1
|
Kukula VA, Dodoo AAN, Akpakli J, Narh-Bana SA, Clerk C, Adjei A, Awini E, Manye S, Nagai RA, Odonkor G, Nikoi C, Adjuik M, Akweongo P, Baiden R, Ogutu B, Binka F, Gyapong M. Feasibility and cost of using mobile phones for capturing drug safety information in peri-urban settlement in Ghana: a prospective cohort study of patients with uncomplicated malaria. Malar J 2015; 14:411. [PMID: 26481106 PMCID: PMC4615326 DOI: 10.1186/s12936-015-0932-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/07/2015] [Indexed: 11/28/2022] Open
Abstract
Background The growing need to capture data on health and health events using faster and efficient means to enable prompt evidence-based decision-making is making the use of mobile phones for health an alternative means to capture anti-malarial drug safety data. This paper examined the feasibility and cost of using mobile phones vis-à-vis home visit to monitor adverse events (AEs) related to artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria in peri-urban Ghana. Methods A prospective, observational, cohort study conducted on 4270 patients prescribed ACT in 21 health facilities. The patients were actively followed by telephone or home visit to document AEs associated with anti-malarial drugs. Call duration and travel distances of each visit were recorded. Pre-paid call cards and fuel for motorbike travels were used to determine cost of conducting both follow-ups. Ms-Excel 2010 and STATA 11.2 were used for analysis. Results Of the 4270 patients recruited, 4124 (96.6 %) were successfully followed up and analyzed. Of these, 1126/4124 (27.3 %) were children under 5 years. Most 3790/4124 (91.9 %) follow-ups were done within 7 days of ACT intake. Overall, follow up by phone (2671/4124—64.8 %) was almost two times the number done by home visits (1453/4124—35.2 %). Duration of telephone calls ranged from 38 s to 53 min, costing between GH¢0.26 (0.20USD) and GH¢41.70 (27.USD). On the average, the calls lasted 3 min 51 s (SD = 3 min, 21 s) costing GH¢2.70 (0.77USD). Distance travelled for home visit ranged from 0.65 to 62 km costing GH¢0.29 (0.20USD) and GH¢279.00 (79.70USD). Thirty-two per cent (1128/4124) of patients reported AEs. In total, 1831 AE were reported, 1016/1831(55.5 %) by telephone and 815/1831 (44.5 %) by home visits. Events such as nausea, dizziness, diarrhoea, and vomiting were commonly reported. Conclusion Majority of patients was successfully followed up by telephone and reported the most AEs. The cost of telephone interviewing was almost two times less than the cost of home visit. Telephone follow up should be considered for monitoring drug adverse events in low resource settings.
Collapse
Affiliation(s)
| | - Alexander A N Dodoo
- Centre for Tropical Clinical Pharmacology, College of Health Sciences, University of Ghana, Legon, Ghana.
| | | | | | - Christine Clerk
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.
| | | | | | - Simon Manye
- Dodowa Health Research Centre, Dodowa, Ghana.
| | | | | | | | | | - Patricia Akweongo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.
| | | | | | - Fred Binka
- INDEPTH-Network, Accra, Ghana. .,University of Science and Allied Sciences, Ho, Ghana.
| | | |
Collapse
|
2
|
Chinbuah MA, Abbey M, Kager PA, Gyapong M, Nonvignon J, Ashitey P, Akpakli J, Appiatse SAA, Kubi D, Gyapong JO. Assessment of the adherence of community health workers to dosing and referral guidelines for the management of fever in children under 5 years: a study in Dangme West District, Ghana. Int Health 2013; 5:148-56. [PMID: 24030115 DOI: 10.1093/inthealth/ihs008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Community health workers (CHW) manage simple childhood illnesses in many developing countries. Information on CHWs' referral practices is limited. As part of a large cluster-randomised trial, this study assessed CHWs' adherence to dosing and referral guidelines. METHODS Records of consultations of children aged 2-59 months with fever managed by CHWs were analysed. Appropriate use of drugs was defined as provision of the correct drug pack(s) for the child's age group. Symptoms requiring referral were categorised into danger signs, respiratory distress and symptoms indicating other illnesses. Multivariate logistic regression examined symptoms most likely to be noted as requiring referral and those associated with provision of a written referral. RESULTS Most children (11 659/12 330; 94.6%) received the appropriate drug. Only 161 of 1758 (9.2%) children who, according to the guidelines required referral were provided with a written referral. Not drinking/breastfeeding, persistent vomiting, unconsciousness/lethargy, difficultly breathing, fast breathing, bloody stool, sunken eyes and pallor were symptoms significantly associated with being identified by CHWs as needing referral or receiving a written referral. CONCLUSIONS CHWs' adherence to dosing guidelines was high. Adherence to referral guidelines was inadequate. More effort needs to be put into strengthening referral practices of CHWs within comparable community programmes.
