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Koompah D, Teye-Kwadjo E, Kretchy IA. Problem Gambling and Suicidal Behaviours in Young Adult men in Ghana: A Moderated Mediation Model of Psychological Distress and Social Support : Journal of Gambling Studies. J Gambl Stud 2024:10.1007/s10899-024-10305-7. [PMID: 38652387 DOI: 10.1007/s10899-024-10305-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 04/25/2024]
Abstract
Problem gambling has been recognised as an important public health issue because of its harmful consequences at the personal, interpersonal, and societal levels. There is a proliferation of gambling activities in Ghana owing to increased access to the internet, soaring smartphone penetration, and an influx of sports betting companies. Yet, very little research has addressed the harm associated with problem gambling in Ghana. This study assessed if the effect of problem gambling severity on suicidal behaviours (ideation, planning, and attempts) through psychological distress is contingent on the level of perceived social support. A total of 350 young adult men in the Greater Accra Region of Ghana provided the data for the current analysis. The data were analysed using a moderated mediation approach. The results showed that psychological distress is an important intervening mechanism through which problem gambling severity influences suicidality. In addition, the positive association between psychological distress and suicidal behaviours was found to be conditional on the levels of perceived social support. In other words, our results showed that problem gambling may first trigger episodes of psychological distress, which, in turn, can lead to suicidality among problem gamblers who report low to moderate levels of perceived social support. Our findings suggest that young adult problem gamblers require higher levels of social support from family, friends, and significant others to prevent those experiencing psychological distress from engaging in suicidal behaviours.
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Affiliation(s)
- Dorothy Koompah
- Department of Psychology, University of Ghana, P. O. Box LG84, Legon, Accra, Ghana
| | - Enoch Teye-Kwadjo
- Department of Psychology, University of Ghana, P. O. Box LG84, Legon, Accra, Ghana.
- Department of Industrial Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa.
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, P. O. Box LG43, Legon, Ghana
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Kwakye AO, Kretchy IA, Peprah P, Mensah KB. Factors influencing medication adherence in co-morbid hypertension and diabetes patients: A scoping review. Explor Res Clin Soc Pharm 2024; 13:100426. [PMID: 38455671 PMCID: PMC10918559 DOI: 10.1016/j.rcsop.2024.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Interest in medication adherence has expanded significantly, especially in relation to the management of hypertension or diabetes in recent years. A scoping review that focuses on medication adherence in the co-morbidity of hypertension and diabetes provides crucial guidance for effective management of these interrelated diseases. Aim To conduct a scoping review of factors associated with medication adherence among individuals with co-morbid hypertension and diabetes. Methods The evaluation was conducted in accordance with the PRISMA-ScR guidelines to ensure the quality of the study. We searched three databases (Scopus, CINAHL, Medline) and one search engine (Google Scholar) from April 2023 to July 2023 on studies related to medication adherence in co-morbid hypertension and diabetes. Except for reviews there were no restrictions on design, location, and time of study. Results In total, 972 studies that were not duplicated were obtained. After eligibility and screening procedures were completed, 31 articles were ultimately included in the scoping review. Medication adherence was significantly affected by patient, condition, therapy, socio-economic and health related factors. Intervention trials revealed that education and counselling by pharmacists, nurses, physicians, diabetes educators, community health workers and the use of telephone to motivate patients significantly improved medication adherence. Conclusion This review shows the intricate factors influencing medication adherence in patients with co-morbid hypertension and diabetes, emphasizing the need for tailored interventions involving healthcare professionals, policymakers, and researchers.
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Affiliation(s)
- Adwoa Oforiwaa Kwakye
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Prince Peprah
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kofi Boamah Mensah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Peprah P, Yeboah-Asiamah Asare B, Nyadanu SD, Asare-Doku W, Adu C, Peprah J, Osafo J, Kretchy IA, Gyasi RM. Considering the Cultural Context of Parental Involvement and Loneliness. J Adolesc Health 2023; 73:1166-1167. [PMID: 37980078 DOI: 10.1016/j.jadohealth.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Prince Peprah
- Social Policy Research Centre, University of New South Wales, Sydney, Australia; Centre for Primary Health Care and Equity, University New South Wales, Sydney, Australia
| | - Bernard Yeboah-Asiamah Asare
- Curtin School of Population Health, Curtin University, Bentley, Western Australia; Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | | | - Winnifred Asare-Doku
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia; Centre for Suicide and Violence Research (CSVR), University of Ghana, Legon, Ghana
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; Center for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer Peprah
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Joseph Osafo
- Centre for Suicide and Violence Research (CSVR), University of Ghana, Legon, Ghana; Department of Psychology, University of Ghana, Legon, Ghana
| | - Irene A Kretchy
- Centre for Suicide and Violence Research (CSVR), University of Ghana, Legon, Ghana; Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya
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Dake S, Bonful HA, Ganu V, Puplampu P, Asamoah A, Arthur HA, Mwintuu L, Asampong E, Kretchy IA, Anum A. Coping strategies among adolescents and young adults living with HIV/AIDS in Accra-Ghana. BMC Public Health 2023; 23:2350. [PMID: 38012649 PMCID: PMC10683146 DOI: 10.1186/s12889-023-17147-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 08/28/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Living with HIV/AIDS is remarkably stressful and has an adverse effect on one's physical and mental health. In Sub-Saharan Africa, the introduction of highly active anti-retroviral therapy has led to an increased number of children with perinatal acquired HIV who are living into adolescence and adulthood. Developing strategies to cope with HIV becomes imperative, especially among these adolescents. The study determined the factors that influence coping strategies among adolescents living with HIV. METHODS An analytic cross-sectional design was used. A total of 154 adolescents aged 10-19 years living with HIV were systematically sampled at the Fevers Unit of Korle Bu Teaching Hospital from June to December, 2021. The adolescent version of the KidCope tool was used to assess the choice of coping strategies. Stata 16 was used to determine associations between independent variables and the coping strategies identified. Only variables that were significant at p = 0.1 or less in the crude model were used to run the adjusted regression model. The level of significance was set at p = 0.05 with a 95% confidence interval. RESULTS The mean age of participants was 19.2 ± 0.45 years with 51.9% (80/154) of participants being males. A majority, 57.1% of the participants employed positive coping strategies with 87.0% (135/154) using cognitive restructuring strategy. In an adjusted linear regression model, participants coping strategies were significantly associated with their educational level (p = 0.04) and presence of both parents as caregivers (p = 0.02). CONCLUSION Participants largely adopted positive coping strategies in managing the disease. Factors that influenced the choice of coping strategies were higher levels of education and the presence of both parents as caregivers. The importance of a good social support structure and pursuing further education needs to be emphasized in counselling adolescents living with HIV as it promotes the choice of positive coping strategies.
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Affiliation(s)
- Selom Dake
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Harriet Affran Bonful
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana.
| | - Vincent Ganu
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Peter Puplampu
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Alexander Asamoah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
- Public Health Division, Ghana Health Service, Accra, Ghana
| | - Hannah Ama Arthur
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Linus Mwintuu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Emmanuel Asampong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Accra, Ghana
| | - Adote Anum
- Department of Psychology, University of Ghana, Accra, Ghana
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Koduah A, Baatiema L, Kretchy IA, Agyepong IA, Danso-Appiah A, de Chavez AC, Ensor T, Mirzoev T. Implementation of Medicines Pricing Policies in Ghana: The Interplay of Policy Content, Actors' Participation, and Context. Int J Health Policy Manag 2023; 12:7994. [PMID: 38618785 PMCID: PMC10699811 DOI: 10.34172/ijhpm.2023.7994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/25/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Implementing medicines pricing policy effectively is important for ensuring equitable access to essential medicines and ultimately achieving universal health coverage. However, published analyses of policy implementations are scarce from low- and middleincome countries. This paper contributes to bridging this knowledge gap by reporting analysis of implementation of two medicines pricing policies in Ghana: value-added tax (VAT) exemptions and framework contracting (FC) for selected medicines. We analysed implications of actor involvements, contexts, and contents on the implementation of these policies, and the interplay between these. This paper should be of interest, and relevance, to policy designers, implementers, the private sector and policy analysts. METHODS Data were collected through document reviews (n=18), in-depth interviews (n=30), focus groups (n=2) and consultative meetings (n=6) with purposefully identified policy actors. Data were analysed thematically, guided by the four components of the health policy triangle framework. RESULTS The nature and complexity of policy contents determined duration and degree of formality of implementation processes. For instance, in the FC policy, negotiating medicines prices and standardizing the tendering processes lengthened implementation. Highly varied stakeholder participation created avenues for decision-making and promoted inclusiveness, but also raised the need to manage different agendas and interests. Key contextual enablers and constraints to implementation included high political support and currency depreciation, respectively. The interrelatedness of policy content, actors, and context influenced the timeliness of policy implementations and achievement of intended outcomes, and suggest five attributes of effective policy implementation: (1) policy nature and complexity, (2) inclusiveness, (3) organizational feasibility, (4) economic feasibility, and (5) political will and leadership. CONCLUSION Varied contextual factors, active participation of stakeholders, nature, and complexity of policy content, and structures have all influenced the implementation of medicines pricing policies in Ghana.
