PUBLIC HEALTH AFFILIATION REPORT

ACKNOWLEDGEMENT

We thank the Lord Almighty for the gift of life, his tender care and his loving kindness for without
Him we would not have accomplished all that we have in this piece of work. We also wish to
express our sincere gratitude to the Nurse in-charge of the Public Health Unit at Suntreso
Government Hospital, Madam Rachel as well as all the staff of the Reproductive and Child Health
Unit, the Family Planning Unit, the Administration and the Information office. We say God richly
bless you for your contributions to this piece.

Lastly, we want to appreciate the efforts of Miss Abigail Amponsah, the community health nurse
in-charge of the Atwima Takyiman Community Health Centre who was very helpful and
contributed to making this report a success.

CHAPTER ONE

INTRODUCTION

According to WHO, public health is defined as the art and science of preventing disease,
prolonging life and promoting health through the organized efforts of society. Public health aims
at providing conditions under which people can maintain good health, improve their health and
wellbeing or prevent the deterioration of their health.

Public health affiliation aims to enable students acquire competencies in all public health nursing
activities and implement appropriate strategies to address community problems.

SPECIFIC OBJECTIVES FOR THE PUBLIC HEALTH AFFILIATION

The student would be able to;

 Appreciate the concepts of public health nursing practice

  Apply the principles of public health nursing in providing preventive, promotive, curative
and rehabilitative aspects of health care
 Develop competencies in planning and organizing various health programmes in
communities
 Develop skills in functioning effectively as a member of the multi-disciplinary team in
health care, in collaboration with other organizations, agencies, community leaders
 Develop competencies in evaluation of health services in communities

PUBLIC HEALTH AFFILIATION AT SUNTRESO GOVERNMENT HOSPITAL

This is a composite field report on a public health affiliation at the Suntreso Government
Hospital in the Bantama sub-metro in the Kumasi Metropolitan Assembly in the Ashanti
Region of Ghana. This piece of writing contains detailed information on all that was done
as part of the affiliation from 10th September, 2018 to 28th September, 2018. The specific
activities undertaken during the three-week period are as follows;
 Reproductive and child health activities (Child Welfare Clinics)
 Family planning services
 Community study
 School health services
 Home visit

CHAPTER TWO
PROFILE OF BANTAMA CATCHMENT AREA

The Bantama sub-metro in Kumasi Metropolitan Assembly in the Ashanti Region is the second
biggest sub-metro. It is 300km from the National Capital, Accra. The sub-metro is approximately
41sq km in size. Politically, Bantama is divided into three sub metropolitan areas namely;
Bantama, Kwadaso and Nhyiaeso.
POPULATION

In terms of population, it is the second largest of the 5 sub-metros in the Kumasi Metropolis. It
has projected population of 544,560 for the year 2017 with an annual growth rate of 27.10%.
There are 81 communities in the sub-metro. The sub-metro which forms part of Kumasi is a
cosmopolitan city with trading being the main occupation of the inhabitants.

Population Distribution and Communities per communities Health Areas

CHPS ZONE COMMUNITY 2017

BANTAMA Bantama 41,073
TOTAL 41,073
NORTH SUNTRESO North Suntreso 19,599
TOTAL 19,599
SUNTRESO EXTENSION Abrepo Junction 6,791
BOHYEN- AMPABAME Bohyen 14,116
Ampabame 7,225
Kropo 5,683
TOTAL 20,844
ABREPO Abrepo kuma 7,933
Abrepo Kesse 9,461
Bronikrom 3,450
TOTAL 20,844
ADOATO- ADOMANU Adoato 6,623
Adomanu 5,155
Anoo 3,304
TOTAL 15,082
KOKOSO- ASUBONTENG Kokoso 3,663
Meredane 4,234
Asubonteng 2,100
 TOTAL 9,997
MPATASIE Mpatasie 5,179
Atafoa 1,989
Tikese 2,665
Asuogya 3,005
TOTAL 12,838
OHWIM/AMANFROM Ohwim 6,903
Amanfrom 5,154
Hwediem 2,939
TOTAL 14,996
KWADASO CENTRAL Kwadaso central 17,928
TOTAL 17,928
KWADASO NORTH Kwadaso Nsuom 8,000
5 Junction 9,053
TOTAL 17,053
KWADASO NSIA ASARE Kwadaso proper 7,852
Nsia Asare 7,149
Sofoline 4,084
Beposo 3,915
TOTAL 15,148
OHWIMASE Ohwimase 17,574
TOTAL 17,574
TAKYIMAN Takyiman 4,986
Denchemuoso 4,535
TOTAL 9,521
AGRIC Edwenase 8,784
Atwima amanfrom 7,295
TOTAL 16,079
DAABAN KROFROM Daaban panin 8,051
Apramang 5,930
Daaban Kuma 9,300
TOTAL 23,281
ANYINAM Anyinam 2,103
Adeaye Eno 1,205
Kagyase 1,920
TOTAL 5,228
ASUOYEBOAH Asuoyeboah 10,884
IPT 4,016
Nana Moko 5,216
SSNIT Flat 1,900
TOTAL 22,016
SOKOBAN- TMPOM Sokoban 8,991
Timpom 5,930
Patuda 2,290
Wood village 2,010
TOTAL 19,221
ADIEBEBA- AHODWO Adiebeba 6,833
Ahodwo 7,976
TOTAL 14,809
TANOSO Tanoso 17,218
Ahwiankwanta 6,465
TOTAL 23,683
FANKYENEBRA- ADIEMBRA Fankyenebra 12,625
Adiembra 6,477
TUC 4,136
Parakuo Estate 6,234
 TOTAL 16,847
ATASOMANSO Atasomanso 13,355
Konkromoase 2,414
TOTAL 15,769
NYANKYERENEASE Nyankyerenease 3,219
Apesika 1,902
Complex 2,062
TOTAL 7,183
APATRAPA Apatrapa 6,234
Pokukrom 1,892
Ahodwo 2,443
TOTAL 10,569
NZEMA Nzema 9,948
Nwamase 5,200
Apire 3,690
Kokode 3,890
TOTAL 22,728
NHYIAESO Nhyiaeso 6,100
Ridge 4,200
Dakojom 4,430
TOTAL 14,730
SANTASI Santasi 7,100
Ahenbronum 4,820
Kwaadei 5,020
TOTAL 16,940
Danyame 6,273
Danyame village 5,241
TOTAL 11,514
 SOUTH SUNTRESO South Suntreso 21,474
TOTAL 21,474
KWADASO ESTATE Kwadaso Estate 8,150
TOTAL 8,150
PATASI Patasi Estate 9,139
Patasi Village 3,005
TOTAL 12,144
ODENEHO KORADASO Odeneho Koradaso 4,102
GRAND TOTAL GRAND TOTAL 544,560

