Commuters as a Major Contributor to the Spread of Communicable Diseases in Public Places
Chapter One
OBJECTIVE OF THE STUDY
- To raise awareness of the role of commuters in spreading communicable diseases in public places.
- To examine the knowledge of commuters on the awareness of their active involvement in the spread of communicable diseases.
- To suggest effective strategies to mitigate the spread of communicable diseases by commuters in public places.
CHAPTER TWO
LITERATURE REVIEW
Introduction
Literature review involves a critical synthesis of already existing research information on a particular subject matter under study (Yaro, 2010; Bolderston, 2008; Ramdhani, A., Ramdhani, M. A., and Amin, A. S., 2014). In other words, literature review seeks to present the state of knowledge and theory on the set of issues examined. This section explores existing works on emerging infectious diseases, notifiable infectious diseases, risk perception of diseases, spreading diseases with transport, transporting infectious patients, using public transport as hearse, emergency medical service delivery, and effectiveness of vehicle fumigation and the standard protocols of vehicle disinfection.
Emerging infectious diseases
Emerging infectious diseases are diseases that have occurred and affected people for the first time, or diseases that have existed earlier but are however increasing in terms of new cases or diffusing to new areas (Mukherjee, 2017). They also include infectious diseases that have affected a geographical area in the past and has declined within time or controlled, but again resurfaced. According to Mukherjee (2017), some old diseases reappear in new forms that may usually be severe or deadly. Example is the 2014 outbreak of the Ebola disease in West Africa. These are known as re-emerging diseases.
Mukherjee (2017) notes that most of the emerging infectious diseases are caused by pathogens that are already present in the environment unnoticed. They tend to emerge when provided with favorable conditions and infect a new host. On rare instances, some of them evolve into a new variant and cause a new disease.
According to the World Health Organization (2009), people traveling could be exposed to numerous infectious diseases depending on the presence of infectious agents in the visiting area. However the possibility of being infected will differ based on the purpose of the trip and the travel plan within the area, including the accommodation standards, sanitation and hygiene, as well as the conduct of the traveler (WHO 2010).
Notifiable infectious diseases
Studies have shown that the control of infectious diseases is more complex than earlier perceived (WHO, 2012). The epidemiology of communicable disease is varying as new infectious diseases are emerging, while old infectious diseases are re-emerging (Bloom, Black, and Rappuoli, 2017). According to the Ghana Health Service (2017), notifiable infectious diseases in Ghana of which cases are reported include: HIV, Hepatitis, Syphilis, Toxoplasmosis, Measles/ Rubella, Yellow Fever, Dengue, Cholera, Bacillary Dysentery, Meningitis, Malaria, Amoebic Dysentery, Onchocerciasi, Lymphatic Filariasis,
Schistosomiasis, Helminthiasis, Tuberculosis, and Buruli Ulcer. However Meningitis, Tuberculosis, Toxoplasmosis, Measles/Rubella, Bacillary Dysentery, Amoebic Dysentery, Schistosomiasis, Soil-transmitted Helminthiasis among the above mentioned diseases are the ones that are contagious and can spread through transport (WHO, 2012). It is also important to know that Typhoid Fever, Severe Acute Respiratory Syndrome (SARS), H1N1 Flu, and Ebola are also notifiable infectious diseases globally (WHO, 2012).
CHAPTER THREE
RESEARCH METHODOLOGY
Research Design
Introduction
Research design involves the planned ways and principles of doing a work. There are two main approaches to social research. These are quantitative and qualitative approaches. The quantitative approach is a formal, objective, systematic process in which numerical data are utilized to obtain information while the qualitative approach involves the generation of data in the form of words, images, impressions, gestures, or tones which represents real events (Yaro, 2010). This study employed both approaches (i.e. the Mixed Method). This was because given the merits and demerits of qualitative and quantitative methods, both approaches complement each other in terms of validity and authenticity (Teye, 2012). Moreover, inspired by the philosophical underpinning of pragmatism, the researcher had the opportunity to choose from both quantitative and qualitative approaches without restrictions (Creswell, 2014). Pragmatists claim that researchers must stress on the research problem and adopt multiple approaches to develop knowledge about the problem as cited in Agyemang (2015). This is because, there is no sole point of view that can ever give the perfect picture since there may perhaps be several realities (Saunders, Lewis, and Thornhill, 2007). Hence, the adoption of the mixed methods research approach in this study is vindicated, considering the fact that it provided the avenue to the researcher to tap into the strengths of both qualitative and quantitative research approaches.
