Ghana's Programme Research Articles

Feasibility, safety, and impact of the RTS,S/AS01E malaria vaccine when implemented through national immunisation programmes: evaluation of cluster-randomised introduction of the vaccine in Ghana, Kenya, and Malawi

The RTS,S/AS01E malaria vaccine (RTS,S) was introduced by national immunisation programmes in Ghana, Kenya, and Malawi in 2019 in large-scale pilot schemes. We aimed to address questions about feasibility and impact, and to assess safety signals that had been observed in the phase 3 trial that included an excess of meningitis and cerebral malaria cases in RTS,S recipients, and the possibility of an excess of deaths among girls who received RTS,S than in controls, to inform decisions about wider use. In this prospective evaluation, 158 geographical clusters (66 districts in Ghana; 46 sub-counties in Kenya; and 46 groups of immunisation clinic catchment areas in Malawi) were randomly assigned to early or delayed introduction of RTS,S, with three doses to be administered between the ages of 5 months and 9 months and a fourth dose at the age of approximately 2 years. Primary outcomes of the evaluation, planned over 4 years, were mortality from all causes except injury (impact), hospital admission with severe malaria (impact), hospital admission with meningitis or cerebral malaria (safety), deaths in girls compared with boys (safety), and vaccination coverage (feasibility). Mortality was monitored in children aged 1-59 months throughout the pilot areas. Surveillance for meningitis and severe malaria was established in eight sentinel hospitals in Ghana, six in Kenya, and four in Malawi. Vaccine uptake was measured in surveys of children aged 12-23 months about 18 months after vaccine introduction. We estimated that sufficient data would have accrued after 24 months to evaluate each of the safety signals and the impact on severe malaria in a pooled analysis of the data from the three countries. We estimated incidence rate ratios (IRRs) by comparing the ratio of the number of events in children age-eligible to have received at least one dose of the vaccine (for safety outcomes), or age-eligible to have received three doses (for impact outcomes), to that in non-eligible age groups in implementation areas with the equivalent ratio in comparison areas. To establish whether there was evidence of a difference between girls and boys in the vaccine's impact on mortality, the female-to-male mortality ratio in age groups eligible to receive the vaccine (relative to the ratio in non-eligible children) was compared between implementation and comparison areas. Preliminary findings contributed to WHO's recommendation in 2021 for widespread use of RTS,S in areas of moderate-to-high malaria transmission. By April 30, 2021, 652 673 children had received at least one dose of RTS,S and 494 745 children had received three doses. Coverage of the first dose was 76% in Ghana, 79% in Kenya, and 73% in Malawi, and coverage of the third dose was 66% in Ghana, 62% in Kenya, and 62% in Malawi. 26 285 children aged 1-59 months were admitted to sentinel hospitals and 13 198 deaths were reported through mortality surveillance. Among children eligible to have received at least one dose of RTS,S, there was no evidence of an excess of meningitis or cerebral malaria cases in implementation areas compared with comparison areas (hospital admission with meningitis: IRR 0·63 [95% CI 0·22-1·79]; hospital admission with cerebral malaria: IRR 1·03 [95% CI 0·61-1·74]). The impact of RTS,S introduction on mortality was similar for girls and boys (relative mortality ratio 1·03 [95% CI 0·88-1·21]). Among children eligible for three vaccine doses, RTS,S introduction was associated with a 32% reduction (95% CI 5-51%) in hospital admission with severe malaria, and a 9% reduction (95% CI 0-18%) in all-cause mortality (excluding injury). In the first 2 years of implementation of RTS,S, the three primary doses were effectively deployed through national immunisation programmes. There was no evidence of the safety signals that had been observed in the phase 3 trial, and introduction of the vaccine was associated with substantial reductions in hospital admission with severe malaria. Evaluation continues to assess the impact of four doses of RTS,S. Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid.

