The knowledge level of nurses managing critically-ill and injured patients in Ashanti Region of Ghana

Background

Shortages in the right cadres of human resources to manage health emergencies remain an acute problem especially in low- and middle-income countries. Efforts to address this challenge are dependent on the knowledge and competency of emergency nurses. We sought to determine the knowledge level of nurses in emergency management in the Ashanti Region of Ghana.

Methods

We used a cross-sectional, quantitative approach to evaluate knowledge about emergency care among 408 nurses working in wards and emergency units in 11 randomly selected district hospitals (6 public and 5 faith-based). Participants were purposively selected and examined on knowledge level using a structured questionnaire. The inclusion criteria were different cadres of nurses who had spent at least 6 months in the selected hospitals.

Results

Four hundred and eight nurses participated. Most were general nurses (73.1 %) or mid-wives (14.4 %), with few specialised in emergency nursing (3.9 %) or critical care nursing (1.6 %). Mean percentage correct on an objective 20 question test on emergency care was 59.8 %. Few (35.6 %) nurses felt that they had adequate knowledge to manage emergencies. Around half (52.5 %) had received training in managing critically ill and injured patients through continuing professional development and 46.6 % felt prepared to work at emergency units. But few (34.7 %) reported having adequate logistics to manage emergencies and fewer (32.2 %) had time off to access training opportunities. Predictors of reporting adequate knowledge to manage emergencies included: having received training in managing critically ill and injured patients (p<.002), feeling prepared to work at emergency units (p<.001), and having adequate logistics to manage emergencies (p<.001).

Conclusion

Most nurses did not feel that they had adequate knowledge to manage emergencies. This study has identified increased availability of continuing professional development on emergency care for nurses as a priority in Ghana.

Seatbelt use among bus passengers in Ghana: observed versus self-reported measures

Many road traffic injuries in low- and middle-income countries (LMICs) are to bus passengers. We sought to determine the availability, functionality, and observed vs. self-reported use of seatbelts in large intercity buses in Ghana. We observed seatbelt use for 1,184 passengers in 35 large intercity buses. We interviewed a separate group of 633 bus passengers. All buses observed had seatbelts and most (92.6%) were functional. A little over a fifth (21.6%) of passengers were observed to wear seatbelts. However, 34.5% of passengers in the self-reported survey indicated always wearing seatbelts when riding in buses. Passengers on 5 buses out of the 35 observed where the driver verbally prompted them to wear seatbelts were more likely (57.8%) to wear seatbelts than on the other buses (15.3%, p = 0.001). Comparing the self-reported survey with observations, passengers tended to overinflate seatbelt use by a factor of 1.6. This study provides useful information for efforts to increase and monitor seatbelt use among large intercity bus passengers in LMICs.Supplemental data for this article is available online at.

Ghana: health system review 2021

 

A health system review provides a detailed description of a health care system and of reform and policy initiatives in progress or under development. The health system review of Ghana serves as an effort to also assess the system's performance towards the attainment of universal health coverage (UHC). A workshop was organized in 2018 to develop a template for writing the health system review of Ghana. This serves as a pilot study to test the feasibility of using a template somewhat like that of the WHO European Observatory on Health Systems and Policies for writing health system reviews of African countries. The health system review of Ghana is the first to be written for an African country modelled after the HiT reviews by the European Observatory. One key characteristics of the health system of Ghana is the introduction and reform of the national health insurance scheme (NHIS) in 2003 and 2012 respectively. About 40% of the population are enrolled and 60% enrolled are exempted from premium payments. Ghana has since 2010 scaled-up a national telemedicine programme, becoming one of the first adopters and innovators in Africa to integrate digital health technologies into mainstream health care system. Since 2018, Ghana has implemented the NHIS mobile renewal service, which allows payment of health insurance coverage using mobile money technologies. Ghana is one of the first countries to introduce a nationwide health insurance in Africa. The NHIS is one significant effort towards health systems strengthening and achieving UHC. Enrolment in in the NHIS contributes to better access to health care and improved financial protection. However, not only is population coverage low, but there is a serious concern about the system's financial sustainability. A promising approach is to improve the mobile-money based intervention through the high mobile-phone penetration rates in Ghana to enable more effective household saving arrangements towards UHC.

Key messages

Ghana presents important lessons, including the introduction of a national health insurance. This contributes to better access to health care and improved financial protection. Ghana is exploiting the use of mobile phone technologies and has become one of the first adopters and innovators in Africa to integrate digital health technologies into mainstream health care system.