District Hospitals In Ghana Research Articles

Health Services Availability and Readiness for Management of Hypertension and Diabetes in Primary Care Health Facilities in Ghana: a Cardiovascular Risk Management project.

Hypertension and diabetes are leading causes of adult hospital admissions and mortality across health facilities in Ghana. Timely screening and diagnosis at primary health facilities are crucial to initiate treatment and avert complications. This study explored service availability and readiness of health systems for managing hypertension and diabetes in selected district hospitals in Ghana. We adapted the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) tool to assess hypertension and diabetes management practices between June and July 2022 in four district hospitals in Ghana. Domain scores of service readiness were calculated based on the mean score of tracer item availability, transformed into percentages, and stratified by facility ownership. The mean readiness index was based on basic clinical logistics and equipment, diagnostic capacity, and first-line medications. Service availability was based on the core health workforce and specific service arrangements for the management of hypertension and diabetes. Facilities were considered 'ready' for services at a cut-off readiness score of 70%. All facilities (n = 4, 100%) provided hypertension and diabetes services, with a median of 118 nurses (IQR 103-140) and 5 physicians (IQR 2-8). Only one facility (n = 1, 25%) had conducted cardiovascular disease training in the past year. All basic equipment (weighing scales, stethoscopes, glucometers, and blood pressure monitors) were available in all 4 facilities. Antihypertensives, including ACE inhibitors (n = 3; 75%), calcium channel blockers (n = 4; 100%), centrally acting agents (n = 4; 100%), and thiazides (n = 4; 100%), were available, as were antidiabetic medications like metformin (n = 4; 100%) and insulin (n = 2; 50%). Only two facilities (n = 2; 50%) could perform the required test (Hemoglobin A1c, full blood count, renal function, serum creatinine, blood urea, electrolytes, and blood lipid tests). Overall readiness score was 75.5%, essential medications (83.5%), basic equipment (78%), clinical guidelines for the management of cardiovascular disease management (75%), and diagnostic capacity (65.5%). Mission facilities had a higher readiness score (96%) and government facilities (55%). Facilities demonstrated high readiness for basic hypertension and diabetes care, with higher availability of some essential medications and basic clinical logistics and equipment. Limited diagnostic capacity and cardiovascular disease training, highlight areas of improvement to strengthen hypertension and diabetes services in Ghana.

Policies for Improving Access to and Quality of Basic and Essential Surgical Care at District Hospitals in Ghana

Background: Ghana Health Service has, as one of its major functions, the provision of accessible healthcare to the rural population with regards to surgical and other medical problems requiring hospital care.
 Methods: Data was obtained from ten district hospitals through interviews with health personnel, from theatre records and by the completion of a questionnaire before the visit of research team members, who then interviewed the person who completed the questionnaire.
 Results: None of the physicians working in these facilities had any formal surgical training beyond that obtained in medical school and during a six-month rotation each in surgery and obstetrics and gynaecology. They performed various emergency and elective surgical procedures such as caesarean sections, laparotomies for typhoid ileal perforation, herniorrhaphies, excision of lumps, among others.
 Outcome measures: Interim measures to expand the quantity and quality of emergency and ssential surgical care at district hospitals include compulsory short-term surgical training for medical officers prior to assuming their responsibilities, making available opportunities for continuing short-term surgical education and additional surgical training for medical officers currently working in district hospitals, provision of financial and nonfinancial incentives to physicians with surgical training or surgical experience to entice them to occupy positions in such facilities and training of diplomates and non-physician clinicians to perform the most common emergency and essential surgical procedures.
 Conclusion: In the absence of surgical specialists in the District Hospitals, measures are needed to expand access to proper emergency and essential surgical service for the over 60% of the rural population.

Factors influencing postoperative pain management among nurses in selected district hospitals in Ghana.

