Background: We set out to estimate the community-level exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Ghana. Methods: Phased seroprevalence studies of 2729 participants at selected locations across Ghana were conducted. Phase I (August 2020) sampled 1305 individuals at major markets/lorry stations, shopping malls, hospitals and research institutions involved in coronavirus disease 2019 (COVID-19) work. The study utilized a lateral flow rapid diagnostic test (RDT) which detected IgM and IgG antibodies against SARS-CoV-2 nucleocapsid protein. Results: During Phase I, 252/1305 (19%) tested positive for IgM or IgG or both. Exposure was significantly higher at markets/lorry stations (26.9%) compared to malls (9.4%), with 41–60-year group demonstrating highest seropositivity (27.2%). Exposure was higher in participants with no formal education (26.2%) than those with tertiary education (13.1%); and higher in informally employed workers (24.0%) than those in the formal sector (15.0%). Results from phases II and III, in October and December 2020 respectively, implied either reduced transmissions or loss of antibody expression in some participants. The Upper East region showed the lowest seropositivity (2%). Phase IV, in February 2021, showed doubled seropositivity in the upper income bracket (26.2%) since August 2020, reflective of Ghana’s second wave of symptomatic COVID-19 cases. This suggested that high transmission rates had overcome the initial socioeconomic stratification of exposure risk. Reflective of second wave hospitalisation trends, the 21-40 age group demonstrated modal seropositivity (24.9) in Phase IV whilst 40-60 years and 60+ previously demonstrated highest prevalence. Conclusions: Overall, the data indicates higher COVID-19 seroprevalence than officially acknowledged, likely implying a considerably lower-case fatality rate than the current national figure of 0.84%. The data also suggests that COVID-19 is predominantly asymptomatic COVID-19 in Ghana. The observed trends mimic clinical trends of infection and imply that the methodology used was appropriate.
Respectful and disrespectful care profoundly influence communication and collaboration between caregivers and patients, shaping outcomes across the continuum of care. Despite patients being the primary users of healthcare services, their experiences of respectful and disrespectful care remain underexplored in Ghanaian healthcare settings. To address these systemic inadequacies, this study explored patients' understanding and experiences of respectful and disrespectful care. The study employed a qualitative design and was conducted in six healthcare facilities across Ghana. Thirteen focus group discussions were conducted with 90 participants, aged 18-87 years, between October and December 2022. Data were audio-recorded, translated, transcribed, and thematically analyzed. The mean age of participants was 42.7 ± 15.3 years, with a majority (72.2%) being female. Participants associated respectful care with timeliness and quality of patient reception, showing hospitality and friendliness to patients, clarity of communication and patient involvement in decisions, and providing non-discriminatory care. On the other hand, disrespectful care was characterized by long waiting times, poor coordination, poor staff attitudes, privacy violations, neglect of patient priorities, navigational challenges, inadequate infrastructure, and lack of required medicines, equipment, and supplies. These experiences significantly influenced participants' psychological well-being, satisfaction, and future healthcare-seeking behavior. While respectful care fosters trust and well-being, disrespectful care erodes satisfaction and discourages engagement with healthcare services. Systemic inadequacies must be urgently addressed to create a dignified, inclusive, compassionate, and responsive healthcare system in Ghana.
