Healthcare Providers' Adherence to COVID-19 Prevention and Control Practices in Health Records and Information Management, Ghana.

Background: The impact of contracting coronavirus on healthcare providers (HCPs) affects their ability to combat the infection. The virus can be transmitted through droplets from sneezing, coughing, and yelling, making it essential for HCPs to plan ahead when dealing with patients with respiratory symptoms. The need to assess healthcare providers' perceived adherence to COVID-19 Prevention and Control Practices (PCP) in Health Records and Information Management is vital for optimizing healthcare operations and ensuring the safety of both patients and providers. This study assesses healthcare providers' perceived adherence to COVID-19 PCP in Health Records and Information Management. Subjects and Method. A cross-sectional survey was conducted to collect data from 1268 HCPs working in eight randomly selected hospitals across five regions in Ghana. The survey was carried out from May 15, 2022, to August 13, 2022. Simple random sampling was used to choose these eight facilities from a total of 204 hospitals. Within each facility, HCPs from various departments were selected using simple random sampling. The EpiInfo 7 software's StatCalc tool was used to choose a total sample size of 1268 from an estimated 4482 HCP-PR from the eight hospitals. Compliance with COVID-19 PCP was assessed using a 3-point scale, ranging from one (Yes always) to three (No). Cronbach's alpha reliability coefficient was used to examine the statistical reliability of the variables in the dataset. Cronbach's alpha was 0.73 overall, suggesting strong reliability. Bartlett's test for equal variances was used for comparative analysis of health facility and overall mean COVID-19 PCP in different areas of health facilities. IBM SPSS (version 23) statistical software was used for the data analysis process. Results: A total of 1268 HCP-PR participated in the survey, resulting in a 99.6% response rate. Findings reveal that 760 healthcare professionals who handle patients' records (HCP-PR), constituting 60%, consistently followed COVID-19 protocols in the registration and clinic preparation zones. Another 390 individuals (30.7%) adhered to these protocols occasionally, while 119 (9.4%) failed to comply. Similarly, in the filing area, 739 respondents (58.3%) consistently adhered to COVID-19 protocols, 358 (28.3%) occasionally did so, and 170 (13.4%) did not follow the protocols at all. Regarding handling health records cautiously, 540 participants (42.5%) always did, 448 (35.3%) did so sometimes, and 280 (22.2%) neglected these precautions. Additionally, 520 respondents (41.0%) consistently followed COVID-19 precautions when handling computers and other equipment, 393 (31.0%) did so occasionally, and 355 (28.0%) did not adhere to these precautions. Conclusion: The majority of respondents showed good compliance with COVID-19 protocol in the registration and clinic preparation areas. However, in the filing area, just over four out of every seven respondents consistently adhered to COVID-19 PCP. Additionally, four out of every seven participants did not comply with COVID-19 PCP when handling patients' records. Analysis reveals diverse adherence to COVID-19 PCP, and statistical tests show variable performance, highlighting standout health facilities.

Unmasking the coronavirus pandemic impact on students' academic performance (University of Cape Coast-Ghana).

The coronavirus (COVID-19) pandemic has impacted various institutions significantly, including education. Although several studies have explored the transmission of the COVID-19 virus among humans health, few have investigated its impact on tertiary education in Ghana. This study, therefore, aimed to unmask the effects of COVID-19 on the academic performance of tertiary students in Ghana, specifically at the University of Cape Coast (UCC). Stratified and convenience sampling techniques were employed to select respondents from the College of Health and Allied Sciences at UCC for this study. Based on Krejcie and Morgan's table for determining sample sizes for a large population in a study, a sample size of 531 was studied. Questionnaires were created and distributed to respondents from various departments to solicit their views. COVID-19 has significantly affected the academic performance of students at the University of Cape Coast, Ghana. A strong positive correlation was found between the positive impact of COVID-19 and academic performance (ß = 3.385, p < 0.001). The study identified the absence of group discussions, poor internet networks, and other factors hurting students' academic performance (ß = -2.308, p < 0.001). Resources such as libraries, conducive environments in halls and hostels, and other factors also significantly influenced students' academic performance (ß = 2.941, p < 0.005). The study's findings suggest that virtual learning platforms, adequate learning infrastructures, and internet packages should be available to students to facilitate teaching and learning as the University prepares for future pandemics.

