Doctoral Degrees (DPBS)

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Browsing Doctoral Degrees (DPBS) by Subject "Namibia"

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    A health in all policies (HIAP) conceptual framework to facilitate the profiling of public servants’ health statuses in the Namibian public service
    (University of Namibia, 2024) Amutenya, Kaarina N.; Iita, Hermine
    Background: The Namibian Public Service (NPS) makes no provision to profile the health statuses of its employees/public servants, despite being a legislative requirement. As a result, government will not be able to, for instance, predict work incapacities due to ill-health absence which is a major measurement of performance/productivity. Worldwide, governments have instituted different approaches, within/outside the Occupational Health and Safety continuum, to profile employees ‘health/ill health to inform promotion of health in workplaces. Aim: This study sought to develop a conceptual framework and an implementation guide to enable the profiling of Namibians public servants’ health statuses entrenched in the principle of the Health in All policies (HiAP) approach. Methods: A multi-phased pragmatic study was conducted. Phase 1 employed an explorative descriptive convergent parallel mixed method design using document reviews, a Focus Group Discussion, a Discourse Analysis, a Cross sectional and a Knowledge, Attitude and Practice (KAP) surveys. Max Weber Qualitative Data Analysis and the Statistical Package for Social Sciences enabled analysis of data, respectively, herein synthesised by means of triangulation. Findings: Documents reviewed revealed the existence of public servants’ health information sources such as the employees’ health recruitment questionnaires, sick leave systems and medical aid, appropriate for profiling. Key Informant’s perspective that the HiAP framework was appropriate to facilitate profiling of public servants’ health statutes was further echoed by result of the Discourse Analysis. The cross-sectional survey, conducted among 346 public servants’ participants established that 83.3% of the survey participants self-reported ‘a good’ health status. The remainder 16.7% self-reported ‘a poor’ health status citing the prevalence of Hypertension (27%), Musculoskeletal disorders (30.6%), Stress (55%), Physical in-activeness (38%) and a High Body Mass Index (BMI) (27%). A Chi-square logistic regression test, pegged to a p-value of less than 5% and using: 1. Good health = self-reported score for Excellent/Very Good/Good; 2. ii Poor health = Fair/Poor/Very Poor: reveals significant statistical associations to poor health in relation to Hypertension (p-value=0.001), Mental conditions (p-value=0.009) and access to electricity (p-value=0.045). No significant statistical association was observed with elevated blood sugar (p-value=0.258≤5%), BMI and income. The KAP study, conducted among 51 Wellness Officers, reported very low HiAP knowledge citing a lack of information and henceforth no application of the HiAP approach, overall. Phase II focussed on the design, and development of the above-mentioned framework using results emanating from Phase I; enlisting elements of the World Health Organization’s (WHO) HiAP Analytical framework alongside elements of the Systems and Practice Oriented Theories, namely: [input (procedures, agent, recipient and dynamics); output (terminus); synergies (agent, recipient, procedures and dynamics) and feedback (context, inputs, outputs, terminus)]. Five purposely selected subject experts who validated the suitability of the developed conceptual frame recommended amongst others aligning it to the legislative provisions of the Public Health and Environmental Act. Phase III enlisted the WHO’s Handbook on developing guidelines and the Public Service Staff Rule format to inform the design of an implementation guide. Conclusions: The study encapsulates evidence that proofs the gap identified as well devised approach to fill the gap: a conceptual framework to profile Namibian public servants’ health statuses embedded in the HiAP principles. Evidence of poor HiAP knowledge could implicate successful implementation. Henceforth a recommendation that the NPS adopts the designed conceptual framework, the introductory and ensued implementation guide using a policy brief, attached hereto, to ensure compliance with the law
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    Factors associated with stillbirth and assessment of maternal health awareness among residents of northern Ghana
    (University of Namibia, 2025) Frimpong, Joseph Asamoah; Mitonga, Kambwebwe Honore
    Globally, 14 stillbirths per 1,000 births occur annually. Most of these deaths occur in Asia and sub-Saharan Africa. Ghana’s stillbirth rate ranges from 13 – 20 per 1,000 births. The northern zone is as high as 20 per 1,000 births. The Early Newborn Action Plan aims at 12 per 1,000 births. This study sought to assess risk factors associated with stillbirth and assess maternal health awareness in northern zone of Ghana to develop a policy brief to inform strategies in reducing stillbirths. The study employed a convergent mixed method of qualitative and quantitative approach (Case-Control study, survey and grounded theory) among residents in the northern part of Ghana from November 2021 – May 2023. Muti-stage sampling was used to select participants for the survey, population proportionate to size was used for the case control, In-depth interviews was based saturation and focus group discussions were based on availability of respondents. Data was collected using a semi-structured questionnaire and interview guide through focused group discussions, in-depth interviews, and records review. Descriptive and analytic statistics were performed using Stata 16. Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for stillbirth. Qualitative data was analysed using the thematic content analysis approach with Nvivo version 10. Risk factors for stillbirth included being unmarried (aOR=9.78, 95%CI:16.48-57.98), family history of stillbirth (aOR=2.63, 95%CI: 1.67-4.12), no patograph use (aOR=2.14,95%CI:1.45- 3.16), partner’s tobacco use (aOR=2.19,95%CI:1.16-4.16), Rhesus negative (aOR=1.75,95%CI:1.12-2.73), sickle cell trait (aOR=2.29,95%CI:1.27-4.10), foetal malpresentation (aOR=2.67,95%CI:1.33-5.35), eclampsia (aOR = 9.00,95%CI:2.91- 27.87) and premature rupture of membranes (aOR=2.64, 95%CI:1.17-5.95). Attending >4 antenatal care visits (aOR=0.53, 95%CI:0.30-0.93) was protective. Overall, 22.89%(276/1206) of the women studied had good knowledge of maternal health, 47.60%(574/1206) of them had good attitude, and 89.55%(1080/1206) had good practices towards maternal healthcare. Community members practiced both orthodox and traditional remedies, perceived some stillbirths are caused by evil spirits. Healthcare workers perceived their responsibilities included routine prenatal, antenatal and postnatal care, with many facilities reporting incapacity of handling severe maternal health conditions. In conclusion, risk factors for stillbirth in Northern Ghana include being unmarried, family history of stillbirth, not using patograph, tobacco use, rhesus negative, sickle cell trait, premature rupture of membrane, foetal malpresentation and eclampsia. Knowledge and attitude on maternal health was poor but practice was high. Maternal healthcare was influence by traditional beliefs with mainly husbands having the right to decision making on maternal health seeking behaviour. Healthcare workers incapacity of handling severe maternal health conditions was identified. A policy brief has been developed to guide interventions by Ghana Health Service with recommendations on improving healthcare capacity, improving collaboration with traditional healers and empowering women to take up their role before and during pregnancy