Regional Health Directorate Research Articles

Ethics in healthcare: Knowledge, attitude and practices of nurses in the Cape Coast Metropolis of Ghana.

Nursing is a profession that care for personal and private aspects of people's lives. Therefore, nurses need to know the basic ethical aspects of nursing which is integral in nursing practices. The purpose of the study was to describe the ethical knowledge, attitude and practice of nurses in the Cape Coast Metropolis of Ghana. A cross-section design was used to collect data from 264 nurses in three selected healthcare facilities in the Metropolis. A structured questionnaire was administered to all the categories of these nurses in the selected facilities. Frequency counts and multiple regression statistics were used to analyze the data. The results show 78% of nurses possess good ethical knowledge, 84% had a positive attitude, while 98% had good ethical practices. The results further show that nurses' professional rank [F (1, 259), 2.35, p = .02] and academic qualification [F (1, 259), 2.67, p = .008] were significant predictors of their ethical knowledge and attitude, respectively. Inadequate resources, poor set up of working areas and understaffing are the major barriers limiting the practice of good ethical standards among the nurses. The Regional Health Directorate, the Ministry of Health and the Managers in charge of the health facilities need to work together to eliminate these barriers as they have the potential to negatively impact quality healthcare delivery in the Metropolis.

Decision-making process in Moroccan public health policy: an empirical study in the Fez-Meknes region

The present study aims at analysing the decision-making process in public health policy in Morocco, diagnosing the factors influencing the proper functioning of the health system, and examining the desired performance while shedding light on the major questions posed to the health system authorities. The objective of this study is twofold: on the one hand, to explore the potential of the public actor in the national health system in Morocco, while identifying the expectations of the target at the regional level, and on the other hand, to propose avenues and to assess the impact of public health policy actions by the regional public actor. We conducted a survey of 212 managers, including 41 managers in the health territory of the Regional Health Directorate in the Fez-Meknes region, with a feminization rate of 56%. According to the respondents, the study on the decision-making process, stopped limits related to the decision-maker himself or with the hierarchy, limits related to the process itself, limits related to the constraints of the field which are political-administrative, and other limits related to the regulation, the administrative and the issue of governance. The perspectives recommended by the target surveyed, whose purpose is to improve the decision-making process of the public health policy, are to act firstly on the regulatory andadministrative obstacles, and secondly by suggesting the establishment of an efficient regional public health system.Keywords: Public health policy in Morocco, Decision-making process, Decision-making, Performance issues.

Management of COVID-19 pandemic in the Souss Massa Region

Since the appearance of the covid19 pandemic and like all regions of Morocco, the regional health directorate SOUSS MASSA has put in place a dynamic and adaptable system to deal with this pandemic while aligning itself with ministerial directives and taking into consideration the specificity of our region. Indeed, several measures have been taken both at the organizational level and in terms of the operation of health structures in the region. It should also be noted the close involvement of all the partners, namely the local and security authorities as well as the councils of elected officials through the strengthening of infrastructure in equipment or even the restoration and care of our health professionals. In addition, our region has implemented a communication plan, which remains the cornerstone of the success of any crisis management. Finally, the DRS has learned many lessons to deal with crisis situations.

Evaluation of pilot implementation of seasonal malaria chemoprevention on morbidity in young children in Northern Sahelian Ghana

BackgroundIn Sahelian Africa, the risk of malaria increases with the arrival of the rains, particularly in young children. Following successful trials, the World Health Organization (WHO) recommended the use of seasonal malaria chemoprevention (SMC) in areas with seasonal peak in malaria cases. This study evaluated the pilot implementation of SMC in Northern Ghana.MethodsFourteen communities each serving as clusters were selected randomly from Lawra District of Upper West Region as intervention area and West Mamprusi District in the Northern Region as the non-intervention area. The intervention was undertaken by the National Malaria Control Programme in collaboration with regional health directorates using sulfadoxine-pyrimethamine plus amodiaquine and standard WHO protocols. Before and after surveys for malaria parasitaemia and haemoglobin levels as well as monitoring for malaria morbidity and mortality were undertaken.ResultsAt the end of the intervention, participant retention was 92.9% (697/731) and 89.5% (634/708) in the intervention and the non-intervention areas, respectively. The proportion of children with asexual parasites reduced by 19% (p = 0.000) in the intervention and increased by 12% (p = 0.000) in the non-intervention area. Incidence rates of severe malaria were 10 and 20 per 1000 person-years follow up in the intervention and comparison areas, respectively with P.E of 45% (p = 0.62). For mild malaria, it was 220 and 170 per 1000 person-years in intervention and comparison area, respectively with PE of - 25% (p = 0.31). The proportion of children with anaemia defined as Hb< 11.0 g/dl reduced from 14.2% (52.8–38.6%) in the intervention area as compared to an increase of 8.1% (54.5% to 62.6) the non-intervention arm, Mean Hb reduced by 0. 24 g/dl (p = 0.000) in the non-intervention area and increased of 0.39 g/dl (p = 000) in the intervention area.ConclusionsThe feasibility and effectiveness of SMC introduction in Northern Ghana was demonstrated as evidenced by high study retention, reduction in malaria parasitaemia and anaemia during the wet season.