Poorly managed postoperative pain is linked to numerous postoperative complications worldwide and in Ghana. This is due to the myriad of physical and psychological problems, such as lifelong chronic pain syndromes, impaired functionality and death. The aim of this study was to assess the barriers and factors influencing postoperative pain management by Ghanaian nurses working in four hospitals. A quantitative descriptive cross-sectional design was employed for this study. Participants were recruited using a multistage sampling technique by which 146 returned their questionnaires out of 194 participants. The statistical analysis of data was done with the Statistical Package of Social Sciences (SPSS) 20.0 version. Findings revealed that some verbal and non-verbal cues from patients such as facial grimacing, restlessness, irritability and distress, lack of concentration and moaning or crying (verbalisation) influenced how nurses controlled postoperative pain with analgesia. The participants also identified several barriers to influence postoperative pain management by nurses. In conclusion, postoperative pain control by nurses is influenced by several factors, and hence, nurses need to manage patients' pain effectively in Ghana and abroad using multiple approaches.

Adherence to drug therapy among hypertensive patients attending two district hospitals in Ghana

A major drawback to the management of hypertension among patients is poor adherence to pharmacotherapy. Factors that influence non-adherence to antihypertensive drugs could vary, depending on the prevailing condition of patient and setting. Knowledge of adherence patterns and behavior of hypertensive patients to pharmacotherapy could improve health-directed policies towards hypertension management. The objective of this study was to determine factors that influence adherence to oral antihypertensive drugs among patients attending two district hospitals in the Volta Region of Ghana. The study was cross-sectional. Respondents were hypertensive patients attending Krachi West District (n=187) and Hohoe Municipal (n=183) hospitals between March 2016 to May 2016. Data was collected using a structured questionnaire and Morisky 8 Item Measurement of adherence scale. Adherence to oral antihypertensive drugs was 89.2%. However, more than half of these respondents appeared to have uncontrolled blood pressure; and this may be due to self-response bias, blood pressure being measured only on the day of the interview or use of fake drugs (which was not assessed in this study). The strongest predictors of adherence were; knowledge on hypertension, perception of severity of condition and the amount of alcohol consumed in a day by respondents. Good adherence to oral antihypertensive drugs was observed in this population despite uncontrolled hypertension in a number of the respondents. The three independent predictors of adherence to antihypertensive medications in this study were respondent's knowledge about hypertension, perception of severity of their condition and the amount of alcohol consumed in a day. Regular patient education and counseling by medical practitioners should be encouraged in these settings to improve patient adherence.

Association between caloric intake and work-related stress among nurses in two district hospitals in Ghana

Background: The nursing profession is generally perceived as tedious and stressful and has been shown to be associated with inappropriate caloric intake with its attending consequences of obesity and increased risk of cardiovascular diseases. Objective: This study examined caloric intake and stress levels among nurses.Methods: A cross sectional study design was used, and a total of 85 nurses were sampled from two district level hospitals. Physiological and psychological levels of stress were measured using Salivary Cortisol Enzyme Immunoassay and the Cooper’s life stress inventory questionnaire, respectively. Body mass index (BMI) using height and weight measurements and caloric intake (using food frequency questionnaire and the 24h recall of participants) were also determined. Stress levels were compared to caloric intakes using the Pearson’s correlation test. Data was analyzed using Statistical Package for Social Scientists, Version 21. Statistical significance was set at p<0.05. Results: Participants were mostly females(90.60%) with a mean age±[standard deviation (SD)]of 34.86 ± 6.27 yr.and majority of them (68.20%) were married. More than half (52.94%) of the nurses were in the World Health Organization classification of overweight, with a mean BMI (±SD)of 26.11 ± 2.96 kg/m2. Their mean caloric intake (±SD) off duty (2368.74 ± 259.67 kcal) was significantly higher (p˂ 0.001) compared to that on duty (1784.80 ± 402.84 kcal). When off duty compared to on duty, the nurses also recorded significantly higher (p< 0.001) mean physiological stress scores(±SD)(61.18 ± 7.42 vs 17.12 ± 7.15) and salivary cortisol levels(±SD)(11.79 ± 1.06 μg/μL vs 5.10 ± 1.02 μg/μL). Significant positive correlations were observed for total caloric intakes and salivary cortisol levels for the nurses, both on duty [r = 0.585; 95% confidence interval(CI),0.425-0.780;p<0.001]and off duty (r= 0.316;95% CI, 0.113-0.498;p<0.003).Conclusion:The nurses had high stress levels whiles on duty and this was associated with low caloric intakes. Excessive caloric intakes were observed during off duty periods and associated with relatively lower stress levels.

