Maintaining essential health services during COVID-19 in Ghana: a qualitative study.

INTRODUCTION: Evidence suggests that non-pharmaceutical interventions such as lockdown policies, restriction of movement and physical distancing to control the novel COVID-19 contributed to the decline in utilisation of essential health services. We explored healthcare providers' and policy-makers' experiences of the barriers, interventions and response actions that contributed to ensuring the continuity of essential health services during the COVID-19 pandemic in Ghana to help inform future practice and policy. METHODS: We used a qualitative study approach. Data were analysed using thematic analysis. Thirty Four participants composed of 20 healthcare providers and 14 policy-makers who worked across regions with low and high recorded COVID-19 cases in Ghana during the COVID-19 pandemic were involved in this study. RESULTS: Participants reported that essential health services including maternal, reproductive and child health services, communicable and non-communicable disease care, and elective surgeries were disrupted during the COVID-19 pandemic. Barriers to the utilisation of essential services were constructed into three subthemes: (1) fear, (2) poor quality of care at the facility and (3) financial limitation. These barriers were mitigated with population-based interventions underpinned by the socioecological model at the individual and interpersonal level (including psychosocial care for families and home visits), institutional and community levels (such as allocation of funds, training of health workers, public education, triage stations, provision of logistics, appointment scheduling, telemedicine and redeployment of health workers) and public policy level (tax relief packages, transportation arrangements and provision of incentives), which helped in maintaining essential health services during COVID-19. CONCLUSION: Disruption of essential health services during COVID-19 in Ghana instigated population-based interventions which aided in expanding the populations' continuous access to essential health services and strengthened health service delivery.

COVID-19 outbreak control strategies and their impact on the provision of essential health services in Ghana: An exploratory-sequential study.

BACKGROUND: The COVID-19 pandemic has led to substantial interruptions in critical health services, with 90% of countries reporting interruptions in routine vaccinations, maternal health care and chronic disease management. The use of non-pharmaceutical interventions (NPIs) such as lockdowns and self-isolation had implications on the provision of essential health services (EHS). We investigated exemplary COVID-19 outbreak control strategies and explored the extent to which the adoption of these NPIs affected the provision of EHS including immunization coverage and facility-based deliveries. Finally, we document core health system strategies and practices adopted to maintain EHS during the early phase of the pandemic. METHODS: This study used an explanatory sequential study design. First, we utilized data from routine health management information systems to quantify the impact of the pandemic on the provision of EHS using interrupted time series models. Second, we explored exemplary strategies and health system initiatives that were adopted to prevent the spread of COVID-19 infections while maintaining the provision of EHS using in-depth interviews with key informants including policymakers and healthcare providers. RESULTS: The COVID-19 pandemic and the interventions that were implemented disrupted the provision of EHS. In the first month of the COVID-19 pandemic, Oral Polio and pentavalent vaccination coverage reduced by 15.2% [95% CI = -22.61, -7.87, p<0.001] and 12.4% [95% CI = 17.68, -7.13; p<0.001] respectively. The exemplary strategies adopted in maintaining the provision of EHS while also responding to the spread of infections include the development of new policy guidelines that were disseminated with modified service delivery models, new treatment and prevention guidelines, the use of telemedicine and medical drones to provide EHS and facilitate rapid testing of suspected cases. CONCLUSION: The implementation of different NPIs during the peak phase of the pandemic disrupted the provision of EHS. However, the Ministry of Health leveraged the resilient health system and deployed efficient, all-inclusive, and integrated infectious disease management and infection prevention control strategies to maintain the provision of EHS while responding to the spread of infections.

Iron- and protein rich diets may boost hemoglobin levels among informal electronic waste recyclers exposed to metals at Agbogbloshie, Ghana.

While human exposure to metals may play a role in the pathogenesis of anemia, consumption of balanced diets may boost blood hemoglobin (Hb) levels in humans. Although informal electronic waste (e-waste) recycling processes have recently drawn attention as an important source of pollution, there is almost no empirical evidence on the relationship between diet, metals exposure and anemia among e-waste recyclers. Therefore, we evaluated possible ameliorating effects of diet on metal exposure related anemia, as measured by Hb levels of e-waste recyclers and a reference population in Ghana. This repeated measure study used data collected from e-waste recyclers (n=142) and a reference population (n=65) between March 2017 and October 2018. Stored whole blood samples were analyzed for the following metals; Cd, Pb, Rb, Tb, Tl, and Eu. Next, Hb levels were analysed using the URIT-810® semiautomatic biochemistry analyzer. Furthermore, a 48-hour dietary recall questionnaire was administered to assess dietary intake parameters such as protein, folate, carbohydrates, Fe, Ca, Mg, Se, Zn, and Cu. Ordinary regression models were used to estimate joint effects of metals and nutrients on Hb levels. At baseline, the mean Hb was lower among recyclers (12.99 ± 3.17 g/dL) than the reference group (13.02 ±2.37 g/dL). Blood Pb, Cd, Rb, Eu and Tb were associated with significant decreases in Hb levels of e-waste recyclers. Dietary intake of proteins and Fe was associated with concomitant increase in Hb levels of both groups as well as when analysis was restricted to recyclers. Despite the high exposure of e-waste recyclers to a myriad of metals, consumption of Fe-rich diets appears to ameliorate anemia and improved Hb levels (ß=0.229; 95% CI: 0.013, 0.445; p=0.04). Therefore, the consumption of Fe and protein-rich foods may boost blood Hb levels in e-waste recyclers, even though exposure to high levels of metals is a predictor of anemia among this worker-group.

Relationship between Metal Exposures, Dietary Macronutrient Intake, and Blood Glucose Levels of Informal Electronic Waste Recyclers in Ghana.

While metal exposures are generally high among informal electronic waste (e-waste) recyclers, the joint effect of metals and dietary macronutrients on their metabolic health is unknown. Therefore, we investigated the relationship between metal exposures, dietary macronutrients intake, and blood glucose levels of e-waste recyclers at Agbogbloshie using dietary information (48-h recall survey), blood metals (Pb & Cd), and HbA1C levels of 151 participants (100 e-waste recyclers and 51 controls from the Accra, Ghana) in March 2017. A linear regression model was used to estimate the joint relationship between metal exposures, dietary macronutrient intake, and blood glucose levels. Except for dietary proteins, both groups had macronutrient deficiencies. Diabetes prevalence was significantly higher among controls. Saturated fat, OMEGA-3, and cholesterol intake were associated with significant increases in blood glucose levels of recyclers. In a joint model, while 1 mg of cholesterol consumed was associated with a 0.7% increase in blood glucose, 1 g/L of Pb was found to significantly increase blood glucose levels by 0.9% among recyclers. Although the dietary consumption of cholesterol and fat was not high, it is still possible that exposure to Pb and Cd may still increase the risk of diabetes among both e-waste recyclers and the general population.