Highlights
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Majority of health care workers reported moderate perceived HIV risk at work.
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Perceived availability of post-exposure prophylaxis was associated with perceived risk of occupational exposure to HIV.
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Perceived social support predicted perceived risk of occupational exposure to HIV.
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Health care workers with less experience were more likely to perceive higher risk of occupational exposure to HIV.
Keywords: Health care workers, HIV, Occupational exposure, Perceived risk, Ghana, District hospitals
Abstract
Objectives
This study examined the perceived risk of occupational exposure to HIV and correlates among health care workers (HCWs) in district hospitals in the Greater Accra Region.
Methods
A cross-sectional study was conducted among 2006 HCWs at district hospitals in the Greater Accra Region of Ghana from February to May, 2025. Data were collected using a pre-tested questionnaire and analyzed with SPSS (version 22). Descriptive statistics, chi-square tests, and multinomial logistic regression were used to analyze data.
Results
Most HCWs perceived themselves at moderate risk of occupational exposure to HIV (69.9%). HCWs reporting moderate social support for post-exposure prophylaxis had higher odds of perceiving moderate risk (adjusted odds ratio [AOR] = 1.49, 95% confidence interval [CI]: 1.08-2.04, P = 0.015). HCWs with 1-5 years (AOR = 2.09, 95% CI: 1.09-4.01, P = 0.027), 6-10 years (AOR = 2.06, 95% CI: 1.08-3.91, P = 0.028), and 11-15 years (AOR = 2.65, 95% CI: 1.36-5.17, P = 0.004) of experience were more likely to report moderate risk of HIV.
Conclusion
Most of the HCWs at the district hospitals in the region perceived themselves at moderate risk of occupational exposure to HIV. Strengthening protective resources and addressing workers’ perceptions can enhance safety, well-being, and resilience within Ghana’s health system.
Introduction
Worldwide, HIV remains a major public health problem. Despite significant progress in prevention and treatment, approximately 40.8 million people were living with HIV in 2024, and about 1.3 million new infections occurred that year [1]. Sub-Saharan Africa, for instance, accounted for two-thirds of all new HIV infections worldwide in 2024 [2]. This high burden makes health care settings in Africa particularly vulnerable to occupational exposures to HIV, with global estimates indicating three million such incidents annually, resulting in approximately 2% HIV seroconversions among exposed workers [3]. In Africa, the prevalence of occupational exposures to HIV is particularly high, partly due to overcrowded facilities, inadequate protective equipment, and inadequate training on infection prevention and control [4]. In sub-Saharan Africa, where HIV prevalence is highest, health care workers (HCWs) experience up to 4.7 needle-stick injuries per HCW per year, often due to inadequate safety protocols and high patient loads [5]. Post-exposure prophylaxis (PEP) availability has reduced transmission risks, yet underreporting persists, with only 22-49% of injuries reported across African settings [4].
Despite established global and regional data, evidence on HCWs perceived risk of occupational exposure to HIV remains limited in Ghana and similar resource-constrained settings [6]. Few studies have examined associated factors, such as social support for PEP, perceived PEP availability, or cadre-specific differences among district hospital workers, creating gaps in targeted intervention design [7]. Local perceptions may influence reporting behaviors and PEP uptake more than objective risks, yet Ghana-specific data on these associations are scarce [8].
This study investigated the perceived risk of occupational exposure to HIV and associated factors among HCWs at district hospitals in the Greater Accra Region of Ghana. By analyzing data from 2006 HCWs, we aimed to identify modifiable barriers to risk perception and inform tailored occupational safety programs. Ultimately, these findings will guide policy formulation to enhance HCW protection and PEP use in Ghanaian public health facilities.
Methods
Study design and setting
The study adopted a cross-sectional design. The study was conducted in the Greater Accra Region of Ghana, which is the smallest yet most densely populated region in the country. It serves as the administrative and economic hub of Ghana, with Accra as its capital. Due to its urban nature, the region has the highest number of persons living with HIV as well as the highest concentration of HCWs compared with other regions in Ghana.
Participants
Study participants were HCWs: medical doctors, nurses, midwives, and laboratory technicians from all 10 district hospitals in the Greater Accra Region of Ghana. Participants were eligible to participate in the study if they were permanent employees, had worked for at least 1 year, and expressed willingness to participate in the study. Census sampling method was used to select the study sites and the participants. All 10 district hospitals in the Greater Accra Region were selected for the study. Participants were approached primarily through face-to-face interactions within their respective health facilities and invited to participate in the study.
