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Dery S, Guure C, Afagbedzi S, Ankomah A, Ampofo W, Atuahene K, Asamoah-Adu C, Kenu E, Weir SS, Tun W, Arhinful D, Torpey K. Biobehavioral survey using time location sampling among female sex workers living in Ghana in 2020. Front Public Health 2024; 12:1137799. [PMID: 38435299 PMCID: PMC10904521 DOI: 10.3389/fpubh.2024.1137799] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Background The HIV epidemic in Ghana is characterized as a mix of a low-level generalized epidemic with significant contributions from transmission among female sex workers (FSW) and their clients. This study seeks to identify and describe key characteristics and sexual behaviors of FSW and estimate the prevalence of HIV, syphilis, gonorrhea, chlamydia, and hepatitis B virus (HBV) among FSW in Ghana. Method A total of 7,000 FSW were recruited for the study using Time Location Sampling (TLS) approach with 5,990 (85.6%) participants completing both biological and the behavioral aspects of the study. A structured questionnaire was administered to respondents to assess several factors, such as background characteristics, sexual risk behaviors, condom usage, HIV/AIDS knowledge, opinions, and attitudes. Trained staff conducted face-to-face interviews using mobile data collection software (REDCap) after provision of specimens for HIV and STI testing. Descriptive statistics such as medians, ranges, charts, and percentages are performed and presented. Also included, are bivariate analyses to establish relationships between FSW type and other relevant characteristics of the study. Results Among the 7,000 (100%) FSW sampled from all regions, 6,773 took part in the behavioral and 6,217 the biological. There were 783 (11.2%) respondents who took part only in the behavioral and 227 (3.2%) only in the biological. Most were young, with a median age of 26 years, majority had never been married or were widowed/divorced and a quarter had no education or had only primary education. Majority (74.8%) of FSW first sold sex at age 25 years or less with a median age of 20 years. Most (84.8%) of the FSW indicated that they entered sex work for money, either for self or family and had an average of eleven (11) sexual partners per week. More than half (55.2%) of the FSW were new entrants who had been in sex work for less than 5 years before the study. Consistent condom use with paying clients was generally unsatisfactory (71%), and was however, very low (24%) with their intimate partners or boyfriends. Only about half (54.6%) of FSW have been exposed to HIV prevention services in the last three months preceding the survey, and this varies across regions. Overall, comprehensive knowledge about HIV and AIDS was low. Only 35% of FSW had comprehensive knowledge. HIV prevalence was 4.6% and was higher among seaters (brothel-based) and older FSW who had been sex work for a longer period. The HIV prevalence from the previous bio-behavioral survey (BBS) in 2015 and 2011 were estimated to be 6.9 and 11.1%, respectively. Conclusion Compared to the results from the previous studies, the findings give an indication that Ghana is making significant progress in reducing the burden of HIV among FSW in the country. However, risky behaviors such as low consistent condom use, low coverage of HIV services across the regions, and low comprehensive knowledge could reverse the gains made so far. Immediate actions should be taken to expand coverage of HIV services to all locations. Efforts must be made to reach out to the new entrants while also addressing strongly held myths and misconceptions about HIV.
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Affiliation(s)
- Samuel Dery
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Seth Afagbedzi
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | | | - William Ampofo
- University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | | | - Ernest Kenu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Sharon Stucker Weir
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Waimar Tun
- HIV and AIDS Program, Population Council, Washington, DC, United States
| | - Daniel Arhinful
- University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Sagoe KWC, Atuahene K, Ayiku ANA, Pappoe-Ashong PJ, Boamah I, Till H, Hagbe FS, Egyire IK, Nyampong M, Addo SA, Manu A, Noora CL, Tetteh M, Ankomah A, Adanu R. Hepatitis B and human immunodeficiency virus infections within correctional facilities in Ghana. PLoS One 2023; 18:e0293009. [PMID: 37922278 PMCID: PMC10624276 DOI: 10.1371/journal.pone.0293009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 10/03/2023] [Indexed: 11/05/2023] Open
Abstract
Previous studies have suggested high Immunodeficiency Virus (HIV) and hepatitis B virus (HBV) prevalence in prisons in Ghana. However, this study was part of a nationally representative bio-behavioural survey and determined the prevalence of HIV and HBV among prison inmates and identified factors associated with these infections. Both biomedical and behavioural data were collected from a total of 2,443 prison inmates from 19 prison stations during 2013 in Ghana; 12 male prisons and 7 female prisons selected across the country. The national HIV screening algorithm was used for HIV testing while two rapid detection tests were used to confirm HBV infections. HIV and HBV prevalence among prisoners in Ghana were approximately 2.34% and 12.38% respectively. Only 5 inmates, had co-infection with both viruses. The prevalence of HIV was significantly lower among male inmates (1.5%) compared to the female inmates (11.8%). Age, sex, and marital status, were significantly associated with both HIV and HBV infections. However, BMI category, IDU, and time spent in prison were associated with HIV infections. The educational level was significantly associated with HBV infections. After binary logistic regression, being female (AOR: 0.18, 95% CI: 0.07-0.45, p<0.001) and having a stay of 5 years or more (AOR: 0.07, 95% CI: 0.01-0.60, p = 0.016), increased the risk of having HIV infection. While, those with no formal education (AOR: 0.65, 95% CI: 0.45-0.95, p = 0.024) and are underweight (AOR: 0.51, 95% CI: 0.27-0.99, p = 0.046), were more likely to have HBV infection. Forced penetrative sex may be a problem in the prisons. The need to have and strengthen an integrated screening, treatment and vaccination plan for the prison is emphasized. The prison does not serve as an exceptionally high risk to the general population. The findings support a critical look at the issue of forced penetrative sex in the prisons.
