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Background: In Ghana, breast cancer remains the most common cancer and the leading cause of cancer deaths among women. The cost of treating cancer is huge and poses a great challenge for patients, their families, and health care systems. While comprehensive studies have been conducted on the economic burden of cancers in developed economies such as the EU and the US, there are limited studies in Africa, and Ghana, in particular. This study quantitatively assessed Ghana's direct and indirect costs of breast cancer treatment. Methods: Primary data were collected using a questionnaire administered to 217 breast cancer patients at the Korle-Bu and Komfo Anokye Teaching Hospitals, Ghana's two leading hospitals, and Sweden Ghana Medical Centre. Direct and indirect costs were computed using the Cost-of-Illness Approach. Quantitative analysis was done using multivariate linear regression. Results: The findings showed that the breast cancer patients studied paid a median amount of Ghana cedis (GHC) 31,021.0 (IQR; 25,262.5–42,147.0), approximating USD 5,500.2 (IQR: 4,477.0–7,469.2 USD) for their treatment within one year of active treatment in 2019. About 61.9% (95% CI: 61.8–62.0%) of this cost was direct cost, while the remaining 38.1% (95% CI: 38.0–38.1%) was indirect cost. Patients who sought care from public facilities for breast cancer paid a median amount of GHC 29,606.3 (USD 5,249.3), while those who sought care from private facilities paid GHC 55,071.2 (USD 9,744.4). Findings from the multivariate linear regression indicate that being married/cohabiting, divorced/separated and having tertiary level education predicted higher cost of breast cancer treatment while patients on retirement and patients in the middle stage (Stage II) of breast cancer diagnoses were associated with lower cost of breast cancer treatment. Conclusions: The cost of breast cancer treatment poses a significant burden on patients and their families. There is a need for increased public funding for breast cancer treatment to reduce the huge economic burden its treatment poses for patients and their families. [ABSTRACT FROM AUTHOR]

Background: Breast and cervical cancers remain the most common cancers and the leading cause of cancer deaths in Ghana. Non-communicable diseases such as cancers, have been associated with psychological burdens such as anxiety and depression disorders as well as severe mental disorders such as bipolar disorder. As such the World Health Organisation has noted that mental health and well-being are crucial in reducing the NCD burden. Methods: A convergent mixed method approach was used to ascertain the psychosocial burden of breast and cervical cancer patients who sought treatment in three major cancer hospitals in Ghana. Primary data were collected using a questionnaire and an interview guide from 298 breast and cervical cancer patients seeking treatment at the Korle-Bu and Komfo Anokye Teaching Hospitals as well as the Sweden Ghana Medical Centre. Qualitative analysis was done using thematic content analysis while quantitative analysis was done using logistic regression. Results: The findings of the study showed that patients not only battled with psychological burdens such as anxiety, depression, pain, stigma, fear of death and loss of spouses but also struggled with physical, social, and dietary restrictions. Patients with low educational levels and income status, retired or unemployed, and/or had larger household sizes suffered more psychosocial burdens. Conclusion: There is a need for liaison psychiatrists and health psychologists to assist oncologists to provide psychological support such as free and routine counselling services for cancer patients and their caregivers. Educational campaigns on mainstream and social media need to be intensified to demystify the stigma surrounding cancers in Ghana. [ABSTRACT FROM AUTHOR]

Background: The epidemiological transition, touted as occurring in Ghana, requires research that tracks the changing patterns of diseases in order to capture the trend and improve healthcare delivery. This study examines national trends in mortality rate and cause of death at health facilities in Ghana between 2014 and 2018. Methods: Institutional mortality data and cause of death from 2014–2018 were sourced from the Ghana Health Service's District Health Information Management System. The latter collates healthcare service data routinely from government and non-governmental health institutions in Ghana yearly. The institutional mortality rate was estimated using guidelines from the Ghana Health Service. Percent change in mortality was examined for 2014 and 2018. In addition, cause of death data were available for 2017 and 2018. The World Health Organisation's 11th International Classification for Diseases (ICD-11) was used to group the cause of death. Results: Institutional mortality decreased by 7% nationally over the study period. However, four out of ten regions (Greater Accra, Volta, Upper East, and Upper West) recorded increases in institutional mortality. The Upper East (17%) and Volta regions (13%) recorded the highest increase. Chronic non-communicable diseases (NCDs) were the leading cause of death in 2017 (25%) and 2018 (20%). This was followed by certain infectious and parasitic diseases (15% for both years) and respiratory infections (10% in 2017 and 13% in 2018). Among the NCDs, hypertension was the leading cause of death with 2,243 and 2,472 cases in 2017 and 2018. Other (non-ischemic) heart diseases and diabetes were the second and third leading NCDs. Septicaemia, tuberculosis and pneumonia were the predominant infectious diseases. Regional variations existed in the cause of death. NCDs showed more urban-region bias while infectious diseases presented more rural-region bias. Conclusions: This study examined national trends in mortality rate and cause of death at health facilities in Ghana. Ghana recorded a decrease in institutional mortality throughout the study. NCDs and infections were the leading causes of death, giving a double-burden of diseases. There is a need to enhance efforts towards healthcare and health promotion programmes for NCDs and infectious diseases at facility and community levels as outlined in the 2020 National Health Policy of Ghana. [ABSTRACT FROM AUTHOR]

