Influence of Supply-side Factors on Access to Healthcare: An Empirical Analysis of Service Delivery in Sierra Leone | Chapter 8 | An Overview of Disease and Health Research Vol. 8

The capacity of the health system to respond timely and adequately to the health needs of the people is critical to averting deaths, especially in vulnerable populations such as pregnant women and children. The robustness and responsiveness of a country’s health system predict access to a range of health services, including maternal and child health (MCH) services.  The purpose of this cross-sectional study was to examine the influence of five (5) health system characteristics (i. type of health provider, ii. level of facility, iii. availability of essential medicines, iv. availability of basic equipment, and v. type of facility) on access to MCH services in Sierra Leone. This study was guided by Bryce, Victora, Boerma, Peters, and Black’s framework for evaluating the scale-up to millennium development goals for maternal and child survival. The study was a secondary analysis of the Sierra Leone 2017 Service Availability and Readiness Assessment (SARA) dataset, which comprised 100% (1,284) of the country’s health facilities. Data analysis included bivariate and multivariate logistic regressions. In the bivariate analysis, all the independent variables showed statistically significant association with access to MCH services and achieved a p-value < .001. In the multivariate analysis, however, only 3 predictors explained 38% of the variance (R² = .380, F (5, 1263) = 154.667, p<.001). The type of health provider significantly predicted access to MCH services (β =.549, p <.001) as did the availability of essential medicines (β= .255, p<.001) and the availability of basic equipment (β= .258, p <.001). According to the study findings, the availability of the right mix of health providers, essential medicines, and basic equipment significantly influenced access to MCH services, regardless of the level and type of health facility. The study has highlighted the relative influence of health system access to MCH services. The findings would inform efforts towards broadening strategies to address weak health system blocks to optimise access to quality MCH services, which ultimately can contribute towards the reduction of maternal and child mortality rates in Sierra Leone and similar contexts.

 

 

Author(s) Details

Alhassan Fouard Kanu
Institute for Health Professionals Development (IHPD), Sierra Leone and Paris Graduate School, France.

 

Please see the book here :- https://doi.org/10.9734/bpi/aodhr/v8/6993

 

Making Decentralised Health Systems Work: Insights from Sierra Leone | Chapter 7 | An Overview of Disease and Health Research Vol. 8

 

Background: A decentralised health system is the cornerstone of a country’s health sector. However, for this system to perform effectively, it requires good leadership and management practices, in addition to the requisite inputs, notably finances and human resources, among others.

 

Aim: The present study aimed to investigate the factors that influence the performance of the district health management team (DHMT) in Sierra Leone.

 

Methods: This was a cross-sectional study with a mixed-method design conducted in four (4) DHMTs (Bo, Kailahun, Kenema, and Kono). A self-administered questionnaire was used to rate the leadership and management practices of District Medical Officers (DMOs), while an interview guide was used to explore the perceived factors that influence the performance of the DHMTs. SPSS version 25 was used to analyse the quantitative data, and a thematic analysis was carried out for the qualitative data.

 

Results: The leadership and management practices of the DMOs are rated as democratic by the majority of the subordinates. While leadership was mainly viewed as democratic, qualitative interviews uncovered underlying issues of domineering behaviour and perceived favouritism, indicating a disconnect between formal management styles and interpersonal dynamics. Despite the geographic variation across the four districts, the influence of leadership on performance remained consistent (p > .05).

 

On the perceived factors that influence the performance of DHMTs, the notable issues are the inadequate and late disbursement of funds to the district. This affects the implementation of planned activities. Further, the lack of adequate and capable staff within the DHMTs was highlighted. Other concerns were the poor coordination between national and district levels, and the poor working conditions (for example, poor office spaces, unreliable power supplies, and internet connectivity).

 

Conclusions: To make district health management teams work in Sierra Leone and in similar contexts, addressing the human resource gaps; ensuring a better flow of funds to the districts; and improving the coordination in health program planning and implementation between the national and the districts are promising measures that will optimise the performance of the decentralised health system.

 

 

Author(s) Details

Alhassan Fouard Kanu
Institute for Health Professionals Development (IHPD), Sierra Leone and Paris Graduate School, France.