Investigating the Impact of IMF Programs on the Bank of Ghana and the Ghanaian Economy

The International Monetary Fund (IMF) has played a pivotal role in shaping the economic policies of developing countries, including Ghana. This study aims to investigate the impact of IMF programs on the performance of the Bank of Ghana and the Ghanaian economy. Employing a quantitative research design, the study utilizes secondary data from reputable sources such as the World Bank, IMF, and the Bank of Ghana. Regression analysis is conducted to establish the relationship between IMF programs and the performance of the Bank of Ghana, as well as their impact on the overall Ghanaian economy. The findings of this study will significantly contribute to our understanding of the effectiveness of IMF programs not only in Ghana but also in other developing countries. Moreover, it will offer valuable insights into the key factors influencing the success of IMF programs in shaping the Ghanaian economy and the performance of the Bank of Ghana. Additionally, practical recommendations will be provided for policymakers, the Bank of Ghana, and other stakeholders to enhance the effectiveness of IMF programs in Ghana.

Assessing the Implementation Determinants of Pilot Malaria Vaccination Programs in Ghana, Kenya, and Malawi through a Complexity Lens: A Rapid Review Using a Consolidated Framework for Implementation Research.

In 2019, national immunization programs in Ghana, Kenya, and Malawi commenced the implementation of RTS,S/AS01 vaccination in large-scale pilot schemes. Understanding the implementation context of this malaria vaccination in the pilot countries can provide useful insights for enhancing implementation outcomes in new countries. There has not yet been a proper synthesis of the implementation determinants of malaria vaccination programs. A rapid review was conducted to identify the implementation determinants of the pilot malaria vaccination programs in Ghana, Kenya, and Malawi, and describe the mechanism by which these determinants interact with each other. A literature search was conducted in November 2023 in PubMed and Google Scholar to identify those studies that described the factors affecting malaria vaccine implementation in Ghana, Kenya, and Malawi. Thirteen studies conducted between 2021 and 2023 were included. A total of 62 implementation determinants of malaria vaccination across all five domains of the consolidated framework for implementation research (CFIR) were identified. A causal loop diagram showed that these factors are interconnected and interrelated, identifying nine reinforcing loops and two balancing loops. As additional countries in Africa prepare for a malaria vaccine roll-out, it is pertinent to ensure that they have access to adequate information about the implementation context of countries that are already implementing malaria vaccination programs so that they understand the potential barriers and facilitators. This information can be used to inform context-specific systems enhancement to maximize implementation success. Going forward, primary implementation studies that incorporate the causal loop diagram should be integrated into the malaria vaccine implementation program to enable immunization program managers and other key stakeholders to identify and respond to emerging implementation barriers in a timely and systematic manner, to improve overall implementation performance.

Barriers to school-based health programs implementation in basic schools in Ghana: education stakeholders' perspective.

School health has been identified as a neglected aspect of primary health care in Ghana, leading to compromised health, well-being and life satisfaction among students. To address this concern, this study identified the barriers hindering the implementation of school-based health programs in Ghana. It employed a qualitative approach, including 116 respondents who participated in interviews. The collected data were analyzed using thematic analysis with the aid of NVivo software. In line with the research objective, findings show that the implementation of school-based health programs faces several teething challenges that serve as barriers to the success and sustainability of the programs. These barriers included resource constraints; a lack of adequate parental and community participation and a lack of adequate collaboration between stakeholders' management and leadership issues, governance issues and political issues. The findings from the study have a relevant and innovative contribution to achieving good health and well-being and quality education as part of the 2030 Agenda for Sustainable Development Goals and shaping primary healthcare management in the context of a developing country. It recommends that policymakers and health practitioners pay special attention to school-based health programs as a key strategy for primary health care management in developing countries.

Changing land cover: Clustering of agents per moral responsibility and culpability

Are all humans morally responsible and deserving of blame for land cover change? Land cover change research has yet to provide an answer to this moral question. The purpose of this study was to answer the moral question of land cover change by conducting a land cover change analysis in six sampled metropolitan/municipal/districts [MMDAs] in Ghana, identify the agents of land cover change, and cluster the agents based on their moral responsibility and culpability. Supervised classification of Landsat images from 1987 to 2022 for the six MMDAs indicated that farmlands increased the most in area size although one-third of the respondents (agents) were into farming and agro-processing occupation. Based on respondants actions, knowledge and norms they were clustered into seven groups (“responsible and culpable”-25.1 %, “responsible due to culpable ignorance”-17.7 %, “responsible although lack knowledge”-14.1 %, “responsible due to weak norms”-9.1 %, “not responsible”-11 % and “not responsible due to culpable ignorance”-9.3 %) using Mason moral responsibility and culpability decision tree. The large number of respondants found to be responsible and culpable was because they had less knowledge about the consequences of land cover change, which limited their participation in environmental protection initiatives. The findings give sufficient evidence to promote educational programs for responsible land cover conservation and alternative livelihoods programs in Ghana.