This study examines the role of poverty in the acquisition of and the adherence to antiretroviral therapy (ART) and prescribed clinical follow-up regimens among HIV-positive women. We conducted in-depth interviews with 40 women living with HIV (WLHIV) in Ghana and 15 stakeholders with a history of work in HIV-focused programs. Our findings indicate that financial difficulty contributed to limited ability to maintain treatment, the recommended nutrient-rich diet, and clinical follow-up schedules. However, enacted stigma and concurrent illness of family members also influenced the ability of the WLHIV to generate income; therefore, HIV infection itself contributed to poverty. To further examine the relation between finances, ART adherence, and the maintenance of recommended clinical follow-up, we present the perspectives of several HIV-positive peer counselor volunteers in Ghana's Models of Hope program. We recommend that programs to combat stigma continue to be implemented, as decreased stigma may reduce the financial difficulties of HIV-positive individuals. We also recommend enhancing current support programs to better assist peer counselor volunteers, as their role directly supports Ghana's national strategic HIV/AIDS plan. Finally, additional investment in poverty-reduction across Ghana, such as broadening meal assistance beyond the currently limited food programs, would lighten the load of those struggling to combat HIV and meet basic needs. [ABSTRACT FROM AUTHOR]

The livelihoods of persons living with HIV/AIDS (PLWHAs) in Ghana and sub-Saharan Africa have generally been under-researched using the social context approach. Employing the social context explanatory framework, we explore the livelihoods and challenges facing 38 PLWHAs in the Lower Manya Krobo Municipality (LMKM) in the Eastern Region of Ghana. LMKM has the highest prevalence of HIV/AIDS in Ghana. In-depth interviews have been conducted with participants who are out-patients at either of the two HIV/AIDS clinics in the study area. Their family relations, healthcare, healthcare seeking, and health status have been explored. The findings show the participants to generally be poor, have poorer health, and to have had some challenges to healthcare seeking, including food insecurity. They also lack sufficient support from family and romantic partners. Most have family members and romantic partners who had succumbed to HIV/AIDS. The participants generally have a high burden of child dependents, including orphans from HIV/AIDS. Our explanatory model confirms that the participants are caught at the interphase of intrapersonal, interpersonal, community, and national vulnerabilities that are interdependent and reciprocal. Safety-net provisions such as the National Health Insurance scheme provide them with inadequate social protection. For improved health status and general livelihood, we recommend more pro-active social support for the participants and their dependents. Furthermore having stakeholders make greater efforts is recommended for strengthening Ghana's economy against shocks. [ABSTRACT FROM AUTHOR]

Ghana implemented the National Health Insurance Scheme (NHIS) in 2005 with the intention of providing residents with quality affordable healthcare. Over the past few years, concerns have been raised about the quality of healthcare clients receive. This study assesses the experiences of NHIS subscribers with the quality of care they receive under the scheme by both private and public hospitals. The results from the 56 interviews show that the majority of the subscribers were dissatisfied with the overall quality of healthcare they received in both private and public hospital because of the long waiting hours, the poor attitude of nurses and the demand for payment of additional money. Even though clients who visited the private hospital paid for all services, excluding consultation, their level of satisfaction with the quality of healthcare was relatively higher than those who visited the public hospital. The paper concludes that NHIS clients do not receive the quality of healthcare the scheme promised, and this has implications for premium renewals and health-seeking behaviour. [ABSTRACT FROM AUTHOR]

Recently, Ghana has been plagued by increasing and disastrous fire emergencies, yet little research exists on Ghana’s fire response system. This paper examines the emergency fire response system in Kumasi, Ghana’s second largest city. We use spatial analysis to evaluate the geographic distribution of existing fire stations and their service areas, and identify coverage gaps based on specified response times. Our results show that large portions of the Kumasi Metropolitan Area are underserved, a situation that partly explains the huge losses in property and lives during recent fire outbreaks. Efficient location of fire stations using simple location–allocation models can help to improve response to fire emergencies and reduce the cost of fire outbreaks in African cities. [ABSTRACT FROM PUBLISHER]

