Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Evaluation of the Tuberculosis Management Program in Ghana Boampong Akese Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Health and Medical Administration Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Boampong Akese has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Gudeta Fufaa, Committee Chairperson, Health Services Faculty Dr. Tolulope Osoba, Committee Member, Health Services Faculty Dr. Scott McDoniel, University Reviewer, Health Services Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2020 Abstract Evaluation of the Tuberculosis Management Program in Ghana by Boampong Akese MHA, Framingham State University, 2014 BSc, University of Ghana, 2011 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Services Walden University February 2020 Abstract Tuberculosis (TB) is a major health issue estimated to be affecting about 1/3 of the world’s population. TB is a major health problem in Ghana primarily because of weak health infrastructure and poor TB case detection and management practices. Measuring and evaluating the performance of health programs is an important aspect of health care services in any country. The purpose of this quantitative study was to evaluate the TB management program in Ghana. A cross-sectional research design was used to answer the research questions. Secondary data were obtained from the Ghana District Health Information Management System database. The theoretical foundation used for this study was the performance measurement model that links accountability and performance measurement. The research questions sought to determine if there is an association between socioeconomic status, education, employment status, health facility location, number of trained health workers, ethnicity/tribe, and TB treatment completion in Ghana. The results of logistic regression and a chi-square test show that number of trained healthcare workers and health facility location significantly predicts the odds of treatment completion among TB patients. The findings from this study may provide crucial information for improving service delivery for TB patients and may contribute to long- term global TB elimination. Results can also serve as a basis for developing guidelines. Evaluation of the Tuberculosis Management Program in Ghana by Boampong Akese MHA, Framingham State University, 2014 BSc, University of Ghana, 2011 Proposal Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Services Walden University February 2020 Dedication This study is dedicated to my wonderful family, especially my wife Racheal and my two daughters Petra and Phoebe, and also to my dad Paul K. Akese. Acknowledgments I would like to thank the Almighty God for his protection. My appreciation goes to my chair Dr. Gudeta Fufaa for his tremendous support and guidance throughout this journey. Also many thanks to my committee members Dr. T. Osoba and Dr. Scott Mcdoniel. Also I would like to thank the Ghana Health Service TB program coordinators for their support. Finally, I would like to thank my siblings Gloria Akese and Oduro Akese for their help and support in making this journey come true. Table of Contents List of Tables ..................................................................................................................... iv List of Figures ......................................................................................................................v Chapter 1: Introduction to the Study ....................................................................................1 Background ....................................................................................................................1 Problem Statement .........................................................................................................3 Purpose of Study ............................................................................................................4 Research Questions and Hypotheses .............................................................................5 Theoretical Framework ..................................................................................................5 Nature of the Study ........................................................................................................7 Definitions of Terms ......................................................................................................7 Limitations .....................................................................................................................9 Significance..................................................................................................................10 Summary ......................................................................................................................10 Chapter 2: Literature Review .............................................................................................12 Introduction ..................................................................................................................12 Literature Search Strategy............................................................................................13 Theoretical Framework ................................................................................................14 Health System Outcomes Quadrant ...................................................................... 17 Health System Outputs Quadrant.......................................................................... 17 Social Determinants of Health Quadrant .............................................................. 17 Health System Inputs and Characteristics Quadrant ............................................. 18 i Management of Tuberculosis in Ghana ................................................................ 18 Tuberculosis Treatment in Ghana ......................................................................... 20 Risk Factors for Tuberculosis in Ghana................................................................ 21 Factors Affecting TB treatment ............................................................................ 22 Critique and gaps in previous Tuberculosis studies .............................................. 29 Summary ......................................................................................................................33 Chapter 3: Research Method ..............................................................................................37 Research method and Rationale ...................................................................................37 Statistical Analyses Methods .......................................................................................39 Methodology ................................................................................................................40 Target Population .................................................................................................. 40 Sampling and Sampling Procedure ..............................................................................42 Sample frame ...............................................................................................................42 Data Collection ............................................................................................................43 Operationalization of Variables ...................................................................................44 Dependent Variable .............................................................................................. 44 Independent Variables .......................................................................................... 44 Sample size estimation .................................................................................................45 Dataset Preparation and Data Analysis Plan ................................................................46 Threats to Validity .......................................................................................................47 Ethical Procedures .......................................................................................................49 Summary ......................................................................................................................49 ii Chapter 4: Results ..............................................................................................................51 Data Collection and Management ................................................................................52 Results of Descriptive Statistics...................................................................................52 Results of Bivariate Analyses ......................................................................................54