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Affiliation(s)
- Kwamena W. C. Sagoe
- Department of Medical Microbiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Angela N. A. Ayiku
- Department of Medical Microbiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Prince J. Pappoe-Ashong
- Department of Medical Microbiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Isaac Boamah
- Department of Medical Microbiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Holger Till
- Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH, Accra, Ghana
| | | | | | | | | | - Adom Manu
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Charles L. Noora
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Millicent Tetteh
- Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH, Accra, Ghana
| | - Augustine Ankomah
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Richard Adanu
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Gyamerah AO, Taylor KD, Atuahene K, Anarfi JK, Fletcher M, Raymond HF, McFarland W, Dodoo FNA. Stigma, discrimination, violence, and HIV testing among men who have sex with men in four major cities in Ghana. AIDS Care 2020; 32:1036-1044. [PMID: 32362131 DOI: 10.1080/09540121.2020.1757020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 10/24/2022]
Abstract
LGBTQ populations experience human rights abuses worldwide; data need to document the health impact of these experiences in Africa. In Ghana, we measured events of sexuality-based stigma, discrimination, and violence among men who have sex with men (MSM) and the impact on HIV testing behavior. Data are from respondent-driven sampling surveillance surveys in Accra/Tema, Kumasi, Cape Coast/Takoradi, and Koforidua. Discrimination was common among MSM: 6.2%-30.6% were refused services, 29.0%-48.9% experienced verbal/symbolic violence, 2.8%-12.8% experienced physical violence, 12.3%-30.0% experienced sexual violence due to their sexuality in the preceding year. MSM who experienced sexual violence in their first male sexual encounter were less likely to ever test for HIV in Accra/Tema and Cape Coast/Takoradi. Further studies are needed to examine the impact of stigma and violence on MSM's HIV health-seeking behavior in Ghana. Structural interventions are needed to mitigate the consequences of stigma and discrimination on MSM health and well-being.
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Affiliation(s)
- Akua O Gyamerah
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kelly D Taylor
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - John K Anarfi
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | | | - Henry F Raymond
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.,School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - F Nii-Amoo Dodoo
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana.,The Pennsylvania State University, University Park, PA, USA
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Nyblade L, Addo NA, Atuahene K, Alsoufi N, Gyamera E, Jacinthe S, Leonard M, Mingkwan P, Stewart C, Vormawor R, Kraemer JD. Results from a difference-in-differences evaluation of health facility HIV and key population stigma-reduction interventions in Ghana. J Int AIDS Soc 2020; 23:e25483. [PMID: 32329153 PMCID: PMC7180216 DOI: 10.1002/jia2.25483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/07/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Stigma undermines all aspects of a comprehensive HIV response, as reflected in recent global initiatives for stigma-reduction. Yet a commensurate response to systematically tackle stigma within country responses has not yet occurred, which may be due to the lack of sufficient evidence documenting evaluated stigma-reduction interventions. With stigma present in all life spheres, health facilities offer a logical starting point for developing and expanding stigma reduction interventions. This study evaluates the impact of a "total facility" stigma-reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff in Ghana. METHODS We evaluated the impact of a total facility stigma-reduction intervention by comparing five intervention to five comparable non-intervention health facilities in Ghana. Interventions began in September 2017. Data collection was in June 2017 and April 2018. The primary outcomes were composite indicators for three stigma drivers, self-reported stigmatizing avoidance behaviour, and observed discrimination. The principal intervention variable was whether the respondent worked at an intervention or comparison facility. We estimated intervention effects as differences-in-differences in each outcome, further adjusted using inverse probability of treatment weighting (IPTW). RESULTS We observed favourable intervention effects for all outcome domains except for stigmatizing attitudes. Preferring not to provide services to people living with HIV (PLHIV) or a key population member improved 11.1% more in intervention than comparison facility respondents (95% CI 3.2 to 19.0). Other significant improvements included knowledge of policies to protect against discrimination (difference-in-differences = 20.4%; 95% CI 12.7 to 28.0); belief that discrimination would be punished (11.2%; 95% CI 0.2 to 22.3); and knowledge of and belief in the adequacy of infection control policies (17.6%; 95% CI 8.3 to 26.9). Reported observation of stigma and discrimination incidents fell by 7.4 percentage points more among intervention than comparison facility respondents, though only marginally significant in the IPTW-adjusted model (p = 0.06). Respondents at intervention facilities were 19.0% (95% CI 12.2 to 25.8) more likely to report that staff behaviour towards PLHIV had improved over the last year than those at comparison facilities. CONCLUSIONS These results provide a foundation for scaling up health facility stigma-reduction within national HIV responses, though they should be accompanied by rigorous implementation science to ensure ongoing learning and adaptation for maximum effectiveness and long-term impact.
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Affiliation(s)
- Laura Nyblade
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | - Nii A Addo
- Educational Assessment Research Centre (EARC)AccraGhana
| | | | | | - Emma Gyamera
- Educational Assessment Research Centre (EARC)AccraGhana
| | | | - Madeline Leonard
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Department of Health Systems AdministrationGeorgetown UniversityWashingtonDCUSA
| | - Pia Mingkwan
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | - Christin Stewart
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | | | - John D Kraemer
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Department of Health Systems AdministrationGeorgetown UniversityWashingtonDCUSA
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Badasu D, Kwankye S, Sanuade O, El-Adas A, Atuahene K. Religiosity and Condom Use with Casual Sex Partners in Ghana. Population Review 2016. [DOI: 10.1353/prv.2016.0005] [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: 11/11/2022]
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Laar A, Manu A, Laar M, El-Adas A, Amenyah R, Atuahene K, Quarshie D, Adjei AA, Quakyi I. Coping strategies of HIV-affected households in Ghana. BMC Public Health 2015; 15:166. [PMID: 25886186 PMCID: PMC4343049 DOI: 10.1186/s12889-015-1418-x] [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: 07/29/2014] [Accepted: 01/14/2015] [Indexed: 12/02/2022] Open
Abstract
Background HIV and negative coping mechanisms have a cyclical relationship. HIV infections may lead to the adoption of coping strategies, which may have undesired, negative consequences. We present data on the various coping mechanisms that HIV-affected households in Ghana resort to. Methods We collected data on coping strategies, livelihood activities, food consumption, and asset wealth from a nationally representative sample of 1,745 Ghanaian HIV-affected households. We computed coping strategies index (CSI), effective dependency rate, and asset wealth using previously validated methodologies. Results Various dehumanizing coping strategies instituted by the HIV-affected households included skipping an entire day’s meal (13%), reducing portion sizes (61.3%), harvesting immature crops (7.6%), and begging (5.6%). Two-thirds of the households were asset poor. Asset-poor households had higher CSI than asset-rich households (p <0.001). CSI were also higher among female-headed households and lower where the education level of the household head is higher. Households caring for chronically ill members recorded higher CSI in comparison with their counterparts without the chronically ill (p < 0.05). Conclusions Institution of degrading measures by HIV-affected households in reaction to threat of food insecurity was prevalent. The three most important coping strategies used by households were limiting portion size (61.3%), reducing number of meals per day (59.5%) and relying on less expensive foods (56.2%). The least employed strategies included household member going begging (5.6%), eating elsewhere (8.7%) and harvesting immature crop (7.6%). Given that household assets, and caring for the chronically ill were associated with high CSI, a policy focusing on helping HIV-affected households gradually build up their asset base, or targeting households caring for chronically ill member(s) with conditional household-level support may be reasonable.
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Affiliation(s)
- Amos Laar
- Department of Population, Family, & Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana.
| | - Abubakar Manu
- Department of Population, Family, & Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana.
| | - Matilda Laar
- School of Dietetics and Human Nutrition, McGill University, Montreal, Canada.
| | | | | | | | - Dave Quarshie
- School of Management, Blekinge Tekniska Högskola, SE-371 79, Karlskrona, Sweden.
| | - Andrew Anthony Adjei
- Department of Pathology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.
| | - Isabella Quakyi
- Department of Biological, Environmental, and Occupational Sciences, School of Public Health, University of Ghana, Accra, Ghana.