 

Please see the book here :- https://doi.org/10.9734/bpi/aodhr/v8/6905

Evaluation of the Knowledge, Practices and Barriers to Peak Flow Meter Use among Nurses in a Ghanaian Tertiary Hospital | Chapter 6 | An Overview of Disease and Health Research Vol. 8

 

Background: Chronic respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), are among the most common non-communicable diseases globally and contribute substantially to morbidity, mortality, and health system costs. In asthma and COPD management, objective assessment of lung function is essential for diagnosis, monitoring exacerbations, and guiding therapy. Asthma and COPD are rising causes of morbidity and mortality in Ghana, yet objective tools for monitoring airflow limitation remain underused. Peak flow meters (PFMs) offer a simple, low-cost method for assessing airway obstruction, but their utilisation by nurses has not been well documented.

 

Objective: The primary objective of this study is to assess nurses’ knowledge, practices, and perceived barriers to PFM utilisation in the management of respiratory disorders at Komfo Anokye Teaching Hospital (KATH), Ghana.

 

Methods: A descriptive cross-sectional survey was conducted among 335 registered nurses selected through proportionate stratified sampling from medical, surgical, and emergency units of KATH. Data were collected using a pretested structured questionnaire. The instrument comprised four sections: demographic characteristics (age, sex, rank, years of practice, unit of work); knowledge of PFM use (purpose, calibration units, colour zones, clinical indications); practice of PFM use (experience, patient instruction, documentation); and perceived barriers to PFM utilisation. All the collected data were analysed with descriptive statistics (SPSS version 26).

 

Results: Knowledge of PFM use was poor, as only 55 nurses (16.4%) correctly identified the PFM as a device for measuring airflow limitation, and 28 (8.4%) recognised litres per minute as the standard calibration unit. Across the seven scored knowledge items, the estimated mean correct score was 2.36 ± 0.9 (out of 7), reflecting limited knowledge overall. Practical use was similarly limited, with 93 (27.8%) reporting ever using a PFM to assess a patient and 20 (6.0%) documenting peak flow values after bronchodilator administration. Major barriers included work overload (329, 98.2%), high device cost (315, 94.0%), lack of time to teach patients (305, 91.0%), and administrative unavailability of PFMs (304, 90.7%).

 

Conclusion: Nurses at KATH demonstrated substantial gaps in both knowledge and practice of PFM use despite acknowledging its clinical importance. Integrating PFM training into pre-service nursing curricula, providing regular in-service education, and ensuring consistent device availability are critical to strengthening respiratory care in Ghana. This study is limited by its cross-sectional design and single-site setting, which constrain generalizability. Future research should therefore involve multiple centres, include observational or audit data on PFM use, and examine both the effects of structured training interventions and the contextual factors influencing PFM utilisation in different clinical areas.

 

 

Author(s) Details

Afua Wirekowaa Adjei Yeboah
Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana, Ghana College of Nurses and Midwives, Ghana and Christian Service University, Kumasi, Ghana.

 

Susana Somuah
Ghana College of Nurses and Midwives, Ghana and Nursing and Midwifery Training College, Koforidua, Ghana.

 

Rasheed Ofosu-Poku
Ghana College of Nurses and Midwives, Ghana, Christian Service University, Kumasi, Ghana and Ahmadiyya Muslim Mission Hospital, Asokore, Ghana.

 

John Antwi
Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana, Ghana College of Nurses and Midwives, Ghana and Christian Service University, Kumasi, Ghana.

 

Please see the book here :- https://doi.org/10.9734/bpi/aodhr/v8/6760

Role of Oil Pulling on Oral Health: An Overview | Chapter 5 | An Overview of Disease and Health Research Vol. 8

 

Oil pulling is a powerful and detoxifying Ayurvedic technique. It is an alternative medical practice in which an edible oil is swished around the mouth for a period of time and then spat out, similar to mouthwash. This chapter presents the role of oil pulling in oral health. Chronic use of mouth rinses containing phenol and other agents, such as chlorohexidine gluconate, used in taking care of the oral cavity, stains the teeth. Also, microorganisms in the oral cavity consist of a single cell covered with a lipid membrane, which, when it comes in contact with some of the oil used in oil pulling, adheres to it to achieve its oral cleansing. The results of studies conducted show that some of the oils, such as coconut oil, sesame oil, and sunflower oil, used in oil pulling therapy can reduce dental plaque, prevent gingivitis, halitosis, dental caries and other dental conditions. This is due to its antibacterial, antifungal, antiviral and antioxidant properties. Outside of offering several oral health benefits, it also contributes positively to overall health with minimal side effects when practised as recommended. Being one of the cheapest, cost-effective, safe, easy and efficient ways to control oral diseases, it should be used as a supplemental oral hygiene aid. It was recommended that oral health professionals should incorporate some of these products into patients’ oral hygiene materials. Additionally, these products should be made in a form that will be handy for patients.

