Ghana Experience Research Articles

English

Girl-child self-esteem, self-confidence and coping capacity with positive effects on their school performance is increase when. Water, sanitation and hygiene (WASH) topics are included in health education. This review explored the relationship and effect of sanitary facilities in schools on Girl-child participation, health impact on Girl-child education, the state of sanitary facilities and sanitary behaviors in public Junior High Schools and as well identified sustainable solutions and made recommendations on how to provide adequate sanitary facilities to reduce inequality in schools. This qualitative review gathered and analyzed secondary data at both global and local levels (with focus on the Ghana experience). Results: availability of sanitary facilities in schools has the potential to reduce students’ absenteeism especially among the girl child. Poor sanitary facilities have an adverse impact on girls’ privacy and comfort. Girls’ inability to manage their menstrual hygiene affects their participation during events at school because of panic over outflow. Girls avoid eating or drinking during the day to further avoid using the sanitary facilities making it difficult to concentrate while in school. This study shows that school WASH issues are associated with health conditions like vector-borne illnesses among others and embarrassment in school toilets. The state of hygienic conveniences and services in schools are poor and inadequate. For schools with basic amenities, they are in an awful state as a result of neglect. Therefore, it is vital to provide adequate sanitary facilities in schools. This will improve the health and wellbeing of the gild child in Ghanaian schools.   Key words: Gender, girl-child education, health, hygiene, sanitation, water.

When the Researched Refused Confidentiality: Reflections from Fieldwork Experience in Ghana

Meeting appropriate ethical standards for research involving human participants, mean ensuring confidentiality. It is assumed that the research participant will accept the safeguarding protocols necessary to ensure confidentiality. This assumption however oversimplifies the variation of motivations that goes into participants’ decisions to participate in research. Drawing on reflections from my fieldwork experience in Ghana, I answer the questions: Why do research participants reject confidentiality? What ethical position can one take when the researcher and the researched have conflicting perspectives about confidentiality? I contend that participants with personal stake refuse confidentiality when they want to be acknowledged for their data. Rejecting confidentiality is however, embedded in the individual perspective, cultural, and political context of the study area. The ethical concerns of such refusal can be ameliorated if confidentiality is nuanced to include six categorically distinct but mutually non-exclusive stages: research-planning, ongoing-information, writing-up, reality-after-research, differential-disseminations, and no-confidentiality-clause. The paper further argues that whilst maintaining institutional allegiance in this matter is crucial, employing confidentiality should lie at the intersection of participants’ motivation for taking part in the research, the socio-cultural-specific-context of the study location and the nature of the topic being explored.

Multi-level manifestations of sexual stigma among men with same-gender sexual experience in Ghana

Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. Such stigma negatively influences health and other material and social aspects of daily life for men who have sex with men (MSM). However, there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at other levels. Few studies provide a comprehensive qualitative assessment of the multi-level sexual stigma derived from the direct narratives of men with same-gender sexual experience. To help fill this gap on sexual stigma, we qualitatively investigated [1] what was the range of sexual stigma manifestations, and [2] how sexual stigma manifestations were distributed across socioecological levels in a sample of Ghanaian MSM. From March to September 2020, we conducted eight focus group discussions (FGDs) with MSM about their experiences with stigma from Accra and Kumasi, Ghana. Data from the FGDs were subjected to qualitative content analysis. We identified a range of eight manifestations of sexual stigma: (1) gossiping and outing; (2) verbal abuse and intrusive questioning; (3) non-verbal judgmental gestures; (4) societal, cultural, and religious blaming and shaming; (5) physical abuse; (6) poor-quality services; (7) living in constant fear and stigma avoidance; and (8) internal ambivalence and guilt about sexual behavior. Sexual stigma manifestations were unevenly distributed across socioecological levels. Our findings are consistent with those of existing literature documenting that, across Africa, and particularly in Ghana, national laws and religious institutions continue to drive stigma against MSM. Fundamental anti-homosexual sentiments along with beliefs associating homosexuality with foreign cultures and immorality drive the stigmatization of MSM. Stigma experienced at all socioecological levels has been shown to impact both the mental and sexual health of MSM. Deeper analysis is needed to understand more of the lived stigma experiences of MSM to develop appropriate stigma-reduction interventions. Additionally, more community-level stigma research and interventions are needed that focus on the role of family and peers in stigma toward MSM in Ghana.

