College of Health Sciences

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Assessing the maternal death audit management system at Komfo Anokye Teaching Hospital using the National (MOH) audit guidelines as reference
(2004) Agyemang, John Kwaku
Maternal death is defined as the death of a woman pregnant or within 42 days following termination of pregnancy, irrespective of duration and site of the pregnancy, from any cause related to or aggravated by pregnancy or its management but not from accidental or incidental causes. (Suleiman,1999). Medical Death Audit is an integral part of modem medicine (Irish Medical Journal, 2001). Audit is of Latin derivation, which means hearing (Arnold et al, 1992). Clinical audit is systematic and critical analysis of quality of clinical care, including the procedures used for diagnosis and treatment, the associated use of resources and the effect of care on the outcome and quality of life for the patient. Even though, maternal death is very high especially in the developing countries including Ghana, information on maternal death audits and its impact in the overall quality of health care. This study examined the Management System of Maternal Death Audit at Komfo Anokye Teaching Hospital, Kumasi. The objective of the study included examining the structure, process and outcome of maternal death audit at KATH so as to give recommendation to improving maternal death thereby reducing maternal mortality. A descriptive study with a cross-sectional design, a total of fifty management/staff was interviewed with a questionnaire. Also a checklist was designed to review one hundred and eighty nine (189) cases of maternal deaths that occurred from 2001-2003. The findings showed the average maternal mortality ratio at KATH is 9.5 1/1000 live births. There is no Maternal Audit Committee at KATH that reviews maternal deaths. In fact, it was found that meeting termed “maternal conference” are rarely organized. Such meeting was held only once. Proceedings of such meeting are not recorded neither are standard forms used to review maternal deaths. From the study, it was evident that there were no dissemination of findings of such meetings and therefore no feedback. This is at the peril of improving maternal health. ‘The practice at KATH was found to be at variance with what has been prescribed by the Ministry of Health as enshrined in the Maternal Death Audit Guidelines document, 2002. Appropriate recommendations have been made to Management, Staff and other stakeholders at KATH to improve the practice of auditing maternal death so as to reduce the high maternal mortality at the hospital.
The health of the elderly at Kpeshie Sub-Metro, Accra
(2004-11-17) Obbu, Cynthia Charity
This study was undertaken to assess the health status of the elderly in the Kpeshie Sub-Metro of the Greater Accra Region. The study was a descriptive one. The sample was made up of one hundred elderly, fifty caretakers and five Key Informants. There was however one Key Informant from Accra Metro Health Directorate. The questionnaire was designed using close and open -ended questions, using mostly face-to-face interview. The respondents were selected using both convenience and purposive sampling methods. Data was analysed and presented using percentages, pie and bar charts. The data that were not easy to quantify were described. Findings revealed that majority of the elderly (60%) and their caretakers (84%) have some form of knowledge in nutrition with some of the elderly (32%) explaining it to be “foods which when eaten in their right quantities will make them healthy”. 74% of the elderly agreed that knowledge in nutrition can go a long way in helping the aged to lead a normal life once again. The study also revealed that majority of the elderly is not affected by food accessibility (geographical). 74% explained that the food they took when they were children happened to still be their favourite foods after attaining 60 years and over because it was their delicacy, thus, giving them satisfaction (38%). Even-though, they appreciate their delicacy, 49% complained of difficulty in eating (dental decay or tooth removal), which was taken into consideration during food preparation (61%). It was confirmed when four options were questioned and chewing (36%) happened to be the worst problem experienced. The findings on their health seeking behaviour showed that 66% use the government health facility mostly because of financial difficulties. As to the drugs prescribed, 35% said they wait and go back to the doctor after 2-3 days for the necessary help. 86% also stated that they regularly take their medications, which was confirmed, by 88% of caretakers who stated the same thing. Hypertension was the most rated chronic disease (45%). The research also revealed that majority (46%) lived with family members who happened to meet their food needs (39%). Almost half of the caretakers (50%) explained that they took the elderly for sightseeing and I or when the need arises. Findings revealed that policies and programs outlined by those involved in this area were: • Working out new modalities to enhance the smooth implementation of the exemption policy. • To initiate education for both the elderly and their families towards retirement • To approve the introduction of the health insurance scheme. • The sector Ministries (MOH and Mm. of Manpower Development and Employment) advocacy for lands to construct various recreational parks for the aged throughout the country. From the above findings, the researcher concluded that the managing of the health of the elderly was on the average. The researcher therefore recommended that national health programs on ageing in order to educate the general public in the future as well as conduct more scientific research on the development of sound policies for the aged.
