares based on Structural Equation Modeling. The results showed a significant positive relationship between AUB and QoL (p < 0.001). Other predictors such as behavioral intention, facilitating conditions, effort expectancy and social influence were also found to significantly impact the actual use behavior of healthcare wearable devices among PWDs. The study also revealed that 4% (14) of patients rated their reported health transition associated with the use of healthcare wearable devices as excellent, 42.5% (136) as very good, and 39.4% (126) as good, respectively at the time of the study compared to a year ago. This study provided empirical evidence of the positive impact of the actual use of healthcare wearable devices on the quality of life of PWDs and further highlighted the factors that drive actual use behavior among PWDs in Ghana. Based on the findings of this study, stakeholders need to create the necessary conditions that will facilitate the adoption and use of healthcare wearable devices, as this will help improve the quality of life, reduce the burden of the disease on caregivers, and enable independent living of PWDs.

Determinants Factors of Digital Financial Services Adoption and Usage Level: Empirical Evidence from Ghana

Digital Financial Services (DFS) have the potential to benefit people in poverty in developing economies significantly. DFS provides a variety of economical, convenient, and secure financial services. However, the DFS adoption rate is slow in Ghana due to being over-reliant on personal cash delivery. Substantial variation in adoption levels across important socio-demographic characteristics is another factor. Using a representative national dataset from Ghana, this study explored digital financial services adoption determinants. It quantified the role played by each of the six incorporating factors and controlled four socio-demographic characteristics. The work also assessed the adoption level among key socio-demographic groups. The determinants of DFS are estimated using logit specification, and average marginal effects are computed. The logit model indicated that effort expectancy, awareness, facilitating conditions, transaction cost, security and privacy, and self-efficacy positively influence DFS adoption and increase DFS adoption by 0.7%, 2.3%, 28.5%, 3%, 2.1%, and 2.4%, respectively. Additionally, the results indicated a significant disparity in adoption levels across key socio-demographic variables, including education level, gender, urban and rural residence, and administrative regions of Ghana. Given the substantial influence of facilitating conditions and transaction costs on DFS adoption, we argue that it would be advisable to incorporate digital infrastructure development and lower transaction cost measures into the planning of any intervention.

Efficiency of malaria service delivery in selected district-level hospitals in Ghana

ABSTRACT Malaria remains an important public health concern. Sub-Saharan African countries carry over 95% of the global burden. Unfortunately, there are also major resource constraints that have limited efforts to reduce the burden. Our study sought to estimate efficiency in the use of malaria resources and to identify potential determinants. We used primary data collected from district-level health facilities in three administrative regions in Ghana from 2014 to 2016. The Data Envelopment Analysis technique was used to estimate efficiency. The Malmquist productivity index was estimated and disaggregated to reflect the sources of productivity change. The findings show an average technical efficiency score of 0.61 with private facilities being more efficient. Productivity changes were driven by changes in technology/innovation advancements. Facility revenue mix and ownership type were important determinants of efficiency. The findings highlight the need to improve resource use in the delivery of specific services such as malaria.

COVID-19 vaccine uptake among health care workers in Ghana: a case for targeted vaccine deployment campaigns in the global south