 

 

Author(s) Details

Ngwu Justina Nnenna
Dental Therapy Department, Faculty of Dental Health Federal, University of Allied Health Sciences, Enugu State, Nigeria.

 

Please see the book here :- https://doi.org/10.9734/bpi/aodhr/v8/6630

 

Rice Cultivation and Weed Control in Ghana’s Guinea Savannah Zone | Chapter 4 | Agricultural Sciences: Techniques and Innovations Vol. 7

 

Rice production in the Guinea Savanna agroecological zone of Ghana faces persistent challenges from weed infestation, soil moisture losses, and high production costs associated with conventional land preparation practices. Conservation-oriented management strategies that integrate reduced tillage and efficient weed control are increasingly recognised as pathways to sustainable intensification of rice-based systems. This chapter evaluates the interactive effects of tillage practices and herbicide-based weed management on weed control efficiency, soil moisture conservation, crop growth, grain yield, and economic performance of rice (Oryza sativa L.). Field experiments were conducted in 2022 at the Nyankpala experimental field of the Savannah Agricultural Research Institute (SARI) using a factorial combination of tillage systems (conventional, minimum, and no tillage) and herbicide regimes: Pendimethalin (400 g a. i. ha⁻¹) applied as pre-emergence, Bispyribac sodium (25 g a. i. ha⁻¹) applied as post-emergence, and a combined pre- and post-emergence application. Agronomic data on weed density, weed biomass, crop vigour, phenological development, and grain yield were collected. Weed control efficiency was quantified, and enterprise budgeting was complemented with sensitivity and risk analyses to assess economic robustness under variable cost and price scenarios. The results showed that minimum tillage combined with pre- and post-emergence herbicide application significantly reduced weed density and biomass, improved soil moisture retention, enhanced crop vigour, accelerated flowering, and increased grain yield compared with conventional tillage systems. Economic analysis indicated that the integrated minimum tillage-herbicide system generated higher net returns and remained economically resilient under simulated input cost increases and output price reductions.

 

This chapter demonstrates that integrated tillage-herbicide management enhances productivity, profitability, and environmental sustainability of rice-based systems in the Guinea Savanna, providing practical evidence to support the wider adoption of conservation agriculture in sub-Saharan Africa.

 

 

Author(s) Details

Wandaat Yennumi Emmanuel
Environmental Protection Authority, P.O. Box 80, Bolgatanga, Ghana.

 

Michael Ayamga
Environmental Protection Authority, P.O. Box 80, Bolgatanga, Ghana.

 

Dzomeku Israel K
Department of Food and Consumer Science, University for Development Studies, Tamale, Ghana.

 

Mahama Ahmed Rufai
Department of Food and Consumer Science, University for Development Studies, Tamale, Ghana.

 

Please see the book here :- https://doi.org/10.9734/bpi/asti/v7/7041

Trace Element Accumulation Patterns in Leafy Vegetables with Varying Heavy Metal Tolerance under Cadmium and Arsenic Stress | Chapter 3 | Agricultural Sciences: Techniques and Innovations Vol. 7

 

Leafy vegetables are a crucial component of the human daily diet. In recent years, research on heavy metal pollution in leafy vegetables has gradually increased, revealing differences in heavy metal accumulation in different vegetables and their potential risks to human health. Currently, some progress has been made in research on the response and regulatory mechanisms of leafy vegetables to heavy metal stress. This chapter examines the growth adaptation, heavy metal (Cd and As) accumulation, translocation dynamics, and mineral nutrient regulation in leafy vegetables exhibiting differential tolerance to heavy metal stress. Focusing on the challenge of combined Cd and As contamination, the study employed a hydroponic system to cultivate three high‑tolerance, four moderate‑tolerance, and one sensitive leafy vegetable variety under Cd and As exposure. Post‑harvest analysis assessed biomass production alongside the concentrations of Cd, As, and essential trace elements.