Health sector preparedness for motor traffic emergencies:- a case study of selected health institutions in the Accra Metropolis
(2005) Damalie, Evelyn Sromawuda
Road traffic accidents are becoming rampant in the Accra metropolis. The after effect rests mainly on the health sector. According to Lt.Col. Dzansi, head of the Accidents and Emergency Unit of 37 Military Hospital, (personal communication 2005), about 70% of cases reported at the Unit are usually RTA related. The main objective is to assess the preparedness of the health sector to take care of these increasing incidences of RTAs within Accra Metropolis. The study was descriptive cross- sectional. It was carried out in the emergency unit of four selected health institutions in the Metropolis namely; Korle Bu Teaching Hospital, Ridge Hospital, Mamobi Polyclinic and 37 Military Hospital. A structured questionnaire and an interview schedule were used to elicit information from respondents. Observation was also carried out to support response. The questionnaire, containing eighteen questions, were given out to sixteen care providers in each facility, and thirty road accident victims interviewed in each facility. The researcher also observed the in inflow of RTAs into the selected facilities during the study period and how these were handled. A key finding is that personnel at the facilities are usually over stressed during RTAs emergencies; however, in many cases they are able to cope and maintain a cordial relationship with the victims and their relations. The study revealed that nurses’ lack specialized training when it comes to handling road accident emergencies. Even though, the facilities do not have adequate equipment for handling RTAs, they are able to improvise when necessary. Ambulance services, in particular, are inadequate. Findings revealed that all the facilities are prepared to handle RTAs emergencies; however, there are few things to put in place to make the facilities’ care delivery better. It is recommended that more nurses should be trained. Infrastructure should also be expanded at the emergency units to make handling of victims of RTAs effective
HIV/STIs health-seeking behaviour among in- and out-of-school urban male adolescents in the Bolgatanga Municipality of Upper East Region, Ghana
(2005) Saaka, Sumaila Seidu
The adolescent period is marked by the emergence of sexual behaviours that may lead to sexually transmitted infections (STIs), including HIV/AIDS and their attendant consequences. Studies conducted across the globe indicate that majority of young people are sexually experienced by the age of 20, and premarital sex is not uncommon among 15-19 year-olds. This partly explains why the control of sexually transmitted infections among adolescents has been recognized as a major concern globally, especially with the onset of the HIV/AIDS pandemic in the 1980s. Regrettably, little is documented on Male adolescents’ HIV/STIs health-seeking behaviour in Ghana to inform policy and programme decisions within specific socio-cultural context. The main objective of the study was to examine and compare the health-seeking behaviour for HIV/STIs among in- and out-of-school adolescents (16-20 years) in urban Bolgatanga Municipality with a view to improving Adolescent Reproductive Health (ARH). A descriptive current cross sectional study that sought to compare the HIV/STIs health-seeking behaviour among in-school and out-of-school urban male adolescents (16-20 years) was used. The study adopted a quantitative method of data collection, using a structured interviewer questionnaire. The study was conducted in three second cycle schools and among selected artisanal training workshops in Bolgatanga, the Upper East Regional capital. A sample of 205 (115 in-school and 90 out-of- school adolescents were selected using multi-stage sampling method. Survey data was entered using Epi Info 6, exported to Excel for cleaning and merging, and analyzed using the Statistical Package for the Social Sciences (SPSS - 11) and STATA 7. Chi-square p-values derived from bivariate cross analysis were used to compare selected exposure variables with the outcome variables. The results indicate that respondents have a high knowledge (100% for students versus 97% for apprentices) of HIV/AIDS, but knew little about other specific STIs. There was, however, no difference in ability to recognize correct symptoms of STIs between the two adolescent groups. In-school adolescents were less likely to have initiated sexual intercourse, compared with their out-of-school counterparts. Almost half (46%) of out-of-school adolescents were sexually active as compared with participants in school (22%). Generally, there was high use of condoms among sexually active adolescents in both groups [currently using condoms: in school 17/26 (65%), out of school 34/41 (83%)]. Majority of respondents in both groups also wanted to be screened and tested for HIV/STIs [in-school (97%), out of school (5 7%)]. Ever had sexual intercourse was strongly associated with having received screening and testing for HIV/AIDS/STIs among out-of-school respondents (p<0.0l), compared with students. There was no significant difference between in-school (3 6%) and out-of-school (33%), with regard to their risk perception for HIV/AIDS/STIs infection, in-school adolescents had better knowledge of the causes of STIs than their out-of-school counterparts. Out-of-school adolescents more frequently practiced risky sexual behaviours that could lead to acquisition of HIV/STIs than in-school adolescents (22.6% of sexually active students versus 46% of sexually active apprentices). More students were willing to undergo VCT (77%), compared with their out-of-school counterparts (57%). There is the need for comprehensive adolescent friendly services where counseling, education and treatment of STIs are provided in the Municipality, targeting especially the out of school youth. Schools could also be good entry points where health workers can make reproductive health services more accessible and friendly to students.
Adherence to anti-hypertensive medication regimens among patients attending the G.P.H.A. Hospital in Takoradi - Ghana.
