Periodic Medical Checkup among Health Workers at a Teaching Hospital in Ghana

General Objectives

The general objective of this study is to assess the practice of routine medical checkup amongst doctors, nurses and Medical Laboratory Scientists (MLS) in the Tamale Metropolis. Specific Objectives

• To determine the proportion of nurses doctors and MLS who practice routine medical checkups.
• To assess their perceptions and reasons for or not practicing routine medical checkups.

Demographics

Age was captured as a categorical variable, ranging from 20-30, 31-40, 41-50 and 51-60yrs. Majority of the participants, 67.3% were between the ages of 20-30yrs, and the least represented age range was 51-60, with only 0.3% of the participants. 65.7% of the participants were males, whilst the remaining 34.3% were females. Majority of the respondents, 56.0% were single, 43.7% were married, whilst 0.3% had lost their partners. The predominant religion was Christianity, making up 55.7%, Islam had 43.3% whilst the African traditional religion and agnostic beliefs made up the remaining percentage (Tables 1-24). Majority of the participants were nurses, comprising 58.3% of the respondents, medical doctors made up 27.7%, whilst the MLS 14.0%. The figures are displayed in Table 1 below.

Source: field work, 2021. Table 1: Participants Demographic Information.

The first objective of the study was to assess the knowledge level of health personnel with regard to RME. To assess this, various questions were asked related to RME, the first of which was the definition of RME which was defined as the process of assessing and individuals’ state of health so as to detect, treat and prevent illness. Various options were provided which ranges from strongly agree to strongly disagree. The responses of the participants are illustrated in the Table 2 below.

Source: Field work, 2021 Table 2: Definition of RME.

The table above illustrates the responses of participants with regard to the definition of RME. 53.3% of the participants strongly agreed with the definition RME provided, 42.3% agreed, 0.3% were neutral, 0.7 disagreed, whilst 3.3% strongly disagreed.

Next on the list of questions to assess level of knowledge was the question “RME is important for asymptomatic adults”. 126 representing 42% of the participants strongly agreed that RME is important for asymptomatic adults. 49.3% agreed, 2.3% were not sure, another 2.3% disagreed, whilst 4% strongly disagreed that RME is important for asymptomatic adults. The results are further tabulated below.

Source: field work 2021. Table 3: Responses on whether RME is important for asymptomatic adults.

The next question asked to assess the knowledge level of respondents was “periodic medical examination helps to establish a health baseline”. 43.0% strongly agreed, 51.5% agreed, 0.7% were not sure, another 0.7% disagreed, whilst 3.3 strongly disagreed that RME helps to establish a health baseline. The responses provided by the respondents are tabulated below.

Source: field work 2021. Table 4: Responses on whether RME helps to establish a health baseline.

The next question asked to assess the level knowledge on RME was whether examination should involve as assessment of one’s entire body’s system. 155 participants representing 51.7% strongly agreed that health examination should involve an assessment of the entire body system. 131 participants constituting 43.7% agreed, 2 respondents representing 0.7% disagreed, whilst 12 respondents representing 4% strongly disagreed. The figures are tabulated below.

Source: field work 2021. Table 5: Responses on assessment of entire body’s system.

When asked whether females above 30yrs should a cervical smear and males above 40yrs should have a PSA done annually, 38.3% strongly agreed, 50.0% agreed, 7.0% were not sure, 1.7% disagreed whilst 2.7% strongly disagreed. The results are further tabulated below.

Source: field work, 2021. Table 6: Responses on annual cervical smear by females and PSA by males.

Assessment on level of knowledge continues with the next question asking respondents whether early detection of diseases such as diabetes and hypertension helps to prevent complications. 190 respondents constituting 63.3% strongly agrees that, early detection of diseases helps to prevent complications.30.7% agrees, 0.7% were neutral and not sure, 0.3% disagrees, whilst 4.3% strongly disagrees. The results are tabulated below.

Source: fieldwork, 2021. Table 7: Early Detection of Diseases Prevents Complications.

Respondents were then asked if counselling and health education is an essential component of RME. 135 respondents representing 45.0% strongly agrees, 46.7% agrees, 3.0% were not sure, 1.7% disagrees, whilst 3.3% strongly disagrees. 0.3% did not respond to this question. The figures are displayed below.

Source: fieldwork, 2021. Table 8: Counselling and Health Education Essential in RME.