Summary of Population

INDICATOR BANTAMA
Proportion of total population 27.10% of Kumasi population
Total Population 544,560
WIFA (24%) 158,140
Expected Pregnancies (4%) 21,782
Expected Births (4%) 21,782
Children 0-11 months (4%) 21,782
Children 12-23 months (2.9%) 15,792
Children 24-59 months (12%) 65,347
Children 0-59 months (20%) 108,912
Children 6-59 months (18%) 98,021
Adolescents (22.9%) 124,704
School Age (36.4%) 198,220
Adults 64+ (6.1%) 33,218
Growth rate (2.7%)
VEGETATION/CLIMATE

The climate is typically wet equatorial with the major rainy season running from late February to
early July and the minor from mid-September to early November. The dry season is at its peak in
the months of December and January with a temperature up to 30 oC in March. The vegetation
can be described as mostly semi-deciduous forest with several valuable trees.

OCCUPATION

The main occupations of the citizens are trading and farming. Bantama Market (the largest open
air market in the sub-metro), Kwadaso Market where onions are purchased, Abrepo Junction
Metro Mass Transit Terminal, Bantama Shopping Centre (also called bantama stores) for
commerce are the main trading centres. There are other trading centres located in the various
communities. Some of the communities also do some farming.

CULTURE/FESTIVALS

Two festivals Akwasidae and Odwira are celebrated every forty days and once in a year
(December) respectively.

RELIGIOUS GROUPS

The major religious groups known in the sub-metro are Christians, Moslems, Faith based
organizations, Traditionalists and Pagans.

EDUCATION

There are two hundred and forty-three (243) basic schools which include public and private, ten
(10) senior high schools, one (1) nursing training college and four (4) tertiary institutions.

TRANSPORTATION

The Metro Mass Transit Terminal (Kufour Bus) at Abrepo Junction which transports passengers
has the largest links to almost all the capital and big towns in the country. The Sofoline
Interchange which was to facilitate road network easy for transportation is still in progress. The
major means of transportation in the sub-metro by the people are minibuses (trotro) and taxis.

UTILITIES

The sub-metro has electricity supply to every community and overhead lines and underground
cables. Water supply to the communities is frequent.

TELECOMMUNICATION

There are many Communication Networks on which people within the sub-metro communicate
including MTN, Vodafone, Tigo, Airtel and Glo. Mobile networks and a fixed line system, it also
has 6 Local FM Stations, 3 TV stations, Internet cafes and among others.

HEALTH SERVICES

The sub-metro Health services are organized around many hospitals, clinics and maternity
homes. There is one Government Hospital designated as a district Hospital (Suntreso
Government Hospital), two CHAG Hospitals, twenty-two (22) Private Hospitals, two Government
Health Centres, fourteen (14) Clinics and Maternity Homes, five Private Laboratories, eighty (80)
Pharmacies and over seventy (70) over-the-counter centres. The sub-metro has thirty-four (34)
CHPS zones.

GOVERNMENT CHAG PRIVATE QUASI- TOTAL

GOV’T
Hospital 1 2 22 0 25
Clinic 0 0 5 2 7
Health 2 0 1 0 3
centres
Maternity 0 0 4 0 4
homes
CHPS zone 34 0 0 0 34
 Psychiatric 0 0 2 0 2
centre
Homeopathic 0 0 2 0 2
TOTAL 37 2 36 2 77

Staffing (Public and some private Health facilities)

GOVERNMENT PRIVATE + CHAG TOTAL

Medical 1 12 13
superintendent
Administrator 1 11 12
Accountant 2 12 14
Medical officers 14 26 39
Pediatrician 2 0 2
General surgeon 1 1 2
Physician assistants 5 12 17
(medical)
Physician assistants 2 0 2
(herbal)
Dental assistants 4 2 6
Pharmacists 5 9 13
General nurses 92 39 131
Midwives 51 55 106
Community Health 43 16 59
Nurses
Enrolled nurses 26 58 84
E.N.T specialists 1 1 2
Optometrists 1 2 3
Support staff 98 386 484
CHALLENGES

Inadequate critical staff is the main challenge in the sub-metropolis.

