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Quality of care provided to febrile children presenting in rural private clinics on the Kenyan coast
TO Abuya, CS Molynuex, ASS Orago, S Were, V Marsh
African Health Sciences , 2004,
Abstract: Background: Private sector health facilities are diverse in nature, and offer widely varying quality of care (QOC). Objectives: The study aimed to describe the QOC provided to febrile children at rural private clinics on the Kenyan coast and stakeholder perspectives on standards of practice and opportunities for change. Methods: Data collection methods were structured observations of consultations; interviews with users on exit from clinic and at home and in depth interviews with private practitioners (PP) and district health managers. Findings: Private clinics have basic structural features for health care delivery. The majority of the clinics in this study were owned and run by single-handed trained medical practitioners. Amongst 92 observed consultations, 62% of diagnoses made were consistent with the history, examinations and tests performed. 74% of childhood fevers were diagnosed as malaria, and 88% of all prescriptions contained an antimalarial drug. Blood slides for malaria parasites were performed in 55 children (60%). Of those whose blood slide was positive (n=27), 52% and 48% were treated with a nationally recommended first or second line antimalarial drug, respectively. Where no blood slide was done (n=37), 73% were prescribed a nationally recommended first line and 27% received a second line antimalarial drug. Overall, 68 % of antimalarial drugs were prescribed in an appropriate dose and regime. Both private practitioners and district health managers expressed the view that existing linkages between the public and private health sectors within the district are haphazard and inadequate. Conclusions: Although rural PPs are potentially well placed for treatment of febrile cases in remote settings, they exhibit varying QOC. Practitioners, users and district managers supported the need to develop interventions to improve QOC. The study identifies the need to consider involvement of the for-profit providers in the implementation of the IMCI guidelines in Kenya Key Words: Quality of care, febrile illness, malaria, private practitioners, private clinics African Health Sciences Vol.4(3) 2004: 160-170
Cross-Sectional Study of Improved Sanitary Facilities’ Availability in an Urban Setting of Ghana
Anthony Mwinilanaa Tampah-Naah, Anthony N-Yelkabong
Open Access Library Journal (OALib Journal) , 2015, DOI: 10.4236/oalib.1101217
Abstract: Background: The availability of sanitary facilities to human populations is deemed a necessity worldwide to promote healthy sanitation. In the Upper West Region, sanitation remains one of the major development challenges of our time, and despite growing attention and efforts by governments and donors, many approaches to urban and rural sanitation are failing. The study was conducted to examine environmental factors linked with sanitary facilities, and to assess socio-demographic factors with the availability, type and location of sanitary facilities in Mangu, a suburb of Wa Municipality, Ghana. Methods: A community-based cross-sectional quantitative study design was applied. The study population was made up of individuals of 18 years and abovein the community who had knowledge about the sanitary conditions within their respective housing units. From this population, 258 individuals were sampled for the study. Chi-square test for independence was applied to discover if there were associations between the study variables (sanitary facility accessibility and environmental characteristics of houses). Results: Factors associated with the availability of sanitary facilitiesin housing units were roofing material, building material, number of rooms, and drinking water source. Conclusions: The findings from the study indicate that a housing unit’s conditions can significantly influence the availability of a sanitary facility in the community.
Measuring client satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana
Paul L Hutchinson, Mai Do, Sohail Agha
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-203
Abstract: Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction.Private health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies.Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries.Numerous studies have examined the effects of family planning quality on the uptake and continuation of family planning methods [1-7]. One principal determinant of uptake and continued utilization of family planning services is overall client satisfaction with those services [8,9]. Studies of contraceptive discontinuation rates, for example, have indicated t
The Role of the Community Ownership and Management Strategy towards Sustainable Access to Water in Ghana (A Case of Nadowli District)  [cached]
Nicholas Fielmua
Journal of Sustainable Development , 2011, DOI: 10.5539/jsd.v4n3p174
Abstract: In rural Ghana, provision of water facilities adopts the demand driven approach and the facilities are community managed. This approach emerged because the supply driven and centralised system of providing water facilities could not sustain access to potable water especially in rural areas. The demand driven approach is expected to guarantee sustainability in access to water. In 1994, Ghana launched the National Community Water and Sanitation Programme with Community Management as a core strategy. This paper assesses the role of community ownership and management strategy towards access to water in the Nadowli District in Ghana. Data was collected through household interviews, focus group discussions and key informant interviews in 10 communities in the District. The findings showed that the community ownership and management strategy has improved access to potable water in Ghana and the Nadowli District in particular. As at December 2008, 88.2 per cent of the District population had access to potable water.
