Assessment of Quality of Care for Children with Sickle Cell Disease in the South Tongu District of Ghana: Nurses’ Perspective
Asian Journal of Research in Nursing and Health,
Sickle cell disease (SCD) is a genetic disorder of erythrocytes with frequent episodes of vaso-occlusive crisis and complex morbidities. Studies identify gaps in quality of care for children with SCD including poor knowledge of providers and inadequate logistics. South Tongu district of Ghana records increasing incidence of SCD children’s morbidities and prolonged hospitalizations.
Aims: The study sought to examine the quality of nursing care for children with SCD in South Tongu district and identify opportunities for improvement. The study was conducted in the two hospitals of the South Tongu district of Ghana.
Study Design: A descriptive cross-sectional survey was employed to examine nurses’ knowledge of comprehensive care and their perspectives on quality of structures, processes and outcomes of care for SCD children.
Methodology: Convenient sampling method was used to obtain data from 74 nurses using structured questionnaires based on Donabedian model.
Results: Results showed a mean score of 10.25 out of 20 (51%) indicating inadequate knowledge of comprehensive care. Nurses’ perception regarding quality of service structures for SCD children obtained the worst evaluations (mean=41.50); mostly in the aspects of service logistics and supplies, and access to emergency vehicles (ambulance). The process dimension had the best evaluation (mean=58.68), followed by outcome (mean=43.17). Communication problems within the nursing team and interpersonal relationships with SCD children/families were major challenges affecting quality care in the process and outcome domains. A weak positive relationship (p=0.188) was found between the process and outcome measures.
Conclusion: The study suggests continuous education and training of nurses on comprehensive care for children with SCD and strengthening of all the dimensions of quality care, particularly the structure.
- Quality of care
- sickle cell disease
- comprehensive care
How to Cite
Chakravorty S, Williams TN. Sickle cell disease: A neglected chronic disease of increasing global health importance. Archives of Disease in Childhood. 2015;100(1):48–53.
Mcgann PT. Time to invest in sickle cell anemia as a global health priority: Difficult or Expensive. Paediatrics. 2016; 137(6).
Ambrose EE, Makani J, Chami N, Masoza T, Kabyemera R, Peck RN, Kamugisha E, Manjurano A, Kayange N, Smart, LR. High birth prevalence of sickle cell disease in Northwestern Tanzania. Pediatric Blood & Cancer. 2018;65(1).
Makani J, Williams TN, Marsh, K. Sickle cell disease in Africa : Burden and research priorities Sickle Haemoglobin and Sickle Cell Disease. Europe PMC Funders Group. 2017;101(1):3–14.
Mcgann PT, Hernandez AG, Ware RE. Sickle cell anemia in sub-Saharan Africa : advancing the clinical paradigm through partnerships and research, Blood Forum. 2018;129(2):155–162.
Azonobi IC, Anderson BL, Byams VR, Grant AM, Schulkin J. Obstetrician-Gynecologists’ knowledge of sickle cell disease screening and management. BMC Pregnancy and Childbirth. 2014;14: 356.
Kavanagh PL. Quality-of-care indicators for children with sickle cell disease; 2015.
Odunvbun ME, Okolo AA. Implementing comprehensive health care management for sickle cell disease in an African setting. Nigerian Journal of Paediatrics. 2015;42(4):298–302.
Yawn BP, John-sowah MJ, Heart N. Management of sickle cell disease: Recommendations from the 2014 Expert Panel Report; 2015.
Bosu WK. A comprehensive review of the policy and programmatic response to chronic non-communicable disease in Ghana. Ghana Med J. 2012;46(2):69–78.
Ghana Ministry of Health. National policy for the prevention and control of chronic non-communicable diseases in Ghana. Ghana Ministry of Health; 2012.
Ansong D, Akoto AO, Ocloo D, Ohene-frempong K. Sickle cell disease : Management options and challenges in developing countries; 2012.
Alhassan RK, Duku SO, Janssens W, Nketiah E, Spieker N, Ostenberg PV, Arhinful DK. Comparison of perceived and technical healthcare quality in primary health facilities : Implications for a sustainable national health insurance scheme in Ghana. PLoS ONE. 2015;10(10):1–19.
Familia S. Nursing care in sickle cell disease in the family health strategy assistência de enfermagem na doença falciforme na estratégia saúde da. J res. 2018;10(1):36–45.
