Ghana Health Research Articles

Socio-economic factors and child health status in Ghana

Ghana’s under-five mortality rate far exceeds the Sustainable Development Goal (SDG) 3.2 Target of 25 deaths per thousand live births by 2030. Therefore to improve upon the situation, it is imperative that the factors which determine the health status of children are investigated. This study therefore used data from the 2014 Ghana Demographic and Health Survey to investigate the socio-economic determinants of child health status in Ghana by employing the binary probit model. The study revealed that, Ewe, Grusi, Muslim and Christian children, children from urban areas, Greater Accra, Northern, Ashanti, Upper east, Eastern and Central regions, were more probable to contract cough. Also children with uneducated mothers, those whose mothers had uneducated partners as well as those whose mothers had no health insurance were revealed to be more likely to be anaemic. Further, male children and children from non-wealthy households were revealed to be more likely to have suffered diarrhoea, fever and anaemia. Also children with employed mothers and those with mothers with big distance challenges to seek care were found to be more likely to have fever. These findings, point out the essence of socio-economic factors to child health outcomes and hence the need to be given attention in child health survival interventions in Ghana.

National health insurance subscription and maternal healthcare utilisation across mothers\u2019 wealth status in Ghana

IntroductionThis study is against the backdrop that despite the forty-nine percent decline in Maternal Mortality Rate in Ghana, the situation still remains high averaging 319 per 100,000 live births between 2011 and 2015.ObjectiveTo examine the relationship between National Health Insurance and maternal healthcare utilisation across three main wealth quintiles (Poor, Middle and Rich).MethodsThe study employed data from the 2014 Ghana Demographic and Health Survey. Both descriptive analysis and binary logistic regression were conducted.ResultsDescriptively, rich women had high antenatal attendance and health facility deliveries represented by 96.5% and 95.6% respectively. However, the binary logistic regression results revealed that poor women owning NHIS are 7% (CI = 1.76–2.87) more likely to make at least four antenatal care visits compared to women in the middle wealth quintile (5%, CI = 2.12–4.76) and rich women (2%, CI = 1.14–4.14). Similarly, poor women who owned the NHIS are 14% (CI = 1.42–2.13) likely to deliver in health facility than women in the middle and rich wealth quintile.ConclusionThe study has vindicated the claim that NHIS Scheme is pro-poor in Ghana. The Ministry of Health should target women in the rural area to be enrolled on the NHIS to improve maternal healthcare utilisation since poverty is principally a rural phenomenon in Ghana.

Task-shifting in mental health services: Extent, impact and challenges in Ghana

AimTo examine the role and scope of practice of community mental health workers (CMHWs) as well as the impact and challenges associated with of work of CMHWs within Ghana's mental health delivery system.MethodsA cross sectional survey of 11 psychiatrists, 29 health policy directors and 164 CMHWs as well as key informant interviews with 3 CMHWs, 5 psychiatrists and 2 health policy directors and three focus group discussions with 21 CMHWs. Results of quantitative data were analysed with SPSS version 20 whilst the results from qualitative data were analysed manually through thematic analysis.ResultsIn addition to duties prescribed in their job descriptions, all the CMHWs identified several jobs that they routinely perform including jobs reserved for higher level cadres such as medication prescribing for which most of the CMHWs have no training. Some CMHWs reported they had considered leaving the mental health profession because of the stigma, risk, lack of opportunities for continuing professional development and career progression as well as poor remuneration. Almost all the stakeholders believed CMHWs in Ghana receive adequate training for the role they are expected to play although many identify some gaps in the training of these mental health workers for the expanded roles they actually play. All the stakeholders expressed concerns about the quality of the care provided by CMHWs.ConclusionThe study highlights several important issues, which facilitate or hinder effective task-shifting arrangements from psychiatrists to CMHWs and impact on the quality of care provided by the latter.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Source of drinking water and the prevalence of diarrhoea among children aged under-five in Ghana - recent evidence

Diarrhoeal diseases are among the leading causes of morbidity and mortality in children in low-and middle-income countries. Although the government of Ghana has implemented some interventions with reasonable successes over the years, diarrhoea morbidity still remains a public health concern. For instance, it was reported in the 2008 Ghana Demographic and Health Survey (GDHS) that one out of every five (20%) children below five years of age had diarrhoea in the two weeks preceding the survey while the 2014 GDHS revealed an incidence of 12%. This paper examines the association between source of drinking water and the prevalence of diarrhoea among children aged under-five years using propensity score matching. The study found that drinking from improved water sources rather increases the odds of diarrhoea by about 1.3 times and this effect persists in both the unmatched and matched samples. We proffer potential explanations for this rather puzzling finding. The paper concludes that the Ghana Standards Authority should regularly monitor sachet water and other 'improved water sources' for its microbial quality to ensure that Ghanaians are offered clean and safe drinking water in order to curb the incidence of diarrhoea among children.