The next objective of the study was to assess the perception of health personnel with regard to the practice of RME. A number of questions were asked to assess this objective. Participants were first asked if it is necessary to practice RME. Options provided were Yes or No 296 respondents, equivalent to 98.7% responded “Yes”, 1 respondent said “No”, whilst 3 participants did not respond. The results are displayed below.

Source: fieldwork, 2021. Table 9: Is RMC Necessary?.

Participants were then asked to what extent they agree or disagree with the statement that, medical examination is only necessary for people who are sick. Responses of participants are tabulated below.

Source: fieldwork, 2021. Table 10: RME is only necessary for people who are sick.

Participants were then asked their perception on whether RME prevent nosocomial infections among health care workers. 100 participants, representing 33.3% strongly agrees that RME helps to prevent nosocomial infections, 48.7% agrees, 5% were not sure, 9.7% disagrees, whilst 3.0% strongly disagrees. The figures are tabulated below.

Source: fieldwork: 2021. Table 11: RMC Prevents Nosocomial Infections.

To assess the perception on the frequency of RME, participants were asked to what extent they agree with the statement “Medical examination should be done yearly in adults”. 15% of respondents strongly agreed on annual examinations, 55.3% agrees, 12% were not sure, 15.0% disagrees whilst 2.0% strongly disagrees. 2 participants did not respond to this question. The results are further tabulated below.

Next under perception was participants view on whether health check-ups should be covered under the national health insurance system. 29.7% strongly agrees, 50.7% agree 7.3% disagrees whilst 12.3% strongly disagreed. The results are illustrated below.

Source: fieldwork, 2021. Table 13: RMC should be covered by NHIS.

The participants were then asked their views on whether the hospital facility should ensure an annual examination of all its staff. 58.7% strongly agrees that the hospital should ensure an annual examination of its staffs. 35.0% agrees, 1.3% disagrees whilst 5% strongly disagrees. The results are displayed below.

Source: fieldwork, 2021. Table 14: Hospital ensure annual checkup of all staff.

Next on perception was the question, do you support the practice of RME? With the options been yes or no, 99.0% of participants supported the practice of RME, whilst only 1.0% objected to the practice of RME. The figures are displayed below.

Source: fieldwork, 2021. Table 15: Support of RMC.

The final question on perception was to assess the views of participants on which age groups should practice RME with the question, only individuals above the age of 40yrs should practice RME. 3.0% strongly agrees, 2.7% agrees, 2.0% were not sure, 51.3% disagrees whilst 40.0% strongly disagrees that only individuals above 40yrs should practice RME. The figures are tabulated below.

Source: fieldwork, 2021. Table 16: Only Individuals above 40yrs should practice RMC.

The next objective of the study was to assess the practice of RME or periodic medical checkup among health personnel. Respondents were asked various questions to achieve this objective.

The first question on practice was, have you ever undergone an RME? 91.0% of the participants, of which 160 were nurses, 72 doctors and 41MLS, have ever undergone a medical checkup, 7.7% said they have never undergone a medical checkup, whilst 1.3% did not respond to the question. The results are displayed below.

Source: fieldwork, 2021. Table 17: Practice of RMC.

Participants were then asked what type of examination they had undergone. Various responses were provided. 60.3% indicated they have ever undergone a general examination, 13.7% indicated blood pressure checkup, 9.3% went in for visual examination, 3.0% indicated dental examination. 6.3% did not respond to this question, whilst 10.4% indicated other examinations such as cervical screening, viral hepatitis, cholesterol examination. The figures are tabulated below.

Source: fieldwork, 2021. Table 18: Types of Checkups Undergone.

Participants were then asked to indicate when last they had RME. 26.3% indicated they had undergone a medical checkup a year ago, 24.0% a month ago, 6.0% within the last six months, 23.0% could not remember, 18.0% in the last 5yrs, whilst 2.7% did not respond. The figures are displayed in the table below.

Source: fieldwork, 2021. Table 19: When Last RMC was done.

The next question that was asked respondents was why they went for a medical checkup. 58.3% of respondents indicated they underwent a medical checkup for personal reasons. 20.0% for employment reasons, 9.3% for a follow up, 3.3% for travelling purposes 4.3% did not response to this question, 1.7% for educational purposes whilst 2.0% for marriage. The figures are tabulated below.

Source: fieldwork, 2021. Table 20: Reasons why RMC was done.

