Edward Kofi Sutherland

Background: Cervical cancer remains a major public health challenge globally and disproportionately affects women in low- and middle-income countries, including Ghana. Community health nurses (CHNs) play a critical role in promoting cervical cancer prevention, education, screening advocacy, and referral services within rural and underserved communities. However, limited evidence exists regarding their cognizance of cervical cancer and related service delivery practices within community-based healthcare settings in Ghana. This study assessed cervical cancer cognizance and service delivery practices among community health nurses within the Krobo Enclave in the Eastern Region of Ghana. Methods: A quantitative cross-sectional descriptive study was conducted among community health nurses within the Upper Manya Krobo, Lower Manya Krobo, and Yilo Krobo municipalities between January and April 2020. Using a census sampling approach, all 177 eligible community health nurses were targeted for participation. Data were collected using a structured questionnaire assessing socio-demographic characteristics, general awareness, knowledge, and cervical cancer-related service delivery practices. Descriptive statistics, Chi-square analysis, logistic regression, and Spearman’s rank correlation analysis were performed using STATA version 14. Results: A total of 145 community health nurses participated in the study, yielding a response rate of 81.9%. Most respondents demonstrated low general awareness regarding cervical cancer (62.8%), although moderate overall knowledge levels were observed, with 55.9% demonstrating high knowledge scores. Knowledge regarding cervical cancer risk factors, prevention, symptoms, and treatment was generally satisfactory; however, knowledge and practical experience related to screening procedures such as Visual Inspection with Acetic Acid (VIA) and Pap smear testing were limited. Cervical cancer service delivery practices were generally poor, with 67.6% of respondents demonstrating low service delivery practice scores. Educational level was significantly associated with general awareness (p = 0.015). A weak but statistically significant positive relationship was observed between cervical cancer cognizance and service delivery practices (r = 0.20, p = 0.015). Conclusion: Although community health nurses demonstrated moderate knowledge regarding cervical cancer, general awareness and service delivery practices were suboptimal. The findings suggest that knowledge alone may not translate into effective cervical cancer prevention practices within community healthcare settings. Regular in-service training, practical screening workshops, and strengthened integration of cervical cancer prevention services within the Community-based Health Planning and Services (CHPS) system are needed to improve community-level cervical cancer prevention and early detection efforts in Ghana.

Background: Obesity is a significant risk factor for several comorbidities, including type II diabetes, cancer, and cardiovascular diseases. Recent studies suggest an increase in the prevalence of overweight and obesity among rural residents. Yet interventions to create awareness and promote lifestyle modifications are limited in rural areas. Aim: The aim of this paper is to assess the effect of a nutrition education intervention in enhancing overweight and obesity knowledge and lifestyle modification in a rural area in the Eastern Region of Ghana. Methods: The study employed an exploratory sequential mixed-methods design and implemented a community-based intervention that involved nutrition education sessions, including songs, food demonstrations, and community engagement called the Oklebenor Awareness Program. Baseline and end-line surveys and in-depth interviews were conducted on the socio-demographic characteristics, participants’ knowledge, attitudes, and behaviours regarding overweight and obesity. The quantitative data were analysed using means, frequencies and T-test. The in-depth interviews were analysed using thematic analysis (n = 22). Results: The average attendance during the lessons was 45 participants. About 50% of the respondents attended 4 lessons. The participants reported the Oklebenor Awareness Program as their main source of knowledge on overweight and obesity (n = 21). The mean score on the Obesity Risk Knowledge Score-10 increased from 5.3 at baseline to 6.6 at endline (mean change = 1.39, p = 0.001). Risk factors of overweight and obesity reported by the participants included unhealthy eating, physical inactivity, alcohol consumption and intentional weight gain. Lifestyle changes reported by the participants due to the intervention included increased dietary diversity by including legumes, fruits and vegetables in their meals and physical activity. Conclusion: The nutrition education intervention enhanced participants’ knowledge of overweight and obesity and promoted dietary diversity and physical activity. Incorporating culturally sensitive approaches and involving families and community resources contributed to the success of the intervention. The findings highlight the need for health education programs to address the rising prevalence of overweight and obesity in rural areas.

