Aliyu Mohammed

Introduction: Stillbirth, although a preventable health outcome, remains a silent contributor to global mortality. Stillbirths have also been deemed to be one of the most significant, albeit least known and reported adverse pregnancy consequences. The regional variations of stillbirth and its risk factors at the district level have not been well studied in Ghana. This study examined the spatiotemporal distribution, hotspots, and determinants of stillbirth in Ghana over 5 years (2017 ‐ 2021). Methods: This study is an ecological, observational analysis using district‐level aggregated stillbirth data from 2017 to 2021. The main analyses used trend analysis, Moran's I, Gi*, and OLS regression. Global Moran's Index was used to determine spatial autocorrelation. Getis Ord G* was used to determine spatial hotspots, clusters and outliers. An Ordinary Least Squares analysis was performed to determine the association between the stillbirth rate and other risk factors. Result: The findings showed that the highest stillbirth rates throughout the 5 years were observed in districts in the Greater Accra region (Tema with SBR between 30.0 and 34.5) and Volta region (Akatsi North (SBR = 45.2)). There were persistent hotspot districts throughout the 5 years. These occurred in the Northern and Greater Accra regions. The regression analysis revealed that age of mothers, number of health facilities in the district, and number of beds per facility in the district are significant risk factors for stillbirth in Ghana. Conclusion: The findings of this study reveal a persistently high stillbirth burden across several districts in Ghana over the 5‐year period, with districts such as Tema, Akatsi North, and La‐Dade‐Kotopon consistently recording the highest stillbirth rates. These high‐burden districts require urgent and targeted quality improvement initiatives, including strengthening emergency obstetric care, improving skilled birth attendance, and enhancing antenatal care coverage.

Introduction: Road traffic crashes are a significant public health concern worldwide, causing numerous injuries and fatalities. While various factors contribute to these crashes, the influence of weather and climate conditions has emerged as an important area of research. This study aimed to access the influence of temperature and rainfall on road traffic crashes in the Greater Kumasi Metropolitan Area (GKMA) of Ghana using a Bayesian spatiotemporal modeling approach.Method: Monthly road traffic crash data from 2010 to 2021, along with monthly temperature and rainfall, were analyzed. A Bayesian geo-spatiotemporal model was self-developed to quantify the effects of climate variables on road crashes while accounting for spatial and temporal dependencies.Results: The findings revealed that a one-degree Celsius decrease in monthly average temperature was associated with a 0.049 increase in the risk of road crashes. On the other hand, one-millimeter increase in monthly average rainfall was associated with a 0.008 increase in crash risk. Significant spatial and temporal patterns were observed, with districts traversed by major highways exhibiting consistently higher relative risks of crashes.Conclusion: This study revealed a significant relationship between monthly average rainfall and monthly road traffic crashes in the Greater Kumasi Metropolitan Area. This finding informs the need for targeted infrastructure improvements and enhancing public awareness campaigns to promote safe driving practices during rainy seasons.

Every child has the right to survive, grow and develop. However, in spite of the considerable global gains that have been made in child survival, Sub-Saharan Africa still has the highest child mortality rates and accounts for the greatest burden of mortality globally. The majority of these children die without ever reaching a health facility. The practice of appropriate healthcare-seeking behaviour has a great potential to reduce the occurrence of severe and life‐threatening childhood illnesses. Several factors, however, influence healthcare-seeking behaviour, including perceptions of the cause of illness and socio-cultural perspectives. This study seeks to understand local concepts of a traditionally-defined illness complex, Asram, and its influence on healthcare seeking behavior of mothers/caregivers. This qualitative study was conducted from October 2019 to February 2020. Four Focus Group Discussions were conducted with mothers/caregivers of children under-5 and 22 Key Informant Interviews with mothers/caregivers of children who had Asram, health workers at district, facility, and community levels, and Asram healers. Participants were selected from two rural communities, Akutuase and Wioso of the Asante Akim North district in the Ashanti region of Ghana. Data analysis was carried out iteratively throughout data collection, using a thematic analysis approach. The study shows that Asram is a childhood illness complex that is perceived to have been acquired spiritually and/or inherited. Nine types of Asram were described. This childhood illness was said to be treatable by Asram healers who had sub-specialties in treatment approaches that were determined by the Asram type reported. Mothers/caregivers trusted Asram healers and preferred to call on them first. This was found to be the main reason for delays in seeking healthcare for children under-5 who showed symptoms of Asram. Asram is a childhood illness complex that is believed to be better managed outside the health facility setting. This study complements existing knowledge and creates opportunities for further research and the introduction of more effective interventions in the effort to improve child survival in rural communities.