Healthcare professionals' perception on emergence of security threat using digital health technologies in healthcare delivery.

Background: The advancement of digital health technologies (DHTs) in the healthcare industry has revolutionized healthcare by improving efficiency and accessibility. The shift from paper-based records to electronic health records (EHRs) as a result of modern technologies introduced various security threats, endangering patient data privacy and system reliability. This study explores intricate security threats among healthcare professionals affecting DHT utilization. Methodology: A structured questionnaire was designed to solicit for data from healthcare professionals on the existence of possible security threats, magnitude of physical and technical threats, and the extent to which the activities of staff and vendors affect the current DHTs being utilized in Cape Coast Teaching Hospital and Directorate of University Health Services at the University of Cape Coast. Purposive and convenience sampling techniques were employed to select healthcare professionals from various medical fields, and their views were captured for the study. Results: Findings and data analyzed from the study revealed that technical threats, such as hacking, phishing, malware, and encryption weaknesses, pose more substantial dangers to DHTs compared to physical threats. The study explored viable strategies to prevent unauthorized access to DHTs and safeguard patient information. Encouraging measures, such as encryption, multi-factor authentication, regular security training, and periodic password changes, emerged as promising methods in addressing DHT security threats. Conclusion: The study emphasizes the necessity of robust security measures and regular updates to effectively counter the emerging security threats. It underscores the critical necessity for a comprehensive protocol to enhance DHT security, addressing physical, technical, and personnel-related threats.

Healthcare providers' perception towards utilization of health information applications and its associated factors in healthcare delivery in health facilities in Cape Coast Metropolis, Ghana.

BACKGROUND: Information and communication technology (ICT) has significantly advanced global healthcare, with electronic health (e-Health) applications improving health records and delivery. These innovations, including electronic health records, strengthen healthcare systems. The study investigates healthcare professionals' perceptions of health information applications and their associated factors in the Cape Coast Metropolis of Ghana's health facilities. METHODS: We used a descriptive cross-sectional study design to collect data from 632 healthcare professionals (HCPs), in the three purposively selected health facilities in the Cape Coast municipality of Ghana, in July 2022. Shapiro-Wilk test was used to check the normality of dependent variables. Descriptive statistics were used to report means with corresponding standard deviations for continuous variables. Proportions were also reported for categorical variables. Bivariate regression analysis was conducted to determine the factors influencing the Benefits of Information Technology (BoIT); Barriers to Information Technology Use (BITU); and Motives of Information Technology Use (MoITU) in healthcare delivery. Stata SE version 15 was used for the analysis. A p-value of less than 0.05 served as the basis for considering a statistically significant accepting hypothesis. RESULTS: Healthcare professionals (HCPs) generally perceived moderate benefits (Mean score (M) = 5.67) from information technology (IT) in healthcare. However, they slightly agreed that barriers like insufficient computers (M = 5.11), frequent system downtime (M = 5.09), low system performance (M = 5.04), and inadequate staff training (M = 4.88) hindered IT utilization. Respondents slightly agreed that training (M = 5.56), technical support (M = 5.46), and changes in work procedures (M = 5.10) motivated their IT use. Bivariate regression analysis revealed significant influences of education, working experience, healthcare profession, and IT training on attitudes towards IT utilization in healthcare delivery (BoIT, BITU, and MoITU). Additionally, the age of healthcare providers, education, and working experience significantly influenced BITU. Ultimately, age, education, working experience, healthcare profession, and IT training significantly influenced MoITU in healthcare delivery. CONCLUSIONS: Healthcare professionals acknowledge moderate benefits of IT in healthcare but encounter barriers like inadequate resources and training. Motives for IT use include staff training and support. Bivariate regression analysis shows education, working experience, profession, and IT training significantly influence attitudes towards IT adoption. Targeted interventions and policies can enhance IT utilization in the Cape Coast Metropolis, Ghana.