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Affiliation(s)
- Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana
| | - Leonard Baatiema
- Department of Health Policy, Planning & Management, School of Public Health, University of Ghana, Legon, Ghana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana
| | - Irene Akua Agyepong
- Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | | | - Timothy Ensor
- Nuffield Centre for International Health, University of Leeds, Leeds, UK
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Opuni KF, Kretchy JP, Agyabeng K, Boadu JA, Adanu T, Ankamah S, Appiah A, Amoah GB, Baidoo M, Kretchy IA. Contamination of herbal medicinal products in low-and-middle-income countries: A systematic review. Heliyon 2023; 9:e19370. [PMID: 37674839 PMCID: PMC10477504 DOI: 10.1016/j.heliyon.2023.e19370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023] Open
Abstract
The use of herbal medicinal products (HMPs) has grown significantly across low-and-middle-income countries (LMICs). Consequently, the safety of these products due to contamination is a significant public health concern. This systematic review aimed to determine the prevalence, types, and levels of contaminants in HMPs from LMICs. A search was performed in seven online databases, i.e., Africa journal online (AJOL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Directory of Open Access Journals (DOAJ), Health Inter-Network Access to Research Initiative (HINARI), World Health Organization Global Index Medicus (WHO GIM), Scopus, and PubMed using appropriate search queries and reported as per the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Ninety-one peer-reviewed articles published from 1982 to 2021 from 28 different countries across four continents were included in the study. Although metals, microbial, mycotoxins, pesticides, and residual solvents were the reported contaminants in the 91 articles, metals (56.0%, 51/91), microbial (27.5%, 25/91), and mycotoxins (18.7%, 17/91) were the most predominant. About 16.4% (1236/7518) of the samples had their contaminant levels above the regulatory limits. Samples tested for microbial contaminants had the highest proportion (46.4%, 482/1039) of contaminants exceeding the regulatory limit, followed by mycotoxins (25.8%, 109/423) and metals (14.3%, 591/4128). The proportion of samples that had their average non-essential metal contaminant levels above the regulatory limit was (57.6%, 377/655), 18.3% (88/480), 10.7% (24/225), and 11.3% (29/257) for Pb, Cd, Hg, and As, respectively. The commonest bacteria species found were Escherichia coli (52.3%, 10/19) and Salmonella species (42.1%, 8/19). This review reported that almost 90% of Candida albicans and more than 80% of moulds exceeded the required regulatory limits. HMP consumption poses profound health implications to consumers and patients. Therefore, designing and/or implementing policies that effectively regulate HMPs to minimize the health hazards related to their consumption while improving the quality of life of persons living in LMICs are urgently needed.
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Affiliation(s)
- Kwabena F.M. Opuni
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - James-Paul Kretchy
- Department of Public Health, School of Medicine and Health Sciences, Central University, P. O. Box 2305, Miotso, Accra, Ghana
| | - Kofi Agyabeng
- Department of Biostatistics, School of Public Health, University of Ghana, P. O. Box LG13, Legon, Accra, Ghana
| | - Joseph A. Boadu
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Theodosia Adanu
- Balme Library, University of Ghana, P.O. Box LG24, Legon, Accra, Ghana
| | - Samuel Ankamah
- Balme Library, University of Ghana, P.O. Box LG24, Legon, Accra, Ghana
| | - Alexander Appiah
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Geralda B. Amoah
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Mariam Baidoo
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
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Peprah P, Asare BYA, Nyadanu SD, Asare-Doku W, Adu C, Peprah J, Osafo J, Kretchy IA, Gyasi RM. Bullying Victimization and Suicidal Behavior among adolescents in 28 Countries and Territories: A Moderated Mediation Model. J Adolesc Health 2023; 73:110-117. [PMID: 36925410 DOI: 10.1016/j.jadohealth.2023.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 12/10/2022] [Accepted: 01/26/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Previous studies have increasingly shown the adverse effects of being bullied on suicidal behavior among young people, but the mechanisms underlying this association remain unclear. We examined the association between bullying and suicidal behavior among in-school adolescents. We further tested whether loneliness mediated the link between bullying and suicidal behavior and explored the moderated role of parental involvement in this association. METHODS We used cross-sectional school-based data from the Global School-based Student Health Survey among 28 countries and territories. Adjusted, modified Poisson regressions with robust variance relative risks and moderation analyses were used to examine associations among bullying, suicidal behavior, and parental involvement. The mediating effect of loneliness on the bullying-suicidal behavior link was assessed using the generalized decomposition method. RESULTS A total of 78,558 school-going adolescents participated in this study. Bullying was associated with a 44% increased risk of suicidal behavior after adjusting for potential confounders (relative risk = 1.44; 95% confidence interval = 1.39-1.48). Loneliness partially mediated the association between bullying and suicidal behavior, and parental involvement moderated the association. DISCUSSION The findings suggest the need to recognize the dual burden of bullying and loneliness when addressing suicidal behavior and the importance of parental support in adolescents' mental health and well-being.
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Affiliation(s)
- Prince Peprah
- Social Policy Research Centre, University of New South Wales, Sydney, Australia; Centre for Primary Health Care and Equity, University New South Wales, Sydney, Australia
| | - Bernard Yeboah-Asiamah Asare
- Curtin School of Population Health, Curtin University, Bentley, Western Australia; Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Winifred Asare-Doku
- National Drug and Alcohol Research Centre, University of New South Wales, Australia; Centre for Suicide and Violence Research (CSVR), University of Ghana, Legon, Ghana
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; Center for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Jennifer Peprah
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Joseph Osafo
- Centre for Suicide and Violence Research (CSVR), University of Ghana, Legon, Ghana; Department of Psychology, University of Ghana, Legon
| | - Irene A Kretchy
- Centre for Suicide and Violence Research (CSVR), University of Ghana, Legon, Ghana; Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Ghana
| | - Razak M Gyasi
- African Population and Health Research Center, Manga Close, Nairobi, Kenya
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Peprah P, Asare BYA, Okwei R, Agyemang-Duah W, Osafo J, Kretchy IA, Gyasi RM. A moderated mediation analysis of the association between smoking and suicide attempts among adolescents in 28 countries. Sci Rep 2023; 13:5755. [PMID: 37031212 PMCID: PMC10082789 DOI: 10.1038/s41598-023-32610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 03/30/2023] [Indexed: 04/10/2023] Open
Abstract
Globally, evidence has shown that many adolescents are victims of substance use, mainly cigarette smoking, and it has been associated with suicidal ideation. However, the mechanisms underlying this association are poorly understood. This study examines whether truancy mediates and gender moderates the association of cigarette smoking with suicide attempts among adolescents in 28 countries. Data from the Global School-Based Student Health Survey were used. Hierarchical multiple logistic regression analyses were used to estimate the effect-modification of gender on cigarette smoking and suicide attempt. The mediating effect of truancy on the association between cigarette smoking and suicidal attempt was assessed using the generalized decomposition method. Cigarette smoking was associated with suicide attempts after adjusting for several confounding variables (aOR = 1.21; 95% CI = 1.09-1.33). The bootstrap results from the generalized decomposition analysis indicated that truancy partially mediated the association of cigarette smoking with a suicide attempt, contributing 21% of the total effect among in-school adolescents. Hierarchical regression analyses suggested that gender moderated the effect of cigarette smoking on suicidal attempts: female adolescents who smoked had 36% higher odds of suicidal attempts compared to male adolescents. The findings suggest possible pathways for designing and implementing interventions to address adolescents' cigarette smoking and truancy to prevent suicidal attempts.
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Affiliation(s)
- Prince Peprah
- Social Policy Research Centre, University of New South Wales, Sydney, Australia.
- Centre for Primary Health Care and Equity, University New South Wales, Sydney, Australia.
