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Objective: To evaluate the effectiveness of a radio campaign involving serial 10-minute drama episodes, 10-minute on air discussion of each episode by trained community health workers and 30-minute phone-ins from listeners in improving mothers' nutrition- and health-related attitudes (HNRAs) and children's minimum acceptable diet (MAD)., Design: A two-arm quasi-experimental trial with a pre-post design was used to quantify the effect of a radio campaign on nutrition before and immediately after the 6-month intervention. Difference-in-difference (DID) analysis was performed to assess the intervention's effect., Setting: Saboba district (intervention) and Central Gonja (comparison district) of northern region of Ghana., Participants: At baseline, a total of 598 mothers with children aged 6-22 months were randomly selected from the intervention ( n 298) and control ( n 300) districts. At endline (6 months post-intervention), 252 mother-child dyads in the intervention district and 275 mother-child dyads in the control district were followed up., Results: The radio campaign was significantly and positively associated with a change in health- and nutrition-related attitudes (HNRA) over time, with DID in mean attitudes significantly improving more over time in the intervention district than the control (DID = 1·398, P < 0·001). Also, the prevalence of MAD over time in the intervention district was significantly higher than the control district (DID = 16·1 percentage points, P = 0·02) in the presence of food insecurity., Conclusions: The study indicates that a radio campaign on nutrition is associated with improved mothers' HNRA and children's MAD. Communication interventions on child nutrition targeting low-resource settings should consider this innovative approach.

Background: Digital technologies can assess the quality of medicines in resource-challenged health facilities in a timely manner and ensure effective healthcare., Objectives: This study assessed the quality of some non-communicable disease medicines, antimalarials, antibiotics, non-steroidal anti-inflammatory drugs and hematinics in selected healthcare facilities as part of their (potential) participation in a digital pharmaceutical supply chain management system (Med4All)., Methods: All the sampled medicines were screened using TruScan analyzer and GPHF-minilab, that is , low-medium field technologies. The quality of a representative subset of the medicines (∼11%) was determined using pharmacopoeia gold standard methods., Results: About 75% of the medicines were manufactured in Ghana, and 16% were imported from India, with the Ghana Food and Drugs Authority registering 72% of the medicines. There was over 90% availability of medicines in health facilities from the middle and southern sectors, while the northern sector had around 64%. Approximately 87% and 88% of the medicines passed TruScan™ Raman and GPHF-minilab analysis, respectively. There was no significant difference between the two screening methods for assessing the quality of the medicines ( p  > 0.05). Of the 21 medicine samples, 5 (∼24%) failed, and 16 (76%) passed the pharmacopoeia test. The failed medicines were diclofenac, azithromycin and glibenclamide. Compared to the pharmacopoeia method, the performance of the TruScan™ Raman analyzer and the GPHF-minilab technologies were 71% and 63%, respectively., Conclusion: The study provides insights into the quality of medicines in resource-limited primary healthcare facilities., Competing Interests: The data collected is either part of the manuscript or the supplemental information. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: The World Health Organization (WHO) encourages all member states to adopt and implement a package of essential evidence-based interventions called the Best Buys to reduce the burden of non-communicable diseases (NCDs). To date, little is known about the implementation of national policies and interventions for NCD control in the WHO member states in sub-Saharan Africa. Our study aimed to evaluate the implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana., Methods: This was explanatory mixed methods research which started with a document review of Ghana's WHO Best Buys scores from the 2015, 2017, 2018, 2020 and 2022 WHO NCD Progress Monitor Reports. Thereafter, we conducted 25 key informant interviews and one focus group discussion (11 participants) with key policymakers and stakeholders in the NCD landscape in Ghana to understand the implementation of the NCD policies and interventions, and the policy implementation gaps and challenges faced. Data from the NCD Progress reports were presented using mean scores whilst the qualitative data was analysed thematically., Results: Ghana has shown some advancements in the implementation of the WHO Best Buys measures. Ghana's implementation scores for 2015, 2017, 2020 and 2022 were 5.0, 9.0, 5.0 and 5.5 respectively, against the mean implementation scores of 7.6/19 for lower-middle-income countries and 9.5/19 for upper-middle-income countries. Efforts to decrease major risk factors such as excessive alcohol consumption and unhealthy diet have been progressing slowly. The most common challenges were related to a) the role of socio-cultural factors, b) stakeholder engagement, c) enforcement and implementation of public health policies, d) implementation guidelines, e) public awareness and education on NCDs, f) financing of NCD prevention and control, g) curative-centered health systems, and h) over-centralization of NCD care., Conclusion: Ghana has made progress in adopting the WHO Best Buys targeting risk factors of NCDs. However, the country faces contextual barriers to effective implementation. With the retrogression of some measures over time despite making progress in some earlier years, further investigation is needed to identify facilitators for sustained implementation of the WHO Best Buys interventions., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Hypertension (HTN) is common in patients with type 2 diabetes mellitus (T2DM). Patients with both T2DM and HTN have a higher risk of heart disease, kidney disorders, and mortality than those with either HTN or T2DM alone. Patients' psychological well-being plays a significant role in the optimum management of these chronic conditions. This study is aimed at determining the current prevalence of HTN and its related clinical and psychological factors in patients with T2DM. Methods: This cross-sectional study was conducted at the Korle-Bu Teaching Hospital with 156 patients diagnosed with T2DM. A structured questionnaire was used to obtain information on sociodemographic and clinical characteristics. In addition, the following information was obtained from the patients' clinical files: blood pressure, height, weight, waist circumference, serum creatinine, and urine protein. Depression, resilience, and coping skills of the participants were measured using the Brief Symptom Inventory-18, Resilience Scale for Adults, and Brief COPE Inventory, respectively. Data were analyzed using STATA version 18, with a significance level of p < 0.05. Results: The median age of respondents was 62.0 (IQR: 51.50, 67.00) years. The majority was female (76.3%). The prevalence of HTN among the patients with T2DM was 79.9% (95% CI: 72.7-85.9). The average body mass index (BMI) of the patients was 28871kg/m 2 with 34.8% and 36.2% being overweight and obese, respectively. The average HBA1C level was 8.6 ± 2.1 with 71.8% of the patients having poor glycemic control. Increasing age, caregiver, and personal resilience were factors significantly associated with HTN ( p value of <0.05) among patients with T2DM. Conclusion: The prevalence of HTN among T2DM patients was high; age, caregiver, and personal resilience significantly predicted HTN among T2DM patients. These findings have implications for healthcare providers in implementing strategies to reduce central obesity and incorporating resilience as an important factor in improving treatment outcomes in patients with T2DM., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 V. Boima et al.)

Background: Without a cure, antiretroviral therapy (ART) continues to be the primary mode of managing HIV, transforming it from a formerly lethal disease to a less severe one. Adherence to ART can be impacted by several factors, including poor quality of care., Methods: A quantitative cross-sectional study design was used to assess the factors that influence adherence to ART among adults receiving care at two health facilities in Accra. A structured interviewer-administered questionnaire was used to collect data on factors associated with medication adherence using a modified four-item Medication Adherence Rating from 255 people living with HIV (PLHIV). Descriptive statistics were used to summarise the data, while multiple binary logistic regression was used to assess the factors influencing adherence to ART., Results: Adherence to HIV medication was 44.7% among PLHIV. Adherence was positively correlated with high client health service satisfaction (adjusted OR [AOR]: 26.59, 95% CI 7.46 to 94.82, p<0.001), increased privacy at the HIV clinics (AOR: 3.40, 95% CI 1.40 to 8.21, p<0.007) and among PLHIV who had been diagnosed with HIV for ≥5 y (AOR: 7.59, 95% CI 2.76 to 20.85, p<0.001)., Conclusions: Adherence to ART was significantly low among study participants. The study highlights the importance of maintaining privacy and confidentiality at the facility while ensuring client satisfaction with HIV care to promote adherence to ART., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Diabetes is a major public health issue, and over half a billion people are estimated to be living with diabetes, with 6.7 million deaths reported in 2021. The global diabetes burden has been recognised and included in the United Nations Sustainable Development Goals to achieve a zero increase in diabetes cases and reduce one-third of premature diabetes deaths by 2030. However, local beliefs about the causes of diabetes have affected its prevention and management. This study examined community beliefs and practices about diabetes and how they affect the prevention and management of diabetes in the community., Methods: This study was carried out in the Ho Municipality of the Volta Region of Ghana. We conducted 33 in-depth interviews with 18 patients with diabetes, 5 carers (caretakers of patients with diabetes), 3 traditional healers, 2 religious leaders, 3 community elders, and 2 assembly members who were purposefully selected from urban and rural areas across the municipality. The interviews were recorded digitally and transcribed verbatim. Thematic analysis was applied to analyse the data using QRS NVivo 20., Results: Diabetes was described locally as sukli dɔ (sugar disease), which affects humans. Diabetes is believed to be caused by spiritual forces (juju, bewitchment, and punishment from gods) and physical factors (unhealthy diet, physical inactivity, eating fruits and vegetables sprayed with pesticides and insecticides, sugary and starchy foods, smoking, and abuse of alcohol). In terms of the management of diabetes, participants said traditional remedies are performed for spiritual interpretation, deliverance, fortification, and cleansing before biomedical and physical remedies are sought. Diabetes was likened to HIV/AIDS, and the sufferers were described as bringing the condition upon themselves as a result of their bad deeds. They were stigmatised, coupled with delays at the hospital, and poverty has also affected the prevention and management of diabetes., Conclusion: The local belief that diabetes is caused by spiritual forces, likened to HIV/AIDS, delays at hospitals, and poverty, has affected the prevention and management of diabetes. Incorporating local beliefs and practices into the intervention design using culturally sensitive health education programmes and improving social determinants of health may help improve the prevention and management of diabetes in communities., (© 2024. The Author(s).)