Perceived impact of digital health technology on health professionals and their work: A qualitative study in Southern Ghana.

Background: Digital health technology (DHT) has become an essential part of an effective and efficient healthcare information system. Although DHT promises great potential it does not always meet the expectation of users. Often, in low- and middle-income countries (LMICs), the implemented DHT does not function as intended and impacts negatively on health professionals and their work. Therefore, this study explored the views of participants about the impact of DHTs on the work of health professionals after it has been introduced in Ghana. Methodology: The study used a qualitative research approach where in-depth interviews (IDIs) were conducted with study participants across three health facilities in Ghana. A purposive sampling technique was used to select participants. All interviews were audio recorded, transcribed, and coded into themes using QSR Nvivo 12 software before thematic content analysis. Results: Our findings revealed that DHT reduced the workload on the healthcare providers and also ensures continuity of care. Participants perceived that DHT was fast, and ensures quality and accurate information, which could be easily accessed by health professionals for better decision making. However, poor internet connectivity and erratic power supplies were reported as the main impediments causing delays and frustrations to the staff at the study health facilities. Conclusion: The study found that DHT has a positive effect on the work of health professionals. However, poor internet connectivity and unstable power supply caused delays in the provision of care and disruptions in the work process affecting the smooth operation of the DHT and threatening to erode the potential benefits to the health system and users.

Telehealth services for global emergencies: implications for COVID-19: a scoping review based on current evidence.

INTRODUCTION: The availability of low-cost computing and digital telecommunication in the 1980s made telehealth practicable. Telehealth has the capacity to improve healthcare access and outcomes for patients while reducing healthcare costs across a wide range of health conditions and situations. OBJECTIVE: This study compares the adoption, advantages, and challenges of telehealth services between high-income (HICs) and low-and-middle-income countries (LMICs) before and during the COVID-19 pandemic. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The key search terms were: "Telehealth", "Telehealth in HICs", "Telehealth in LMICs", "Telehealth before COVID-19", "Telehealth during COVID-19". We searched exhaustively ProQuest, Scopus, Web of Science, Google Scholar, CINAHL, and EMBASE databases from 2012. Booleans OR/AND were combined with key search terms to increase relevant search results. The literature search and selection process followed the Sample, Phenomena of Interest, Design, Evaluation, and Research (SPIDER) question format. RESULTS: The adoption of telehealth before COVID-19 was generally low in both HICs and LMICs. The impact of COVID-19 accelerated the adoption of telehealth at the facility level but not nationwide in both high-income countries and LMICs. The rapid adoption of telehealth at the facility level in both high-income and LMICs introduced several challenges that are unique to each country and need to be addressed. CONCLUSION: The lack of national policies and regulations is making the adoption of telehealth at the national level challenging in both high and low-middle-income countries. Governments and Stakeholders of healthcare must consider telehealth as a healthcare procedure that should be deployed in clinical working procedures. Primary quantitative and qualitative studies must be conducted to address challenges encountered during the pilot implementation of telehealth services in both high-income countries and LMICs before and during pandemics.

Health professional's readiness and factors associated with telemedicine implementation and use in selected health facilities in Ghana.

