Stephen Tetteh Engmann

Introduction: Burnout among healthcare workers threatens workforce well-being and quality of care. Evidence from Ghana remains limited, particularly regarding demographic and professional differences in tertiary hospitals. This study aimed to examine burnout prevalence and its association with key demographic characteristics, including age, gender, marital status, and professional category among healthcare workers in a tertiary facility in Ghana. Methods: A cross-sectional retrospective study analyzed secondary data from a routine clinical audit of 333 healthcare workers (86 doctors, 233 nurses, and 14 health assistants) at Cape Coast Teaching Hospital. Burnout was measured using the validated Burnout Assessment Tool with sound psychometric properties. Associations between burnout and age, gender, marital status, and profession were examined using descriptive statistics and multivariable logistic regression. Statistical significance was set at p≤ 0.05. Results: Among the 333 healthcare workers studied, the overall burnout prevalence was 62.4% (n = 208). Women and men had comparable overall burnout prevalence (62.9% versus 61.7%), although women reported higher psychosomatic symptoms. Burnout prevalence declined with increasing age, from 64.4% among those aged 20–29 years to 56.5% among those aged 50–59 years. Single healthcare workers experienced slightly higher burnout prevalence than married workers (64.7% versus 59.6%). Bivariate analysis identified profession as the only demographic factor significantly associated with burnout (χ ² = 6.24, p = 0.044). In multivariable logistic regression analysis, nurses and health assistants had significantly lower odds of burnout compared to doctors (adjusted odds ratio [aOR] = 0.47, 95% CI: 0.26–0.83; p = 0.009). Conclusion: Burnout at Cape Coast Teaching Hospital is both substantial and varies by profession, underscoring the need for differentiated responses. Nurses and health assistants had lower odds of experiencing burnout compared to doctors. These findings highlight the need for targeted interventions, including workload adjustments, structured mental health support, and organizational wellness programs.

Background/Aim: In most of Africa, including Ghana, access to surgical care is limited by socioeconomic factors, infrastructural constraints, and shortages in human resources. Short-term surgical missions (STSMs) have been used to bridge this gap by providing free surgical services, especially in rural areas. This study aimed to determine the morbidity profile and prevalence of postoperative complications among patients who underwent surgery during an STSM at a municipal hospital in the Volta Region of Ghana. Methods: This cross-sectional descriptive study involved a secondary analysis of data from 180 patients who underwent surgical procedures during an STSM at Ketu North Municipal Hospital, Volta Region, Ghana, from October 27 to November 2, 2024. The mission was conducted by a local team of 38 health professionals, including surgeons, nurses, and anesthetists. Patients’ selection was based on predetermined criteria. Results: The mean age of the patients was 45.7 (18.7) years, with a range of 2 to 82 years. Most patients were male (54.4%). Surgical care was provided for general surgical and gynecologic conditions. Inguinal hernia was the most common diagnosis (35.0%), with right-sided hernia being the predominant type, followed by lipoma (24.4%) and goiter (15.6%). Spinal anesthesia was the most frequently used anesthetic technique (47.8%). A low complication rate of 1.0% was observed, consisting mainly of urinary retention and pruritus. Conclusion: Short-term surgical missions can effectively address surgical needs in low-resource settings such as rural Ghana by providing safe surgical care with minimal complications. These findings underscore the importance of a well-organized mission and sustainable local partnerships to improve access to surgical care and patient outcomes.

The issue of antimicrobial resistance (AMR) is of global significance, affecting both developed and underdeveloped nations. In the context of low- and middle-income countries (LMICs), in Africa and other regions confronted with worsening health inequities such as inadequate healthcare resources and infrastructure, and a rising burden of infectious diseases, the adverse impact of antimicrobial resistance is exacerbated. This narrative review delves into the difficulties encountered in tackling the effects of AMR, focusing specifically on LMICs in Africa, where the overlap of climatic factors, socio-economic disparities, and inequities in access to healthcare intensifies the problem. The themes that emerged from the review include the need for infection prevention and control strategies, the adoption of a One Health approach to combat AMR, and the need for surveillance and monitoring. Several challenges were identified, including organizational and governmental issues, and the absence of leadership commitment. The review also emphasized the need for public and professional education for healthcare professionals and patients to promote and influence behavioral change patterns, a central aspect of AMR issues in Africa. These initiatives should be in tandem with enhanced diagnostic capacity, effective AMR surveillance, and capacity building at all levels of the healthcare system. Sustaining antimicrobial stewardship programs in Africa presents considerable obstacles, ranging from financial constraints to the lack of political will and coordinated efforts. When countries and partners adequately address these challenges by implementing sustainable solutions, LMICs in Africa can mitigate the threat of AMR, safeguard public health, and promote the responsible use of antimicrobials for future generations.

