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Abdul-Mumin A, Boi-Dsane NAA, Oladokun ST, Owusu SA, Ansah P. A retrospective data analysis on prevalence and risk factors for hypothermia among sick neonates at presentation to the neonatal intensive care unit of the Tamale Teaching Hospital. PLoS One 2024; 19:e0303159. [PMID: 38753864 PMCID: PMC11098396 DOI: 10.1371/journal.pone.0303159] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/20/2024] [Indexed: 05/18/2024] Open
Abstract
Neonatal hypothermia, defined as an axillary temperature of <36.5C in a neonate, is common in neonatal intensive care units and is almost universal across all geographic and climatic regions of the world. This is even though environmental temperature is a known risk factor for its occurrence. We conducted a retrospective study in the Neonatal Intensive Care Unit of the Tamale Teaching Hospital (TTH) to document the prevalence and risk factors associated with hypothermia at presentation to the hospital. The study spanned the period from January 2019 to December 2019 and involved all neonates with axillary temperature documented at the time of admission. The prevalence of neonatal hypothermia in this study was 54.76%. Hypothermia was most common in neonates diagnosed with meconium aspiration syndrome (87/105, 82.86%), prematurity and low birth weight (575/702, 81.91%), and birth asphyxia (347/445, 77.98%). Neonates who were delivered vaginally were less likely to develop hypothermia compared to those delivered via Cesarean section. Inborn neonates (delivered in TTH) were 3.2 times more likely to be hypothermic when compared to those who were delivered at home. Neonates with low birth weight and APGAR scores < 7 at 1 and 5 minutes were more likely to be hypothermic. The dry season was found to be protective against hypothermia when compared to the rainy season. The overall mortality rate was 13.68% and the mortality in the subgroup with hypothermia at presentation was 18.87%. Our study documented a high prevalence of hypothermia with higher rates in neonates requiring intervention at birth. It is therefore crucial for perinatal care providers to adhere to the warm chain precautions around the time of birth.
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Affiliation(s)
- Alhassan Abdul-Mumin
- Department of Pediatrics and Child Health, School of Medicine, University for Development Studies, Box TL, 1350, Tamale, Ghana
- Department of Pediatrics and Child Health, Tamale Teaching Hospital, Box TL 16, Tamale, Ghana
| | | | | | - Sheila Agyeiwaa Owusu
- Department of Pediatrics and Child Health, School of Medicine, University for Development Studies, Box TL, 1350, Tamale, Ghana
- Department of Pediatrics and Child Health, Tamale Teaching Hospital, Box TL 16, Tamale, Ghana
| | - Patrick Ansah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
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Cliff M, Welaga P, Mohammed N, Ansah P, Heyderman RS, Trotter C, Kwambana-Adams B. Strategies for controlling pneumococcal disease and outbreaks during humanitarian emergencies. Nat Med 2024:10.1038/s41591-024-02922-x. [PMID: 38649779 DOI: 10.1038/s41591-024-02922-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Molly Cliff
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Paul Welaga
- Navrongo Health Research Centre, Navrongo, Ghana
- C.K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Nuredin Mohammed
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Robert S Heyderman
- Division of Infection and Immunity, University College London, London, UK
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Brenda Kwambana-Adams
- Division of Infection and Immunity, University College London, London, UK.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi.
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Welaga P, Mutua MK, Ahmed Hanifi SM, Ansah P, Aaby P, Nielsen S. Effect of national immunisation campaigns with oral polio vaccine on all-cause mortality in children in rural northern Ghana: 20 years of demographic surveillance cohort data. EClinicalMedicine 2023; 66:102322. [PMID: 38143803 PMCID: PMC10746391 DOI: 10.1016/j.eclinm.2023.102322] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/26/2023] Open
Abstract
Background Studies from Guinea-Bissau and Bangladesh have shown that campaigns with oral polio vaccine (C-OPV) may be associated with 25-31% lower child mortality. Between 1996 and 2015, Ghana had 50 national C-OPVs and numerous campaigns with vitamin A supplementation (VAS), and measles vaccine (MV). We investigated whether C-OPVs had beneficial non-specific effects (NSEs) on child survival in northern Ghana. Methods We used data from a health and demographic surveillance system in the Navrongo Health Research Centre in rural northern Ghana to examine mortality from day 1-5 years of age. We used Cox models with age as underlying time scale to calculate hazard ratios (HR) for the time-varying covariate "after-campaign" mortality versus "before-campaign" mortality, adjusted for temporal change in mortality, other campaign interventions and stratified for season at risk. Findings From 1996 to 2015, 75,610 children were followed for 280,156 person-years between day 1 and 5 years of age. In initial analysis, assuming a common effect across all ages, we did not find that OPV-only campaigns significantly reduced all-cause mortality, the HR being 0.96 (95% CI: 0.88-1.05). However, we subsequently found the HR differed strongly by age group, being 0.92 (0.75-1.13), 1.29 (1.10-1.51), 0.79 (0.66-0.94), 0.67 (0.53-0.86) and 1.03 (0.78-1.36) respectively for children aged 0-2, 3-5, 6-8, 9-11 and above 12 months of age (p < 0.001). Triangulation of the evidence from this and previous studies suggested that increased frequency of C-OPVs and a different historical period could explain these results. Interpretation In Ghana, C-OPVs had limited effects on overall child survival. However, triangulating the evidence suggested that NSEs of C-OPVs depend on age of first exposure and routine vaccination programs. C-OPVs had beneficial effects for children that were not exposed before 6 months of age. These non-specific effects of OPV should be exploited to further reduce child mortality. Funding DANIDA; Else og Mogens Wedell Wedellsborgs Fond.