Background: Telemedicine, which is the practice of medicine using technology to deliver health care remotely, has a low adoption rate in low- and middle-income countries (LMICs). However, the advent of coronavirus disease 2019 (COVID-19) has forced healthcare systems in these settings to begin implementing telemedicine programs. It is unknown how prepared health professionals and the healthcare system are to adopt this technology. Therefore, this study aimed to assess the readiness of health professionals and explore factors associated with telemedicine implementation in Ghana. Methods: A cross-sectional study was conducted in six health facilities between March and August 2021. Convenience sampling was used to select the six health facilities, and the participants were selected randomly for the study. Questionnaires were self-completed by participants. Data was exported into STATA 15.0 for analysis, and appropriate statistical methods were employed. All statistical tests were performed at a significance level of p < 0.05. Results: Of the 613 health professionals involved in the study, about 579 (94.5%) were comfortable using computers, and the majority, 503 (82.1%) of them, had access to computers at the workplace. Health professionals agreed that the measures outlined by the health facilities supported their readiness to use telemedicine for healthcare services. Analysis revealed a statistically significant positive relationship between health facilities' core readiness and health professionals' readiness, with a correlation coefficient (r) of 0.5484 and a p-value<0.0001. Of the factors associated with health professionals' readiness towards telemedicine implementation, facility core readiness, engagement readiness, staff knowledge and attitude readiness showed a statistically significant relationship with health professionals' readiness. Conclusion: The study revealed that health professionals are ready to adopt telemedicine. There was a statistically significant relationship between health facilities' core readiness, engagement readiness, staff knowledge and attitude readiness, and health professionals' readiness. The study identified factors facilitating telemedicine adoption.

Electronic health records post-implementation challenges in selected hospitals: A qualitative study in the Central Region of southern Ghana.

BACKGROUND: Electronic health records (EHRs) are useful tools in healthcare settings but implementation in low and middle-income countries (LMIC) face challenges. OBJECTIVE: To explore post-implementation challenges affecting the deployment of EHRs and their use in selected health facilities in Ghana. METHOD: Using a qualitative research approach, 21 in-depth interviews were conducted with health workers in two hospitals in the study area in Ghana, in February and June 2020. Purposive sampling was used to select participants. All interviews were audio recorded, transcribed, and coded into themes using QSR Nvivo12 software to aid thematic analyses. RESULTS: Post-implementation challenges were grouped into lack of technological, logistical and managerial support, and inadequate training. Inadequate equipment was the most reported post-implementation challenge that affected EHR use. Unreliable Internet and network connectivity was a source of frustration, which caused staff to develop negative attitudes towards use of the system. Lack of funding stalled implementation of the system and limited its use to critical care units only. It was also the reason replacement of equipment delayed. CONCLUSION: While EHR post-implementation challenges facing health facilities are surmountable, managerial support, backed with the requisite logistical and technical support is needed. It is not enough to rely on funding; health institutions should prioritise emerging EHR post-implementation challenges in their operating budgets. IMPLICATIONS: A national framework is needed to guide effective and sustainable EHR implementation across the country.

Moving towards Digitising COVID-19 Vaccination Certificate: A Systematic Review of Literature.

The coronavirus pandemic is the greatest crisis of our time, having claimed over 2 million lives and shocking the global economy. Scientists and governments have suggested the idea of a digital COVID-19 certificate, to identify vaccinated persons easily. This paper assesses the positions of stakeholders on COVID-19 vaccination certificates, their presentation, and their importance. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was applied in this study. Search terms with Boolean and/or operators were combined to increase relevant results. Four large digital databases were used for the search. Inclusion and exclusion criteria were used to screen 298 collated studies. Two reviewers independently assessed search results, extracted data, and assessed the quality of the included studies. It is essential to re-examine digital COVID-19 vaccination certificates, considering their benefits, such as real-time detection of fake vaccination certificates and identifying and mapping non-vaccinated areas for strategic vaccination planning. The use of a single electronic platform globally will ease verification processes while bringing economies back to their feet. Digital COVID-19 vaccination certificates may provide balance in this pandemic era. With digital COVID-19 certificate exceeding documentation purposes, it is important to recognise factors such as global economy and human rights, boosting free movements of persons.

Assessment of health staff's proficiency and quality of key malaria indicators in rural district of Ghana.