Kanter J, Kruse-jarres R. Management of sickle cell disease from childhood through adulthood. Blood Reviews YBLRE. 2013;27(6):279–287.
Ayanian JZ, Markel H. Donabedian’ s lasting framework for health care quality. N Engl J Med. 2016;375(3):205–207.
Muoghalu CO, Awolowo O. The Health Workers Perspectives in the Management of Sickle Cell Disease in an Urban Health Centre in Ile-Ife, Nigeria. J Hematol Thrombo Dis. 2017;5(1): 1–5. Available: https://doi.org/10.4172/2329-8790.1000262
Ghana District Health Information Management System (DHIMS2) Database. Ghana Health Service South Tongu District Sickle Cell Disease Admissions data; 2016-2018.
Alomar A, Baawadh AA, Alotaibi A, Sadek NA, Mansi S, Alharthi MM, Eid AOA. Interventions to improve appropriate use of therapies for sickle cell disease. EC Endocrinology And Metabolic Research. 2017;1:39–48.
Gomes LMX, Vieira MM, Reis TC, Barbosa TLA, Caldeira AP. Knowledge of family health program practitioners in Brazil about sickle cell disease : A descriptive cross-sectional study. BMC Family Practice. 2011;12(89).
Mourão L, Gomes X, Reis TC, Vieira MM, Andrade-barbosa TLD. Quality of assistance provided to children with sickle cell disease by primary healthcare services. Rev. Bras. Hematol. Hemoter. 2011;33(4): 277–282. Available: https://doi.org/10.5581/1516-8484.20110077
Voyce J. A Donabedian model of the quality of nursing care from nurses ’ perspectives in a Portuguese hospital : A pilot study. J. Nurs Meas. 2015;23(3):474-84.
Akachi Y, Kruk ME. Quality of care : Measuring a neglected driver of improved health; 2017. Bull World Health Organ. 2017;95:465–472:
Nylenna M, Bjertnaes O, Saunes IS, Lindahl AK. What is Good Quality of Health Care ?, Professions and Professionalism. 2015;5(1): 1–15.
Sardasht FG, Shourab NJ, Jafarnejad F, Esmaily H. Application of donabedian quality-of-care framework to assess the outcomes of preconception care in urban health centers, Mashhad, Iran in 2012. Journal of Midwifery & Reproductive Health. 2013;2(1):50-59.
Puszczak K, Fronczyk A. Task force on quality of BCS data Analysis of sample size in consumer surveys theoretical considerations and factors determining minimum necessary sample sizes, link between country size and sample size (impact of larger structural heterogeneity), gross versus effective sample size (i.e. volatility and possibly bias); 2013.
Taber KS. The use of cronbach’s alpha when developing and reporting research instruments in science education; 2016.
Yuri NE, Tronchin R. Quality of maternal-child health care at a university hospital, according to nurses' perspective. Rev Esc Enferm USP. 2010;44(2):329–336.
Yaqoob SH. Nurses’ knowledge and attitudes toward pain assessment and management for adult sickle cell disease patients during sickling crisis; 2017.
Stoverock LA Quality improvement project: Nursing knowledge of adolescents with SCD and judgment of Pain; 2014.
Reeves SL, Tribble AC, Madden B, Freed GL, Dombkowski KJ. Antibiotic prophylaxis for children with sickle cell anemia. Pediatrics. 2018;141(3).
Karoline K, Diniz S, Pagano AS, Paula A, Chagas P, Reis I A, Gonc L. Knowledge of professional healthcare providers about sickle cell disease : Impact of a distance education course. Hematology, Transfusion and Cell Therapy. 2018;1(1): 62–68.
Oduro GD. Improving emergency care in Ghana. Postgraduate Medical Journal of Ghana. 2015;4(1):23–29.
Adu-Gyamfi S, Brenya E. International scholarly research notices nursing in Ghana : A search for florence nightingale in an African City; 2016.
Obioma C. Improving the quality of nursing documentation in home health care setting; 2017.
Foronda C, Macwilliams B, Mcarthur E. Nurse education in practice interprofessional communication in healthcare : An integrative review. Nurse Education in Practice. 2016;(19):36–40.
Ameh S, Gómez-olivé FX, Kahn K, Tollman SM, Klipstein-grobusch K. Relationships between structure, process and outcome to assess quality of integrated chronic disease management in a rural South African setting : Applying a structural equation model. BMC Health Services Research. 2017;17(229): 1–15.
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