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Affiliation(s)
- Paul Welaga
- School of Public Health, CK Tedam University of Technology and Applied Sciences, P. O. Box 24, Navrongo, Ghana
- Navrongo Health Research Centre, P. O. Box 114, Navrongo, Ghana
| | - Martin Kavao Mutua
- African Population and Health Research Center, P.O Box 10787 – 00100, Nairobi, Kenya
| | - Syed Manzoor Ahmed Hanifi
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Patrick Ansah
- Navrongo Health Research Centre, P. O. Box 114, Navrongo, Ghana
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- OPEN, Institute for Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Sebastian Nielsen
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- OPEN, Institute for Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
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Oduro AR, Anyorikeya M, Ansah P, Oladokun S, Tei EM, Oduro-Ayeh R, Welaga P, Deh S. Birth preparedness and complications readiness among women in disadvantaged rural districts of Ghana. BMC Pregnancy Childbirth 2023; 23:728. [PMID: 37838691 PMCID: PMC10576372 DOI: 10.1186/s12884-023-06041-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/02/2023] [Indexed: 10/16/2023] Open
Abstract
INTRODUCTION Essentially all women and babies irrespective of their economic and social status should reach their full potential for health and well-being. The study assessed the readiness of mothers and their preparedness for birth across three disadvantaged rural districts in Ghana. METHODS A multi-centre quantitative survey from January to December 2018 using a multistage sampling approach was employed. Using a structured questionnaire data from mothers attending antenatal and postnatal clinics in three main ecological zones of Ghana were collected. Women who provided informed consent were consecutively recruited until the sample size was achieved. For categorical data, summary tables, proportions and percentage are presented. Multivariate logistic regression analysis determined the effect of selected characteristics on birth preparedness. Ethics approval was obtained from the Navrongo Health Research Centre. RESULTS A total of 1058 mothers were enrolled: 33.6%, 33.4% and 33.0% respectively from the Ada west, Upper Denkyira west and Builsa south districts. About 94% of the women had prior knowledge of birth preparedness. Approximately 22.6% (95%CI 20.1, 25. 2) of the mothers were assessed to have poor birth preparedness: 8.0% in Builsa south, 27.8% in Ada west and 31.7% in Upper Denkyira west. Prenatal and postnatal data showed no statistically significant difference in poor preparedness (21.9% vs 23.3%; p-value > 0.05). Maternal age, employment status, religious affiliation and parity were not associated with birth preparedness (p-value > 0.05). Area of study (P < 0.001), educational level (P < 0.016), marital status (p < 0.001) and antenatal contacts (< 0.001) were significantly associated with birth preparedness. CONCLUSIONS As an important safe motherhood strategy woman should plan their pregnancy and birth well to reduce maternal and neonatal mortality. Policy initiatives should take into consideration area of residence, education, marital status and antenatal contacts of women.
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Affiliation(s)
- Abraham Rexford Oduro
- Research and Development Division, Ghana Health Service, Accra, Ghana.
- Population and Health Research Centre, Dunkwa, Ghana.
| | | | | | | | - Ernest Maya Tei
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Randy Oduro-Ayeh
- Population and Health Research Centre, Dunkwa, Ghana
- Navrongo Health Research Centre, Navrongo, Ghana
| | - Paul Welaga
- Navrongo Health Research Centre, Navrongo, Ghana
| | - Seli Deh
- Population and Health Research Centre, Dunkwa, Ghana
- Krowor Municipal Health Directorate, Regional Health Directorate, Accra, Ghana
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Bawa FK, Mutocheluh M, Dassah S, Ansah P, Oduro AR. Genetic diversity of rotavirus infection among young children with diarrhoea in the Kasena-Nankana Districts of Northern Ghana: a seasonal cross-sectional survey. Pan Afr Med J 2023. [DOI: 10.11604/pamj.2023.44.148.36783] [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: 03/30/2023] Open
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Oduro AR, Francke J, Ansah P, Jackson EF, Wak G, Phillips JF, Haykin LA, Azongo D, Bawah AA, Welaga P, Hodgson A, Aborigo R, Heller DJ. Social and demographic correlates of cardiovascular mortality in the Kassena-Nankana districts of Ghana: a verbal post-mortem analysis. Int J Epidemiol 2021; 51:591-603. [PMID: 34957517 DOI: 10.1093/ije/dyab244] [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: 03/17/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The burden of cardiovascular disease (CVD) in Ghana is rising, but details on its epidemiology are scarce. We sought to quantify mortality due to CVD in two districts in rural Ghana using verbal post-mortem (VPM) data. METHODS We conducted a proportional sub-hazards analysis of 10 232 deaths in the Kassena-Nankana East and West districts from 2005 to 2012, to determine adult mortality attributed to CVD over time. We stratified results by age, gender and socio-economic status (SES), and compared CVD mortality among SES and gender strata over time. A competing risk model estimated the cumulative effect of eliminating CVD from the area. RESULTS From 2005 to 2012, CVD mortality more than doubled overall, from 0.51 deaths for every 1000 person-years in 2005 to 1.08 per 1000 person-years in 2012. Mortality peaked in 2008 at 1.23 deaths per 1000 person-years. Increases were comparable in men (2.0) and women (2.3), but greater among the poorest residents (3.3) than the richest (1.3), and among persons aged 55-69 years (2.1) than those aged ≥70 years (1.8). By 2012, male and female CVD mortality was highest in middle-SES persons. We project that eliminating CVD would increase the number of individuals reaching age 73 years from 35% to 40%, adding 1.6 years of life expectancy. CONCLUSIONS The burden of CVD on overall mortality in the Upper East Region is substantial and markedly increasing. CVD mortality has especially increased in lower-income persons and persons in middle age. Further initiatives for the surveillance and control of CVD in these vulnerable populations are needed.
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Affiliation(s)
- Abraham R Oduro
- Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - Jordan Francke
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Dr. Francke's current affiliation is the Department of Anesthesia and Perioperative Medicine, UCLA Health, Los Angeles, CA, USA
| | - Patrick Ansah
- Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - Elizabeth F Jackson
- The Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - George Wak
- Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - James F Phillips
- The Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Leah A Haykin
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Azongo
- Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - Ayaga A Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Paul Welaga
- Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - Abraham Hodgson
- Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - Raymond Aborigo
- Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana
| | - David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Quashie PK, Mutungi JK, Dzabeng F, Oduro-Mensah D, Opurum PC, Tapela K, Udoakang AJ, Asante I, Paemka L, Kumi-Ansah F, Quaye O, Amoako E, Armah R, Kilba C, Boateng NA, Ofori M, Kyei GB, Bediako Y, Ndam N, Abugri J, Ansah P, Ampofo WK, Mutapi F, Awandare GA. Trends of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody prevalence in selected regions across Ghana. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16890.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: We set out to estimate the community-level exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Ghana. Methods: Phased seroprevalence studies of 2729 participants at selected locations across Ghana were conducted. Phase I (August 2020) sampled 1305 individuals at major markets/lorry stations, shopping malls, hospitals and research institutions involved in coronavirus disease 2019 (COVID-19) work. The study utilized a lateral flow rapid diagnostic test (RDT) which detected IgM and IgG antibodies against SARS-CoV-2 nucleocapsid protein. Results: During Phase I, 252/1305 (19%) tested positive for IgM or IgG or both. Exposure was significantly higher at markets/lorry stations (26.9%) compared to malls (9.4%), with 41–60-year group demonstrating highest seropositivity (27.2%). Exposure was higher in participants with no formal education (26.2%) than those with tertiary education (13.1%); and higher in informally employed workers (24.0%) than those in the formal sector (15.0%). Results from phases II and III, in October and December 2020 respectively, implied either reduced transmissions or loss of antibody expression in some participants. The Upper East region showed the lowest seropositivity (2%). Phase IV, in February 2021, showed doubled seropositivity in the upper income bracket (26.2%) since August 2020, reflective of Ghana’s second wave of symptomatic COVID-19 cases. This suggested that high transmission rates had overcome the initial socioeconomic stratification of exposure risk. Reflective of second wave hospitalisation trends, the 21-40 age group demonstrated modal seropositivity (24.9) in Phase IV whilst 40-60 years and 60+ previously demonstrated highest prevalence. Conclusions: Overall, the data indicates higher COVID-19 seroprevalence than officially acknowledged, likely implying a considerably lower-case fatality rate than the current national figure of 0.84%. The data also suggests that COVID-19 is predominantly asymptomatic COVID-19 in Ghana. The observed trends mimic clinical trends of infection and imply that the methodology used was appropriate.