PROFILE OF SUNTRESO GOVERNMENT HOSPITAL

The Suntreso Government Hospital was commissioned as Suntreso Urban Health Centre on 22 nd
November, 1963 by Mr. L. R. Abavana.

However, the first patient was seen on the 27th January, 1964. The maternity unit was added in
1973. It was given a Polyclinic Status in 1985. In 1998, a specialist clinic for Sexually Transmitted
Infections (STIs) was added to the range of services.

In the year 2000, the facility again was given a District Hospital status within the Bantama sub-
metro, under the auspices of the millennium cities initiative and the Israeli Consul (Mashav). In
2009, another Specialist Clinic mother and baby unit was added.

The Dermatology Unit was added in September, 2014.

ORGANOGRAM OF THE HOSPITAL

 AVAILABLE SERVICES

 General OPD
 Inpatient care
 Disease Surveillance
 CT (PMTCT)
 Pharmacy
 Paediatric care (MBU)
 Obstetrics / Gynaecology
 Surgery
 Eye care
 Dental
 ENT
 STI clinic
 Ultrasound
 Laboratory
 X- ray
 Family planning
 Herbal Medicine
 Psychiatry
 General Administration

TOP CAUSES OF OPD CONSULTATIONS

2015 2016 2017

Cases NO. % Cases NO. % Cases NO. %

Malaria 8,636 14. Upper 6,285 14. Upper 8,125 17.
8 Respiratory 5 Respiratory 9
 Tract Tract
Infections Infections
Upper 5,575 9.6 Malaria 4,475 10. Rheumatism & 3,182 7.0
Respiratory 3 other Joint
Tract Pains
Infections
Diarrhoea 1,391 2.4 Rheumatism & 2,282 5.5 Malaria 2620 5.8
diseases other Joint
pains
Skin 1,342 2.3 Diarrhoea 1,874 4.3 Acute Urinary 1,719 3.8
diseases diseases Tract Infection
Rheumatis 1,243 2.1 Pregnancy 1,625 3.7 Diarrhoea 1,170 2.6
m & other related diseases
Joint pains complications
Vaginal 1,110 1.9 Vaginal 1,466 3.4 Skin diseases 1,130 2.5
discharge discharge
Anaemia 960 1.6 Skin diseases 1,426 3.3 Gynaecologica 1,107 2.4
l conditions
Intestinal 952 1.6 Acute Urinary 1,341 3.1 Diabetes 745 1.6
worms Tract Mellitus
Infections
Acute 928 1.6 Gynaecologica 1,239 2.9 Hypertension 695 1.5
Urinary l conditions
Tract
Infections
Urethral 806 1.4 Intestinal 812 1.9 Intestinal 667 1.5
Discharge worms worms
All other 35,41 60. All other 20,44 47. All other 24,30 53.
diseases 8 7 diseases 2 1 diseases 9 5
 INPATIENTS STATISTICS

INDICATORS 2015 2016 2017

Total admissions 6,780 9,492 9,204
Hospital admission 12.6 17.3 16.9
rate
Number of patients 39,805 43,552 30,233
days
Total number of beds 116 (46.6% increase) 116 111
in use
Total number of 4,458 6,703 7,536
discharges
Total number of 31 74 67
deaths
Number of Major 410 755 692
operations
performed
Number of minor 654 1,004 1,143
operations
performed

ARRIVAL OF STUDENTS

We reported at Suntreso Government Hospital on 10th September, 2018. We (Pokua Konadu

Yiadom, Ewurama Addai, Juliet Owusu Achiaw, Diana Nsowaah Sekyere and Eno-Abasi Asangansi)
were directed to the Matron of the hospital who asked us to go for our letter from the general
office. She took our logistics and directed us to the public health office where we met Madam
Rachel, the nurse in-charge of the public health unit. We introduced ourselves as students from
the Kwame Nkrumah University of Science and Technology (KNUST) on a public health affiliation.
We were warmly welcomed and the nurse in-charge asked one of the staff nurses to acquaint us
with the hospital and all its departments. After the orientation, we were assigned to the Child
Welfare Clinic (CWC) for a week. At the CWC, we were further oriented to the unit by the nurse
in-charge of the unit, sister Portia. She also educated us on the components of public health of
which some are Reproductive and Child health, Maternal health, Community study, home visit,
school health, family planning and others. She went ahead to teach us what goes on at the Child
Welfare Clinic which include- Registration, Growth monitoring, Immunization, Individual
counselling and education. Afterwards, she divided us and assigned us to the various stations
specifically immunization, growth monitoring and registration.