| | - Bernard Yeboah-Asiamah Asare
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Reforce Okwei
- Department of Geography, Miami University, Oxford, USA
| | | | - Joseph Osafo
- Department of Psychology, University of Ghana, Legon, Ghana
- Centre for Suicide and Violence Research - CSVR, Accra, Ghana
| | - Irene A Kretchy
- Centre for Suicide and Violence Research - CSVR, Accra, Ghana
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Razak M Gyasi
- African Population and Health Research Center, Manga Close, Off-Kirawa Road, P.O. Box 10787, Nairobi, 00100, Kenya
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Baah-Nyarkoh E, Alhassan Y, Dwomoh AK, Kretchy IA. Medicated-related burden and adherence in patients with co-morbid type 2 diabetes mellitus and hypertension. Heliyon 2023; 9:e15448. [PMID: 37151709 PMCID: PMC10161589 DOI: 10.1016/j.heliyon.2023.e15448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 05/09/2023] Open
Abstract
Background Medication adherence is an integral component in the management of patients with co-morbid type 2 diabetes mellitus (T2DM) and hypertension. However due to their combined conditions, there is likelihood of polypharmacy and medication-related burden, which could negatively impact adherence to therapy. This study aimed to assess the perceived medication-related burden among patients with co-morbid T2DM and hypertension and to evaluate the association between the perceived burden and adherence to medication therapy. Methods A cross-sectional study was conducted among adult patients with co-morbid T2DM and hypertension attending a primary health facility. The living with medicines questionnaire and the medication adherence report scale were used to assess extent of medication-related burden and adherence respectively. Binary logistic regression model was used to estimate the adjusted odds and their corresponding 95% confidence interval for medication-related burden and adherence outcomes. All observed categorical variables were considered for the multivariable binary logistic regression model. Results The total number of participants was 329 with a median age of 57.5 ± 13.2 years. The median score for the overall burden was 99 (IQR: 93-113), and this significantly varied by sex (p = 0.012), monthly income (p = 0.025), monthly expenditure on medications (p = 0.012), frequency of daily dose of medications (p = 0.020) and family history of T2DM (p < 0.001). About 30.7% and 36.8% of participants reported moderate/high burden and medication adherence respectively. Uncontrolled diastolic blood pressure (AOR: 2.46, 95% CI: 1.20-5.05, p = 0.014), high glucose (AOR: 4.24, 95% CI: 2.13-8.46, p < 0.001) and no family history of T2DM (AOR: 2.14, 95% CI: 1.14-4.02, p = 0.026) were associated with moderate/high medication burden. Uncontrolled diastolic blood pressure (AOR: 0.48, 95% CI: 0.25-0.94, p = 0.031), at least 5 years since hypertension diagnosis (AOR: 0.55, 95% CI: 0.30-0.99, p = 0.045) and moderate/high medication-related burden (AOR: 0.33, 95% CI: 0.16-0.69, p = 0.003) were associated with lower odds of medication adherence. Conclusion These findings suggest that to improve the preventive and optimal care of patients with T2DM and hypertension, interventions that aim to reduce medication-related burden and morbidity are recommended. The study proposes that health stakeholders such as clinicians, pharmacists, and policy makers, develop multidisciplinary clinical and pharmaceutical care interventions to include provision of counselling to patients on adherence. In addition, developing policies and sensitization activities on deprescribing and fixed-dose drug combinations aimed at reducing medication-related burden, while promoting better adherence, blood pressure and blood glucose outcomes are recommended.
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Affiliation(s)
- Emmanuella Baah-Nyarkoh
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Yakubu Alhassan
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana
| | - Andrews K. Dwomoh
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
- Corresponding author.
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Kretchy IA, Okoibhole LO, Sanuade OA, Jennings H, Strachan DL, Blandford A, Agyei F, Asante P, Todowede O, Kushitor M, Adjaye-Gbewonyo K, Arhinful D, Baatiema L, Dankyi E, Grijalva-Eternod CS, Fottrell EF, de-Graft Aikins A. Scoping review of community health participatory research projects in Ghana. Glob Health Action 2022; 15:2122304. [DOI: 10.1080/16549716.2022.2122304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana
| | | | - Olutobi Adekunle Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Hannah Jennings
- Department of Health Sciences, University of York and Hull York Medical School, York, UK
| | - Daniel Ll Strachan
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Ann Blandford
- Department of Computer Science, UCLIC, University College London, London, UK
| | - Francis Agyei
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Paapa Asante
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Olamide Todowede
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Mawuli Kushitor
- Department of Health Policy Planning and Management, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Kafui Adjaye-Gbewonyo
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - Daniel Arhinful
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Leonard Baatiema
- Department of Health Policy, School of Public Health, Planning and ManagementUniversity of Ghana, Legon, Ghana
| | - Ernestina Dankyi
- Centre for Social Policy Studies, University of Ghana, Legon, Ghana
| | - Carlos S. Grijalva-Eternod
- Institute for Global Health, University College London, London, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Koduah A, Baatiema L, de Chavez AC, Danso-Appiah A, Kretchy IA, Agyepong IA, King N, Ensor T, Mirzoev T. Implementation of medicines pricing policies in sub-Saharan Africa: systematic review. Syst Rev 2022; 11:257. [PMID: 36457058 PMCID: PMC9714131 DOI: 10.1186/s13643-022-02114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND High medicine prices contribute to increasing cost of healthcare worldwide. Many patients with limited resources in sub-Saharan Africa (SSA) are confronted with out-of-pocket charges, constraining their access to medicines. Different medicine pricing policies are implemented to improve affordability and availability; however, evidence on the experiences of implementations of these policies in SSA settings appears limited. Therefore, to bridge this knowledge gap, we reviewed published evidence and answered the question: what are the key determinants of implementation of medicines pricing policies in SSA countries? METHODS We identified policies and examined implementation processes, key actors involved, contextual influences on and impact of these policies. We searched five databases and grey literature; screening was done in two stages following clear inclusion criteria. A structured template guided the data extraction, and data analysis followed thematic narrative synthesis. The review followed best practices and reported using PRISMA guidelines. RESULTS Of the 5595 studies identified, 31 met the inclusion criteria. The results showed thirteen pricing policies were implemented across SSA between 2003 and 2020. These were in four domains: targeted public subsides, regulatory frameworks and direct price control, generic medicine policies and purchasing policies. Main actors involved were government, wholesalers, manufacturers, retailers, professional bodies, community members and private and public health facilities. Key contextual barriers to implementation were limited awareness about policies, lack of regulatory capacity and lack of price transparency in external reference pricing process. Key facilitators were favourable policy environment on essential medicines, strong political will and international support. Evidence on effectiveness of these policies on reducing prices of, and improving access to, medicines was mixed. Reductions in prices were reported occasionally, and implementation of medicine pricing policy sometimes led to improved availability and affordability to essential medicines. CONCLUSIONS Implementation of medicine pricing policies in SSA shows some mixed evidence of improved availability and affordability to essential medicines. It is important to understand country-specific experiences, diversity of policy actors and contextual barriers and facilitators to policy implementation. Our study suggests three policy implications, for SSA and potentially other low-resource settings: avoiding a 'one-size-fits-all' approach, engaging both private and public sector policy actors in policy implementation and continuously monitoring implementation and effects of policies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178166.
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Affiliation(s)
- Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Leonard Baatiema
- Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Anna Cronin de Chavez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | | | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Timothy Ensor
- Nuffield Centre for International Health, University of Leeds, Leeds, UK
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Koduah A, Baatiema L, Kretchy IA, Agyepong IA, Danso-Appiah A, de Chavez AC, Ensor T, Mirzoev T. Powers, engagements and resultant influences over the design and implementation of medicine pricing policies in Ghana. BMJ Glob Health 2022; 7:bmjgh-2021-008225. [PMID: 35589156 PMCID: PMC9121428 DOI: 10.1136/bmjgh-2021-008225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Universal availability and affordability of essential medicines are determined by effective design and implementation of relevant policies, typically involving multiple stakeholders. This paper examined stakeholder engagements, powers and resultant influences over design and implementation of four medicines pricing policies in Ghana: Health Commodity Supply Chain Master Plan, framework contracting for high demand medicines, Value Added Tax (VAT) exemptions for selected essential medicines, and ring-fencing medicines for local manufacturing. Methods Data were collected using reviews of policy documentation (n=16), consultative meetings with key policy actors (n=5) and in-depth interviews (n=29) with purposefully identified national-level policymakers, public and private health professionals including members of the National Medicine Pricing Committee, pharmaceutical wholesalers and importers. Data were analysed using thematic framework. Results A total of 46 stakeholders were identified, including representatives from the Ministry of Health, other government agencies, development partners, pharmaceutical industry and professional bodies. The Ministry of Health coordinated policy processes, utilising its bureaucratic mandate and exerted high influences over each policy. Most stakeholders were highly engaged in policy processes. Whereas some led or coproduced the policies in the design stage and participated in policy implementation, others were consulted for their inputs, views and opinions. Stakeholder powers reflected their expertise, bureaucratic mandates and through participation in national level consultation meetings, influences policy contents and implementation. A wider range of stakeholders were involved in the VAT exemption policies, reflecting their multisectoral nature. A minority of stakeholders, such as service providers were not engaged despite their interest in medicines pricing, and consequently did not influence policies. Conclusions Stakeholder powers were central to their engagements in, and resultant influences over medicine pricing policy processes. Effective leadership is important for inclusive and participatory policymaking, and one should be cognisant of the nature of policy issues and approaches to policy design and implementation.