The study employed a cross- sectional survey design because cross-sectional survey is good for determining variation, patterns of associations, and indicate causation by examining relationships between variables (Mayoux, 2006).
In-depth key informant interviews and focus group discussions were also employed. In depth key informant interviews and focus group discussions allowed for face- to- facecontact with the respondents and consequently provided in- depth data, while questionnaires also saved time of both the researcher and respondents (Bryman, 2016).
Target Population
Data was collected at the same time (concurrently) within a short time frame from a large number of public transport drivers, ambulance drivers, and passengers/households who are dispersed across Greater Accra Metropolitan Area (GAMA). GAMA is a conceptualized area within the Greater Accra region of Ghana in earlier studies (Oteng- Ababio, Melara Arguello & Gabbay, 2013; Yankson, Kofie & Moller-Jensen, 2005) as illustrated in Chapter 2.3.
Stakeholder institutions like the Ghana Health Service, Ministry of Health, National Disaster Management Organization (NADMO), Ghana National Public Health, Ghana Red Cross Society, Environmental Health Department (AMA) and the Ghana Ambulance Service were also targeted.
CHAPTER FOUR
DATA ANALYSES AND RESULT
Normality Test
Before the analysis of the results, the researcher first of all run a normality test of the data collected to analyse its adequacy in making statistical inferences.
According to the central limit theorem, as long as the sample size is 30 or more; the sampling distribution would tend to be normal irrespective of the population distribution. The sample size used in this study was large enough to satisfy the requirement of normality according to the central limit theorem (Ghasemi and Zahediasl, 2012). Besides, the study used 320 respondents which is representative enough to make generalization of the population. Meyer et al (2005) purported that the larger the sample size used in the study, the more precise and stable the estimates of the population parameter would be for statistical inferences.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Summary of Main Findings
This study was aimed at achieving five specific objectives. The first was to assess the main transport modes used during emergency situations. The second was to examine the protocols employed to prevent vehicle infection. The third was to analyze risk factor and exposure of people involved in infectious patient care. The forth objective was to discuss the perception of risk of the key actors in the chain, while the fifth and last objective was to analyze the effectiveness of medical emergency delivery system in addressing these issues. The Environmental Health Hazard Pathway model of Corvalan and Kjellstrom (1995) was adopted and modified to explain the phenomenon under study.
From the primary data gathered, the main transport modes used during emergency health situations are taxis due to their availability, affordability, reliability, convenience, and effectiveness. However, these taxis do employ only normal cleaning methods such as detergents and resorting to the washing bay rather than the standard protocols for vehicle disinfection.
Analysis from previous chapters indicate that all the people (Nurses and Doctors) involved in infectious patient care are at risk but not vulnerable to infectious diseases as they adhere to safety precaution in the cause of carrying out their duties. All the key actors in the chain including: household individuals, drivers, passengers, health workers and patients are aware of the everyday risk associated with transporting patients with public transport. This findings therefore rejects the null hypothesis of the study. However the use of public and private transport as ambulance has become an acceptable risk due to the deficiency of the emergency medical transport delivery system (ambulance service) in Ghana.