An exploratory study on excess weight gain: Experiences of Postmenopausal Women in Ghana.

Excess weight gain is a problem with a significant impact on health and quality of life as well as the consequent economic burden on human populations. While society advocates preference for excess weight gain, limited evidence exists concerning postmenopausal women's experiences in Ghana. The current study explored the experiences regarding excess weight (overweight and obesity) gain among Ghanaian postmenopausal women in Bono East (Techiman) region. This is a qualitative exploratory descriptive study where anthropometric measurements [body mass index (BMI), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR)] were determined and participants who were identified with excess weight (obesity and overweight) were recruited to participate in a focus group discussion (FGD). Four focus group discussions were held and 24 postmenopausal women (>45 years) in Techiman took part. Discussions were audio-recorded and transcribed for thematic analysis. From the qualitative analysis of the FGD, three major themes emerged from the study namely, (i) perception of body weight, (ii) measures to reduce body weight, and (iii) support to adhere to the weight management program. Sub-themes revealed that weight gained was viewed as the presence of diseases and admired by society as a culturally accepted body image. Diet-related changes, a combination of diet modification and physical activity, and weight management supplements emerged as measures to reduce excess weight. Support to adhere to the weight program included health education, access, affordable exercise facilities, and social support. Sociocultural norms influence the image perception and acceptance of weight gain among postmenopausal women in Ghana, but there is an acknowledgment of the perceived negative health implications of such excess weight. Measures for weight reduction and support to adhere to the weight reduction programme require attention in Ghana.

Mothers' perspectives of physical and psychological issues associated with caring for Ghanaian children living with tuberculosis: A qualitative study.

The aim of the study was to explore and describe the mothers' perspectives on issues associated with caring for Ghanaian children aged 0-14 years living with tuberculosis. Exploratory descriptive qualitative design. Semi-structured individual interviews were conducted face to face with 15 purposively sampled mothers from two health facilities in the Greater Accra area. Transcribed data were analysed using computer-enhanced thematic analysis. Findings were grouped into (1) physical burden on the mothers and (2) psychological burden on mothers. The eight subthemes indicate that mothers of children living with tuberculosis experienced tiredness, sleeplessness, body pains, weight loss and sicknesses as they cared for their children. In addition to worrying, mothers experienced stigma and negative emotions such as sadness, guilt, fear and loneliness. Mothers of children diagnosed with tuberculosis in Ghana experience physical and psychological health problems related to their caregiving roles. Nurses and other healthcare providers should identify specific problems and offer broad-based emotional and other support for these women.

Exploring perspectives on sustainability and planning from national and local planners for effective practice: the experience of Ghana

ABSTRACT Understanding how the planning system is (not) functioning remains a challenge for many urban planners in the developing world. This paper responds by conducting an analysis of the discourse between national and local planners. It seeks to unfold the challenges of informal settlement planning in Accra, Ghana. Through in-depth interviews, this paper suggests that: (I) Grounding sustainability must be conducted by implementing the plans rather than producing the plans. (II) Empowering local planners should be a primary task to incrementally remedy the challenging planning system in countries like Ghana.

Factors Influencing Pre-Service Teachers’ Performance in Mathematics in Colleges of Education: Re-counting Experiences in Ghana

This study explored the factors affecting pre-service teachers’ performance in mathematics in the colleges of education in Ghana. A descriptive cross-sectional survey design was employed. Data was collected with the use of a questionnaire from a sample of 400 first-year pre-service teachers selected using stratified random sampling technique from the three regions across the Ghana. Data were analyzed using exploratory factor analysis and regression analysis. The results suggested that pre-service teachers perceived the following as factors affecting their performance in mathematics: teaching-learning conditions, motivation, parents’ educational background, valuing of mathematics, and health and safety issues. It was also revealed that pre-service teachers’ motivation was the best predictor of their performance in mathematics, followed by health and safety issues and then teaching-learning conditions. Implications of the findings are discussed in the study.