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Affiliation(s)
- Augustina Koduah
- Pharmacy Practice and Clinical Pharmacy, University of Ghana School of Pharmacy, Legon, Accra, Ghana
| | - Leonard Baatiema
- Health Policy, Planning & Management, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Irene A Kretchy
- Pharmacy Practice and Clinical Pharmacy, University of Ghana School of Pharmacy, Legon, Accra, Ghana
| | - Irene Akua Agyepong
- Dodowa Health Research Centre, Ghana Health Service, Accra, Greater Accra, Ghana.,Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Greater Accra, Ghana
| | - Anthony Danso-Appiah
- Epidemiology and Disease Control, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Anna Cronin de Chavez
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Timothy Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Tolib Mirzoev
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, London, UK
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Boima V, Yeboah AK, Kretchy IA, Koduah A, Agyabeng K, Yorke E. Health-related quality of life and its demographic, clinical and psychosocial determinants among male patients with hypertension in a Ghanaian tertiary hospital. Ghana Med J 2022; 56:5-14. [PMID: 35919776 PMCID: PMC9334954 DOI: 10.4314/gmj.v56i1.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: This study aimed to evaluate Health-related quality of life (HRQoL) among male patients with hyperten-sion and its associated demographic, clinical and psychosocial factors.Design: This was a facility-based cross-sectional studySetting: This study was carried out at the outpatient department in Korle-Bu Teaching HospitalParticipants: Three hundred and fifty-eight hypertensive patients were recruited for this studyData collection: Information on socio-demographic characteristics, clinical features, insomnia, medication adherence, psychological distress, sexual dysfunction and HRQoL were obtained through patient-reported measures using struc-tured questionnaires and standardised instruments. Statistical analysis/Main outcome measure: The study assessed HRQoL among male hypertensive patients. One-way ANOVA was used to compare the average scores of the various domains of HRQL across the independent vari-ables. Multivariate linear regression models with robust standard errors were used to determine factors associated with quality of life.Results: Participants with poor perceived overall HRQoL was 14.0%. Comparatively, HRQoL (mean ± SD) was the least in the physical health domain (56.77±14.33) but the highest in the psychological domain (58.7 ± 16.0). Multi-variate linear regression showed that income level, educational level, insomnia, overall satisfaction, sexual desire and medication adherence were significant predictors of HRQoL. Average scores of HRQoL domains reduced with a higher level of sexual desire dysfunction.Conclusion: HRQoL among male hypertensive patients was negatively affected by insomnia, sexual desire dysfunc-tion, educational level and adherence to antihypertensive medications but positively affected by income level. Clinical practice and policy processes should be directed at these factors to improve HRQoL.
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Affiliation(s)
- Vincent Boima
- University of Ghana Medical School, Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana, Box 4236 Accra, Ghana
| | - Alberta K Yeboah
- School of Pharmacy, Department of Pharmacy Practice and Clinical Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Irene A Kretchy
- School of Pharmacy, Department of Pharmacy Practice and Clinical Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Augustina Koduah
- School of Pharmacy, Department of Pharmacy Practice and Clinical Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Kofi Agyabeng
- National Inspectorate Board. Ministry of Education, PMB M18, Accra, Ghana
| | - Ernest Yorke
- University of Ghana Medical School, Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana, Box 4236 Accra, Ghana
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Nanteer-Oteng E, Kretchy IA, Nanteer DO, Kretchy JP, Osafo J. Hesitancy towards COVID-19 vaccination: The role of personality traits, anti-vaccine attitudes and illness perception. PLOS Glob Public Health 2022; 2:e0001435. [PMID: 36962915 PMCID: PMC10021484 DOI: 10.1371/journal.pgph.0001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/28/2022] [Indexed: 12/29/2022]
Abstract
There is an increased need for COVID-19 vaccination since the world is gradually returning to normal. Current evidence supports vaccination activity more towards viral suppression than COVID-19 prevention. This has led to divergent views regarding vaccination which may influence anti-vaccine attitudes and vaccine hesitancy. The study examined the role of personality traits, anti-vaccine attitudes and illness perceptions on vaccine hesitancy. The study was a cross-sectional survey using snowball and convenience sampling to recruit 492 participants via social media platforms. Multivariate analysis of variance and regression analysis were used to test the hypotheses. The study found that some facets of illness perception (identity, concern, emotional representation and treatment control), extraversion, experience with COVID-19 and anti-vaccine attitudes (mistrust, profiteering, worries about unforeseen effects of vaccine) predicted vaccine hesitancy. The outcomes from this study have implications for achieving public health goals and developing strategies for reaching optimal vaccination targets and attaining herd immunity. Health-promoting programs need to be intensified and could include psychosocial perspectives on vaccine hesitancy so that specific target groups can be reached to be vaccinated.
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Affiliation(s)
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Accra, Ghana
| | - Deborah Odum Nanteer
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Accra, Ghana
| | - James-Paul Kretchy
- Public Health Unit, School of Medicine and Health Sciences, Central University, Miotso, Accra, Ghana
| | - Joseph Osafo
- Department of Psychology, University of Ghana, Legon, Accra, Ghana
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Alhassan Y, Kwakye AO, Dwomoh AK, Baah-Nyarkoh E, Ganu VJ, Appiah B, Kretchy IA. Determinants of blood pressure and blood glucose control in patients with co-morbid hypertension and type 2 diabetes mellitus in Ghana: A hospital-based cross-sectional study. PLOS Glob Public Health 2022; 2:e0001342. [PMID: 36962917 PMCID: PMC10022155 DOI: 10.1371/journal.pgph.0001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
Hypertension and diabetes are major risk factors for cardiovascular diseases and optimal control of blood pressure (BP) and blood glucose are associated with reduced cardiovascular disease events. This study, therefore, sought to estimate the prevalence and associated factors of controlled BP and blood glucose levels among patients diagnosed with both hypertension and Type 2- diabetes mellitus (T2DM). A quantitative cross-sectional study was conducted in a primary health setting in Ghana among patients 18 years and older diagnosed with both hypertension and T2DM. Pearson's chi-square was used to assess the association between BP and blood glucose levels and the independent variables. The multivariable binary logistic regression model was used to assess the adjusted odds of controlled BP and blood glucose levels. Among the 329 participants diagnosed with both hypertension and T2DM, 41.3% (95% CI: 36.1-46.8%) had controlled BP, 57.1% (95% CI: 51.7-62.4%) had controlled blood glucose whilst 21.8% (95% CI: 17.7-26.7%) had both controlled BP and blood glucose levels. Increased age, non-formal education, non-married, employed, single-dose anti-hypertensives or anti-diabetic medications, and hyperlipidaemia or stroke co-morbidities were positively associated with controlled BP levels. Being female, married, taking 2 or more anti-hypertensive medications, and moderate to high medication-related burden were positively associated with controlled blood glucose levels. In terms of both controlled BP and blood glucose levels, being employed, reduced income level, being registered with national health insurance, single anti-diabetes or anti-hypertensive medications, hyperlipidaemia or stroke co-morbidities, and moderate to high medication-related burden were positively associated with having both controlled BP and blood glucose levels. One in five patients with hypertension and T2DM had both BP and blood glucose levels under control. The benefits and risks of blood pressure and blood glucose targets should thus be factored into the management of patients with hypertension and T2DM.
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Affiliation(s)
- Yakubu Alhassan
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Adwoa Oforiwaa Kwakye
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Andrews K Dwomoh
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Emmanuella Baah-Nyarkoh
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | - Bernard Appiah
- Department of Public Health, Falk College, Syracuse University, Syracuse, NY, United States of America
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
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Kretchy IA, Boadu JA, Kretchy JP, Agyabeng K, Passah AA, Koduah A, Opuni KFM. Utilization of complementary and alternative medicine for the prevention of COVID-19 infection in Ghana: A national cross-sectional online survey. Prev Med Rep 2021; 24:101633. [PMID: 34777985 PMCID: PMC8575551 DOI: 10.1016/j.pmedr.2021.101633] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/28/2021] [Accepted: 11/07/2021] [Indexed: 12/24/2022] Open
Abstract
82.5% of all participants reported CAM use during the COVID-19 pandemic period. 69.1% of CAM users intended it for COVID-19 infection prevention. Commonly used CAM include vitamins, spiritual healing/prayer, minerals and herbals. Age, sex and COVID-19 illness perception significantly predicted CAM use.
Complementary and alternative medicine (CAM) use is widespread and has played critical roles in preventing infections, including previous coronaviruses. This study sought to document current practices in the use of CAM for the prevention of COVID-19 disease in Ghana. An anonymous electronic survey was conducted from February 1, 2021 to April 30, 2021. Data on demographic characteristics, basic clinical information, illness perceptions about COVID-19, and CAM use during the pandemic period were generated. While about 82.5% (986/1195) of the participants used CAM during the COVID-19 period, 69.1% (681/986) of CAM users intented it for COVID-19 infection prevention. Vitamin supplements (88.1%, 869/986), spiritual healing/prayer (23.3%, 230/986), mineral supplements (22.3%, 220/986), botanical/herbal medicines (22.2%, 219/986), and diet therapy (19.4%, 191/986) were the main types of CAM used. From the adjusted binary logistic regression model, current age (aOR: 1.03, 95%CI: 1.01–1.05), sex (aOR: 1.41, 95%CI: 1.02–1.95), participants’ perceptions of consequences (aOR: 1.10, 95%CI: 1.04–1.17), identity (aOR: 1.15, 95%CI: 1.06–1.25) and concerns about COVID-19 (aOR: 0.91, 95%CI: 0.85–0.97) were statistically significant predictors of CAM use. These results suggest the need for appropriate public health policy on COVID-19 and CAM use in addition to directing further research initiatives toward an optimized COVID-19 prevention scheme using clinically validated CAM treatments. Research to validate the clinical efficacy of these products, especially the herbs, for COVID-19 prevention while isolating lead compounds that could be optimized and used for the treatment and prevention of COVID-19 is also recommended.
