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Rockson Adjei M, Longsignikuu A, Saeed Iddris I, Nang Suuri T, Asamoah B, Okoye M, Vanessa Baafi J, Kubio C, Ohene SA, Grobusch MP. Trend of measles-rubella vaccination coverage and impact on measles epidemiology in the Savannah Region, Ghana; 2018-2022: A secondary data analysis. Vaccine 2024; 42:1910-1917. [PMID: 38365480 DOI: 10.1016/j.vaccine.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Ghana witnessed an outbreak of measles in 2022 following the COVID-19 pandemic, and Savannah Region was among the regions severely impacted. The objective of this study was to conduct trend analysis of measles case incidence and measles-rubella (MR) vaccination coverage in the Savannah Region to identify gaps and propose remedial actions to mitigate future outbreaks of vaccine preventable diseases (VPDs). METHODS Analysis of measles surveillance and measles-rubella vaccination data for 2018-2022 was conducted to assess relationship between immunization coverage and measles case incidence. Data were extracted from the District Health Information Management System (DHIMS) platform and loaded into Microsoft Excel 16.0 spreadsheet for analysis. Coverages for first (MR1) and second (MR2) doses of measles-rubella vaccination, dropout rates, and measles incidence (per 100,000) were calculated. RESULTS The coverage trend for both vaccine doses followed similar trajectories, increasing from 2018 to a peak in 2019, and declining sequentially thereafter to the lowest (for the study period) in 2022. Generally, MR1/MR2 dropout rate was high across all districts during the entire study period. The regional incidence of confirmed measles rose sharply from less than 1/1,000,000 in 2018-2021 to 94 in 2022. Wide variations in vaccination coverage and dropout rates were observed among the districts. There was moderate to fairly strong negative correlation between MR vaccination coverage and measles case incidence. CONCLUSIONS The MR vaccination coverage in the Savannah Region declined probably due to pre-existing weaknesses in the immunization programme accentuated by impact of the COVID-19 pandemic. The lowered population immunity likely contributed to occurrence of the measles outbreak in 2022. Pragmatic actions are needed to catch-up on missed children, restore coverage to pre-pandemic levels, and strengthen the immunization programme as part of global efforts towards achieving the Immunization Agenda 2030 (IA2030) trajectory.
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Affiliation(s)
- Michael Rockson Adjei
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Iocation AMC, University of Amsterdam, Amsterdam, the Netherlands; World Health Organization, Country Office, Accra, Ghana.
| | - Amos Longsignikuu
- Ghana Health Service, Regional Health Directorate, Savannah Region, Damongo, Ghana
| | - Ibrahim Saeed Iddris
- Ghana Health Service, Regional Health Directorate, Savannah Region, Damongo, Ghana
| | - Thomas Nang Suuri
- Ghana Health Service, Regional Health Directorate, Savannah Region, Damongo, Ghana
| | | | | | - Janet Vanessa Baafi
- Ghana Health Service, District Health Directorate, Sunyani West, Odumase, Ghana
| | - Chrysantus Kubio
- Ghana Health Service, Regional Health Directorate, Savannah Region, Damongo, Ghana
| | | | - Martin Peter Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Iocation AMC, University of Amsterdam, Amsterdam, the Netherlands; Institute of Tropical Medicine, and German Center of Infectious Diseases (DZIF), University of Tuebingen, Tuebingen, Germany; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Centre de Recherches Médicales En Lambaréné (CERMEL), Lambaréné, Gabon; Masanga Medical Research Unit, Masanga, Sierra Leone
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Poynton-Smith E, Orrell M, Osei A, Ohene SA, Ansong J, Gyimah L, McKenzie C, Moro MF, Drew-Bold N, Baingana F, Carta MG, Tawiah P, Brobbey K, Funk M. A quantitative analysis of human rights-related attitude changes towards people with mental health conditions and psychosocial, intellectual, or cognitive disabilities following completion of the WHO QualityRights e-training in Ghana. Int J Ment Health Syst 2023; 17:46. [PMID: 38053116 PMCID: PMC10698997 DOI: 10.1186/s13033-023-00609-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 10/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Despite growing recognition of essential human rights, people with mental health conditions and psychosocial, intellectual, or cognitive disabilities' rights are known to be frequently violated in mental healthcare worldwide, with common use of coercive practices and limited recognition of people's right to exercise their legal capacity and make decisions for themselves on treatment and other issues affecting them. To tackle this issue, Ghana adopted the WHO QualityRights Initiative in 2019. This aims to