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Naghavi M, Ong KL, Aali A, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbasi-Kangevari M, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdollahifar MA, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abebe SS, Abedi A, Abegaz KH, Abhilash ES, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Abolmaali M, Abouzid M, Aboye GB, Abreu LG, Abrha WA, Abtahi D, Abu Rumeileh S, Abualruz H, Abubakar B, Abu-Gharbieh E, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Accrombessi MMK, Adal TG, Adamu AA, Addo IY, Addolorato G, Adebiyi AO, Adekanmbi V, Adepoju AV, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adeyinka DA, Adeyomoye OI, Admass BAA, Adnani QES, Adra S, Afolabi AA, Afzal MS, Afzal S, Agampodi SB, Agasthi P, Aggarwal M, Aghamiri S, Agide FD, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed LA, Ahmed MS, Ahmed MS, Ahmed MB, 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K, Deng X, Denova-Gutiérrez E, Deravi N, Dereje N, Dervenis N, Dervišević E, Des Jarlais DC, Desai HD, Desai R, Devanbu VGC, Dewan SMR, Dhali A, Dhama K, Dhimal M, Dhingra S, Dhulipala VR, Dias da Silva D, Diaz D, Diaz MJ, Dima A, Ding DD, Ding H, Dinis-Oliveira RJ, Dirac MA, Djalalinia S, Do THP, do Prado CB, Doaei S, Dodangeh M, Dodangeh M, Dohare S, Dokova KG, Dolecek C, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorostkar F, Dorsey ER, dos Santos WM, Doshi R, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Du M, Dube J, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dwyer-Lindgren L, Dzianach PA, Dziedzic AM, E'mar AR, Eboreime E, Ebrahimi A, Echieh CP, Edinur HA, Edvardsson D, Edvardsson K, Efendi D, Efendi F, Effendi DE, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, Elbarazi I, Elema TB, Elemam NM, Elgar FJ, Elgendy IY, ElGohary GMT, Elhabashy HR, Elhadi M, El-Huneidi W, Elilo LT, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emeto TI, Engelbert 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Ghahramani S, Ghailan KY, Ghasemi MR, Ghasempour Dabaghi G, Ghasemzadeh A, Ghashghaee A, Ghassemi F, Ghazy RM, Ghimire A, Ghoba S, Gholamalizadeh M, Gholamian A, Gholamrezanezhad A, Gholizadeh N, Ghorbani M, Ghorbani Vajargah P, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Ginindza TG, Girmay A, Glasbey JC, Gnedovskaya EV, Göbölös L, Godinho MA, Goel A, Golchin A, Goldust M, Golechha M, Goleij P, Gomes NGM, Gona PN, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Goulart BNG, Goyal A, Grada A, Graham SM, Grivna M, Grosso G, Guan SY, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Guimarães RA, Gulati S, Gunawardane DA, Gunturu S, Guo C, Gupta AK, Gupta B, Gupta MK, Gupta M, Gupta RD, Gupta R, Gupta S, Gupta VB, Gupta VK, Gupta VK, Gurmessa L, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Haddadi R, Hadei M, Hadi NR, Haep N, Hafezi-Nejad N, Hailu A, Haj-Mirzaian A, Halboub ES, Hall BJ, Haller S, Halwani R, Hamadeh RR, Hameed S, Hamidi S, Hamilton EB, Han C, Han Q, Hanif A, Hanifi N, 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A, Lai DTC, Lal DK, Lalloo R, Lallukka T, Lam H, Lám J, Landrum KR, Lanfranchi F, Lang JJ, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lassi ZS, Latief K, Latifinaibin K, Lauriola P, Le NHH, Le TTT, Le TDT, Ledda C, Ledesma JR, Lee M, Lee PH, Lee SW, Lee SWH, Lee WC, Lee YH, LeGrand KE, Leigh J, Leong E, Lerango TL, Li MC, Li W, Li X, Li Y, Li Z, Ligade VS, Likaka ATM, Lim LL, Lim SS, Lindstrom M, Linehan C, Liu C, Liu G, Liu J, Liu R, Liu S, Liu X, Liu X, Llanaj E, Loftus MJ, López-Bueno R, Lopukhov PD, Loreche AM, Lorkowski S, Lotufo PA, Lozano R, Lubinda J, Lucchetti G, Lugo A, Lunevicius R, Ma ZF, Maass KL, Machairas N, Machoy M, Madadizadeh F, Madsen C, Madureira-Carvalho ÁM, Maghazachi AA, Maharaj SB, Mahjoub S, Mahmoud MA, Mahmoudi A, Mahmoudi E, Mahmoudi R, Majeed A, Makhdoom IF, Malakan Rad E, Maled V, Malekzadeh R, Malhotra AK, Malhotra K, Malik AA, Malik I, Malta DC, Mamun AA, Mansouri P, Mansournia MA, Mantovani LG, Maqsood S, Marasini 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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2100-2132. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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N, Zakzuk J, Zamagni G, Zaman BA, Zaman SB, Zamora N, Zand R, Zandi M, Zandieh GGZ, Zanghì A, Zare I, Zastrozhin MS, Zeariya MGM, Zeng Y, Zhai C, Zhang C, Zhang H, Zhang H, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao Y, Zhao Y, Zheng P, Zhong C, Zhou J, Zhu B, Zhu Z, Ziaeefar P, Zielińska M, Zou Z, Zumla A, Zweck E, Zyoud SH, Lim SS, Murray CJL. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:1989-2056. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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Immurana M, Klu D, Aberese-Ako M, Abdullahi I. Malaria Prevalence and Macroeconomic Output in Ghana, 1990 to 2019. Inquiry 2024; 61:469580241248101. [PMID: 38685826 PMCID: PMC11062221 DOI: 10.1177/00469580241248101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
