Strengths, disconnects and lessons in local and central governance of the response to the first wave of COVID-19 in Ghana

Objectives: To explore governance, coordination and implementation actors, structures and processes, facilitators, and barriers within local government and between central and local government in Ghana's COVID-19 response during the first wave of the outbreak. Design: Cross-sectional single case study. Data collection involved a desk review of media, policy and administrative documents and key informant in-depth interviews. Setting: Two municipalities in the Greater Accra region of Ghana Participants: Local government decentralised decision makers and officials of decentralised departments. Interventions: None. Main Outcome Measures: None Results: Coordination between the national and local government involved the provision of directives, guidelines, training, and resources. Most of the emergency response structures at the municipal level were functional except for some Public Health Emergency Management Committees. Inadequate resources challenged all aspects of the response. Coordination between local government and district health directorates in risk communication was poor. During the distribution of relief items, a biased selection process and a lack of a bottom-up approach in planning and implementation were common and undermined the ability to target the most vulnerable beneficiaries. Conclusions: Adequate financing and equipping of frontline health facilities and workers for surveillance, laboratory and case management activities, transparent criteria to ensure effective targeting and monitoring of the distribution of relief items, and a stronger bottom-up approach to the planning and implementation of interventions need to be given high priority in any response to health security threats such as COVID-19.

Outcome of training intervention on teachers' knowledge, perception and self-efficacy for preventing childhood lead poisoning in Ido Local Government Area, Ibadan Nigeria

Exposure of school children to lead from various sources, including the school environment, is perilous to their health. In this study, teachers' knowledge of Lead Poisoning (LP) was assessed and the effects of training on their knowledge, perceptions and self-efficacy for preventing childhood LP in Ido Local Government Area (LGA), Oyo state was determined. The quasi- experimental study involved an Experimental Group (EG) of 27 teachers nominated by 15 purposively selected schools in Ido LGA and a Control Group (CG) of 30 teachers from 15 schools in Egbeda LGA. The two groups completed a pre -test using a validated questionnaire and the results were used to design a 4-day Training Intervention for the EG. A post-test was conducted among the two groups using the same questionnaire. Data were analyzed using descriptive, Chi-square, ANOVA and t-test statistics. The EG and CG Mean Knowledge (MK) scores at pre-test using a 74-point knowledge scale were 20.2±16.3 and 14.6±14.4 respectively. Mean scores at post-test for the EG and CG were 71.8±3.1 and 19.2±17.8 respectively (p<0.05). A significant difference was found between the EG's pre-test (20.2±16.3) and post-test (71.8±3.1) scores (p<0.05). The control's mean pre-test and post-test knowledge scores of 14.6±14.4 and 19.2±17.8 respectively were not significantly different. Perception of the EG that LP is more serious in children than adults changed from 5% at pre-test to 100% at post-test (p<0.05), while for the control perceptions were 13.3% and 23.3% for pre-test and post-test respectively with no significant difference. The EG participant's self-efficacy relating to level of confidence in advocating for school-based LP control rose significantly from 29% at pre-test to 100% at post-test (p<0.05); values among the control at pre-test and post-test were 26.7% and 23.3% respectively (p>0.05). Training intervention was effective in improving teachers' knowledge and influenced their perception and self-efficacy relating to the control of LP. Teachers can be used to upgrade their peers' knowledge

Contraceptive knowledge and compliance with guidelines for providing contraceptive services by patent medicine vendors in Ibadan North Local Government Area, Nigeria

Previous studies conducted in Nigeria have shown that Patent Medicine Vendors (PMVs) provide a substantial proportion of contraceptive services. The Federal Ministry of Health (FMOH) provided guidelines for the delivery of contraceptive services by PMVs. This study was therefore designed to identify types of contraceptives dispensed by PMVs and determine their compliance with the FMOH guidelines in Ibadan North Local Government Area. An observational check-list and a validated interviewer administered questionnaire containing a 47- point knowledge scale were used for data collection. Data were analysed using descriptive and Chi-square statistics. Respondents' mean age was 32.8±7.0 years, 80.9% were females, 63.5% were West African School Certificate holders. Most respondents (98.2%) were trained through the apprenticeship system. Only 17.4% were formally trained on the provision of contraceptive services. Contraceptive- related services offered by PMVs as stipulated by the guidelines were: counselling (96.5%), community sensitization (46.3%) and referral (96.4%). Virtually all (98.6%) respondents had ever dispensed contraceptives. A large proportion (72.7%) of respondents dispensed oral contraceptives contrary to the FMOH guidelines. The contraceptives ever dispensed by respondents included: male condoms (96.1%), female condoms (4.3%), doufem (72.3%), pregnon (18.8%), spermicide (4.9%) and intrauterine device (1.8%). Respondents' mean knowledge score was 25.9±5.8. Mean knowledge score on the provision of contraceptives services among males and females were 27.7±5.9 and 25.6±5.7 respectively. On compliance 3.7% of respondents complied fully with the FMOH guidelines on contraceptive service delivery. Compliance with stipulated guidelines by the Federal Ministry of Health on the provision of contraceptive services was low among the study population. The patent medicine licensing authorities should ensure that all patent medicine vendors are provided with the Federal Ministry of Health guidelines relating to the dispensing of contraceptives. Patent Medicine Vendors should be trained on the effective use of the guidelines