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Domingo C, Bhat N, Ansah P, Mejía JE. Stablity of yellow fever virus neutralising antibody titres – Authors' reply. The Lancet Infectious Diseases 2020; 20:167. [DOI: 10.1016/s1473-3099(19)30749-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
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Idoko OT, Mohammed N, Ansah P, Hodgson A, Tapia MD, Sow SO, Chowdhury PR, Niedrig M, Saathoff E, Kampmann B. Antibody responses to yellow fever vaccine in 9 to 11-month-old Malian and Ghanaian children. Expert Rev Vaccines 2019; 18:867-875. [PMID: 31269829 DOI: 10.1080/14760584.2019.1640118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/26/2022]
Abstract
Background: The World Health Organization recommends use of a single yellow fever (YF) vaccine dose for life and fractional doses in outbreaks when there are limited vaccine stocks. In endemic regions, this vaccine is given as part of routine infant immunization programs around 9 months of age. There is a need to better understand immune responses when vaccinating infants particularly in contexts where the child may be malnourished. Methods: Data from 393 Malian and Ghanaian infants who concomitantly received measles and YF vaccines at 9 to 11 months of age were retrospectively analyzed. Response to YF vaccine was examined for association with nutritional status at time of vaccination, sex, age, pre-vaccination titers and season of vaccination. Results: Neutralizing antibodies following vaccination were unaffected by season of vaccination, sex, pre-vaccination titers or nutritional status, though there was a trend to higher titers in males and children with higher height for age z-scores. Seroconversion rates differed significantly between countries (63.5 in Ghana vs. 91.0% in Mali). Conclusion: Longitudinal, prospective studies are needed to optimize the use of YF vaccine in infants in endemic settings. There may be a need for booster vaccinations and to compare various vaccine preparations to optimize the use of available vaccines.
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Affiliation(s)
- Olubukola T Idoko
- a The Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine , Fajara , The Gambia.,b CIHLMU Center for International Health, Medical Center of the University of Munich (LMU) , Munich , Germany
| | - Nuredin Mohammed
- a The Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine , Fajara , The Gambia
| | - Patrick Ansah
- c Navrongo Health Research Centre, Ghana Health Service , Navrongo , Ghana
| | - Abraham Hodgson
- c Navrongo Health Research Centre, Ghana Health Service , Navrongo , Ghana
| | - Milagritos D Tapia
- d Centre pour le Developement des Vaccins, University of Maryland , Bamako , Mali
| | - Samba O Sow
- d Centre pour le Developement des Vaccins, University of Maryland , Bamako , Mali
| | - Paanchali R Chowdhury
- e Centre for Biologic Threats and Special Pathogens, Robert Koch Institute , Berlin , Germany
| | - Matthias Niedrig
- e Centre for Biologic Threats and Special Pathogens, Robert Koch Institute , Berlin , Germany
| | - Elmar Saathoff
- f Division of Infectious Diseases and Tropical Medicine, University Hospital , LMU Munich , Germany.,g German Centre for Infection Research (DZIF), partner site Munich , Germany
| | - Beate Kampmann
- a The Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine , Fajara , The Gambia.,h The Vaccine Centre, London School of Hygiene and Tropical Medicine , London , England
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Nonvignon J, Aryeetey GC, Issah S, Ansah P, Malm KL, Ofosu W, Tagoe T, Agyemang SA, Aikins M. Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana. Malar J 2016; 15:367. [PMID: 27423900 PMCID: PMC4947302 DOI: 10.1186/s12936-016-1418-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 04/22/2016] [Accepted: 07/04/2016] [Indexed: 11/29/2022] Open
Abstract
Background In Ghana, malaria is endemic and perennial (with significant seasonal variations in the three Northern Regions), accounting for 33 % of all deaths among children under 5 years old, with prevalence rates in children under-five ranging from 11 % in Greater Accra to 40 % in Northern Region. Ghana adopted the WHO-recommended Seasonal Malaria Chemoprevention (SMC) strategy with a trial in the Upper West Region in 2015. The objective of this study was to estimate the cost-effectiveness of seasonal malaria chemoprevention. Methods Costs were analysed from provider and societal perspectives and are reported in 2015 US$. Data on resource use (direct and indirect costs) of the SMC intervention were collected from intervention records and a survey in all districts and at regional level. Additional numbers of malaria cases and deaths averted by the intervention were estimated based on prevalence data obtained from an SMC effectiveness study in the region. Incremental cost-effectiveness ratios (ICERs) were estimated for the districts and region. Sensitivity analyses were conducted to test the robustness of the ICERs. Results The total financial cost of the intervention was US$1,142,040.80. The total economic cost was estimated to be US$7.96 million and US$2.66 million from the societal and provider perspectives, respectively. The additional numbers of cases estimated to be averted by the intervention were 24,881 and 808, respectively. The economic cost per child dosed was US$67.35 from societal perspective and US$22.53 from the provider perspective. The economic cost per additional case averted was US$107.06 from the provider perspective and US$319.96 from the societal perspective. The economic cost per additional child death averted by the intervention was US$3298.36 from the provider perspective and US$9858.02 from the societal perspective. The financial cost per the SMC intervention delivered to a child under-five was US$9.66. The ICERs were sensitive to mortality rate used. Conclusions The SMC intervention is economically beneficial in reducing morbidity in children under-5 years and presents a viable approach to improving under-five health in Ghana.
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Affiliation(s)
- Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana
| | - Genevieve Cecilia Aryeetey
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana
| | - Shamwill Issah
- UK Department for International Development, Accra, Ghana
| | - Patrick Ansah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Keziah L Malm
- National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | - Winfred Ofosu
- Upper West Regional Health Directorate, Ghana Health Service, Wa, Ghana
| | - Titus Tagoe
- Upper West Regional Health Directorate, Ghana Health Service, Wa, Ghana
| | - Samuel Agyei Agyemang
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana
| | - Moses Aikins
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana.