TME TABLE FOR PUBLIC HEALTH AFFILIATION

DAYS 1ST WEEK (10TH -14TH 2ND WEEK (17TH -21ST 3RD WEEK (24TH -28TH
SEPTEMBER) SEPTEMBER) SEPTEMBER)
MONDAY CHILD WELFARE FAMILY PLANNING CHPS ZONE (ATWIMA
CLINIC UNIT TAKYIMAN)
TUESDAY CHILD WELFARE FAMILY PLANNING COMMUNITY STUDY
CLINIC UNIT
WEDNESDAY CHILD WELFARE FAMILY PLANNING HOME VISIT
CLINIC UNIT
THURSDAY CHILD WELFARE FAMILY PLANNING SCHOOL HEALTH
CLINIC UNIT
FRIDAY CHILD WELFARE FAMILY PLANNING CHILD WELFARE
CLINIC UNIT CLINIC
IN-PATIENTS CARE STATISTICS
INDICATORS 2015 2016 2017

Total admissions 6,780 9,492 9,204

Hospital admission rate 12.6 17.3 16.9

Number of patients days 39,805 43,552 30,233

Total number of beds in use 116 (46.6% increase) 116 111

Total number of discharges 4,458 6,703 7,536

Total number of deaths 31 74 67

Number of Major operations performed 410 755 692

Number of minor operations performed 654 1,004 1,143

CHAPTER THREE

HEALTH ACTIVITIES UNDERTAKEN

COMMUNITY STUDIES

Community is a group of people living in a given area or place and share certain common
characteristics (language, religion, beliefs, norms and morals) or have certain interests or goals
in common. Community study is a survey carried out on the community to gather data about the
people and identify specific needs or problems and to implement strategic measures to solve
those problems.

The significance of conducting a community study are;

 To discover the main health needs of the community

 To help health workers schedule their work effectively to cover target population
 To focus implemented measures on the proportion of the population at risk.
 To teach and sensitize the people of the community about the problems identified and
how it could be solved.
 COMMUNITY STUDY AT ATWIMA TAKYIMAN

COMMUNITY ENTRY

We (Ewurama Addai, Pokua Konadu Yiadom and Juliet Owusu Achiaw) arrived at Atwima
Takyiman on Monday,24th September, 2018 in the morning (around 9:00am). We entered the
community through Miss Abigail Amponsah, the community health nurse in-charge of the
community health centre in the community who gave us directions to the community and to
the health centre. She welcomed us upon our arrival and immediately arranged for us to meet
the community volunteer, Mr. David Asare. We were introduced to Mr. David Asare as KNUST
students on a public health affiliation programme. He also gave us a warm welcome and said
to arrange a meeting with the linguist of the community, Okyeame Tieku. We could not go to
the palace to meet the chief and elders of the community because the chief (Nana Aboagye
Takyi II) had passed away. We met with Okyeame Tieku later in the day and we were formally
introduced to him by the community health nurse and the purpose of entering the
community was stated. He, in turn welcomed us and introduced himself as the linguist of
Atwima Takyiman. He then went ahead to give a brief history of the community and a profile
of the community as well.

HISTORY OF THE COMMUNITY

According to Okyeame Tieku of Atwima Takyiman, the name of the town originated from the one
who first settled on it, Takyi. During the era of Otumfuo Osei Tutu I, he wanted to bring the whole
Asante Kingdom together. He sought for the help of his friend who was then the Kontihene of
Denkyira. The Kontihene of Denkyira agreed to help Otumfuo Osei Tutu I and so moved from
Denkyira along with his wife, children and his entire family. They then settled at Sanoma. The
Kontihene gave the land (now Atwima Takyiman) to his brother-in-law, Takyi. Takyi settled on
the land with his family and also received foreigners who had come from far away or other towns
to settle there. The town was then named after him hence the name Takyiman. After Nana Takyi
passed, his descendants were too young to take up the mantle of ruling the town. A tailor called
Kofi Manu from Bantama was made the caretaker of the town for quite a long time. A descendent
of Nana Takyi was found and the mantle had to be restored back to his family. The descendants
of Kofi Manu also held claim to the stool. There was conflict between the two parties for two
years until the issue was resolved at the traditional court, Manhyia palace and in favour of Nana
Aboagye Takyi II, a descendant of Nana Takyi. Nana Aboagye Takyi II has recently passed away
and another ‘odikro’ is yet to be enstooled.

COMMUNITY PROFILE

DEMOGRAPHY

The Atwima Takyiman community has a population of 5,104. The community is situated in the
Bantama sub-metropolis. Some of the predominant tribes found in the community are Asantes,
Fantes, Ewes, Sefwi, Gas, Dagombas, and Frafras.

WATER SOURCES

The community has about five rivers namely Mansakor, Dwahyen, Bokro, Atopo and Apapa.
There is a borehole in the community that supplies the people with water for domestic activities.

CUSTOMS AND BELIEFS

The people of Atwima Takyiman have some beliefs or customs which have their root source from
the oracle, Kobri. They believe that it is a taboo to bring a full palm nut as it was harvested into
the community. The palm nuts have to be plucked off into a basket before entering the
community from the farm. It is also a taboo to rear goats in the community. They believe that
the oracle dislikes goat rearing. Also, they do not go to the river Dwahyen on Wednesdays.

RELIGIOUS GROUPS

There are Christians, Muslims and traditionalists in the community. Everyone has the freedom
to practice whatever religion they prefer.

ECONOMIC ACTIVITIES
The main economic activities carried out by the people of Atwima Takyiman are farming and
trading although most of the town folks are into trading. The community has a decent
marketplace where buying and selling of food commodities and other items takes place.