Variables
Sociodemographic factors encompass the basic social and demographic characteristics of HCWs that may influence their perceptions and behaviors within the workplace. Knowledge of HIV PEP reflects the level of understanding HCWs have regarding its use, timing, procedures, and effectiveness after potential exposure to HIV. Perceived social support for PEP describes the extent to which HCWs expect to receive emotional, informational, and practical support from colleagues and supervisors regarding PEP use. Perceived availability of PEP refers to HCWs’ perception of the accessibility and availability of PEP services and medications within their health facility. Perceived risk of occupational exposure to HIV represents HCWs’ subjective assessment of their likelihood of being exposed to HIV in the course of their professional duties.
Pre-testing of the questionnaire was conducted at the Dansoman Polyclinic, a facility which provides similar health services as the district hospitals. Data collection was done primarily using Google form and paper questionnaires which were administered individually to participants who consented to participate in the study. Completed questionnaires were submitted in hard copies and the through the Google form platform.
Data sources and measurements
A pre-tested questionnaire was used to collect data from February to May, 2025. Perceived risk of occupational exposure to HIV was measured with the perceived risk of HIV scale (PRHS) [9]. The eight-item PRHS was primarily developed to assess how people think and feel about their risk of HIV infection based on their sexual behaviors. However, the measure could be adapted for studies examining whether risk perception predicts the use of PEP [9]. The scale examined three distinct dimensions of perceived HIV risk: cognitive, which encompasses a response range from “zero” to “very large”; intuitive, which has response range from “strongly disagree” to “strongly agree”; and salience, with response options ranging from “never thought about” to “thought about often.” The format of the response varies across items, with options ranging from four to six, depending on the specific item. The total score on the scale ranged from 10 to 40 and categorized as low risk (10-20 points), moderate risk (21-30 points), and high risk (31-40 points) [9]. The PRHS had a Cronbach’s α reliability of 0.667.
The knowledge questionnaire was adapted from Tshering et al. [9] and comprised seven items which assessed knowledge of PEP indications, appropriate first aid after exposure, the optimal initiation timeline, duration of therapy, effectiveness, the recommended administration window, and first-line antiretroviral drugs used for PEP. Item 1 had two correct responses out of three options, whereas item 7 had three correct responses out of four options. Each correct response was awarded a score of 1, whereas incorrect responses were scored 0, producing a total score ranging from 0 to 10. Knowledge levels were categorized as poor (<50%, three or less correct responses), fair (50-74%, four to five correct responses), and good (≥75%, six or more correct responses) [10]. The internal consistency of the scale was acceptable, with a Cronbach’s α of 0.712.
Perceived availability of PEP services was assessed using the availability dimension of the perceived health access questionnaire validated by Hoseini-Esfidarjani et al. [11]. The three-item scale demonstrated acceptable reliability (Cronbach’s α = 0.738) with scores categorized as low (0-4 points), moderate (5-8 points), and high (9-12 points). Perceived social support was measured with the three-item Oslo social support scale standardized by Kocalevent et al. [12]. The scale has a Cronbach’s α of 0.69, with a total score ranging from 3-14 and categorized as poor support (3-8 points), moderate support (9-11 points), and strong support (12-14 points) [12].
Bias
Efforts were made to minimize potential sources of bias in this study. Selection bias was reduced through the use of census approach and clearly defined inclusion criteria. Information bias was minimized by using a structured and pre-tested questionnaire to ensure consistency in data collection. To limit social desirability bias, respondents were assured of anonymity and confidentiality and participation was voluntary.
Data analysis
Data were first exported from MS Excel to IBM SPSS software version 22.0 and carefully checked for accuracy, completeness, and consistency before analysis. Missing quantitative data were replaced with the series mean, and categorical data were replaced with simple imputation with the most common category. Descriptive statistics, chi-square analysis, and multinomial logistic regression were used in analyzing the data. Variables were selected using a combination of statistical and theoretical approaches. First, bivariate chi-square analyses were conducted, and variables with a P <0.05 were considered for inclusion in the multivariable model. In addition, variables identified in previous studies as important predictors were included regardless of their statistical significance at the bivariate level. A significant level of 0.05 was used for all statistical tests. Missing data were handled using the direct imputation method. For variables with missing values, appropriate summary measures were used to replace missing entries; specifically, the mean was used for continuous variables, whereas the mode was applied for categorical variables.