Fostering the wellbeing of adolescent girls through an out-of-school sexuality education programme in Ghana

ABSTRACT Ghanaian adolescents face considerable sexual and reproductive health challenges that can disrupt human capital formation. However, a positive and healthy transition from adolescence to adulthood can be achieved by increasing access to sexual and reproductive health information, education, and services. This paper documents emerging findings from an adolescent girls’ programme delivered in 56 districts of Ghana. Data were collected from girls and young women aged 10–24 years who participated in the programme as part of a larger study that included in-school and out-of-school participants. In-depth interviews (IDI) [N = 49] and focus-group discussions (FGDs) [N = 13] were conducted in November 2021 and November 2022. An abductive approach was used to develop key themes from the data. The analysis revealed that the programme showed promise in changing the attitudes of beneficiaries towards safe sexual practices through condom use, in increasing assertiveness towards sexual and gender-based violence, and in real-life application of the knowledge and skills gained for health and social wellbeing. Out-of-school sexuality education programmes such as the one described here can be important catalysts for developing and maintaining meaningful relationships with others through the provision of information and education, and service delivery.

Nurse-patient relationship and its implications for retention in the PMTCT of HIV programme in Ghana: an appreciative inquiry

BackgroundRelationships established between nurses and midwives, and their patients have far-reaching implications; the most significant being their impact on the health-related outcomes of patients. These relationships are especially relevant in the Prevention of Mother-to-Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) programme as women, diagnosed with HIV navigate the emotional and psychological effects of their diagnosis while carrying pregnancies. This study aimed to explore the relationships between nurses, midwives and mothers diagnosed with HIV and its impact on retention in the PMTCT Programme.MethodsAn Appreciative Inquiry approach that employed qualitative research methods was conducted among twenty-four participants made up of 12 HIV positive mothers, and eight midwives and four community health nurses engaged in the PMTCT programme. Individual generative interviews were conducted among the mothers while paired interviews were conducted among the health professionals. Thematic analysis guided by Colaizzi’s approach was conducted.ResultsThree main themes emerged each with its subthemes. Under Establishing Rapport, two sub-themes emerged; making the connection and building trusting relationships. The second theme, Journeying Together, describes how the nurse-patient relationship evolved as the participant engaged in the programme; sub-themes include developing mutual goals, impactful communication, and showing commitment and building self-worth. The third theme; Ending the professional relationship details two sub-themes; continuity of care across the cascade, and termination of care which proved unsuccessful in some relationships due to blurring professional boundaries.ConclusionsThe nurse-patient relationship in the PMTCT programme evolved as the relationship progressed along the PMTCT cascade. Strengthening of the nurse-patient relationships was underscored by building trust through the maintenance of confidentiality, setting mutual goals, shared emotional experiences and personal stories, and building clients’ self-worth. Therefore, there is a need to ensure that professional boundaries are set and maintained to reduce the occurrence of over-dependence of the clients and burnout of the nurses.

Knowledge and perceptions of lymphatic filariasis patients in selectedhotspot endemic communities in southern Ghana.