BACKGROUND: Routine Health Information Systems (RHIS) are important for not just sure enough control of malaria, but its elimination as well. If these systems are working, they can extensively provide accurate data on reported malaria cases instead of presenting modelled approximations of malaria burden. Queries are raised on both the quality and use of generated malaria data. Some issues of concern include inaccurate reporting of malaria cases as well as treatment plans, wrongly categorizing malaria cases in registers used to collate data and misplacing data or registers for reporting. This study analyses data quality concerning health staff's proficiency, timeliness, availability and data accuracy in the Sissala East Municipal Health Directorate (MHD). METHODS: A cross-sectional design was used to collect data from 15 facilities and 50 health staff members who offered clinical related care for malaria cases in the Sissala East MHD from 24th August 2020 to 17th September 2020. Fifteen health facilities were randomly selected from the 56 health facilities in the municipality that were implementing the malarial control programme, and they were included in the study. RESULTS: On the question of when did staff receive any training on malaria-related health information management in the past six months prior to the survey, as minimal as 13 out of 50(26%) claimed to have been trained, whereas the majority 37 out of 50 (74%) had no training. In terms of proficiency in malaria indicators (MI), the majority (68% - 82%) of the respondents could not demonstrate the correct calculations of the indicators. Nevertheless, the MHD recorded monthly average timeliness of the 5th day [range: 4.7-5.7] within the reporting year. However, the MHD had a worse average performance of 5.4th and 5.7th days in July and September respectively. Furthermore, results indicated that 14 out of 15(93.3%) facilities exceeded the target to accomplish report availability (> = 90%) and data completeness (> = 90%). However, the verification factor (VF) of the overall malaria indicator showed that the MHD neither over-reported nor under-reported actual cases, with the corresponding level of data quality as Good (+/-5%). CONCLUSIONS: The Majority of staff had not received any training on malaria-related RHIS. Some staff members did not know the correct definitions of some of MI used in the malaria programme, while the majority of them could not demonstrate the correct calculations of MI. Timeliness of reporting was below the target, nevertheless, copies of data that were submitted were available and completed. There should be training, supervision and monitoring to enhance staff proficiency and improve the quality of MI.

Healthcare Providers' Intention to Use Technology to Attend to Clients in Cape Coast Teaching Hospital, Ghana.

BACKGROUND: Patient records' relevance is associated with a variety of needs and objectives. Substantiating the health of patients perpetually and allowing professionals in the medical field to assess both signs and symptoms that fall in a relatively wider temporal point of view and contributions that lead to enhanced diagnoses and treatment are all quintessential of patient records. The advancement of information technology systems has led to the anticipation that development will be put into digitization and electronic means of storing patient records in order to grease their handling. Cape Coast Teaching Hospital (CCTH) is piloting implementation of patient's electronic health record system. The introduction of the electronic health record system known as Lightwave Hospital Information Management System (LHIMS) was to provide a permanent solution to patients' continuity of care. User's acceptance of new information technology is seen to be one of the most challenging issues in information system. This study assesses healthcare providers' (HP') behavioural intention to use LHIMS to attend to clients in Cape Coast Teaching Hospital and other factors influencing it. METHODS: A nonexperimental cross-sectional study was used to obtain information from 84 HP recruited from the various departments and units in CCTH who use LHIMS to attend to clients. The sample size of 90, representing 8% of HP in CCTH, was randomly selected from the various departments and units. However, 84 (indicating 93.3% response rate) of the selected HP were available during the period of the research. RESULTS: Perceived ease of use (PEOU) of LHIMS had the strongest direct effect on perceived usefulness (PU), with a highly significant path coefficient of 0.75. PU had the greatest impact on attitude about HP' behavioural intention to use (BIU) LHIMS to attend to patients' healthcare delivery in CCTH (0.91). This relationship was highly significant at p < 0.001. PEOU did not have a significant direct effect on attitude about LHIMS use, as hypothesized in the original technology acceptance model. However, attitude towards use had a strong significant effect on HP' BIU of LHIMS, with a strong statistically significant path coefficient of 0.98 at p < 0.001. CONCLUSIONS: We conclude that attitude towards use have a significant influence on HP' behavioural intention to use LHIMS to attend to clients in Cape Coast Teaching Hospital.

Challenges and experiences in linking community level reported out-of-pocket health expenditures to health provider recorded health expenditures: Experience from the iHOPE project in Northern Ghana.