Treating Hepatitis B Virus in Times of COVID-19: The Case for Clinical Pharmacogenomics Research in Tenofovir-Induced Kidney Toxicity.

The current pandemic has markedly shifted the focus of the global research and development ecosystem toward infectious agents such as SARS-CoV-2, the causative agent for COVID-19. A case in point is the chronic liver disease associated with hepatitis B virus (HBV) infection that continues to be a leading cause of severe liver disease and death globally. The burden of HBV infection is highest in the World Health Organization designated western Pacific and Africa regions. Tenofovir disoproxil fumarate (TDF) is a nucleoside analogue used in treatment of HBV infection but carries a potential for kidney toxicity. TDF is not metabolized by the cytochrome P450 enzymes and, therefore, its clearance in the proximal tubule of the renal nephron is controlled mostly by membrane transport proteins. Clinical pharmacogenomics of TDF with a focus on drug transporters, discussed in this perspective article, offers a timely example where resource-limited countries and regions of the world with high prevalence of HBV can strengthen the collective efforts to fight both COVID-19 and liver diseases impacting public health. We argue that precision/personalized medicine is invaluable to guide this line of research inquiry. In all, our experience in Ghana tells us that it is important not to forget the burden of chronic diseases while advancing research on infectious diseases such as COVID-19. For the long game with COVID-19, we need to address the public health burden of infectious agents and chronic diseases in tandem.

Embedding Research on Implementation of Primary Health Care Systems Strengthening: A Commentary on Collaborative Experiences in Ethiopia, Ghana, and Mozambique

Achieving universal health care coverage requires the adoption of primary health care policies and delivery strategies that are evidence based. Although this has been confronted by manifold challenges, particularly in the health systems of sub-Saharan Africa, there are promising approaches for accomplishing this objective. Salient among these is embedding implementation research (i.e., the study of methods to promote the systematic uptake of evidence-based interventions (EBIs) into routine practice) into policy making and implementation processes. Since 2007, the African Health Initiative of the Doris Duke Charitable Foundation supported partnerships that strengthened primary health systems and policy implementation in 7 countries in sub-Saharan Africa using the embedded implementation research as a core strategy. This programmatic review and analysis aims to identify the core features and processes that characterized how the partnerships operationalized the embedded implementation research approach and understand the factors that helped and constrained partnerships' effective use of this approach. For this, we drew upon findings from a desk review that consisted of 30 examples of embedded implementation research conducted by 3 African Health Initiative partnerships between 2016 and 2021 in Ethiopia, Ghana, and Mozambique. In addition, we conducted and analyzed 13 in-depth interviews with embedded implementation research stakeholders of the 3 projects. Core features and processes of embedded implementation research were: (1) the leadership role of policy decision makers and implementation leaders; (2) positioning research with program implementation at multiple levels of health systems; (3) multidisciplinary and multisectoral partnerships; (4) focus on research capacity building; and (5) real-time feedback loops and knowledge translation. Factors influencing the effectiveness of the embedded implementation research experiences involved: (1) the implementation climate and leadership; (2) opportunities and capacities to circulate and absorb new information; and (3) stakeholders' baseline knowledge and embedded scientists' identification within their organizations.

The liminality of institutional design of petroleum governance in Ghana: Political will, political settlements and contentions as defining factors

Governance of Ghana's petroleum sector has evolved from personalised moments of institutional adjudication, and through exclusive clientelist political manoeuvres, to the active involvement of non-state actors. These three phases have also coincided with peaceful political transitions from one political party or regime to the other: from 1983 to 2000, 2001 to 2008, and 2009 to 2016. This paper investigates the trajectories of institutional design in these phases using the lens of an originally anthropological concept called liminality. The study is a synthesis analysis of qualitative interviews with over 100 people, including petroleum governance stakeholders, practitioners, and extractive community members in Ghana. The findings show that by 2016, the governance of the petroleum sector had transformed from liminal spaces into a more counterbalanced and predictable institutional framework despite persistent constraints. I argue that during the in-betwixt and in-between of institutional design, contentious politics and political settlement superseded any predictable and intentional objectivity in petroleum governance. By situating Ghana's petroleum experience within broader theoretical discourse, this paper offers scholars an opportunity to apply the findings to other geographies and sectors.