In Ghana, malaria remains the number 1 reason for outpatient department visits, making it a major public health problem. Thus, there could be significant lost productivity days as a result of malaria morbidity and mortality, which could negatively affect economic output at the macrolevel. Nonetheless, there is a dearth of empirical evidence of the effect of malaria on macroeconomic output in Ghana. This study therefore aims to provide the foremost empirical evidence regarding the effect of malaria prevalence on macroeconomic output in Ghana using a time series design with data spanning the period 1990 to 2019. Gross Domestic Product (GDP), serving as a proxy for macroeconomic output, is the dependent variable, while the prevalence of malaria (overall, among only males and among only females) serves as the main independent variable. The Ordinary Least Square (OLS) regression is used as the baseline estimation technique and the Instrumental Variable Two-Stage Least Square (IV2SLS) regression is employed as the robustness check estimator due to its ability to deal with endogeneity. The IV2SLS regression results show that a percentage increase in the overall prevalence of malaria is associated with a 1.16% decrease in macroeconomic output at 1% significance level. We also find that the effect of malaria in males on macroeconomic output is slightly higher relative to females. The findings from the OLS regression are not qualitatively different from the IV2SLS regression estimates. There is therefore the need to strengthen efforts such as quality case management, larval source management, mass distribution of long-lasting insecticide-treated bed nets, social behavior change, surveillance (both epidemiological and entomological), intermittent preventive treatment of malaria in pregnancy, research among others, which are important toward eliminating malaria.
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Affiliation(s)
| | - Desmond Klu
- University of Health and Allied Sciences, Ho, Ghana
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Klu D, Gyapong M, Agordoh PD, Azagba C, Acquah E, Doegah P, Ofosu A, Ansah EK. Adolescent perception of sexual and reproductive health rights and access to reproductive health information and services in Adaklu district of the Volta Region, Ghana. BMC Health Serv Res 2023; 23:1456. [PMID: 38129807 PMCID: PMC10740242 DOI: 10.1186/s12913-023-10447-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND One of the key targets of Ghana's Adolescent Health Service Policy and Strategy is to ensure that 90% of adolescents and young people have knowledge of sexual and reproductive health services and rights. This phenomenon has led to the establishment of adolescent-friendly health facilities to increase access to health information and services among adolescents. Despite these efforts, access to health information and service utilisation remains low among adolescents. Our study seeks to examine adolescents' perception of sexual and reproductive health rights (SRHR) and access to reproductive health information and services in the Adaklu district of the Volta region of Ghana. METHODS A baseline cross-sectional household survey of 221 adolescents aged 10-19 years in 30 randomly selected communities was used. A structured questionnaire was developed and administered to the respondents. A binary logistic regression analysis was used to examine the association between adolescents' perception of adolescent sexual and reproductive health rights (ASRHR) and access to reproductive health information and services. RESULTS Adolescents' perception of SRHR was poor, and this poor perception may have been reflected in a few proportions (10%) of adolescents accessing SRH information and services. Majority (91.9%) of adolescents do not use sexual and reproductive health (SRH) services in the Adaklu district. Adolescents who attained primary education (aOR = 5.99, CI: 1.16-30.95), those who never had sexual communication with their father (aOR = 8.89, CI: 1.99-39.60) and adolescents who never experienced any form of sexual coercion (aOR = 11.73, CI: 1.61-85.68) had a higher likelihood of not utilising SRH services in Adaklu district. Regarding access to SRH information, adolescents who ever discussed sexual matters with their fathers, those who ever used contraceptives and adolescents who ever experienced sexual coercion had lower odds of accessing information on contraception, sexually transmitted infections, and teenage pregnancy. CONCLUSIONS Access to and use of sexual and reproductive information and health services among adolescents in Adaklu district remain very low, which has implications for adolescents' knowledge and perception of their SRHR. Considering the factors predicting this phenomenon, it is recommended that interventions can be tailored to address the unique challenges faced by adolescent in accessing comprehensive SRH support.