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Affiliation(s)
- Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Joseph A Boadu
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - James-Paul Kretchy
- Department of Physician Assistantship Studies, School of Medicine and Health Sciences, Central University, Miotso, Accra, Ghana
| | - Kofi Agyabeng
- Department of Mathematics, KU Leuven, Leuven, Belgium
| | - Alfred A Passah
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Kwabena F M Opuni
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
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Ocansey PM, Kretchy IA, Aryeetey GC, Agyabeng K, Nonvignon J. Anxiety, depression, and stress in caregivers of children and adolescents with mental disorders in Ghana and implications for medication adherence. Ghana Med J 2021; 55:173-182. [PMID: 35950177 PMCID: PMC9334939 DOI: 10.4314/gmj.v55i3.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: This study assessed levels of anxiety, depression, and stress among family caregivers of children and adolescents with mental disorders in Ghana and the implication on medication adherence.Design: A cross-sectional study.Setting: The study was conducted at the outpatient departments of the three main public psychiatric hospitals in Ghana.Participants: Two hundred and ten non-paid family caregivers of children and adolescents with mental disorders were recruited for this study.Main Outcome Measure: The study assessed symptoms of anxiety, depression and stress among the caregivers and estimated caregiver-reported medication adherence.Results: About 56.2%, 66.2% and 78% of the caregivers experienced severe anxiety, severe depression and moderate to severe stress symptoms respectively. From the multiple logistic regression model, while anxiety was significantly affected by religion and education, depression was influenced by sex, age, marital status, proximity to facility, and employment status. Female caregivers had about four times higher odds of being depressed compared to male caregivers(aOR: 3.81, 95% CI: 1.66 - 8.75). The caregiver-reported medication adherence was 11.9%. Anxiety was significantly predictive of medication adherence.Conclusion: Most family caregivers of children and adolescents with mental disorders experienced symptoms of anxiety, depression and stress with anxiety having implications for medication adherence. The study findings underscore the need to consider psychological characteristics of caregivers and the provision of mental health support for them, as part of the routine health care for children and adolescents with mental disorders.
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Affiliation(s)
- Patience Me Ocansey
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Legon, Ghana
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana
| | - Genevieve C Aryeetey
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | - Kofi Agyabeng
- Department of Mathematics, KU Leuven, Leuven-Belgium
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
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Kretchy IA, Blewuada EK, Debrah AB. A qualitative study exploring community pharmacists’ perspectives of child and adolescent mental healthcare. Scientific African 2021. [DOI: 10.1016/j.sciaf.2021.e00969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Anakwa NO, Teye‐Kwadjo E, Kretchy IA. Illness perceptions, social support and antiretroviral medication adherence in people living with HIV in the greater Accra region, Ghana. Nurs Open 2021; 8:2595-2604. [PMID: 33626226 PMCID: PMC8363381 DOI: 10.1002/nop2.797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/14/2020] [Accepted: 01/29/2021] [Indexed: 11/08/2022] Open
Abstract
AIM To assess how illness perceptions and social support influence antiretroviral medication adherence in a HIV patient population in Ghana. DESIGN This study used a correlational research design with cross-sectional data. METHOD A total of 235 people living with HIV at two general hospitals in the Greater Accra Region of Ghana provided data on illness perceptions, social support and medication adherence. Hierarchical multiple regression test was used to analyse the data. RESULTS Illness perceptions' facets of timeline, personal control and treatment control were negatively associated with medication adherence, whereas emotional response was positively associated with adherence. Further, significant other support was negatively associated with adherence. Family and friend support were not associated with adherence. The findings offer preliminary evidence that illness perceptions may have utility for medication adherence in a HIV patient population in Ghana.
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Affiliation(s)
- Nella O. Anakwa
- Department of PsychologySchool of Social SciencesUniversity of GhanaLegonGhana
| | - Enoch Teye‐Kwadjo
- Department of PsychologySchool of Social SciencesUniversity of GhanaLegonGhana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical PharmacySchool of PharmacyUniversity of GhanaLegonGhana
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Kretchy IA, Appiah B, Agyabeng K, Kwarteng EM, Ganyaglo E, Aboagye GO. Psychotropic medicine beliefs, side effects and adherence in schizophrenia: a patient-caregiver dyad perspective. Int J Clin Pharm 2021; 43:1370-1380. [PMID: 33835372 DOI: 10.1007/s11096-021-01264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
Background Medication adherence is essential in the management of schizophrenia. Yet poor treatment uptake has negative consequences on patients and their primary caregivers. Objective To examine the association among beliefs about psychotropic medications, side effects and adherence from a patient-caregiver dyad perspective. Setting This study was conducted in a public psychiatric hospital setting in Accra, Ghana. Methods A cross-sectional study was conducted among 121 patient-caregiver dyads using an interviewer-administered data collection approach.Main outcome measure Beliefs about medicines, side-effects and medication adherence. Results The patient and caregiver-reported level of medication adherence was 28.1 %. Using the Kappa index, the level of agreement between the responses of patients and their caregivers ranged from slight to moderate. Both patients and caregivers rated necessity higher than concern (patients: 1.67 ± 0.84, caregiver: 1.79 ± 0.96). Significant positive relations between specific-necessity, necessity-concerns differential and medication adherence were recorded while specific-concern, general harm and side-effects correlated negatively with medication adherence from the dyad. The odds of adhering to medications increased by 58 and 64 % for each unit increase in specific-necessity and general overuse scores respectively. However, a unit increase in specific-concern score and high side-effects scores were associated with lower odds of adherence. Conclusions This study highlights the need for patient-caregiver collaborations in decision-making relating to medication adherence in schizophrenia. Thus, in clinical practice, there is the need to recognize that caregivers are essential partners, and patient-caregiver views about psychotropic medications are critical in enhancing adherence for positive mental health outcomes.
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Affiliation(s)
- Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana.
| | - Bernard Appiah
- Department of Public Health, Falk College, Syracuse University, White Hall, 13244, Syracuse, NY, USA
| | - Kofi Agyabeng
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana
| | - Emmanuel M Kwarteng
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Enyonam Ganyaglo
- Department of Pharmacy, Accra Psychiatric Hospital, Accra, Ghana
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Mirzoev T, Koduah A, Cronin de Chavez A, Baatiema L, Danso-Appiah A, Ensor T, Agyepong IA, Wright JM, Kretchy IA, King N. Implementation of medicines pricing policies in sub-Saharan Africa: protocol for a systematic review. BMJ Open 2021; 11:e044293. [PMID: 33622951 PMCID: PMC7907884 DOI: 10.1136/bmjopen-2020-044293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Ensuring universal availability and accessibility of medicines and supplies is critical for national health systems to equitably address population health needs. In sub-Saharan Africa (SSA), this is a recognised priority with multiple medicines pricing policies enacted. However, medicine prices have remained high, continue to rise and constrain their accessibility. In this systematic review, we aim to identify and analyse experiences of implementation of medicines pricing policies in SSA. Our ambition is for this evidence to contribute to improved implementation of medicines pricing policies in SSA. METHODS AND ANALYSIS We will search: Medline, Web of Science, Scopus, Global Health, Embase, Cairn.Info International Edition, Erudit and African Index Medicus, the grey literature and reference from related publications. The searches will be limited to literature published from the year 2000 onwards that is, since the start of the Millennium Development Goals.Published peer-reviewed studies of implementation of medicines pricing policies in SSA will be eligible for inclusion. Broader policy analyses and documented experiences of implementation of other health policies will be excluded. The team will collaboratively screen titles and abstracts, then two reviewers will independently screen full texts, extract data and assess quality of the included studies. Disagreements will be resolved by discussion or a third reviewer. Data will be extracted on approaches used for policy implementation, actors involved, evidence used in decision making and key contextual influences on policy implementation. A narrative approach will be used to synthesise the data. Reporting will be informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guideline. ETHICS AND DISSEMINATION No ethics approvals are required for systematic reviews.Results will be disseminated through academic publications, policy briefs and presentations to national policymakers in Ghana and mode widely across countries in SSA. PROSPERO REGISTRATION NUMBER CRD42020178166.
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Affiliation(s)
- Tolib Mirzoev
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Augustina Koduah
- School of Pharmacy, University of Ghana, Legon, Greater Accra, Ghana
| | - Anna Cronin de Chavez
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Leonard Baatiema
- School of Public Health, University of Ghana, Accra-Legon, Ghana
| | | | - Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Irene Akua Agyepong
- Research and Development Division, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Irene A Kretchy
- School of Pharmacy, University of Ghana, Legon, Greater Accra, Ghana
| | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
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Kretchy IA, Koduah A, Opuni KFM, Agyabeng K, Ohene‐Agyei T, Boafo EA, Ntow PO. Prevalence, patterns and beliefs about the use of herbal medicinal products in Ghana: a multi‐centre community‐based cross‐sectional study. Trop Med Int Health 2021; 26:410-420. [DOI: 10.1111/tmi.13541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy School of Pharmacy University of Ghana Legon Ghana
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy School of Pharmacy University of Ghana Legon Ghana
| | - Kwabena F. M. Opuni
- Department of Pharmaceutical Chemistry School of Pharmacy University of Ghana Legon Ghana
| | | | - Thelma Ohene‐Agyei
- Department of Pharmacy Practice and Clinical Pharmacy School of Pharmacy University of Ghana Legon Ghana
| | - Eugene A. Boafo
- Department of Pharmaceutical Chemistry School of Pharmacy University of Ghana Legon Ghana
| | - Prisca O. Ntow
- Department of Pharmacy Practice and Clinical Pharmacy School of Pharmacy University of Ghana Legon Ghana
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Kretchy IA, Asiedu-Danso M, Kretchy JP. Medication management and adherence during the COVID-19 pandemic: Perspectives and experiences from low-and middle-income countries. Res Social Adm Pharm 2021; 17:2023-2026. [PMID: 32307319 PMCID: PMC7158799 DOI: 10.1016/j.sapharm.2020.04.007] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/05/2020] [Indexed: 01/06/2023]
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic is placing a huge strain on health systems worldwide. Suggested solutions like social distancing and lockdowns in some areas to help contain the spread of the virus may affect special patient populations like those with chronic illnesses who are unable to access healthcare facilities for their routine care and medicines management. Retail pharmacy outlets are the likely facilities for easy access by these patients. The contribution of community pharmacists in these facilities to manage chronic conditions and promote medication adherence during this COVID-19 pandemic will be essential in easing the burden on already strained health systems. This paper highlights the pharmaceutical care practices of community pharmacists for patients with chronic diseases during this pandemic. This would provide support for the call by the WHO to maintain essential services during the pandemic, in order to prevent non-COVID disease burden on healthcare systems particularly in low-and middle-income countries.