(2006-08-08) Jambedu, Haruna Ahmed
Background: Adherence is the extent to which a person’s medication-taking behaviour coincides with the healthcare providers’ medical advice. It includes both dosing regularity and timing of intake. Many physicians face the problem of non-adherence among their hypertensive patient population. During the first year of treatment 16 – 50% of patients stop taking their high blood pressure medications. Overall, it is estimated that only about 30 – 50% of patients with hypertension adhere precisely to their hypertension medication regimens. Adherence is important in the treatment of hypertension Objectives: The objective of this study was to assess the extent of non-adherence to hypertensive medication regimen in G.P.H.A. Hospital, Takoradi. The reasons for non-adherence in the study were also evaluated. Methods: A prospective study of 150 hypertensive patients on medication for at least 6 months, who reported at the OPD of this hospital, was carried out. The Morisky questionnaire was administered to the patients and reasons for non-adherence sought. Pregnancy related hypertensive patients were excluded in this study. Results: The study revealed that total adherence to anti-hypertensive medications regimens was 19.3% and partial or medium adherence was 49.3%. Hence the adherence rates (i.e. those who took their medications ≥ 75%) to anti-hypertensive medicines in the institution was 68.6% and the non-adherence rate was 31.4%. The major reasons for non-adherence were forgetfulness (45.4%) by the patient to take medications on time or missed doses and side effects of the medications (20.8%). Finance (10.4% was also a problem for the paying patients who have to make up-front payment to re-fill their medicines. Conclusion: The prevalence of adherence among hypertensive patients in this health facility was 68.6%. Thus, indicating the need for adherence counselling.
Factors contributing to low utilization of maternal health services in Kumasi
(2007-07-12) Owusu–Danso, Joana
The primary means of preventing maternal deaths is to provide and increase access to supervised delivery. A greater portion of women attend antenatal clinic yet only a few get quality of care. Previous research in many developed countries showed that underlying causes of high maternal mortality was related to women not utilizing the existing health facilities. This research was conducted to determine the factors contributing to the utilization of maternal health services in Kumasi.The study was descriptive cross- sectional which was qualitative and quantitative in approach. The data were collected from pregnant women and women with children under one year. Tools for data collection include structured interview guide and questionnaires . Information was collected on knowledge of danger signs in pregnancy among community members. Categorical variables were analyzed using EPI INFO The findings of the study revealed that health services are available and that pregnant women are attended to satisfactorily as soon as they get to the hospital. Though cost of service is expensive, few people have registered with the national health insurance scheme. Mothers in the community have a fair idea about complications of pregnancy and labour .Also mothers with education are more likely to be convinced through health education on the need to utilize maternal health care facilities. Majority of the mothers do not believe in the existence of any traditional beliefs about place of delivery but few said beliefs exist. Education on national health insurance should intensified to reach all women in their reproductive ages wherever they are. Ministry of health and Ghana health services (MOH/GIS) should organize workshops on periodic bases to educate nurses and midwives on the need for attitudinal change towards pregnant women.
Assessing mothers’ knowledge of prevention of diarrhoeal diseases among children under five years in Ahafo Ano South District of Ghana
(2007-08-05) Amo, Kwame Adinkra
In the year 2005, there was an outbreak of cholera in the AASD of the Ashanti Region. The number of Out-Patient-Department cases in the district rose to a total of 684. Notwithstanding the various interventions, there was an increase to 690 in 2006. A study to assess mothers’ knowledge of prevention of diarrhoea diseases was conducted in the Ahafo Ano District of Ghana. A three-staged sampling strategy was used to select 300 respondents. This study showed that 58.3% of the respondents practised exclusive breast feeding; it exceeded the WHO recommendation (James, 2000). There were positive associations between mothers’ level of education and introduction of water, occupation and hand washing, and the level of education and the use of IEC on health issues (p < 0.05; OR=1.46). IEC was highly effective for feeding practices. The findings also showed that there was no significant association between occupation of mothers and introduction of water, however, 85.1% of the 121 respondents who served water to their babies before six months were self-employed. Significantly, 60.2% of the respondents were also adult mothers between 26 and 35 years who gave artificial feed to their children. This study showed that 44.7% and 1.3% of the respondents obtain drinking water from hand-dug wells and streams respectively. This revelation render support to WHO 2005 Report that indicated one billion people in the world cannot get access to safe drinking water and develop diarrhoea. 143 (47.7%) of the respondents mentioned that they sometimes wash their hands with soap and water before they breastfeed their babies. This confirms the results by Mensah and others in 2002. The study also revealed that 79.9% of those who do not wash their hands with soap and water were self-employed and 20.1% were public service employees (0dds ratio=1.4594), this shows a positive association between mother’s occupation and hand washing practices. Again, 39.3% of the respondents store water in wide-mouthed pots and buckets and the use of cups which are kept under unhygienic conditions. This can cause contamination. Significantly, there were no clear socio-cultural barriers to the use health information but farming and poverty affect mothers use of health information. In management of diarrhoea diseases, 26.0% mentioned the use of ORS and drugs; this confirms the WHO/UNICEF Report in 2008 that recommends the combination of ORS and oral zinc supplementation. It is recommended that more health staff should be retrain to manage diarrhoea cases, intensify and broaden its health education and promotion activities.