Results
The results of this study were based on responses of 2006 participants, equivalent to a 78.3% response rate. Heavy workload was the main reason for the non-response.
Sociodemographic characteristics of participants
Of the 2006 respondents, the majority were female (78.0%; n = 1564). Most participants were aged between 31 and 40 years (59.3%; n = 1189) and more than half (51.5%; n = 1033) were married. The majority of HCWs were nurses (63.6%; n = 1276), whereas doctors accounted for only 4.2% (n = 84). The most common qualification was a diploma (46.4%; n = 930), whereas only 16.4% (n = 328) held a Masters or PhD degree. The majority (50.7%; n = 1017) had worked for 1-5 years (Table 1).
Table 1.
Background characteristics and factors associated with perceived risk of HIV among HCWs.
| Variable | No. (%) (N = 2006) |
Perceived risk of HIV |
χ2 (P-value) | ||
|---|---|---|---|---|---|
| High N (%) |
Moderate N (%) |
Low N (%) |
|||
| Sex | 0.602 (P = 0.740) | ||||
| Female | 1564 (78.0) | 214 (15.1) | 1100 (69.1) | 250 (15.7) | |
| Male | 442 (22.0) | 66 (14.9) | 303 (68.6) | 73 (16.5) | |
| Age | 4.727 (P = 0.579) | ||||
| 20-30 years | 695 (34.6) | 94 (13.5) | 477 (68.6) | 124 (17.8) | |
| 31-40 years | 1189 (59.3) | 169 (14.2) | 844 (71.0) | 176 (14.8) | |
| 41-50 years | 111 (5.5) | 15 (13.5) | 76 (68.5) | 20 (18.0) | |
| 51-60 years | 11 (0.6) | 2 (18.2) | 6 (54.5) | 3 (27.3) | |
| Marital status | 0.901 (P = 0.637) | ||||
| Married | 1033 (51.5) | 141 (13.7) | 732 (70.9) | 160 (15.5) | |
| Single | 973 (48.5) | 139 (14.3) | 671 (68.9) | 163 (16.7) | |
| Cadre of HCW | 6.467 (P = 0.373) | ||||
| Doctor | 84 (4.2) | 15 (17.9) | 50 (59.5) | 19 (22.6) | |
| Laboratory technician | 135 (6.7) | 16 (11.9) | 96 (71.1) | 23 (17.0) | |
| Midwife | 511 (25.5) | 65 (12.7) | 369 (72.2) | 77 (15.1) | |
| Nurse | 1276 (63.6) | 184 (14.4) | 888 (69.6) | 204 (16.0) | |
| Qualification | 0.371 (P = 0.985) | ||||
| Diploma | 930 (46.4) | 127 (13.7) | 653 (70.2) | 150 (16.1) | |
| Degree | 748 (37.2) | 108 (14.4) | 518 (69.3) | 122 (16.3) | |
| Masters/PhD | 328 (16.4) | 45 (13.7) | 232 (70.7) | 51 (15.5) | |
| Work experience | 12.304 (P = 0.056)a | ||||
| 1-5 years | 1017 (50.7) | 145 (14.3) | 703 (69.1) | 169 (16.6) | |
| 6-10 years | 563 (28.1) | 73 (13.0) | 400 (71.0) | 90 (16.0) | |
| 11-15 years | 329 (16.4) | 48 (14.6) | 242 (73.6) | 39 (11.9) | |
| 16-20 years | 97 (4.8) | 14 (14.4) | 58 (59.8) | 25 (25.8) | |
| PEP knowledge | 4.222 (P = 0.377) | ||||
| Poor | 74 (3.7) | 8 (10.8) | 51 (68.9) | 15 (20.3) | |
| Fair | 662 (33.0) | 88 (13.3) | 456 (68.9) | 118 (17.8) | |
| Good | 1270 (63.3) | 184 (14.5) | 896 (70.6) | 190 (15.0) | |
| Perceived social support for PEP | 10.458 (P = 0.033)b | ||||
| Poor | 599 (29.9) | 84 (14.0) | 413 (68.9) | 102 (17.0) | |
| Moderate | 1006 (50.1) | 131 (13.0) | 732 (72.8) | 143 (14.2) | |
| Strong | 401 (20.0) | 65 (16.2) | 258 (64.3) | 78 (19.5) | |
| Perceived availability of PEP | 18.224 (P = 0.001)b | ||||
| Low | 91 (4.6) | 10 (11.0) | 58 (63.7) | 23 (25.3) | |
| Moderate | 554 (27.6) | 58 (10.5) | 419 (75.6) | 77 (13.9) | |
| High | 1361 (67.8) | 212 (15.6) | 926 (68.0) | 223 (16.4) | |
HCW, health care worker; PEP, post-exposure prophylaxis.