Out of pocket health payment (OOPs) has been identified by the System of Health Accounts (SHA) as the largest source of health care financing in most low and middle-income countries. This means that most low and middle-income countries will rely on user fees and co-payments to generate revenue, rationalize the use of services, contain health systems costs or improve health system efficiency and service quality. However, the accurate measurement of OOPs has been challenged by several limitations which are attributed to both sampling and non-sampling errors when OOPs are estimated from household surveys, the primary source of information in LICs and LMICs. The incorrect measurement of OOP health payments can undermine the credibility of current health spending estimates, an otherwise important indicator for tracking UHC, hence there is the need to address these limitations and improve the measurement of OOPs. In an attempt to improve the measurement of OOPs in surveys, the INDEPTH-Network Household out-of-pocket expenditure project (iHOPE) developed new modules on household health utilization and expenditure by repurposing the existing Ghana Living Standards Survey instrument and validating these new tools with a 'gold standard' (provider data) with the aim of proposing alternative approaches capable of producing reliable data for estimating OOPs in the context of National Health Accounts and for the purpose of monitoring financial protection in health. This paper reports on the challenges and opportunities in using and linking household reported out-of-pocket health expenditures to their corresponding provider records for the purpose of validating household reported out-of-pocket health expenditure in the iHOPE project.

Effect of specificity of health expenditure questions in the measurement of out-of-pocket health expenditure: evidence from field experimental study in Ghana.

BACKGROUND: The effect of number of health items on out-of-pockets (OOPs) has been identified as a source of bias in measuring OOPs. Evidence comes mostly from cross-sectional comparison of different survey instruments to collect data on OOPs. Very few studies have attempted to validate these questionnaires, or distinguish bias arising from the comprehensiveness of the OOPs list versus specificity of OOPs questions. OBJECTIVES: This study aims to estimate biases arising from the specificity of OOPs questions by comparing provider and household's information. METHODS: A generic questionnaire to collect data on household's OOPs was developed following the nomenclature proposed in division 6 of the classification of household final consumption 2018. The four categories within such division are used to set the comprehensiveness of the OOPs list, the specificity within each category was tailored to the design of the nationally representative living standard survey in Ghana where a field experiment was conducted to test the validity of different versions. Households were randomised to 11, 44 or 56 health items. Using data from provider records as the gold standard, we compared the mean positive OOPs, and estimated the mean ratio and variability in the ratio of household expenditures to provider data for the individual households using the Bland-Altman method of assessing agreement. FINDINGS: We found evidence of a difference in the overall mean ratio in the specificity for OOPs in inpatient care and medications. Within each of these two categories, a more detailed disaggregation yielded lower OOPs estimates than less detailed ones. The level of agreement between household and provider OOPs also decreased with increasing specificity of health items. CONCLUSION: Our findings suggest that, for inpatient care and medications, systematically decomposing OOPs categories into finer subclasses tend to produce lower OOPs estimates. Less detailed items produced more accurate and reliable OOPs estimates in the context of a rural setting.

Promising adoption of an electronic clinical decision support system for antenatal and intrapartum care in rural primary healthcare facilities in sub-Saharan Africa: The QUALMAT experience.