Impact of a Clinical Trial in Two District Hospitals in Ghana: Perspectives of Ghanaian Researchers.

Conducting clinical trials in resource-poor settings may contribute to local capacity building. We describe the perspectives of local research personnel regarding the impact of collaborating in a clinical trial in rural Ghana. Forty-six Ghanaian research personnel were eligible to complete an anonymous survey, and 35 (76%) participated. Of the 35 respondents, 32 (91%) agreed that future patients will benefit because the hospital was part of the study. All 35 respondents reported a personal benefit derived from study involvement, most commonly citing skills or knowledge gained. Of the 35 individuals, 21 reported one or more burdens, most commonly citing nonspecific research responsibilities. Our data support the hypothesis that participation in clinical trials can contribute to capacity building in district hospitals in a lower middle-income country.

Leadership styles in two Ghanaian hospitals in a challenging environment.

Hospital managers’ power to exercise effective leadership in daily management can affect quality of care directly as well as through effects on frontline workers’ motivation. This paper explores the influence of contextual factors on hospital managers’ leadership styles and the motivation of frontline workers providing maternal and new born care in two public district hospitals in Ghana. It draws on data from an ethnographic study that involved participant observation, conversations and in-depth interviews conducted over 20 months, with frontline health workers and managers. Qualitative analysis software Nvivo 11 was used to facilitate coding, and common patterns emerging from the codes were grouped into themes. Ethical clearance was obtained from the Ghana Health Service Ethical Review Committee. Contextual factors such as institutional rules and regulations and funding constrained managers’ power, and influenced leadership styles and responses to expressed and observed needs of frontline workers and clients. The contextual constraints on mangers’ responses were a source of demotivation to both managers and frontline workers, as it hampered quality health service provision. Knowing what to do, but sometimes constrained by context, managers described ‘feeling sick’ and frustrated. On the other hand in the instances where managers’ were able to get round the constraints and respond effectively to frontline health workers and clients’ needs, they felt encouraged and motivated to work harder. Effective district hospital management and leadership is influenced by contextual factors; and not just individual manager’s knowledge and skills. Interventions to strengthen management and leadership of public sector hospitals in low- and middle-income countries like Ghana need to consider context and not just individual managers’ skills and knowledge strengthening.

Completing the Maternal Care Team: OB/GYN Expertise at Rural District Hospitals in Ghana, a Qualitative Study.

Introduction To provide a qualitative perspective on the changes that occurred after newly placed OB/GYNs began working at district hospitals in Ashanti, Ghana. Methods Structured interviews of healthcare professionals were conducted at eight district hospitals located throughout the Ashanti district of Ghana, four with and four without a full-time OB/GYN on staff. Individuals interviewed include: medical superintendents, medical officers, district hospital administrators, OB/GYNs (where applicable), and nurse-midwives. Interviews were transcribed verbatim and content analysis was performed to identify common themes. Characteristics quotes were identified to illustrate principal interview themes. Quotes were verified in context by researchers for accuracy. Results Interviews with providers revealed four areas most impacted by an OB/GYN's leadership and expertise at district hospitals: patient referral patterns, obstetric protocol and training, facility management and organization, and hospital reputation. Discussion OB/GYNs are uniquely positioned to add clinical capacity and care quality to established maternal care teams at district hospitals-empowering district hospitals as reliable care centers throughout rural Ghana for women's health. Coordinated efforts between government, donors and OBGYN training institutions to provide complete obstetric teams is the next step to achieve the global goal of eliminating preventable maternal mortality by 2030.

Knowledge, Attitudes, and Practices of Postoperative Pain Management by Nurses in Selected District Hospitals in Ghana.