Next on perception, participants were asked to indicate how often they think individuals should have medical checkups. 9.3% of participants felt individuals should have monthly medical checkups, 56.3% indicated every six months, 28.3% felt medical checkups should be done yearly, 2.3% indicated other periods of time such as when one is sick, when necessary, when exposed to risk factors and so on whilst 2.77% did not respond. The figures are tabulated below.

Source: fieldwork, 2021. Table 21: How often RMC should be conducted.

The next question still under practice of RME was, according to participants, what are the factors that prevents their colleagues from undergoing medical checkups? 15.7% said because they are not sick, 40.3% cited financial constraints, 16.7% cited their colleagues felt medical checkups are not necessary, 24.7% indicated time constraints, whilst 2.6% indicated other factors as breach in confidentiality, lack of privacy, medical doctors not willing to conduct examinations and so on. Results are displayed below.

Source: fieldwork, 2021. Table 22: What Inhibits the Practice of RMC?.

Participants were then asked whether they will encourage their colleague health workers to undergo medical checkups. 99.0% said yes, 0.3% said no, whilst 0.7% did not respond. Figures displayed below.

Source: fieldwork, 2021. Table 23: Will you Encourage the Practice of RMC?.

The final question on practice, which also doubles as the final question of the study was, do you conduct monthly breast self-examination? 17.3% of respondents said yes, 56.7% said no, 20.7% said not regularly, whilst 5.3% did not respond. The figures are tabulated below.

Source: fieldwork, 2021. Table 24: Do you conduct monthly breast self-examination?.

Demographics

A total of 300 participants were recruited for the study, representing 90% of the estimated sample size. Majority of the participants, 58.3% were nurses, this is normal as nurses form the majority of the health care force, followed by medical doctors which constituted 27.7% whilst the MLS constituted 14.0%.

The male gender dominated the study with 65.7%. This is partly due to the male dominated medical and medical laboratory professions. However, the method employed to collect data, where the researcher collected contacts of participants for them to answer questionnaire also contributed to the male dominance of the study. 91.3% of the male population have ever undergone routine medical checkup compared to 94.0% of females. The female gender undergoes routine medical checkups than their male counterparts, as was also reported by Eke, et al. [9], where 39.4% of females regularly examine their health compared to 29.4% of males. However, studies from Australia reported no difference in medical examination between males and females [11].

56% of the participants were single at the time of data collection. This might be due to the fact that, most of the participants, 67.3% are with the ages of 20-30yrs. With regard to the practice of medical checkups, 89.8% of participants who are single have ever undergone a medical checkup, compared to 95.3% of the married population. Married couples tend to undergo routine medical checkups compared to the single population, this was also reported by Albaloushi [12].

For religious affiliations, 93.8% of Muslims have ever undergone medical checkup, compared to 91.0% of Christians.

The first objective of the study was to assess the level of knowledge of participants regarding RME. Series of questions were asked and analyzed.

The first question that was put before participants to assess their knowledge was the definition of RME, which was defined as the process of assessing an individual’s state of health so as to detect, treat and prevent illnesses. 56.6% of nurses strongly agreed with the definition, 49.4% of doctors strongly agreed whilst 47.6% of medical laboratory scientists strongly agreed. 39.4% of nurses agreed, 45.8% of medical doctors agreed, whilst 47.6% of laboratory scientists agreed. Cumulatively, 95.6% of the participants either strongly agreed or agreed with the definition. This is similar to a study conducted in Nigeria, where 100% answered yes to the same definition [13]. This is however comparatively higher than that reported by Appiah [10] who reported 38.6%.

Next on assessing knowledge was the question, health checkup is important for asymptomatic adults. 40%, 45.8% and 42.9% of nurses, doctors and medical laboratory scientist respectively strongly agreed, whilst 48.6%, 50.6% and 50.0% of nurses, doctors and laboratory scientists respectively agreed. Cumulatively, 91.3% of the participants either strongly agreed or agreed to the statement that, medical checkups are necessary for asymptomatic adults. This is similar to that reported by Appiah [10] where 92.1% also strongly agreed or agreed to the assertion that, medical checkup is important for asymptomatic adults.

Periodic health checkups help to establish a health baseline was the next question put before participants to assess their knowledge. 42.8%, 49.4% and 33.3% of nurse, doctors and laboratory personnel respectively strongly agreed to the statement, whilst 52.2% of nurses, 45.8% of doctors and 61.9% of laboratory personnel agreed to the statement. Cumulatively, 94.5% of participants either strongly agreed or agreed to the statement. This is similar to that reported by Appiah [10], where 96.0% either strongly disagreed or agreed to the statement.