Employee Engagement and Organizational Performance

This study sought to find out the extent of employee engagement in the public sector in Ghana using the Upper East Regional Health Directorate as a case study. The survey method was employed in the study. Close-ended and Likert-Scaled questionnaires were administered to participants to generate the data. Descriptive statistics were used to analyze the demographic data while the Relative Importance Index (RII) was used to analyze the scaled responses using the equation: RII= Σ???? / (???? × ????). The figures obtained confirmed the positive relationship between employee engagement and organizational performance. The good performance of the Upper East Regional Health Directorate was found to be influenced by the effective engagement of the staff.

Prevalence of Typhoid Fever in Franceville (Gabon): Case of the Sino-Gabonese Friendship Hospital; Retrospective Analysis of Clinical Data Over Three Years

Typhoid fever is an infectious disease that is fatal if left untreated. The most recent global data show more than 20 million cases annually, with more than 200,000 deaths. In Gabon, a study has shown that young adults are increasingly affected. Nevertheless, national data on this scourge are rare. The aim is to determine the prevalence of typhoid fever at the Sino-Gabonese Friendship Hospital in Franceville. The data are confirmed cases of typhoid fever at the Sino-Gabonese Friendship Hospital in Franceville, entered into a database of the health information management system of the South-East Franceville Gabon Regional Health Directorate between January 2018 and December 2020. A trend analysis was conducted over time to establish correlations between the prevalence of typhoid fever and factors such as age, gender and time of year. To statistically analyze these data, measure incidence rates, and establish relationships between these values and their significance, we used R version 3.6.1 software. 2175 people suffered from typhoid fever during the three years of the study. Of these, 960 (44.07%) were men and 1215 (55.93%) were women. A 95% confidence interval was estimated and a value p≤0.05 was considered statistically significant. The age group 15-49 years was the most affected. Although cases occurred throughout the year, there were increasing cases of typhoid from 2018 to 2020 and a high prevalence during quarters 1 and 4. The prevalence over the years was 454 cases or 20.87% in 2018, 750 cases or 34.48% in 2019, and 971 cases or 44.65% in 2020. In Gabon, particularly in Franceville, typhoid fever is a real public health problem. To protect themselves against this disease and avoid possible epidemics, the health authorities and decision-makers must educate the population about the disease.