Evaluation of information, education and communication on child health in Amansie East District, Ashanti Region, Ghana
(2007-08-08) Nti, Richard
The provision of IEC has been long considered a key component of public health programmes. Within the Ghana Health Service, not only is IEC supposed to inform mothers of the existing services in order to increase the use of those services, but also to educate mothers on the proper use of services to ensure correct and continued usage. The present national and regional situations indicate that coverage indicators of some child health services are still not the best in spite of various planned interventions. The main purpose of the study was to evaluate IEC on Child health in the Amansie East District in Ashanti Region and to make recommendations. The study was a descriptive one. The sample of the study was drawn using a multi stage sampling. A total of 213 respondents were selected, comprising 202 mothers and 11 RCH staff for the data collection. Existing IEC approaches/strategies, mode of administration of IEC, quality of staff disseminating IEC, reach and frequency of the existing IEC and effects of IEC on mothers were evaluated to find out whether IEC could be part of the reasons for the low coverage as far as child health services are concerned. The analysis of the findings reveals that 100% of the RCH staff used print materials (posters) as the main mode of administration. Approximately 90% used interpersonal as the main strategy. On the reach of existing IEC, only the district capital and the health centres had few posters on child health. On the frequency, approximately one out of every four mothers questioned in the community was able to recall that nurses visit them monthly. It is also striking to note that approximately 90% of the RCH staff were not able to define IEC, neither were they able to say anything meaningful as far as IEC is concerned. Mothers’ knowledge on various antigens for immunizations and immunization schedule are still very low. 20.8% of mothers were found not to be able to mention any antigen despite their exposure. The study suggests that IEC may be a determinant of low coverage of child health indicators. It is recommended that minimum budget should be provided by the District Health Management Team (DHMT) for the development of the basic formula of IEC. In addition, the DHMT should implement selective reward programme for health staff in communities where caregivers are highly knowledgeable about vaccines and immunization schedules. Also further studies should be conducted to determine the best approach of IEC based on the characteristics of mothers in the district.
Prevalence of Medication Errors at Tema General Hospital
(2007-08-18) Ahado, John
With a lot of drugs to choose from, the most educated professional health care providers make medication errors, and somewhat less experienced providers may compound the problem. A medication error may be defined as any preventable event that may cause or lead to inappropriate medication use or patient harm. Medication errors may be caused by factors such as: sleep deprivation, mental lapses and fatigue, inadequate knpwledge of drugs and of a patient's existing medical conditions, faulty drug identification, patient's allergies not documented, and handwriting and dosage errors. The study setting was at Tema General Hospital. It is a district referral hospital in the Greater Accra Region of Ghana. The study aimed to identify the prevalence of medication errors at the hospital. The number of errors from a sample of two hundred (200) inpatients' folders on admission was recorded over an eight-week period. The errors were categorized as errors of prescription writing, dispensing and administration. Methods used for detecting these errors were: An interviewer-administered questionnaire, analyses of sampled folders to identify causal factors,incidence reports and direct observation. Overall, 501 of the errors, representing 48.8%, were detected as prescribing errors. A total of 187 dispensing errors representing 18.3% were detected, while 338 of the errors representing 32.9% were drug administration. The study confirmed the view held earlier that medication errors do occur at the hospital. Moreover, the errors cut across the whole spectrum of service provided, and that medication errors seldom occur because of one person.
Knowledge, attitudes and practices of lactating mothers related to postnatal care in Obuasi municipality, Ghana.
(2007-09-25) Abu-Sakyi, Ernest
The purpose of this study was to determine the knowledge, attitudes and practices of lactating mothers related to postnatal care in the Obuasi Municipality. A descriptive cross-sectional study design was used and the study period was July to October, 2007. Simple random and purposive sampling methods were used to select 384 lactating mothers who had babies within the last one year. They were interviewed in August, 2007. The results of the study showed that 88.3% of the mothers had knowledge postnatal care services of which 85.6% actually attended postnatal clinic on one to three times. The attitude of respondents was positive. A total of 352 mothers forming 91% or more felt that postnatal care was essential to their health. With regard to practices of lactating mothers, some women had a bad practice of using enema as a form of treatment on their infants. A total of 236 (63.5%) practiced this. On whether there was any relationship between educational background and the practices of lactating mothers, the use of enema was not found to have any significant relationship with educational background. A Chi-square of 0.09 and a P-value of 0.76, which is greater than 0.05 were obtained. With regard to giving of water to infants during the PNC period, a Chi-square of 5.51 and a P-value of 0.019 were obtained. This shows a significant relationship with educational background. On the giving of colostrums as first food to infants in relation to educational background, a Chi-square of 0.76 and a P-value of 0.382. This does not show a significant relationship. It was recommended among other things that, in order to improve access to postnatal care services further, the government should locate maternal health services close to the communities where the people live. This could be done by training more midwives to serve as the critical link between communities, and post them to the community level. Also, the Ministry of Health has to make a comprehensive plan to overcome information barriers by increasing the women’s knowledge further of the need to go in for postnatal care services. Further, service providers need to acquire attitudes that will enable them to overcome cultural barriers by recognizing the conflict between the biomedical and traditional explanations for health phenomena, especially those related to maternal care including postnatal care.