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Affiliation(s)
- Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, P.O. Box LG 43, University of Ghana, Legon, Ghana.
| | - Michelle Asiedu-Danso
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, P.O. Box LG 43, University of Ghana, Legon, Ghana.
| | - James-Paul Kretchy
- Department of Physician Assistantship Studies, School of Medicine and Health Sciences, Central University, Accra, Ghana.
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Asiedu-Danso M, Kretchy IA, Sekyi JK, Koduah A. Adherence to Antidiabetic Medications among Women with Gestational Diabetes. J Diabetes Res 2021; 2021:9941538. [PMID: 34395632 PMCID: PMC8363457 DOI: 10.1155/2021/9941538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/06/2021] [Accepted: 07/19/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Optimal adherence to prescribed medications in women with gestational diabetes is relevant for perinatal outcomes. OBJECTIVE To summarize available information on the prevalence and factors contributing to medication adherence in women with gestational diabetes from the biological and psychosocial perspectives. METHODS A literature search on adherence in gestational diabetes was conducted in PubMed/MEDLINE, CINAHL, Scopus, and the Directory of Open Access Journals for studies published on the topic. The Arksey and O'Malley framework for scoping reviews was used to explore and summarize the evidence. RESULTS A total of 2395 studies were retrieved of which 13 fully met the eligibility criteria. The studies were reported in Zimbabwe (n = 5), Iran (n = 1), Mexico (n = 1), South India (n = 1), the United States of America (n = 4), and one multinational study covering Australia, Europe, North and South America. The main types of antidiabetic medications used were insulin (n = 6), metformin (n = 4), and glyburide (n = 2). The prevalence of adherence ranged from 35.6% to 97%, with the assessment tool being self-report measures (n = 8). The main factors associated with nonadherence included worsening pregnancy symptoms, side effects of medications, perceived risks, mental health symptoms, poor social support, and socioeconomic status. Recommendations that evolved from the studies to improve adherence included education, counselling, improved support networks, and social interventions, while the main reported interventional study employed continuous education on the impact of adherence on perinatal outcomes. CONCLUSION Medication nonadherence in gestational diabetes seems to be influenced by multiple factors with some educational interventions positively impacting adherence behaviours. Thus, future research in women with gestational diabetes could consider interventions from a multifactorial perspective to improve therapeutic outcomes.
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Affiliation(s)
- Michelle Asiedu-Danso
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG, 43 Legon, Ghana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG, 43 Legon, Ghana
| | - Jeremiah Kobby Sekyi
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG, 43 Legon, Ghana
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG, 43 Legon, Ghana
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Kretchy IA, Boima V, Agyabeng K, Koduah A, Appiah B. Psycho-behavioural factors associated with medication adherence among male out-patients with hypertension in a Ghanaian hospital. PLoS One 2020; 15:e0227874. [PMID: 31995606 PMCID: PMC6988959 DOI: 10.1371/journal.pone.0227874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/01/2020] [Indexed: 11/18/2022] Open
Abstract
Medication adherence is a key health outcome that reflects the health and general well-being of patients with hypertension. Challenges with adherence are common and associated with clinical, behavioural and psychosocial factors. This study sought to provide data on the extent of medication adherence among male patients with hypertension and their biopsychosocial predictors. Patient and clinical characteristics, psychological distress, insomnia and sexual dysfunction were hypothesized to predict outcomes of medication adherence. Utilizing quantitative data from a hospital-based cross-sectional study from 358 male out-patients with hypertension attending a tertiary hospital in Ghana, medication adherence was associated with age, marital status, educational level, income, duration of diagnosis, number of medications taken and sexual dysfunction. These findings support the need for biopsychosocial interventions aiming at promoting adherence while taking these factors into consideration for the benefit of improving the health and general well-being of male patients with hypertension.
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Affiliation(s)
- Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Ghana
- * E-mail: ,
| | - Kofi Agyabeng
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Bernard Appiah
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M Health Science Center, TAMU, College Station, Texas, United States of America
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Kretchy IA, Koduah A, Ohene-Agyei T, Boima V, Appiah B. The Association between Diabetes-Related Distress and Medication Adherence in Adult Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. J Diabetes Res 2020; 2020:4760624. [PMID: 32190697 PMCID: PMC7071811 DOI: 10.1155/2020/4760624] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/31/2020] [Accepted: 02/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a major public health problem associated with distress. T2DM can affect health outcomes and adherence to medications. Little is however known about the association between diabetes distress and medication adherence among patients with T2DM in Ghana. OBJECTIVE The objective of the present study is twofold: to estimate distress associated with T2DM and to examine its association with medication adherence. METHODS A hospital-based cross-sectional study was conducted among 188 patients with T2DM recruited from a diabetes specialist outpatient clinic at the Pantang Hospital in Accra, Ghana. Data were obtained using the Problem Areas In Diabetes (PAID) scale and the Medication Adherence Report Scale. RESULTS The findings showed that about 44.7% of the patients showed high levels of diabetes-related distress. Poor adherence to medications was recorded in 66.5% of the patients. Patients who were highly distressed had 68% lower odds of adhering to their medications compared to those who were not (OR: 0.32, 95% CI: 0.15-0.65). A principal component analysis revealed four areas of T2DM distress which were conceptualized as negative emotions about diabetes, dietary concerns and diabetes care, dissatisfaction with external support, and diabetes management helplessness. CONCLUSION Our findings suggest that diabetes distress is a significant determinant of medication adherence behaviour in patients with T2DM. Thus, incorporating routine screening for distress into the standard diabetes care within the Ghanaian health system and having health practitioners adopt holistic approaches to diabetes management will be important context-specific interventions to improve adherence and health outcomes of people living and coping with T2DM.
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Affiliation(s)
- Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Ghana
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Ghana
| | - Thelma Ohene-Agyei
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Ghana
| | - Vincent Boima
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana
| | - Bernard Appiah
- Centre for Science and Health Communication, PMB M71, Ministries, Accra, Ghana
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University Health Science Center, 212 Adriance Lab Rd, 1266 TAMU, College Station, Texas, USA
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Kretchy IA, Okere HA, Osafo J, Afrane B, Sarkodie J, Debrah P. Perceptions of traditional, complementary and alternative medicine among conventional healthcare practitioners in Accra, Ghana: Implications for integrative healthcare. J Integr Med 2018; 14:380-8. [PMID: 27641609 DOI: 10.1016/s2095-4964(16)60273-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Integrative medicine refers to ongoing efforts to combine the best of conventional and evidence-based complementary therapies. While this effort for collaboration is increasing, traditional complementary and alternative medicine (TM-CAM) remains poorly integrated into the current healthcare system of Ghana. At present, it is not clear if practitioners of mainstream medicine favor integrative medicine. The present study, therefore, sought to explore the perceptions of conventional healthcare professionals on integrative medicine. METHODS A qualitative design composed of semi-structured interviews was conducted with 23 conventional healthcare professionals comprising pharmacists, physicians, nurses and dieticians from two quasi-government hospitals in Accra, Ghana. RESULTS Participants' knowledge of TM-CAM was low, and although they perceived alternative medicine as important to current conventional healthcare in Ghana, they expressed anxieties about the potential negative effects of the use of TM-CAM. This paradox was found to account for the low levels of use among these professionals, as well as the low level of recommendation to their patients. The practitioners surveyed recommended that alternative medicine could be integrated into mainstream allopathic healthcare in Ghana through improving knowledge, training as well as addressing concerns of safety and efficacy. These findings are discussed under the themes: the knowledge gap, the paradox of TM-CAM, experience of use and prescription, and guided integration. We did not observe any differences in views among the participants. CONCLUSION The conventional healthcare professionals were ready to accept the idea of integrative medicine based on knowledge of widespread use and the potential role of TM-CAM products and practices in improving healthcare delivery in the country. However, to achieve an institutional integration, practitioners' understanding of TM-CAM must be improved, with specific attention to issues of safety, regulation and evidence-based practice of TM-CAM products and services in Ghana.