Background Ghana introduced the RTS,S/AS01 E (RTS,S) four-dosage malaria vaccine on a pilot basis to reduce malaria burden among children. However, achieving high coverages for all four recommended doses remains a challenge. We assessed coverage and factors associated with RTS,S vaccination uptake in a Health and Demographic Surveillance System (HDSS) area in Ghana. Methods The study used vaccination data collected through biannual cross-sectional surveys of children under-five years of age in the Navrongo HDSS area in 2021 and 2022. Data on RTS,S vaccination dates were transcribed from the maternal and child health record books. Poisson regression models were used to determine factors associated with receiving three or four RTS,S doses. Results Overall, 95%, 94%, and 89% of children aged 12 to 23 months received the first, second and third doses of RTS,S vaccine respectively. Children aged 12–23 months whose mothers had secondary or tertiary education were more likely to receive three RTS,S doses compared to those whose mothers had basic education (Prevalence ratio (PR): 1.03; 95% CI:(1.01–1.05)). Children delivered at home were less likely to receive three RTS,S doses compared to those delivered in health facilities (PR:0.89; 95% CI (0.85–0.94). Coverage of the fourth RTS,S dose was 66% among children aged 27–38 months, and 70% among children aged 27–48 months. Children aged 27–38 months delivered at home were less likely to receive four RTS,S doses compared to those delivered in a health facility (PR: 0.87; 95%CI: 0.79–0.96). Among children aged 27–38 months, those whose mothers were Christians were more likely to receive four RTS,S doses compared with those whose mothers were traditionalist (PR:1.08; 95% CI: 1.01–1.16). Residing in rural areas is associated with receiving four RTS,S doses compared to urban areas (PR: 1.24; 95% CI: 1.10–1.39). Conclusion This study revealed high coverages of the first three RTS,S doses. However, coverage of the fourth dose remains suboptimal. To improve uptake, particularly dose four, targeted interventions should focus on improving health facility delivery, addressing religious and urban-specific barriers to RTS,S vaccination to maximize the public health impact of the RTS,S vaccine.
The World Health Organization (WHO) recommends systematic follow-up testing for all bacteriologically confirmed pulmonary TB (PTB) cases under treatment to track progress towards successful treatment completion. However, this topic has received little attention from researchers. We assessed the extent of documentation of follow-up laboratory testing for TB treatment monitoring. Matched and unmatched records of bacteriologically confirmed PTB cases recorded between January 2016 and December 2017 across three TB registers from five districts of the Eastern Region were analyzed to assess documentation of follow-up laboratory testing at recommended treatment time points (months 2/3, 5, and 6/8). A cross-register consistency analysis assessed agreement between follow-up testing records documented in the laboratory register and those recorded in the district TB register, with the laboratory register treated as the reference source. A logistic regression model was used to identify factors associated with documentation of follow-up laboratory testing. A total of 773 bacteriologically confirmed PTB cases were successfully matched across the three registers after record linkage. The mean age was 42.6 years (SD = ± 15.0). More than half of the PTB cases in the district register did not have follow-up test results documented at 2 or 3 months (62.9
Background Anaemia is a major public health problem globally. District and community estimates of anaemia burden are crucial for appropriate targeted interventions. We described the prevalence and risk factors of low haemoglobin (Hb) levels and anaemia in a cross-sectional survey in the Navrongo Health and Demographic Surveillance. Methods We recruited participants aged < 1 to > 40 years from the Kassena-Nankana districts in Northern Ghana. We estimated distributions of Hb concentrations by age, sex, district and Hb variant status. We defined anaemia based on the WHO threshold of Hb < 11.0 g/dL for children under 5 years, < 11.5 g/dL for children between 5 and 12 years, < 13 g/dL for men and < 12 g/dL for women. We then performed covariate-adjusted logistic and linear regression models to investigate predictors of anaemia and Hb concentrations. Results The prevalence of anaemia was 53.2% (95% CI: 50.7-55.7) and was significantly higher in participants below 18 years. The lowest mean Hb levels (11.0 g/dL +/- 1.32) were observed in children less than 5 years who contributed 84.1% of the anaemia. Participants with sickle cell condition had the highest prevalence of anaemia (68.2%). Male gender, positive malaria status and living in the Kassena-Nankana West (KNW) were significantly associated with increased odds of anaemia. Conclusions Malaria, sickle cell conditions and male gender are some of the risk factors for anaemia in the study area. Health education should be continuous in the districts. Interventions to reduce anaemia should also target males, since it has clearly shown that male gender increases the risk of anaemia.