Healthy Firms: Constraints to Growth among Private Health Sector Facilities in Ghana and Kenya  [PDF]
Nicholas E. Burger, Daniel Kopf, Connor P. Spreng, Joanne Yoong, Neeraj Sood
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0027885
Abstract: Background Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. Methodology/Principal Findings We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. Conclusions/Significance The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business and health facility.
Low-income Urban Settlements in Ghana: The State of Housing Facilities in Two Indigenous Settlements in Kumasi  [PDF]
Solomon-Ayeh, B. E.,Decardi-Nelson, I.,Okoko, E.
International Journal of Economic Development Research and Investment , 2012,
Abstract: Declining physical housing quality and lack of access to basic amenities remain the characteristics of much of the current housing stock in African countries, including Ghana. These are mostly found in the traditional old towns where the practice of providing public facilities was common in the past, but has currently outlived its relevance basically due to urbanization. The goal of this study is to examine housing conditions and access to housing facilities in old towns in Ghana. The case study method was used for the study with the Kentinkrono and Ayeduase settlements which are suburbs of Kumasi in the Ashanti Region of Ghana, as the focus area of the study. The study revealed that, pipe-borne water and borehole were the most dominant sources of water supply in the two communities and most of the residents did not have water in their houses. Most households had bathrooms in their homes but some had converted their bathrooms into bedrooms for rental purposes. Almost half of the households lacked toilet facilities in their houses and so made use of the public toilets which were not in good hygienic condition. The study therefore recommended that, there is the need to train and equip building inspectors to undertake regular inspection of houses using modern technologies such as Geographic Information Systems (GIS). This would ensure that physical developments are kept under control. The housing challenge is therefore not only quantitative with exclusive focus on housing deficits but also in ensuring that, the traditional old towns in cities are provided with basic housing facilities which is also vital for preventing slum formation and informal housing processes.
The Influence of Workplace Facilities on Lactating Working Mothers’Job Satisfaction and Organisational Commitment: A Case Study of Lactating Working Mothers in Accra, Ghana  [cached]
Abigail Opoku Mensah
International Journal of Business and Management , 2011, DOI: 10.5539/ijbm.v6n7p234
Abstract: The purpose of the study was to find out the influence of workplace facilities on lactating working mothers’ job satisfaction and their commitment level at work. The subjects for the study were two hundred and sixty lactating working mothers who were working full time from five different organizations in the Accra Metropolis in Ghana with age range of 24-41 years, mean age of 32.2 and a standard deviation of 8.8. Data were analyzed using descriptive statistics of mean, standard deviation and Analysis of Variance (ANOVA) was used at 0.05 levels of significance. The findings of the study revealed that, lactating working mothers who get Workplace Facilities are more committed to their work and also more satisfied with their work than those who do not get workplace facilities. This paper, therefore, suggests that employers should provide workplace facilities for lactating working mothers who want to continue the practice of exclusive breastfeeding when they return to work, Since the provision of workplace facilities benefit both the employers, the child and the working mothers. The result of this study is to help policy makers in Ghana to have a second look at the Ghana labour Act (2003) about employment of women especially lactating mothers who want to continue the practice of exclusive breastfeeding with full time work. The findings will also educate employers in Ghana about the benefit of workplace facilities for lactating working mothers and the organization as a whole.