IntroductionThere is documented evidence pointing to the fact that there are numerous challenges with postoperative pain (POP) management globally. However, these challenges with POP management are more profound in developing countries.PurposeThe purpose of this study is to examine the knowledge, attitude, and practices of nurses concerning POP management in four selected district hospitals in Ghana.MethodologyA descriptive, cross-sectional survey was employed to evaluate nurse's knowledge, attitude, and practices pertaining to POP management. Multistaged sampling was used to draw the respondents. An adapted version of the Nurses Knowledge and Attitudes Survey Regarding Pain instrument was used to test the knowledge, attitude, and practices of nurses and midwives. Descriptive statistics were used to analyze the data in order to present quantitative descriptions of variables in this study.ResultsThis study showed that nurses in the four district hospitals had knowledge deficits regarding POP management. Eighty-one representing 48% of nurses had low knowledge on POP management. An overwhelming majority of nurses (97.6%) relied on routinely rendered basic nursing skills to relieve POP and a few used pharmacological interventions. However, nurses had good attitudes toward POP management.ConclusionsPOP is ineffectively managed by nurses in district hospitals in Ghana. Nurses and midwives in Ghana need to adhere to best practices in POP management by increasing their theoretical and practical knowledge, so that there will be tangible positive change in POP management in Ghana.RecommendationsNurses must be empowered through continuous development programs to keep abreast with changing trends that pertain to POP management.

W/M serrated osteotomy for infantile Blount's disease in Ghana: Short-term results.

The W/M serrated high tibial osteotomy is a not frequently described surgical technique for simultaneously correcting the varus and torsional deformity in patients with Blount's disease. Without the need for internal fixation, this surgical treatment is well suited for developing countries. This study describes the short-term results of the bilateral and unilateral W/M serrated osteotomy in patients with infantile Blount's disease. Between May 2008 and January 2013, 52 patients were treated with uni- (n = 22) or bi-lateral (n = 30) W/M serrated osteotomy of the proximal tibia due to a tibial varus deformity in two district hospitals in Ghana. Other causes than infantile Blount's disease were excluded from the analysis. Pre- and post-operative clinical and radiological measurements were done, and complications were monitored up to 12 weeks after surgery. Seventeen patients (five males, 12 females; mean age 4.9 [standard deviation: 2.10]) were included, which underwent a total of 25 W/M serrated osteotomies. The femorotibial angle was corrected from 34.1° ([mean] range: 6-68°) to - 7.1° ([mean] range: -28-5°). Only one patient had developed a wound infection, and all reached full consolidation. The W/M serrated osteotomy seems a profitable alternative technique for treating the varus and torsional deformity in patients with Blount's disease in the circumstances of developing countries. The short-term outcomes are good and promising with a low complication rate and good consolidation. Long-term follow-up results of these patients are needed to observe possible complications. IV, therapeutic case series.

A retrospective analysis of the impact of an obstetrician on delivery and care outcomes at four district hospitals in Ghana.

A retrospective analysis of the impact of an obstetrician on delivery and care outcomes at four district hospitals in Ghana.

A cluster-randomized trial of task shifting and blood pressure control in Ghana: study protocol.

BackgroundCountries in sub-Saharan Africa (SSA) are experiencing an epidemic of cardiovascular disease (CVD) propelled by rapidly increasing rates of hypertension. Barriers to hypertension control in SSA include poor access to care and high out-of-pocket costs. Although SSA bears 24% of the global disease burden, it has only 3% of the global health workforce. Given such limited resources, cost-effective strategies, such as task shifting, are needed to mitigate the rising CVD epidemic in SSA. Ghana, a country in SSA with an established community health worker program integrated within a national health insurance scheme provides an ideal platform to evaluate implementation of the World Health Organization (WHO) task-shifting strategy. This study will evaluate the comparative effectiveness of the implementation of the WHO Package targeted at CV risk assessment versus provision of health insurance coverage, on blood pressure (BP) reduction.MethodsUsing a cluster randomized design, 32 community health centers (CHCs) and district hospitals in Ghana will be randomized to either the intervention group (16 CHCs) or the control group (16 CHCs). A total of 640 patients with uncomplicated hypertension (BP 140–179/90–99 mm Hg and absence of target organ damage) will be enrolled in this study (20 patients per CHC). The intervention consists of WHO Package of CV risk assessment, patient education, initiation and titration of antihypertensive medications, behavioral counseling on lifestyle behaviors, and medication adherence every three months for 12 months. The primary outcome is the mean change in systolic BP from baseline to 12 months. The secondary outcomes are rates of BP control at 12 months; levels of physical activity, percent change in weight, and dietary intake of fruits and vegetables at 12 months; and sustainability of intervention effects at 24 months. All outcomes will be assessed at baseline, six months and 12 months. Trained community health nurses will deliver the intervention as part of Ghana’s community-based health planning and services (CHPS) program.DiscussionFindings from this study will provide policy makers and other stakeholders needed information to recommend scalable and cost-effective policy with respect to comprehensive CV risk reduction and hypertension control in resource-poor settings.Trial registrationNCT01802372.