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Affiliation(s)
- Desmond Klu
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Percival Delali Agordoh
- School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Charles Azagba
- Adaklu District Health Directorate, Ghana Health Service, Adaklu, Volta Region, Ghana
| | - Evelyn Acquah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Phidelia Doegah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Anthony Ofosu
- Ghana Health Service, Accra, Greater Accra Region, Ghana
| | - Evelyn Korkor Ansah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Klu D. Are fertility theories still relevant in explaining fertility behaviour in traditional and contemporary societies in sub-Saharan Africa? A systematic review. J Pop Research 2023. [DOI: 10.1007/s12546-023-09306-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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Klu D, Atiglo DY, Christian AK. Multinomial logistic regression analysis of the determinants of anaemia severity among children aged 6-59 months in Ghana: new evidence from the 2019 Malaria Indicator Survey. BMC Pediatr 2023; 23:91. [PMID: 36850016 PMCID: PMC9969679 DOI: 10.1186/s12887-023-03919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 02/20/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Anaemia among children under age five is a major public health issue. Although anaemia prevalence is declining in Ghana, the severity among anaemic children is worsening. This study aims to investigate the determinants of anaemia severity among children aged 6 to 59 months in Ghana. METHOD The study utilized a weighted sample of 1,258 children with anaemia with data obtained from the 2019 Ghana Malaria Indicator Survey. The predictor variables included maternal, household child and health system characteristics. SPSS version. At the multivariate level, three different multinomial logistic models were run with selected predictor variables. All tests were conducted at the 95% confidence level. RESULTS The overall anaemia prevalence among children under age five was 43.5%. Of these, 2.6% were severely anaemic, 48.5% were moderately anaemic, and 48.9% had mild anaemia. The multinomial analysis showed that maternal, household, child and health system factors significantly predicted anaemia levels among anaemic children. The results indicate that a lower likelihood of anaemia severity is likely to be found among children whose mothers belong to Pentecostal/Charismatic faith (AOR = 0.18-model I; AOR = 0.15-model III) and children who tested negative for malaria (AOR = 0.28-model II and III). Again, a higher probability of anaemia severity was found among anaemic children whose mothers were not aware of NHIS coverage of malaria (AOR = 2.41-model II, AOR = 2.60-model III). With regard to moderate anaemia level, children who belong to the poorest, poorer and middle household wealth index had a higher likelihood of being moderately anaemic compared to those in rich households. Similarly, anaemic children who were less than 12 months old (AOR = 2.21-model II, AOR = 2.29-model III) and those between the ages of 1-2 years (AOR = 1.84-model II, AOR = 1.83-model III) were more likely to have moderate anaemia levels. CONCLUSION The study findings show the importance of understanding the interrelation among different factors that influence anaemia severity among children under age five as critical in developing strategies and programmes aimed at addressing childhood anaemia.
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Affiliation(s)
- Desmond Klu
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana.