General medical checkups should involve an assessment of one’s entire body system. This was the next question under knowledge category to 56.0% of nurses. 50.6% of doctors and 35.7% of laboratory staffs strongly agreed. 40%. 43.4% and 43.7% of nurses, doctors and laboratory scientist respectively agreed to the statement. Cumulatively, 95.3% of participants either strongly agreed to agree to the statement. Similar results were reported by Appiah [10].

Females above 30yrs and males above 40yrs should have cervical smear and PSA done respectively. 37.1%, 44.6% and 31.7% of nurses, doctors and laboratory staffs respectively strongly agreed to the statement, whilst 49.7%, 47.0% and 58.5% of nurses, doctors and laboratory staffs respectively agreed to the statement. Cumulatively, 88.3% of participants either strongly agreed or agreed to the statement. This is higher than that reported from a study conducted among medical students, which reported 61% [14].

Early detection of diseases such as hypertension and diabetes can prevent complications later in life. 94% of participants either agreed or strongly agreed to this statement. 65.9%, 69.9% and 42.9% of nurses, doctors and laboratory scientists strongly agreed, whilst 30.1%, 25.3% and 45.2% of nurses, doctors and laboratory staffs agreed to the statement.

Counselling and health education is essential in health checkup. 44.0% of nurses, 54.2% of doctors and 31.7% of laboratory scientists strongly agreed to this assertion, whilst 48.0%, 39.8% and 56.1% of nurses, doctors and laboratory personnel respectively agreed. Accumulatively, 91.6% of participants either agreed or strongly agreed to this statement. According to a study conducted by Priscilla, et al. [7] this assertion was rated “very important” and ranked as second most important by participants.

The study finds a high level of knowledge among health care personnel, nurses doctors and medical laboratory scientists. More than 90% of the participants either agreed or strongly agreed to all questionnaire item related to knowledge. This finding is similar to that of several other studies such as Ojong, et al. [13] who reported knowledge prevalence of 92.8% among health personnel in a teaching hospital in Nigeria. This finding is however considerably higher than that reported from a study in Saudi Arabia, where 69.6% of the participants are reported to have adequate knowledge about medical checkups [15]. There were no significant differences between the three professions.

The next objective of the study was to assess the perception of health care personnel towards routine medical checkup. Series of questions were asked to assess this objective. First on the list was to elicit the views of participants as to whether medical checkups are necessary. 99.7% of participants responded yes, that medical checkups are important. This was considerably higher than that reported from Saudi Arabia, where 88.9% said medical checkups are important [15].

Next on perception was the question, medical checkups are only necessary for people who are sick. A cumulative 97.0% of participants either disagreed or strongly disagreed to the statement. 56.5%, 31.7% and 11.8% of nurses, doctors and laboratory personnel respectively strongly disagreed, whilst 36.8%, 28.0% and 42.9% of nurses, doctors and laboratory personnel disagreed. The results of this study was considerably higher than that reported by Eke, et al. [9] where 36,4% said medical checkups are only necessary for people who are sick.

Medical checkups help to prevent nosocomial infections among health personnel. 30.3%, 42.2% and 29.3% of nurses, doctors and laboratory staffs respectively strongly agreed, whilst 49.7%, 45.8% and 51.2% of nurses, doctors and laboratory staffs respectively agreed to the assertion. Cumulatively, 82.0% of participants either agreed or strongly agreed to that statement. This finding is higher than that reported by Ojong, et al. [13], where in a similar study among health care workers in a teaching hospital in Nigeria, 45.9% said health checkups reduces the incidence of nosocomial infections.

When asked about the frequency at which health checkups should be done, 13.2%, 20.7% and 11.9% of nurses, doctors and laboratory personnel respectively strongly agreed that, medical checkups should be done yearly, whilst 57.5%, 54.9% and 50.0% of nurses, doctors and laboratory personnel respectively agreed that, medical checkups should be done yearly. Cumulatively, a total of 70.3% of the respondents believed medical checkups should be conducted annually. This finding differs from that of where 59.9% of respondents felt medical checkups should be conducted monthly.

