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Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana)
Bruno Marchal, McDamien Dedzo, Guy Kegels
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-787
Abstract: A realist case study design was used to analyse how specific management practices might contribute to improving the performance of an urban district hospital in Ho, Volta Region, in Ghana. Mixed methods were used to collect data, including document review, in-depth interviews, group discussions, observations and a review of routine health information.At Ho Municipal Hospital, the management team dealt with the crisis engulfing the ailing urban district hospital by building an alliance between hospital staff to generate a sense of ownership with a focus around participative problem analysis. The creation of an alliance led to improving staff morale and attitude, and contributed also to improvements in the infrastructure and equipment. This in turn had a positive impact on the revenue generating capacity of the hospital. The quick turn around in the state of this hospital showed that change was indeed possible, a factor that greatly motivated the staff.In a second step, the management team initiated the development of a strategic plan for the hospital to maintain the dynamics of change. This was undertaken through participative methods and sustained earlier staff involvement, empowerment and feelings of reciprocity. We found that these factors acted as the core mechanisms underlying the changes taking place at Ho Municipal Hospital.This study shows how a hospital management team in Ghana succeeded in resuscitating an ailing hospital. Their high commitment management approach led to the active involvement and empowerment of staff. It also showed how a realist evaluation approach such as this, could be used in the research of the management of health care organisations to explain how management interventions may or may not work.Over the last 20 years, a number of strategies aimed at improving the performance of health services have been implemented in low- and middle-income countries (LMIC). Each strategy has had its specific perspective and focused on one particular is
Social Death through HIV and AIDS Stigmatization and Discrimination in Ghana: A Case Study of the Central Regional Hospital, Cape Coast, Ghana  [PDF]
Eric Koka, Collins K. Ahorlu, Dominic K. Agyeman
Advances in Applied Sociology (AASoci) , 2013, DOI: 10.4236/aasoci.2013.36031

Stigmatization of and discrimination against People Living with the Human Immunodeficiency Virus (PLHIV) and Acquired Immunodeficiency Syndrome (AIDS) are increasingly recognized as the single greatest challenge to slowing the spread of HIV and partly the cause of the increased death rate particularly in Africa and Ghana to be specific. The purpose of the study was to identify the causes and effects of stigmatization of and discrimination against PLHIV visiting the Central Regional Hospital of Ghana for treatment and care. The research was conducted with a sample size of 120. Purposive and convenient/accidental sampling techniques were used to select respondents for the study. The study revealed that some people in Ghana stigmatize PLHIV because of the misconceptions they have about the modes of HIV transmission, the myths surrounding HIV and AIDS as well as their socio-cultural backgrounds and orientations. These stigmatizing behaviors towards PLHIV have serious health, social and psychological effects on them in particular and the society at large. Based on the results of the study, it is recommended that there should be an intensification of education on HIV and AIDS through the media. This would make the population in Ghana more knowledgeable about the disease, which may help to reduce stigmatization of and discrimination against persons living with HIV.

Potential sources of transmission of hospital acquired infections in the volta regional hospital in Ghana
DNA Tagoe, SE Baidoo, I Dadzie, D Tengey, C Agede
Ghana Medical Journal , 2011,
Abstract: Background: The study was undertaken to assess potential sources that might transmit Hospital Acquired Infections in the Volta Regional Hospital of Ghana. Method: A total of 218 swabs were taken over a six month study period of two weeks sampling bi-monthly from 33 different door handles, taps, desk surfaces and lavatories and 15 different surfaces in the theatre before and after cleaning on each sampling day. The swabs were cultured on Blood, Chocolate and Mac-Conkey agars and incubated for 24hrs at 35±2oC afterwhich isolates were identified morphologically and biochemically. Results: A total of 187 (88.8%) bacterial isolates were obtained from the swabs (P<0.0017) made up of 55.5% non-pathogenic isolates, 33.3% pathogenic isolates and 14.2% no bacteria growth. There was significant difference between pathogenic isolates and no bacterial growth (P=0.0244). The largest pathogenic isolates were S. aureus (57.6%) and E. coli (39.4%) whilst Bacillus spp. was the only non-pathogenic isolate. Door handles of the various wards and theatre had the highest total bacterial isolates (25.7%), followed by the lavatories (24.6%); whereas the lavatories recorded the most pathogenic isolate (21), followed by taps. There was no change in S. aureus isolate numbers after cleaning whereas E. coli decreased by (26.7%) and Bacillus spp. increase by (32.7%). Conclusion: The high percentage of pathogenic isolates of S. aureus and E. coli as well as Bacillus spp. on fomites at the Volta Regional Hospital indicates a high potential risk of HAI in the hospital.