Lymphatic filariasis (LF) is a mosquito-borne neglected tropical disease that is one of the leading global causes of permanent disability. To date, LF interventions have been largely biomedical, focusing on drug treatments to disrupt parasite transmission and manage disease morbidity. Although important, these Mass Drug Administration (MDA) programs neglect the significance of socio-economic burden to the health of LF patients, which are compounded by social stigmatization, discrimination and associated depressive illnesses. The MDA program also typically fails to engage with local community beliefs and perceptions of LF, which may differ markedly from biomedical explanations and may have fueled non-compliance to treatments which is one of the major challenges of the Mass Drug Administration program. LF is not only a biomedical issue but also a social issue and LF interventions need to understand people's world views and the contexts through which they interpret bodily maladies. Hence, an effective LF intervention must bring together both the biomedical and the social components. The goal of this exploratory study was to assist in refining a large qualitative study (currently underway) that seeks to integrate culturally appropriate LF interventions into current LF control programs in Ghana. In this paper, we discuss the findings of a pre-intervention, exploratory study aimed at gaining a baseline grasp of a local culturally informed understanding of lymphatic filariasis and the knowledge gaps looking at three endemic Ghanaian communities in the Ahanta West District. A structured questionnaire was employed to assess the wellbeing, social inclusion, and cultural understanding of LF with a geographic focus within LF-endemic areas in Ghana. Interestingly, 45.8% of the 72 participants reported to have received information about LF from health care providers and the MDA program but only 5 out of the 72 (6.9%) respondents believed that LF was transmitted by mosquitos. This baseline study revealed several alternative interpretations and misconceptions about the disease, as well as the social and economic impacts, and importantly, the need to integrate qualitative research to develop culturally appropriate interventions and increase engagement with existing control programs.

Determinants Of Intention To Emigrate Among Final Year Medical Students And Junior Doctors In Ghana

Objective: Historically, doctors left the shores of Ghana for professional development and greener pastures; however, the institution of Ghana College of Physicians and Surgeons to train postgraduate doctors locally significantly reduced the rate of emigration. Methodology: A cross-sectional survey-based study of final year medical students of the University of Ghana Medical School, house officers and medical officers working at the Korle Bu Teaching Hospital. Demographic data, Push Factors (poor conditions of service, lack of equipment and facilities, and economic instability) and Pull Factors (better career opportunities, shorter length of training programmes, family or spouse living abroad and improved conditions of service) were collected and analysed. Results: Of the 189 respondents, 94.18% intended to  pursue postgraduate medical education, with greater than half wanting to go outside Ghana due to push factors. The existence of a well-established postgraduate training programme in Ghana, was a consideration that could influence their decision to stay for 24.27% of the participants who wished to emigrate, however for 65.05%, this did not influence their decision. Other factors like the Covid-19 pandemic had no impact on the decision to emigrate among most respondents. Conclusion: Physician emigration, although dynamic, is not as rife as it was two to three decades ago in Ghana. This study recommends a review of existing policies and strategic planning among all stakeholders to ensure that postgraduate training is locally attractive to stem the possibility of another cycle of brain drain.

Impact of agricultural policy intervention on yield and profitability of maize farmers: The case of Planting for Food and Jobs (PFJ) programme in Ghana

Impact of agricultural policy intervention on yield and profitability of maize farmers: The case of Planting for Food and Jobs (PFJ) programme in Ghana

An Analysis of Gender Mainstreaming in National Agricultural Policies and Programs in Ghana

Aim: The study examined the extent of gender integration in agricultural policies at the regional and national levels in Northern Ghana.
 Methods: Three Metropolitan, Municipal and District Assemblies (MMDAs) were purposively sampled from the 16 MMDAs in the region. The interview method was used to obtain information from 24 purposively selected key informants of MoFA and gender focal persons in Accra, Tamale, Savelugu, Zabzugu. Ten selected agricultural policy documents that addressed gender integration in agricultural policies were reviewed and descriptive and content analysis of the documents were conducted. The study applied a framework developed by Gumuchio and Rueda (2015) to analyze the extent of gender mainstreaming in agricultural policies and programmes.
 Results: The study found that most national-level agricultural policies and programmes on gender recognize the need for gender equality by specifying issues of concern, but fall short of highlighting the means of addressing the issues.  It was also observed that most agricultural policies are moving from gender-blind policies to integrating gender in the objective or cross-cutting issues category, emphasizing an increasingly positive response in the extent of integrating gender in agricultural policies and programmes but with little or no budget provision to operationalize gender integration.   
 Conclusion: The study concludes that recent agricultural policies (2015 to 2023) are progressively shifting from gender-blind policies to integrating gender at different levels of policies and programmes. The predominance of women’s issues in gender policy documents coupled with a lack of clear gender indicators to little or no budget provision to operationalize gender integration in programs and projects.
 Recommendation: The study recommends that gender mainstreaming should move beyond women to include men to ensure gender equity.  Also, policies and programmes on gender-specific issues of concern should highlight the means of addressing such issues and also ensure that gender-specific policies are accompanied by resource allocations.