Participants were sked whether they wanted medical checkups to be captured under the National Health Insurance Scheme NHIS. 32.0%, 32.5% and 14.3% of nurses, doctors and medical laboratory scientists respectively strongly agreed that, health checkups be captured under the NHIS, whilst 48.0%, 58.2% and 50.7% of MLS agreed. Cumulatively, 80.3% of participants either agreed or strongly agreed that, health checkups be captured under the NHIS. Several studies, including this current study reported cost of financial constraints as a major obstacle to the practice of health checkups. In their study, Appiah, et al. [10] reported that, 41.6% of participants cited cost the main reason for not undergoing health checkups. Similarly, 41.3% of the participants of this study cited cost as the main reason for not undergoing medical checkups. Similarly, 93.6% of participants either agree of strongly agreed that, the hospital should conduct yearly medical checkups for all staffs. This clearly indicates a positive attitude or perception of participants towards health checkups.

When asked whether or not they support the practice of regular health checkups, 99.0% of participants responded in the affirmative. This is further cemented by the finding that, 91.3% of participants believed health checkups are necessary for everyone, and not just the elderly or those above 40yrs. This finding differs from that reported by Al- kahil, et al. [15], where only 58.7% said health checkups should be undertaken by all age groups. In a related finding, 99% of participants in this study said they will encourage their colleague health workers to practice periodic medical checkup.

The final objective of the study was to assess the practice of Routine Medical Checkup among health care personnel. To this effect, a simple question put before participants; “have you ever under gone routine medical checkup?” 94.2%, 89.2% and 90.5% of nurses, doctors and MLS responded yes, thus have ever under gone medical checkup. Cumulatively, 91.0% of participants have ever undergone medical checkup. This is considerably higher than reported from Saudi Arabia, 22.5% [12], Nigeria, 46% Tema Community 20, 68.1% Kaneshie market, 46.7% India 36% [16] as well as Austria, 41.8% [11]. However, when participants were asked whether they conduct monthly breast self-examination, only 17.3% responded yes, whilst 20.7% said not regularly. Only 36.8% of female participant conduct monthly breast examination. This finding though one would have expected a high prevalence rate is still higher than that reported among medical students in Kenya, with BSE prevalence rate of 19.2% [17, 18, 19, 20, 21, 22, 23, 24, 25].

Participants were asked to indicate the type of checkup they had undergone [26, 27, 28, 29, 30]. General examination was the highest checkup undergone with 64.6% this is similar to that reported from where Nigeria, where 61.8% of respondents underwent general examinations, but slightly higher than that reported by Appiah, et al. [10] where 52.2% underwent general examination [31]. This might be attributed to high level of knowledge exhibited by the participants. Blood pressure examination was undergone by 14.6%. This is in contrast to that reported by Ojong, et al. [13], where 61.3% had blood pressure checkups. This may be due to the fact that blood pressure examination is included in general medical checkups. Other checkups were Random Blood Sugar, Cholesterol examination, dental and visual examinations, hepatitis, and cervical examinations [32, 33].

Participants were asked to indicate the last time they went for a medical checkup. 56.3% had undergone medical checkup within the previous year. This is slightly higher than that reported by Ojong, et al. [13] where 44.9% undergone medical checkup within the past year.

Majority of the participants, 58.3%, had undergone medical checkups for personal reasons. This might be due to the fact most of participants regard medical checkups as important, due to their level of knowledge. This finding was higher than that reported by Priscilla, et al. [7] where 35.4% of participants went for medical checkups for personal reasons as well as that reported by Albaloushi, et al. [12] 40.7%. It was however lower than that reported from Saudi Arabia, 77.5% Albaloushi, et al. [12]. 21% undergo medical checkups for employment, whilst 9.9% as a follow up on treatment. This finding differs significantly from that of where 64% percent undergo medical checkups only when they are sick [16].

When asked how often individuals should undergo medical checkups, majority of the patients, 56.3% recommended every six months, whilst 28.3% said annually. This was in contrast to that reported by Eke, et al. [9] who reported that, 59.9% of respondents said individuals should undergo medical checkups monthly whilst 12.4% of their participants did not know how often medical checkups should be done.

The major obstacle that impedes the practice of periodic medical checkup is financial constraint, 40.3%, followed by time constraints, 24.7%. This was similar to the study conducted at Kaneshie market, where 41.6%, 40.7% and 39.8% respectively cited high cost of service, time constraints and not been sick enough to be major challenges towards the practice of RMC. A handful of the participants cited issues such as privacy and confidentiality.