Health

The Metropolis has a numerous health facilities including a Regional Hospital which serves as a referral centre. Table 1.10 shows the types of health facilities and their numbers that exists the municipality.

Health Facilities

Table 1.10: Health facilities

SOURCE: NJSMA, MPCU, 2021

Trend of Diseases Reported (2018-2021)

The Metropolis is faced with a double burden of communicable diseases and increasing number of non-communicable diseases. The situation necessitated a paradigm shift from merely providing health care services which are mainly medical to promotion, protective and restoration of health. Malaria continues to be the topmost communicable disease over the years followed by STIs. There has been a significant reduction in malaria cases over the period 2018-2021. On the other hand, STIs even though saw an increase from 2018-2019, it further declined drastically between 2020 and 2021. Table 1.11 below provides the trend of diseases reported between 2018-2021 whereas Figure 1.11 gives a graphical presentation of diseases reported for the year 2019.

Table 1.11: Trend of Diseases Reported (2018-2021)

SOURCE: NJSMA, MPCU, 2021

Figure 1.11: Diseases Reported (2019)

Outpatient Department (OPD) Attendance The number of OPD visits can be seen as a proxy measure for patients access to healthcare. However, The OPD attendance declined from 2018 to 2020. Even though some other factors could be attributed to the drop, Covid 19 played a key role. Patients insured with NHIS makes up to 90% of OPD. Table 1.12 show the OPD attendance for insured and non-insured patients at the various health facilities.

OPD Attendance

Table 1.12: OPD Attendance

SOURCE: NJSMA, MPCU, 2021

Nutrition

The key nutrition activities implemented in the New Juaben South include:

Growth Monitoring and Promotion

The regular monitoring of the weight of infants and young children is effective in early detection of growth faltering and provides timely opportunity for intervention. This approach does not only measure the wellbeing of children but also serves as a proxy indicator for determining household food security.

Growth Monitoring and Promotion helps to identify underweight children who are given the necessary support through counselling or case management. Through static and outreach Child Welfare Clinic (CWC) sessions, all children under the age of five years are assessed and given the appropriate immunizations.

Though the malnutrition rate of the municipal (0.1%) is acceptable (5%) according to the Global Acute Malnutrition criteria, however unidentified and unreported cases of malnutrition in the peripheral and hard-to-reach areas remains an issue of great concern.

Stunting is an indicator of chronic malnutrition and a proxy for household food security. According to the 2017/18 MICS, 16% of children in Eastern region and 18% in Ghana respectively were stunted. Though stunting is not a problem in New Juaben South municipality the proportion of eligible children whose length/ height were measured is still not encouraging (21%). Despite efforts to ensure equitable distribution of the stadiometer/ infantometer, most facilities do not have and the commitment of staff to undertake measurement according to schedule is still low.

Community Based Management of Acute Malnutrition (CMAM)

Early identification and prompt referral of children with Severe Acute Malnutrition (SAM) underscore the effectiveness of case management interventions. To this end, it is imperative to intensify the outreach services such as home visits and active case search to ensure timely identification and appropriate management of all cases. More so, adherence to weekly visits by clients established as a Standard Procedure to a large extent greatly enhances the success of CMAM treatment outcome.     

Despite the commitment of staffs, enthusiasm has been short changed due to shortage of therapeutic foods across the country since 2019. This has limited the management of SAM in the region to Inpatient Care at the Regional Hospital.

Community Infant and Young Child Feeding (C-IYCF)

Caregivers and pregnant women are counseled on appropriate Infant and Young Child Feeding and care practices to promote behavior change for improved nutrition outcome.   

According to MICS 2017/2018, early initiation of breast feeding is practiced most in Central region (65%) and least in Eastern region (40%) with the national coverage of 52%. The Holistic Assessment target of 95% babies put to breast within 30 minutes of birth was not achieved in 2020. This could be due to delayed initiation for babies delivered through Caesarian Section hence only 87.2% babies born were initiated. In 2020, there was a slight increase (97.5%) in the proportion of infants exclusively breastfed at month 3 due to strengthening of nutrition counselling.

According to the MICS, 2017/18 nine in every ten babies continue with breastfeeding at 1 year while only four in every ten do the same at 2 years. In the New Juaben municipality, nine in every ten babies continue with breastfeeding at 1 year. This when sustained presents prospects to achieve full growth and development potentials.

One in every five babies in Ghana is not introduced to solid or semi – solid foods from 6-8 months and this contributes to slow growth in babies (MICS, 2017/18). The situation is not different from the New Juaben South Metropolis.

Vitamin A Supplementation Vitamin A is an essential micronutrient for improving vision and building strong immunity. Based on UNICEF/WHO guidelines, the Ghana Ministry of Health recommends that children aged 6-11 months and 12-59 months be given one high dose (100,000IU) and (200,000IU) of vitamin A capsules every 6 months respectively.   

Routine Vitamin A supplementation is also undertaken through CWC, School Health and other contact point. Following the WHO recommendation on Postpartum Vitamin A Supplementation as weak, the routine Postpartum Vitamin A supplementation has been discontinued as a public health intervention.

Shortage of Vitamin A capsules in March and April 2020 coupled with the COVID- 19 pandemic affected service coverage. Though coverage of routine Vitamin A supplementation is generally low (< 80%), it appears better in the first semester (27%) than the second semester (22.5%). This can be attributed to ineffective School Vaccination services because most caregivers do not present the Maternal and Child Health Record Book of their children.

