The study was conducted at two primary health centers in the Ashanti Region of Ghana (Fig. 1), namely Agona Government Hospital (AGH) and Mankranso Government Hospital (MGH). AGH is situated at Agona, the administrative capital of the Sekyere South District in Ghana, where it serves as the main referral health facility for surrounding villages and towns (latitude 6o50’N and longitude 1o29’W). About 47% of the inhabitants live in rural areas and 67% are involved in agriculture. The mean annual rainfall ranges between 855 mm and 1500 mm with a daily warm to hot temperature at about 27 °C [31 ].

A map showing the location of the study areas in the Ashanti Region of Ghana. [The map was created by Mr. Ema Dari of the Department of Geography and Rural Development, KNUST using ArcGIS Desktop 10.6.1 software]

Mankranso Government Hospital is located at Mankranso, the capital of the Ahafo Ano South West District (formerly Ahafo Ano South District) in the Ashanti Region of Ghana. According to the 2010 Population and Housing Census, about 90% of the total population live in rural areas. Approximately 81.7% percent of indigenous households in Mankranso are engaged in crop farming whiles others are actively involved in poultry farming. The district is located at latitude 6o42’N and longitude1o45’W. Mankranso has a wet semi-equatorial climate with a mean monthly temperature between 26 °C–28 °C with two major rainfall patterns in the district [32 ].
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