BACKGROUND: The QUALMAT project has successfully implemented an electronic clinical decision support system (eCDSS) for antenatal and intrapartum care in two sub-Saharan African countries. The system was introduced to facilitate adherence to clinical practice guidelines and to support decision making during client encounter to bridge the know-do gap of health workers. OBJECTIVES: This study aimed to describe health workers' acceptance and use of the eCDSS for maternal care in rural primary health care (PHC) facilities of Ghana and Tanzania and to identify factors affecting successful adoption of such a system. METHODS: This longitudinal study was conducted in Lindi rural district in Tanzania and Kassena-Nankana district in Ghana between October 2011 and December 2013 employing mixed methods. The study population included healthcare workers who were involved in the provision of maternal care in six rural PHC facilities from one district in each country where the eCDSS was implemented. RESULTS: All eCDSS users participated in the study with 61 and 56 participants at the midterm and final assessment, respectively. After several rounds of user training and support the eCDSS has been successfully adopted and constantly used during patient care in antenatal clinics and maternity wards. The eCDSS was used in 71% (2703/3798) and 59% (14,189/24,204) of all ANC clients in Tanzania and Ghana respectively, while it was also used in 83% (1185/1427) and 67% (1435/2144) of all deliveries in Tanzania and in Ghana, respectively. Several barriers reported to hinder eCDSS use were related to individual users, tasks, technology, and organization attributes. CONCLUSION: Implementation of an eCDSS in resource-constrained PHC facilities in sub-Saharan Africa was successful and the health workers accepted and continuously used the system for maternal care. Facilitators for eCDSS use included sufficient training and regular support whereas the challenges to sustained use were unreliable power supply and perceived high workload. However our study also shows that most of the perceived challenges did not substantially hinder adoption and utilization of the eCDSS during patient care.

Impact of an electronic clinical decision support system on workflow in antenatal care: the QUALMAT eCDSS in rural health care facilities in Ghana and Tanzania.

BACKGROUND: The implementation of new technology can interrupt established workflows in health care settings. The Quality of Maternal Care (QUALMAT) project has introduced an electronic clinical decision support system (eCDSS) for antenatal care (ANC) and delivery in rural primary health care facilities in Africa. OBJECTIVE: This study was carried out to investigate the influence of the QUALMAT eCDSS on the workflow of health care workers in rural primary health care facilities in Ghana and Tanzania. DESIGN: A direct observation, time-and-motion study on ANC processes was conducted using a structured data sheet with predefined major task categories. The duration and sequence of tasks performed during ANC visits were observed, and changes after the implementation of the eCDSS were analyzed. RESULTS: In 24 QUALMAT study sites, 214 observations of ANC visits (144 in Ghana, 70 in Tanzania) were carried out at baseline and 148 observations (104 in Ghana, 44 in Tanzania) after the software was implemented in 12 of those sites. The median time spent combined for all centers in both countries to provide ANC at baseline was 6.5 min [interquartile range (IQR) =4.0-10.6]. Although the time spent on ANC increased in Tanzania and Ghana after the eCDSS implementation as compared to baseline, overall there was no significant increase in time used for ANC activities (0.51 min, p=0.06 in Ghana; and 0.54 min, p=0.26 in Tanzania) as compared to the control sites without the eCDSS. The percentage of medical history taking in women who had subsequent examinations increased after eCDSS implementation from 58.2% (39/67) to 95.3% (61/64) p<0.001 in Ghana but not in Tanzania [from 65.4% (17/26) to 71.4% (15/21) p=0.70]. CONCLUSIONS: The QUALMAT eCDSS does not increase the time needed for ANC but partly streamlined workflow at sites in Ghana, showing the potential of such a system to influence quality of care positively.

Health workers' knowledge of and attitudes towards computer applications in rural African health facilities.

BACKGROUND: The QUALMAT (Quality of Maternal and Prenatal Care: Bridging the Know-do Gap) project has introduced an electronic clinical decision support system (CDSS) for pre-natal and maternal care services in rural primary health facilities in Burkina Faso, Ghana, and Tanzania. OBJECTIVE: To report an assessment of health providers' computer knowledge, experience, and attitudes prior to the implementation of the QUALMAT electronic CDSS. DESIGN: A cross-sectional study was conducted with providers in 24 QUALMAT project sites. Information was collected using structured questionnaires. Chi-squared tests and one-way ANOVA describe the association between computer knowledge, attitudes, and other factors. Semi-structured interviews and focus groups were conducted to gain further insights. RESULTS: A total of 108 providers responded, 63% were from Tanzania and 37% from Ghana. The mean age was 37.6 years, and 79% were female. Only 40% had ever used computers, and 29% had prior computer training. About 80% were computer illiterate or beginners. Educational level, age, and years of work experience were significantly associated with computer knowledge (p<0.01). Most (95.3%) had positive attitudes towards computers - average score (±SD) of 37.2 (±4.9). Females had significantly lower scores than males. Interviews and group discussions showed that although most were lacking computer knowledge and experience, they were optimistic about overcoming challenges associated with the introduction of computers in their workplace. CONCLUSIONS: Given the low levels of computer knowledge among rural health workers in Africa, it is important to provide adequate training and support to ensure the successful uptake of electronic CDSSs in these settings. The positive attitudes to computers found in this study underscore that also rural care providers are ready to use such technology.