Borderline significance
significant at P <0.05.
Knowledge of PEP, perceived social support, and availability of PEP among HCWs
Most HCWs demonstrated good knowledge of PEP (63.3%), with fewer reporting fair (33.0%) or poor knowledge (3.7%). Perceived social support for PEP use was predominantly moderate (50.1%), whereas perceived availability of PEP services was generally high (67.8%) (Table 1).
Perceived risk of occupational exposure to HIV among HCWs
The mean (SD) perceived risk score was 25.20 (4.93). The majority of HCWs reported moderate perceived risk (69.9%), whereas 14.0% reported high perceived risk, respectively (Table 1).
Factors associated with perceived risk of occupational exposure to HIV
Perceived social support for PEP (P = 0.033) and perceived availability of PEP (P = 0.001) were associated with perceived risk of HIV from occupational exposure. No statistically significant association was observed between years of work experience and perceived risk (P = 0.056), although a trend was noted (Table 1).
Predictors of perceived risk of occupational exposure to HIV among HCWs
Compared with HCWs who had 16-20 years of experience, those with 1-5 years (adjusted odds ratio [AOR] = 2.09, 95% confidence interval [CI] = 0.76-4.43, P = 0.027), 6-10 years (AOR = 2.06, 95% CI = 0.66-3.78, P = 0.028), and 11-15 years (AOR = 2.65, 95% CI = 0.89-5.25, P = 0.004) were significantly more likely to perceive themselves at moderate risk of occupational exposure to HIV.
Those HCWs reporting moderate support had higher odds of perceiving moderate risk relative to those with strong support (AOR = 1.49, 95% CI = 1.08-2.04, P = 0.015). Other variables, including sex, age, marital status, cadre, qualification, knowledge of PEP, and perceived availability of PEP were not significant predictors of perceived risk of HIV in this model (Table 2).
Table 2.
Predictors of perceived risk of HIV among HCWs.
| Variable | Perceived risk of HIV |
|
|---|---|---|
| Moderate risk vs low risk | High risk vs low risk | |
| AOR (95% CI), P-value | AOR (95% CI), P-value | |
| Sex | ||
| Female | 0.94 (0.67-1.32), P = 0.731 | 0.88 (0.56-1.36), P = 0.559 |
| Male | 1.00 | 1.00 |
| Age | ||
| 20-30 years | 0.80 (0.42-1.56), P = 0.518 | 0.80 (0.34-1.91), P = 0.618 |
| 31-40 years | 0.94 (0.51-1.74), P = 0.850 | 1.01 (0.45-2.25), P = 0.987 |
| 41-50 years | 1.00 | 1.00 |
| Marital status | ||
| Married | 1.07 (0.81-1.40), P = 0.643 | 0.98 (0.69-1.40), P = 0.914 |
| Single | 1.00 | 1.00 |
| Cadre of HCW | ||
| Doctor | 0.58 (0.32-1.06), P = 0.076 | 0.81 (0.38-1.75), P = 0.597 |
| Laboratory technician | 1.00 (0.59-1.72), P = 0.987 | 0.80 (0.38-1.66), P = 0.543 |
| Midwife | 1.09 (0.80-1.48), P = 0.584 | 0.96 (0.64-1.43), P = 0.823 |
| Nurse | 1.00 | 1.00 |
| Qualification | ||
| Diploma vs | 0.97 (0.72-1.30), P = 0.823 | 0.90 (0.61-1.33), P = 0.600 |
| Masters/PhD | 1.10 (0.76-1.59), P = 0.620 | 0.98 (0.60-1.59), P = 0.938 |
| Degree | 1.00 | 1.00 |
| Work experience | ||
| 1-5 years | 2.09 (1.09-4.01), P = 0.027a | 1.84 (0.76-4.43), P = 0.177 |
| 6-10 years | 2.06 (1.08-3.91), P = 0.028a | 1.58 (0.66-3.78), P = 0.302 |
| 11-15 years | 2.65 (1.36-5.17), P = 0.004a | 2.16 (0.89-5.25), P = 0.090 |
| 16-20 years | 1.00 | 1.00 |
| PEP knowledge | ||
| Average | 1.24 (0.67-2.31), P = 0.495 | 1.39 (0.56-3.45), P = 0.480 |
| Good | 1.54 (0.84-2.83), P = 0.166 | 1.76 (0.72-4.31), P = 0.215 |
| Poor | 1.00 | 1.00 |
| Perceived social support | ||
| Poor | 1.19 (0.84-1.69), P = 0.333 | 1.11 (0.70-1.75), P = 0.660 |
| Moderate | 1.49 (1.08-2.04), P = 0.015a | 1.13 (0.75-1.71), P = 0.566 |
| Strong | 1.00 | 1.00 |
| Perceived PEP availability | ||
| Low | 0.64 (0.38-1.08), P = 0.093 | 0.46 (0.21-1.01), P = 0.053 |
| Moderate | 1.34 (1.00-1.81), P = 0.051 | 0.81 (0.54-1.22), P = 0.312 |
| High | 1.00 | 1.00 |
AOR, adjusted odds ratio; CI, confidence interval; HCW, health care worker; PEP, post-exposure prophylaxis.