Prevention of 21st Century Emerging Pandemics, Covid-19: Using Face Masks

Background: Emerging infections that are airborne or droplets infections, spread by inhalation or cotact with infected ‘Aerosols' or droplets. COVID-19 and TB are examples of infectious pathogens that are transmitted by inhalation of infected droplets or air. All human beings are at risk of breathing in infectious microbes in the air. Despite this fact and the negative impacts caused by infectious diseases, much attention is still not given to the use of face masks; as they were not recommended for preventing airborne/droplets infections in previous epidemics or pandemics. It was during the emergence of SARS in 2003 that droplets infections and the use of face masks were taken seriously by authorities, but most people are still reluctant to use them. The SARS outbreak was followed by Human swine influenza (H1N1) in 2009, also from zoonotic origin. Face masks were then found to be helpful in the prevention of epidemics/pandemics that can spread through airborne or droplets infections, during and after these two outbreaks. However, face masks have never been given any serious attention by the public, just like now; as some people still refuse to wear them despite warning that COVID-19 can be transmitted through infected droplets. From this project's objectives, we would be able to know whether people are complying with the wearing of masks or not. We will also know the weaknesses or strengths of wearing them, and give professional recommendations. Aside these the study will also benefit everyone, especially the vulnerable group in the COVID-19 Pandemic's transmission, like pregnant women. It will draw the attention of health workers, especially midwives, the pregnant women, the community and family heads to the prevention of stillbirth or preterm delivery due to COVID-19. This project's findings will serve as a guide to Regional, Metropolitan, Municipal, and District Health Directorates in their Every Newborn Action Plan (ENAP) strategy to curb stillbirth rate, especially soaring in the Tema metropolis. It may also serve as a source of reference for future researchers who would take up similar studies.Aim: To assess people compliance to the wearing of face masks and find out the strengths or weaknesses associated with it and give recommendations.Methodology: A checklist will be used to observe how two thousand, seven hundred (2,700) people (above 18 years who are not incapacitated) are wearing face/nose masks. This will be started after approval. Then, questionnaires will be given out to one thousand, three hundred and fifty (1,350) consented individuals (health workers, patients and the general public) who are above eighteen (18) years to answer. Published and grey literatures will be reviewed using related online publications from any year that is related to this project. Three strategical search approaches will be used to search for literature: data from health and social issues would be reviewed, custom Google seacrhes; then experts would be consulted for validation of results. Hypothesis: Some people are not wearing face/nose masks; others wear them wrongly.Expected Outcome: Our expectations are that the project would reveal whether people are complying the directive from experts and national presidents to wear face masks. Findings of this projects are expected to reveal the strengths or weaknesses associated with the wearing of face masks and give professional recommendations. The project is an emergency one started in April, 2020 and will end in October, 2020. Findings of the projects are expected to be submitted in October or November, 2020.

From paper to practice: an exploratory study of policy making and implementation in alternative forms of healthcare public-private partnership in Ghana.

There has been growing advocacy for public-private partnership (PPP) in healthcare in both policy and academic circles over the last 3decades. However, our understanding of the tensions between the policy cycle and critical organisational trade-offs that characterise alternative forms of healthcare PPPs remains limited. In this paper, we use Walt and Gilson's policy analysis triangle to explore the policy and practice of two alternative models of healthcare PPPs-autonomous and integrative partnerships-at the sub-national level in Ghana, a typical case of a polycentric health management structure. The study is a sequential exploratory qualitative design, consisting of review of four policy documents and in-depth interviews with 13 key informants, comprising health managers from the regional and district health directorates, and medical directors of selected private health facilities. Our findings reveal that in spite of the natural potential of integrative PPP models to present a relatively stronger policy capacity to the private partner than autonomous models, the capacity of sub-national level public-private actors to participate in policy making and implementation remains very limited across both models. We further find that effective policy making and implementation requires significant governance attention to building the policy capacity of actors across vertical and horizontal levels of the partnership, regardless of the model of engagement. We suggest that this is achievable through instrumental multistakeholderism in PPP policy, planning and management. The paper contributes to developing understanding of the policy and practice of healthcare PPP in polycentric institutional settings.

Quality policies to improve user care in Callao public hospitals 2016 – 2018

This research work was carried out with the aim of analyzing the impact of the implementation of quality policies in public hospitals in the Callao region, hospitals that are under the direction of the Callao Regional Government and its Regional Health Directorate. As it is public knowledge through the various written, radio, television and digital media, the health system's problem with regard to user satisfaction is very high, this evidenced by the high percentages of dissatisfaction that The frequent user has health services, related to the lack of medications, poor treatment of service providers to users, obsolete technology, excessive time to obtain medical appointments and other factors that generate a decrease in this degree of dissatisfaction; In this work we can see how the correct implementation of quality policies in the various health institutions of the Callao Region that are public (3 hospitals), as well as raising awareness by health professionals, administrative and care technicians can generate that the user feels with a better level of satisfaction with regard to the care and its derived processes, these policies must be in accordance with the national standards of accreditation of health establishments and what is indicated in the respective technical standard on the management of the quality.

