Dodowa Health Research Centre

BackgroundIn 2019, the RTS,S/AS01E malaria vaccine (RTS,S) was introduced into Ghana’s routine health system as part of the Malaria Vaccine Implementation Programme (MVIP). Household surveys were conducted prior to vaccine introduction and approximately 18 and 30 months post-introduction. We present a description of the area in Ghana based on the baseline household survey including malaria prevalence, malnutrition, wealth, insecticide-treated net (ITN) coverage, other health interventions (deworming, Vitamin A supplementation (VAS)), coverage of Expanded Programme on Immunization (EPI) vaccines, and health-seeking behaviour for febrile children.MethodsThe baseline household survey was conducted between 25 February and 18 March 2019 in a representative sample of 6778 households across 66 districts (33 in each of the implementing and comparator areas) in Ghana. Caregivers of children aged 5–48 months were interviewed. For each child, vaccination details were transcribed from the maternal and child health record book, and we measured the mid-upper arm circumference and obtained a malaria Rapid Diagnostic Test (RDT). Survey-weighted coverage estimates were obtained using standard survey methods. Survey Poisson regression was used to estimate prevalence ratios.ResultsOverall, 7768 children were included in the study, and 21% (95% CI 18–23) tested positive for malaria parasitemia by RDT. About 87%, 95%CI (85–89) of all households owned at least one ITN, and 62%, 95%CI (59–64) of children aged 5–48 months slept under an insecticide-treated net (ITN) the night before the survey. Additionally, 22%, 95%CI (21–24) of children reported having fever in the two weeks preceding the survey; among those with reported fever, 72%, 95%CI (69–74) sought advice or treatment, 40%, 95%CI (37–44) were tested for malaria, and 42%, 95%CI (39–46) of those with fever took an antimalarial drug. Additionally, 17%, 95%CI (16–19) had a mid-upper arm circumference (MUAC) ≤ 13.5 cm, and 1%, 95%CI (0–1) had a (MUAC) ≤ 11.5 cm. The uptake of vitamin A VAS in the 6 months prior to the survey was 36%, based on routine delivery through EPI, and deworming coverage was 29%. Coverage of EPI vaccines was > 90%. Indicators in comparison and implementation areas were comparable.ConclusionsThe pilot implementation and evaluation of the RTS,S malaria vaccine in Ghana was conducted in an area with substantial malaria transmission and illness, modest health-seeking behaviour and ITN use, and good EPI vaccine coverage. This study has established the baseline comparability between implementation and comparator areas, which serves as the foundation for future feasibility assessments.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12936-025-05778-9.

IntroductionProviding family-centred maternal, newborn and child health (MNCH) services along a care continuum could significantly improve outcomes in low- and middle-income countries (LMICs). In LIMCs, family systems care (FSC) is currently not well integrated into the continuum of care from hospital, community, to the home levels.ObjectiveThis scoping review aims to explore the approaches, methodologies and tools used to translate family systems care programmes/interventions in the continuum of care for MNCH in different care settings in LMICs.Eligibility criteriaThis scoping review will include evidence of approaches, methodologies and tools used to translate FSC into the care continuum for MNCH in LMICs. It will also include evidence reporting on contextual determinants, such as mitigating and limiting factors. Evidence not in English, outside the MNCH scope or using a person- rather than family-centred approach will be excluded.MethodsFollowing the recommendations of the Joanna Briggs Institute and the PRISMA Extension for Scoping Review checklist, the following stages will involve two or more researchers: (1) literature search, (2) data extraction, (3) analysis and (4) narrative summary. Medical Literature Analysis and Retrieval System Online (Medline), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and grey literature via organisational homepages will be searched. Published English work without limitation on publication year is eligible. Data extraction and analysis will be guided by a template comprising approaches, methodologies and tools to translate FSC into the care continuum. Data will be presented in tabular form with an accompanying narrative summary.Systematic review registrationThe protocol is registered with the Open Science Framework (https://osf.io/zwg9k).

Africa is the second largest and second most populous continent in the world. Governed by 54 recognised sovereign states, its people celebrate multiple traditions and speak countless dialects and languages apart from those inherited by varied colonial legacies. Despite historical and ongoing debts, it has one of the fastest growing global economies and vast natural resources.1 Its full potential, however, is not realized due in part to the lack of progress and regression on gender equality and sexual and reproductive health and rights.2