Significant at P <0.05.
Discussion
This study found that majority of HCWs had moderate perceived risk of occupational exposure to HIV. The study also found that perceived social support predicted perceived risk of occupational exposure to HIV when comparing moderate to low risk. HCWs reporting moderate support were more likely to perceive moderate risk. The study also found that work experience predicted perceived risk of occupational exposure to HIV, such that HCWs with less work experience were more likely to perceive moderate risk as opposed to HCWs with more experience.
The finding that majority of HCWs moderately perceived themselves to be at risk of occupational exposure to HIV suggests that majority recognize that there is a real risk of HIV acquisition in their work environment, but they do not perceive it as extremely high or negligible. This indicates that basic knowledge of occupational risk exists, but the perceived threat may not be strong enough to consistently drive optimal preventive behaviors in all situations. The availability and use of standard precautions, including personal protective equipment and PEP, may contribute to a reduced sense of vulnerability among HCWs. When such measures are perceived to be effective and accessible, HCWs may consider themselves protected, thereby maintaining a moderate rather than high perception of risk [13].
Importantly, evidence from across sub-Saharan Africa indicates that HCWs face substantial occupational exposure to blood and body fluids, which provides context for these perceptions. A systematic review conducted across 21 African countries reported high prevalence of occupational exposure, particularly, due to needle-stick injuries and gaps in infection prevention training [14]. Similarly, studies in Ethiopia and Tanzania have identified lack of training, unsafe practices, and limited access to PEP as key predictors of occupational exposure among HCWs [15,16]. These findings provide an indication that the risk of occupational exposure is real and shaped by systemic and behavioral factors within health care settings. In this context, the moderate risk perception observed in the present study may reflect HCWs’ awareness of these underlying workplace hazards while recognizing the protective role of available preventive measures.
In addition, work experience has been found to shape risk perception. HCWs with longer years of service may develop familiarity and confidence in handling occupational hazards, which can reduce the perceived severity or likelihood of acquisition [13,17]. This finding aligns with patterns observed across sub-Saharan Africa, where HCWs typically exhibit moderate-to-high risk perception despite low actual transmission rates (0.3%) [18]. In Nigeria, 96.5% of HCWs reported moderate-to-high perceived risk, attributed to heightened community HIV prevalence juxtaposed against resource constraints [19]. Similarly, Tanzanian HCWs described occupational HIV exposure as a persistent but manageable threat, moderated by PEP policies implemented since 2005 [20].
The finding that perceived social support predicted perceived risk of occupational exposure to HIV indicates that psychosocial factors play an important role in shaping how HCWs perceive their risk of HIV acquisition. This observation suggests that HCWs who feel supported by colleagues, supervisors, or the health system may perceive their risk differently. Strong social support can enhance confidence, reduce anxiety, and promote a sense of shared responsibility in managing occupational hazards [21,22]. Evidence from Southern Africa highlights the role of institutional and social environments in shaping HCWs perceptions related to HIV risk. For instance, HCWs in South Africa reported concerns about stigma, confidentiality, and workplace dynamics influencing their engagement with HIV testing and prevention services [23]. This finding underscores the importance of supportive workplace environments in shaping perceived and actual responses to occupational HIV risk.