Investing in activism: Learning from children’s actions to stop child marriage

This article draws on child activists’ experiences in Bangladesh and Ghana, who mobilised to stop potential child marriages from their respective Child Forums and Children’s Parliaments. Case studies were undertaken with 75 child activists, 10 girls whose child marriages had been stopped, and 22 adult stakeholders. The children’s activism disrupted intergenerational relations – unsettling adults’ attitudes towards children – and depended on such relations – children were successful in stopping child marriages because they drew on critical social capital and mobilised key stakeholders. Children’s activism thus has lessons for children’s participation literature more generally, in the synergies between children’s mobilisation and intergenerational relations.

Delays in Breast Cancer Treatment Schedules During the Covid-19 Pandemic and Patient Experience with Saftey Protocols: A Tertiary Hospital Experience in Ghana

Objective: As at 30th September 2020 in Ghana 46,626 confirmed cases of COVID-19 with 301 related deaths had been reported. All over the world and in Ghana, elective surgeries including cancer surgeries were delayed. Korle Bu Teaching Hospital had to adjust byperforming fewer elective surgeries. The hospital also put into place COVID-19 safety protocols to protect both patients and staff. These included temperature checks, handwashing, limited number of visitors and health education at the Out-patient Departments. This study set out to evaluate how the pandemic affected access to breast cancer treatment, particularly surgery and the patients’ experience with the COVID-19 safety protocols.Methodology: This was a cross-sectional study conducted on all patients who had surgery for breast cancer during the COVID-19 pandemic, from April to September 2020. The areas assessed were OPD, chemotherapy and surgery appointments. Categoricalvariables were reported as percentages and continuous variables as mean (± SD) or median (with IQR). Descriptive analysis used to represent delays in OPD, Chemotherapy and Surgery appointments.Results: A total of 103 breast cancer surgeries were identified. Seventy-seven (74.8%) of these consented to participate in the study. This study documented 10.4% delays in OPD attendance, 24.5% delays in chemotherapy sessions and 61.0% postponement ofsurgeries with a mean waiting time to surgery of 6.4 weeks [SD 3.8]. The enforcement of the COVID-19 safety protocols and the practice of physical distancing made the majority (72.7%) feel safe.Conclusion: Healthcare capacity and planning should support the national agenda to fight the pandemic without undue delays in cancer care.

Comparative Overview of Tax Amnesty Policy Implementation in Nigeria

Nigeria between 2016 and 2019 implemented several tax amnesty programmes successively. Tax amnesty is the release from the consequence of non-compliance with a tax obligation. The repetition of tax amnesty schemes within a short period indicates that there are lapses in tax administration in Nigeria. This paper examines the role of Tax amnesty in catalysing domestic resource mobilisation and voluntary compliance to tax obligations in Nigeria; drawing from the lessons presented by the experiences of Ghana, South Africa, Mauritius, Kenya, Ireland, Indonesia and the United Kingdom. The doctrinal research methodology is adopted in this research. The paper will contend that for a tax amnesty to succeed there is need for an effective tax administrative system that has the capacity to enforce tax laws and sanctions. It recommends that a sectorial tax amnesty is preferable for Nigeria.

Barriers to adequate pain control among women with cervical cancer: exploring unmet pain control needs in Ghana