Alcohol use is a major global public health issue due to associated negative physical, mental, and social health outcomes among adolescents. This study examined the current alcohol use, drunkenness, and alcohol problems and associated correlates among 16,331 adolescents from eight selected sub-Saharan African countries. A secondary analysis of the Global School-based Student Health Survey (GSHS) datasets from eight cross-sectional surveys was conducted. The STATA statistical software package (Version 17) was used for the data analysis. Chi-square and multivariate logistic regression analyses were conducted with statistical significance set at p-value < 0.05. We found that the overall prevalence of current alcohol use, drunkenness, and alcohol-related problems among adolescents was 12.56%, 8.32%, and 4.74%, respectively. Seychelles recorded the highest rates of current alcohol use (47.21%) and lifetime drunkenness (42.17%), while Tanzania reported the lowest for both (2.89% and 1.41%, respectively). The highest prevalence of alcohol-related problems was observed in Namibia (13.76%), with the lowest again in Tanzania (1.89%). Risk factors associated with alcohol use behaviours included male gender, older adolescent age (15–18 years), mental health challenges (anxiety, loneliness, suicidal behaviours), and psychosocial issues (truancy, bullying, fighting, physical attacks, lack of close friends, hunger, cigarette and marijuana use). However, peer support and positive parenting emerged as protective factors. This study highlights the urgency of addressing alcohol use behaviours among adolescents, taking into cognizance the prevalence and country-level variations. Multilevel vulnerability and resilience factors consistent with the socio-ecological model were identified, and they should be incorporated into school-based public health interventions to reduce the risk and burden of alcohol use among adolescents in SSA.

Background: Ghana’s healthcare sector came under criticism regarding the quality of healthcare delivery, with issues relating to high-profile healthcare controversies, civil suits, and unfavorable patient outcomes due to medical incompetence. Despite the implementation of quality health programs, quality culture is yet to be institutionalized, leading to poor ties between clinical care and public health at the district level, and unclear monitoring and governance mechanisms. These have resulted in quality approaches that have had no effect on patient satisfaction and health outcomes. Even though nurses devote more hours to patients than most healthcare staff and offer care to patients on a regular basis, the daily assessment of the care they provide to patients is conducted without a thorough understanding of what quality healthcare entails. This study aims at assessing the quality of healthcare service delivery from the nurses’ perspective in a healthcare facility. Materials and Methods: This was a cross-sectional quantitative study carried out among 104 systematically selected nurses. A standard questionnaire designed in accordance with the Donabedian Model of Quality Care was administered, and a reliability analysis ( α ) was conducted to ensure internal validity and reliability of the items used to measure the constructs. The structure subscale consisted of 12 items ( α = 0.51), process subscale, 12 items ( α = 0.62), and service quality (outcome) also consisted of 12 items ( α = 0.58). Mardia’s Skewness and Kurtosis, Henze–Zirkler, and Doornik–Hansen multivariate normality tests were conducted at p values of .006, .102, .034, and .048, respectively, to ensure the independence of each construct as well as to satisfy the normality criteria. Descriptive analysis was also run to determine the extent to which the items reflect the current state of healthcare delivery. Finally, correlation, linear regression, and multivariate analysis of variance (MANOVA) analyses were carried out at a significant level of ≤0.05 to determine relationships and effects on healthcare delivery outcomes. Results: Findings indicated a generally neutral opinion of the quality measures in relation to structures, processes, and outcomes of care at the study facility. Nurses faced limitations in providing needed care due to inadequate policy framework and enforcement, insufficient human resources, and lack of motivational packages. A Pearson r correlation matrix of the Donabedian constructs showed significant positive relationships between Structure and Process as well as Outcome and Process categories. A weak positive association outcome and structure constructs was, however, deemed insignificant. A MANOVA determined a significant effect of respondents’ gender and educational levels on their perception of quality healthcare. Conclusion: Supervision in the hospital company and staff-management relationship must be strengthened to ensure a holistic quality of nursing care delivery.