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Chandra R, Ansah P, Sagara I, Sie A, Tiono AB, Djimde AA, Zhao Q, Robbins J, Penali LK, Ogutu B. Comparison of azithromycin plus chloroquine versus artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in children in Africa: a randomized, open-label study. Malar J 2015; 14:108. [PMID: 25881046 PMCID: PMC4358906 DOI: 10.1186/s12936-015-0620-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/22/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This randomized, open-label study was conducted to establish the non-inferiority of a combination of azithromycin (AZ) and chloroquine (CQ) to artemether-lumefantrine (AL) for treatment of uncomplicated malaria in children from six sites in sub-Saharan Africa. METHODS Children with uncomplicated Plasmodium falciparum malaria between six and 59 months of age were randomized 1:1 to either AZCQ (30 mg/kg AZ + 10 mg/kg CQ base) or AL per prescribing information for three days (Days 0, 1, 2). Each site could enrol in the study population once the treatment of uncomplicated malaria in five children five to 12 years of age was deemed to be effective and well tolerated. The primary efficacy evaluation was the proportion of subjects in both the modified intent-to-treat (MITT) and per-protocol (PP) populations with an adequate clinical and parasitological response (PCR corrected) at Day 28. Non-inferiority was concluded if the lower bound of the 95% confidence interval comparing the two groups was 10 percentage points or greater. RESULTS A total of 255 children were enrolled in the efficacy analysis (AZCQ, n = 124; AL, n = 131). The PCR corrected clearance rates were 89% (AZCQ) versus 98% (AL) for MITT, a difference of -9.10 (95% confidence interval; -16.02, -2.18) and 93% (AZCQ) versus 99% (AL) for PP, a difference of -6.08 (-12.10, -0.05). Early and late treatment failures were more common in subjects receiving AZCQ. Adverse events were more common in subjects treated with AZCQ. Drug concentrations obtained at specified time points following AZCQ administration had a large coefficient of variation partially due to sparse sampling with sample collection time window. CONCLUSIONS In this study, non-inferiority of AZCQ to AL was not demonstrated. TRIAL REGISTRATION ClinicalTrials.gov NCT00677833 .
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Affiliation(s)
| | - Patrick Ansah
- Navrongo Health Research Centre, Ghana Health Service War Memorial Hospital, Navrongo, Ghana.
| | - Issaka Sagara
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali.
| | - Ali Sie
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
| | - Alfred B Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
| | - Abdoulaye A Djimde
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali.
| | - Qinying Zhao
- Global Research and Development, Pfizer Inc, 445 Eastern Point Road, Groton, CT, 06340, USA.
| | - Jeffery Robbins
- Global Research and Development, Pfizer Inc, 445 Eastern Point Road, Groton, CT, 06340, USA.
| | - Louis K Penali
- Institut Pasteur de Côte d' Ivoire, Unité de Paludologie, Abidjan, Côte d'Ivoire.
| | - Bernhards Ogutu
- Walter Reed Project, Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya.
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Streatfield PK, Khan WA, Bhuiya A, Hanifi SMA, Alam N, Bagagnan CH, Sié A, Zabré P, Lankoandé B, Rossier C, Soura AB, Bonfoh B, Kone S, Ngoran EK, Utzinger J, Haile F, Melaku YA, Weldearegawi B, Gomez P, Jasseh M, Ansah P, Debpuur C, Oduro A, Wak G, Adjei A, Gyapong M, Sarpong D, Kant S, Misra P, Rai SK, Juvekar S, Lele P, Bauni E, Mochamah G, Ndila C, Williams TN, Laserson KF, Nyaguara A, Odhiambo FO, Phillips-Howard P, Ezeh A, Kyobutungi C, Oti S, Crampin A, Nyirenda M, Price A, Delaunay V, Diallo A, Douillot L, Sokhna C, Gómez-Olivé FX, Kahn K, Tollman SM, Herbst K, Mossong J, Chuc NTK, Bangha M, Sankoh OA, Byass P. Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites. Glob Health Action 2014; 7:25365. [PMID: 25377326 PMCID: PMC4220128 DOI: 10.3402/gha.v7.25365] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 07/03/2014] [Revised: 08/30/2014] [Accepted: 09/02/2014] [Indexed: 11/21/2022] Open
Abstract
Background Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15–64 years) and older (65+ years) NCD mortality. Design All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15–64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. Conclusions These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work.
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Affiliation(s)
- P Kim Streatfield
- Matlab HDSS, Bangladesh; International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana
| | - Wasif A Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana; Bandarban HDSS, Bangladesh
| | - Abbas Bhuiya
- INDEPTH Network, Accra, Ghana; Chakaria HDSS, Bangladesh; Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Syed M A Hanifi
- INDEPTH Network, Accra, Ghana; Chakaria HDSS, Bangladesh; Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nurul Alam
- INDEPTH Network, Accra, Ghana; AMK HDSS, Bangladesh; Centre for Population, Urbanisation and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Cheik H Bagagnan
- INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso
| | - Ali Sié
- INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso
| | - Pascal Zabré
- INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso
| | - Bruno Lankoandé
- INDEPTH Network, Accra, Ghana; Ouagadougou HDSS, Burkina Faso; Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Burkina Faso and Institut d'Études Démographique et du parcours de vie, Université de Genève, Geneva, Switzerland
| | - Clementine Rossier
- INDEPTH Network, Accra, Ghana; Ouagadougou HDSS, Burkina Faso; Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Burkina Faso and Institut d'Études Démographique et du parcours de vie, Université de Genève, Geneva, Switzerland
| | - Abdramane B Soura
- INDEPTH Network, Accra, Ghana; Ouagadougou HDSS, Burkina Faso; Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Burkina Faso and Institut d'Études Démographique et du parcours de vie, Université de Genève, Geneva, Switzerland
| | - Bassirou Bonfoh
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Siaka Kone
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Eliezer K Ngoran
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Université Félix Houphoët-Boigny, Abidjan, Côte d'Ivoire
| | - Juerg Utzinger
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Fisaha Haile
- INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yohannes A Melaku
- INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Berhe Weldearegawi
- INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Pierre Gomez
- INDEPTH Network, Accra, Ghana; Farafenni HDSS, The Gambia; Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - Momodou Jasseh
- INDEPTH Network, Accra, Ghana; Farafenni HDSS, The Gambia; Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - Patrick Ansah
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - Cornelius Debpuur
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - Abraham Oduro
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - George Wak
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - Alexander Adjei
- INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Dodowa Health Research Centre, Dodowa, Ghana
| | - Margaret Gyapong
- INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Ballabgarh HDSS, India
| | - Doris Sarpong
- INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Ballabgarh HDSS, India
| | - Shashi Kant
- INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India
| | - Puneet Misra
- INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay K Rai
- INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Juvekar
- INDEPTH Network, Accra, Ghana; Vadu HDSS, India; Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Pallavi Lele
- INDEPTH Network, Accra, Ghana; Vadu HDSS, India; Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Evasius Bauni
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - George Mochamah
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Carolyne Ndila
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Thomas N Williams
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Medicine, Imperial College, St. Mary's Hospital, London, United Kingdom
| | - Kayla F Laserson
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Amek Nyaguara
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Frank O Odhiambo
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Penelope Phillips-Howard