How is dietary diversity related to haematological status of preschool children in Ghana?

ABSTRACTBackground: The role of dietary diversity on blood biomarkers may be significant, but the evidence is limited.Objective: This study assessed the association between dietary diversity and haematological status of children aged 6-59 months controlling for various known confounders.Design: The analysis in this study is based on the 2014 Ghana Demographic and Health survey data.The study involved 2,388 pre-school children aged 6-59 months who constituted the sub-sample for anaemia assessment.Results: The mean haemoglobin concentration (Hb) was 10.2 g/dl ± 1.50 (95 % CI: 10.1 to 10.3), and anaemia prevalence (Hb < 11 g/dl) among children aged 6-59 months was 66.8 % (CI: 63.7 to 69.8). In multivariable logistic regression analysis,continued breastfeeding [Adjusted odds ratio (AOR) = 1.9 (95% CI: 1.19–2.91], 12–23 months of age (AOR = 2.4 (95% CI: 1.40–3.98), having fever in last two weeks (AOR = 1.7 (95% CI: 1.20–2.45, birth interval ≤ 24 months (AOR = 1.9 (1.20–2.84), and poorest wealth quintile (AOR = 2.6 (95% CI: 1.48–4.48) were positively associated with anaemia.Conclusion: The current study showed that factors other than poor dietary diversity predicted anaemia among children aged 6–59 months in Ghana.

Contraceptive Use among Women in Accra, Ghana: 2003 and 2008.

Despite a relatively low fertility rate, maternal mortality in Ghana still remains high. According to the Ghana Demographic and Health Surveys, about 22% of Ghanaian women of reproductive age currently use contraception. We analyzed contraceptive use among a representative sample of women in Accra, Ghana, to better understand contraceptive use patterns. We used data from two cross-sectional surveys of a representative cohort of women in Accra. In 2003, 28.9% of sexually active women used a contraceptive method. In 2008, 31.5% of sexually active women used a contraceptive method. Additionally, we observed high rates of discontinuation-from 64.1% among those using longer-acting methods to 82.1% among those using traditional methods-between years. Further research on women's contraceptive decision-making is needed to explain these patterns and to ensure that family planning interventions meet the needs of women in Ghana.

Contraceptive Use in Ghana: What about Women Empowerment?

Introduction: Although contraceptive usage appears to be increasing in Ghana, 30 and 42 percent of married and unmarried women respectively still have unmet need for family planning services partly due to their inability to exercise their basic rights on fertility issues. Meanwhile, expanding freedom of choice and actions to shape women’s life is critical to how women can be autonomous about issues surrounding their fertility. On this premise, this study aimed at investigating empowerment status and usage of contraceptives among women in the reproductive age in Ghana. Methods: The study made use of the 2014 Ghana Demographic and health survey with a sample size of 9396. The outcome variable was contraceptive use whilst the main independent variable was women empowerment (measured by ability to decide on a woman’s own healthcare, large household purchases and visiting family members). Both bivariate and multivariate binary logistic regressions were carried out generating odd ratios to explore the association at 95% confidence interval. Results: The results indicated that women who were not deciding alone on their own healthcare were less probable to use contraceptives (OR = 0.92, CI = 0.80 - 1.07) as well as those who were not deciding alone on large household purchases (OR = 0.96, CI = 0.82 - 1.11) and visiting family members (OR = 0.63, CI = 0.93 - 1.25) at the bivariate level. However, at the multivariate level, higher likelihoods of contraceptive use were found among those who were not deciding alone on health (OR = 1.26, CI = 1.18 - 1.68), large household purchases (OR = 1.30, CI = 1.08 - 1.55) and visiting family members (OR = 1.32, CI = 1.12 - 1.57). Conclusion: This has inspired the need to intensify women empowerment interventions through mass media and all possible avenues in order to enhance reproductive health.