Background: Prostate cancer is the most prevalent male malignancy in Ghana, with a high-risk of metastatic progression. Early detection and adequate disease severity stratification are crucial for timely intervention, comprehensive management, and improved outcomes. This study evaluates and compares the predictive abilities of a multiparametric model and a PSA-alone model in forecasting metastasis in prostate cancer patients. Objective: To compare the performance of a multiparametric model and a PSA-alone model in predicting metastasis in prostate cancer patients in Ghana. Methodology: Logistic regression analyses were conducted on a dataset of 426 prostate cancer cases. The multiparametric model included variables such as age, BMI, marital status, ethnicity, socioeconomic status, clinical stage by DRE findings, PSA levels, and Gleason score. The PSA-alone model focused solely on PSA levels. Model performance metrics included Pseudo R-Squared, AUC, sensitivity, specificity, accuracy, PPV, NPV, FPR, FNR, and F1-Score. The Hosmer-Lemeshow test assessed the goodness-of-fit for the multiparametric model. All analyses were conducted at a 5% level of significance. Results: The multiparametric model achieved a Pseudo R-Squared of 71.17%, AUC of 97.18%, sensitivity of 93.20%, specificity of 96.21%, accuracy of 92.25%, PPV of 85.62%, NPV of 96.24%, FPR of 8.24%, FNR of 6.80%, and F1-Score of 81.02%. The Hosmer-Lemeshow test yielded a non-significant p-value of 0.2405. The PSA-alone model had sensitivity of 32.24%, specificity of 91.76%, accuracy of 88.03%, PPV of 77.47%, NPV of 92.02%, FPR of 3.79%, FNR of 67.76%, F1-Score of 45.76%, and AUC of 73.79%. The multiparametric model’s Prevalence Yield was 32.15% and Sensitivity Yield was 32.15%, compared to the PSA-alone model’s 6.95% and 13.32%, respectively. Conclusion: Both models effectively predict metastasis in prostate cancer patients. The multiparametric model shows superior overall performance with higher Pseudo R-Squared, AUC, and a better balance in sensitivity, specificity, and accuracy. These results suggest the multiparametric model as a more robust tool for metastasis risk assessment in resource-poor settings. However, clinical context and patient characteristics should guide model choice for optimal outcomes.

Introduction: Breast cancer poses a significant health challenge in Sub-Saharan Africa, particularly in Ghana, where late-stage diagnoses and limited healthcare access contribute to elevated mortality rates. This study focuses on the crucial role of pathology and laboratory medical (PALM) services in the timely diagnosis of breast cancer within Ghana. Methods: A cross-sectional survey of hospitals was completed from November 2020 to October 2021, with 94.8% of identified in-country hospitals participating. Pathology service-related parameters assessed included whether pathology was available for the diagnosis of breast cancer on-site or via external referral, the number of pathology personnel, additional breast cancer diagnostic capabilities including estrogen and progesterone and/or HER2 testing, and the time from biopsy to patients receiving their results. Geospatial mapping was used to identify areas of limited access. Results: Of the 328 participating hospitals, 136 (41%) reported breast cancer pathology services, with only 6 having on-site capabilities. Pathology personnel, comprising 15 consultants and 15 specialists, were concentrated in major referral centers, particularly in Greater Accra and Kumasi. An assessment of referral patterns suggested that 75% of the population reside within an hour of breast cancer pathology services. Among the 136 hospitals with access to breast cancer pathology, only a limited number reported that results included ER/PR (38%) and HER2 testing (33%). Conclusion: Ghana has been able to ensure significant pathology service availability through robust referral pathways with centralized labs. Despite this, difficulties persist with the majority of pathology results not including hormone receptor testing which is important in providing tumor specific treatment.

PURPOSE: Breast cancer is the leading type of cancer diagnosed and the second leading cause of cancer-related death in Ghana. Mammography and ultrasound have proven benefits in the early detection of breast cancer. This study evaluates mammography, breast ultrasound, and radiology work force availability throughout Ghana. METHODS: A survey was administered to all hospitals in Ghana from November 2020 to October 2021. Mammography, breast ultrasound services, and the number of radiologists were assessed. For mammography, the number performed per month, cost incurred by the patient, where images were read, and how long it took to receive reports were also assessed. Health Facilities Regulatory Authority records on diagnostic centers were obtained to identify additional in-country breast imaging services. RESULTS: Three hundred and twenty-eight of 346 hospitals participated in the survey (95%). Only 21 hospitals reported on-site mammography. One hospital reported performing >100 mammographies per month. The average cost to the patient ranged from 100 to 500 Cedis ($17-87 US dollars [USD]), although three hospitals performed mammography at no cost. An additional 10 mammography machines were identified at diagnostic centers throughout the country, with 41.3% of the female population living within 1 hour of mammography services. There were 135 hospital-based breast ultrasound services identified with 69.5% of the female population living within 1 hour of these services. There were an additional 190 ultrasound machines at diagnostic centers. There were 96 in-country radiologists identified. CONCLUSION: Although there is limited availability and utilization of mammography in Ghana, there is more readily available ultrasonography. A focus on increasing breast cancer early diagnostic capabilities with breast ultrasound should be prioritized in addition to further expansion of the radiology workforce.