Background: Non-communicable diseases (NCDs) predispose households to exorbitant healthcare expenditures in health systems where there is no access to effective financial protection for healthcare. This study assessed the economic burden associated with the rising burden of type-2 diabetes (T2D) and hypertension comorbidity management, and its implications for healthcare seeking in urban Accra., Methods: A convergent parallel mixed-methods study design was used. Quantitative sociodemographic and cost data were collected through survey from a random community-based sample of 120 adults aged 25 years and older and living with comorbid T2D and hypertension in Ga Mashie, Accra, Ghana in November and December 2022. The monthly economic cost of T2D and hypertension comorbidity care was estimated using a descriptive cost-of-illness analysis technique from the perspective of patients. Thirteen focus group discussions (FGDs) were conducted among community members with and without comorbid T2D and hypertension. The FGDs were analysed using deductive and inductive thematic approaches. Findings from the survey and qualitative study were integrated in the discussion., Results: Out of a total of 120 respondents who self-reported comorbid T2D and hypertension, 23 (19.2%) provided complete healthcare cost data. The direct cost of managing T2D and hypertension comorbidity constituted almost 94% of the monthly economic cost of care, and the median direct cost of care was US$19.30 (IQR:10.55-118.88). Almost a quarter of the respondents pay for their healthcare through co-payment and insurance jointly, and 42.9% pay out-of-pocket (OOP). Patients with lower socioeconomic status incurred a higher direct cost burden compared to those in the higher socioeconomic bracket. The implications of the high economic burden resulting from self-funding of healthcare were found from the qualitative study to be: 1) poor access to quality healthcare; (2) poor medication adherence; (3) aggravated direct non-medical and indirect cost; and (4) psychosocial support to help cope with the cost burden., Conclusion: The economic burden associated with healthcare in instances of comorbid T2D and hypertension can significantly impact household budget and cause financial difficulty or impoverishment. Policies targeted at effectively managing NCDs should focus on strengthening a comprehensive and reliable National Health Insurance Scheme coverage for care of chronic conditions., (© 2024. The Author(s).)

Problem gambling has been recognised as an important public health issue because of its harmful consequences at the personal, interpersonal, and societal levels. There is a proliferation of gambling activities in Ghana owing to increased access to the internet, soaring smartphone penetration, and an influx of sports betting companies. Yet, very little research has addressed the harm associated with problem gambling in Ghana. This study assessed if the effect of problem gambling severity on suicidal behaviours (ideation, planning, and attempts) through psychological distress is contingent on the level of perceived social support. A total of 350 young adult men in the Greater Accra Region of Ghana provided the data for the current analysis. The data were analysed using a moderated mediation approach. The results showed that psychological distress is an important intervening mechanism through which problem gambling severity influences suicidality. In addition, the positive association between psychological distress and suicidal behaviours was found to be conditional on the levels of perceived social support. In other words, our results showed that problem gambling may first trigger episodes of psychological distress, which, in turn, can lead to suicidality among problem gamblers who report low to moderate levels of perceived social support. Our findings suggest that young adult problem gamblers require higher levels of social support from family, friends, and significant others to prevent those experiencing psychological distress from engaging in suicidal behaviours., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.

Diabetes remains a major, global clinical and public health threat with consistent rises in prevalence around the world over the past four decades. Two-thirds of the projected increases in global diabetes prevalence to 2045 are expected to come from low- and middle-income countries, including those in sub-Saharan Africa. Ghana is typical of this trend. However, there are gaps in evidence regarding the appropriate development of interventions and well-targeted policies for diabetes prevention and treatment that pay due attention to relevant local conditions and influences. Due consideration to community perspectives of environmental influences on the causes of diabetes, access to appropriate health services and care seeking for diabetes prevention and management is warranted, especially in urban settings. The 'Contextual Awareness, Response and Evaluation (CARE): Diabetes in Ghana' project is a mixed methods study in Ga Mashie, Accra. An epidemiological survey is described elsewhere. Six qualitative studies utilising a range of methodologies are proposed in this protocol to generate a contextual understanding of type 2 diabetes mellitus in an urban poor population. They focus on community, care provider, and policy stakeholder perspectives with a focus on food markets and environmental influences, the demand and supply of health services, and the history of the Ga Mashie community and its inhabitants. The results will be shared with the community in Ga Mashie and with health policy stakeholders in Ghana and other settings where the findings may be usefully transferable for the development of community-based interventions for diabetes prevention and control.

Background: Diabetes is a significant contributor to kidney failure, heart attack, strokes, lower limb amputation, blindness, and other complications that negatively impact health-related quality of life (HRQOL). This study assessed the HRQOL and clinical outcomes of patients with diabetes accessing healthcare in south-eastern Ghana., Methods: This was a hospital-based cross-sectional descriptive study conducted in the Ho Municipal and Ho Teaching Hospitals in Ghana among patients with type 2 diabetes who were seeking healthcare at both hospitals for at least 12 months. Systematic random sampling technique was used to select 310 respondents out of the total sample size of 326 patients with type 2 diabetes and data were collected using diabetes-39 questionnaire. The data were analysed using STATA 16.0. Socio-demographic and clinical variables were expressed as frequencies and percentages. Differences between proportions were tested using Chi-square to identify predictors of poor HRQOL and Pearson correlation for association. The p < 0.05 was considered significant., Results: Out of 310 respondents, 171 (55.0%) had poor HRQOL. The predictors of poor HRQOL were age (p < 0.008), education (p < 0.028), employment (p < 0.001), residence (p < 0.01), duration of diabetes (p < 0.002), diabetes education (p < 0.001), BMI (p < 0.005), and glycaemic control (p < 0.001). Energy and mobility (63.2%), anxiety and worry (53.9%), and diabetes control (49.6%) dimensions were the most prevalent of poor HRQOL. Diabetes education, complications, being diabetic for 16 years and above, earning income, resident in rural area, being married, being pensioner and national Service Personnel, and diabetes comorbidities were significantly associated with HRQOL., Conclusions: More than half of the respondents had poor HRQOL. Clinical and public health efforts should focus on effective control and screening measures for the individual patients and general population., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: Interest in medication adherence has expanded significantly, especially in relation to the management of hypertension or diabetes in recent years. A scoping review that focuses on medication adherence in the co-morbidity of hypertension and diabetes provides crucial guidance for effective management of these interrelated diseases., Aim: To conduct a scoping review of factors associated with medication adherence among individuals with co-morbid hypertension and diabetes., Methods: The evaluation was conducted in accordance with the PRISMA-ScR guidelines to ensure the quality of the study. We searched three databases (Scopus, CINAHL, Medline) and one search engine (Google Scholar) from April 2023 to July 2023 on studies related to medication adherence in co-morbid hypertension and diabetes. Except for reviews there were no restrictions on design, location, and time of study., Results: In total, 972 studies that were not duplicated were obtained. After eligibility and screening procedures were completed, 31 articles were ultimately included in the scoping review. Medication adherence was significantly affected by patient, condition, therapy, socio-economic and health related factors. Intervention trials revealed that education and counselling by pharmacists, nurses, physicians, diabetes educators, community health workers and the use of telephone to motivate patients significantly improved medication adherence., Conclusion: This review shows the intricate factors influencing medication adherence in patients with co-morbid hypertension and diabetes, emphasizing the need for tailored interventions involving healthcare professionals, policymakers, and researchers., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Living with HIV/AIDS is remarkably stressful and has an adverse effect on one's physical and mental health. In Sub-Saharan Africa, the introduction of highly active anti-retroviral therapy has led to an increased number of children with perinatal acquired HIV who are living into adolescence and adulthood. Developing strategies to cope with HIV becomes imperative, especially among these adolescents. The study determined the factors that influence coping strategies among adolescents living with HIV., Methods: An analytic cross-sectional design was used. A total of 154 adolescents aged 10-19 years living with HIV were systematically sampled at the Fevers Unit of Korle Bu Teaching Hospital from June to December, 2021. The adolescent version of the KidCope tool was used to assess the choice of coping strategies. Stata 16 was used to determine associations between independent variables and the coping strategies identified. Only variables that were significant at p = 0.1 or less in the crude model were used to run the adjusted regression model. The level of significance was set at p = 0.05 with a 95% confidence interval., Results: The mean age of participants was 19.2 ± 0.45 years with 51.9% (80/154) of participants being males. A majority, 57.1% of the participants employed positive coping strategies with 87.0% (135/154) using cognitive restructuring strategy. In an adjusted linear regression model, participants coping strategies were significantly associated with their educational level (p = 0.04) and presence of both parents as caregivers (p = 0.02)., Conclusion: Participants largely adopted positive coping strategies in managing the disease. Factors that influenced the choice of coping strategies were higher levels of education and the presence of both parents as caregivers. The importance of a good social support structure and pursuing further education needs to be emphasized in counselling adolescents living with HIV as it promotes the choice of positive coping strategies., (© 2023. The Author(s).)

