Strengthening the injury surveillance system in rural Ghana as a measure of developing appropriate injury prevention strategies, a case study of the Ejura - Sekyeredumase District in the Ashanti Region of Ghana.

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The public health in rural Ghana is challenged severely with the occurrence of injuries and disabilities, yet little attention is given to injuries as compared with malaria and HIV/ AIDS. Accurate and reliable data on injury is needed to support efforts to develop, implement and evaluate policies and interventions on injury prevention and safety promotion in rural Ghana. The Ejura-Sekyedumase district has persistently recorded various forms of injuries such as machete wounds, road traffic crashes, pedestrian knockdowns and gunshots. Strengthening the injury surveillance system is necessary to provide accurate injury data to inform interventions to promote safety in the district. A cross-sectional survey involving 650 injury patients who have sustained injuries within the past 12 calendar months was conducted. The study was designed to establish the effect of education, economic status and type of settlement on injury reporting. It also tested the importance of staff training (intervention) on the output from an injury surveillance system. The study was organized in three phases; the household survey using structured questionnaire, discussions with stakeholders by using interview guides and training programme for data personnel using the Epi data and SPSS softwares. Information on injuries which were obtained from the interviews with injury patients and discussions with stakeholders were analyzed using both qualitative and quantitative methods. Frequency with percentage and cross tabulations and logistic regression using Epi data and the Statistical Package for Social Sciences (SPSS) softwares were used to analyze the data on injuries. Primary determinants of injury reporting were the type of settlement, education and economic background of injury patients. Respondents with secondary and tertiary education reported injuries based on the knowledge on the relative injury management capacity of the orthodox medical practice. The odd of reporting injury conditions among tertiary injury patients was 16.9 times than injury patients with basic education. Similarly, the likelihood of reporting injury condition among the high income injury patients was 7.8 times the odds of the low income-income earners. The ability to pay for orthodox medical care informed patients with good economic status to seek injury care at the orthodox medical centres. Comparatively, severe injuries such as compound fractures and heavy bleeding were much reported than minor injury conditions. The difficulties involved in transporting injury conditions on bad roads and trust in the traditional herbal practice were the main reasons why some injury conditions were not documented. Institutional challenges facing injury reporting institutions were lack of knowledge on injury data management and the difficulty in transforming injury data into safety. The outcome of an intervention in the form of staff training showed a significant improvement in the staff capacity to manage injury data in conformity with the World Health Organization’s standard. Injury surveillance system in least resourced settlements could be improved through public health education on the role of injury data in injury prevention and staff training on injury data management. Finally, this study has established strategies to improve injury reporting as well as transforming injury data into injury prevention and safety promotion in rural settlements. The study recommends the establishment of a Community-based Injury Reporting Desk which will register all injuries free of charge irrespective of the source of care. Intensive public health education is necessary to educate the people to take absolute control of their health needs and to make appropriate decisions on choice of injury care.
A thesis submitted to the Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi in partial fulfillment of the requirements for the degree of Doctor of Philosophy.