Factors Influencing the Utilisation of Family Planning Services in Kwabre District, Ghana
(2007-10-10) Akyeah, Fredrick
In a cross sectional study to assess the potential barriers to the utilization of family planning services among women in fertility age ( WIFA), 400 women from 6 communities in three sub-districts aged 15 – 49 years were selected by systematic sampling technique and then interviewed using structured questionnaire. The findings of the study revealed that most of the women have high level of knowledge about contraceptive but this does not translate into the use of modern contraceptives. Most of the respondents (122) (30.5%) were aware of at least three methods of contraception while 47 (4.7%) were aware of seven to nine contraceptive methods. Also 367 (91.7%) of the respondents knew at least two contraceptive methods. It also came out that these women have access to family planning services but the quality of the services offered is quite low in terms of availability of different contraceptive methods. The most common contraceptive methods available were contraceptive pill, contraceptive injection and the condom. Besides, the fertility preference expressed by most of the respondents was high since as much as 300 (75%) wanted between 4 – 6 children in their entire life. An improvement in the quality of service offered, increase public education on high fertility and integrating family planning services with other services are recommended for increase contraceptive use.
Acceptance of HIV Counselling and Testing Among Pregnant Women in the Kumasi Metropolis
(2008) Kwofie, Gabriel Sakyi (Dr.)
In Ghana, as in most parts of Africa, south of the Sahara, HIV/AIDS account for a lot of mortality and morbidity in children. Children born to infected mothers acquire infection and progress to clinical diseases. This mother-to-child-Transmission (MTCT), accounts for most of the cases in children less than 15 years. To help address this problem, the Ghana National Policy on HIV/AIDS and STIs has come out with strategies that include the use of routine Counseling and Testing (CT) as a tool for the prevention of MTCT (PMTCT). The main objective of this study was to determine the level of acceptance of this routine HIV CT, as well as factors associated with acceptance among pregnant women in Kumasi Metropolis. The study was a descriptive cross-sectional type, with structured questionnaire as the data collection tool served on 200 pregnant women attending Antenatal Clinic (ANC) in the Kumasi Metropolis. The sampling frame was pregnant women attending ANC at the three hospitals in the metropolis. The 200 ANC attendants were selected by a systematic random sampling technique. Findings include a high level of acceptance, with 87.5% of respondents accepting to undergo HIV testing either before or after counseling. The effects of socio-demographic characteristics on acceptance of HIV CT were not statistically significant. The knowledge level of pregnant women on HIV/AIDS and Prevention of mother to Child transmission (PMTCT) significantly affected HIV CT acceptance (p = 0.000): Those with adequate knowledge levels were twenty four times more likely to accept HIV CT than those with inadequate knowledge levels. Seeking Spousal permission did not significantly affect acceptance (p= 0.86). However, spousal involvement significantly encouraged HIV CT (p = 0.04) Given the high, level of acceptance which is consistent with high acceptance levels in some African studies, the existing strategy of routine HIV CT, as a tool for PMTCT of HIV, should be sustained, and if possible improved upon.
Factors Influencing Women’s Decision to Adopt Family Planning Methods: a Case Study of Women Aged 15-39 Years in East Akim District.
(2008) Anyomi, Josephine Ansaa Larbi
Family planning helps save women's and children's lives and preserves their health by reducing women's exposure to the health risks of childbirth and abortion and giving women more time to care for their children and themselves. Also all couples and individuals had the right to decide on the number and spacing of their children and to have access to the information, education and means to do so (UNFPA, 1999). This study determines the factors that influenced the decision of women in their reproductive age between 15-39 years to adopt family planning. A cross-sectional descriptive study was conducted in three sub districts of East Akim district from August to November 2008. Two hundred women practicing or had ever practiced family planning and 30 providers were used for the study. The purpose of the study was to assess clients’ satisfaction in FP method and services, to find out how client-provider interaction increase quality care, to find out the effectiveness in providers’ supervision, identify logistic availability and how to improve FP policy. Simple random sampling was used based on clinical attendance and home visit. The data techniques used were observation, check list, FGD among others. The result of the study showed that among the respondents, 76.0% were currently married or ever been married before and 23.0% were singles. About 89.5% had formal education. Knowledge of family planning was universal as 97% of respondents had an idea about family planning, 62.0% attended clinic continuously, 29.0% ever discontinued while 9.0% defaulted. Fear of side effect was the major reason attributed for FP method switched or discontinuation and was also confirmed in the focus group discussion. Injectable was the commonest current family planning method used which constituted 60% with 30.0% using pills and the remaining methods recorded less than 10.0%. About 55.5% of respondents were satisfied with family planning method used. Half of the respondents represented 51.5% received support from husbands to practice family planning while 6.0% practiced FP without the awareness of their husband. Statistically, alpha level of 0.05 at 95% confident interval, p=0.002, knowledge of family planning, age of the woman and husband support were all significant for a woman to adopt FP. Other factors such as client satisfaction of method, clinical accessibility and waiting time less than 30 minutes with visit to the clinic at any time were also statistically significant. It was found that supervision, information on side effect which was the main reason for stopping FP, logistics and FP policy needed to be improved. Recommendations were made to the DHMT, the and the community members and the Government of Ghana to improve the FP policy and its implementation.