TRANSPORTATION

The people of Atwima Takyiman travel by car especially by commercial vehicles like the vans
(trotro) and taxis. The road leading to the town is very dusty, rough and untarred making
transportation to the community uncomfortable and difficult.

COMMUNICATION

Most of the people in the town possess mobile phones and have access to various
communication networks like MTN, Vodafone and AirtelTigo with very good network service.
The community also has an information centre where important information is announced or
passed on to the people.

EDUCATION SYSTEM

There are about eight schools in the community comprising basic, secondary and tertiary
institutions.

SOCIAL AMENITIES AND INFRASTRUCTURE

The community is made up of decent shelters or houses (concrete buildings with roofing). The
community has electricity supply and minor roads linking different parts of the community
together. There is one public toilet (KVIP) in the entire town. There is no bank or microfinance
organization in the community. The community also has a good drainage system by virtue of
constructed gutters or drains. The drains are clean and free of waste materials capable of
choking them.

SECURITY SERVICES

There is a police station in the community to ensure implementation of laws and maintenance
of order.
HEALTH FACILITIES

There is a community health centre which is patronized by all in the community. Also, there is a
herbal hospital known as Dr. Amen Hospital.

ASSESSMENT OF COMMUNITY NEEDS

During the study of the community, we came across certain needs or problems that need to be
addressed. These needs were mostly health and social needs. The health needs of the
community were as follows;

 Insufficient number of boreholes

 Dusty and untarred roads
 Presence of a waste disposal site behind the marketplace

The social needs of the community were as follows;

 Insufficient number of latrines (KVIP)

 Lack of electricity supply to the community health centre
 Lack of banks or microfinance organizations

SOLUTIONS TO RESPECTIVE PROBLEMS OR NEEDS

 Construction of more boreholes to serve the people of the community

 Reconstruction of the road leading to the community to reduce dust production and an
increased risk of respiratory diseases
 Education of the community members on the health risks associated with dumping
refuse close to an open marketplace.
 Construction of more latrines to prevent the people from practicing indiscriminate
defecation
 Supply of electricity to the community health centre to facilitate its effective functioning
 Establishment of a bank or microfinance organization in the community
 COMMUNITY EXIT

We got in touch with the linguist, Okyeame Tieku and the community volunteer, Mr. David Asare
and relayed all of our findings to them through the observation we made on the community as
well as how best to ensure that all the needs of the community are met. They expressed their
gratitude for carrying out the study on their community and bringing on board measures to
ensure that all the problems are solved. We also thanked them for welcoming us into their
community and helping us with whatever information they had given us to fuel our study. We
humbly requested to leave and our request was granted.

COMMUNITY STUDY AT DENKYEMUOSO

COMMUNITY ENTRY

We (Diana Nsowaah Sekyere and Eno- Abasi Asangansi) arrived at Denkyemuoso on Monday,
24th September, 2018 in the morning around 9:00am. We were directed into the community by
the community health nurse in-charge of the Atwima Takyiman community health centre. She
welcomed us upon our arrival and led us to the royal palace of Denkyemuoso. At the palace, we
met with the chief, Nana Sarkodie Ofori and the linguist of Denkyemuoso. The community health
nurse introduced us as students from KNUST and stated the purpose of our entry into the
community. The chief and his linguist welcomed us and assured us of providing whatever
information we needed for our study. Certain traditions were observed as well.

HISTORY OF THE COMMUNITY

According of Nana Sarkodie Ofori, Denkyem Da Bo)so is the actual name of the town but over the
years it has been modified to Denkyemuoso. Some time ago in the 17 th century, Nana Osei Tutu
I moved to settle at the present-day children’s hospital, Komfo Anokye Teaching Hospital and the
cultural centre. He told his friends, the Bantamahene and the Atwimahene. The Atwimahene,
Bofo Kwadwo continued further and came across a pond with stones in it and a crocodile lying
on one of the stones with two of its offspring by its side. The crocodile had a pot full of gold
resting on its head. He then decided to settle there and use the pond to mark his territory. He
named the town ‘Denkyem Da Bo)so’ meaning a crocodile lying on a stone.

COMMUNITY PROFILE

DEMOGRAPHY

Atwima Denkyemuoso is a community in the Bantama sub-metropolis. The community has a

population of 4,643 people. Some of the predominant tribes in the community are Asantes,
Fantes, Ewes, Sewfi, Gas, Dagombas and Frafras. There are seven small towns that make up the
community namely Sunoroase, Abensereho No. 1, Abensereho No.2, Abensereho No.3, Beposo,
Atekyemu and Nufuomuase.

WATER SOURCES

The community has a borehole which supplies the people with water for domestic activities.

CUSTOMS AND BELIEFS

The people of Atwima Denkyemuoso believe that it is a taboo to rear goats or dogs in the
community. They also do not go to the river or to the farm on Tuesdays.

RELIGIOUS GROUPS

The people in the community have the freedom to practice any religion of their choice. There are
Christians, Muslims and traditionalists in the community.

ECONOMIC ACTIVITIES

The people of Atwima Denkyemuoso are into farming and trading. The community has an open
market as well as provision shops or small supermarkets.