| | - Donatus Yaw Atiglo
- Regional Institute for Population Studies, University of Ghana, Legon-Accra, Ghana
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Klu D, Agordoh PD. Sex of household head and other household determinants of childhood anaemia among households in Ghana: regression analysis of the 2019 Malaria Indicator Survey. J Health Popul Nutr 2022; 41:46. [PMID: 36217188 PMCID: PMC9549624 DOI: 10.1186/s41043-022-00327-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Childhood anaemia is still a major public health concern. Although the prevalence of anaemia among children under age five is reducing in Ghana, the severity level is still worsening. This study sought to examine and compare household factors affecting the anaemia status of children under age five living in male- and female-headed households in Ghana. METHODS The study used a weighted sample of 5,799 household heads from the 2019 Ghana Malaria Indicator Survey (GMIS). A binary logistic regression analysis was used to examine the effect of sex of household heads and other household factors on the anaemia status of children under the age of five in male- and female-headed households in Ghana. All analyses were conducted at the 95% confidence level. RESULTS The results showed that a higher proportion (83.0%) of children under age five are not anaemic in households in Ghana. However, the probability of a child being anaemic is higher in male-headed households (aOR = 1.28; C.I:1.08-1.51), in the poorest (aOR = 2.41; CI: 1.59-3.65), poorer (aOR = 2.04; C.I:1.41-2.94) and middle (aOR = 1.78; C.I:1.29-2.46) household wealth category. Higher likelihood of anaemia was found among children in households that used charcoal (aOR = 1.51; C.I:1.15-1.99) and fuelwood (aOR = 1.44; C.I:1.02-2.02) for cooking. Similarly, there is a high probability of childhood anaemia in households with 5-10 members (aOR = 4.49; C.I: 3.78-5.34), 11 or more members (aOR = 7.21; C.I: 4.60-11.31) and household residing in northern part of Ghana (aOR = 1.40; C.I:1.07-1.83). The lower odds of being anaemic were recorded among children whose household heads were aged 40 years and older, household using other cooking fuels (aOR = 0.49; C.I: 0.21-0.78) and household with no bednets (aOR = 0.57; C.I: 0.44-0.74). CONCLUSIONS The GMIS data suggest that anaemia and its severity are higher among children living in MHH than among those living in FHH. The results indicate that poverty, a higher number of household members, relatively younger male household heads and the type of cooking fuel used were factors accounting for the differences in childhood anaemia in MHH and FHH. Equal attention should be given to MHH and FHH in terms of programmes and interventions aimed towards preventing and reducing childhood anaemia in Ghana.
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Affiliation(s)
- Desmond Klu
- Centre for Malaria Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana.
| | - Percival Delali Agordoh
- Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
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Klu D, Yeboah I, Kayi EA, Okyere J, Essiaw MN. Utilization of abortion services from an unsafe provider and associated factors among women with history of induced abortion in Ghana. BMC Pregnancy Childbirth 2022; 22:705. [PMID: 36100858 PMCID: PMC9469529 DOI: 10.1186/s12884-022-05034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa (SSA), numerous studies have examined women's choice of abortion methods and services using hospital-based data, community-based surveys and nationally representative data. Little research focuses on the factors influencing a woman's choice of abortion provider. This study sought to identify factors that are associated with why a woman seeks abortion care services from an unsafe provider in Ghana. METHODS We used nationally representative data of women from the 2017 Ghana Maternal Health Survey (GMHS). Data analysis was restricted to women aged 15-49 with a recent history of induced abortion. Analyses focused on a weighted sample of 1,880. Descriptive analysis and the chi-square test were used to examine the proportion of women utilizing abortion services from unsafe providers. Factors hypothesized to affect the utilization of abortion services from unsafe providers were examined using both bivariable and multivariable logistic regression analyses. RESULTS The proportion of survey respondents who reported that they utilize abortion service from unsafe providers were 57.5%. After adjusting for confounders, those who have knowledge of abortion legality [aOR: 0.381 (0.271-0.541)] and those who have attained secondary or higher education [aOR: 0.613 (0.411-0.914)] were less likely to use abortion services from unsafe providers. On the other hand, women belonging to the Ewe ethnic group [aOR: 0.696 (0.508-0.953)], those residing in the middle belt zone [aOR: 1.743 (1.113-2.728)], younger women aged 15-29 years [aOR: 2.037 (1.234-3.362)] were more likely to use abortion services from unsafe abortion providers. CONCLUSIONS This research suggests that increasing the knowledge of women on the legal status of abortion through public education and encouraging more women to pursue secondary or higher education can contribute to reducing the use of abortion services from unsafe providers. These interventions should be targeted among younger women and those who reside in the middle belt zones of Ghana.
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Affiliation(s)
- Desmond Klu
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Isaac Yeboah
- Institute of Work, Employment and Society, University of Professional Studies, P.O. Box LG 149, Legon, Accra, Ghana.