Reducing the unmet needs of family planning among women of reproductive age in Northern Region of Ghana

The recent Ghana Demographic and Health Survey 2014, estimated that 30 % of currently married women have an unmet need for family planning services, with 17% having an unmet need for spacing and 13% having an unmet need for limiting. The objective of the study was to review the unmet need of family planning in order to make appropriate recommendation to improve family planning use in the Northern Region of Ghana. A conceptual framework which outlines the factors that interplay to determine the use of family planning services in Northern Region of Ghana was designed and used for the study. The data were sought from unpublished documents from the Regional Health Directorate of Northern Ghana, websites of Ghana Health Service, online international publications and University of Leeds Library. The unmet needs of family planning in the region was found to result from a number of factors including inaccessibility to family planning services, non-availability of some type of contraceptive methods in the communities, religious beliefs that contradict the use of family planning, traditional and cultural belief system which promotes high fertility preferences, high illiteracy level, non-approval of family planning by men who are the decision makers, misconception about the use of contraception and high poverty in the region. The identified possible strategies for tackling the factors responsible for unmet need of family planning in the Northern Region, community-based family planning services, family planning health education outreach, peer education and religious-based education were found to be considerably effective, feasible and sustainable.

Increasing the use of continuing professional development courses to strengthen trauma care in Ghana.

None.

Protracted cholera outbreak in the Central Region, Ghana, 2016.

On 24th October 2016, the Central Regional Health Directorate received report of a suspected cholera outbreak in the Cape Coast Metropolis (CCM). We investigated to confirm the diagnosis, identify risk factors and implement control measures. We used a descriptive study followed by 1:2 unmatched case-control study. We reviewed medical records, conducted active case search and contact tracing, interviewed case-patients and their contacts and conducted environmental assessment. Case-patients' stool samples were tested with point of care test kits (SD Bioline Cholera Ag 01/0139) and sent to the Cape Coast Teaching Hospital Laboratory for confirmation. Cause of outbreak, risk factors associated with spread of outbreak. Vibrio cholerae serotype Ogawa caused the outbreak. There was no mortality. Of 704 case-patients, 371(52.7%) were males and 55(7.8%) were aged under-five years. The median age was 23 years (interquartile range: 16-32 years). About a third 248(35.2%) of the case patients were aged 15-24 years. The University of Cape Coast subdistrict was the epicenter with 341(48.44%) cases. Compared to controls, cholera case-patients were more likely to have visited Cholera Treatment Centers (CTC) (aOR=12.1, 95%CI: 1.5-101.3), drank pipe-borne water (aOR=11.7, 95%CI: 3.3-41.8), or drank street-vended sachet water (aOR=11.0, 95%CI: 3.7-32.9). Open defecation and broken sewage pipes were observed in the epicenter. Vibrio cholerae serotype Ogawa caused the CCM cholera outbreak mostly affecting the youth. Visiting CTC was a major risk factor. Prompt case-management, contact tracing, health education, restricting access to CTC and implementing water sanitation and hygiene activities helped in the control. This work was supported by Ghana Field Epidemiology and Laboratory Training Program (GFELTP), University of Ghana.

The Effects of Malaria Control Interventions on Out-patient and In-patient Malaria Cases in the Northern Region of Ghana

In this study, change detection in Out-patient and In-patient malaria cases in the Northern Region of Ghana was examined using time series intervention analysis. Data on monthly Out-patient and In-patient malaria cases obtained from the Northern Regional Health Directorate were modelled using Seasonal Autoregressive Integrated Moving Average with an Independent variable (SARIMAX) and Autoregressive Integrated Moving Average with an Independent variable (ARIMAX) models. The results revealed that SARIMAX (1, 1, 1)(1, 1, 1)12 was the best model for predicting Out-patient malaria cases while SARIMAX (1, 1, 1)(2, 1, 1)12 emerged as the best model for predicting the In-patient cases in the region. Diagnostic checks of the two models with the Ljung-Box test and Autoregressive Conditional Heteroscedasticity Lagrange Multiplier (ARCH-LM) test revealed that both models were free from higher-order serial correlation and conditional heteroscedasticity respectively. A chi-square goodness-of-fit test also revealed that there was no significant difference between the predicted values from the models and the observed values for the year 2018. The study further revealed that the coefficients of the intervention variable for the Out-patient and In-patient cases were both negative, which suggest that the intervention policy the government of Ghana implemented brought about a decline in the number of Out-patient and In-patient cases in the region.