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Affiliation(s)
- Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Harry A Okere
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Joseph Osafo
- Department of Psychology, School of Social Studies, College of Humanities, University of Ghana, Legon, Ghana
| | - Barima Afrane
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Joseph Sarkodie
- Department of Pharmacognosy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Philip Debrah
- Department of Pharmaceutics and Microbiology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
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Appiah B, Burdine JN, Aftab A, Asamoah-Akuoko L, Anum DA, Kretchy IA, Samman EW, Appiah PB, Bates I. Determinants of Intention to Use Mobile Phone Caller Tunes to Promote Voluntary Blood Donation: Cross-Sectional Study. JMIR Mhealth Uhealth 2018; 6:e117. [PMID: 29728343 PMCID: PMC5960044 DOI: 10.2196/mhealth.9752] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/14/2018] [Accepted: 02/23/2018] [Indexed: 12/03/2022] Open
Abstract
Background Voluntary blood donation rates are low in sub-Saharan Africa. Sociobehavioral factors such as a belief that donated blood would be used for performing rituals deter people from donating blood. There is a need for culturally appropriate communication interventions to encourage individuals to donate blood. Health care interventions that use mobile phones have increased in developing countries, although many of them focus on SMS text messaging (short message service, SMS). A unique feature of mobile phones that has so far not been used for aiding blood donation is caller tunes. Caller tunes replace the ringing sound heard by a caller to a mobile phone before the called party answers the call. In African countries such as Ghana, instead of the typical ringing sound, a caller may hear a message or song. Despite the popularity of such caller tunes, there is a lack of empirical studies on their potential use for promoting blood donation. Objective The aim of this study was to use the technology acceptance model to explore the influence of the factors—perceived ease of use, perceived usefulness, attitude, and free of cost—on intentions of blood or nonblood donors to download blood donation-themed caller tunes to promote blood donation, if available. Methods A total of 478 blood donors and 477 nonblood donors were purposively sampled for an interviewer-administered questionnaire survey at blood donation sites in Accra, Ghana. Data were analyzed using descriptive statistics, exploratory factor analysis, and confirmatory factory analysis or structural equation modeling, leading to hypothesis testing to examine factors that determine intention to use caller tunes for blood donation among blood or nonblood donors who use or do not use mobile phone caller tunes. Results Perceived usefulness had a significant effect on intention to use caller tunes among blood donors with caller tunes (beta=.293, P<.001), blood donors without caller tunes (beta=.165, P=.02, nonblood donors with caller tunes (beta=.278, P<.001), and nonblood donors without caller tunes (beta=.164, P=.01). Attitudes had significant effect on intention to use caller tunes among blood donors without caller tunes (beta=.351, P<.001), nonblood donors with caller tunes (beta=.384, P<.001), nonblood donors without caller tunes (beta=.539, P<.001) but not among blood donors with caller tunes (beta=.056, P=.44). The effect of free-of-cost caller tunes on the intention to use for blood donation was statistically significant (beta=.169, P<.001) only in the case of nonblood donors without caller tunes, whereas this path was statistically not significant in other models. Conclusions Our results provide empirical evidence for designing caller tunes to promote blood donation in Ghana. The study found that making caller tunes free is particularly relevant for nonblood donors with no caller tunes.
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Affiliation(s)
- Bernard Appiah
- Research Program on Public and International Engagement for Health, Department of Environmental and Occupational Health, Texas A&M School of Public Health, Texas A&M University, College Station, Texas, TX, United States.,Centre for Science and Health Communication, Accra, Ghana
| | - James N Burdine
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, Texas A&M University, College Station, Texas, TX, United States
| | - Ammar Aftab
- Department of Health Policy and Management, Texas A&M School of Public Health, Texas A&M University, College Station, Texas, TX, United States
| | - Lucy Asamoah-Akuoko
- Centre for Science and Health Communication, Accra, Ghana.,Research and Development, National Blood Service Ghana, Accra, Ghana.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - David A Anum
- Centre for Science and Health Communication, Accra, Ghana
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Accra, Ghana
| | - Elfreda W Samman
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, Texas A&M University, College Station, Texas, TX, United States
| | | | - Imelda Bates
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Kretchy IA, Osafo J, Agyemang SA, Appiah B, Nonvignon J. Psychological burden and caregiver-reported non-adherence to psychotropic medications among patients with schizophrenia. Psychiatry Res 2018; 259:289-294. [PMID: 29091831 DOI: 10.1016/j.psychres.2017.10.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/09/2017] [Accepted: 10/22/2017] [Indexed: 11/18/2022]
Abstract
The study examined the association between psychological distress, caregiving burden and caregiver-reported medication adherence in 444 informal family caregivers of patients with schizophrenia. Participants were assessed on the Depression, Anxiety Stress Scale, Zarit Burden Interview and the Medication Adherence Report Scale. Caregivers reported a non-adherence rate of 54.5% among patients with schizophrenia. Poor adherence to antipsychotics was significantly associated with caregiver burden (p < 0.01) and experience of anxiety (p < 0.0001). The burden of caregiving should be considered during the assessment of adherence. The findings suggest a need for culturally appropriate interventions that improve antipsychotic adherence of outpatients with schizophrenia with specific attention to the burden of the caregiver.
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Affiliation(s)
- Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana.
| | - Joseph Osafo
- Department of Psychology, School of Social Studies, College of Humanities, University of Ghana, P.O. Box LG 84, Legon, Ghana.
| | - Samuel Agyei Agyemang
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana.
| | - Bernard Appiah
- Department of Public Health Studies, School of Public Health, Texas A&M Health Science Center, 212 Adriance Lab Rd, 1266 TAMU, College Station, TX, USA.
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana.
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Opoku-Boateng YN, Kretchy IA, Aryeetey GC, Dwomoh D, Decker S, Agyemang SA, Tozan Y, Aikins M, Nonvignon J. Economic cost and quality of life of family caregivers of schizophrenic patients attending psychiatric hospitals in Ghana. BMC Health Serv Res 2017; 17:697. [PMID: 29219074 PMCID: PMC5773918 DOI: 10.1186/s12913-017-2642-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low and middle income countries face many challenges in meeting their populations' mental health care needs. Though family caregiving is crucial to the management of severe mental health disabilities, such as schizophrenia, the economic costs borne by family caregivers often go unnoticed. In this study, we estimated the household economic costs of schizophrenia and quality of life of family caregivers in Ghana. METHODS We used a cost of illness analysis approach. Quality of life (QoL) was assessed using the abridged WHO Quality of Life (WHOQOL-BREF) tool. Cross-sectional data were collected from 442 caregivers of patients diagnosed with schizophrenia at least six months prior to the study and who received consultation in any of the three psychiatric hospitals in Ghana. Economic costs were categorized as direct costs (including medical and non-medical costs of seeking care), indirect costs (productivity losses to caregivers) and intangible costs (non-monetary costs such as stigma and pain). Direct costs included costs of medical supplies, consultations, and travel. Indirect costs were estimated as value of productive time lost (in hours) to primary caregivers. Intangible costs were assessed using the Zarit Burden Interview (ZBI). We employed multiple regression models to assess the covariates of costs, caregiver burden, and QoL. RESULTS Total monthly cost to caregivers was US$ 273.28, on average. Key drivers of direct costs were medications (50%) and transportation (27%). Direct costs per caregiver represented 31% of the reported monthly earnings. Mean caregiver burden (measured by the ZBI) was 16.95 on a scale of 0-48, with 49% of caregivers reporting high burden. Mean QoL of caregivers was 28.2 (range: 19.6-34.8) out of 100. Better educated caregivers reported lower indirect costs and better QoL. Caregivers with higher severity of depression, anxiety and stress reported higher caregiver burden and lower QoL. Males reported better QoL. CONCLUSIONS These findings highlight the high household burden of caregiving for people living with schizophrenia in low income settings. Results underscore the need for policies and programs to support caregivers.
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Affiliation(s)
- Yaw Nyarko Opoku-Boateng
- National Health Insurance Authority, Accra, Ghana.,Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Genevieve Cecilia Aryeetey
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | - Samuel Agyei Agyemang
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Yesim Tozan
- College of Global Public Health, New York University, New York, NY, USA
| | - Moses Aikins
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
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Opoku-Acheampong A, Kretchy IA, Acheampong F, Afrane BA, Ashong S, Tamakloe B, Nyarko AK. Perceived stress and quality of life of pharmacy students in University of Ghana. BMC Res Notes 2017; 10:115. [PMID: 28253905 PMCID: PMC5335855 DOI: 10.1186/s13104-017-2439-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/24/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Stress among pharmacy students could greatly affect their learning activities and general well-being. It is therefore necessary to investigate how stress relates with the quality of life of students to maintain and/or improve their personal satisfaction and academic performance. A school-based longitudinal study was used to investigate the relationship between stress and quality of life of undergraduate pharmacy students. The 10-item perceived stress scale and the shorter version of the WHO quality of life scale were administered to the same participants at two time points i.e. Time 1 (4 weeks into the semester) and Time 2 (8 weeks afterwards). The correlations and differences between the study variables were tested using the Pearson's coefficient and independent sample t test. RESULTS The mean stress scores were higher at Time 2 compared to Time 1 for the first and second years. However, there was no significant difference in stress for different year groups-Time 1 [F (3) = 0.410; p = 0.746] and Time 2 [F(3) = 0.909; p = 0.439]. Female students had higher stress scores at Time 2 compared to male students. The main stressors identified in the study were; large volume of material to be studied (88.2%), laboratory report writing (78.2%), constant pressure to maintain good grades (66.4%) and the lack of leisure time (46.4%). Even though most students employed positive stress management strategies such as time management (68.2%), other students resorted to emotional eating (9.1%) and alcohol/substance use (1.8%). At Time 2, perceived stress scores were significantly negatively correlated with social relationship (r = -0.40, p ≤ 0.0001), environmental health (r = -0.37, p ≤ 0.0001), physical health (r = -0.49, p ≤ 0.0001) and psychological health (r = -0.51, p ≤ 0.0001). CONCLUSION The study reported significant correlations between stress and various domains of quality of life of undergraduate pharmacy students. It is thus necessary to institute some personal and institutional strategies to ameliorate the effect of stress on the quality of life of pharmacy students while encouraging the use of positive stress management strategies.