ICT integration in teaching and learning: Perceptions and practices in Ghanaian college of education

This research study investigates the perceptions and practices of Information and Communication Technology (ICT) integration in teaching and learning within Ghanaian Colleges of Education. With the increasing recognition of ICT as a valuable tool in education, it is crucial to understand how these technologies are being utilized in the context of teacher training institutions, specifically in Ghana. The research employs a qualitative data collection method. Semi-structured interviews were conducted to gather comprehensive insights into the perceptions and practices of ICT integration among college faculty and students. The participants include teacher educators, and pre-service teachers in Ghanaian College of Education. Through thematic analysis, the qualitative data provide a deeper understanding of various stakeholders' attitudes, beliefs, and perceptions toward ICT integration. The findings of this study contribute to the existing body of knowledge on ICT integration in teaching and learning in Ghanaian College of Education. It will shed light on the current practices, challenges faced, and potential opportunities for improvement. The research outcome can inform policy decisions, curriculum development, and professional development initiatives to enhance ICT integration within teacher training programs in Ghana. By addressing the perceptions and practices surrounding ICT integration, this study aspires to support the transformation of teacher education, leading to more proficient and technologically equipped educators prepared for the 21st-century classroom challenges.

[Vaccination against malaria].

Vaccination against malaria is an old dream that reemerged in 2015 with the European Medicines Agency's favourable opinion on a first antimalarial vaccine, RTS,S/ AS01. Six years later, the World Health Organization (WHO) is advising a wide deployment of this vaccine in sub-Saharan Africa and in regions with high and moderate transmission where Plasmodium falciparum circulates. This follows favourable results from the pilot programme in Ghana, Kenya and Malawi involving over 800,000 children since 2019. This article addresses the objectives and main vaccine candidates targeting the different stages of parasite development, highlighting the progress and limitations of these different approaches. The RTS,S saga has been a milestone in vaccine development, with a first-generation vaccine recommended by the WHO for use in children over 5 months of age in sub-Saharan Africa and other areas of moderate to high transmission of P. falciparum malaria, in combination with other prevention measures. Research efforts continue to better understand the correlates of protection. With advances in vaccine platforms, new multi-antigen, multi-stage, and even multi-species approaches might emerge and brighten the horizon for malaria control.

Higher Fashion Education in Perspective: The Effects of Work-Based Learning On Industry Requirements

Change occurs rapidly in the world of work these days. Keeping pace with this rapid change is a continuing challenge for Ghana’s Higher Education (HE) institutions. The study, thus, explored the effects of work-based learning (WBL) on industry requirements through higher fashion education in Ghana. The research adopted the quantitative data collection and analysis method. The population for the study comprised postgraduate and undergraduate students of the HE institution in Ghana, offering the fashion design and textiles option as well as fashion houses (industry). The data was analysed using the hierarchical multiple regression statistical technique. Regarding policy, the findings may be used to inform decisions related to the curriculum of fashion design and textile programmes in Ghana. In terms of research, it provides evidence of the positive impact of WBL experiences on students’ preparedness for the fashion industry.
  

Role and capacity needs of community based surveillance volunteers in the integrated management of skin neglected tropical diseases (skin NTDs): a qualitative study from central Ghana