The use of herbal medicinal products (HMPs) has grown significantly across low-and-middle-income countries (LMICs). Consequently, the safety of these products due to contamination is a significant public health concern. This systematic review aimed to determine the prevalence, types, and levels of contaminants in HMPs from LMICs. A search was performed in seven online databases, i.e., Africa journal online (AJOL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Directory of Open Access Journals (DOAJ), Health Inter-Network Access to Research Initiative (HINARI), World Health Organization Global Index Medicus (WHO GIM), Scopus, and PubMed using appropriate search queries and reported as per the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Ninety-one peer-reviewed articles published from 1982 to 2021 from 28 different countries across four continents were included in the study. Although metals, microbial, mycotoxins, pesticides, and residual solvents were the reported contaminants in the 91 articles, metals (56.0%, 51/91), microbial (27.5%, 25/91), and mycotoxins (18.7%, 17/91) were the most predominant. About 16.4% (1236/7518) of the samples had their contaminant levels above the regulatory limits. Samples tested for microbial contaminants had the highest proportion (46.4%, 482/1039) of contaminants exceeding the regulatory limit, followed by mycotoxins (25.8%, 109/423) and metals (14.3%, 591/4128). The proportion of samples that had their average non-essential metal contaminant levels above the regulatory limit was (57.6%, 377/655), 18.3% (88/480), 10.7% (24/225), and 11.3% (29/257) for Pb, Cd, Hg, and As, respectively. The commonest bacteria species found were Escherichia coli (52.3%, 10/19) and Salmonella species (42.1%, 8/19). This review reported that almost 90% of Candida albicans and more than 80% of moulds exceeded the required regulatory limits. HMP consumption poses profound health implications to consumers and patients. Therefore, designing and/or implementing policies that effectively regulate HMPs to minimize the health hazards related to their consumption while improving the quality of life of persons living in LMICs are urgently needed., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Previous studies have increasingly shown the adverse effects of being bullied on suicidal behavior among young people, but the mechanisms underlying this association remain unclear. We examined the association between bullying and suicidal behavior among in-school adolescents. We further tested whether loneliness mediated the link between bullying and suicidal behavior and explored the moderated role of parental involvement in this association., Methods: We used cross-sectional school-based data from the Global School-based Student Health Survey among 28 countries and territories. Adjusted, modified Poisson regressions with robust variance relative risks and moderation analyses were used to examine associations among bullying, suicidal behavior, and parental involvement. The mediating effect of loneliness on the bullying-suicidal behavior link was assessed using the generalized decomposition method., Results: A total of 78,558 school-going adolescents participated in this study. Bullying was associated with a 44% increased risk of suicidal behavior after adjusting for potential confounders (relative risk = 1.44; 95% confidence interval = 1.39-1.48). Loneliness partially mediated the association between bullying and suicidal behavior, and parental involvement moderated the association., Discussion: The findings suggest the need to recognize the dual burden of bullying and loneliness when addressing suicidal behavior and the importance of parental support in adolescents' mental health and well-being., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Medication adherence is an integral component in the management of patients with co-morbid type 2 diabetes mellitus (T2DM) and hypertension. However due to their combined conditions, there is likelihood of polypharmacy and medication-related burden, which could negatively impact adherence to therapy. This study aimed to assess the perceived medication-related burden among patients with co-morbid T2DM and hypertension and to evaluate the association between the perceived burden and adherence to medication therapy., Methods: A cross-sectional study was conducted among adult patients with co-morbid T2DM and hypertension attending a primary health facility. The living with medicines questionnaire and the medication adherence report scale were used to assess extent of medication-related burden and adherence respectively. Binary logistic regression model was used to estimate the adjusted odds and their corresponding 95% confidence interval for medication-related burden and adherence outcomes. All observed categorical variables were considered for the multivariable binary logistic regression model., Results: The total number of participants was 329 with a median age of 57.5 ± 13.2 years. The median score for the overall burden was 99 (IQR: 93-113), and this significantly varied by sex (p = 0.012), monthly income (p = 0.025), monthly expenditure on medications (p = 0.012), frequency of daily dose of medications (p = 0.020) and family history of T2DM (p < 0.001). About 30.7% and 36.8% of participants reported moderate/high burden and medication adherence respectively. Uncontrolled diastolic blood pressure (AOR: 2.46, 95% CI: 1.20-5.05, p = 0.014), high glucose (AOR: 4.24, 95% CI: 2.13-8.46, p < 0.001) and no family history of T2DM (AOR: 2.14, 95% CI: 1.14-4.02, p = 0.026) were associated with moderate/high medication burden. Uncontrolled diastolic blood pressure (AOR: 0.48, 95% CI: 0.25-0.94, p = 0.031), at least 5 years since hypertension diagnosis (AOR: 0.55, 95% CI: 0.30-0.99, p = 0.045) and moderate/high medication-related burden (AOR: 0.33, 95% CI: 0.16-0.69, p = 0.003) were associated with lower odds of medication adherence., Conclusion: These findings suggest that to improve the preventive and optimal care of patients with T2DM and hypertension, interventions that aim to reduce medication-related burden and morbidity are recommended. The study proposes that health stakeholders such as clinicians, pharmacists, and policy makers, develop multidisciplinary clinical and pharmaceutical care interventions to include provision of counselling to patients on adherence. In addition, developing policies and sensitization activities on deprescribing and fixed-dose drug combinations aimed at reducing medication-related burden, while promoting better adherence, blood pressure and blood glucose outcomes are recommended., Competing Interests: The authors declare no competing interests., (© 2023 The Authors.)

Globally, evidence has shown that many adolescents are victims of substance use, mainly cigarette smoking, and it has been associated with suicidal ideation. However, the mechanisms underlying this association are poorly understood. This study examines whether truancy mediates and gender moderates the association of cigarette smoking with suicide attempts among adolescents in 28 countries. Data from the Global School-Based Student Health Survey were used. Hierarchical multiple logistic regression analyses were used to estimate the effect-modification of gender on cigarette smoking and suicide attempt. The mediating effect of truancy on the association between cigarette smoking and suicidal attempt was assessed using the generalized decomposition method. Cigarette smoking was associated with suicide attempts after adjusting for several confounding variables (aOR = 1.21; 95% CI = 1.09-1.33). The bootstrap results from the generalized decomposition analysis indicated that truancy partially mediated the association of cigarette smoking with a suicide attempt, contributing 21% of the total effect among in-school adolescents. Hierarchical regression analyses suggested that gender moderated the effect of cigarette smoking on suicidal attempts: female adolescents who smoked had 36% higher odds of suicidal attempts compared to male adolescents. The findings suggest possible pathways for designing and implementing interventions to address adolescents' cigarette smoking and truancy to prevent suicidal attempts., (© 2023. The Author(s).)