TRANSPORTATION

The community members travel by commercial vehicles mainly vans (trotro) and taxis. The road
to the community is dusty and untarred.
COMMUNICATION

The people of the community have access to mobile phones and communication networks like
MTN, Vodafone and AirtelTigo. They have good network service as well. The community also has
an information centre where relevant information reaches the people from.

EDUCATION SYSTEM

The community has three basic schools and on Senior High School.

SOCIAL AMENITIES AND INFRASTRUCTURE

The people in the community live in concrete buildings with roofing. The community has
electricity supply and a borehole as a good source of water. There is a latrine in the community
that serves the general public aside the fact that people have toilets in their homes. The
community also has no bank or microfinance organization. The road in the community is dusty
and untarred.

SECURITY SERVICES

Denkyemuoso has a police station to ensure that the laws of the country are kept and to maintain
order in the community.

HEALTH FACILITIES

The community has no community health centre rather it shares the health centre at Takyiman.
There is no clinic in the community as well. Instead, there are chemical shops that are licensed
to sell over-the-counter drugs.

ASSESSMENT OF COMMUNITY NEEDS

Some of the needs identified in the community are;

 Insufficient number of boreholes

 Dusty and untarred road leading to the community
 Inadequate number of latrines
 Lack of a bank of microfinance organization
SOLUTIONS TO IDENTIFIED PROBLEMS

The following recommendations are respective to the problems or needs above;

 Construction of more boreholes to satisfy the demands of the people in the community
 Reconstruction of the road to reduce dust production and decrease the risk of getting
respiratory diseases
 Building of more latrines to curb the problem of indiscriminate defecation.
 Setting up of a bank or microfinance organization in the community to encourage saving
for future security among the town folks.

COMMUNITY EXIT

After carrying out the study, we went back to the chief’s palace to present to him all that we
observed and the problems we identified. We also suggested ways by which they could be solved.
The chief was very pleased with the study carried out and expressed sincere appreciation for it.
We also mentioned how thankful we were for all the information and the go ahead to study their
community. We then humbly asked to take our leave.
 HOME VISIT

A home visit is a family-nurse contact which allows the health worker to assess the home and
family situation in order to provide the necessary nursing care and health-related activities.it is
considered as the backbone of community health service. It is carried out to promote health and
wellbeing among families.

The home visit took place at Atwima Takyiman. The objectives for the home visit were;

 To visit at least five homes

 To identify the health needs of clients
 To offer counselling and education on certain health needs specific to clients
 To give interventions for health needs identified if possible.

We were able to visit five homes in the community and we were led by the community health
nurse, Miss Abigail Amponsah. The first home we entered was that of a middle aged woman with
three children (7 years, 5 years and 3years). The house was in good condition, the environment
was clean and it had good electricity and water supply. We could not meet the children because
they had left for school. We asked to see the weighing card of the last child and got to know that
she was a regular attendant of the Child Welfare Clinic. We commended her on that and also on
keeping her environment clean. We also got to know that she was already on a contraceptive
plan (injection). We then gave her an overview of how the hormonal injections worked. We also
advised that she should not hesitate to visit the health centre if she had any enquiries to make
or if there was a problem. We thanked the client for receiving us and asked to take our leave.

In the next home, we came across an old woman (probably in her 80s) with a child (10 years of
age). The house was tidy but they had big silver basins of water (not covered) which they drank
and used for cooking. From a conversation with the woman, we found out that the child was her
great grandchild who had been living with her since he was three years old. By request, we
checked her blood pressure which was normal (128/80 mmHg). She also complained of feeling
dizzy most of the time and urinating very frequently. We advised that she goes to the hospital
for a thorough check up. We also educated her on the need to cover their water to prevent
contamination. Also, we advised that they boil the water before drinking it to ensure its safety.
The woman was very grateful for the visit and assured us that she was going to visit the hospital
for a checkup.

In the next three homes, we came across an issue of overcrowding where a woman and her five
children all slept in a single room. The house was messy and unclean. We educated the woman
on the benefits of maintaining good sanitation and a good personal hygiene. We go to know that
all her pregnancies were not planned. We advised her on the need for her to go on a family
planning method. We explained the various methods available and gave her chance to make her
choice. We also cleared certain misconceptions she had about family planning. She decided to go
for a long term form of contraception and was then referred to Suntreso Government Hospital.
We also came across a woman who had a four month old baby. Upon interrogating the mother,
we realized she was giving water and artificial feeds to the baby. We educated her on the need
for exclusive breastfeeding before six months and on the benefits for both mother and baby.
Lastly, we went to the home of a young lady who seemed to be in a hurry to go out. Her
surroundings were clean and she seemed to be educated. We took our leave as she was about
stepping out.

SCHOOL HEALTH

A school health programme is an integrated set of planned, sequential, school-affiliated

strategies, activities and services designed to promote the optimal physical, emotional, social and
educational development of students and staff which includes health services, healthful school
environment and health education.

We set off for Ghanaian German School at about 9:00am together with the community health
nurse, Miss Abigail Amponsah. The school is about a ten-minute walk from the community health
centre. When we got there, we met with the school authorities who directed us to the class
teachers of the various classes. We were going to be working with children from the kindergarten
to class three. The class teachers of the kindergarten children organized them and made them
form two rows of lines while coming for growth monitoring and immunization. Each child was
made to stand on the scale when it got to their turn and their weights were recorded in a record
book with their names in it. Those who had their weighing books available had their weights
recorded in their weighing books as well. Most of the children were due for vitamin A and thus it
was administered to them orally and according to age. The children were very cooperative and
responsive.