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Alex Ezeh
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Catherine Kyobutungi
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Samuel Oti
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Amelia Crampin
- INDEPTH Network, Accra, Ghana; Karonga HDSS, Malawi; Karonga Prevention Study, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Moffat Nyirenda
- INDEPTH Network, Accra, Ghana; Karonga HDSS, Malawi; Karonga Prevention Study, Chilumba, Malawi
| | - Alison Price
- INDEPTH Network, Accra, Ghana; Karonga HDSS, Malawi; Karonga Prevention Study, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Valérie Delaunay
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - Aldiouma Diallo
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - Laetitia Douillot
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - Cheikh Sokhna
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - F Xavier Gómez-Olivé
- INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Stephen M Tollman
- INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Kobus Herbst
- INDEPTH Network, Accra, Ghana; Africa Centre HDSS, South Africa; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa
| | - Joël Mossong
- INDEPTH Network, Accra, Ghana; Africa Centre HDSS, South Africa; National Health Laboratory, Surveillance & Epidemiology of Infectious Diseases, Dudelange, Luxembourg
| | - Nguyen T K Chuc
- INDEPTH Network, Accra, Ghana; FilaBavi HDSS, Vietnam; Health System Research, Hanoi Medical University, Hanoi, Vietnam
| | | | - Osman A Sankoh
- INDEPTH Network, Accra, Ghana; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hanoi Medical University, Hanoi, Vietnam;
| | - Peter Byass
- INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
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Streatfield PK, Khan WA, Bhuiya A, Hanifi SMA, Alam N, Millogo O, Sié A, Zabré P, Rossier C, Soura AB, Bonfoh B, Kone S, Ngoran EK, Utzinger J, Abera SF, Melaku YA, Weldearegawi B, Gomez P, Jasseh M, Ansah P, Azongo D, Kondayire F, Oduro A, Amu A, Gyapong M, Kwarteng O, Kant S, Pandav CS, Rai SK, Juvekar S, Muralidharan V, Wahab A, Wilopo S, Bauni E, Mochamah G, Ndila C, Williams TN, Khagayi S, Laserson KF, Nyaguara A, Van Eijk AM, Ezeh A, Kyobutungi C, Wamukoya M, Chihana M, Crampin A, Price A, Delaunay V, Diallo A, Douillot L, Sokhna C, Gómez-Olivé FX, Mee P, Tollman SM, Herbst K, Mossong J, Chuc NTK, Arthur SS, Sankoh OA, Byass P. HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Glob Health Action 2014; 7:25370. [PMID: 25377330 PMCID: PMC4220131 DOI: 10.3402/gha.v7.25370] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 07/03/2014] [Revised: 08/28/2014] [Accepted: 09/02/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data. OBJECTIVE To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia. DESIGN Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population. RESULTS The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates. CONCLUSIONS Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS.
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Affiliation(s)
- P Kim Streatfield
- Matlab HDSS, Bangladesh; International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana
| | - Wasif A Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana; Bandarban HDSS, Bangladesh
| | - Abbas Bhuiya
- INDEPTH Network, Accra, Ghana; Chakaria HDSS, Bangladesh; Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Syed M A Hanifi
- INDEPTH Network, Accra, Ghana; Chakaria HDSS, Bangladesh; Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nurul Alam
- INDEPTH Network, Accra, Ghana; AMK HDSS, Bangladesh; Centre for Population, Urbanisation and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Ourohiré Millogo
- INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso
| | - Ali Sié
- INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso
| | - Pascal Zabré
- INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso
| | - Clementine Rossier
- INDEPTH Network, Accra, Ghana; Ouagadougou HDSS, Burkina Faso; Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Burkina Faso; Institut d'Études Démographique et du parcours de vie, Université de Genève, Geneva, Switzerland
| | - Abdramane B Soura
- INDEPTH Network, Accra, Ghana; Ouagadougou HDSS, Burkina Faso; Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Burkina Faso
| | - Bassirou Bonfoh
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Siaka Kone
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Eliezer K Ngoran
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Université Félix Houphoët-Boigny, Abidjan, Côte d'Ivoire
| | - Juerg Utzinger
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Semaw F Abera
- INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yohannes A Melaku
- INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Berhe Weldearegawi
- INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Pierre Gomez
- INDEPTH Network, Accra, Ghana; Farafenni HDSS, The Gambia; Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - Momodou Jasseh
- INDEPTH Network, Accra, Ghana; Farafenni HDSS, The Gambia; Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - Patrick Ansah
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - Daniel Azongo
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - Felix Kondayire
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - Abraham Oduro
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - Alberta Amu
- INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Dodowa Health Research Centre, Dodowa, Ghana
| | - Margaret Gyapong
- INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Dodowa Health Research Centre, Dodowa, Ghana
| | - Odette Kwarteng
- INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Dodowa Health Research Centre, Dodowa, Ghana
| | - Shashi Kant
- INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India
| | - Chandrakant S Pandav
- INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay K Rai
- INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Juvekar
- INDEPTH Network, Accra, Ghana; Vadu HDSS, India; Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Veena Muralidharan
- INDEPTH Network, Accra, Ghana; Vadu HDSS, India; Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Abdul Wahab
- INDEPTH Network, Accra, Ghana; Purworejo HDSS, Indonesia; Department of Public Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Siswanto Wilopo
- INDEPTH Network, Accra, Ghana; Purworejo HDSS, Indonesia; Department of Public Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Evasius Bauni
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - George Mochamah
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Carolyne Ndila
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Thomas N Williams
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Medicine, Imperial College, St. Mary's Hospital, London, United Kingdom
| | - Sammy Khagayi
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Kayla F Laserson
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Amek Nyaguara
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Anna M Van Eijk
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Alex Ezeh
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Catherine Kyobutungi
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Marylene Wamukoya
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Menard Chihana
- INDEPTH Network, Accra, Ghana; Karonga HDSS, Malawi; African Population and Health Research Center, Nairobi, Kenya
| | - Amelia Crampin
- INDEPTH Network, Accra, Ghana; Karonga HDSS, Malawi; Karonga Prevention Study, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alison Price
- INDEPTH Network, Accra, Ghana; Karonga HDSS, Malawi; Karonga Prevention Study, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Valérie Delaunay
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - Aldiouma Diallo
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - Laetitia Douillot
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - Cheikh Sokhna
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - F Xavier Gómez-Olivé
- INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul Mee
- INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Tollman
- INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal; Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Kobus Herbst
- INDEPTH Network, Accra, Ghana; Africa Centre HDSS, South Africa; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa
| | - Joël Mossong