Background: The novelty and complexity of the COVID-19 pandemic has resulted in various coping mechanisms adopted by individuals as a means of averting the perceived fatalities of the pandemic. The use of antibiotics in the management of COVID-19 is clinically recommended under specific conditions. However, there are increasing trends of non-adherence to the recommended criteria resulting in the unwarranted use of antibiotics as an adaptative approach to the ongoing pandemic., Objective: The objective was to identify and classify factors associated with the unwarranted use of antibiotics in the management of COVID-19 from published literature and the perspectives of key stakeholders along a Biopsychosocial model., Methods: Literature was searched in the following databases: PubMed/MEDLINE, Scopus, Embase and Google Scholar for studies published between 31 st December 2019 and 31 st January 2022. The Arskey and O'Malley framework modified by Levac in the six-stage methodological process was adopted for this review and included: a) identification of research questions, b) identification of relevant research articles, c) selection of studies, d) data charting and synthesis, e) summary, discussion and analysis, and f) stakeholder consultations., Results: Out of 10,252 records identified from all sources, 12 studies were selected for inclusion in this scoping review. The selected articles reflected both antibiotic use and COVID-19 whilst capturing the biological (medical) and psychosocial perspectives. Most of the studies reported the overuse or abuse of Azithromycin especially in hospital settings. Common themes across the review and stakeholder consultations included fear, anxiety, media influences and deficits in public knowledge., Conclusion: The findings of the study highlight the complexity of antibiotic control especially in the context of a pandemic. The identified determinants of antibiotic use provide the necessary framework to simulate health emergencies and be better positioned in the future through the development of targeted and comprehensive policies on antibiotic stewardship., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Hypertension is associated with high morbidity and mortality and this has been linked to poor treatment and control rates. To optimize drug treatment, patient-centered strategies such as coping, resilience, and adherence to medication may improve control rates and decrease the morbidity and mortality associated with hypertension. This study, therefore, assessed coping skills and resilience among patients with hypertension in Ghana., Methods: A cross-sectional study was conducted at Korle Bu Teaching Hospital. 224 consented patients with a diagnosis of hypertension were consecutively selected from the outpatient clinic. Questionnaires comprising socio-demographic characteristics, clinical parameters, Adult Resilience Measure, and the Africultural Coping Systems Inventory were administered. Data were analyzed using Stata version 16.1 and significance level was set at p -value of ≤ 0.05., Results: The mean age of participants was 62.03 ± 11.40 years and the majority were female (63%). The overall coping strategy mean score was 43.13 ± 13.57. For resilience, median relational and personal resilience (PR) scores were 32 (IQR-7) and 39 (IQR-9), respectively. Increased systolic BP significantly increases the overall coping strategy score. Collective coping strategy and systolic BP significantly increased coping scores (95%CI = 0.05-3.69 vs. 95%CI = 0.58-5.31). Overall coping strategy significantly increased personal and relational resilience (RR) domain scores by 0.004 (95%CI = 0.002-0.01) and 0.005 (95%CI = 0.003-0.006) units, respectively. This study demonstrated that Cognitive and emotional debriefing coping strategy was mostly used by patients with hypertension., Conclusion: Coping strategies had a positive and significant correlation with personal and RR, specifically collective and cognitive debriefing had a significant positive association with resilience among study participants. There is a need to actively put in measures that can improve the coping strategies and resilience among patients with hypertension to adjust to the long-term nature of the illness and treatment as this will promote better treatment outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Boima, Yorke, Ganu, Gyaban-Mensah, Ekem-Ferguson, Kretchy and Mate-Kole.)

Background: Implementing medicines pricing policy effectively is important for ensuring equitable access to essential medicines and ultimately achieving universal health coverage. However, published analyses of policy implementations are scarce from low- and middleincome countries. This paper contributes to bridging this knowledge gap by reporting analysis of implementation of two medicines pricing policies in Ghana: value-added tax (VAT) exemptions and framework contracting (FC) for selected medicines. We analysed implications of actor involvements, contexts, and contents on the implementation of these policies, and the interplay between these. This paper should be of interest, and relevance, to policy designers, implementers, the private sector and policy analysts., Methods: Data were collected through document reviews (n=18), in-depth interviews (n=30), focus groups (n=2) and consultative meetings (n=6) with purposefully identified policy actors. Data were analysed thematically, guided by the four components of the health policy triangle framework., Results: The nature and complexity of policy contents determined duration and degree of formality of implementation processes. For instance, in the FC policy, negotiating medicines prices and standardizing the tendering processes lengthened implementation. Highly varied stakeholder participation created avenues for decision-making and promoted inclusiveness, but also raised the need to manage different agendas and interests. Key contextual enablers and constraints to implementation included high political support and currency depreciation, respectively. The interrelatedness of policy content, actors, and context influenced the timeliness of policy implementations and achievement of intended outcomes, and suggest five attributes of effective policy implementation: (1) policy nature and complexity, (2) inclusiveness, (3) organizational feasibility, (4) economic feasibility, and (5) political will and leadership., Conclusion: Varied contextual factors, active participation of stakeholders, nature, and complexity of policy content, and structures have all influenced the implementation of medicines pricing policies in Ghana., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Community health participation is an essential tool in health research and management where community members, researchers and other relevant stakeholders contribute to the decision-making processes. Though community participation processes can be complex and challenging, evidence from previous studies have reported significant value of engaging with community in community health projects., Objective: To identify the nature and extent of community involvement in community health participatory research (CHPR) projects in Ghana and draw lessons for participatory design of a new project on diabetes intervention in Accra called the Contextual Awareness Response and Evaluation (CARE) diabetes project., Methods: A scoping review of relevant publications on CHPR projects in Ghana which had a participatory component was undertaken. PubMed, PsycINFO, African Journal Online, Health Source: Nursing/Academic Edition, Humanities International Complete and Google Scholar were searched for articles published between January 1950 and October 2021. Levac et al.'s (2010) methodological framework for scoping reviews was used to select, collate and characterise the data., Results: Fifteen studies were included in this review of CHPR projects from multiple disciplines. Participants included community health workers, patients, caregivers, policymakers, community groups, service users and providers. Based on Pretty's participation typology, several themes were identified in relation to the involvement of participants in the identified studies. The highest levels of participation were found in two studies in the diagnosis, four in the development, five in the implementation and three in the evaluation phases of projects. Community participation across all studies was assessed as low overall., Conclusion: This review showed that community participation is essential in the acceptability and feasibility of research projects in Ghana and highlighted community participation's role in the diagnosis, development, implementation and evaluation stages of projects. Lessons from this review will be considered in the development, implementation, and future evaluation of the CARE diabetes project.