The present finding is also consistent with evidence from Nigeria where perceived organizational support was linked to higher confidence in managing HIV exposure [19] and from Ethiopia where PEP access and supportive environments were shown to influence use and risk perception [24]. Similarly, evidence from South Africa, Zimbabwe, Kenya, and Eswatini indicates that social support systems, particularly, peer relationships, and stigma at the workplace influence HCWs’ perception of HIV risk [9,25]. However, variations exist across contexts, with some studies reporting persistently high risk perception, irrespective of social support [19].
The finding that HCWs with less work experience were more likely to report higher risk of occupational exposure to HIV may probably be due to limited practical exposure, lower confidence in handling occupational hazards, and fear of accidental exposure [14,19,20]. In contrast, HCWs with longer experience may have developed greater familiarity, competence, and confidence in infection prevention practices, which could reduce their perceived vulnerability [20,26]. The present finding is consistent with previous studies conducted in Africa. A study in Ethiopia found that HCWs with less than 5 years of experience were significantly more at risk of needle-stick and sharp injuries than those with longer experience, indicating higher vulnerability among less experienced staff [27]. Similarly, a West African study of international HCWs reported significant association between risk perception and work experience [28]. The finding also aligns with broader evidence showing that occupational exposure is often higher among less experienced HCWs, particularly, in settings with inadequate training and supervision [15].
Some studies, however, present contrasting evidence. For instance, a study in Malawi found no association between work experience and risk perception at the workplace [29]. In addition, a study in Northern Nigeria among HCWs in public health facilities found no association between HIV risk perception and years of work experience [30]. Overall, although some studies report no significant association, the preponderance of evidence suggests that work experience plays an important role in shaping HCWs’ risk perception and vulnerability to occupational exposure.
Strength and limitations
This study has several important strengths. First, it used a large sample drawn from all district hospitals in the Greater Accra Region, which enhances the representativeness of the findings. In addition, to the best of our knowledge, this study is among the first to examine HIV risk perception among HCWs at the primary health care level in the country. Furthermore, the use of a census sampling approach further reduces selection bias and increases confidence that the results reflect the characteristics of HCWs within the study setting. Despite these strengths, some limitations should be acknowledged. The use of self-reported data may introduce social desirability bias. Nonetheless, the anonymous nature of the questionnaire likely minimized this bias. Furthermore, the study did not account for potential confounding variables. However, this limitation may not have substantially altered the main findings because the study primarily identified consistent associations between key variables, such as social support, work experience, and perceived risk of HIV acquisition. These relationships are also supported by existing literature, suggesting that the observed patterns are plausible.
Public health implications
The findings of this study point to the need for targeted interventions aimed at reducing occupational HIV risk and improving risk perception accuracy among HCWs. The association between lower work experience and higher perceived risk suggests that younger or less experienced HCWs should be prioritized in training programs on universal precautions and occupational safety. The role of social support further implies that public health strategies should not only focus on individual knowledge but also on improving the work environment. Policies should promote institutional support systems, such as regular training, accessible personal protective equipment, PEP awareness, and supportive reporting systems for occupational exposure.
Conclusion
This study examined the perceived risk of HIV acquisition and associated factors among HCWs. The findings revealed that most HCWs perceived a moderate risk of HIV acquisition from occupational exposure. Perceived social support and work experience significantly predicted perceived risk of HIV acquisition from occupational exposures. These findings highlight the importance of strengthening workplace support systems and continuous training, particularly, for less experienced HCWs, to improve occupational safety and risk awareness.
Declaration of competing interest
The authors have no conflicting interest to declare.
Acknowledgments
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical approval and consent to participate
Ethical approval was obtained from the Ghana Health Service Ethics Review Committee (GHS-ERC: 006/10/24). Participants signed informed consent forms to indicate their voluntary participation in the study.
Acknowledgment
We acknowledge the District Directors of Health Services, the Medical Superintendents, and the relevant unit heads of the district hospitals in the Greater Accra Region for granting us access to their facilities for the study.
Author contributions
Conceptualization: PKS, TH. Data collection: PKS, TH, JOS. Result analysis and presentation: PKS, TH, MA. Writing of original draft PKS. All authors contributed to the review and editing of manuscript and approved the final draft.
Consent for publication
Not applicable.
Availability of data
The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Contributor Information
Promise Kwame Salu, Email: promise.salu@stu.ucc.edu.gh.
Mustapha Amoadu, Email: mustapha.amoadu@ucc.edu.gh.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.