Drug stock-outs are an unfortunate yet common reality for patients living in low and middle income countries, particularly in sub-Saharan Africa where trouble with consistent stock of antiretroviral medications (ARVs) continues. Our study takes a snapshot of this problem in Ghana. Although the country launched its antiretroviral therapy (ART) programme in 2003, progress toward realising the full benefit of ART for treated individuals has been limited, in part, because of stock-outs. In Ghana's Greater Accra region, we conducted semi-structured interviews with 40 women living with HIV (WLHIV) and 15 individuals with a history of HIV-related work in government or non-governmental organisations, or healthcare facilities. We used repeated review with coding and mapping techniques to analyse the transcripts and identify common themes. Stock-outs of ARVs result in inconsistent administration of therapy, increased indirect medical costs for WLHIV, and negative labelling of patients. Inefficiencies in drug supply, poor coordination with port authorities, inadequate government funding and dependence on international aid contribute to the stock-outs experienced in Ghana. Although using ARVs produced in-country could reduce supply problems, the domestically-manufactured product currently does not meet World Health Organization (WHO) standards. We recommend focused efforts to produce WHO standard ARVs in Ghana, and a review of current supply chain management to identify and mend pitfalls in the system. [ABSTRACT FROM PUBLISHER]

Although disclosure of positive HIV status has recognized benefits, enacted and perceived stigma is a continuing problem in Ghana, especially affecting women living with HIV (WLHIV). This qualitative study investigates how WLHIV make these decisions. We interviewed 40 WLHIV, analysing their transcripts using thematic content analysis. Four themes emerged from the data: selectivity in disclosure; disclosure for education, prevention and to provide support; concern for the potential confident, and safety in secrets. Women’s awareness of and concerns about HIV-related stigma led them to seriously weigh the costs and benefits of disclosure decisions. Overall, our participants disclosed only when they believed that disclosure would benefit them or the confidant. They did not condone open disclosure, and preferred non-disclosure to minimize harm to themselves and loved ones. Though disclosure occurred for HIV education and prevention purposes, personal safety was the priority. We recommend revision of current post-HIV testing and pre-treatment counselling procedures to incorporate WLHIVs’ judgements about disclosure and discussion of the perceived benefits of disclosure. Disclosure is an intricate process that involves support seeking and educating others while averting harm. Continued research of the factors related to disclosure is important to enhance understanding of the disclosure process. [ABSTRACT FROM PUBLISHER]

Background: Improving access to supervised and emergency obstetric care resources through fee reduction/exemption maternity care initiatives has been touted as one major strategy to avoiding preventable maternal deaths. Evaluations on the effect of Ghana's fee exemption policy for maternal healthcare have largely focused on how it has influenced health outcomes and patterns of use of supervised care with little attention to understanding the main factors influencing use. This study therefore sought to explore the main individual and health system factors influencing use of delivery care services under the policy initiative in the Central Region.Methods: A cross-sectional study was conducted using 412 mothers with children aged less than one year in one largely rural and another largely urban districts in the Central Region of Ghana from September to December 2013. Data were collected using a questionnaire survey on the socio-demographic characteristics of mothers, their knowledge and use of care under the fee free policy. Chi-square and Binary Logistic Regression tests were used to evaluate the main determinants of delivery care use under the policy.Results: Out of the 412 mothers interviewed, 268 (65 %) reported having delivered their most recent birth under the fee exemption policy even though awareness about the policy was almost universal 401 (97.3 %) among respondents. Utilization however differed for the two study districts. Respondents in the Cape Coast Metropolis (largely urban) used delivery service more (75.7 %) than those in the largely rural Assin North Municipal area (54.4 %). Binary logistic regression results identified maternal age, parity, religion, place of residence, awareness and knowledge about the fee exemption policy for maternal healthcare as significantly associated with the likelihood of delivery care use under the policy. The likelihood of using supervised delivery care under the policy was lower for mothers aged 20-29 compared to those in the age bracket of 40-49 (Odds ratio (OR) = 0.069, p = 0.003). For their index (last child), mothers who already had 1, 2 or 3 births were more likely to deliver under the policy than those with five or more births. Mothers living in urban areas were 3.79 times more likely to use delivery services under the policy than those living in rural areas (OR = 3.793, p = 0.000). The likelihood of using delivery services under the policy was higher for mothers who were aware and had full knowledge of the total benefit package of the policy (OR = 13.820, p = 0.022 and OR = 2.985, p = 0.001 for awareness and full knowledge respectively).Conclusions: Delivery service use under the free maternal healthcare policy is relatively low (65 %) when compared with nearly universal awareness (97.3 %) about the policy. Factors influencing delivery service use under the policy operate at both individual and policy implementation levels. Effective interventions to improve delivery service use under the policy should target the underlying individual and health policy implementation factors identified in the study. [ABSTRACT FROM AUTHOR]