There is an increased need for COVID-19 vaccination since the world is gradually returning to normal. Current evidence supports vaccination activity more towards viral suppression than COVID-19 prevention. This has led to divergent views regarding vaccination which may influence anti-vaccine attitudes and vaccine hesitancy. The study examined the role of personality traits, anti-vaccine attitudes and illness perceptions on vaccine hesitancy. The study was a cross-sectional survey using snowball and convenience sampling to recruit 492 participants via social media platforms. Multivariate analysis of variance and regression analysis were used to test the hypotheses. The study found that some facets of illness perception (identity, concern, emotional representation and treatment control), extraversion, experience with COVID-19 and anti-vaccine attitudes (mistrust, profiteering, worries about unforeseen effects of vaccine) predicted vaccine hesitancy. The outcomes from this study have implications for achieving public health goals and developing strategies for reaching optimal vaccination targets and attaining herd immunity. Health-promoting programs need to be intensified and could include psychosocial perspectives on vaccine hesitancy so that specific target groups can be reached to be vaccinated., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Nanteer-Oteng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Hypertension and diabetes are major risk factors for cardiovascular diseases and optimal control of blood pressure (BP) and blood glucose are associated with reduced cardiovascular disease events. This study, therefore, sought to estimate the prevalence and associated factors of controlled BP and blood glucose levels among patients diagnosed with both hypertension and Type 2- diabetes mellitus (T2DM). A quantitative cross-sectional study was conducted in a primary health setting in Ghana among patients 18 years and older diagnosed with both hypertension and T2DM. Pearson's chi-square was used to assess the association between BP and blood glucose levels and the independent variables. The multivariable binary logistic regression model was used to assess the adjusted odds of controlled BP and blood glucose levels. Among the 329 participants diagnosed with both hypertension and T2DM, 41.3% (95% CI: 36.1-46.8%) had controlled BP, 57.1% (95% CI: 51.7-62.4%) had controlled blood glucose whilst 21.8% (95% CI: 17.7-26.7%) had both controlled BP and blood glucose levels. Increased age, non-formal education, non-married, employed, single-dose anti-hypertensives or anti-diabetic medications, and hyperlipidaemia or stroke co-morbidities were positively associated with controlled BP levels. Being female, married, taking 2 or more anti-hypertensive medications, and moderate to high medication-related burden were positively associated with controlled blood glucose levels. In terms of both controlled BP and blood glucose levels, being employed, reduced income level, being registered with national health insurance, single anti-diabetes or anti-hypertensive medications, hyperlipidaemia or stroke co-morbidities, and moderate to high medication-related burden were positively associated with having both controlled BP and blood glucose levels. One in five patients with hypertension and T2DM had both BP and blood glucose levels under control. The benefits and risks of blood pressure and blood glucose targets should thus be factored into the management of patients with hypertension and T2DM., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Alhassan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: High medicine prices contribute to increasing cost of healthcare worldwide. Many patients with limited resources in sub-Saharan Africa (SSA) are confronted with out-of-pocket charges, constraining their access to medicines. Different medicine pricing policies are implemented to improve affordability and availability; however, evidence on the experiences of implementations of these policies in SSA settings appears limited. Therefore, to bridge this knowledge gap, we reviewed published evidence and answered the question: what are the key determinants of implementation of medicines pricing policies in SSA countries?, Methods: We identified policies and examined implementation processes, key actors involved, contextual influences on and impact of these policies. We searched five databases and grey literature; screening was done in two stages following clear inclusion criteria. A structured template guided the data extraction, and data analysis followed thematic narrative synthesis. The review followed best practices and reported using PRISMA guidelines., Results: Of the 5595 studies identified, 31 met the inclusion criteria. The results showed thirteen pricing policies were implemented across SSA between 2003 and 2020. These were in four domains: targeted public subsides, regulatory frameworks and direct price control, generic medicine policies and purchasing policies. Main actors involved were government, wholesalers, manufacturers, retailers, professional bodies, community members and private and public health facilities. Key contextual barriers to implementation were limited awareness about policies, lack of regulatory capacity and lack of price transparency in external reference pricing process. Key facilitators were favourable policy environment on essential medicines, strong political will and international support. Evidence on effectiveness of these policies on reducing prices of, and improving access to, medicines was mixed. Reductions in prices were reported occasionally, and implementation of medicine pricing policy sometimes led to improved availability and affordability to essential medicines., Conclusions: Implementation of medicine pricing policies in SSA shows some mixed evidence of improved availability and affordability to essential medicines. It is important to understand country-specific experiences, diversity of policy actors and contextual barriers and facilitators to policy implementation. Our study suggests three policy implications, for SSA and potentially other low-resource settings: avoiding a 'one-size-fits-all' approach, engaging both private and public sector policy actors in policy implementation and continuously monitoring implementation and effects of policies., Systematic Review Registration: PROSPERO CRD42020178166., (© 2022. The Author(s).)

The literature on behavioral outcomes associated with the COVID-19 pandemic is inundated with mental health burdens such as depression and stress disorders. The current study investigated gender invariance on resilience and post-traumatic growth (PTG) as positive psychological changes associated with the COVID-19 pandemic. A total of 381 survivors of the COVID-19 infection completed measurements of resilience, PTG, violence and stigma experience, and mental health problems like post-traumatic stress disorder (PTSD). The data were analyzed using descriptive statistics, correlation, multivariate regression, and a latent profile analysis. The results revealed that more than half of the participants had high scores on resilience (53.6%) and PTG (60.9%). The positive psychological changes, although independent of each other, were moderated by gender, and influenced by the negative experiences of participants such as stigma, violence, and PTSD. Latent profile analyses revealed three classes of participants, two of which were characterized by high scores on mental health problems and PTG. The clusters were invariant across gender. Surviving COVID-19 contributed to resilience and PTG. These can be targeted for intervention programs to mitigate the mental health burden occasioned by the pandemic.

Introduction: Universal availability and affordability of essential medicines are determined by effective design and implementation of relevant policies, typically involving multiple stakeholders. This paper examined stakeholder engagements, powers and resultant influences over design and implementation of four medicines pricing policies in Ghana: Health Commodity Supply Chain Master Plan, framework contracting for high demand medicines, Value Added Tax (VAT) exemptions for selected essential medicines, and ring-fencing medicines for local manufacturing., Methods: Data were collected using reviews of policy documentation (n=16), consultative meetings with key policy actors (n=5) and in-depth interviews (n=29) with purposefully identified national-level policymakers, public and private health professionals including members of the National Medicine Pricing Committee, pharmaceutical wholesalers and importers. Data were analysed using thematic framework., Results: A total of 46 stakeholders were identified, including representatives from the Ministry of Health, other government agencies, development partners, pharmaceutical industry and professional bodies. The Ministry of Health coordinated policy processes, utilising its bureaucratic mandate and exerted high influences over each policy. Most stakeholders were highly engaged in policy processes. Whereas some led or coproduced the policies in the design stage and participated in policy implementation, others were consulted for their inputs, views and opinions. Stakeholder powers reflected their expertise, bureaucratic mandates and through participation in national level consultation meetings, influences policy contents and implementation. A wider range of stakeholders were involved in the VAT exemption policies, reflecting their multisectoral nature. A minority of stakeholders, such as service providers were not engaged despite their interest in medicines pricing, and consequently did not influence policies., Conclusions: Stakeholder powers were central to their engagements in, and resultant influences over medicine pricing policy processes. Effective leadership is important for inclusive and participatory policymaking, and one should be cognisant of the nature of policy issues and approaches to policy design and implementation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Introduction: self-medication involves the use of medicines without the input of health professionals. Available studies are not entirely conclusive on self-medication among health science versus non-health science university students. The current study therefore sought to investigate relevant aspects of self-medication among pharmacy and non-pharmacy students., Methods: this quantitative cross-sectional research was conducted among undergraduate pharmacy and non-pharmacy students of the University of Ghana from October 1 st 2019 to December 6 th 2019. Using a questionnaire, interviews were conducted to assess the pattern and attitude towards self-medication among respondents within the last 2 months., Results: a total of 337 (163 pharmacy and 174 non-pharmacy) students filled and completed questionnaires. The prevalence of self-medication was 55.2% for pharmacy and 51.1% for non-pharmacy students. Both pharmacy and non-pharmacy students were either accepting or ambivalent towards self-medication. Painkillers were the major class of medications that were self-medicated by both pharmacy (38.5%) and non-pharmacy students (30.7%). The most common reason for self-medication among pharmacy (62.2%) and non-pharmacy (56.2%) students was the need for rapid relief from an illness. Majority of the participants who were self-medicated (27.6% among non-pharmacy and 36.8% among pharmacy students) demonstrated ambivalent attitude towards self-medication. An increase in the study level reduced the likelihood of self-medication in both pharmacy and non-pharmacy students: OR=0.442, CI = 0.266-0.736 for pharmacy students and OR=0.671, CI = 0.456-0.987 for non-pharmacy students., Conclusion: self-medication is common students of the University of Ghana. Prevalence of self-medication was higher among pharmacy students than non-pharmacy students. This study provides data for targeted education and sensitisation of self-medication among university students., Competing Interests: The authors declare no competing interests., (Copyright: Seth Kwabena Amponsah et al.)