Girls Iron Folate Tablet Supplementation (GIFTS)

Anemia prevalence has been persistently high in Ghana among women of childbearing age and children. According to 2014 Ghana Demographic and Health Survey (GDHS) 42% of women and 66% of children below five years are affected. Among women, those within the adolescent age group of 15- 19 years and pregnant women have the highest prevalence levels of 48% and 45% respectively.       

Anemia remains one of the greatest woes that could mare healthy pregnancy outcomes as such the need for effective counseling on good nutrition, early identification and management of all cases. The Focused Antenatal Care (FANC) considers the assessment of maternal hemoglobin levels at registration, 36 weeks gestation and any other period where signs and symptoms of anemia may ensue.

From 2019 to 2020, anemia among ANC registrants has peaked at mild though there has been a slight improvement from (18.6%) to (18.2%). Likewise, anemia among women 36 weeks gestation is still mild but has improved slightly from 18.0% to 15.2%. This trend presents a public health burden with a tendency to affect maternal health outcomes.

The New Juaben South Metropolis has a lot of laboratory facilities among which many are privately owned. All government facilities providing maternal services have hemoglobin meters with only Koforidua Polyclinic having Full blood count machine in addition to the afore mentioned. This has greatly increased accessed to hematological examinations especially during pregnancy. Continuous counselling on good nutrition and the free maternal access to NHIS has greatly augmented positive nutritional outcomes.

Adolescence is an opportune time for interventions to address anemia, as it is a time for rapid growth and development, and a critical time for laying the nutrition foundation for childbearing. Providing Iron and Folic Acid (IFA) supplements during adolescence, and continuing into adulthood improves iron status, and reduces risk of developing iron deficiency and anemia.

The Girls’ Iron-Folate Tablet Supplementation (GIFTS) Programme is designed to provide weekly IFA supplements through schools, health facilities and other channels. IFA supplements will be provided to in-school adolescent girls and out-of-school adolescent girls aged 10-19 years. The programme will reach out to other menstruating women aged 20 years and above through communication to generate demand and encourage them to buy and take IFA supplements.

Out of the minimum coverage of 60% only 4102 (23.3%) of adolescent girls were reached out- of school in 2020. Supplementation to adolescent girls has been halted due to attrition of teachers trained and low commitment of staffs.

Challenges/ Major Issues

• Attrition of staffs: Despite the non-availability of Medical Officers and inadequate Physician/Medical Assistants, the effectiveness of health service delivery is greatly mitigated by the continuous attrition of staffs most of who were trained on Community Infant and Young Child Feeding (C-IYCF) and Community Management of Acute Malnutrition (CMAM).

• Low coverage of Vitamin A Supplementation: The level of Vitamin A uptake by children aged 6- 59 months in the period is very low. Most children aged 12-59 months do not turn up for the second dose of Vitamin A in a year and this greatly affects the effectiveness of the intervention. More so, data on children given two doses of Vitamin A in a year is scanty because it is not captured as a routine data.

• High Anemia among Pregnant women 36weeks gestation: The effect of anemia in pregnancy is deleterious as such the need to ensure that no pregnant women go into labor with anemia.

• Shortage of Therapeutic foods for the management of Severe Acute Malnutrition: The prolonged shortage is affecting staff commitment to case search and treatment outcome

• Inadequate Anthropometric equipment: Lack of essential equipment like stadiometer/ infantometer is affecting measurement according to schedule for early identification of malnutrition.

• Frequent shortage of Maternal and Child Health Record Book: The unpredictable supply of the MCHRB affects effective documentation of maternal and child health services.

• Misconceptions about public health interventions
• Low stakeholder commitment to nutrition
• No NGO implementing nutrition activities
• Low uptake of public health interventions    

Way Forward

To improve the nutrition situation in New Juaben South, there is the need for:
• Effective collaboration among stakeholders to implement the Nutrition Sensitive interventions
• Promote the cultivation of foods crops e.g., home garden
• Regulate the use of agrochemicals
• Community sensitization on appropriate feeding and care practices
• Active case search for children with Severe Acute Malnutrition
• Sanctions against caregivers who default in bringing children for childhood services.

Child Protection

Child Protection activities implemented by the department seeks to guarantee the right of all children to a life free from violence, abuse, exploitation and neglect. The Department works in collaboration with sister agencies which include children and youth, families, communities, government, civil society and private organizations.

Child protection activities being implemented are grouped un the Child and Family welfare policy. Activities undertaken in relation to Child Protection include:

- Child Maintenance
It is an ongoing, periodic payment made by a parent for the financial benefit of a child following the end of a marriage or other relationship

- Child Custody and Access
This has to do with the issue of which parent the child will reside with. It is determined in accordance with the best interests of the child standard.

- Fosterage/Adoption
The goal of foster care is to provide a child with a temporary, stable foster family until he or she can be move on to a permanent family.

- Paternity
There are instances whereby men deny the paternity of their children and these cases come before the Department to help determine the paternity of the child.

Family Tribunal/Juvenile Court Cases Recorded 2020

Table 1.13: Family Tribunal/Juvenile Court Cases Recorded 2020

SOURCE: NJSMA, MPCU, 2021