Geographic availability of and physical accessibility to tuberculosis diagnostic tests in Ghana: a cross-sectional survey.

BACKGROUND: In Ghana, tuberculosis (TB) case detection is low (< 34%). Existing scientific evidence suggest access to TB diagnostic tests play an essential role in TB case detection, yet little has been scientifically documented on it in Ghana. This study, therefore, sought to map TB diagnosis sites, and describe the geographic availability and physical accessibility to TB diagnosis in six regions of Ghana to inform scale-up and future placement of TB diagnostic tests. METHODS: We assembled the geolocation and attribute data of all health facilities offering TB diagnosis in Upper West Region (UWR), Upper East Region (UER), Ahafo, North-East, Northern, and Savannah regions. QGIS was employed to estimate the distance and travel time to TB diagnosis sites within regions. Travel time estimates were based on assumed motorised tricycle speed of 20 km (km)/hour. RESULTS: Of the total 1584 health facilities in the six regions, 86 (5.4%) facilities were providing TB diagnostic testing services. This 86 TB diagnosis sites comprised 56 (65%) microscopy sites, 23 (27%) both microscopy and GeneXpert sites, and 7 (8%) GeneXpert only sites (8%). Of the 86 diagnosis sites, 40 (46%) were in the UER, follow by Northern Region with 16 (19%), 12 (14%) in UWR, 9 (10%) in Ahafo Region, 5 (6%) in North East, and 4 (5%) in Savannah Region. The overall estimated mean distance and travel time to the nearest TB diagnosis site was 23.3 ± 13.8 km and 67.6 ± 42.6 min respectively. Savannah Region recorded the longest estimated mean distance and travel time with 36.1 ± 14.6 km and 108.3 ± 43.9 min, whilst UER recorded the shortest with 10.2 ± 5.8 km and 29.1 ± 17.4 min. Based on a 10 km buffer of settlement areas, an estimated 75 additional TB diagnosis sites will be needed to improve access to TB diagnosis services across the six regions. CONCLUSION: This study highlights limited availability of TB diagnosis sites and poor physical accessibility to TB diagnosis sites across five out of the six regions. Targeted implementation of additional TB diagnosis sites is needed to reduce travel distances to ≤ 10 km.

Health-Seeking Behavior and Quality of Life of People Living With HIV: Novel Evidence From Ghana.

The health and economic burdens of HIV/AIDS in low-and-middle-income countries are enormous despite global and local efforts to prevent and mitigate its effect. This study seeks to assess cadres' (or people living with HIV [PLHIV]) health-seeking behavior and its effects on their quality of life (QoL). We collected cross-sectional data from 218 HIV community cadres and 255 noncadres in 11 out of the 16 political regions in Ghana based on a modified WHOQOL-HIV-Brief and EQ-5D questionnaires. We used descriptive statistics to describe the sample and calculate the QoL scores. We also used regression analysis (ordered logit and ordinary least squares) to analyze the factors associated with the QoL of our respondents. We found that women (77%) are still disproportionally affected by HIV. Similarly, the youth, less educated and informal sector employees continue to be affected most by HIV. Factors related to QoL of PLHIV include being a community cadre, health-seeking behavior, comorbidities, and employment type. We recommend that alternative health providers be educated on the basic science of HIV/AIDS to help them offer appropriate support to PLHIV who visit them for care. Additionally, PLHIV should be supported to engage in less energy demanding employment options.

A bivariate probit analysis of child passenger's sitting behaviour and restraint use in motor vehicle.

Motor vehicle injuries are a leading cause of death among children worldwide, though many of these deaths are preventable. Buckling young children in age- and size-appropriate car seats, booster seats, or seat belts and also seating them in appropriate position can lead to a significant reduction of serious and fatal injuries. This study investigated sitting behaviour and restraint use among child passengers through cross-sectional observational surveys conducted in Kumasi, Ghana. A bivariate probit model was developed for simultaneous determination of the contributing factors influencing child passenger's sitting behaviour and restraint use. The results showed that 26% of the child passengers observed were occupying the front seat and the prevalence rate of restraint use was 4.5%. The developed bivariate probit model clearly highlights the existence of interrelationship between child passenger's sitting position and restraint use. The key factors simultaneously influencing child passenger's sitting position and restraint use include vehicle type, driver's gender, driver's belt use, child's age, and the presence of other child or adult passenger. Furthermore, time of day and day of week also influence child passenger sitting behaviour but not their restraint use. These findings provide insight for better understanding of child transporting practices and the contributing factors influencing their sitting behaviour and restraint use. The findings also highlight the need for policy makers to design effective countermeasures to promote rear sitting and restraint use among child passengers.