Evidence‐based training and mentorship combined with enhanced outcomes surveillance to address the leading causes of neonatal mortality at the district hospital level in Ghana

To evaluate the impact of a district hospital intervention focused on enhancing healthcare provider capacity to address leading causes of neonatal death: birth asphyxia, infection and prematurity. The neonatal quality improvement initiative was launched at two intervention referral district hospitals in Ghana. Local Health and Demographic Surveillance Systems were enlisted to enhance recording of neonatal and infant deaths in the community and at the facility. After baseline site assessments, a team of local paediatric experts conducted three clinical trainings on-site at each intervention hospital. Assessments were conducted to evaluate participant knowledge before and after participation in training modules. Monthly mentorship visits provided additional training to support the adoption of essential early neonatal care practices. In the first year of implementation, the initiative provided focused clinical training to 278 participants. A comparison of pre- and post-training test results demonstrates significant improvement in provider knowledge (73% vs. 89% correct, P < 0.001), with even greater improvement among trainees receiving recurrent refresher training (86% vs. 94% correct, P < 0.001). Participant feedback following training revealed enthusiasm about the programme and improved confidence. Locally led initiatives that invest directly in healthcare provider education and health systems strengthening represent a promising avenue for reducing neonatal morbidity and mortality. The NQI initiative demonstrates the positive impact of a district hospital intervention that combines on-site training, mentorship and enhanced demographic surveillance.

Presentation, management, and outcome of snake-bite in two district hospitals in Ghana

INTRODUCTION: the burden of disease represented by snakebites is widely underestimated and often neglected public health problem in the tropics. There is insufficient epidemiological data to guide distribution of antivenin and proper management of venomous snakebites. We describe the presentation, management and outcome of snakebites in two district hospitals in Ghana. METHODS: using data collection sheet, we prospectively documented information on all snakebite victims presenting at two Ghanaian district hospitals from 1st January 2011 to 31st December 2011. RESULTS: 163 snakebites representing incidence of 92/100,000 were recorded with mean age of 24 (16SD) years. 62.0% were males and 41.7% were farmers. Most bites occurred in April (14.3%), June (12.4%) and November (12.4%) and had occurred when victims were involved in farm-related activities (50.3%). Average time of presentation after snakebite was 3.6 (1.0 SD) hours and commonest clinical presentations were pain (93.0%), swelling (84.0%) and bleeding (51%). Of the total cases 76.7% were given antivenon, 96.3% were given antibiotics, 91.4% corticosteroids and 58.3% antihistamines. No mortality was recorded. CONCLUSION: provision of protocols and their strict adherence in the management of snakebites is required to limit unwarranted use of antibiotics and steroids in the management of snakebite. We recommend evaluation of all antivenins imported for management of snakebites to ascertain their effectiveness so as to reduce morbidity and mortality associated with snakebites in this region.

Ownership and technical efficiency of hospitals: evidence from Ghana using data envelopment analysis