Regional economic growth and equilibrium as well as the regional policy
Kocziszky Gy?rgy
Marketing ì Mened?ment Innovacìj , 2012,
Abstract: This paper presents a theoretical review of possibilities for a change in paradigm in regional policy, which is part of both territorial policy and economic policy. Advantages and disadvantages of each kind of regional policy are analyzed. Causes and results of the economic depression and its influence on Hungarian economic and regional policy are shown. Desirable directions of a paradigm change in Hungarys regional policy are proposed.
Enucleation of a Giant Prostatic Hyperplasia in Ghana: A Case Report and Mini Literature Review  [PDF]
Alexander K. Egote, Paul Poku Sampene Ossei, John Taylor, Theophilus Bortier
Case Reports in Clinical Medicine (CRCM) , 2018, DOI: 10.4236/crcm.2018.712053
Abstract: Herein we report a patient with a prostatic hyperplasia weighing exactly 700 g which was successfully removed at the Brong Ahafo Regional Hospital theatre in Ghana by Pfannesteil Transvesical Simple Prostatectomy. A prostatic hyperplasia of enormous size is very uncommon and to the best of our knowledge, only ten of such cases have been previously reported. The case report presented here constitutes the eleventh heaviest prostate reported in medical literature and also forms the first case report of giant prostatic hyperplasia from Ghana.
Designing of a letter sorting machine for the regional post offices in Ghana
Erwin Normanyo,Daniel Ayim,Adetunde Isaac
Journal of Engineering and Applied Sciences , 2009,
Abstract: The hitherto manual sorting of 1,200 letters per hour in the post offices is laborious, labour-intensive and time-consuming. This paper seeks to design a letter sorting machine (LSM) based on the conveyor belt transportation and letter sorting principle to replace the manual method of sorting letters. This machine is designed to make sorting of letters very effective and efficient thus, minimizing sorting into wrong destination bins and increasing the number of well-sorted letters per hour to over 30,000. A programmable logic controller (PLC) installed in-between the sensors and actuators effects programming flexibility by way of the control program in its memory. Optical character recognition (OCR) technology and barcode sorter (BCS) systems are employed to read handwritten and printed addresses as well as barcodes. Coding of the regions and a proposed addressing format is resolved thereby enhancing compatibility with the postal optical character reading system. This paper therefore seeks to design a letter sorting machine for the regional post offices in Ghana to increase effectiveness and efficiency of letter delivery.
Correlates of Hepatitis B Virus Infection among Antenatal Clinic Attendees of Volta Regional Hospital, Ho, Volta Region, Ghana  [PDF]
Joseph Otoo, Paschal Kofi Dah, Ernest Yeboah Boateng, Daniel A. Abaye
Open Journal of Applied Sciences (OJAppS) , 2019, DOI: 10.4236/ojapps.2019.97045
Abstract: Hepatitis B virus (HBV) infection remains a global health problem. With about 380 million chronic carriers of the HBV virus, there are over two million global deaths annually. Ghana is among the high endemic countries in Africa, with HBV prevalence ranging from 4.8% to 12.3% in the general population, 10.8% to 12.7% in blood donors and about 10.6% in antenatal clinic (ANC) attendees. The main objectives of this study were to test how socioeconomic factors, risky behaviors, knowledge and awareness of HBV infection correlate with actual HBV status among antenatal clinic attendees and to determine the predictors of HBV testing among ANC attendees. The study employed random sampling technique to sample 500 pregnant women, at mothers’ clinic of Volta Regional Hospital, Ho, Ghana. A structured questionnaire was used to collect information on socio-demographic characteristics, Hepatitis B status, possible risk factors, awareness and knowledge levels of HBV infection. Cross tabulation and the chi-square (χ2) statistic were used to determine statistical independence or association of study variables. Kruskal-Wallis test was applied to test for the differences in HBV knowledge scores across HBV status and levels of HBV awareness; and the binomial regression model was used to determine the predictors of HBV testing among ANC attendees. It is evident that age, religion, ethnicity, educational level, blood transfusion, number of blood transfusions, gravidity, parity, awareness of HBV and monthly income were associated with HBV status. Results of the Binomial Logistic Regression model indicate that Age (p = 0.03), Education level (p = 0.04), Religion (
Prevalence of Malaria Positive Rapid Diagnostic Test and Antimalarial Treatment in Patients with Fevers in the Accident and Emergency Unit of Effia Nkwanta Regional Hospital, Western Region, Ghana
Verner N. Orish, Jones Ofori-Amoah, Innocent Afeke, Ibrahim Jamfaru, Donatus W. Adongo, Kokou H. Amegan-Aho
Open Access Library Journal (OALib Journal) , 2016, DOI: 10.4236/oalib.1103097