BackgroundCommunity Based Surveillance Volunteers (CBSVs) have been instrumental in the management of Neglected Tropical Diseases (NTDs) but a concern that their services in scale up programmes may be affected due to high attrition rates has been widely acknowledged. We explored the roles and capacity needs of existing CBSVs to inform for a successful integrated NTD management programme in Ghana and similar contexts.MethodsWe conducted qualitative interviews with 50 CBSVs, 21 Community Nurses, 4 Disease control officers, 7 skin NTD researchers, 2 skin NTD patients and a Director of District Health Services in Central Ghana. Interviews were digitally recorded, transcribed and coded prior to translation and thematic analysis.ResultsThe roles of CBSVs in NTD management were shown to have an impact on disease identification, surveillance, health seeking behaviours and status of CBSVs. Lack of motivation, inadequate structures for engagement of CBSVs within the health system and delayed management of reported cases were identified as gaps that hinder effective delivery of CBSV roles. Provision of incentives as recognition for the unpaid services rendered by CBSVs was seen as a major factor to reduce the rate of CBSV attrition in this scale up programme. Other factors included the formulation of policies by government to guide CBSV engagement, regular training of CBSV in NTD management as well as provision of resources and logistics.ConclusionMeasures including continuous training, institution of rewards and incentivization are important for ensuring the sustainability of CBSVs in the provision of skin NTD services in Ghana.

Survey of knowledge, and attitudes to storage practices preempting the occurrence of filamentous fungi and mycotoxins in some Ghanaian staple foods and processed products

Mycotoxigenic fungi can infect and produce potent mycotoxins in foodstuffs prior to harvest, during harvest (field fungi), and in storage after harvest (storage fungi), which when ingested, can result in adverse health effects. This study was aimed at assessing the knowledge, attitudes, and practices adopted by the Ghanaian populace to help mitigate the occurrence of molds and mycotoxins in foods. A cross-sectional survey involving a structured questionnaire was conducted with 642 respondents from twelve regions of Ghana. Descriptive statistics and analyses of variance were calculated. Correct Classification Rate (CCR) was measured to assess the utility of a logistic regression model. The results of the study showed that the majority of 299 (46.6%) of the respondents were between the ages of 18–25. Age and educational level were related to knowledge about the occurrence of fungi and mycotoxins in foods (p < 0.05). More than half the respondents, 50% indicated that they knew of aflatoxins as a major mycotoxin present in food. Higher education directly influenced on the knowledge of mycotoxicosis and the management of stored food to present intoxication by fungal metabolites. 502 (32.9%) knew that consuming foods with toxins could cause stomach aches. The most commonly consumed food commodity despite the presence of visible growth of fungi was bread (35.3%). The average KAP score for knowledge showed that, out of 100%, there was adequate knowledge (63.8%) among the members of the Ghanaian populace. Favorable environmental conditions of high humidity (> 85% ERH) and temperature (> 28–32 °C) enhance the proliferation of fungi in most foods and the attendant production of mycotoxins such as aflatoxins, ochratoxins, and fumonisins are associated with several severe human and animal health conditions; mycotoxicosis was associated with high fever, pain, vomiting, suppression of immunity, cancer, etc. when these foods are consumed on regular basis for a prolonged length of time. Future examination of the food items used for the School Feeding Programme in Ghana will offer opportunities to examine the risks of feeding youth with fungal-contaminated food preparations from providers.

Policies for optimal nutrition-sensitive options: a study of food and nutrition security policies, strategies and programs in Ghana, Kenya and South Africa

Sub-Saharan Africa is experiencing the coexistence of overnutrition, undernutrition and micronutrient deficiencies. Comprehensive programs and coherent public policies are required to address this problem. A study of food and nutrition security policies, strategies and programs in Ghana, Kenya and South Africa was conducted between February and July 2022 through desk reviews and key informant interviews. The aim was to generate evidence on the extent to which the policies, strategies and programs were nutrition-sensitive and add value to the scaling up of nutrition and food security. The assessment of the documents was based on the four dimensions of food security, and the Food and the Food and Agriculture Organization of the United Nations guidelines on nutrition-sensitive agriculture. A total of 48 policies, strategies and programs were reviewed. To ensure food availability, most reviewed documents tend to focus on food production and income generation, with limited attention on production and supply of diverse and nutrient-dense foods. Access to inputs, credit and land is targeted at smallholder farmers, without little sensitivity to women and youth engagement. Food access is promoted through improved market access by upgrading infrastructure and promoting social safety nets for vulnerable populations. However, information systems for agricultural marketing as well as labor- and time-saving technologies are lacking. Although nutrition education is widely promoted, especially for mothers and children, there is a gap in addressing the nutrition needs of adolescent girls. Regarding food stability, inadequate funding, poor leadership and governance and inadequate monitoring and evaluation systems are the main barriers to successful implementation of policies, strategies and programs. While efforts have been made to promote nutrition-sensitive options in the agriculture and food system value chains, the study identified several gaps that need to be addressed to ensure adequate food and nutrition security.