Objectives: This study aimed to evaluate Health-related quality of life (HRQoL) among male patients with hypertension and its associated demographic, clinical and psychosocial factors., Design: This was a facility-based cross-sectional study., Setting: This study was carried out at the outpatient department in Korle-Bu Teaching Hospital., Participants: Three hundred and fifty-eight hypertensive patients were recruited for this study., Data Collection: Information on socio-demographic characteristics, clinical features, insomnia, medication adherence, psychological distress, sexual dysfunction and HRQoL were obtained through patient-reported measures using structured questionnaires and standardised instruments., Statistical Analysis/main Outcome Measure: The study assessed HRQoL among male hypertensive patients. One-way ANOVA was used to compare the average scores of the various domains of HRQL across the independent variables. Multivariate linear regression models with robust standard errors were used to determine factors associated with quality of life., Results: Participants with poor perceived overall HRQoL was 14.0%. Comparatively, HRQoL (mean ± SD) was the least in the physical health domain (56.77±14.33) but the highest in the psychological domain (58.7 ± 16.0). Multivariate linear regression showed that income level, educational level, insomnia, overall satisfaction, sexual desire and medication adherence were significant predictors of HRQoL. Average scores of HRQoL domains reduced with a higher level of sexual desire dysfunction., Conclusion: HRQoL among male hypertensive patients was negatively affected by insomnia, sexual desire dysfunction, educational level and adherence to antihypertensive medications but positively affected by income level. Clinical practice and policy processes should be directed at these factors to improve HRQoL., Funding: No external funding., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Background: Antimicrobial resistance (AMR) is a global health challenge, particularly in low- and middle-income countries where antibiotics are widely available to consumers, leading to their misuse. However, AMR educational interventions for engaging parents of schoolchildren are mainly lacking in Sub-Saharan Africa. This study aimed to assess the potential of AMR animation and schoolchildren in influencing parents' AMR knowledge, attitudes, and beliefs., Methods: Parents of schoolchildren aged 11-15 years in Tema, a city in Ghana, watched and discussed an AMR animation designed with ideas from the schoolchildren's top stories and picture drawings. The children from two schools were first engaged with AMR lessons, with one school using storytelling, the other school using picture drawing, and none serving as a control. The children were then asked to discuss the lessons with their parents. Baseline surveys of parents of randomly selected children were conducted to assess AMR knowledge, attitudes and beliefs before engaging the students and parents, and immediately after the parents participated in viewing and discussing the animation. McNemar and t-tests were used to assess changes in AMR knowledge, attitudes and beliefs., Results: Parents who participated in the animation event, and whose schoolchildren were in the storytelling intervention school had significantly improved knowledge regarding the statement "Antibiotics will cure any infection" (p = 0.021, χ2 = 0.711; 88% vs 50%) between baseline and endline. However, these parents also had statistically significant decreased scores regarding the statement "Antibiotics do not kill our good bacteria" (p = 0.021, χ2 = 1.042; 71.4% vs 40%) between baseline and endline. There was no significant effect on any statement among parents whose children were in the picture drawing school. However, t-test results combining the statements as composite scores showed statistically significant difference in only the attitude construct among parents whose children participated in storytelling intervention (p = 0.043) or picture drawing intervention (p = 0.019). There were no statistically significant changes in knowledge and beliefs constructs., Conclusions: This study shows that interventions involving schoolchildren with parents engagements and AMR animation could influence parents' AMR attitudes. The intervention could also positively or negatively impact parents' AMR knowledge. Modifications of the interventions may be needed for tackling AMR., (© 2022. The Author(s).)

Complementary and alternative medicine (CAM) use is widespread and has played critical roles in preventing infections, including previous coronaviruses. This study sought to document current practices in the use of CAM for the prevention of COVID-19 disease in Ghana. An anonymous electronic survey was conducted from February 1, 2021 to April 30, 2021. Data on demographic characteristics, basic clinical information, illness perceptions about COVID-19, and CAM use during the pandemic period were generated. While about 82.5% (986/1195) of the participants used CAM during the COVID-19 period, 69.1% (681/986) of CAM users intented it for COVID-19 infection prevention. Vitamin supplements (88.1%, 869/986), spiritual healing/prayer (23.3%, 230/986), mineral supplements (22.3%, 220/986), botanical/herbal medicines (22.2%, 219/986), and diet therapy (19.4%, 191/986) were the main types of CAM used. From the adjusted binary logistic regression model, current age (aOR: 1.03, 95%CI: 1.01-1.05), sex (aOR: 1.41, 95%CI: 1.02-1.95), participants' perceptions of consequences (aOR: 1.10, 95%CI: 1.04-1.17), identity (aOR: 1.15, 95%CI: 1.06-1.25) and concerns about COVID-19 (aOR: 0.91, 95%CI: 0.85-0.97) were statistically significant predictors of CAM use. These results suggest the need for appropriate public health policy on COVID-19 and CAM use in addition to directing further research initiatives toward an optimized COVID-19 prevention scheme using clinically validated CAM treatments. Research to validate the clinical efficacy of these products, especially the herbs, for COVID-19 prevention while isolating lead compounds that could be optimized and used for the treatment and prevention of COVID-19 is also recommended., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Published by Elsevier Inc.)

Background Medication adherence is essential in the management of schizophrenia. Yet poor treatment uptake has negative consequences on patients and their primary caregivers. Objective To examine the association among beliefs about psychotropic medications, side effects and adherence from a patient-caregiver dyad perspective. Setting This study was conducted in a public psychiatric hospital setting in Accra, Ghana. Methods A cross-sectional study was conducted among 121 patient-caregiver dyads using an interviewer-administered data collection approach.Main outcome measure Beliefs about medicines, side-effects and medication adherence. Results The patient and caregiver-reported level of medication adherence was 28.1 %. Using the Kappa index, the level of agreement between the responses of patients and their caregivers ranged from slight to moderate. Both patients and caregivers rated necessity higher than concern (patients: 1.67 ± 0.84, caregiver: 1.79 ± 0.96). Significant positive relations between specific-necessity, necessity-concerns differential and medication adherence were recorded while specific-concern, general harm and side-effects correlated negatively with medication adherence from the dyad. The odds of adhering to medications increased by 58 and 64 % for each unit increase in specific-necessity and general overuse scores respectively. However, a unit increase in specific-concern score and high side-effects scores were associated with lower odds of adherence. Conclusions This study highlights the need for patient-caregiver collaborations in decision-making relating to medication adherence in schizophrenia. Thus, in clinical practice, there is the need to recognize that caregivers are essential partners, and patient-caregiver views about psychotropic medications are critical in enhancing adherence for positive mental health outcomes., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Aim: To assess how illness perceptions and social support influence antiretroviral medication adherence in a HIV patient population in Ghana., Design: This study used a correlational research design with cross-sectional data., Method: A total of 235 people living with HIV at two general hospitals in the Greater Accra Region of Ghana provided data on illness perceptions, social support and medication adherence. Hierarchical multiple regression test was used to analyse the data., Results: Illness perceptions' facets of timeline, personal control and treatment control were negatively associated with medication adherence, whereas emotional response was positively associated with adherence. Further, significant other support was negatively associated with adherence. Family and friend support were not associated with adherence. The findings offer preliminary evidence that illness perceptions may have utility for medication adherence in a HIV patient population in Ghana., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Objective: This study assessed levels of anxiety, depression, and stress among family caregivers of children and adolescents with mental disorders in Ghana and the implication on medication adherence., Design: A cross-sectional study., Setting: The study was conducted at the outpatient departments of the three main public psychiatric hospitals in Ghana., Participants: Two hundred and ten non-paid family caregivers of children and adolescents with mental disorders were recruited for this study., Main Outcome Measure: The study assessed symptoms of anxiety, depression and stress among the caregivers and estimated caregiver-reported medication adherence., Results: About 56.2%, 66.2% and 78% of the caregivers experienced severe anxiety, severe depression and moderate to severe stress symptoms respectively. From the multiple logistic regression model, while anxiety was significantly affected by religion and education, depression was influenced by sex, age, marital status, proximity to facility, and employment status. Female caregivers had about four times higher odds of being depressed compared to male caregivers (aOR: 3.81, 95% CI: 1.66 - 8.75). The caregiver-reported medication adherence was 11.9%. Anxiety was significantly predictive of medication adherence., Conclusion: Most family caregivers of children and adolescents with mental disorders experienced symptoms of anxiety, depression and stress with anxiety having implications for medication adherence. The study findings underscore the need to consider psychological characteristics of caregivers and the provision of mental health support for them, as part of the routine health care for children and adolescents with mental disorders., Funding: None indicated., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Background: Optimal adherence to prescribed medications in women with gestational diabetes is relevant for perinatal outcomes., Objective: To summarize available information on the prevalence and factors contributing to medication adherence in women with gestational diabetes from the biological and psychosocial perspectives., Methods: A literature search on adherence in gestational diabetes was conducted in PubMed/MEDLINE, CINAHL, Scopus, and the Directory of Open Access Journals for studies published on the topic. The Arksey and O'Malley framework for scoping reviews was used to explore and summarize the evidence., Results: A total of 2395 studies were retrieved of which 13 fully met the eligibility criteria. The studies were reported in Zimbabwe ( n = 5), Iran ( n = 1), Mexico ( n = 1), South India ( n = 1), the United States of America ( n = 4), and one multinational study covering Australia, Europe, North and South America. The main types of antidiabetic medications used were insulin ( n = 6), metformin ( n = 4), and glyburide ( n = 2). The prevalence of adherence ranged from 35.6% to 97%, with the assessment tool being self-report measures ( n = 8). The main factors associated with nonadherence included worsening pregnancy symptoms, side effects of medications, perceived risks, mental health symptoms, poor social support, and socioeconomic status. Recommendations that evolved from the studies to improve adherence included education, counselling, improved support networks, and social interventions, while the main reported interventional study employed continuous education on the impact of adherence on perinatal outcomes., Conclusion: Medication nonadherence in gestational diabetes seems to be influenced by multiple factors with some educational interventions positively impacting adherence behaviours. Thus, future research in women with gestational diabetes could consider interventions from a multifactorial perspective to improve therapeutic outcomes., Competing Interests: All authors have no conflict of interest to declare with respect to the research and publication of this article., (Copyright © 2021 Michelle Asiedu-Danso et al.)