| | - Esinam Afi Kayi
- Department of Adult Education and Human Resource Studies, School of Continuing and Distance Education, University of Ghana, P.O. Box LG 25, Accra, Legon, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, PMB 40, Cape Coast, Ghana
| | - Mary Naana Essiaw
- Institute of Work, Employment and Society, University of Professional Studies, P.O. Box LG 149, Legon, Accra, Ghana
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Aberese-Ako M, Doegah P, Acquah E, Magnussen P, Ansah E, Ampofo G, Agyei DD, Klu D, Mottey E, Balen J, Doumbo S, Mbacham W, Gaye O, Gyapong M, Owusu-Agyei S, Tagbor H. Motivators and demotivators to accessing malaria in pregnancy interventions in sub-Saharan Africa: a meta-ethnographic review. Malar J 2022; 21:170. [PMID: 35659232 PMCID: PMC9166609 DOI: 10.1186/s12936-022-04205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite the introduction of efficacious interventions for malaria control, sub-Saharan Africa continues to bear the highest burden of malaria and its associated effects on vulnerable populations, such as pregnant women and children. This meta-ethnographic review contributes to literature on malaria in pregnancy interventions in sub-Saharan Africa by offering insights into the multiple factors that motivate or demotivate women from accessing MiP interventions. Methods A meta-ethnographic approach was used for the synthesis. Original qualitative research articles published from 2010 to November 2021 in English in sub-Saharan Africa were searched for. Articles focusing on WHO’s recommended interventions such as intermittent preventive treatment with sulfadoxine-pyrimethamine, long-lasting insecticidal nets and testing and treatment of Malaria in Pregnancy (MiP) were included. Selected articles were uploaded into Nvivo 11 for thematic coding and synthesis. Results Twenty-seven original qualitative research articles were included in the analysis. Main factors motivating uptake of MiP interventions were: (1) well organized ANC, positive attitudes of health workers and availability of MiP services; (2) Women’s knowledge of the effects of malaria in pregnancy, previous experience of accessing responsive ANC; (3) financial resources and encouragement from partners, relatives and friends and (4) favourable weather condition and nearness to a health facility. Factors that demotivated women from using MiP services were: (1) stock-outs, ANC charges and health providers failure to provide women with ample education on the need for MiP care; (2) perception of not being at risk and the culture of self-medication; (3) fear of being bewitched if pregnancy was noticed early, women’s lack of decision-making power and dependence on traditional remedies and (4) warm weather, long distances to health facilities and the style of construction of houses making it difficult to hang LLINs. Conclusions Health system gaps need to be strengthened in order to ensure that MiP interventions become accessible to women. Additionally, health managers need to involve communities in planning, designing and implementing malaria interventions for pregnant women. It is important that the health system engage extensively with communities to facilitate pregnant women and communities understanding of MiP interventions and the need to support pregnant women to access them.
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Affiliation(s)
| | - Phidelia Doegah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Evelyn Acquah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Evelyn Ansah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Gifty Ampofo
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | | | - Desmond Klu
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Elsie Mottey
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Julie Balen
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Safiatou Doumbo
- University of Sciences, Techniques and Technologies of Bamako, Malaria Research and Training Center, Bamako, Mali
| | - Wilfred Mbacham
- The Fobang Institutes for Innovations in Science and Technologies & The Biotechnology Center, The Centre for Health Innovations and Translational Research, University of Yaounde I, Yaounde, Cameroon
| | - Ouma Gaye
- Faculty of Medicine, University Cheikh Anta Diop Dakar, Dakar, Senegal
| | - Margaret Gyapong
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Seth Owusu-Agyei
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Harry Tagbor
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Klu D, Agordoh P, Azagba C, Acquah E, Doegah P, Ofosu A, Ansah EK, Gyapong M. Determinants of communication on sexual issues between adolescents and their parents in the Adaklu district of the Volta region, Ghana: a multinomial logistic regression analysis. Reprod Health 2022; 19:101. [PMID: 35477467 PMCID: PMC9044737 DOI: 10.1186/s12978-022-01402-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor communication on sexual issues between adolescents and their parents results in high rates of negative sexual practices such as teenage pregnancy. Contributing factors to this poor communication on sexual issues between adolescents and their parents in a high teenage pregnancy setting have not been adequately explored. We sought to fill this gap by examining the factors that predict communication on sexual issues between adolescents and their parents in the Adaklu district of the Volta region of Ghana. METHODS A baseline cross-sectional household survey of 221 adolescents aged 10-19 years in 30 randomly selected communities was used. A well-structured questionnaire was developed. A multinomial logistic regression analysis was used to examine factors that significantly influenced communication between adolescents and their parents regarding sex. RESULTS Only 11.3% of adolescents had discussions on sexual issues with both parents while 27.6% of communicated sexual issues with only one parent in Adaklu district. Adolescent males (AOR = 0.21, CI = 0.06-0.75), those aged 10-14 years (AOR = 0.41, CI = 0.04-0.57), non-members of adolescent health clubs (AOR = 0.46, CI = 0.21-1.00), and those living with only a father (AOR = 0.19, CI = 0.06-0.61) had lower odds of communicating with their parents on sexual issues. CONCLUSIONS Adolescent-parental communication on sexual issues in Adaklu district is very low. This situation requires more empowerment of adolescents to enable them to discuss sexual issues with their parents through increased engagement with adolescent health club activities and capacity building capacity of parents with the right information on sexual and reproductive health by health staff within the district. Additionally, parents need to be equipped with communication skills to enable them to communicate effectively with their children.