Collapse
Affiliation(s)
- Margaret A Chinbuah
- Research and Development Division, Ghana Health Service, PM Bag 190, Accra, Ghana
| | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Källander K, Kadobera D, Williams TN, Nielsen RT, Yevoo L, Mutebi A, Akpakli J, Narh C, Gyapong M, Amu A, Waiswa P. Social autopsy: INDEPTH Network experiences of utility, process, practices, and challenges in investigating causes and contributors to mortality. Popul Health Metr 2011; 9:44. [PMID: 21819604 PMCID: PMC3160937 DOI: 10.1186/1478-7954-9-44] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 08/05/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Effective implementation of child survival interventions depends on improved understanding of cultural, social, and health system factors affecting utilization of health care. Never the less, no standardized instrument exists for collecting and interpreting information on how to avert death and improve the implementation of child survival interventions. OBJECTIVE To describe the methodology, development, and first results of a standard social autopsy tool for the collection of information to understand common barriers to health care, risky behaviors, and missed opportunities for health intervention in deceased children under 5 years old. METHODS Under the INDEPTH Network, a social autopsy working group was formed to reach consensus around a standard social autopsy tool for neonatal and child death. The details around 434 child deaths in Iganga/Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda and 40 child deaths in Dodowa HDSS in Ghana were investigated over 12 to 18 months. Interviews with the caretakers of these children elicited information on what happened before death, including signs and symptoms, contact with health services, details on treatments, and details of doctors. These social autopsies were used to assess the contributions of delays in care seeking and case management to the childhood deaths. RESULTS At least one severe symptom had been recognized prior to death in 96% of the children in Iganga/Mayuge HDSS and in 70% in Dodowa HDSS, yet 32% and 80% of children were first treated at home, respectively. Twenty percent of children in Iganga/Mayuge HDSS and 13% of children in Dodowa HDSS were never taken for care outside the home. In both countries most went to private providers. In Iganga/Mayuge HDSS the main delays were caused by inadequate case management by the health provider, while in Dodowa HDSS the main delays were in the home. CONCLUSION While delay at home was a main obstacle to prompt and appropriate treatment in Dodowa HDSS, there were severe challenges to prompt and adequate case management in the health system in both study sites in Ghana and Uganda. Meanwhile, caretaker awareness of danger signs needs to improve in both countries to promote early care seeking and to reduce the number of children needing referral. Social autopsy methods can improve this understanding, which can assist health planners to prioritize scarce resources appropriately.
Collapse
Affiliation(s)
- Karin Källander
- Department of Health Policy, Planning & Management, School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
- Iganga/Mayuge Health & Demographic Surveillance Site (HDSS), P.O. Box 111, Iganga, Uganda
- Department of Public Health Sciences, Division of International Health (IHCAR), Nobels Väg 9, Karolinska Institutet, Stockholm 17176, Sweden
- Malaria Consortium Africa, P.O box 8045, Kampala, Uganda
| | - Daniel Kadobera
- Iganga/Mayuge Health & Demographic Surveillance Site (HDSS), P.O. Box 111, Iganga, Uganda
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Epidemiological and Demographic Surveillance System (EPI-DSS) Group, Kilifi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Old Road, Oxford OX3 7LJ, UK
| | - Rikke Thoft Nielsen
- Bandim Health Project, Apartado 861, Bissau, 1004 Bissau Codex, Guinea-Bissau
- Statens Serum Institut, 5 Artillerivej, Copenhagen 2300, Denmark
| | - Lucy Yevoo
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dodowa, Ghana
| | - Aloysius Mutebi
- Department of Health Policy, Planning & Management, School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
- Iganga/Mayuge Health & Demographic Surveillance Site (HDSS), P.O. Box 111, Iganga, Uganda
| | - Jonas Akpakli
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dodowa, Ghana
| | - Clement Narh
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dodowa, Ghana
| | - Margaret Gyapong
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dodowa, Ghana
| | - Alberta Amu
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dodowa, Ghana
| | - Peter Waiswa
- Department of Health Policy, Planning & Management, School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
- Iganga/Mayuge Health & Demographic Surveillance Site (HDSS), P.O. Box 111, Iganga, Uganda
| |
Collapse
|