Background: Research is needed to improve the performance of primary health care. In Africa, few family physicians conduct research, and therefore an online research training and mentorship programme was developed to build research capacity amongst novice and early career researchers. Aim: To evaluate the implementation of the AfriWon Research Collaborative (ARC) training and e-mentorship programme in sub-Saharan Africa. Methods: A 10-module online curriculum was supported by peer and faculty e-mentorship, to mentor participants in writing a research protocol. A convergent mixed methods study combined quantitative and qualitative data to evaluate nine implementation outcomes. Findings: Fifty-three participants (20 mentees, 19 peer mentors, and 14 faculty mentors), mostly male (70%), participated in the ARC online programme. The programme was seen as an acceptable and appropriate initiative. Mentees were mostly postgraduate students from African countries. Faculty mentors were mostly experienced researchers from outside of Africa. There were issues with team selection, orientation, communication, and role clarification. Only 35% of the mentees completed the programme. Alignment of mentoring in teams and engagement with the online learning materials was an issue. Costs were relatively modest and dependent on donor funds. Conclusion: Despite many challenges, the majority of participants supported the sustainability of the programme. The evaluation highlights the strengths and weaknesses of the ARC programme and e-mentoring. The ARC working group needed to ensure better organization and leadership of the teams. Going forward the programme should focus more on developing peer mentors and local supervisory capacity as well as the mentees.

The integration of mental health into the management of non-communicable diseases (NCDs) is crucial, particularly in low-resource settings like Ghana. This is a report of an integrated care project in primary care for the management of patients with hypertension and type 2 diabetes mellitus. This quality improvement project involved screening, providing information and education about common warning signs for mental health problems, and available health personnel from whom patients can seek help. This practice quality improvement project was executed in a primary care hospital in Ghana under the World Organization of Family Doctors (WONCA) Integrating Care Leadership and Advocacy Programme. Adult patients with hypertension and/or type 2 diabetes mellitus were screened using the 4-item Patient Health Questionnaire (PHQ-4) tool for anxiety and depression. The project screened 205 patients, of which 39 (19%) were found to have either anxiety and/or depression and were managed appropriately. The findings underscore the importance of integrating mental health care into the management of non-communicable diseases. Additionally, integration is essential to enhancing access to appropriate interventions and decreasing fragmentation in the delivery of care. This approach improves access to comprehensive care, reduces treatment fragmentation, lowers healthcare costs, fosters better patient satisfaction through holistic treatment, and reduces the stigma associated with mental health issues. This paper gives support to the feasibility of this integration in primary care settings. Several benefits have been demonstrated, showing the necessity of such integration in primary care settings, and advocating for policy with detailed guidelines for integrating mental health into non-communicable disease care in Ghana.

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.

This article investigates the escalating occurrence of zoonotic diseases in Africa, attributing their spread to climate change and human activities. Africa’s unique combination of biodiversity, reliance on animal husbandry, and swift urbanization heightens its susceptibility. Climate change disrupts ecosystems and animal habitats, intensifying human-wildlife interactions. Urbanization, inadequate sanitation, and insufficient healthcare infrastructure further facilitate disease spread. Climate-induced displacement adds another layer of complexity. Mitigation strategies include improving surveillance systems, fostering early detection via point-of-care diagnostics and digital contact tracing, and investing in vaccines and therapeutics. Our purpose of this is to advocate for sustainable land use, robust community-level public health systems, international cooperation, and resource-sharing. We also emphasize the need for effective vector-control policies, dedicated research funding, and annual awareness, vaccination, and early detection campaigns in endemic regions.