Objective: Worldwide, herbal medicinal products (HMPs) play key roles in healthcare systems, especially in developing countries, yet there is inconsistent evidence about their prevalence and patterns of use in Ghana. This study therefore sought to determine the prevalence, patterns and beliefs about the use of HMPs in Ghana., Methods: A descriptive community-based cross-sectional survey was conducted using a researcher-administered questionnaire on 1364 adults, selected from five communities for each of the ecological zones in Ghana using a multi-stage sampling procedure. The study was conducted between December 2019 and March 2020., Results: The prevalence of ever use of HMPs was 76.5% with 73.0% of respondents using these products within the past year. Almost 60% of respondents reported using HMPs that were registered by the Ghana Food and Drugs Authority. About 56.7% used these products to cure diseases. All the sociodemographic characteristics (age, religion, marital status, educational level and employment status) except for sex were significantly associated with the use of HMPs (P < 0.001). For beliefs about HMPs, the proportion of respondents classified to be accepting, ambivalent, indifferent and sceptical was 14.3%, 25.2%, 47.5% and 13.07%, respectively. About 62.2% of study participants had plans to use HMPs in the future, and 69.1% were willing to encourage others to use such products. However, 51.6% of the participants did not perceive HMPs as more effective and safe compared with orthodox products., Conclusion: The prevalence of use of HMPs in Ghana is high, thus suggesting an appropriate public health policy to improve the regulation of these products and also provide basis for the integration of HMPs into the healthcare system in Ghana., (© 2020 John Wiley & Sons Ltd.)

Background: In several African and Asian countries, callers to mobile phones sometimes hear a song or message in place of the typical ringing sound. This application, called caller tunes, may offer a unique opportunity to promote medication adherence that is yet to be explored., Objectives: Assess the application of the technology acceptance model to a potential caller tunes approach designed to enhance medication adherence, with a specific focus on the interrelationships of perceived ease of use, perceived usefulness, cost, and intention., Methods: Data from a cross-sectional sample of 996 adult mobile phone users in Ghana, approximately half of whom were current caller tunes users, was examined using exploratory factor analysis for scale evaluation and structural equation modeling to assess associations among perceived ease of use, perceived usefulness, and cost on intention to use mobile phone caller tunes to promote medication adherence., Results: Consistent with the technology acceptance model, intention to use the caller tunes as a means of enhancing medication adherence was higher among those who viewed the application positively in terms of ease of use and usefulness. Among those who were already caller tunes users, availability as a free download was also associated with more positive intentions., Conclusion: The present study provides preliminary evidence in support of caller tunes as a novel strategy to promote medication adherence. Future studies interested in using this approach would be advised to consider factors such as participants' current use of caller tunes, age, availability as a free download, and perceptions of ease of use and perceived usefulness of the approach as potential moderators of study outcomes., Competing Interests: None., (© 2021 Published by Elsevier Inc.)

Introduction: Ensuring universal availability and accessibility of medicines and supplies is critical for national health systems to equitably address population health needs. In sub-Saharan Africa (SSA), this is a recognised priority with multiple medicines pricing policies enacted. However, medicine prices have remained high, continue to rise and constrain their accessibility. In this systematic review, we aim to identify and analyse experiences of implementation of medicines pricing policies in SSA. Our ambition is for this evidence to contribute to improved implementation of medicines pricing policies in SSA., Methods and Analysis: We will search: Medline, Web of Science, Scopus, Global Health, Embase, Cairn.Info International Edition, Erudit and African Index Medicus, the grey literature and reference from related publications. The searches will be limited to literature published from the year 2000 onwards that is, since the start of the Millennium Development Goals.Published peer-reviewed studies of implementation of medicines pricing policies in SSA will be eligible for inclusion. Broader policy analyses and documented experiences of implementation of other health policies will be excluded. The team will collaboratively screen titles and abstracts, then two reviewers will independently screen full texts, extract data and assess quality of the included studies. Disagreements will be resolved by discussion or a third reviewer. Data will be extracted on approaches used for policy implementation, actors involved, evidence used in decision making and key contextual influences on policy implementation. A narrative approach will be used to synthesise the data. Reporting will be informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guideline., Ethics and Dissemination: No ethics approvals are required for systematic reviews.Results will be disseminated through academic publications, policy briefs and presentations to national policymakers in Ghana and mode widely across countries in SSA., Prospero Registration Number: CRD42020178166., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

The current coronavirus disease 2019 (COVID-19) pandemic is placing a huge strain on health systems worldwide. Suggested solutions like social distancing and lockdowns in some areas to help contain the spread of the virus may affect special patient populations like those with chronic illnesses who are unable to access healthcare facilities for their routine care and medicines management. Retail pharmacy outlets are the likely facilities for easy access by these patients. The contribution of community pharmacists in these facilities to manage chronic conditions and promote medication adherence during this COVID-19 pandemic will be essential in easing the burden on already strained health systems. This paper highlights the pharmaceutical care practices of community pharmacists for patients with chronic diseases during this pandemic. This would provide support for the call by the WHO to maintain essential services during the pandemic, in order to prevent non-COVID disease burden on healthcare systems particularly in low-and middle-income countries., Competing Interests: None declared., (© 2020 Elsevier Inc. All rights reserved.)

Background: Type 2 diabetes mellitus (T2DM) is a major public health problem associated with distress. T2DM can affect health outcomes and adherence to medications. Little is however known about the association between diabetes distress and medication adherence among patients with T2DM in Ghana., Objective: The objective of the present study is twofold: to estimate distress associated with T2DM and to examine its association with medication adherence., Methods: A hospital-based cross-sectional study was conducted among 188 patients with T2DM recruited from a diabetes specialist outpatient clinic at the Pantang Hospital in Accra, Ghana. Data were obtained using the Problem Areas In Diabetes (PAID) scale and the Medication Adherence Report Scale., Results: The findings showed that about 44.7% of the patients showed high levels of diabetes-related distress. Poor adherence to medications was recorded in 66.5% of the patients. Patients who were highly distressed had 68% lower odds of adhering to their medications compared to those who were not (OR: 0.32, 95% CI: 0.15-0.65). A principal component analysis revealed four areas of T2DM distress which were conceptualized as negative emotions about diabetes, dietary concerns and diabetes care, dissatisfaction with external support, and diabetes management helplessness., Conclusion: Our findings suggest that diabetes distress is a significant determinant of medication adherence behaviour in patients with T2DM. Thus, incorporating routine screening for distress into the standard diabetes care within the Ghanaian health system and having health practitioners adopt holistic approaches to diabetes management will be important context-specific interventions to improve adherence and health outcomes of people living and coping with T2DM., Competing Interests: All authors have no conflict of interest to declare., (Copyright © 2020 Irene A. Kretchy et al.)

Medication adherence is a key health outcome that reflects the health and general well-being of patients with hypertension. Challenges with adherence are common and associated with clinical, behavioural and psychosocial factors. This study sought to provide data on the extent of medication adherence among male patients with hypertension and their biopsychosocial predictors. Patient and clinical characteristics, psychological distress, insomnia and sexual dysfunction were hypothesized to predict outcomes of medication adherence. Utilizing quantitative data from a hospital-based cross-sectional study from 358 male out-patients with hypertension attending a tertiary hospital in Ghana, medication adherence was associated with age, marital status, educational level, income, duration of diagnosis, number of medications taken and sexual dysfunction. These findings support the need for biopsychosocial interventions aiming at promoting adherence while taking these factors into consideration for the benefit of improving the health and general well-being of male patients with hypertension., Competing Interests: The authors have declared that no competing interests exist.