System, institutional, and client-level factors associated with formal healthcare utilisation among older adults with low income under a social protection scheme in Ghana

BackgroundIn sub-Saharan African context, effect of system, institutional and client-level factors on formal healthcare utilisation among older adults with low income, especially those under a social protection scheme (called Livelihood Empowerment against Poverty [LEAP] programme) is least explored in the literature. However, an adequate understanding of how these factors contribute to formal healthcare utilisation among older adults who are classified as poor (in terms of low income) is important to inform health policy decisions. The aim of this study, therefore, was to examine the contributions of system, institutional and client-level factors in formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana.MethodsData associated with this study were obtained from an Ageing, Health, Lifestyle and Health Services survey conducted between 1 and 20 June 2018 (N = 200) in the Atwima Nwabiagya Municipal and Atwima Nwabiagya North District of Ghana. Multivariable logistic regressions were used to determine system, institutional and client-level factors associated with formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana. The significance of the test was set at a probability value of 0.05 or below.ResultsThe study revealed that participants who relied on the LEAP programme and/or health insurance subscription to cater for their healthcare expenses (AOR: 11.934, CI: 1.151-123.777), those whose family/caregivers decided on when and where to use formal healthcare (AOR:12.409; CI: 2.198–70.076) and those who did not encounter communication problem with healthcare providers (AOR: 1.358; CI: 1.074–3.737) were significantly more likely to utilise formal healthcare services compared with their counterparts. The study further found that participants who perceived the attitude of healthcare providers as poor (AOR: 0.889; CI: 0.24–0.931) and those who spent 20–40 minutes at the healthcare facility were significantly less likely to utilise formal healthcare services compared with their counterparts (AOR: 0.070; CI: 0.006–0.195).ConclusionOur findings suggest that reducing waiting time at healthcare facilities, improving social protection and/or health insurance schemes, improving patient-doctor communication and promoting attitudinal change programmes (such as orientations and supportive supervision) for healthcare providers may help to facilitate the use of needed formal healthcare services by older adults with low income in Ghana.

An investigation into the role of innovative learning environments in fostering creativity for secondary visual arts programmes in Ghana

Innovative learning environments (ILEs) have been regarded as one of the contributing factors that facilitate creativity in learners. At the pre-tertiary level of education, Ghana has recently undergone educational reform that sees creativity being added as a key goal for education, but it is unknown if teachers' practices within current educational facilities can support the enactment of this goal. The multi-site qualitative case study explores the secondary visual arts learning environments within the Sekondi-Takoradi Metropolis in Ghana. Interviews and observations were used as instruments for data collection with 16 visual arts teachers. This study confirmed two categories of environments that foster creativity: innovative spaces and innovative practices (pedagogies). It recommends the prioritisation of innovative learning environments that facilitate creative development across secondary schools, the need for more collaborative classroom settings and a reduction of features (non-flexible layout, large class size, & under-resourced learning spaces) in the classroom that impede creativity.

Impacts of cash transfer and “cash plus” programs on self- perceived stress in Africa: Evidence from Ghana, Malawi, and Tanzania

Poverty and poor mental health are closely linked. Cash transfers have significantly expanded globally. Given their objectives around poverty reduction and improving food security, a major chronic stressor in Africa, cash transfers may affect mental health outcomes. We examine impacts of three large-scale government cash transfer or cash plus programs in Ghana, Malawi, and Tanzania on self-perceived stress using an innovative, newly adapted measure for rural African settings. Linear regression models were used to estimate treatment impacts. We find that cash transfers reduced self-perceived stress in Malawi, but programs in Ghana and Tanzania had no impacts on self-perceived stress. These mixed findings, combined with recent reviews on cash transfers and mental health, suggest that cash transfers may play a role in improving mental health. However, cash alone may not be sufficient to overcome many challenges related to poverty, and complementary programming may also be needed to improve mental health.