Factors Contributing to Maternal Mortality: The Case of Bawku West District in the Upper East Region Ghana
(2008-07-11) Abotzabire, Azambarima William
This is a cross-sectional study of 341 household on factors that accounts for high maternal mortality in Bawku East district, in Upper East region of Ghana. The objectives of the study were to: ascertain the incidence of non-institutional maternal deaths in the district; determine the differences in backgrounds of maternal deaths and non-maternal death; assess the health seeking behaviour of cases of maternal deaths; and identify and describe the socio-cultural influences that accounted for maternal deaths in the district. The methodology used was a multistage sampling for the administration of interview guide in Tilli /Widnaba, Zebilla and Zongoire sub-districts. In addition, the purposive sampling technique was used to conduct a focus group discussion with men, women and compound heads in the selected communities. The results showed that, a maternal death per household was 158 per 1000 households which occur mainly at home (58%). The trend of maternal death in the communities is increasing, recording seven in 2004 and 37 in 2007. Most (54.8%) of the maternal deaths occurred after the women had delivered. When characteristics of maternal death cases and non-maternal death cases were compared, it was evident that: maternal death cases were significantly occurring among the younger age mothers with (chi square = 21.6, p=0.00); being married reduced the risk of maternal death significantly (chi = 5.34, p = 0.02; OR = 0.35); It was also evident that the risk of maternal death among women with no formal education was 3.27, 2.29 and 8.02 folds compared with the event in mothers who had 1st cycle, 2nd cycle and tertiary educated women respectively. On health seeking behaviour it is demonstrated that maternal death cases (47.2%) did not use ANC services because they were prevented by their compound heads. There are embedded cultural and traditional barriers to accessing maternity services. They are the use of soothsaying, libation, consultation with ancestors and use of herbs for pregnant women before orthodox services is contacted. It is recommended that women and women groups should advocate through the chiefs, opinion leaders, compound heads, and by the facilitative efforts of the district assembly, the district health directorate and Mr. Abotzabire Azambarima William (Author of this document),to help enact by-laws and ensure its’ implementation in curtailing the cultural practices that prevents women for seeking prompt maternity care.
Evaluating the Implementation of Intermittent Preventive Treatment (IPTP) Programme Using Sulphadoxine Pyrimethamine for the Control of Malaria in Pregnancy in the Kwabre District of Ghana
(2008-07-12) Agyare, Charlotte Sena
Malaria is one of the major public health problems worldwide especially in Sub-Saharan Africa. Its effect is severest amongst pregnant women and children. The introduction of a weekly antenatal chloroquine treatment for pregnant women and children, however, failed. In its place, the World Health Organization (WHO) recommended Intermittent Preventive Treatment in pregnancy (IPTp) using Sulphadoxine-Pyrimethamine (SP), which was introduced in Ghana in 2005. This study sought to evaluate the implementation of the IPTp programme and its effects on pregnant women in the Kwabre district to inform policy. The study is a descriptive cross-sectional study that was conducted from July to September 2007 in the Kwabre district of the Ashanti Region of Ghana. Three hundred and eight (308) pregnant women and nursing mothers who had recently delivered were sampled and interviewed using close-ended questionnaires. Twenty-five midwives and twenty-four heads of health facilities were purposively selected and interviewed using interview guides. Records were reviewed at both the facility and district levels. Key findings were that more than 90 percent of midwives on the IPTP programme had been adequately trained, though 78.8 percent had not had training in almost two years. Knowledge of the effects of malaria in pregnancy was high amongst midwives, nursing mothers and pregnant women, whilst record keeping in most of the health facilities was quite poor, because only 62.5 percent employed ledger/tally cards to keep records on the drugs and half of the facilities (50%) had run out of stock of SP for over a week in the last three months prior to the study. Majority of the nursing mothers received SP during pregnancy (65.4 percent), but most of them received it only once (40.2 percent). Adverse reactions of SP such as dizziness, nausea, itching, and palpitations were experienced by 27.3 percent of respondents but were not reported at the health facilities in the district. The proportion of pregnant women who had malaria decreased from 5.4 percent in 2004 to 4.3 percent in 2006 and so did the incidence of low birth weight rate. ANC attendance was also very high (98.7%) in the District. The implementation of the IPTp programme in the Kwabre district has been successful in terms of the awareness and knowledge of both the midwives and pregnant women of the effects of malaria in pregnancy. However, some major challenges exist which constrain the effective running of the programme. These include improper records keeping, adverse drug effect monitoring, regular shortages of SP, low second and third dose of IPTp coverage, and irregular training of midwives. These challenges pose a threat to the IPT programme and must be addressed. The study recommends that implementation lapses in training, drug supply, pharmacovigilance, record keeping and communication must be should be addressed to achieve targets readily.
Decentralization in the Health Care Delivery in Ghana. ‘A Case Study of Komfo Anokye Teaching Hospital-Kumasi’.