Sensitivity of health sector indicators' response to climate change in Ghana

There is accumulating evidence that the emerging burden of global climate change threatens the fidelity of routine indicators for disease detection and management of risks to public health. The threat partially reflects the conservative character of the health sector and the reluctance to adopt new indicators, despite the growing awareness that existing environmental health indicators were developed to respond to risks that may no longer be relevant, and are too simplistic to also act as indicators for newer global-scale risk factors. This study sought to understand the scope of existing health indicators, while aiming to discover new indicators for building resilience against three climate sensitive diseases (cerebro spinal meningitis, malaria and diarrhea). Therefore, new potential indicators derived from human and biophysical origins were developed to complement existing health indicators, thereby creating climate-sensitive battery of robust composite indices of resilience in health planning. Using Ghana's health sector as a case study systematic international literature review, national expert consultation, and focus group outcomes yielded insights into the relevance, sensitivity and impacts of 45 indicators in 11 categories in responding to climate change. In total, 65% of the indicators were sensitive to health impacts of climate change; 24% acted directly; 31% synergistically; and 45% indirectly, with indicator relevance strongly associated with type of health response. Epidemiological indicators (e.g. morbidity) and health demographic indicators (e.g. population structure) require adjustments with external indicators (e.g. biophysical, policy) to be resilient to climate change. Therefore, selective integration of social and ecological indicators with existing public health indicators improves the fidelity of the health sector to adopt more robust planning of interdependent systems to build resilience. The study highlights growing uncertainties in translating research into protective policies when new indicators associated with non-health sources are needed to complement existing health indicators that are expected to respond to climate change.

Improving Ghana's mental healthcare through task-shifting- psychiatrists and health policy directors perceptions about government's commitment and the role of community mental health workers.

BackgroundThe scarcity of mental health professionals places specialist psychiatric care out of the reach of most people in low and middle income countries. There is growing interest in the effectiveness of task shifting as a strategy for targeting expanding health care demands in settings with shortages of qualified health personnel.Given this background, the aim of our study was to examine the perceptions of psychiatrists and health policy directors about the policy to expand mental health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs).MethodsA self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors. Key informant interviews were also held with five psychiatrists and four health policy directors. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically.ResultsAlmost all the psychiatrists and 23 (79.3 %) health policy directors were aware of the policy of the Government of Ghana to improve on the human resource base within mental health through a system of task-shifting. Overall, about half of the psychiatrists and 9 (31 %) health policy directors perceived there is some professional resistance to the implementation of the policy of task shifting. The majority of respondents were of the view that CMHWs should be allowed to assess, diagnose and treat most of the common mental disorders. The respondents identified that CMHWs usually perform two sets of roles, namely; officially assigned roles for which they have the requisite training and assumed roles for which they usually do not have the requisite training. The stakeholders identified multiple challenges associated with current task shifting arrangements within Ghana’s mental health delivery system, including inadequate training and supervision, poor awareness of the scope of their expertise on the part of the CMHWs.ConclusionPsychiatrists and health policy directors support the policy to expand mental health service coverage in Ghana through a system of task-shifting, despite their awareness of resistance from some professionals. It is important that the Government of Ghana upholds its commitment of expanding mental healthcare by maintaining and prioritizing its policy on task shifting and also providing the necessary resources to ensure its success.

Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of Primary Health Care? Perspectives of key stakeholders in northern Ghana

BackgroundIn 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana’s health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC.MethodsUsing qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers.A stakeholders’ workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from respondents for the achievement of the goals of UHC and PHC.ResultsThe key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS; inadequate coordination among stakeholders in PHC delivery; and inadequate funding for PHC, particularly on preventive and promotive services. Other areas are: the bypassing of PHC facilities due to lack of basic services at the PHC level such as laboratory services, as well as proximity to the district hospitals; and finally the lack of clear understanding of the national policy on PHC.ConclusionThis study suggests that despite the progress that has been made since the establishment of the NHIS in Ghana, there are still huge gaps that need urgent attention to ensure that the goals of UHC and PHC are met. The key areas of misalignment identified in this study, particularly on the delays in reimbursements need to be taken seriously. It is also important for more dialogue between the NHIA and service providers to address key concerns in the implementation of the NHIS which is key to achieving UHC.

Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of Primary Health Care? Perspectives of key stakeholders in northern Ghana.

BackgroundIn 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana’s health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC.MethodsUsing qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers.A stakeholders’ workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from participants for the achievement of the goals of UHC and PHC.ResultsThe key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS, inadequate coordination among stakeholders in PHC delivery; and inadequate funding for PHC, particularly on preventive and promotive services. Other areas are: the bypassing of PHC facilities due to lack of basic services at the PHC level such as laboratory services, as well as proximity to the district hospitals; and finally the lack of clear understanding of the national policy on PHC.ConclusionThis study suggests that despite the progress that has been made since the establishment of the NHIS in Ghana, there are still huge gaps that need urgent attention to ensure that the goals of UHC and PHC are met. The key areas of misalignment identified in this study, particularly on the delays in reimbursements need to be taken seriously. It is also important for more dialogue between the NHIA and service providers to address key concerns in the implementation of the NHIS which is key to achieving UHC.

An Assessment of enhanced personal exposure monitoring among children using the Ghana Randomised Air Pollution and Health Study (GRAPHS) Platform

An Assessment of enhanced personal exposure monitoring among children using the Ghana Randomised Air Pollution and Health Study (GRAPHS) Platform

In utero household air pollution and lung development: Evidence from the Ghana Randomized Air Pollution and Health Study (GRAPHS)

In utero household air pollution and lung development: Evidence from the Ghana Randomized Air Pollution and Health Study (GRAPHS)

Challenges and successes in delivering LPG as an intervention in a randomized control trial: Experience from the Ghana Randomized Air Pollution and Health Study (GRAPHS)

Challenges and successes in delivering LPG as an intervention in a randomized control trial: Experience from the Ghana Randomized Air Pollution and Health Study (GRAPHS)

A qualitative appraisal of stakeholder reactions to a tool for burden of disease–based health system budgeting in Ghana

BackgroundIn 2010, the Ghana Health Service launched a program of cooperation with the Tanzania Ministry of Health and Social Welfare that was designed to adapt Tanzania's PLANREP budgeting and reporting tool to Ghana's primary health care program. The product of this collaboration is a system of budgeting, data visualization, and reporting that is known as the District Health Planning and Reporting Tool (DiHPART).ObjectiveThis study was conducted to evaluate the design and implementation processes (technical, procedures, feedback, maintenance, and monitoring) of the DiHPART tool in northern Ghana.DesignThis paper reports on a qualitative appraisal of user reactions to the DiHPART system and implications of pilot experience for national scale-up. A total of 20 health officials responsible for financial planning operations were drawn from the national, regional, and district levels of the health system and interviewed in open-ended discussions about their reactions to DiHPART and suggestions for systems development.ResultsThe findings show that technical shortcomings merit correction before scale-up can proceed. The review makes note of features of the software system that could be developed, based on experience gained from the pilot. Changes in the national system of financial reporting and budgeting complicate DiHPART utilization. This attests to the importance of pursuing a software application framework that anticipates the need for automated software generation.ConclusionsDespite challenges encountered in the pilot, the results lend support to the notion that evidence-based budgeting merits development and implementation in Ghana.

Who uses outpatient healthcare services under Ghana's health protection scheme and why?

BackgroundThe National Health Insurance Scheme (NHIS) was launched in Ghana in 2003 with the main objective of increasing utilisation to healthcare by making healthcare more affordable. Previous studies on the NHIS have repeatedly highlighted that cost of premiums is one of the major barriers for enrollment. However, despite introducing premium exemptions for pregnant women, older people, children and indigents, many Ghanaians are still not active members of the NHIS. In this paper we investigate why there is limited success of the NHIS in improving access to healthcare in Ghana and whether social exclusion could be one of the limiting barriers. The study explores this by looking at the Social, Political, Economic and Cultural (SPEC) dimensions of social exclusion.MethodsUsing logistic regression, the study investigates the determinants of health service utilisation using SPEC variables including other variables. Data was collected from 4050 representative households in five districts in Ghana covering the 3 ecological zones (coastal, forest and savannah) in Ghana.ResultsAmong 16,200 individuals who responded to the survey, 54 % were insured. Out of the 1349 who sought health care, 64 % were insured and 65 % of them had basic education and 60 % were women. The results from the logistic regressions show health insurance status, education and gender to be the three main determinants of health care utilisation. Overall, a large proportion of the insured who reported ill, sought care from formal health care providers compared to those who had never insured in the scheme.ConclusionThe paper demonstrates that the NHIS presents a workable policy tool for increasing access to healthcare through an emphasis on social health protection. However, affordability is not the only barrier for access to health services. Geographical, social, cultural, informational, political, and other barriers also come into play.