Abstract Introduction The World Health Organization in 2012 introduced the test, treat and track (T3) policy to standardize the process of malaria management in endemic settings. All malaria suspected conditions are expected to be confirmed by test and treatment initiated with recommended artemisinin-based combination therapy (ACTs) and treatment outcomes monitored over the course of the illness. This study evaluated the adherence to the T3 policy in selected health facilities within three malaria epidemiological zones in Ghana. Methods This crossectional study was conducted in November 2019 involving thirty health facilities comprising one district hospital, one Health Centre and 3 Community Health and Planning Services (CHPS) randomly selected from six districts in the 3 malaria epidemiological zones. In addition, Clients exit interviews were conducted from each facility. Frequency charts highlighted facility characteristics. Factors associated with the test, treat and track defined outcomes were assessed using chi square and multivariable logistic regression models at 5% level of significance and 95% confidence interval. Data were classified according to facility and clients’ perspectives. Results Overall, 590 patients and 30 health facility managers were interviewed from 30 facilities in 6 districts across the three zones. CHPS compounds formed 18 (60.0%) of facilities assessed. Twenty-nine out of 30 health facilities had Rapid Diagnostic Test (RDT) kits and antimalarials. In all, adherence to the T3 policy was 31.9%, whiles 30% of facility managers in the North and Middle zones indicated inadequate training on the T3 policy. The study showed that 90% and 98% of patients were tested and treated respectively for malaria. However only 35% (range 22% − 44%) of patients were tracked according to the T3 policy across all zones. Health facilities in the southern zone of Ghana had almost three-fold increased odds of adhering to the T3 policy compared to the middle zone [aOR = 2.87 (1.7, 4.8): p < 0.001]. Males were more likely not to return to the health facility for review [aOR = 0.6 (0.3, 0.9): p = 0.018]. Conclusion Testing and treating for malaria were high among health facilities in the three epidemiological zones. However, tracking of patients was very low across the zones. Adherence from clients’ perspective was low especially for males, who were more likely to default on health facility return for review, even though facility prescribers informed participants on the need to return for review. The hurdle for one to adhere to the policy was to return to facility for review. Recommendations The National Maria Elimination Program (NMEP) should ensure periodic trainings of health facility staff especially those within the Northern and Middle zones of Ghana and strengthen monitoring and supervision of health facilities to enhance adherence to the T3 policy. The NMEP could also intensify Client sensitization programs especially targeting male clients to help understand the need to return to health facilities for review in line with the T3 policy. There is also the need for implementation research to explore strategies to improve the tracking component of the policy at the client and health facilities levels within the T3 policy framework.

With most households in rapidly urbanizing cities in low- and medium-income countries using private and informal providers for basic healthcare, the need to establish linkages with the formal sector is paramount in the drive for universal health coverage. Successful and effective linkage of informal healthcare providers to the formal health system requires an understanding of prevailing contextual factors and how they can be modulated to support the linkages. Context plays a pivotal role in shaping the nature and success of any integration efforts. This paper, based on a qualitative study, explored the facilitating and constraining contextual influences shaping the linkage of informal healthcare providers into the formal health system in governance, service delivery, and data reporting. The research was conducted in Enugu and Anambra states in southeastern Nigeria. In-depth interviews were held with 12 senior healthcare managers, 16 primary healthcare facility managers, 32 informal providers, and 16 community leaders. Eight sex-disaggregated focus group discussions were held with health service users. Transcripts were coded in NVivo using a pre-defined coding framework comprising facilitators and constraints at the individual, organisational, and environmental levels. Individual factors that influence linkage of informal providers into the formal health system include personal attitudes towards linkage, capacity of informal providers to deliver quality services, nature of existing relationships between formal and informal providers, and trust in the formal health system. Organizational factors include leadership structure, coordination and accountability mechanisms, functional management capacity of the formal health system, and multiple regulatory frameworks. External factors include supportive health policies on integration, sustainable funding for continuous training and supportive supervision, and global agenda/support for integration. This study has provided valuable insights for decision makers and practitioners for harnessing the contextual factors to link informal healthcare providers successfully and effectively to the formal health system in order to improve access to quality health services in urban slums

BackgroundGlobally, adolescent health remains a public health priority given that adolescents often face unique vulnerabilities to health issues like mental disorders, substance abuse, and sexual health risks. In developing countries like Ghana, primary healthcare facilities (PHCs) are often the first point of contact for addressing these issues. However, there is a lack of literature examining the capacity of PHCs to address adolescent sexual and reproductive health (ASRH) issues. This study aims to fill this gap in the literature by assessing the availability and readiness of ASRH services within Ghana’s PHCs.MethodsThe study utilized a multi-stage sampling approach to select 67 PHCs across four districts in the Greater Accra region, reflecting Ghana's broad demographic diversity. We employed the WHO's Services Availability and Readiness Assessment (SARA) tool to measure the availability and readiness of ASRH services. This framework focused on key domains including service availability and readiness, assessing aspects such as HIV testing, family planning, and availability of contraceptives and necessary staff training. Data analysis was conducted using Stata version 17.0, analysing frequencies and percentages to capture the extent of service provision across the selected facilities.ResultsThe study highlighted significant disparities in the availability and readiness of essential ASRH services (HIV services, family planning, contraceptive pills, IUCD provisions, and male condoms) across selected districts and facility types. In Shai Osudoku, 65% of facilities offered a full range of selected ASRH services, the highest among the districts, whereas Ningo Prampram had the lowest at just 16%. In terms of facility types, 57% of CHPS facilities, 59% of health centres, and 44% of clinics provided all the selected ASRH services. Urban areas reported a 51% provision rate of these services, slightly less than the 54% observed in rural areas. Additionally, readiness disparities were evident: only 21% of urban facilities had adequate service guidelines compared to 29% in rural areas, and a higher percentage of rural facilities (46%) had trained staff, compared to 23% in urban areas.ConclusionThis study examined the availability and readiness of ASRH services in PHCs across the Greater Accra region, revealing significant disparities by location and facility type. Particularly, rural and public facilities demonstrated a higher availability of ASRH services compared to urban and private facilities. These findings suggest an uneven distribution of resources and highlight a potential urban underutilization of public health services. Moreover, the study identified a critical lack of service guidelines and trained staff across many facilities, emphasizing the need for enhanced training and resource allocation to improve service readiness. Targeted interventions are necessary to elevate the quality and accessibility of ASRH services, ensuring equitable health care delivery across all regions. Future research should expand to other regions to validate these findings and inform nationwide health strategies.