District Health Service Management

District Health System Management is a comprehensive study of the health system of the district as a unit of national health system. The report of District Health System Management has been prepared as per the MBBS 4th year (Third phase) curriculum of Tribhuvan University (TU), Institute of Medicine (IOM), Nepal after the field placement of our group in Gorkha and Kaski districts.&#x0D; We prepared regional health directorate profile, regional tuberculosis center profile, district profile, district health profile of Kaski, hospital profile of Western Regional Hospital, Kaski, and critical analysis on human resources of the Aampipal hospital. We prepared five year plan on ICU services of Gorkha District Hospital and conducted epidemiological study on COPD in WRH, Pokhara.&#x0D; The techniques used in this study were observation, interviews, interactions, participation, secondary data retrieval, analysis and presentation using specific tools and guidelines devised for the same.&#x0D; The field practice proved to be a milestone in enabling the students to develop aptitude in the fields of management, administration and communication in different health set-ups of the country. It is in fact once-in-a lifetime opportunity for the medical students to imbibe the practicality of management skills at various levels.

Accessibility of pregnancy-related point-of-care diagnostic tests for maternal healthcare in rural primary healthcare facilities in Northern Ghana: A cross-sectional survey

BackgroundImproving access to maternal healthcare in resource-limited settings plays a critical role in improving maternal health outcomes and reducing maternal deaths. However, barriers and challenges may exist in rural clinics and could affect successful implementation. This study assessed the current accessibility of pregnancy-related point-of-care (POC) diagnostic tests for maternal healthcare in rural primary healthcare (PHC) clinics in northern Ghana. MethodWe randomly selected 100 PHC clinics providing maternal healthcare from a total list of 356 PHC clinicss obtained from the Regional Health Directorate. Selected clinics were surveyed from February to March 2018, using an adopted survey tool. We obtained data for clinic-level staffing, availability, usage, and desired POC diagnostic tests. Stata 14 was used for data analysis. FindingsMajority (64%) of the respondents were midwives. The mean ± standard deviation (SD) years of work experience and working hours per week were estimated at 5.6 years ± 0.4 and 122 hours ± 5.2 respectively. Average antenatal clinic attendance (clinic census) per month was 65 ± 67 pregnant women (Range: 3–360). The mean ± SD POC tests available and use was 4.9 tests ± 2.2. POC tests for malaria, HIV, urine pregnancy, and blood pressure monitoring devices were available in most clinics. POC tests requested by the clinics to assist them care for pregnant women included: Glucose-6-phosphate dehydrogenase (95%); hepatitis C (94%); sickling (91%); tuberculosis, blood glucose and blood type (89%) each; urinary tract infection (87%); urine protein (81%); hepatitis B (78%); haemoglobin (76%); and syphilis (76%). InterpretationThere is poor accessibility to pregnancy-related POC diagnostic tests for maternal healthcare due to low availability (≤5 tests per PHC clinic) of POC tests in rural PHC clinics in northern Ghana.

Spatial analysis of caries experience in population of teens, adults, and elderly people in the state of São Paulo: data from SB SP 2015

OBJECTIVE: Estimate the prevalence and gravity of coronal dental caries for populations of adolescents, adults and elderly people.METHODS: For the crossing of data of the average DMF rates by Regional Health Directorate (RHD) with the digital cartographical base, municipals were grouped by RHD, and the connection between the two bases was formed by a common code or “primary key” in the TerraView® software program (version 4.2.1).RESULTS: The distribution of the DMF average for the teen population was the worst for RHD 8, while RHDs 4, 7 and 14 had lower averages. For the adult population, RHDs 4 and 12 presented the lowest DMF averages. On the other hand, RHDs 8, 13, and 16 had the worst results. For the elderly population, the RHD 4 presented the lowest average, and RHD 9 the highest DMF rate for this population.CONCLUSION: The differences in DMF averages among the RHDs and the populations studied showed that it is necessary to plan different locoregional oral health actions to face the severe clinical state exposed, since its spatial distribution is disparate, with concentrations of cases in certain regions for all age groups studied.