On the other hand, children from class one to three were organized by their class teachers in
their classrooms for a health talk. We were asked to give them a health talk on cholera and its
prevention. After the health talk, we asked a couple of questions to be sure that they understood
what we talked to them about. They were able to answer all the questions very well and
according to their understanding of what we talked about.

When we were done with all the activities planned for the day we thanked the teachers and
authorities of the school and asked to take our leave. They in turn expressed their gratitude for
always making time to come around to assess the health of the children in the school. We finished
with the school health programme and left the school around 1:00pm.

FAMILY PLANNING

Family planning services are defined as educational, comprehensive medical or social activities
which enable individuals, including adolescents to determine freely the number and spacing of
their children and to select the means by which this may be achieved.

We were directed to the family planning unit by the nurse in-charge of the public health unit
where we met with the nurse in-charge at the family planning unit, Mrs. Georgina Mensah on
17th September, 2018. We introduced ourselves as KNUST students on a public health affiliation
programme and that we were going to be there for one week. She welcomed us to the unit and
had one of the staff nurses orient us. After orientation, we were separated and allocated to the
different sectors of the unit which are registration desk, counselling room, procedure room 1 and
procedure room 2. There was a waiting area for clients as well.

Throughout the week we had the opportunity to engage in activities like checking of vital signs,
counselling of clients, administration of injectables and insertion and removal of implants.

CHECKING OF VITAL SIGNS

At the registration desk, clients who had come to the unit for the first time or those who wanted
to renew their contraceptive plans were first assessed and their vital signs checked. We got the
chance to check the vital signs of patients (especially blood pressure) and also checked their
weights and recorded them in their cards.

COUNSELLING OF CLIENTS

We were given the opportunity as students to participate in counselling of clients. The nurse in-
charge of the unit explained that there is the need to use the steps of REDI in order to achieve
successful counselling.

R- RAPPORT BUILDING

Clients who came to the unit were welcomed and offered seats. All counselling activities were
carried out on a one-on-one basis and away from crowd or hearing distance of other parties. The
clients were then asked the purpose of their visit and what they have in mind.

E- EXPLORATION

After the client has stated what they had in mind, the nurse would now add up to what they
know by explaining the method of action of the various family planning methods, their side
effects and contraindications.

D- DECISION MAKING

The client after listening and understanding all about the various methods will now make her
decision on which method she preferred.
I-IMPLEMENTATION

After making the decision, the nurse will ask her to confirm if that was her final decision. After
giving her confirmation, the nurse would arrange for the decision taken by the client to be
implemented.

ADMINISTRATION OF INJECTABLES

There are two kinds of hormonal injections as we learnt at the unit namely norigynon and depo
provera. Norigynon is an oil while depo provera is a suspension. They can both be administered
on the upper arm but because of the pain and numbness associated with norigynon, it is usually
administered on the buttocks. Norigynon is administered every month while depo provera has a
three-month interval. They are both administered at an angle of 90 o. We were made to
administer both norigynon and depo provera to clients under supervision.

INSERTION AND REMOVAL OF IMPLANTS

There were two kinds of implants that we got to work with at the unit. They are Jadelle and
Implanon. Jadelle lasts for five years and consists of two rods. Implanon on the other hand is valid
for three years and consists of just a rod which comes in its applicator. Before insertion, the client
is given lidocaine (1ml for implanon and 2mls for Jadelle) as a local anaesthetic. After about two
minutes when the client does not feel any pain at the site (inner arm), the implant is inserted.
Implanon comes with its own applicator while Jadelle rods are inserted with a trocar. For
removal, the client again is given lidocaine as a local anaesthetic. After anaesthesia is obtained,
a small incision is made at the site of insertion and using a curved arterial forcep the rod(s) are
removed. They are then shown to the client for her to confirm removal. We participated in the
insertion and removal of implants all under supervision.
 REPRODUCTIVE AND CHILD HEALTH (CHILD WELFARE CLINIC)

Reproductive and child health is extended maternal child health of family welfare or safe
motherhood or child survival and safe motherhood programme. The activities undertaken at the
child welfare clinic are immunization, growth monitoring, registration and counselling.