BackgroundIn order to measure and analyse the technical efficiency of district hospitals in Ghana, the specific objectives of this study were to (a) estimate the relative technical and scale efficiency of government, mission, private and quasi-government district hospitals in Ghana in 2005; (b) estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient; and (c) use Tobit regression analysis to estimate the impact of ownership on hospital efficiency.MethodsIn the first stage, we used data envelopment analysis (DEA) to estimate the efficiency of 128 hospitals comprising of 73 government hospitals, 42 mission hospitals, 7 quasi-government hospitals and 6 private hospitals. In the second stage, the estimated DEA efficiency scores are regressed against hospital ownership variable using a Tobit model. This was a retrospective study.ResultsIn our DEA analysis, using the variable returns to scale model, out of 128 district hospitals, 31 (24.0%) were 100% efficient, 25 (19.5%) were very close to being efficient with efficiency scores ranging from 70% to 99.9% and 71 (56.2%) had efficiency scores below 50%. The lowest-performing hospitals had efficiency scores ranging from 21% to 30%.Quasi-government hospitals had the highest mean efficiency score (83.9%) followed by public hospitals (70.4%), mission hospitals (68.6%) and private hospitals (55.8%). However, public hospitals also got the lowest mean technical efficiency scores (27.4%), implying they have some of the most inefficient hospitals.Regarding regional performance, Northern region hospitals had the highest mean efficiency score (83.0%) and Volta Region hospitals had the lowest mean score (43.0%).From our Tobit regression, we found out that while quasi-government ownership is positively associated with hospital technical efficiency, private ownership negatively affects hospital efficiency.ConclusionsIt would be prudent for policy-makers to examine the least efficient hospitals to correct widespread inefficiency. This would include reconsidering the number of hospitals and their distribution, improving efficiency and reducing duplication by closing or scaling down hospitals with efficiency scores below a certain threshold. For private hospitals with inefficiency related to large size, there is a need to break down such hospitals into manageable sizes.

Planning among nurse managers in district hospitals in Ghana

This article reports the results of a study that explored the planning practices of nurse managers at ward level, their knowledge of planning process and the factors that influence effective planning. Although the practice of planning was almost universal, half the participants had no knowledge of the process, and this knowledge gap was traced to a lack of educational preparation before their appointment. In-service training, support from management and staff, and funding were identified as major factors influencing effective planning at ward level. The authors recommend that prospective nurse managers have educational preparation before they take up these positions and nurse managers already in post have capacity-building training in planning.

Quality Improvement Activities for Surgical Services at District Hospitals in Developing Countries and Perceived Barriers to Quality Improvement: Findings From Ghana and the Scientific Literature

Most quality improvement (QI) activities in developing countries, established with funds from external donors, are focused on specific diseases or outreach programs, such as family planning or child survival. District hospitals in developing countries serve as the primary entry point for patients with surgical problems in developing countries, yet little is known about the extent to which formal QI activities for surgical services are present in these settings or the perceptions of hospital staff about the barriers to improving quality in this setting. This study aimed to document surgical QI efforts at district hospitals and perceived barriers to improving quality in a developing country-Ghana. It also provides a summary of the existing published scientific literature concerning surgical QI in developing countries. A survey team visited 10 government district hospitals in Ghana, one in each of Ghana's 10 regions. The number and type of QI activities (surgical and nonsurgical) at these district hospitals and the perspectives of hospital staff regarding the steps required to improve the quality of surgical services in their facility were recorded. Of the 10 hospitals assessed, nine reported having some type of QI activity, ranging from satisfaction surveys to assessing quality of infection prevention. Only one hospital reported having QI activity addressing surgical care. To improve the quality of surgical care, seven hospitals reported the need for trained specialists in surgery, obstetrics, and gynecology. Six cited the need for an appropriately equipped operating theater and recovery ward. The primary barrier to achieving these recommendations, cited by 70 % of the hospitals, was the inability to recruit and retain qualified specialists with surgical skills. For Ghana to improve significantly the quality of surgical care provided in its district hospitals, greater emphasis is needed for continuous, systematic QI monitoring and for solving the problems identified. Increasing the number of appropriately trained surgical care providers is essential to strengthen the quality of surgical services in district hospitals. These findings likely apply to other resource-limited countries as well. Increased attention to improving the quality of surgical services at district hospitals in developing countries is urgently needed.