Epidemiological surveillance activities for malaria in the colombian-peruvian border diagnostic network

To describe the activities of the malaria diagnostic network and its quality control in the Colombian-Peruvian border to characterize the functioning of the epidemiological surveillance system. Descriptive study with a research focus on implementation. We visited border communities with health care centers or volunteers trained to diagnose malaria. The visited sites were georeferenced to know their distribution. With information from departmental public health laboratories, the quality component was analyzed and compliance with the national guidelines for malaria diagnostic networks in the border area of the two countries was evidenced. Twenty-five Colombian and 18 Peruvian sites were visited, of which 25% had only microscopy posts, 56% made a diagnosis for malaria, and 19% only took samples and the plates were sent to a reference point for diagnosis. The Ministry of Health of the Amazon (Colombia) did not carry out direct supervision visits to the malaria diagnostic network during 2016-2017; the Regional Health Directorate of Loreto (Peru) has not carried out visits since 2015. Sixty percent of the diagnosis points in the Amazon and 29% in Loreto participated in quality assurance. Lack of opportunity in the diagnosis was identified in 44% of the visited sites and deficiencies in the quality component of the border diagnostic network.

Geographical Accessibility of Antenatal Diagnostic Services in Rural Ghana' Primary Health Care Clinics: The Role of District Hospitals/Medical Laboratories Locations in the Upper East Region

Background: Efforts to reduce maternal mortality to less than 70 per 100000 live births is a priority of the Government of Ghana and globally. Access to district hospitals/medical laboratories from rural primary healthcare (PHC) clinics for antenatal diagnostic services is critical for improving pregnancy outcomes and reducing maternal mortality. We assessed the geographical accessibility of district hospitals/medical laboratories for antenatal diagnostic services in Upper East Region, Ghana. Methods: We assembled detailed spatial data on weighted 100 rural clinics and their district hospitals/medical laboratories; and landscape features influencing journeys in the region. These were used in a geospatial model to estimate actual distance and travel time from a PHC facility to the nearest district hospital/medical laboratory for diagnostic services. Distribution of facilities was done using spatial autocorrelation (Global Moran's I) run in ArcMap 10.4.1. Logistics regression analysis was done utilizing STATA 14 to determine the strength of association between geographical accessibility and pregnancy outcome predictors. Findings: Of the 100 rural clinics included in the analysis, only 15% were located less than 10km (travel time: 5-30 minutes) to their nearest referral health facilities. The likelihood of a pregnant woman accessing a referral facility for diagnostic services in the region was after every 25 km (range: 0.2-62). Spatial distribution of the referral facilities was shown to be dispersed (MI= -0.69, z-score= -2.05, p=0.04). Likewise, the spatial distribution of the PHC clinics appeared to be at random (MI=0.01, z-score = 0.33, p=0.74). Logistic regression showed maternal mortality (OR=1.25, [95%CI=1.1-1.4] p<0.05); stillbirth (OR=1.1, [95%CI= 1.0-1.2], p=0.01); and miscarriage/abortion (OR=1.13, [95%CI=1.1-1.2]; p<0.05) were significantly associated with poor geographical accessibility. nterpretation: Geographical location of a district hospital/medical laboratory affected geographical accessibility of antenatal diagnostic services for rural populations in Upper East Region, Ghana. Targeted improvement of essential point-of-care diagnostics in rural primary health care clinics is recommended for both maternal healthcare and the general population. Funding: University of KwaZulu-Natal, College of Health Sciences Research Scholarship. Declaration of Interest: None declared. Ethical Approval: This study was approved by the Navrongo Health Research Centre Institutional Review Board/Ghana Health Service (approval number: NHRCIRB291) and the University of KwaZulu-Natal Biomedical Research Ethics Committee (approval number: BE565/17). Permission was obtained from the Upper East Regional Health Directorate prior to conducting the study. All study participants signed an informed consent prior to participating in this study.

Analysis of Malaria diagnosis and treatment data amongst pregnant women after the implementation of Test-Treat-Track policy, Brong Ahafo Region-2017