BACKGROUNDPain because of cervical cancer is a significant health issue globally, especially in women with advanced disease. However, little is known about unmet needs for pain control in low-resource settings where the burden of cervical cancer is the greatest.OBJECTIVEThis study aimed to quantify the level of pain that women with cervical cancer in Ghana experience, explore attitudes toward pain and pain medications, and determine the barriers to adequate pain control.STUDY DESIGNA cross-sectional survey was conducted on 100 adult women with a histopathologic diagnosis of cervical cancer presenting for care at Komfo Anokye Teaching Hospital in Ghana. In addition, a descriptive analysis was conducted among all participants and the subgroup of women who reported pain but did not report pain medication use.RESULTSAmong 100 participants with cervical cancer, the mean age was 59.5 years, and the median parity was 6.0 (interquartile range, 5.0–6.0); moreover, most participants presented with inoperable stage II or greater cervical cancer (99 of 100 [99%]). Of 100 participants, 80 (80%) had pain caused by their cervical cancer, with more than half (51 of 100 [51%]) rating their pain as a 3, 4, or 5 on a 5-point scale. Most participants reported pain significant enough to impact their sleep (58 of 99 [58.6%]) and their ability to carry out daily activities (54 of 100 [54%]). Furthermore, 55 of 100 participants (55%) took pain medications in the last week; however, only 5 of 54 participants (9.3%) reported complete improvement in their pain, and most participants (30 of 54 [55.6%]) felt they needed a stronger pain medication. Barriers to adequate pain control included the healthcare provider's focus on pain, with 14.1% of women reporting that their healthcare providers never asked about their pain (14 of 99 [14.1%]). In addition, participants’ attitudes toward pain control demonstrated that 34 of 95 participants (35.8%) believed that they should be able to tolerate their cervical cancer pain without medication. Among participants who ever took pain medication, 16 of 58 (27.6%) were bothered that they took pain medication, and 19 of 58 (32.7%) were concerned that they used too much medication. Most participants were able to afford (51 of 58 [88%]) and access (56 of 58 [96.6%]) pain medications and did not worry their supply would run out (56 of 58 [96.6%]).CONCLUSIONMost patients had significant pain because of cervical cancer, and many of them endorsed needing more pain medications than what they were prescribed. The etiologies of the unmet need for pain control included missed opportunities to discuss pain control at clinic visits and patients’ attitudes toward pain management. Financial and access barriers to obtaining pain medications were minimal.

Promoting respectful maternity care: challenges and prospects from the perspectives of midwives at a tertiary health facility in Ghana

BackgroundEvidence shows that women in Ghana experience disrespectful care (slapping, pinching, being shouted at, etc.) from midwives during childbirth. Hence, evidence-based research is needed to advance the adoption of respectful maternity care (RMC) by midwives. We therefore sought to explore and document midwives’ perspectives concerning challenges faced and prospects available for promoting RMC in a tertiary health facility.MethodsWe employed an exploratory descriptive qualitative study design. In total, we conducted 12 interviews with midwives educated on RMC. All audio data were transcribed verbatim and exported to NVivo-12 for data management and analyses. We relied on the Consolidated Criteria for Reporting Qualitative Research guideline in reporting this study.ResultsThe findings were broadly categorised into three themes: emotional support, dignified care and respectful communication which is consistent with the WHO’s quality of care framework. For each theme, the current actions that were undertaken to promote RMC, the challenges and recommendations to improve RMC promotion were captured. Overall, the current actions that promoted RMC included provision of sacral massages and reassurance, ensuring confidentiality and consented care, and referring clients who cannot pay to the social welfare unit. The challenges to providing RMC were logistical constraints for ensuring privacy, free movement of clients, and alternative birthing positions. Poor attitudes from some midwives, workload and language barrier were other challenges that emerged. The midwives recommended the appointment of more midwives, as well as the provision of logistics to support alternative birthing positions and privacy. Also, they recommended the implementation of continuous training and capacity building.ConclusionWe conclude that in order for midwives to deliver RMC services that include emotional support, dignified care, and respectful communication, the government and hospital administration must make the required adjustments to resolve existing challenges while improving the current supporting activities.

Analysis of Non-Fiscal Measures in the Forestry Sector in Stimulating Growth and Jobs Creation: The Ghana Experience

The accelerated development of forestry sector over the past two decades has stimulated an increasing number of researchers to investigate the impact of forestry resources on economic growth amidst forest quality and quantity deteriorating factors, including illegalities. This study aims to identify and examine non-fiscal measures implemented in stimulating growth and job in the sector. Employing mixed research approach, the study provides inferences based on detailed performance description of core centers of the sector. The study revealed that, the government and regulatory agencies need to acknowledge the existence and importance of SMEs and making them part of economic analysis to project growth, innovation, job creation to social inclusion, and rural development. Also, trade associations are handicapped logistically and this derails their ability to support their members both financially and technically. Similarly, in adoption of strategies to improve short term development of wildlife resources, tourism attraction sites within wildlife protected areas could be created, which will control encroachments and add to revenue streams of the sector and would contribute to economic growth as a whole.