Background. Healthcare providers play a major role in the implementation of family planning policies. In Ghana, there has been a conscious effort to improve the knowledge of preservice and practicing health professionals on family planning. However, there have been concerns about the appropriateness of the attitudes and practices of these health cadres and, hence, their propensity to become barriers to the uptake of contraception in the general population. This study is aimed at assessing the attitudes and practices of healthcare workers and clinical-year medical students in contraceptives use, advocacy, and service provision. Methods. A cross-sectional survey was conducted among health workers and clinical-year medical students from January 1 to June 30, 2018. Variables assessed included sexual activity status, previous and current contraceptive use, and satisfaction with contraceptive use among others. Data from 400 self-administered, structured questionnaires comprising close- and open-ended questions was entered in SPSS version 22 and analysed using same. The variables assessed were presented as means, frequencies, and percentages. Results. About 58 of the respondents were sexually active. Half of the participants (50.2) had used a form of contraception before, with condoms and other barrier methods being the most preferred (67.7). However, only 18 of respondents were on a form of contraceptive at the time of the survey. Four out of five (82.6) of the users of these contraceptives were satisfied with their past use. A little over half of the participants had discussed contraception with their partners. Over four-fifths of participants thought family planning was beneficial and were willing to encourage others to use a method of family planning. Majority (63.7) of the participants had had formal training in family planning, but only 72 (18) were actively involved in the provision of family planning services. Conclusions. Although the attitudes of the health workers and trainees toward family planning were excellent generally, only a few were using a method of contraception at the time of the survey despite the fact that most of them were sexually active. There is a need to intensify communication on behaviour change towards contraception among health professionals and clinical-year medical students in order to strengthen their role as change agents in an effort to improve community uptake.

Morbidity burden of lymphatic filariasis (LF) relies on the information from the Mass Drug Administration (MDA) programme where Community Health Volunteers (CHVs) passively report cases identified. Consequently, the exact prevalence of morbidity cases is not always accurate. The use of mobile phone technology to report morbidity cases was piloted in Ghana using a text-based short messaging service (SMS) tool by CHVs. Though successful, illiterate CHVs could not effectively use the SMS tool. The aim of this study was to evaluate the use of a mobile phone-based Interactive Voice Response System (mIVRS) by CHVs in reporting LF morbidity cases and acute dermatolymphangioadenitis (ADLA) attacks in Ghana. The mIVRS was designed as a surveillance tool to capture LF data in Kassena Nankana Districts of Ghana. One hundred CHVs were trained to identify and report lymphedema and hydrocele cases as well as ADLA attacks by calling a hotline linked to the mIVRS. The system asked a series of questions about the disease condition. The ability of the CHV to report accurately was assessed and the data from the mIVRS were compared with the paper records from the CHVs and existing MDA programme records from the same communities and period. Higher numbers of lymphedema and hydrocele cases were recorded by the CHVs using the mIVRS (n = 590 and n = 103) compared to the paper-based reporting (n = 417 and n = 76) and the MDA records (n = 154 and n = 84). Female CHVs, CHVs above 40 years, and CHVs with higher educational levels were better at paper-based reporting (P = 0.007, P = 0.001, P = 0.049 respectively). The system, when fully developed and linked to national databases, may help to overcome underreporting of morbidity cases and ADLA attacks in endemic communities. The system has the potential to be further expanded to other diseases.

Background: Family instability and partner conflicts are reportedly common in serodiscordant relationships. To date, the family adaptability, partnership, growth, affection and resolve (Family APGAR), a standardised tool for assessing family function, has not been used in any published literature involving this peculiar group. Aim: The aim of this study was to determine the predictors of family functionality and its association with human immunodeficiency virus (HIV) serodiscordance. Setting: The study was undertaken at the Kwame Nkrumah University of Science and Technology Hospital and Komfo Anokye Teaching Hospital in Kumasi, Ghana. Method: This was a cross-sectional study. A systematic sampling method was used to select HIV-positive clients whose partners were seropositive (concordant) or seronegative (discordant). A standardised format was used to extract relevant data. All data were analysed using STATA^® (version 14). Results were reported as odds ratios with 95% confidence intervals for study and outcome variables. Results: The study recruited 374 respondents, of which 52% (195) were in HIV-discordant relationships. Approximately 68% (254) of the respondents rated their families as functional, 15% (57) rated as moderately dysfunctional and 17% (63) rated as severely dysfunctional. A statistically significant relationship was found between family functionality and gender, as well as between family functionality and HIV status disclosure to the partner. No association was found between the Family APGAR and HIV serodiscordance. Conclusion: Amongst HIV couples, the strongest predictors of family functionality are gender and status disclosure. Healthcare providers should invest efforts into addressing gender-based challenges, utilise the Family APGAR and support disclosure of HIV status, especially amongst discordant couples.

Despite the potential of mobile technology in improving health systems, its use as a surveillance tool is still unclear. This study aimed to examine the feasibility of a mobile phone-based system as a surveillance tool for identifying common symptoms of childhood illnesses. We conducted a community-based cross-sectional study involving caregivers (n = 161) of children under 5 years. The system was designed to assess disease symptoms of the sick children and provide health advice to caregivers regarding what to do with the sick child. The capacity of the system to correctly assess the disease symptoms of sick children, and provide referral was examined using Kappa statistics. Of the 126 calls recorded by the system, 52 (41.3%) were valid with complete data. The level of agreement between the system and clinicians’ report with respect to common symptoms of childhood illnesses varied: fever (kappa = 0.70, p < 0.001); vomiting (kappa = 0.46, p < 0.002); diarrhoea (kappa = 0.44, p < 0.007); and cough (kappa = 0.37, p < 0.0129). An acceptable level of symptom reliability was achieved by the system. The results suggest that the system can be used as a first line surveillance tool for identifying potential childhood disease outbreaks based on symptom reports.