introduce a right-based, person-centred recovery approach within the mental health care system, protecting and promoting the rights of people with mental health conditions, psychosocial, cognitive, and intellectual disabilities in the healthcare context and community. METHODS E-training (capacity-building) was provided in Ghana across a broad array of stakeholder groups including healthcare professionals, carers, and people with lived experience. The training covered legal capacity, coercion, community inclusion, recovery approach, service environment, and the negative attitudes commonly held by stakeholder groups; it was completed by 17,000 people in Ghana as of December 2021. We assessed the impact of the e-training on attitudes through comparing trainees' pre- and post-questionnaire responses on 17 items, each measured on a 5-point Likert scale (strongly disagree to strongly agree), such that higher scores indicated negative attitudes towards persons with mental health conditions and psychosocial disabilities as rights holders. Analyses were conducted on two main groups: matched pairs (417 pairs of baseline and follow-up questionnaire responses matched to a high degree of certainty), and the unmatched group (4299 individual completed questionnaire responses). RESULTS We assessed the impact of the WHO QualityRights e-training on attitudes: training resulted in highly significant attitude changes towards alignment with human rights, with scores changing by approximately 40% between baseline and follow-up. In particular, attitude changes were seen in items representing treatment choice, legal capacity, and coercion. This change was not affected by age, gender, or background experience. CONCLUSIONS The QualityRights e-training programme is effective in changing people's (especially healthcare professionals') attitudes towards people with mental health conditions and psychosocial, intellectual, or cognitive disabilities: this is a step towards mental healthcare being more with human rights-based worldwide.
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Affiliation(s)
| | | | - Akwasi Osei
- Ghana Ministry of Health-Mental Health Authority, Accra, Ghana
| | | | | | - Leveana Gyimah
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | | | | | | | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Kwaku Brobbey
- Ghana Ministry of Health-Mental Health Authority, Accra, Ghana
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Fall IS, Wango RK, Yahaya AA, Stephen M, Mpairwe A, Nanyunja M, Herring BL, Latt A, Mghamba J, Ndoungue VF, Yota D, Massidi C, Diallo AB, Ohene SA, Njuguna C, Oke A, Kizerbo GA, Chamla D, Yoti Z, Talisuna A. Implementing Joint External Evaluations of the International Health Regulations (2005) capacities in all countries in the WHO African region: process challenges, lessons learnt and perspectives for the future. BMJ Glob Health 2023; 8:e013326. [PMID: 37802545 PMCID: PMC10565161 DOI: 10.1136/bmjgh-2023-013326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Following the West Africa Ebola virus disease outbreak (2013-2016), the Joint External Evaluation (JEE) is one of the three voluntary components recommended by the WHO for evaluating the International Health Regulations (2005) capacities in countries. Here, we share experience implementing JEEs in all 47 countries in the WHO African region. In February 2016, the United Republic of Tanzania (Mainland) was the first country globally to conduct a JEE. By April 2022, JEEs had been conducted in all 47 countries plus in the island of Zanzibar. A total of 360 subject matter experts (SMEs) from 88 organisations were deployed 607 times. Despite availability of guidelines, the process had to be contextualised while avoiding jeopardising the quality and integrity of the findings. Key challenges were: inadequate understanding of the process by in-country counterparts; competing country priorities; limited time for validating subnational capacities; insufficient availability of SMEs for biosafety and biosecurity, antimicrobial resistance, points of entry, chemical events and radio-nuclear emergencies; and inadequate financing to fill gaps identified. Key points learnt were: importance of country leadership and ownership; conducting orientation workshops before the self-assessment; availability of an external JEE expert to support the self-assessment; the skills, attitudes and leadership competencies of the team lead; identifying national experts as SMEs for future JEEs to promote capacity building and experience sharing; the centrality of involving One Health stakeholders from the beginning to the end of the process; and the need for dedicated staff for planning, coordination, implementation and timely report writing. Moving forward, it is essential to draw from this learning to plan future JEEs. Finally, predictable financing is needed immediately to fill gaps identified.