 

Key findings reveal that: (1) Co‑exposure to Cd and As markedly enhanced the root‑to‑shoot translocation of Cd compared to single‑metal treatments, with translocation factors increasing by up to 83.83% in black bean sprouts and 503.2% in white radish sprouts. (2) While shifts in mineral nutrient concentrations under single and combined stress were generally consistent, the regulatory responses varied significantly across vegetable species. (3) High‑tolerance varieties, such as Pak choi, demonstrated a pronounced capacity for heavy metal accumulation under Cd/As stress, coupled with a positive regulation of mineral elements in root tissues. In contrast, sensitive species like pea sprouts often showed suppressed root mineral content—a likely adaptive strategy to limit heavy metal uptake.

 

These insights elucidate critical resistance mechanisms to combined heavy metal pollution in leafy vegetables, providing a scientific basis for advancing phytoremediation strategies and guiding the safe production of vegetables in contaminated environments.

 

Author(s) Details

Yuan Meng

School of Agriculture and Bioengineering, Longdong University, Qingyang 745000, China and Gansu Key Laboratory of Conservation and Utilization of Biological Resources and Ecological Restoration in Longdong, Qingyang 745000, China.

 

Liang Zhang
School of Agriculture and Bioengineering, Longdong University, Qingyang 745000, China and Environmental Engineering Technology Research Center, Longdong University, China.

 

Liping Li
School of Environmental Engineering, Henan University of Technology, Zhengzhou 450001, China.

 

Linquan Wang
College of Natural Resources and Environment, Northwest A&F University, Yangling 712100, China.

 

Yongfu Wu
School of Agriculture and Bioengineering, Longdong University, Qingyang 745000, China.

 

Tao Zeng
School of Agriculture and Bioengineering, Longdong University, Qingyang 745000, China.

 

Haiqing Shi
School of Resources and Environment, Northeast Agricultural University, Harbin 150030, China.

 

Zeli Chang
School of Agriculture and Bioengineering, Longdong University, Qingyang 745000, China.

 

Qian Shi
School of Agriculture and Bioengineering, Longdong University, Qingyang 745000, China.

 

Jian Ma
School of Agriculture and Bioengineering, Longdong University, Qingyang 745000, China.

 

Please see the book here :- https://doi.org/10.9734/bpi/asti/v7/6984

Environmental Compliance and Poultry Waste Management in Commercial Layer Farms of Batangas, Philippines | Chapter 2 | Agricultural Sciences: Techniques and Innovations Vol. 7

 

The performance of the layer industry is strongly influenced by management practices, including nutrition and waste management, with proper utilisation, such as composting, biogas generation, and use as organic fertiliser, helping to reduce environmental hazards like water contamination, air pollution, and the spread of diseases, while ensuring compliance with environmental regulations and sustainable farming practices. The study aimed to assess waste management practices, the utilisation of poultry waste, compliance with environmental regulations, and potential environmental hazards among the 100 selected commercial layer chicken farms in Batangas, Philippines. Using a purposive sampling method and a descriptive survey design, the study was conducted in ten municipalities with the highest inventory of layer chicken farms, as recorded by the Department of Agriculture Region IV-A. Results revealed that most farms generated cage layer waste and primarily disposed of dry manure, with an average daily manure production of 833.17kg. Manure was commonly collected by manure buyers or given free to neighbours and LGUs, while 36% of farmers sold manure for use as fertiliser. Although 66% of farms had compost pits, storage capacity was generally insufficient relative to the volume of manure produced, and only a few farms utilised manure for biogas. Compliance with ECC and RA 6969 was high, although ISO certifications remained uncommon. Flies and odour were the most frequently reported environmental concerns, often associated with inadequate manure drying, prolonged waste storage, and poor waste-handling facilities. Farmers with higher educational attainment demonstrated better compliance with environmental standards. Overall, the findings indicate that while basic waste management practices are implemented, significant gaps remain in storage capacity, manure handling, and odour and fly control. Strengthened training programs, improving waste utilisation technologies, and increased engagement in poultry associations are recommended to support better waste management and environmental compliance.

 

 

Author(s) Details

Monette S. De Castro-Naagas
Department of Animal Science, College of Agriculture and Allied Fields, Mindoro State University, Philippines.

 

Please see the book here :- https://doi.org/10.9734/bpi/asti/v7/6866