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Affiliation(s)
- Desmond Klu
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana.
| | - Percival Agordoh
- School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Charles Azagba
- Adaklu District Health Directorate, Ghana Health Service, Accra, Ghana
| | - Evelyn Acquah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Phidelia Doegah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | | | - Evelyn Korkor Ansah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Klu D, Aberese-Ako M, Manyeh AK, Immurana M, Doegah P, Dalaba M, Acquah E, Alhassan RK, Ansah EK. Mixed effect analysis of factors influencing the use of insecticides treated bed nets among pregnant women in Ghana: evidence from the 2019 Malaria Indicator Survey. BMC Pregnancy Childbirth 2022; 22:258. [PMID: 35346098 PMCID: PMC8958761 DOI: 10.1186/s12884-022-04586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Malaria during pregnancy is a major cause of maternal morbidity globally and leads to poor birth outcomes. The World Health Organization has recommended the use of insecticide treated bed nets (ITN) as one of the effective malaria preventive strategies among pregnant women in malaria endemic areas. This study, therefore, seeks to examine the individual and household factors associated with the use of ITNs among pregnant women in Ghana. Methods Data for this study was obtained from the 2019 Ghana Malaria Indicator Survey (GMIS) conducted between September 25 and November 24, 2019. The weighted sample comprised 353 pregnant women aged 15–49 years. Data was analyzed with SPSS version 22 using both descriptive and multilevel logistics regression modelling. Statistically significant level was set at p < 0.05. Results The study found that 49.2% of pregnant women in Ghana use ITN to prevent malaria. Pregnant women aged 35–49 years (AOR = 3.403, CI: 1.191–9.725), those with no formal education (AOR = 5.585, CI = 1.315–23.716), and those who had secondary education (AOR = 3.509, CI = 1.076–11.440) had higher odds of using ITN. Similarly, higher odds of ITN usage was found among who belonged to the Akan ethnic group (AOR = 7.234, CI = 1.497–34.955), dwell in male-headed households (AOR = 2.232, CI = 1.105–4.508) and those whose household heads are aged 60–69 years (AOR = 4.303, CI = 1.160–15.966). However, pregnant women who resided in urban areas (AOR = 0.355, CI = 0.216–0.582), those whose household heads aged 40–49 years (AOR = 0.175, CI = 0.066–0.467) and those who belonged to richer (AOR =0.184, CI = 0.050–0.679) and richest (AOR = 0.107, CI = 0.021–0.552) households had lower odds of using ITN for malaria prevention. Conclusions Individual socio-demographic and household factors such as pregnant women’s age, educational level, place of residence, ethnicity, sex and age of household head, and household wealth quintile are associated with the use of ITN for malaria prevention among pregnant women. These factors ought to be considered in strengthening malaria prevention campaigns and develop new interventions to help increase ITN utilization among vulnerable population living in malaria- endemic areas.
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Immurana M, Boachie MK, Klu D, Dalaba MA, Manyeh AK, Alhassan RK. Determinants of willingness to accept child vaccination against malaria in Ghana. Int J Health Plann Manage 2022; 37:1439-1453. [PMID: 34984733 DOI: 10.1002/hpm.3406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/17/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Malaria is a public health problem in Ghana with children being one of the most vulnerable. Given this, in 2019, Ghana decided to add the first malaria vaccine (RTS, S) as part of routine immunisations for children in the near future. This study, thus, examines the determinants of malaria vaccine awareness and willingness to uptake the vaccine for children in Ghana. METHOD The study uses data from the 2019 Ghana Malaria Indicator Survey while employing the binary logistic regression as the empirical estimation technique. RESULTS The study finds that religion, region of residence and awareness of the malaria vaccine, influence the willingness to uptake the vaccine for children. Moreover, younger mothers (15-26 years), households in the richest wealth quintile, male-headed households and the number of children aged five years and below in a household, are found to be associated with less willingness to uptake the vaccine for children. CONCLUSION Paying attention to awareness creation, region, religion, younger mothers (15-26 years), households in the richest wealth quintile, male-headed households and households with more children aged five years and below, can ensure optimal uptake of the malaria vaccine for children in Ghana.