Background: In 2015, WHO estimates 212 million malaria cases, 429 000 deaths globally. In 2015, Africa homed 90%, malaria cases, 92% of malaria deaths. Ghana malaria in pregnancy accounts, 17.6% OPD attendance, admissions 13.7%, 3.4% maternal deaths. Strategy for malaria control in endemic countries hinges on diagnosis, treatment, and surveillance. However, proportion of suspected Malaria treated without laboratory diagnosis has remained high. In 2012, WHO initiated the Test-Treat- Track(T3) policy to reduce the proportion of suspected malaria not confirmed by laboratory before treatment. We analysed malaria data amongst pregnant women to determine trends of laboratory diagnosis to provide information on progress of the T3 policy in the Brong Ahafo Region (BAR). Methods & Materials: Methods: We conducted a retrospective descriptive data analysis of suspected malaria among pregnant women in BAR, for the period 2012 to 2016. We abstracted data from the District Health Information Management System (DHIMS) data base, consulting room, admissions and Ante-natal Clinic registers. Variables collected included: diagnostic and treatment status, age, and district of residense. Data was analyzed using excel for frequencies and proportions and presented in text, tables and charts. Results: A total of 99,896 pregnant women were suspected of Malaria for the period 2012-2015 in BAR. Age range was 10-49years (median: 26years). Majority of suspected cases were age group 20-34years, 4560/99896 (4.6%). Of the total suspected cases, 7826/99896(7.8%) were treated without laboratory diagnosis confirmation. The trend of proportion of suspected cases not confirmed by laboratory was: 2014, 3336/99896(3.3%), 2015, 1849/99896(1.9%), 2016, 2641/99896 (2.6%). There was no data for laboratory confirmed cases for the period 2012 and 2013 in the DHIMS data base. Highest proportion of the suspected cases without laboratory confirmation was from Techiman Municipal, 1004/7826(12.8%), least proportion from Nkoranza North, 21/7826(0.3%), Conclusion: Proportion of Malaria in pregnancy not laboratory confirmed but treated has been increasing from 2015(1.9%) to 2016(2.6%) in BAR, despite the T3 policy implementation. Agegroup 20-34 years and Techiman Municipality had the highest occurrence with no laboratory confirmation. We recommend Brong Ahafo regional health directorate to sensitise clinician on the need for laboratory testing before treatment of malaria amongst pregnant women.

Geographical Accessibility of Referral Health Facilities from Rural Primary Healthcare Clinics for Antenatal Diagnostic Services in the Upper East Region, Ghana

Background: Efforts to reduce maternal mortality to less than 70 per 100000 live births is a priority of the Government of Ghana and globally. Access to referral health facilities from rural primary healthcare (PHC) clinics for antenatal diagnostic services is critical for improving pregnancy outcomes and reducing maternal mortality. We assessed the geographical accessibility of referral health facilities from rural clinics for antenatal diagnostic services in Upper East Region, Ghana. Methods: We assembled detailed spatial data on weighted 100 rural clinics, referral health facilities, and landscape features influencing journeys in the region. These were used in a geospatial model to estimate actual distance and travel time from a PHC facility to the nearest referral facility for diagnostic services. Distribution of facilities was done using spatial autocorrelation (Global Moran's I) run in ArcMap 10.4.1. Logistics regression analysis was done utilizing STATA 14 to determine the strength of association between long distances and pregnancy outcome predictors. Findings: Of the 100 rural clinics included in the analysis, only 15% were located less than 10km (travel time: 5-30 minutes) to their nearest referral health facilities. The likelihood of a pregnant woman accessing a referral facility for diagnostic services in the region was after every 25 km (range: 0.2-62). Spatial distribution of referral facilities was found to be dispersed (p<0.05, z-score= -2.05). Likewise, the spatial distribution of the PHCs appear to be at random (p<0.05, z-score = 0.33). Logistic regression showed maternal mortality (OR=1.25, 95%CI=1.1-1.4); stillbirth (OR=1.1, 95%CI= 1.0-1.2); and miscarriage/abortion (OR=1.13, 95%CI=1.1-1.2) were significantly associated with long distance all p<0.05. Mean test results turnaround time from referred clients to the PHC clinic midwife was estimated at 15.4 (SD= 8.6, 95%CI= 13.7-17.1). No form of electronic option for communicating test results existed between the rural clinics and their referral facilities. Interpretation: There is poor geographical accessibility of referral health facilities from rural PHC clinics for antenatal diagnostic services in Upper East Region, Ghana. Targeted improvement of essential point-of-care diagnostics in rural clinics is recommended for both maternal healthcare and the general population. Funding: University of KwaZulu-Natal, College of Health Sciences Research Scholarship. Declaration of Interest: None declared. Ethical Approval: This study was approved by the Navrongo Health Research Centre Institutional Review Board/Ghana Health Service (approval number: NHRCIRB291) and the University of KwaZulu-Natal Biomedical Research Ethics Committee (approval number: BE565/17). Permission was obtained from the Upper East Regional Health Directorate prior to conducting the study. All study participants signed an informed consent prior to participating in this study.