- INDEPTH Network, Accra, Ghana; Africa Centre HDSS, South Africa; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa; National Health Laboratory, Surveillance & Epidemiology of Infectious Diseases, Dudelange, Luxembourg
| | - Nguyen T K Chuc
- INDEPTH Network, Accra, Ghana; FilaBavi HDSS, Vietnam; Health System Research, Hanoi Medical University, Hanoi, Vietnam
| | | | - Osman A Sankoh
- INDEPTH Network, Accra, Ghana; FilaBavi HDSS, Vietnam; Hanoi Medical University, Hanoi, Vietnam;
| | - Peter Byass
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Umeå University, Sweden
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Oduro A, Anyorigiya T, Anto F, Amenga-Etego L, Ansah N, Atobrah P, Ansah P, Koram K, Hodgson A. A randomized, comparative study of supervised and unsupervised artesunate–amodiaquine, for the treatment of uncomplicated malaria in Ghana. Annals of Tropical Medicine & Parasitology 2013; 102:565-76. [DOI: 10.1179/136485908x337508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Vogt S, Siebenlist S, Hensler D, Weigelt L, Ansah P, Woertler K, Imhoff AB. Osteochondral transplantation in the elbow leads to good clinical and radiologic long-term results: an 8- to 14-year follow-up examination. Am J Sports Med 2011; 39:2619-25. [PMID: 21868690 DOI: 10.1177/0363546511420127] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the long-term follow-up after debridement, microfracture, or drilling of osteochondral lesions in the elbow, subsequent osteoarthritis is a problem. Osteochondral transplantation for these defects has become a more common procedure. However, long-term results are unknown. PURPOSE This study was undertaken to evaluate long-term clinical and radiologic outcomes of advanced osteochondral lesions in the elbow treated with osteochondral transplantation. STUDY DESIGN Case series; Level of evidence, 4. METHODS The study included 8 patients with osteochondral lesions in the elbow who were treated by autologous osteochondral transplantation between 1996 and 2002. Patients (average age, 17 years) were evaluated pre- and postoperatively by Broberg-Morrey score to assess elbow function and by American Shoulder and Elbow Surgeons (ASES) score for pain analysis. In addition, radiographs (at the first postoperative day, and at 5-year and 10-year follow-up) and magnetic resonance images (8 to 12 weeks postoperatively, and at 5-year and 10-year follow-up) were made to evaluate the joint status. At last follow-up (range, 8-14 years postoperatively), 7 of 8 patients were seen for clinical examination and radiologic analysis. RESULTS The Broberg-Morrey score increased from an average of 75.9 ± 13.1 to 96.4 ± 2.4 and ASES score significantly improved as follows: worst pain, 7.9 ± 1.1 to 1.6 ± 1.9; rest pain, 3.14 ± 2.7 to 0.6 ± 1.5; weight-lifting pain, 7.6 ± 0.8 to 3.1 ± 1.6; and repetitive movement pain, 5.3 ± 2.4 to 1.6 ± 1.5. Compared with the contralateral side, there was a mean preoperative flexion lag of 12.5° ± 11.6°. At the final follow-up, flexion was free. The mean extension lag was reduced from average 5.4° ± 5.7° to 0°. Radiographs of 2 patients made at final follow-up showed mild signs of osteoarthritis (Kellgren and Lawrence grade I). Postoperative magnetic resonance images showed graft viability in all and a congruent chondral surface in 6 of 7 patients. CONCLUSION Clinical long-term results after osteochondral transplantation in the elbow are good to excellent and comparable with midterm results in the literature. Therefore, this technique is a reliable option for satisfactory long-term results regarding treatment of advanced osteochondral lesions in the elbow.
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Affiliation(s)
- Stephan Vogt
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Oduro A, Ansah P, Hodgson A, Afful T, Baiden F, Adongo P, Koram K. Trends in the prevalence of female genital mutilation and its effect on delivery outcomes in the kassena-nankana district of northern ghana. Ghana Med J 2011; 40:87-92. [PMID: 17299573 PMCID: PMC1790849 DOI: 10.4314/gmj.v40i3.55258] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Summary RATIONAL Female genital mutilation (FGM) is prevalent in northern Ghana, as the practice is seen as a passage rite to women adulthood and thus undertaken just before marriage. OBJECTIVES We determined the changes in trend of FGM in deliveries at the Navrongo War Memorial hospital, and compared the outcomes and FGM status. DESIGN Retrospective extraction and analysis of delivery data at the hospital from 1(st) January 1996 to 31(st) December 2003. RESULTS Of the 5071 deliveries, about 29% (1466/5071) were associated with FGM. The highest prevalence (95% CI) of 61.5% (50.9, 71.2) was in women aged 40 years and above, and the lowest of 14.4% (11.7, 17.0) was in women below 20 years. The all-age prevalence of FGM showed a significant decline (p-value for linear trend < 0.01) from 35.2% in 1996 to 21.1% in 2003. About 6% (89/1466) of mothers with FGM had stillbirths compared with about 3% (123/3605) of mothers without FGM. Again FGM was associated with 8.2% (120/1466) caesarean section rate compared with 6.7% (241/3605) in mothers without FGM. Mean birth weight and frequency of low birth weights were not significantly associated with FGM status. CONCLUSION Although there is a high rate of FGM among mothers in the district and is associated with a higher proportion of stillbirths and caesarean sections, practice has shown a significant decline in the district in recent years due to the prevailing campaigns and intervention studies. There is therefore the need to sustain the ongoing intervention efforts.
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Affiliation(s)
- Ar Oduro
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
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Dodoo D, Atuguba F, Bosomprah S, Ansah NA, Ansah P, Lamptey H, Egyir B, Oduro AR, Gyan B, Hodgson A, Koram KA. Antibody levels to multiple malaria vaccine candidate antigens in relation to clinical malaria episodes in children in the Kasena-Nankana district of Northern Ghana. Malar J 2011; 10:108. [PMID: 21529376 PMCID: PMC3101166 DOI: 10.1186/1475-2875-10-108] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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: 02/01/2011] [Accepted: 05/01/2011] [Indexed: 11/20/2022] Open
Abstract
Background Considering the natural history of malaria of continued susceptibility to infection and episodes of illness that decline in frequency and severity over time, studies which attempt to relate immune response to protection must be longitudinal and have clearly specified definitions of immune status. Putative vaccines are expected to protect against infection, mild or severe disease or reduce transmission, but so far it has not been easy to clearly establish what constitutes protective immunity or how this develops naturally, especially among the affected target groups. The present study was done in under six year old children to identify malaria antigens which induce antibodies that correlate with protection from Plasmodium falciparum malaria. Methods In this longitudinal study, the multiplex assay was used to measure IgG antibody levels to 10 malaria antigens (GLURP R0, GLURP R2, MSP3 FVO, AMA1 FVO, AMA1 LR32, AMA1 3D7, MSP1 3D7, MSP1 FVO, LSA-1and EBA175RII) in 325 children aged 1 to 6 years in the Kassena Nankana district of northern Ghana. The antigen specific antibody levels were then related to the risk of clinical malaria over the ensuing year using a negative binomial regression model. Results IgG levels generally increased with age. The risk of clinical malaria decreased with increasing antibody levels. Except for FMPOII-LSA, (p = 0.05), higher IgG levels were associated with reduced risk of clinical malaria (defined as axillary temperature ≥37.5°C and parasitaemia of ≥5000 parasites/ul blood) in a univariate analysis, upon correcting for the confounding effect of age. However, in a combined multiple regression analysis, only IgG levels to MSP1-3D7 (Incidence rate ratio = 0.84, [95% C.I.= 0.73, 0.97, P = 0.02]) and AMA1 3D7 (IRR = 0.84 [95% C.I.= 0.74, 0.96, P = 0.01]) were associated with a reduced risk of clinical malaria over one year of morbidity surveillance. Conclusion The data from this study support the view that a multivalent vaccine involving different antigens is most likely to be more effective than a monovalent one. Functional assays, like the parasite growth inhibition assay will be necessary to confirm if these associations reflect functional roles of antibodies to MSP1-3D7 and AMA1-3D7 in this population.