Community participation in malaria control in olorunda local government area, osun state, southwestern Nigeria

Malaria is a major health burden in developing countries and needs multiple strategies for its control. Community participation as one of the strategies for malaria control promotes self-awareness and confidence; causes the people to examine the problems and to think positively about the solutions. The study was aimed at assessing the level of community participation in malaria control in Olorunda local government area of Osogbo; Osun state; Nigeria. The study employed a cross-sectional descriptive design. Multi-staged sampling technique was used to choose 550 respondents. An interviewer-administered semi-structured questionnaire was used to elicit information from the respondents. Most of the respondents (65.0) fell between the age ranges 20-39 years; with a mean age of 32.85 + 12 years. Almost all (98.4) respondents had knowledge of malaria with most of them (88.0) correctly aware that mosquito bite could lead to malaria fever. Respondents stated that stagnant pool (92.6) and refuse dump (89.0) could predispose to malaria. About two-thirds (60.6) of the respondents participated in the control of the breeding sites of mosquitoes on specific days for environmental sanitation. The association between community participation in health talk and community participation in malaria control was statistically significant (p

A Survey of the activities of traditional medicine Practitioners (Tmps) in Southern Ijaw, Sagbama and Ogbia Local Government Areas of Bayelsa State, Nigeria

The impact of Traditional Medicine Practitioners (TMPs) in healthhcare delivery; their role in over exploitation of natural plant resources plants were studied in Southern Ijaw; Sagbama and Ogbia Local Government areas of Bayelsa State; Nigeria. A total of sixty-nine (69) TMPs were interviewed. Most of the TMPs were general practitioners; and bone setters. Patients are referred to them from hospitals; chemists and churches. The practice may be going into extinction as more than three quarters of the TMPs are between age range 41 - 80 with about 13between 31 and 40 and approximately 40have not trained anyone. About 70of the respondents depend on collection of plants from the wild for treating their patients; thereby posing a serious bioconservation problem on species of plants they exploit

Delivering on a Gendered Definition of Health Needs in Local Government Budgeting: Experiences and Concepts

Background: Local governments are granted budgetary power in the Local Governments Act of the Republic of Uganda2; which allows for local-level participation and flexibility in the allocation of financial grants channelled annually from central to local governments. The act prescribes a legal mandate to allocate public resources based on local priorities including the health needs of women compared with men. This study investigated the responsiveness of local government budgeting to the health needs of women as compared to men.Methodology: A qualitative study was conducted in Mpigi district using a set of data collection methods including: a) three (3) focus group discussions with 8 female and 8 male respondents in each group; b) face-to-face interviews with a random sample of 120 households; 75of which were male-headed and 25female-headed ; c) key informant interviews with a sample of 10 administrative officers in Mpigi district ; and d) desk-review of the Mpigi district Budget Framework Paper 4. Results: Health needs consist of the daily requirements; which; arise out of common disease infections and the socio-economic constraints that affect the well-being of women and men. However; the primary concern of the district health sector is disease control measures; without emphasis on the differing socio-economic interests of women as compared to men. Local government budgeting; therefore; does not reflect the broad community-wide understanding of health needs. Conclusion: Local government budgeting should be informed by a two-fold framework for the gendered definition of health needs. The two-fold framework combines both disease-based health needs and socio-economic needs of women as compared to men

Sickle cell knowledge, premarital screening and marital decisions among local government workers in Ile-Ife, Nigeria

Background: In Nigeria; as in the rest of equatorial Africa; sickle cell disease (SCD) has its highest incidence and continues to cause high morbidity and early death. The condition is a major public health problem among the black race. The aim of this survey is to determine the level of knowledge about SCD and the factors associated with its prevention among local government workers in Ile- Ife. Methods: This is a cross-sectional descriptive study of the knowledge about SCD; attitude towards premarital sickle cell screening and marital decisions among local government workers in Ile-Ife; Nigeria; using a self-administered questionnaire. Results: 69of study subjects had poor knowledge of SCD; while attitude towards premarital screening was favourable in 95of the study subjects. Knowledge and attitude were significantly better among subjects with tertiary education. There was a strong positive association between attitude towards sickle cell screening and a history of undergoing screening or partner screening. Most (86.7) of the respondents and 74.0of their partners have had sickle cell screening. One-quarter of married and engaged respondents did not know their partner's sickle cell status. One-third to two-thirds of study subjects will continue the relationship with their partner when either or both have haemoglobinopathy. Conclusion and recommendation: This study showed poor knowledge of SCD among the studied subjects. There is a need for more emphasis on health education through programmes promoting sickle cell education. In addition; the development of multifaceted patient and public health education programmes; the intensification of screening for the control of SCD by heterozygote detection; particularly during routine preplacement and premarital medical examinations; and the provision of genetic counselling to all SCD patients and carriers are vital to the identification and care of the couples at risk. These will enhance the capacity of the intending couples to make informed decisions and be aware of the consequences of such decisions. Policies are needed to ensure easily accessible community-wide sickle cell screening and premarital and genetic counselling to achieve the desired decline in new births of children with SCD