ABSTRACT
OBJECTIVE@#Barriers to healthcare in Ghana are multifaceted. Many people, including patients and providers, face them at different levels. To address these barriers, there is a need to explore the role of an intercultural healthcare system. This paper explores and provides the first evidence on ways through which an intercultural healthcare system can reduce the sociocultural and economic barriers to healthcare in Ghana.@*METHODS@#Focus group discussions with 35 participants comprising 17 healthcare users, 11 formal healthcare providers and 7 alternative healthcare providers were conducted to gather data. Thematic analyses were performed on the transcribed data and presented based on a posteriori inductive reduction approach.@*RESULTS@#Findings reveal that an intercultural healthcare system in Ghana can help reduce barriers to healthcare, especially cultural, social and economic barriers, by fostering an enhanced relationship between culture and healthcare, promoting affordable healthcare and promoting effective communication between healthcare providers and users. Weak institutional support, lack of strong political will and commitment, lack of training to meet standards of practice, poor registration and regulatory measures, and lack of universal acceptance inhibit implementation of an intercultural healthcare system in Ghana.@*CONCLUSION@#The support for intercultural healthcare system and the agreement on its perceived ability to reduce social, cultural and economic healthcare barriers for service users offer an opportunity for policymakers to demonstrate a stronger political will and improved commitment for effective education and training, enforcement of regulatory measures, inclusion of intercultural healthcare in medical school curricula across the country, and community engagement.
ABSTRACT
BackgroundOne major micronutrient known to have a possible protective effect against COVID-19 disease is vitamin D. This systematic review sought to identify and synthesise available evidence to aid the understanding of the possible effect of vitamin D deficiency on COVID-19 status and health outcomes in COVID-19 patients. MethodsThree databases PubMed, ScienceDirect, and Google Scholar were searched systematically to obtain English language journal article published within 1/12/2019 and 3/11/2020. The search consisted of the terms ("Vitamin D," OR "25{square}Hydroxyvitamin D," OR "Low Vitamin D.") AND ("COVID-19" OR "2019-nCoV" OR "Coronavirus" OR "SARS-CoV-2") AND ("disease severity" OR "IMV" OR "ICU admission" OR "mortality" OR "hospitalization" OR "infection"). We followed the recommended PRISMA guidelines in executing this study. After going through the screening of the articles, eleven articles were included in the review. FindingsAlmost all the included studies reported a positive association between Vitamin D sufficiency and COVID-19 status and health outcomes. Vitamin D deficient patients (< 25 ng/mL) are 5.84 times [aOR=6.84, p=0.01] more likely to die from COVID-19 compared to the vitamin D sufficient people. Another study also found that Vitamin D deficiency is associated with higher risk of death with Hazard ratio (HR) 14.73, p<0.001. Vitamin D deficient (<12 ng/mL) people were 2.2 times [aOR=3.2, p=0.07] more likely to develop severe COVID-19 after adjusting for age, gender, obesity, cardiac disease, and kidney disease compared to the vitamin D sufficient people. One study found that after controlling for confounders, patients with low 25(OH)D (<30 ng/mL) level are more likely [aOR=1.45, p=<0.001] to be COVID-19 infected compared to the patients with 25(OH)D level >=30 ng/mL. ConclusionFindings from the study included suggest Vitamin D may serve as a mitigating effect for covid-19 infection, severity and mortality. We recommend the need to encourage people to eat foods rich in vitamin D such as fish, red meat, liver and egg yolks whiles at the same time providing vitamin D supplements for individuals with COVID-19 in order to boost their immune systems.