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Affiliation(s)
- Daniel Dodoo
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
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Imhoff AB, Ansah P, Tischer T, Reiter C, Bartl C, Hench M, Spang JT, Vogt S. Arthroscopic repair of anterior-inferior glenohumeral instability using a portal at the 5:30-o'clock position: analysis of the effects of age, fixation method, and concomitant shoulder injury on surgical outcomes. Am J Sports Med 2010; 38:1795-803. [PMID: 20566721 DOI: 10.1177/0363546510370199] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traumatic anterior-inferior shoulder joint dislocations are common injuries among the young athletic population. The aim of this study was to assess which factors, including concomitant injury (rotator cuff tears, superior labral anterior posterior [SLAP] lesions), patient age, and fixation methods, led to redislocation after arthroscopic stabilization. HYPOTHESIS There are several risk factors for the outcome after arthroscopic anterior-inferior glenohumeral stabilization. STUDY DESIGN Cohort Study; Level of evidence, 3. METHODS Between 1996 and 2000, 221 patients were treated with arthroscopic stabilization for anterior-inferior shoulder dislocation. Of these 221 consecutive patients, 190 (140 male, 50 female) with an average age of 28.0 years (range, 14.4-59.2 years) were available for follow-up (average follow-up, 37.4 +/- 15.8 months). Fixation methods were FASTak (n = 138), Suretac (n = 28), or Panalok (n = 24) anchors. Concomitant SLAP lesions were seen in 38 of 190 cases (20%). RESULTS Redislocation rates varied between anchor systems (FASTak, 6.5%; Suretac, 25%; Panalok, 16.8%). Superior labral anterior posterior lesions, when treated, did not influence clinical outcomes or redislocation rate. A concomitant rotator cuff tear did not influence redislocation rate. Postoperative outcomes (Rowe score, Constant score, American Shoulder and Elbow Surgeons [ASES] shoulder index, 12-item questionnaire) in patients with a partial tear were also not altered. On the other hand, the redislocation rate correlated with patient age and number of prior dislocations. Return to sports at preinjury level was possible in 80% of cases. CONCLUSION Arthroscopic repair of anterior-inferior instability using the 5:30-o'clock portal is dependent on anchor type and can show good to excellent results. Because of several coinjuries in anterior-inferior instability, an arthroscopic approach may be required to identify and treat such lesions.
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Affiliation(s)
- Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Strasse 22, 81675 Munich, Germany.
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Oduro AR, Fryauff DJ, Koram KA, Rogers WO, Anto F, Atuguba F, Anyorigiya T, Adjuik M, Ansah P, Hodgson A, Nkrumah F. Sulfadoxine-pyrimethamine-based intermittent preventive treatment, bed net use, and antenatal care during pregnancy: demographic trends and impact on the health of newborns in the Kassena Nankana District, northeastern Ghana. Am J Trop Med Hyg 2010; 83:79-89. [PMID: 20595482 DOI: 10.4269/ajtmh.2010.10-0066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Demographics and health practices of 2,232 pregnant women in rural northeastern Ghana and characteristics of their 2,279 newborns were analyzed to determine benefits associated with intermittent preventive treatment (IPTp), antenatal care, and/or bed net use during pregnancy. More than half reported bed net use, 90% reported at least two antenatal care visits, and > 82% took at least one IPTp dose of sulfadoxine-pyrimethamine. Most used a bed net and IPTp (45%) or IPTp alone (38%). Low birth weight (< 2,500 grams) characterized 18.3% of the newborns and was significantly associated with female sex, Nankam ethnicity, first-born status, and multiple births. Among newborns of primigravidae, IPTp was associated with a significantly greater birth weight, significantly fewer low birth weight newborns, improved hemoglobin levels, and less anemia. Babies of multigravidae derived no benefit to birth weight or hemoglobin level from single or multiple doses of sulfadoxine-pyrimethamine during pregnancy. No differences or benefits were seen when a bed net was the only protective factor.
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Vogt S, Ansah P, Imhoff AB. Complete osseous avulsion of the adductor longus muscle: acute repair with three fiberwire suture anchors. Arch Orthop Trauma Surg 2007; 127:613-5. [PMID: 17505839 DOI: 10.1007/s00402-007-0328-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND An acute tear of the adductor longus tendon is a seldom injury. A proximal osseous avulsion of this tendon has never been reported in literature. METHODS Acute repair (refixation) of the osseous avulsion with three suture anchors. RESULTS Physical examinations 3, 6 and 24 months following the injury revealed no evidence of tenderness over the adductor muscle group, and range of motion was equal to the contra lateral hip. Manual muscle strength testing was 5/5 with resisted adduction and identical to the opposite side. The patient returned to his previous level of sports. CONCLUSION This case seems to be the first description of a proximal tendon rupture of the adductor longus muscle with an isolated osseous avulsion. Surgical treatment of this injury with the use of three fiberwire suture anchorstrade mark was successful. STUDY DESIGN Case report.
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Affiliation(s)
- Stephan Vogt
- Department of orthopaedic sports medicine, Klinikum Rechts der Isar, TU Munich, Munich, Germany.
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Abstract
BACKGROUND Effective treatment of osteochondral lesions in the elbow remains challenging. Arthroscopic débridement and microfracture or retrograde drilling techniques are often insufficient and provide only temporary symptomatic relief. The purpose of this study was to evaluate the treatment of these lesions with osteochondral autografts. METHODS From 1999 to 2002, seven patients with osteochondral lesions of the capitellum humeri (five patients), trochlea (one patient), or radial head (one patient) were treated with cylindrical osteochondral grafts, which were harvested from the non-weight-bearing area of the proximal aspect of the lateral femoral condyle. The patients (three female and four male patients with an average age of seventeen years) were evaluated preoperatively and postoperatively, with an average follow-up of fifty-nine months. The Broberg and Morrey score was chosen for functional evaluation of the elbow (with regard to motion, pain, strength, activities of daily living, and stability), and the American Shoulder and Elbow Surgeons score was used for the analysis of pain. All patients had imaging studies done preoperatively to evaluate the defect and postoperatively to assess the ingrowth and viability of the graft. The ipsilateral knee was examined for donor-site morbidity. RESULTS The Broberg and Morrey score improved from a mean (and standard deviation) of 76.3 +/- 13.2 preoperatively to 97.6 +/- 2.7 postoperatively, and pain scores were significantly reduced (p < 0.05). The mean elbow extension lag of 4.7 degrees +/- 5.8 degrees was reduced to 0 degrees postoperatively. Compared with the contralateral side, there was a mean preoperative flexion lag of 12.9 degrees +/- 13.8 degrees . At the time of the final follow-up, flexion was free and was equal bilaterally in all patients. None of the plain radiographs made at the time of follow-up showed any degenerative changes or signs of osteoarthritis. The postoperative magnetic resonance imaging scans showed graft viability and a congruent chondral surface in all seven patients. No donor-site morbidity was noted at one year postoperatively. CONCLUSIONS The osteochondral autograft procedure described in the present study provides the opportunity to retain viable hyaline cartilage for the repair of osteochondral lesions in the elbow while restoring joint congruity and function and perhaps reducing the risk of osteoarthritis. These medium-term results suggest that the risks of a two-joint procedure are modest and justifiable. In addition, the described technique provides an option for revision surgery after the failure of other surgical procedures.