Costs associated with implementation of computer-assisted clinical decision support system for antenatal and delivery care: case study of Kassena-Nankana district of northern Ghana.

OBJECTIVE: This study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS) in selected health care centres in Ghana. METHODS: A descriptive cross sectional study was conducted in the Kassena-Nankana district (KND). CDSS was deployed in selected health centres in KND as an intervention to manage patients attending antenatal clinics and the labour ward. The CDSS users were mainly nurses who were trained. Activities and associated costs involved in the implementation of CDSS (pre-intervention and intervention) were collected for the period between 2009-2013 from the provider perspective. The ingredients approach was used for the cost analysis. Costs were grouped into personnel, trainings, overheads (recurrent costs) and equipment costs (capital cost). We calculated cost without annualizing capital cost to represent financial cost and cost with annualizing capital costs to represent economic cost. RESULTS: Twenty-two trained CDSS users (at least 2 users per health centre) participated in the study. Between April 2012 and March 2013, users managed 5,595 antenatal clients and 872 labour clients using the CDSS. We observed a decrease in the proportion of complications during delivery (pre-intervention 10.74% versus post-intervention 9.64%) and a reduction in the number of maternal deaths (pre-intervention 4 deaths versus post-intervention 1 death). The overall financial cost of CDSS implementation was US$23,316, approximately US$1,060 per CDSS user trained. Of the total cost of implementation, 48% (US$11,272) was pre-intervention cost and intervention cost was 52% (US$12,044). Equipment costs accounted for the largest proportion of financial cost: 34% (US$7,917). When economic cost was considered, total cost of implementation was US$17,128-lower than the financial cost by 26.5%. CONCLUSIONS: The study provides useful information in the implementation of CDSS at health facilities to enhance health workers' adherence to practice guidelines and taking accurate decisions to improve maternal health care.

"Quality of prenatal and maternal care: bridging the know-do gap" (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa.

BACKGROUND: Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. METHODS: A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". RESULTS: The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. CONCLUSION: The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings.

A randomized, controlled trial of intermittent preventive treatment with sulfadoxine-pyrimethamine, amodiaquine, or the combination in pregnant women in Ghana.

BACKGROUND: The use of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) is threatened by the spread of resistance to SP. Therefore, we studied the efficacy, safety, and tolerance of amodiaquine (AQ) or the combination of AQ and SP (SPAQ) as possible alternative treatments. METHODS: The study was performed in Ghana from June 2004 through February 2007. Women were individually randomized to receive IPTp with SP (n=1328), AQ (n= 986), or SPAQ (n=1328). Incidences of anemia, peripheral anemia, and placental parasitemia at delivery were assessed for paucigravidae, as were the birth weights of their infants. Delivery outcomes and the incidence of adverse events were investigated for all women. RESULTS: The prevalences of anemia (as defined by a hemoglobin concentration of <11.0 g/dL) at delivery were comparable between the SP and AQ groups and between the SP and SPAQ groups. Similarly, there was no significant difference between the SP and AQ groups or between the SP and SPAQ groups with regard to the incidences of low birth weight (LBW). Women who received AQ or SPAQ were more likely to report adverse events than were those who received SP. CONCLUSION: The effects of IPTp with AQ or SPAQ on maternal anemia and LBW were comparable to the effects of IPTp with SP; however, IPTp regimens that contain AQ are unlikely to be useful as an alternative to IPTp with SP in Ghana, because of a high frequency of associated adverse events. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT00146783 .