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Affiliation(s)
- Mustapha Immurana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Micheal Kofi Boachie
- Department of Health Policy Planning and Management, School of Public Health, University of Health and Allied Sciences, Ho, Ghana.,SAMRC Centre for Health Economics and Decision Science, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Desmond Klu
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | | | - Alfred Kwesi Manyeh
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Kaba Alhassan
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Alhassan RK, Aberese-Ako M, Doegah PT, Immurana M, Dalaba MA, Manyeh AK, Klu D, Acquah E, Ansah EK, Gyapong M. COVID-19 vaccine hesitancy among the adult population in Ghana: evidence from a pre-vaccination rollout survey. Trop Med Health 2021; 49:96. [PMID: 34915939 PMCID: PMC8674411 DOI: 10.1186/s41182-021-00357-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has already claimed over four million lives globally and over 800 deaths in Ghana. The COVID-19 vaccine is a key intervention towards containing the pandemic. Over three billion doses of the vaccine have already been administered globally and over 800,000 doses administered in Ghana, representing less than 5% vaccination coverage. Fear, uncertainty, conspiracy theories and safety concerns remain important threats to, a successful rollout of the vaccine if not managed well. Objective Ascertain the predictors of citizens’ probability of participating in a COVID-19 vaccine trial and subsequently accept the vaccine when given the opportunity. Methodology The study was an online nation-wide survey among community members (n = 1556) from 18th September to 23rd October, 2020 in the 16 regions in Ghana. Binary probit regression analysis with marginal effect estimations was employed to ascertain the predictors of community members’ willingness to participate in a COVID-19 vaccine trial and uptake the vaccine. Results Approximately 60% of respondents said they will not participate in a COVID-19 vaccine trial; 65% will take the vaccine, while 69% will recommend it to others. Willingness to voluntarily participate in COVID-19 vaccine trial, uptake the vaccine and advise others to do same was higher among adults aged 18–48 years, the unmarried and males (p < 0.05). Significant predictors of unwillingness to participate in the COVID-19 vaccine trial and uptake of the vaccine are: married persons, females, Muslims, older persons, residents of less urbanised regions and persons with lower or no formal education (p < 0.05). Predominant reasons cited for unwillingness to participate in a COVID-19 vaccine trial and take the vaccine included fear, safety concerns, lack of trust in state institutions, uncertainty, political connotations, spiritual and religious beliefs. Conclusion The probability of accepting COVID-19 vaccine among the adult population in Ghana is high but the country should not get complacent because fear, safety and mistrust are important concerns that have the potential to entrench vaccine hesitancy. COVID-19 vaccine rollout campaigns should be targeted and cognisant of the key predictors of citizens’ perceptions of the vaccine. These lessons when considered will promote Ghana’s efforts towards vaccinating at least 20 million people to attain herd immunity. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-021-00357-5.
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Affiliation(s)
- Robert Kaba Alhassan
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana. .,Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana.
| | - Matilda Aberese-Ako
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | | | - Mustapha Immurana
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | | | - Alfred Kwesi Manyeh
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | - Desmond Klu
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | - Evelyn Acquah
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | - Evelyn Korkor Ansah
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana
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14
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Dalaba MA, Welaga P, Dalinjong PA, Chatio S, Immurana M, Alhassan RK, Klu D, Manyeh AK, Agorinya I, Oduro A, Adongo PB, Akweongo P. Health-seeking behaviour and cost of fever treatment to households in a malaria-endemic setting of northern Ghana: a cross-sectional study. BMJ Open 2021; 11:e052224. [PMID: 34518274 PMCID: PMC8438825 DOI: 10.1136/bmjopen-2021-052224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To examine the health-seeking behaviour and cost of fever treatment to households in Ghana. DESIGN Cross-sectional household survey conducted between July and September 2015. SETTING Kassena-Nankana East and West districts in Upper East region of Ghana. PARTICIPANTS Individuals with an episode of fever in the 2 weeks preceding a visit during routine health and demographic surveillance system data collection were selected for the study. Sociodemographic characteristics, treatment-seeking behaviours and cost of treatment of fever were obtained from the respondents. RESULTS Out of 1845 households visited, 21% (393 of 1845) reported an episode of fever. About 50% (195 of 393) of the fever cases had blood sample taken for testing by microscopy or Rapid Diagnostic Test, and 73.3% (143 of 195) were confirmed to have malaria. Of the 393 people with fever, 70% (271 of 393) reported taking an antimalarial and 24.0% (65 of 271) took antimalarial within 24 hours of the onset of illness. About 54% (145 of 271) of the antimalarials were obtained from health facilities.The average cost (direct and indirect) incurred by households per fever treatment was GH¢27.8/US$7.3 (range: GH¢0.2/US$0.1-GH¢200/US$52.6). This cost is 4.6 times the daily minimum wage of unskilled paid jobs of Ghanaians (US$1.6). The average cost incurred by those enrolled into the National Health Insurance Scheme (NHIS) was GH¢24.8/US$6.5, and GH¢50/US$11.6 for those not enrolled. CONCLUSIONS Prompt treatment within 24 hours of onset of fever was low (24%) compared with the Roll Back Malaria Programme target of at least 80%. Cost of treatment was relatively high when compared with average earnings of households in Ghana and enrolment into the NHIS reduced the cost of fever treatment remarkably. It is important to improve access to malaria diagnosis, antimalarials and enrolment into the NHIS in order to improve the case management of fever/malaria and accelerate universal health coverage in Ghana.