Background: Patient reporting of adverse drug reactions (ADRs) is low in low- and middle-income countries, in part because of poor awareness to report. With the increase in mobile subscription, mobile phones can be used as a platform to disseminate information on ADRs. The aim of this study was to qualitatively assess the potential of using mobile phone caller tunes (the message or sound the caller hears before the receiver answers the call) to encourage patient reporting of ADRs., Methods: A total of 38 key informant interviews and 12 focus group discussions (57 participants in groups of 4-5) were conducted in Accra, Ghana. The transcripts were analysed using key constructs of the Technology Acceptance Model (TAM) including perceived usefulness, perceived ease of use, and behavioural intention to use caller tunes for patient reporting of ADRs., Results: Respondents mentioned lack of knowledge on reporting ADRs, and their willingness to use mobile phone caller tunes to promote patient reporting of ADRs. Many respondents pointed out how ADRs usually led to discontinuity in medication use, usually without consultation with health professionals. Caller tunes were regarded an innovative, accessible and convenient platform to disseminate information on ADRs. Most respondents intended to use caller tunes with drug safety information to promote ADR reporting, particularly to help their friends and family members. Simplicity of the message, use of songs or messages in local languages and price of downloading the caller tunes were important considerations., Conclusion: There is a need for the creation and testing of caller tunes on ADRs in Ghana to promote patient or consumer reporting of ADRs. Further studies are needed to assess factors that could influence the creation and use of caller tunes to disseminate information on drug safety., Competing Interests: Conflict of interest statement: The authors declare that there is no conflict of interest., (© The Author(s), 2019.)

Background: Hypertension is a major health problem that remains a significant threat to the health and general wellbeing of many people all over the world. In some patients, the etiology and prognosis of hypertension have been linked to psychological factors including personality traits. One primary goal of management is to improve the health-related quality of life (HRQoL) of patients with hypertension. This study aimed to examine the association between personality traits, clinical characteristics, and HRQoL in hypertension., Methods: A hospital-based cross-sectional quantitative study was conducted in a sample of 331 individuals with hypertension. Data on sociodemographic characteristics, clinical information, personality traits, and HRQoL were obtained from participants using an interviewer administered questionnaire., Results: The number of participants with a 1-10 years' duration of diagnosis for hypertension was highest (56.8%), with 52.9% having comorbidities such as diabetes (40.2%) and dyslipidaemia (20.9%). The average number of medications taken per patient was 2.14 (SD±0.79) and about 47.1% of the participants reported adequate medication adherence. Significant associations for age, education, monthly income, number of years with hypertension, and HRQoL were observed. While conscientiousness was significantly associated with all HRQoL domains, extraversion and agreeableness were significantly related to only the environmental domain., Conclusion: This study has demonstrated that clinical characteristics and patients' perception of their personality are relevant to their health-related quality of life outcomes. The findings suggest that when intervention efforts to improve the quality of life of patients with hypertension are being considered, a biopsychosocial approach should be employed. The implication is that treatment of hypertension in Ghana should be broadened to include the expertise of mental health professionals.

Background: Voluntary blood donation rates are low in sub-Saharan Africa. Sociobehavioral factors such as a belief that donated blood would be used for performing rituals deter people from donating blood. There is a need for culturally appropriate communication interventions to encourage individuals to donate blood. Health care interventions that use mobile phones have increased in developing countries, although many of them focus on SMS text messaging (short message service, SMS). A unique feature of mobile phones that has so far not been used for aiding blood donation is caller tunes. Caller tunes replace the ringing sound heard by a caller to a mobile phone before the called party answers the call. In African countries such as Ghana, instead of the typical ringing sound, a caller may hear a message or song. Despite the popularity of such caller tunes, there is a lack of empirical studies on their potential use for promoting blood donation., Objective: The aim of this study was to use the technology acceptance model to explore the influence of the factors-perceived ease of use, perceived usefulness, attitude, and free of cost-on intentions of blood or nonblood donors to download blood donation-themed caller tunes to promote blood donation, if available., Methods: A total of 478 blood donors and 477 nonblood donors were purposively sampled for an interviewer-administered questionnaire survey at blood donation sites in Accra, Ghana. Data were analyzed using descriptive statistics, exploratory factor analysis, and confirmatory factory analysis or structural equation modeling, leading to hypothesis testing to examine factors that determine intention to use caller tunes for blood donation among blood or nonblood donors who use or do not use mobile phone caller tunes., Results: Perceived usefulness had a significant effect on intention to use caller tunes among blood donors with caller tunes (beta=.293, P<.001), blood donors without caller tunes (beta=.165, P=.02, nonblood donors with caller tunes (beta=.278, P<.001), and nonblood donors without caller tunes (beta=.164, P=.01). Attitudes had significant effect on intention to use caller tunes among blood donors without caller tunes (beta=.351, P<.001), nonblood donors with caller tunes (beta=.384, P<.001), nonblood donors without caller tunes (beta=.539, P<.001) but not among blood donors with caller tunes (beta=.056, P=.44). The effect of free-of-cost caller tunes on the intention to use for blood donation was statistically significant (beta=.169, P<.001) only in the case of nonblood donors without caller tunes, whereas this path was statistically not significant in other models., Conclusions: Our results provide empirical evidence for designing caller tunes to promote blood donation in Ghana. The study found that making caller tunes free is particularly relevant for nonblood donors with no caller tunes., (©Bernard Appiah, James N Burdine, Ammar Aftab, Lucy Asamoah-Akuoko, David A Anum, Irene A Kretchy, Elfreda W Samman, Patience B Appiah, Imelda Bates. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 04.05.2018.)

The study examined the association between psychological distress, caregiving burden and caregiver-reported medication adherence in 444 informal family caregivers of patients with schizophrenia. Participants were assessed on the Depression, Anxiety Stress Scale, Zarit Burden Interview and the Medication Adherence Report Scale. Caregivers reported a non-adherence rate of 54.5% among patients with schizophrenia. Poor adherence to antipsychotics was significantly associated with caregiver burden (p < 0.01) and experience of anxiety (p < 0.0001). The burden of caregiving should be considered during the assessment of adherence. The findings suggest a need for culturally appropriate interventions that improve antipsychotic adherence of outpatients with schizophrenia with specific attention to the burden of the caregiver., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Patients with schizophrenia are managed with antipsychotics and other psychotropic medications., Objectives: This study aimed to assess the commonly prescribed psychotropic medications for patients with schizophrenia, explore the types of therapeutic monitoring that were performed, and find out whether the side effects experienced by the patients played any role in their adherence behaviour., Methods: This hospital-based cross-sectional study enrolled 259 patients with schizophrenia from Accra Psychiatric Hospital and Pantang Psychiatric Hospital. Data were collected on mental status, side effects, types of therapeutic monitoring performed, and adherence behaviour., Results: Olanzapine was the commonly prescribed psychotropic medication. Most of respondents (73.4%) experienced mild levels of side effects. The negative effects were predominantly genitourinary (26%) and gastrointestinal (17.2%). Blood pressure and heart rate measures were the main types of monitoring performed but no measurement of drug levels was reported. About 98.1% of the participants poorly adhered to their medications and the major reasons for poor adherence were economic challenges, forgetfulness, and the feeling of wellness., Conclusion: Adherence to medication is a major health problem among patients with schizophrenia and there is a need to improve adherence and treatment outcomes.

Background: Low and middle income countries face many challenges in meeting their populations' mental health care needs. Though family caregiving is crucial to the management of severe mental health disabilities, such as schizophrenia, the economic costs borne by family caregivers often go unnoticed. In this study, we estimated the household economic costs of schizophrenia and quality of life of family caregivers in Ghana., Methods: We used a cost of illness analysis approach. Quality of life (QoL) was assessed using the abridged WHO Quality of Life (WHOQOL-BREF) tool. Cross-sectional data were collected from 442 caregivers of patients diagnosed with schizophrenia at least six months prior to the study and who received consultation in any of the three psychiatric hospitals in Ghana. Economic costs were categorized as direct costs (including medical and non-medical costs of seeking care), indirect costs (productivity losses to caregivers) and intangible costs (non-monetary costs such as stigma and pain). Direct costs included costs of medical supplies, consultations, and travel. Indirect costs were estimated as value of productive time lost (in hours) to primary caregivers. Intangible costs were assessed using the Zarit Burden Interview (ZBI). We employed multiple regression models to assess the covariates of costs, caregiver burden, and QoL., Results: Total monthly cost to caregivers was US$ 273.28, on average. Key drivers of direct costs were medications (50%) and transportation (27%). Direct costs per caregiver represented 31% of the reported monthly earnings. Mean caregiver burden (measured by the ZBI) was 16.95 on a scale of 0-48, with 49% of caregivers reporting high burden. Mean QoL of caregivers was 28.2 (range: 19.6-34.8) out of 100. Better educated caregivers reported lower indirect costs and better QoL. Caregivers with higher severity of depression, anxiety and stress reported higher caregiver burden and lower QoL. Males reported better QoL., Conclusions: These findings highlight the high household burden of caregiving for people living with schizophrenia in low income settings. Results underscore the need for policies and programs to support caregivers.