Abstract Background Mental health conditions are a significant threat to global health and have recently seen increased efforts to tackle them. Despite these efforts, common mental health conditions like stress, anxiety disorders, depression, schizophrenia, bipolar disorder, and substance use disorder continue to affect many people worldwide. In West Africa, the situation is worse because of the many factors that hinder access to primary care for these conditions. Our scoping review explored the factors that influence primary care access for common mental health conditions among adults in West Africa. Methods Using the approach for the conduct of scoping reviews described by Arksey and O’Malley in 2005, five electronic databases (PubMed, Embase, PsycINFO, CAIRN INFO, and Google Scholar), were searched for articles published between 1st January 2002 and 31st January 2024. Papers were screened by two independent reviewers and selected based on predetermined inclusion and exclusion criteria. This review adheres to the requirements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, extension for scoping reviews. Results After removing duplicate records titles and abstracts were screened for 1736 articles resulting in 39 articles eligible for full-text screening. After full-text screening, 28 articles were included in the review. Our review revealed that the factors that influence primary care access for common mental health conditions in West Africa act either at the level of the patient, the primary healthcare facility, or outside these two levels at the contextual level. Contextual factors include social norms, cultural beliefs, traditions, and socio-economic status. They influence primary care access for mental health by affecting the patient level and healthcare facility-level factors. Furthermore, the domains of influence at the patient level and facility level are interrelated. Conclusion Factors influencing primary care access for common mental health conditions among adults in West Africa are multiple, complex, and interrelated. Effective Interventions to improve primary care access for mental health need to be multi-faceted addressing individual, facility and systems, as well as contextual factors.

PurposeThe purpose of this study explores the perspective of key informants (educators, preceptors and former students) of the Kintampo Project, on the perceived effectiveness, gains and challenges in delivering this large-scale training innovation in Ghana. The problem of mental health care neglect in Ghana is gradually improving. The Kintampo Project which trained mental health workers in Ghana has played a critical role in increasing access to mental health care.Design/methodology/approachThis qualitative study explored participants' perspectives on the Kintampo Project in three broad areas: perceived effectiveness, gains and challenges. In all, 17 interviews were conducted with former students, preceptors and educators from the project. The interviews were digitally audio-recorded, transcribed, coded and analysed using deductive and thematic methods.FindingsThe participants perceived the project to have been successful in increasing the number of mental health workers in Ghana. The project provided a route for career progression for those involved. However, the Kintampo Project faced accreditation issues, low recognition, improper integration and remuneration of trained staff in the Ghana Health Service. This study points to the fact that the sustainability of mental health training in Ghana can be obstructed, because of this career path being less attractive. Further research is needed to explore how best to achieve sustainability of similar mental health innovations.Originality/valueThis paper shares the views of participants in the Kintampo Project.

To explore the experiences of health professionals and families concerning supporting low-birth weight (LBW) infants along the continuum of care (CoC) in Ghana with the goal to unveil new strategies to improve the quality of neonatal care. A constructivist grounded theory. Simultaneous data collection and analysis among health professionals alongside families with LBW infants from September 2020 to April 2021. The study used constructivist grounded theory strategies for data collection and analysis. The analysis of 25 interviews resulted in a theoretical model describing 10 themes along the CoC for LBW infants, categorized into health and family systems drivers. In this paper, we focus on the latter. Early bonding and family involvement were empowering. Mothers needed assistance in balancing hope and confidence which enabled them to render special care to their LBW infants. Providing mothers with financial and domestic support as well as creating awareness on newborn health in communities were important. To achieve family involvement, a coordinated CoC must entail key players and be culturally inclusive. It must be applied at all levels in the CoC process in a non-linear faction. This can help LBW infants to thrive and to reach their full developmental potential. The theoretical model developed shows the importance of family involvement through family systems care for a comprehensive response in addressing needs of health professionals and families with LBW infants and bridging the fragmentations in the neonatal CoC in Ghana. Context-tailored research on family systems care in the neonatal period is necessary to achieve a quality CoC for LBW infants and their families. Caregivers and providers participated by granting in-depth interviews. Care providers further contributed through their feedback on preliminary findings.