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Affiliation(s)
| | - Paul Welaga
- School of Medicine, C K Tedam University of Technology and Applied Sciences, Navrongo, Upper East, Ghana
- Social Science Department, Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - Philip Ayizem Dalinjong
- Social Science Department, Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - Samuel Chatio
- Social Science Department, Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - Mustapha Immurana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Robert Kaba Alhassan
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Desmond Klu
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Alfred Kwesi Manyeh
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Isaiah Agorinya
- School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Abraham Oduro
- Social Science Department, Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
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15
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Alhassan RK, Nutor JJ, Abuosi AA, Afaya A, Mohammed SS, Dalaba MA, Immurana M, Manyeh AK, Klu D, Aberese-Ako M, Doegah PT, Acquah E, Nketiah-Amponsah E, Tampouri J, Akoriyea SK, Amuna P, Ansah EK, Gyapong M, Owusu-Agyei S, Gyapong JO. Urban health nexus with coronavirus disease 2019 (COVID-19) preparedness and response in Africa: Rapid scoping review of the early evidence. SAGE Open Med 2021; 9:2050312121994360. [PMID: 33633859 PMCID: PMC7887690 DOI: 10.1177/2050312121994360] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/20/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 also called coronavirus disease 2019 was first reported in the African continent on 14 February 2020 in Egypt. As at 18 December 2020, the continent reported 2,449,754 confirmed cases, 57,817 deaths and 2,073,214 recoveries. Urban cities in Africa have particularly suffered the brunt of coronavirus disease 2019 coupled with criticisms that the response strategies have largely been a 'one-size-fits-all' approach. This article reviewed early evidence on urban health nexus with coronavirus disease 2019 preparedness and response in Africa. METHODS A rapid scoping review of empirical and grey literature was done using data sources such as ScienceDirect, GoogleScholar, PubMed, HINARI and official websites of World Health Organization and Africa Centres for Disease Control and Prevention. A total of 26 full articles (empirical studies, reviews and commentaries) were synthesised and analysed qualitatively based on predefined inclusion criteria on publication relevance and quality. RESULTS Over 70% of the 26 articles reported on coronavirus disease 2019 response strategies across Africa; 27% of the articles reported on preparedness towards coronavirus disease 2019, while 38% reported on urbanisation nexus with coronavirus disease 2019; 40% of the publications were full-text empirical studies, while the remaining 60% were either commentaries, reviews or editorials. It was found that urban cities remain epicentres of coronavirus disease 2019 in Africa. Even though some successes have been recorded in Africa regarding coronavirus disease 2019 fight, the continent's response strategies were largely found to be a 'one-size-fits-all' approach. Consequently, adoption of 'Western elitist' mitigating measures for coronavirus disease 2019 containment resulted in excesses and spillover effects on individuals, families and economies in Africa. CONCLUSION Africa needs to increase commitment to health systems strengthening through context-specific interventions and prioritisation of pandemic preparedness over response. Likewise, improved economic resilience and proper urban planning will help African countries to respond better to future public health emergencies, as coronavirus disease 2019 cases continue to surge on the continent.
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Affiliation(s)
- Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Jerry John Nutor
- School of Nursing, University of California, San Francisco, CA, USA
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Agani Afaya
- School of Nursing, University of Health and Allied Sciences, Ho, Ghana
| | | | - Maxwel Ayindenaba Dalaba
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Mustapha Immurana
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Alfred Kwesi Manyeh
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Desmond Klu
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Matilda Aberese-Ako
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Phidelia Theresa Doegah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Evelyn Acquah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | | | - John Tampouri
- Ho Teaching Hospital (HTH), Ho, Ministry of Health, Ghana
| | | | - Paul Amuna
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Evelyn Kokor Ansah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Margaret Gyapong
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Seth Owusu-Agyei
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - John Owusu Gyapong
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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