Meanwhile the standard protocols of vehicle disinfection are not adhered to. This leaves both drivers and passengers at risk of infectious diseases because, patients being transported may cough, vomit, urinate, or exude pathogenic microorganisms in vehicle. And since effective protocols are not employed in disinfecting vehicles afterwards, persons who come into contact with vehicle may absorb these microbes. This may lead to infection which will lead to sickness or loss of life as illustrated in conceptual framework (see figure 1.1).
Conclusion
Every individual will want the best pre-hospital care and timely intervention during emergency health situations. It is however not the wish for anyone to resort to vehicles (taxis) that are not designed for such purpose in times of emergency, but it only happens because the system provides no option. This therefore has become an “acceptable risk” to both authorities and individuals.
In this case, should there be a single case of an infectious disease like Ebola in Ghana, one can imagine the rate at which it will spread and the losses considering the mode of transportation used during emergencies, and the cleaning methods employed by drivers after service delivery. It is therefore crucial for the government and relevant stakeholders to put in the necessary measures to curb the spread of infectious diseases through transport, while ensuring the effectiveness of emergency medical transport delivery across the country because “prevention is better than cure”.
Recommendations
Based on the findings of the study, the following short term and long term recommendations are proposed in preventing the spread of infectious disease via public transport;
Education
The research findings have is that, majority of the people have the risk knowledge of public transport and infectious diseases which is welcoming. However, a handful of the population do not have the risk knowledge. This indicates that there is the need to eradicate the ignorance of the few people in the respective population. Therefore the ministry of health and the Ghana Health Service should target stakeholder institutions especially the GPRTU and religious bodies, to educate their members and congregation respectively. This will go a long way to add up to the risk knowledge and ensure the abolition of attributing faith and belief to risk.
Provision of Logistics to Various Health Facilities
Both government and Non-Governmental Organizations should help the Ministry of Health and the Ghana Health Service to provide the various health facilities with adequate logistics (disinfectants/fumigants, gloves, amongst others), so that any vehicle that conveys an infectious patient is fumigated at the facility (destination) before leaving the facility. This will help address the problem of inadequate logistics at the health facilities due to financial constraints. Moreover, there will be no excuse for both healthcare providers and drivers for not adhering to the SOPs 2016.
Law Enforcement
This study revealed that people including key stakeholder institutions are unaware of the SOPs 2016 which outlines the standard protocols of transporting infectious bodies. The SOPs 2016 on transporting and translocation of infectious patients and dead bodies should be made available to all stakeholders. Recalcitrant individuals and institutions should be punished to serve as deterrence. This will help ensure the effective enforcement of the law.
Equipping the Ambulance Service
Majority of respondents in this research used or prefer to use other means other than the ambulance during emergency health situations due to the ineffectiveness of the Ghana Ambulance Service. This is because the Ghana Ambulance Service is unable to timely meet the demands of victims considering the challenges facing the Ambulance Service in Ghana which includes inadequate ambulances, equipment, and staff. Therefore Government should add emergency service delivery to its priority by equipping the Ghana Ambulance Service with adequate ambulances and staff, to make the service efficient and effective. This will help reduce the reliance on public and private transport during emergency health situations and also curb the possible spread of infectious diseases.
Expansion and demarcation of roads
The Ministry of Roads and Highways as well as the Ministry of Transport with the support from government must construct new roads and expand already existing roads. Emergency lanes should be demarcated on our roads like the Bus Rapid Transport (BRT). This will help facilitate efficient transportation and timely response of the Ambulance Service during emergencies.
Direction for Further Studies
This study revealed that motor bikes are not used to transport sick patients during emergencies. However it can still play a role in spreading infectious diseases especially via the helmet that is being used by different people who patronize commercial motor taxi (Okada) services. As illustrated in the conceptual frame work (see Figure 1.1), concentration of microorganism in the helmet from an infectious person can be absorbed by another person who wears it. Although motor taxi service is illegal in Ghana, it still remains a lucrative transport business in the country (Oteng-Ababio and Agyeman, 2012) as some people patronize the service. Therefore, new and further studies should be directed towards the area of motor taxi and infectious diseases.
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