Management of Febrile Neutropenia in Patients receiving Chemotherapy for Solid Tumors: A Retrospective Study of Twenty Cases from the Radiotherapy Centre, Accra, Ghana
V Vanderpuye, J Yarney, K Beecham
West African Journal of Medicine , 2010,
Abstract: BACKGROUND: One in ten patients on anticancer medication will develop febrile neutropenia irrespective of tumour type. There is need to protect our patients from this fatal condition while optimising chemotherapy. This may be difficult for a poor country. OBJECTIVE: To assess the management of cancer patients with febrile neutropenia in a low resource setting. METHODS: Records of 20 cancer patients with febrile neutropenia (FN) over a three-year period were retrospectively analysed. Data retrieved included age, sex, type of cancer and number of cycles of chemotherapy taken. Other parameters included initial temperature, site of infection, absolute neutrophil count (ANC) at presentation and antibiotic choice. Use of antifungal drugs, duration of fever and overall treatment outcome were also assessed. RESULTS: The male : female ratio was 3:2 with a median age of 24 years (range: 15 – 68 years), and a mean temperature of 38.8 oC (range 38.0–39.8 0C). Mean absolute neutrophil count was 0.2 x 109 (range: 0.0 to 0.6 x 109). Thirteen (65%) received Cisplatin, five (25%) received Adriamycin, two (10%) received Paclitaxel or Cyclophosphomide-Methotrexate-5, Fluorouracil (CMF). Ten(50%) developed FN with the first cycle of chemotherapy, and six(30%) in the second cycle. Twelve (60%) had oral infection, four(20%) had gastroenteritis and single episodes of respiratory and urinary tract infections. Eleven (55%), received Ceftriaxone and Gentamycin, five (25%) cases received Levofloxacin or ciprofloxacin and Amoxicillin/clavunate + metronidazole; two cases(10%), Ceftazidime and Gentamycin; two cases(10%) received Meropenem. Twelve (60%) patients had antifungal therapy for oral candidiassis. Eight (40%) patients received growth factors. The mean fever duration was 4.5 days (range 1–10 days). Two (10%) of the patients died. CONCLUSION: Febrile neutropenia in resource limited countries can be managed with good history and physical examination skills. Aminoglycosides are important components of empiric treatment in Ghana
A Spatial Perspective to the Distribution of Healthcare Facilities and Health Personnel in the Eastern Region of Ghana
Stephen Manortey, Gideon Kwarteng Acheampong
Open Access Library Journal (OALib Journal) , 2016, DOI: 10.4236/oalib.1102956
Background: A major factor for health services provision in various communities is the concern for spatial justice in the distribution of healthcare facilities. The eastern region with most of its population in rural areas has been subject to frequent increases in the number of administrative districts over time. This however has not correspondingly followed with a significant increase in the number of health facilities and health personnel in the region, a phenomenon that has disturbed the distribution of health facilities and personnel, thus the purpose of this study to investigate the spatial pattern in the distribution of health facilities and health personnel. Methods: Data on the global positioning system of each health facility and the total number of health workers were factored with the population in the administrative districts of the eastern region as part of analysis to investigate the distribution of health facilities and health personnel per population of each district and the Region. Results: Health facilities and health personnel were unevenly distributed, recently added districts such as Kwahu Afram Plains South, Ayensuano, Upper West Akim along with existing ones such as Birim South, Kwahu West, Akyem Mansa, and Kwahu East all lacked in terms of health facilities and health personnel. Conclusions: This observed deficiency in distribution of health facilities and health personnel has the potential to generate productivity inequalities among residents of the Eastern Region which in turn has a negative effect on the entire development of the region. Areas that were identified as disadvantaged districts should be considered for various intervention strategies.
Health Seeking Behaviour and Utilization of Health Facilities for Schistosomiasis-Related Symptoms in Ghana  [PDF]
Anthony Danso-Appiah ,Wilma A. Stolk,Kwabena M. Bosompem,Joseph Otchere,Caspar W. N. Looman,J. Dik F. Habbema,Sake J. de Vlas
PLOS Neglected Tropical Diseases , 2010, DOI: 10.1371/journal.pntd.0000867
Abstract: Background Schistosomiasis causes long-term illness and significant economic burden. Morbidity control through integration within existing health care delivery systems is considered a potentially sustainable and cost-effective approach, but there is paucity of information about health-seeking behaviour. Methods A questionnaire-based study involving 2,002 subjects was conducted in three regions of Ghana to investigate health-seeking behaviour and utilization of health facilities for symptoms related to urinary (blood in urine and painful urination) and intestinal schistosomiasis (diarrhea, blood in stool, swollen abdomen and abdominal pain). Fever (for malaria) was included for comparison. Results Only 40% of patients with urinary symptoms sought care compared to >70% with intestinal symptoms and >90% with fever. Overall, about 20% of schistosomiasis-related symptoms were reported to a health facility (hospital or clinic), compared to about 30% for fever. Allopathic self-medication was commonly practiced as alternative action. Health-care seeking was relatively lower for patients with chronic symptoms, but if they took action, they were more likely to visit a health facility. In a multivariate logistic regression analysis, perceived severity was the main predictor for seeking health care or visiting a health facility. Age, socio-economic status, somebody else paying for health care, and time for hospital visit occasionally showed a significant impact, but no clear trend. The effect of geographic location was less marked, although people in the central region, and to a lesser extent the north, were usually less inclined to seek health care than people in the south. Perceived quality of health facility did not demonstrate impact. Conclusion Perceived severity of the disease is the most important determinant of seeking health care or visiting a health facility in Ghana. Schistosomiasis control by passive case-finding within the regular health care delivery looks promising, but the number not visiting a health facility is large and calls for supplementary control options.
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