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Quaye S, Fisher Raymond H, Atuahene K, Amenyah R, Aberle-Grasse J, McFarland W, El-Adas A. Critique and lessons learned from using multiple methods to estimate population size of men who have sex with men in Ghana. AIDS Behav 2015; 19 Suppl 1:S16-23. [PMID: 25704987 DOI: 10.1007/s10461-014-0943-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Population size estimation of key populations at risk of HIV is essential to every national response. We implemented population size estimation of men who have sex with men (MSM) in Ghana using a three-stage approach within the 2011 Ghana Men's Study: during the study's formative assessment, the larger integrated bio-behavioral surveillance (IBBS) survey; and during the stakeholder meeting. We used six methods in combination within the three-stage approach (literature review, mapping with census, unique object multiplier, service multiplier, wisdom of the crowd, and modified Delphi) to generate size estimates from 16 locations (4 IBBS survey sites and 12 other locations) and used the estimates from the 16 sites to extrapolate the total MSM population size of Ghana. We estimated the number of MSM in Ghana to be 30,579 with a plausible range of 21,645-34,470. The overall estimate suggests that the prevalence of MSM in Ghana is 0.48 % of the adult male population. Lessons learned are shared to inform and improve applications of the methods in future studies.
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Affiliation(s)
- Silas Quaye
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, 24 Fourth Circular Rd., Cantonments, Accra, Ghana,
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Reynolds HW, Atuahene K, Sutherland E, Amenyah R, Kwao ID, Larbi ET. Development of a Nationally Coordinated Evaluation Plan for the Ghana National Strategy for Key Populations. J AIDS Clin Res 2014; 5:389. [PMID: 26120495 PMCID: PMC4479146 DOI: 10.4172/2155-6113.1000389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Just as HIV prevention programs need to be tailored to the local epidemic, so should evaluations be country-owned and country-led to ensure use of those results in decision making and policy. The objective of this paper is to describe the process undertaken in Ghana to develop a national evaluation plan for the Ghana national strategy for key populations. METHODS This was a participatory process that involved meetings between the Ghana AIDS Commission (GAC), other partners in Ghana working to prevent HIV among key populations, and MEASURE Evaluation. The process included three two-day, highly structured yet participatory meetings over the course of 12 months during which participants shared information about on-going and planned data and identified research questions and methods. RESULTS An evaluation plan was prepared to inform stakeholders about which data collection activities need to be prioritized for funding, who would implement the study, the timing of data collection, the research question the data will help answer, and the analysis methods. The plan discusses various methods that can be used including the recommendation for the study design using multiple data sources. It has an evaluation conceptual model, proposed analyses, proposed definition of independent variables, estimated costs for filling data gaps, roles and responsibilities of stakeholders to carry out the plan, and considerations for ethics, data sharing and authorship. CONCLUSION The experience demonstrates that it is possible to design an evaluation responsive to national strategies and priorities with country leadership, regardless of stakeholders' experiences with evaluations. This process may be replicable elsewhere, where stakeholders want to plan and implement an evaluation of a large-scale program at the national or subnational level that is responsive to national priorities and part of a comprehensive monitoring and evaluation system.
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Affiliation(s)
- Heidi W Reynolds
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, 400 Meadowmont Village Circle, 3rd Floor, Chapel Hill, NC 27517, USA
| | | | - Elizabeth Sutherland
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, 400 Meadowmont Village Circle, 3rd Floor, Chapel Hill, NC 27517, USA
| | - Richard Amenyah
- Technical Assistance and Capacity Building Manager, Technical Support Facility for West and Central Africa, UNAIDS, Ouagadougou, Burkina Faso, Africa
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Laar A, Fiaveh D, Laar M, Boatemaa S, Abugri J, El-Adas A, Amenyah R, Atuahene K, Adjei AA, Quakyi I. Profiles of HIV-Affected Households in Ghana. Health (London) 2014. [DOI: 10.4236/health.2014.615235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hetzer R, Atuahene K, Balten U, Sippel R, Hundeshagen H, Walter P, Borst HG. [Proceedings: Cineradiographical studies of the behavior of contraction of temporary ischemic areas of the myocardium in pigs (author's transl)]. Thoraxchir Vask Chir 1973; 21:301-5. [PMID: 4542974 DOI: 10.1055/s-0028-1098681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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