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Affiliation(s)
- Adomah Opoku-Acheampong
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | - Barima A. Afrane
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Sharon Ashong
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Bernice Tamakloe
- Administration, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Alexander K. Nyarko
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
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Oppong S, Kretchy IA, Imbeah EP, Afrane BA. Managing mental illness in Ghana: the state of commonly prescribed psychotropic medicines. Int J Ment Health Syst 2016; 10:28. [PMID: 27051464 PMCID: PMC4820990 DOI: 10.1186/s13033-016-0061-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 03/23/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In Ghana, about 13 % of the adult population is estimated to be affected by mental health disorders of varying forms. In managing these patients, psychotropic medications are mostly employed. Since most of these conditions are chronic cases, the medications are consumed for prolonged periods of time. However, there exists an absence of information on efficacy, side effects, accessibility and prescription practices of psychotropic medication utilization from the viewpoint of the practitioners who are primarily involved in prescribing, dispensing and administering these medications. METHOD Qualitative study composed of semi-structured interviews were conducted with twenty three (23) participants from Accra psychiatry, Pantang and Ankaful hospitals. These were fifteen (15) nurses, six (6) clinicians and two (2) pharmacists. All interviews were recorded digitally and analyzed thematically. RESULTS The commonly prescribed psychotropic medications were grouped into four classes. These were antipsychotics, antidepressants, anticonvulsants and hypnosedatives. Although each facility had at least one drug belonging to each class, there were frequent shortages recorded across the board. Also, drugs were free when supplied by government, and expensive when obtained from outside. When subsidized, the average cost of a day's supply of the most common antipsychotic was 4 % of the daily minimum wage. The procurement system for the medications was fraught with challenges such as inadequate financing, poor procurement practices and bureaucracies with the process which affected the availability and quality of medications. CONCLUSION The commonly prescribed psychotropic medications are in conformity with the recommendations of the WHO guidelines and the standard treatment guidelines of Ghana. However, the accessibility and quality of medications in the sector are inadequate. To improve mental health services in the country, it is important to ensure the adequate and regular provision of quality medicines in the mental health sector.
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Affiliation(s)
- Samuel Oppong
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana
| | - Emelia P. Imbeah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana
| | - Barima A. Afrane
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana
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Kretchy IA, Owusu-Daaku FT, Danquah SA, Asampong E. A psychosocial perspective of medication side effects, experiences, coping approaches and implications for adherence in hypertension management. Clin Hypertens 2015; 21:19. [PMID: 26893929 PMCID: PMC4750803 DOI: 10.1186/s40885-015-0028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/26/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION This study examined whether psychosocial variables influenced patients' perception and experience of side effects of their medicines, how they coped with these experiences and the impact on medication adherence behaviour. METHODS A hospital-based mixed methods study using quantitative and qualitative approaches was conducted with hypertensive patients. Participants were asked about side effects, medication adherence, common psychological symptoms and coping mechanisms with the aid of standard questionnaires and an interview guide. RESULTS The experiences of side effects-such as palpitations, frequent urination, recurrent bouts of hunger, erectile dysfunction, dizziness, cough, physical exhaustion-were categorized as no/low (39.75 %), moderate (53.0 %) and high (7.25 %). Significant relationships between depression (x (2) = 24.21, p < 0.0001), anxiety (x (2) = 42.33, p < 0.0001), stress (x (2) = 39.73, p < 0.0001) and side effects were observed. A logistic regression model using the adjusted results for this association is reported-depression [OR = 1.9 (1.03-3.57), p = 0.04], anxiety [OR = 1.5 (1.22-1.77), p ≤ 0.001] and stress [OR = 1.3 (1.02-1.71), p = 0.04]. Side effects significantly increased the probability of individuals to be non-adherent [OR = 4.84 (95 % CI 1.07-1.85), p = 0.04] with social factors, media influences and attitudes of primary care givers further explaining this relationship. Personal adoption of medication modifying strategies, espousing the use of complementary and alternative treatments and interventions made by clinicians were the main forms of coping with side effects. DISCUSSION Results from this study show that, in addition to a biomedical approach, the experience of side effects has biological, social and psychological interrelations. The results offer more support for the need for a multi-disciplinary approach to healthcare where all forms of expertise are incorporated into health provision and patient care.
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Affiliation(s)
- Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, University of Ghana School of Pharmacy, College of Health Sciences, Legon, Ghana
| | - Frances T Owusu-Daaku
- Department of Clinical and Social Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Emmanuel Asampong
- Department of Social and Behavioural Health, School of Public Health, University of Ghana, Legon, Ghana
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Kretchy IA, Owusu-Daaku FT, Danquah SA. Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence. Int J Ment Health Syst 2014; 8:25. [PMID: 24987456 PMCID: PMC4077111 DOI: 10.1186/1752-4458-8-25] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/19/2014] [Indexed: 02/01/2023] Open
Abstract
Background Patients with chronic conditions like hypertension may experience many negative emotions which increase their risk for the development of mental health disorders particularly anxiety and depression. For Ghanaian patients with hypertension, the interaction between hypertension and symptoms of anxiety, depression and stress remains largely unexplored. To fill this knowledge gap, the study sought to ascertain the prevalence and role of these negative emotions on anti-hypertensive medication adherence while taking into account patients’ belief systems. Methods The hospital-based cross-sectional study involving 400 hypertensive patients was conducted in two tertiary hospitals in Ghana. Data were gathered on patient’s socio-demographic characteristics, anxiety, depression and stress symptoms, spiritual beliefs, and medication adherence. Results Hypertensive patients experienced symptoms of anxiety (56%), stress (20%) and depression (4%). As a coping mechanism, a significant relation was observed between spiritual beliefs and anxiety (x2 = 13.352, p = 0.010), depression (x2 = 6.205, p = 0.045) and stress (x2 = 14.833, p = 0.001). Stress among patients increased their likelihood of medication non-adherence [odds ratio (OR) = 2.42 (95% CI 1.06 – 5.5), p = 0.035]. Conclusion The study has demonstrated the need for clinicians to pay attention to negative emotions and their role in medication non-adherence. The recommendation is that attention should be directed toward the use of spirituality as a possible mechanism by which negative emotions could be managed among hypertensive patients.
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Affiliation(s)
- Irene A Kretchy
- Department of Clinical and Social Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana ; Department of Pharmacy Practice and Clinical Pharmacy, University of Ghana School of Pharmacy, College of Health Sciences, Legon, Ghana
| | - Frances T Owusu-Daaku
- Department of Clinical and Social Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Kretchy IA, Owusu-Daaku F, Danquah S. Patterns and determinants of the use of complementary and alternative medicine: a cross-sectional study of hypertensive patients in Ghana. Altern Ther Health Med 2014; 14:44. [PMID: 24495363 PMCID: PMC3936816 DOI: 10.1186/1472-6882-14-44] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/31/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) is widespread and high utilization rates are associated with people who have chronic conditions like hypertension which management requires adherence to conventional treatment. Often however, the use of alternative medicines has been linked to negative health outcomes. The purpose of the study therefore was to evaluate the pattern, determinants and the association between CAM use and the adherence behaviour of hypertensive patients in Ghana. METHODS A cross-sectional study was conducted using 400 hypertensive patients attending Korle-bu and Komfo Anokye Teaching Hospitals in Ghana from May to July, 2012. Information was gathered on the socio-demographic characteristics of patients, CAM use, and adherence using the 8-item Morisky Medication Adherence Scale (MMAS). RESULTS Out of the 400 study participants, 78 (19.5%) reported using CAM with the majority (65.38%) utilizing biological based therapies. About 70% of CAM users had not disclosed their CAM use to their healthcare professionals citing fear and the lack of inquiry by these health professionals as the main reasons for non-disclosure. Males were 2.86 more likely to use CAM than females [odds ratio (OR) = 2.86 (95% CI 1.48-5.52), p = 0.002]. Participants who could not afford their medications had 3.85 times likelihood of CAM use than those who could afford their medicines [OR = 3.85 (1.15-12.5), p = 0.029]. In addition, a significant relationship between CAM use and experiences of anti-hypertensive side effects was observed, X2 = 25.378, p < 0.0001. CAM users were 2.22 times more likely to be non-adherent than participants who did not use CAM [OR = 2.22 (0.70-7.14), p = 0.176]. CONCLUSION Hypertensive patients in Ghana have shown utilization for CAM. It is important that healthcare providers understand the patterns and determinants of CAM use among their patients. Intervention programmes can then be incorporated to enhance the desired health outcomes of patients.
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