Background: Rapid diagnostic test (RDT) is a simpler, easy to read malaria diagnostic test. It was introduced by the World Health Organization (WHO) to supplement the use of microscopy and can be used alone in areas where microscopy is unavailable. Its introduction was necessary to maintain the WHO test-based treatment protocol for malaria, as dependence of microscopy which is the gold standard is not possible in many areas in Sub-Saharan Africa which lack the wherewithal to run efficient laboratory services. WHO strongly recommends that only patients with parasitological confirmation of malaria should be treated with antimalarial drugs. In this study, the prevalence of malaria positive RDT and antimalarial treatment was evaluated in patients presenting with fevers at the outpatient section of the accident and emergency unit of the Effia Nkwanta Regional Hospital, Ghana. Methodology: This was a retrospective study carried out in the outpatient section of the accident emergency unit of Effia Nkwanta Regional Hospital. The outpatient register was reviewed from October 2014 to March 2015, for patients who came with fever. Data on demographics, malaria RDT status and antimalarial treatment were collected and analyzed. Result: A total of 607 patients with fever had their RDT performed. Of these, 131 (21.58%) were positive for malaria while 467 (78.42%) were negative. Out of the 131 tested positive, 55 represented patients above 12 years and 76 represent children aged 0 to12 years, p = 0.002. Fifty children under the age of 5 years tested positive for malaria whereas 26 were above the age 5 years, p = 0.03. All the 131 positive patients were treated for malaria while 276 out of 476 negative patients were also treated for malaria, p < 0.001. Conclusion: Patients positive for malaria RDT in this study were lower. Children were more positive for malaria than adults, with those under 5 years constituting the majority. This study also shows that indiscriminate malaria prescription is still a problem, a situation that should be tackled immediately, to prevent malaria parasite being resistant to current antimalarial drugs.
Kuhn: Realist or Antirealist?
Michel Ghins
Principia : an International Journal of Epistemology , 1998,
Abstract: Although Kuhn is much more an antirealist than a realist, the earlier and later articulations of realist and antirealist ingredients in his views merit close scrutiny. What are the constituents of the real invariant World posited by Kuhn and its relation to the mutable paradigm-related worlds? Various proposed solutions to this problem (dubbed the "new-world problem" by Ian Hacking) are examined and shown to be unsatisfactory. In The Structure of Scientific Revolutions, the stable World can reasonably be taken to be made up of ordinary perceived objects, whereas in Kuhn's later works the transparadigmatic World is identified with something akin to the Kantian world-in-itself. It is argued that both proposals are beset with insuperable difficulties which render Kuhn's earlier and later versions of antirealism implausible.
RAMESES publication standards: realist syntheses  [cached]
Wong Geoff,Greenhalgh Trish,Westhorp Gill,Buckingham Jeanette
BMC Medicine , 2013, DOI: 10.1186/1741-7015-11-21
Abstract: Background There is growing interest in realist synthesis as an alternative systematic review method. This approach offers the potential to expand the knowledge base in policy-relevant areas - for example, by explaining the success, failure or mixed fortunes of complex interventions. No previous publication standards exist for reporting realist syntheses. This standard was developed as part of the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) project. The project's aim is to produce preliminary publication standards for realist systematic reviews. Methods We (a) collated and summarized existing literature on the principles of good practice in realist syntheses; (b) considered the extent to which these principles had been followed by published syntheses, thereby identifying how rigor may be lost and how existing methods could be improved; (c) used a three-round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, realist research, policy and/or publishing to produce and iteratively refine a draft set of methodological steps and publication standards; (d) provided real-time support to ongoing realist syntheses and the open-access RAMESES online discussion list so as to capture problems and questions as they arose; and (e) synthesized expert input, evidence syntheses and real-time problem analysis into a definitive set of standards. Results We identified 35 published realist syntheses, provided real-time support to 9 on-going syntheses and captured questions raised in the RAMESES discussion list. Through analysis and discussion within the project team, we summarized the published literature and common questions and challenges into briefing materials for the Delphi panel, comprising 37 members. Within three rounds this panel had reached consensus on 19 key publication standards, with an overall response rate of 91%. Conclusion This project used multiple sources to develop and draw together evidence and expertise in realist synthesis. For each item we have included an explanation for why it is important and guidance on how it might be reported. Realist synthesis is a relatively new method for evidence synthesis and as experience and methodological developments occur, we anticipate that these standards will evolve to reflect further methodological developments. We hope that these standards will act as a resource that will contribute to improving the reporting of realist syntheses. To encourage dissemination of the RAMESES publication standards, this article is
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