IMMUNIZATION
We observed how the nurses administered the vaccines to the children that is the route of
administration and dosage of each vaccine given. We also observed that they always cross
checked the weighing cards or books to confirm the date of birth, age and vaccines for which the
child was due. We had the opportunity to give some vaccines like measles, meningitis and tetanus
(injectables) and also vitamin A (oral) all under supervision. We also tallied the vaccines given in
the immunization tally book.
AGE VACCINE DOSAGE ROUTE AND SITE
OF
ADMINISTRATION
At birth BCG 0.05ml Intradermal, right
upper arm
OPV 0 2 drops Oral
6 weeks OPV 1 2 drops Oral
DPT-HebB-Hib 0.5ml Intramuscular,
1 left thigh
Pneumococcal 0.5ml Intramuscular,
1 right thigh
Rotavirus 1 1.5ml Oral
10 weeks OPV 2 2 drops Oral
DPT-HebB-Hib 0.5ml Intramuscular,
2 left thigh
Pneumococcal 0.5ml Intramuscular,
2 right thigh
Rotavirus 2 1.5ml Oral
14 weeks OPV 3 2 drops Oral
DPT-HebB-Hib 0.5ml Intramuscular,
3 left thigh
Pneumococcal 0.5ml Intramuscular,
3 right thigh
IPV 0.5ml Intramuscular,
right thigh (2.5cm
away from PCV
site)
6 months Vitamin A 100,000 IU Oral
 9 months Measles 0.5ml Subcutaneous,
1,rubella left upper arm
Yellow fever 0.5ml Subcutaneous,
right upper arm
12 months Vitamin A 200,000 IU Oral
18 months Measles 2 0.5ml Subcutaneous,
left upper arm
Meningitis A 0.5ml Subcutaneous,
right upper arm
Vitamin A 200,000 IU Oral
ITN One

GROWTH MONITORING
At the growth monitoring station, the nurse taught us the necessity of adjusting the weighing
scale to the observer’s eye level so as to read the scale accurately. We were also taught how to
record and plot weights in the weighing book or card as well as tallying according to the sex and
age of the child. She also taught us how to position the child’s hands in the weighing pants before
hanging them on the scale. She told us to always adjust the scale to the ‘zero’ mark before
weighing each child for precision and accuracy of readings. We were made to weigh some of the
children and record weights in the weighing books or cards. We also did some tallying in the tally
book under the supervision of the nurse.

REGISTRATION
At the registration table, we were shown the various register books into which the records of all
the children who attended the child welfare clinic were entered. We were informed that the
register books were according to age or stages of development that is from 0-11, 12-23 and 24-
59 months. The weights and vaccines administered to each child were recorded in the register
book as well as other details of the child found in the weighing book. We were taught also that
when a child moved from one stage of development to another, all his records were migrated
into another register book for his or her current age. Also, mothers whose children were
underweight were directed to the dietician for counselling.

CHAPTER FOUR
LESSONS LEARNT
HOME VISIT
With the help of the community health nurse, we learnt how to plan for and conduct a home
visit. We also learnt how to make observations in the homes of clients. We learnt how to counsel
and educate clients on identified health needs or problems. We learnt how to identify health
problems by observation and questioning.

SCHOOL HEALTH
We learnt about activities and processes involved in organizing a school health programme. We
learnt the importance of planning a health talk or education for a school health programme. We
also learnt that knowing the profile of the audience for a health education for a school health
programme helps in the delivery of a good health talk.

FAMILY PLANNING
We learnt at the family planning unit about the various methods of contraception and how they
all work to prevent pregnancy. We learnt that norigynon (hormonal injection) is administered on
the buttocks instead of the upper arm because of the pain associated with it. We also learnt how
to insert and remove implants. We learnt that certain factors like high blood pressure can restrict
the choice of clients on the method of contraception they may prefer. We also learnt how to
apply the steps of REDI in counselling clients on contraception.

REPRODUCTIVE AND CHILD HEALTH

We learnt that some of the vaccines like Meningitis (right upper arm), Pneumococcal (right upper
thigh) and Diphtheria, Pertussis, Tetanus, Hepatitis B and Haemophilia Influenza type B (left
upper thigh) are given at an angle of ninety degrees (90o ). Others like Measles (left upper arm)
and Yellow Fever (right upper arm) are given at an angle of fourty-five degrees (45o ). We also
learnt about the new vaccines that were now given together with previous ones. At growth
monitoring, we learnt certain techniques of weighing and how to record and plot weights as well
as tallying in the tally book. At the registration desk, we learnt about the need to direct mothers
whose children were underweight and overweight to the dietician for counselling so as to correct
certain misconceptions mothers have about feeding and weight loss or gain.

CHAPTER FIVE

CONCLUSION AND RECOMMENDATIONS

Public Health Affiliation reveals the components and activities involved in administering
affordable health services to the general public with particular focus on the have-nots. It draws
its import in the consideration that everyone should have access to basic health services and by
extension a healthier life.

The hospital authorities should see to it that sufficient seats are provided for the mothers to
prevent them from standing with their children and to prevent overcrowding of the units. Also,
arrangements can be made for more nurses to be involved in the immunizations and growth
monitoring. This will prevent the mothers from standing or sitting in long queues waiting for their
turn to be attended to.

Logistics should be provided for mobility of the Community Health Officer to also perform home
visits thereby administering preventive measures to the residents. This will reduce in-patient
cases drastically.

The Community as well as the District Health Planning Office should help provide or advocate for
the provision of infrastructural support especially electricity at the Community Based Health
Planning Services (CHPs) compound. This will improve storage and availability of vaccines which
require a refrigeration.

Community members should be adequately sensitized on the best suitable family planning
methods to adopt in order for its application to be achieved.

Throughout the exercise, we have developed adequate skills pertaining to the various
components of public health practice.

To God be the glory.

NAME INDEX NUMBER
ADDAI, Ewurama 4185515
KONADU, Yiadom Pokua 4188315
OWUSU ACHIAW, Juliet 9574617
ASANGANSI, Eno-Abasi 4186815
NSOWAAH SEKYERE, Diana 4204315