Assessing the Surgical and Obstetrics-Gynecology Workload of Medical Officers

Surgical and obstetrics-gynecology (Ob-Gyn) workload of medical officers (MOs) is substantial and may inform policies for training investment and surveillance to strengthen surgical care at district hospitals in Ghana. Observational study. Academic research. Using standardized criteria, 12 trained on-site observers assessed the surgical and Ob-Gyn workload of MOs at 10 district hospitals in each of 10 administrative regions in Ghana, West Africa. The number of patients seen by MOs and the time spent managing each patient were recorded. According to each patient's diagnosis, the encounters were categorized as medical/nonsurgical, Ob-Gyn, or surgical. The proportions of patients having Ob-Gyn and surgical conditions and the time expended providing care to Ob-Gyn and surgical patients. Of the observed patient encounters, 1600 (64.5%) were classified as medical or nonsurgical, 514 (20.7%) as Ob-Gyn, and 368 (14.8%) as surgical (9.0% nontrauma and 5.8% trauma). The most common diagnosis among Ob-Gyn patients was obstetric complication requiring cesarean section. The most common diagnosis among surgical patients was inguinal hernia. Medical officers devoted 24.8% of their time to managing Ob-Gyn patients and 18.9% to managing surgical patients (which included 5.4% for the management of traumatic injuries). Surgical and Ob-Gyn patients represent a substantial proportion of the workload among MOs at district hospitals in Ghana. Strategies to increase surgical capacity at these facilities must include equipping MOs with the appropriate training and resources to address the significant surgical and Ob-Gyn workload they face.

Resistance to antimicrobial drugs in Ghana

BackgroundAntimicrobial drug resistance is a global issue that affects health, economic, and social development. The problem has been attributed to misuse of antimicrobial agents.PurposeTo identify the agents of bacterial infection in Ghana, determine their antibiogram, and the possibility of setting up a surveillance program.Patients and methodsA prospective quantitative study set in various hospitals including two teaching hospitals, seven regional hospitals, and two district hospitals in Ghana. A total of 5099 bacterial isolates from various clinical specimens were collected over a period of 1 year, including data related to the patients. Susceptibility of the isolates was determined by the Kirby–Bauer method. In addition, the minimum inhibitory concentration (MIC) of multidrug-resistant isolates of epidemiological significance was also determined using the E-test.ResultsA wide range of bacterial isolates were identified in both teaching and regional hospitals. High percentage of resistance was observed for tetracycline (82%), cotrimoxazole (73%), ampicillin (76%), and chloramphenicol (75%). Multidrug resistance was observed to a combination of ampicillin, tetracycline, chloramphenicol, and cotrimoxazole. On the other hand, a lower percentage of resistance was observed for ceftriaxone (6.3%), ciprofloxacin (11%), and amikacin (9.9%).ConclusionGenerally, the prevalence of multidrug resistance was widespread among the various isolates. Some multidrug-resistant strains of Staphylococcus aureus, Salmonella typhi, and non-typhoidal Salmonella (NTS) had high MIC to cefuroxime (>256), gentamicin (>256), and ciprofloxacin (>32).

Validation of the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care at District Hospitals in Ghana

BackgroundThe World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care (hereafter called the WHO Tool) has been used in more than 25 countries and is the largest effort to assess surgical care in the world. However, it has not yet been independently validated. Test–retest reliability is one way to validate the degree to which tests instruments are free from random error. The aim of the present field study was to determine the test–retest reliability of the WHO Tool.MethodsThe WHO Tool was mailed to 10 district hospitals in Ghana. Written instructions were provided along with a letter from the Ghana Health Services requesting the hospital administrator to complete the survey tool. After ensuring delivery and completion of the forms, the study team readministered the WHO Tool at the time of an on-site visit less than 1 month later. The results of the two tests were compared to calculate kappa statistics for each of the 152 questions in the WHO Tool. The kappa statistic is a statistical measure of the degree of agreement above what would be expected based on chance alone.ResultsTen hospitals were surveyed twice over a short interval (i.e., less than 1 month). Weighted and unweighted kappa statistics were calculated for 152 questions. The median unweighted kappa for the entire survey was 0.43 (interquartile range 0–0.84). The infrastructure section (24 questions) had a median kappa of 0.81; the human resources section (13 questions) had a median kappa of 0.77; the surgical procedures section (67 questions) had a median kappa of 0.00; and the emergency surgical equipment section (48 questions) had a median kappa of 0.81.ConclusionsHospital capacity survey questions related to infrastructure characteristics had high reliability. However, questions related to process of care had poor reliability and may benefit from supplemental data gathered by direct observation. Limitations to the study include the small sample size: 10 district hospitals in a single country. Consistent and high correlations calculated from the field testing within the present analysis suggest that the WHO Tool for Situational Analysis is a reliable tool where it measures structure and setting, but it should be revised for measuring process of care.Electronic supplementary materialThe online version of this article (doi:10.1007/s00268-010-0918-1) contains supplementary material, which is available to authorized users.