Art therapy allows people to express feelings about any subject through creative work. It is beneficial for people who feel out of touch with their emotions. In Ghana, little is known about art therapy as a therapeutic tool. Herbal treatment, biomedical and faith healing practices are the most common treatment options for mental health. This research aimed to provide new insights into clinical psychologists on their knowledge and use of art therapy in treating clients and identified the enablers and barriers in this therapeutic intervention. Twenty-one clinical psychologists were sampled using the snowball sampling method. They were interviewed over the phone using a semi-structured interview guide which was developed based on the predefined study objectives. Thematic analysis was employed to analyze the data resulting in three central thematic areas. Twelve of the clinical psychologists were females and eight were male, with an age range between twenty-five to fifty years. The major themes identified were knowledge of art therapy, the use of art therapy and enablers and barriers in using art therapy. The study revealed that clinical psychologists had limited knowledge of art therapy mainly due to lack of training. With the use of art therapy, the participants revealed that they had used some form of art therapy before and they perceived art therapy to be effective on their clients however, they demonstrated low confidence in using it. Practitioner training and the availability of art therapy-related resources were identified as both facilitators and hindrances to the use of art therapy. Clinical Psychologists are cognizant of art therapy albeit they have limited knowledge. Therefore, training in how to use art therapy and the availability of resources to facilitate art therapy can be provided for Clinical Psychologists by the Ghana Mental Health Authority.

PURPOSE: Breast cancer is the most frequent cancer and second most common cause of cancer-related death in Ghana. Early detection and access to diagnostic services are vital for early treatment initiation and improved survival. This study characterizes the geographic access to hospital-based breast cancer diagnostic services in Ghana as a framework for expansion. METHODS: A cross-sectional hospital-based survey was completed in Ghana from November 2020 to October 2021. Early diagnostic services, as defined by the National Comprehensive Cancer Network (NCCN) Framework for Resource Stratification, was assessed at each hospital. Services were characterized as available >80% of the time in the previous year, 80% of the time, with 43% of the population living within 45 km. Ten of the 12 met full NCCN Core criteria, and none met full NCCN Enhanced criteria. An additional 12 hospitals were identified that provide the majority of NCCN Basic services but lack select services necessary to meet this criterion. Expansion of services in these hospitals could result in an additional 20% of the population having access to NCCN Basic-level early diagnostic services within 45 km. CONCLUSION: Hospital-based services for breast cancer early diagnosis in Ghana are available but sparse. Many hospitals offer fragmented aspects of care, but only a limited number of hospitals offer the full NCCN Basic or Core level of care. Understanding current availability and geographical distribution of services provides a framework for potential targeted expansion of services.

Cervical cancer is the most common cancer and the leading cause of cancer-related death in Gambian women. The Gambian Ministry of Health is striving to improve access to screening, diagnostic, and treatment services for cervical cancer, but comprehensive data on currently available services is limited making it challenging to appropriately prioritize the ideal next steps for expanding care. This study aims to describe the current services available for the prevention, screening, and treatment of cervical cancer in The Gambia and provide suggestions for expanding geographic access to care. A survey aimed at assessing the availability of key cervical cancer-related services was developed and then administered in person by research assistants to all secondary and tertiary health facilities (HFs) in The Gambia. ArcGIS Pro Software and 2020 LandScan population density raster were used to visualize and quantify geographic access to care. Survey results were compared with published targets outlined by the Gambian Ministry of Health in the “Strategic Plan for the Prevention and Control of Cervical Cancer in The Gambia: 2016–2020.” One hundred and two HFs were surveyed including 12 hospitals, 3 major health centers, 56 minor health centers, and 31 medical centers/clinics. Seventy-eight of these HFs provided some form of cervical cancer-related service. HPV vaccination was available in all health regions. Two-thirds of the population lived within 10 km of a HF that offered screening for cervical cancer and half lived within 10 km of a HF that offered treatment for precancerous lesions. Ten HFs offered hysterectomy, but nine were located in the same region. Two HFs offered limited chemotherapy. Radiotherapy was not available. If all major health centers and hospitals started offering visual inspection with acetic acid and cryotherapy, 86.1% of the population would live within 25 km of a HF with both services. Geographic access to cervical cancer screening, and precancer treatment is relatively widespread across The Gambia, but targeted expansion in line with the country’s “Strategic Plan” would improve access for central and eastern Gambia. The availability of treatment services for invasive cancer is limited, and establishing radiotherapy in the country should continue to be prioritized.