BackgroundHealth care workers (HCWs) are among the high-risk groups in contracting and dying from COVID-19. World Health Organization estimates that over 10,000 HCWs in Africa have been infected with COVID-19 making it a significant occupational health hazard to HCWs. In Ghana, over 100 HCWs have already been infected and dozen others died from the virus. Acceptability and uptake of the COVID-19 vaccine is therefore critical to promote health and safety of HCWs as the country battles out of a third wave of the pandemic.ObjectiveThe study sought to ascertain the correlates of HCWs likelihood of participating in a COVID-19 vaccine trial and accepting the vaccine when given the opportunity.MethodsThe study was a web-based cross-sectional survey among HCWs (n = 1605) in all sixteen (16) administrative regions in Ghana. Data were analyzed with STATA statistical analysis software (version 14). Chi-square (X2) and Fisher’s exact tests were used to test for differences in categorical variables; bivariate probit regression analysis with Average Marginal Effect (AME) was employed to ascertain the determinants of HCWs’ likelihood of participating in a COVID-19 vaccine trial and taking the vaccine.ResultsIt was found that 48% of HCWs will participate in a COVID-19 vaccine trial when given the opportunity; 70% will accept the COVID-19 vaccine; younger HCWs (AME = 0.28, SE = 0.16, p < 0.1), non-Christians (AME = 21, SE = 0.09, p < 0.05) and those who worked in faith-based health facilities (AME = 18, SE = 0.07, p < 0.05) were more likely to participate in a COVID-19 vaccine trial. Female HCWs (AME = − 11, SE = 0.04, p < 0.05) and those with lower educational qualification were less likely to accept a COVID-19 vaccine (AME = − 0.16, SE = 0.08, p < 0.1). Reasons cited for unwillingness to participate in a COVID-19 vaccine trial or uptake the vaccine were mainly fear, safety concerns, mistrust, uncertainty, spiritual and religious beliefs.ConclusionsAcceptance of the COVID-19 vaccine appear to be high among HCWs; conversely, willingness to volunteer for the vaccine trial was low. Continuous targeted and integrated public health education for HCWs will enhance vaccine acceptability to promote safety and population health in the global south as Ghana intensifies efforts to produce COVID-19 vaccines locally.

A Bayesian Spatio-Temporal Analysis of Malaria in the Greater Accra Region of Ghana from 2015 to 2019.

The Greater Accra Region is the smallest of the 16 administrative regions in Ghana. It is highly populated and characterized by tropical climatic conditions. Although efforts towards malaria control in Ghana have had positive impacts, malaria remains in the top five diseases reported at healthcare facilities within the Greater Accra Region. To further accelerate progress, analysis of regionally generated data is needed to inform control and management measures at this level. This study aimed to examine the climatic drivers of malaria transmission in the Greater Accra Region and identify inter-district variation in malaria burden. Monthly malaria cases for the Greater Accra Region were obtained from the Ghanaian District Health Information and Management System. Malaria cases were decomposed using seasonal-trend decomposition, based on locally weighted regression to analyze seasonality. A negative binomial regression model with a conditional autoregressive prior structure was used to quantify associations between climatic variables and malaria risk and spatial dependence. Posterior parameters were estimated using Bayesian Markov chain Monte Carlo simulation with Gibbs sampling. A total of 1,105,370 malaria cases were recorded in the region from 2015 to 2019. The overall malaria incidence for the region was approximately 47 per 1000 population. Malaria transmission was highly seasonal with an irregular inter-annual pattern. Monthly malaria case incidence was found to decrease by 2.3% (95% credible interval: 0.7–4.2%) for each 1 °C increase in monthly minimum temperature. Only five districts located in the south-central part of the region had a malaria incidence rate lower than the regional average at >95% probability level. The distribution of malaria cases was heterogeneous, seasonal, and significantly associated with climatic variables. Targeted malaria control and prevention in high-risk districts at the appropriate time points could result in a significant reduction in malaria transmission in the Greater Accra Region.

How does it affect service delivery under the National Health Insurance Scheme in Ghana? Health providers and insurance managers perspective on submission and reimbursement of claims.

IntroductionIn 2003, the Government of Ghana launched the National Health Insurance Scheme (NHIS) to enable all Ghanaian residents to have access to health services at the point of care without financial difficulty. However, the system has faced a number of challenges relating to delays in submission and reimbursement of claims. This study assessed views of stakeholders on claims submission, processing and re-imbursement under the NHIS and how that affected health service delivery in Ghana.MethodsThe study employed qualitative methods where in-depth interviews were conducted with stakeholders in three administrative regions in Ghana. Purposive sampling method was used to select health facilities and study participants for the interviews. QSR Nvivo 12 software was used to code the data into themes for thematic analysis.ResultsThe results point to key barriers such as lack of qualified staff to process claims, unclear vetting procedure and the failure of National Health Insurance Scheme officers to draw the attention of health facility staff to resolve discrepancies on time. Participants perceived that lack of clarity, inaccurate data and the use of non-professional staff for NHIS claims vetting prolonged reimbursement of claims. This affected operations of credentialed health facilities including the provision of health services. It is perceived that unavailability of funds led to re-use of disposable medical supplies in health service delivery in credentialed health facilities. Stakeholders suggested that submission of genuine claims by health providers and regular monitoring of health facilities reduces errors on claims reports and delays in reimbursement of claims.ConclusionLong delays in claims reimbursement, perceived vetting discrepancies affect health service delivery. Thus, effective collaboration of all stakeholders is necessary in order to develop a long-term strategy to address the issue under the NHIS to improve health service delivery.