Parliamentary Primaries After Democratic Transitions: Explaining Reforms To Candidate Selection In Ghana

Abstract Candidate selection procedures play a crucial role in shaping parliaments and influencing the quality of democracy. Yet, our understanding of what motivates parties to reform candidate selection mechanisms at specific points in time is limited. To address this gap, we examine the experience of Ghana’s National Democratic Congress (NDC), which reformed its selection procedures in 2015 allowing all party members to vote in primary elections for parliamentary candidates. We ask what triggered these reforms and identify four motivations—the confluence of which explains why the reforms were adopted in 2015. These motivations were: making the party more democratic by expanding participation, reducing the cost of the primary process, building the party’s organizational capacity, and keeping up with the party’s main competitor. Together, these led NDC leaders to believe that reforms would benefit the party. However, a divergence between actual and intended effects meant some of these benefits were not realized, so the NDC reversed its reforms. This case suggests that the current shift towards more inclusive candidate selection mechanisms across parts of Africa will not be linear: party leaders will adopt such reforms when they believe it is in their party’s interest.

Factors associated with the family reintegration stability for children with a residential care experience in Ghana

There is limited evidence on family reintegration for children who have been in residential care within the African context. The goal of this study is to find out what factors impact reintegrated institutionalized children’s desire to remain with their biological parents or extended family. The dataset included records for 659 interviewed children and their guardians. However, the analyses were limited to 408 cases with complete data on the dependent and independent variables. Most of the children in the study (73%) preferred to remain with their relatives. The age of the child, length of time spent in residential care, and having a case file, were all factors linked to the children’s wish to stay with their family. Based on the findings of the study, social workers should do a full assessment and documentation to decide if reintegration is appropriate, prepare the child and family, and give follow-up assistance to ensure stable reintegration. Social workers must also link reunified families to long-term support such as enrollment on the Livelihood Empowerment against Poverty social protection program, and they should monitor placements to improve the stability of the reintegration.

Travel and personal growth: the value of visits to the country of origin for transnational migrant youth

ABSTRACT Migrant-background youth travel often to their or their parents’ country of origin, yet little is known about how such trips affect their personal growth. These trips have either been ignored or analysed through concepts of belonging or identity. By contrast, studies on international education and travel and tourism, which commonly focus on youth without migration background, highlight positive personal impacts of experiences abroad. This paper applies a personal growth lens to analyse how visits to the origin country impact Ghanaian-background youth living in Belgium. Drawing on 18 months of ethnographic fieldwork in Belgium and Ghana with 25 young people, we show how such trips stimulate self-confidence and aspirations. Self-confidence is strengthened through favourable treatment and access to luxurious spaces that make youth feel special. Young people develop educational and career aspirations after comparing opportunity structures they face in Belgium with their experiences in Ghana and engaging with Ghanaian role models.

Challenges to Scaling up Mhealth in Ghana. A Framework for Assessing the Health System

The promise for improving healthcare services has been confirmed by mobile device technology, but the decision-making process to acquire and use mHealth technologies on a scale is not directed. We apply a methodology to assess the potential and difficulties of efficient deployment of the mHealth at a scale in healthcare systems using the instance of Community Base Health Services (CBS) in Ghana. The advantage and difficulties of mHealth in community-based services in Ghana were examined in comprehensive research via a blend of key informant interviews, document reviews, and local project visits. The lessons gained from Ghana's local experience and elsewhere were based on a framework adjusted from 3 approaches to sustainable information and Communication Technology (ICT) evaluation. Four major characteristics of the system have been identified and evaluated: government stewardship and organizational, technical, and financial system. The prospects for successfully implementing mHealth in Ghana include the high penetration of mobile devices and a favorable e-health policy framework. Again, given a health system with a weal ICT setting and limited implementing ability, it is doubtful if the potential benefits of mHealth would benefit CBS through direct broad-scale adoption. The application of a healthcare system framework facilitates a systematic assessment of possible barriers to CBS growth in Ghana and is helpful for decision-making policy and practice for other small and medium enterprises.