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Affiliation(s)
- Patrick Ansah
- Department of Orthopedic Sports Medicine, Technical University Munich, Connollystrasse 32, 80809 Munich, Germany
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Oduro AR, Koram KA, Rogers W, Atuguba F, Ansah P, Anyorigiya T, Ansah A, Anto F, Mensah N, Hodgson A, Nkrumah F. Severe falciparum malaria in young children of the Kassena-Nankana district of northern Ghana. Malar J 2007; 6:96. [PMID: 17662142 PMCID: PMC1950879 DOI: 10.1186/1475-2875-6-96] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 07/27/2007] [Indexed: 11/22/2022] Open
Abstract
Study design Severe falciparum malaria in children was studied as part of the characterization of the Kassena-Nankana District Ghana for future malaria vaccine trials. Children aged 6–59 months with diagnosis suggestive of acute disease were characterized using the standard WHO definition for severe malaria. Results Of the total children screened, 45.2% (868/1921) satisfied the criteria for severe malaria. Estimated incidence of severe malaria was 3.4% (range: 0.4–8.3%) cases per year. The disease incidence was seasonal: 560 cases per year, of which 70.4% occurred during the wet season (June-October). The main manifestations were severe anaemia (36.5%); prolonged or multiple convulsions (21.6%); respiratory distress (24.4%) and cerebral malaria (5.4%). Others were hyperpyrexia (11.1%); hyperparasitaemia (18.5%); hyperlactaemia (33.4%); and hypoglycaemia (3.2%). The frequency of severe anaemia was 39.8% in children of six to 24 months of age and 25.9% in children of 25–60 months of age. More children (8.7%) in the 25–60 months age group had cerebral malaria compared with 4.4% in the 6–24 months age group. The overall case fatality ratio was 3.5%. Cerebral malaria and hyperlactataemia were the significant risk factors associated with death. Severe anaemia, though a major presentation, was not significantly associated with risk of death. Conclusion Severe malaria is a frequent and seasonal childhood disease in northern Ghana and maybe an adequate endpoint for future malaria vaccine trials.
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Affiliation(s)
- Abraham R Oduro
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, UG, Box 25, Legon, Accra, Ghana
| | - William Rogers
- Naval Medical Research Centre, Malaria Program, Silver Spring, Maryland, USA
| | - Frank Atuguba
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Patrick Ansah
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | | | - Akosua Ansah
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Francis Anto
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Nathan Mensah
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Abraham Hodgson
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Francis Nkrumah
- Noguchi Memorial Institute for Medical Research, UG, Box 25, Legon, Accra, Ghana
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Ueblacker P, Ansah P, Vogt S, Imhoff AB. Bilateral reverse shoulder prosthesis in a patient with severe syringomyelia. J Shoulder Elbow Surg 2007; 16:e48-51. [PMID: 17560806 DOI: 10.1016/j.jse.2006.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Accepted: 12/27/2006] [Indexed: 02/01/2023]
Affiliation(s)
- Peter Ueblacker
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Abstract
BACKGROUND Over 100 techniques for acromioclavicular joint (ACJ) reconstruction have been described. Most of these techniques are invasive and are associated with a high complication rate. We therefore developed a new minimally invasive arthroscopic technique for reconstruction of the ACJ. METHODS The new operation technique is described in detail. We operated 13 patients with Rockwood IV or V dislocations of the ACJ using this new technique. Intra- and postoperative complications were recorded. Each patient was evaluated after 3, 6, and 9 months using the Constant score for shoulder function and radiographs (anteroposterior, axillary, and Zanca views) of the operated and nonoperated shoulder for radiologic evaluation. The objective of this study was to evaluate the first clinical results and complication rates using this technique. RESULTS The mean follow-up was 9 months. Of the 13 patients, 12 could be included in the study and we had 1 dropout. The mean Constant score was 97; all patients were satisfied with the postoperative shoulder function and cosmetics. Radiologically we observed ten patients with anatomic reduction and two with a subluxation between 2 and 4 mm compared to the nonoperated side. In one patient we determined coracoclavicular ossifications which were asymptomatic. There were no complications intra- and postoperatively. CONCLUSIONS These first results suggest that this is a good and safe technique for ACJ reconstruction. Further randomized studies with more patients have to follow to confirm the results.
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Affiliation(s)
- F Elser
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität, München.
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Oduro AR, Anyorigiya T, Hodgson A, Ansah P, Anto F, Ansah NA, Atuguba F, Mumuni G, Amankwa J. A randomized comparative study of chloroquine, amodiaquine and sulphadoxine-pyrimethamine for the treatment of uncomplicated malaria in Ghana. Trop Med Int Health 2005; 10:279-84. [PMID: 15730512 DOI: 10.1111/j.1365-3156.2004.01382.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The study examined the efficacy of chloroquine (CQ), amodiaquine (AQ) and sulphadoxine-pyrimethamine (SP) for the treatment of uncomplicated Plasmodium falciparum malaria in Ghana. A total of 351 children were randomized to receive either of the three study drugs. Patients were evaluated using the WHO 14-day in vivo antimalarial testing guidelines. The 14-day adequate clinical and parasitological response analysis revealed that CQ, 46.7% (95% CI 37.5, 56.0) has the least efficacy compared with AQ, 86.1% (95% CI 78.3, 91.8) and SP, 77.6% (95% CI 68.9, 84.8). Late parasite failures were also lower and similar in the AQ and SP (9.6% and 10.3%) than in the CQ (32.5%) group. However, CQ and AQ groups showed better fever clearance compared with SP throughout except for day 7 and after when possibly due to its significant late clinical failures, clearance by CQ was lower. Our findings suggest that CQ is no longer useful in Ghana and should be replaced as a first-line treatment of malaria. Replacement of CQ preferably with AQ combination treatment will be an effective and an affordable alternative for the treatment of uncomplicated malaria.
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