Background: Chronic diseases are among the leading causes of morbidity and mortality worldwide that profoundly affect the quality of life of individuals. Quality of life assessment is crucial for developing effective interventions and policies aimed at improving patient outcomes and overall well-being. This study aimed to determine the quality of life of chronic disease patients treated with herbal medicine and their morbidity profile. Methods: This was a descriptive cross-sectional study done at the herbal clinic of the Ledzokuku Municipal Assembly Hospital in the greater Accra region of Ghana from March to June 2019. A consecutive sampling method was used. Data was collected through the administration of a structured questionnaire. Data was analysed using STATA 16. The level of significance used was p <0.05. Results: The qualities of life from the transformed mean scores of the four domains were good in physical health (51.33±15.91), psychological health (57.18±15.74), and environmental domain (55.72±13.82) but poor in social relationships (50.18±15.44). There was a significant association between the quality of life and physical health (p<0.05), psychological factors (p<0.05), social relationships (p=0.029) and environmental factors (p<0.05). Conclusion: The most frequent chronic disease presenting for herbal treatment in this study is hypertension. Patients with chronic diseases treated with herbal medicine had good transformed mean scores of quality of life (QOL) in the physical health, psychological domain, and environmental domain; however, only 44.1% of the participants rated their overall QOL as good.

Sub-Saharan Africa faces a rising burden of non-communicable diseases, particularly among young adults. Structured self-management education is essential for managing chronic conditions, especially in low-income settings where a significant portion of the population with noncommunicable diseases resides. To describe the effect of structured self-management education interventions on cardiometabolic disease outcomes in Sub-Saharan Africa. A systematic review of controlled trials that assessed the effect of structured self-management education interventions on cardiometabolic outcomes such as HbA1c, blood pressure, and quality of life was conducted. We searched across PubMed, CINAHL, and Cochrane Library databases. Data retrieval, appraisal, and extraction were done with confidence and involved key study characteristics. The risk of bias was assessed using the Cochrane Risk-of-Bias tool. The review was registered on PROSPERO CRD42024539490. In total 1821 studies were identified. Of these, 19 studies involving 6344 participants from eight sub-Saharan countries were included. The review found that in six out of 14 studies, structured self-management education intervention significantly improved glycaemic control in patients with type 2 diabetes. However, evidence regarding blood pressure control was limited, with only five studies reporting relevant outcomes, two of which showed statistically significant improvements. Overall, 68% (n=13) of the studies had either high risk or some risk of bias. The existing evidence on the effect of structured self-management education interventions on cardiometabolic disease outcomes in Sub-Saharan Africa is limited and checkered. Larger controlled trials are urgently needed to guide policy, and clinical practice and hopefully reverse the disturbing epidemiological trends in SubSaharan Africa.

The World Health Organisation's (WHO) 2013-2030 mental health action plan emphasized the complex relationship between mental disorders and non-communicable diseases (NCDs). The integration of mental health into the management of non-communicable diseases (NCDs) is crucial. This is a report of an integrated care project in primary care for the management of patients with hypertension and Type 2 diabetes. This practice quality improvement project was executed in a primary care hospital in Ghana under the World Organization of Family Doctors (WONCA) Integrating Care Leadership and Advocacy Programme. To increase mental health help-seeking among adult patients with hypertension and Type 2 diabetes through service integration. The project duration was from September 2023 to April 2024. The project involved screening, providing information about common warning signs for mental health problems through posters, and available health personnel from whom patients can seek help. Adult patients with hypertension and/or Type 2 diabetes were screened using the PHQ-4 tool for anxiety and depression from October 2023 to January 2024 and Health education sessions on mental health were organized for patients once every three months. The project screened 205 patients from October 2023 to January 2024, of which 39 (19%) were found to have either anxiety or depression and were managed by a collaborative team of professionals through patient-centred approaches. Following management, 36 had resolution of symptoms and three transferred their care to other facilities. The findings underscore the importance of incorporating mental health into care for chronic diseases enhancing access to appropriate interventions through collaborative teams. Integrating mental health into NCD management is essential for improving patient outcomes. This project demonstrates the necessity of such integration in primary care settings, advocating for policy with detailed guidelines for integrating mental health into NCD care in Ghana.