(2008-07-12) Brenyah, Joseph Kwasi
Since the 1980’s both developing and developed countries have been embarking on public sector management reforms. One such Reform was decentralization. The level of implementation of Health Care Decentralization in an institution depends on a number of indicators such as; the right of Directorates to generate their own income, the authority of Directorates to allocate resources, the authority to set targets and see to achieving them, the number and type of decisions taken by the Directorates, the degree of independence of Directorate from the CEO as self managed Directorates, the number of hierarchical levels in the organogram, the degree of delegations etc. Komfo Anokye Teaching Hospital(KATH) implemented decentralization of Health Care Delivery in the form of directorates system along the pattern of age, sex, diseases etc. five (5) years ago. There has not being much research to establish the existence of these indicators above and the level of the implementation of decentralization of health care is still unknown. The general objective of the research was to identify how decentralization in the Health Care Delivery is implemented at KATH in relation to Human resource, Finance and Service Organization. It was a descriptive cross-sectional study with purposive sampling size of 60 subjects. SPSS were used to analyze the raw data collected. The major outcome of the research was that about 55% of respondents appreciate the level of Health Care Decentralization at KATH. The major benefit of Decentralization of Health care Delivery at KATH was quick decision making (88.3%) whiles the major limitation was the GH¢ 25 spending limit of Directorates. In nutshell, for the fact that there is decentralization does not mean Directorates activities should not be subjected to approval by hospital top management. At least there should be some degree of accountability of the Directorates to the top Management of KATH.
Evaluation Of Intermittent Preventive Treatment Of Malaria In Pregnancy (IPT) Implementation In The Kumasi Ashanti Region, Ghana.
(2008-07-12) Priscilla Anima, Siaw
Malaria is a serious public health problem that affects both the young and old especially the vulnerable ones being children and pregnant women. Again, prevention of the serious health impact associated with malaria during pregnancy represents one of the pending public health goals of WHO policy as well as the Ghana Roll Back Preventive Treatment (IPT) is a preventive measure adopted for the prevention of malaria in pregnancy. Objective The primary objective of this study is to assess the IPT of malaria in pregnancy in relation to the processes, outcomes and impact of the policy in the Kumasi metropolis of the Ashanti Region – Ghana. Methodology The study was a descriptive qualitative and quantitative cross sectional study supported with health facilities records review. The data were collected in August 2008 using household interviews during which 400 respondents (280 pregnant women and 120 nursing mothers who have delivered between January and June, 2008) were sampled using a EPI cluster sampling technique were interviewed. Seventy (70) midwives and 22 key informants at post in some selected health facility within the Manhyia North, the Subin and the Bantama Sub-metros were in-depth interviewed with close-ended questionnaire. Forty-seven (47) health facilities which offer maternity services were also surveyed with the aid of a checklist. A review of the Kumasi Metropolis health records was also conducted. Seven descriptive processes, out come and impact indicators were used in the study. These included: training and KAP of midwives, ANC utilization in the metropolis, the KAP of pregnant mothers and midwives towards malaria in pregnancy, IPT coverage, management supply of SP, the incidence of adverse effects of SP in pregnant mothers on IPT and the incidence of LBW as well as maternal aneamia.
Assessing the dropout rate of the expanded programme on immunisation in Asutifi District.
(2008-07-12) Akutteh, Hanson Mensah
The induction of an immune response to infectious disease by vaccination has become a widely applied and acceptable public health intervention. For immunisation to be effective as a long-term global childhood disease control strategy, it is essential that parents continue to present their children for vaccination. A recent study in assessing the dropout rate of immunization has shown that, immunization coverage in Asutifi District has been high with percentage of fully vaccinated children ranging between 95% in the district and 90% to 97% in the sub-districts. There is an account of high dropout rate of eligible children receiving the vaccines in the sub-district above the National and WHO, recommended level of dropout rate less than 10% (WHO, 2005). The aim of the study was to determine the dropout rate of the Expanded Program on Immunization to assess the ability of the service to hold on to the number of children who started the vaccination. A descriptive cross-sectional survey among a representative sample of 300 children between the ages of 12-23 months from households with varying socio-economic status from both urban and rural sub-districts was done to illicit information on the immunization coverage. Approximately 95% of children under the age of two had been completely vaccinated. Averagely about 40% of eligible children in the district had timely received vaccines during EPI programme. Seventy seven percent of children receive their vaccination at the outreach post. The vaccination schedule showed that 4.4% who started BCG vaccination dropped out as at the time of receiving measles vaccine. The dropout rate for DPT1 and DPT 3 was 0.67%. More than 62% of mothers do not present their children for vaccination because they are busy with their economic activities and 31.25% of household are unaware of the need to return for subsequent doses. These shortcomings are affecting the sustainability of routine immunisation programmes and are promoting the growth of a large number of partially immunised children. To protect the continued operations and to enhance the coverage of routine vaccination programmes, it is important that the dropout rate and these difficulties be addressed. The dropout rates for children in the sub-district are between 5% and 10% signifying differences in how each sub-district is able to hold the number of eligible children who were targeted for vaccination. Generally the dropout rate indicates that the efficiency of the service delivered during EPI programme in the sub-district differ from one sub-district to another. The difference that exist in the dropouts within the sub-districts demonstrate a service delivery gap and suggest that greater efforts are required by government and the district health management team to rethink of resource allocation and strengthening processes to improve immunization coverage among rural poor.