\u201cTop-down bottom-up\u201d estimation of per capita cost of new-born care interventions in four regions of Ghana: beyond implementation to scalability and sustainability

BackgroundLimited financial, human and material health resources coupled with increasing demand for new-born care services require efficiency in health systems to maximize the available sources for improved health outcomes. Making Every Baby Count Initiative (MEBCI) implemented by local and international partners in 2013 in Ghana aimed at attaining neonatal mortality of 21 per 1000 livebirths by 2018 in four administrative regions in Ghana. MEBCI interventions benefited 4027 health providers, out of which 3453 (86%) were clinical healthcare staff.ObjectiveDetermine the per capita cost of the MEBCI interventions towards enhancing new-born care best practices through capacity trainings for frontline clinical and non-clinical staff.MethodsParameters for determining per capita cost of the new-born care interventions were estimated using expenditure on trainings, supervisions, monitoring and evaluation, advocacy, administrative/services and medical logistics. Data collection started in October 2017 and ended in September 2018. Data sources for the per capita cost estimations were invoices, expense reports and ledger books at the national, regional and district levels of the health system.ResultsTotal of 4027 healthcare providers benefited from the MEBCI training activities comprising of 3453 clinical staff and 574 non-clinical personnel. Cumulative cost of implementing the MEBCI interventions did not necessarily match the cost per capita in staff capacity building; average cost per capita for all staff (clinical and non-clinical staff) was approximately US$ 982 compared to a per capita cost of US$ 799 for training only core clinical staff. Average cost per capita for all regions was approximately US$ 965 for all staff compared to US$ 777 per capita cost for only clinical staff. Per capita cost of training was relatively lower in regions with more staff than regions with lower numbers, perhaps due to economies of scale.ConclusionThe MEBCI intervention had a wide coverage in terms of training for frontline healthcare providers albeit the associated cost may be potentially unsustainable for Ghana’s health system. Emerging digital training platforms could be leveraged to reduce per capita cost of training. Large-scale on-site batch-training approach could also be replaced with facility-based workshops using training of trainers (TOTs) approach to promote efficiency.

Prevalence and associated risk factors of symptomatic dry eye in Ghana: A cross-sectional population-based study

PurposeThis study sought to estimate the prevalence and associated risk factors of symptomatic dry eye in the general non-clinical Ghanaian population. MethodsThis was a cross-sectional population-based study conducted from November 2019 to February 2020. A stratified, multistage, random sampling technique was used to select participants aged 18 years and above from the capital cities of eight administrative regions in Ghana. Symptomatic dry eye was assessed using the Ocular Surface Disease Index questionnaire (OSDI). A study specific structured questionnaire was administered to collect information on participants’ demographics and self-reported risk factors of dry eye disease such as smoking, diabetes, hypertension, arthritis, ocular allergies, pregnancy, contact lens wear, use of topical glaucoma medication and multivitamin supplement. Multiple linear regression analysis was used to explore associations between symptomatic dry eye and participant characteristics. A p-value of 0.05 was considered statistically significant. ResultsA total of 1316 individuals participated in the study [mean (SD) age 37.0 (15.72) years; range 18–90 years; 50.2 % males]. The prevalence of symptomatic dry eye was 69.3 % [95 % CI: 66.7 % - 71.7 %; mean (SD) OSDI score of 26.97 (21.52)]: 19.8 %, 16.6 % and 32.9 % mild, moderate and severe symptoms respectively. The most common ocular symptom was sensitivity to light (experienced at least some of the time), reported by 67.1 % of participants; most affected vision-related activity was reading (49.3 %); most common environmental trigger of dry eye symptoms was windy conditions (61.3 %). There was a significant positive association between symptomatic dry eye and age (p < .0001), female sex (p = .026), arthritis (p = .031), ocular surface allergy (p = .036) and regional zone (p = .043). ConclusionThere is a high prevalence of dry eye symptoms in Ghana. This represents a high dry eye disease burden and a significant public health problem that needs immediate attention.