Health Provider Characteristics and Choice of Health Care Facility among Ghanaian Health Seekers

—Although largely controlled by government, Ghana's health delivery system has witnessed dramatic growth in private sector participation. This growth is important for consumers of health care because it provides a wide range of choices, while informing health providers, through consumer feedback, of the quality indicators relevant for improving their services. For consumers of health care, measuring and monitoring quality based on health provider characteristics is crucial to making appropriate choices, especially because these have implications for morbidity, mortality, and longevity. There is limited research in sub-Saharan Africa, and Ghana in particular, that examines how health provider characteristics associate with choice of health facility. Using recently collected data from the Ghana Demographic and Health Survey and employing random intercept models, we fill this research void. Results showed that Ghanaian men and women who were satisfied with wait time at the health facility were significantly more likely to have visited private health facilities compared to public health facilities. Similarly, Ghanaian women who appeared satisfied with conditions at the health facility and accessibility of the health facility were significantly more likely to have visited private hospitals compared to public hospitals. This study provides important evidence to policy makers and major stakeholders in the public health sector of the need for quality adjustments and the relevance of improving health care delivery in the public health facilities.

Improving Ghana's mental health care through task shifting – psychiatrists and health policy directors views

BackgroundCurrently, Ghana has only twelfth psychiatrists in active service providing for the mental health needs of a population of nearly 25 million people. Ghana has therefore adopted a system of task-shifting to address the critical shortage of psychiatrists.AimTo examine the perception of psychiatrists and health policy directors about the government's policy to expand metal health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs).MethodsA self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors.ResultsOnly one psychiatrist and 3 (10.3%) health policy directors reported they were not aware of task-shifting within Ghana's mental health delivery system. Ten (91.1%) psychiatrists and 23 (79.3%) health policy directors were aware of a policy of the Government of Ghana to improve on the human resource base within mental health through a system task-shifting. Overall, 5 (45.5%) of the psychiatrists and 9 (31%) health policy directors perceived there are some resistance to the implementation of a policy of task shifting including resistance from traditional and spiritual healers, some psychiatrists, some community psychiatric nurses and psychologists. The majority of psychiatrists and health policy directors were of the view that CMHWs should be allowed to assess, diagnose and treat most of the common mental disorders.ConclusionPsychiatrists and health policy directors in Ghana support Governments policy to expand on mental health care delivery through a system of task-shifting despite their knowledge of resistance from certain professionals.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Lineage and Women’s Autonomy in Household Decision-making in Ghana

This paper examines the relationship between lineage and women’s autonomy in household decisionmaking using the 2008 Ghana Demographic and Health Survey dataset. The sample consists of 1,870 women ...

Effect of National Health Insurance Holding on the Choice of Health Facility for Childbirth in Ghana

Maternal and child mortalities are among major health problems facing developing countries such as Ghana. Most of these deaths can be avoided by utilization of maternity health care services. The study examines the effect of health insurance holding and other socioeconomic and demographic factors on the choice of health facility for childbirth in Ghana. The study used data from the 2008 Ghana Demographic and Health survey. Data were analyzed for descriptive statistics as well as a Multinomial Logistic Regression for identification of factors that influence delivery in health facility. The study results have shown that, holding of health insurance and wealth significantly influences expectant mother’s decision to use government health facilities for childbirth. Also, the study revealed considerable variations in region and between rural and urban utilization of this services in Ghana. It is recommended that in order to improve the utilization of health facility for childbirth services and hence maternal health care utilization, there is the need to improve public awareness and efforts should also be taking by policy makers to integrate the private sector properly into the National Health Insurance scheme. Policy should also target mothers who have had the experience of child birth on the need to use health care facility services for each pregnancy. The government and other service providers (NGOs, religious institutions and private providers) may endeavor to improve on the distribution of health facilities, human resources, good roads and necessary infrastructure among other things in order to facilitate easy access to health care providers especially for rural dwellers.