A Retrospective Descriptive Study on Cerebrovascular Accidents at the Komfo Anokye Teaching Hospital (Kath) in Kumasi.
(2008-07-12) Adjepong, Grace Attah
INTRODUCTION: Stroke is a major challenge facing medicine with an alarming statistics of being the second leading cause of death and the leading cause of physical disability worldwide. Recognition and management of risk factors remain key to reducing morbidity and mortality from stroke. OBJECTIVES: The main objective of this project was to conduct a retrospective study to assess stroke outcomes among stroke patients at KATH for the years 2006 and 2007. METHODS/ DESIGN: A retrospective descriptive study involving review of adult stroke patients records on; age, sex, length of hospital stay, outcome of management (dead/alive), socio-demography, blood pressure on admission and before discharge or death, patient’s knowledge of his/her hypertension status and the most common presenting features. DATA ANALYSIS \ STATISTICAL METHOD Data was first entered in excel 2003 and transported into Epi info version 3.4.1 for further statistical analysis. RESULTS: Stroke constituted 1.3% of total hospital admissions and 6.3% of total hospital deaths within the period under review, 9.1% of total medical adult admissions and 13.2% of the total medical adult mortality were ascribed to stroke. A total of 1,050 cases made up of 537 (51.1%) males and 513 (48.9%) females were involved. 456(43.4%. 95% CI = 40.4%-46.5%) patients died from stroke of which 244 (53.5%) were men (RR= 1.10. 95% CI = 0.96-1.26).The peak age was 66-75 years representing 274 (26.1%) of stroke cases. The mean age of those who died was higher than that of those who survived (65.37 years versus 62.38 years).The average length of hospital stay of those who died was lower than that of those who survived (5.13 days versus 7.07). Hemiplegia/hemiparesia and hypertension were topmost on the list of most commonly presenting features. Fifty-four patients (18%. 95% CI = 13.8%–22.8%) had previous episode of stroke. CONCLUSION AND RECOMMENDATIONS: Stroke is an important health problem affecting both males and females with hypertension as a major risk factor. Majority of stroke victims belong to the active segment of the population. Attention needs to be focused on patients, health personnel and public education with the intention of reducing as many modifiable risk factors as possible to stop the weakening of the country’s labor force by the disease and to forestall premature deaths.
A community survey on the factors influencing the utilization of skilled delivery services in the offinso south
(2008-07-12) Obeng, Dr. Joseph Baah
The fifth Millennium Development Goal (MDG-5) is to improve maternal health by targeting a reduction in maternal mortality ratios by 75% between 1990 and 2015, and increasing the proportion of all births assisted by skilled attendants to at least 90% globally by 2015. Progress towards these targets seems to have slowed down and even stagnated in many parts of Sub-Saharan Africa where many women continue to deliver at home without skilled assistance. The Ghana Demographic Health Survey (GDHS) 1988- 2003 reports for instance show that for over two decades, the percentage gain in skilled assistance was just six points, rising from 41% in 1988 to 47 % in 2003. The Offinso District which lies in the Ashanti region of Ghana has observed rising trends in its maternal mortality ratio (MMR) figures over the past three years with a steady decline in the proportion of ANC attendants who deliver in health facilities and thus receive skilled assistance. Marternal Mortality Ratio has risen from 140/100 000 in 2004 to 210/100 000 in 2006 and skilled attendance has declined from 92% to 81% over the same period. To determine the factors influencing the utilization of skilled delivery services in the Offinso district of Ghana and identify the barriers that pregnant women encounter in their bid to access delivery. A descriptive cross sectional study was done between September and October 2008 by administering a structured questionnaire to 400 women between the ages of 15-49 years who had delivered within 12months prior to the survey. Socio-demographic, household level, community, pregnancy care and delivery related factors were collected and analysed. A majority, (97%) of respondents attended ANC at least once, and another 80% of them attended four times or more. Only 63% had skilled assistance at delivery with the rest delivering at home. Barriers cited include transportation (27%); money (23%); short labour (22%) and socio-cultural (11%). Urban residency, (contrast rural) odds ratio (OR)=4.32 (2.82-6.63); women with more than basic formal education, (contrast less) OR=3.55 (2.33-5.40); women living in proximity to a health facility, (contrast living afar) OR=3.60 (1.90-6.72); with relatively higher income (compared to lesser) OR=7.10 (3.7- 13.7) and respondents who paid four or more ANC visits during pregnancy (in contrast to those who paid fewer) OR=8.52 (4.8-15.1) all showed statistical association with the utilization of skilled assistance during labour. ANC coverage is high but delivery care coverage has stagnated at 61% since 2003 GDHS. There are still significant rural urban disparities, and women with lower education, lower monthly earnings and living far from health facilities face challenges accessing skilled care and hence deliver at home. Transportation, money and socio cultural barriers need to be overcome to improve delivery care coverage in district.

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