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Affiliation(s)
- Ibrahima-Soce Fall
- Neglected Tropical Diseases (NTDs), WHO Headquarters, Geneva, Switzerland
| | - Roland Kimbi Wango
- Emergency Preparedness and Response Hub, WHO Regional Office for Africa, Dakar, Senegal
| | - Ali Ahmed Yahaya
- AMR Unit, Office of the Assistant Regipnal Director, WHO regional Office for Africa, Brazzaville, Congo
| | - Mary Stephen
- Emergency Preparedness and Response Cluster, WHO, Regional Office for Africa, Brazzaville, Congo
| | - Allan Mpairwe
- Emergency Preparedness and Response Hub, WHO, Regional Office for Africa, Nairobi, Kenya
| | - Miriam Nanyunja
- Emergency Preparedness and Response Hub, WHO, Regional Office for Africa, Nairobi, Kenya
| | - Belinda Louise Herring
- Emergency Preparedness and Response Cluster, WHO, Regional Office for Africa, Brazzaville, Congo
| | - Anderson Latt
- Emergency Preparedness and Response Hub, WHO Regional Office for Africa, Dakar, Senegal
| | | | - Viviane Fossouo Ndoungue
- Emergency Preparedness and Response Cluster, WHO, Regional Office for Africa, Brazzaville, Congo
| | - Daniel Yota
- Emergency Preparedness and Response Hub, WHO Regional Office for Africa, Dakar, Senegal
| | - Christian Massidi
- Emergency Preparedness and Response Hub, WHO Regional Office for Africa, Dakar, Senegal
| | - Amadou Bailo Diallo
- Emergency Preparedness and Response Hub, WHO Regional Office for Africa, Dakar, Senegal
| | - Sally-Ann Ohene
- Emergency Preparedness and Response Programme, WHO, Ghana Country Office, Accra, Ghana
| | - Charles Njuguna
- Health Emergecy Programme, WHO, Sierra Leone Country Office, Free Town, Sierra Leone
| | - Antonio Oke
- WHE Programme, WHO, Sudan Country Office, Juba, South Sudan
| | - Georges Alfred Kizerbo
- Liaison Office to the African Unions and the United Nations Economic Commission for Africa, WHO Regional Office for Africa, Addis Ababa, Ethiopia
| | - Dick Chamla
- Emergency Preparedness and Response Cluster, WHO, Regional Office for Africa, Brazzaville, Congo
| | - Zabulon Yoti
- Emergency Preparedness and Response Cluster, WHO, Regional Office for Africa, Brazzaville, Congo
| | - Ambrose Talisuna
- Liaison Office to the African Unions and the United Nations Economic Commission for Africa, WHO Regional Office for Africa, Addis Ababa, Ethiopia
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Bonney JHK, Sanders T, Pratt D, Agbodzi B, Laryea D, Agyeman NKF, Kumordjie S, Attiku K, Adams PL, Boateng GA, Ohene SA, Tamal C, Mawuli G, Yeboah C, Dadzie S, Kubio C, Asiedu-Bekoe F, Odoom JK. Molecular Characterization of Circulating Yellow Fever Viruses from Outbreak in Ghana, 2021-2022. Emerg Infect Dis 2023; 29:1818-1826. [PMID: 37610174 PMCID: PMC10461649 DOI: 10.3201/eid2909.221671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Yellow fever virus, transmitted by infected Aedes spp. mosquitoes, causes an acute viral hemorrhagic disease. During October 2021-February 2022, a yellow fever outbreak in some communities in Ghana resulted in 70 confirmed cases with 35 deaths (case-fatality rate 50%). The outbreak started in a predominantly unvaccinated nomadic community in the Savannah region, from which 65% of the cases came. The molecular amplification methods we used for diagnosis produced full-length DNA sequences from 3 confirmed cases. Phylogenetic analysis characterized the 3 sequences within West Africa genotype II; strains shared a close homology with sequences from Cote d'Ivoire and Senegal. We deployed more sensitive advanced molecular diagnostic techniques, which enabled earlier detection, helped control spread, and improved case management. We urge increased efforts from health authorities to vaccinate vulnerable groups in difficult-to-access areas and to educate the population about potential risks for yellow fever infections.
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Lartey M, Kenu E, Ganu VJ, Asiedu-Bekoe F, Opoku BK, Yawson A, Ohene SA. Risk factors for COVID-19 infections among health care workers in Ghana. PLoS One 2023; 18:e0288242. [PMID: 37410736 PMCID: PMC10325113 DOI: 10.1371/journal.pone.0288242] [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: 10/05/2022] [Accepted: 06/22/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION Health care workers (HCWs) are crucial to the fight against COVID-19 and are at risk of being infected. We sought to determine the risk factors and associations of COVID-19 among HCWs in Ghana during the period of the pandemic. MATERIALS AND METHODS A case-control study was conducted using the WHO COVID-19 HCWs exposure risk assessment tool. A HCW was categorized as "high risk" for COVID-19 if s/he did not respond "always, as recommended" to adherence to Infection Prevention and Control (IPC) measures during a healthcare interaction. A HCW was categorized as "low risk" if s/he responded "always, as recommended" to adherence to IPC measures. We used univariate and multiple logistic regression models to determine associated risk factors. Statistical significance was set at 5%. RESULTS A total of 2402 HCWs were recruited and the mean age was 33.2±7.1 years. Almost 87% (1525/1745) of HCWs had high risk for COVID-19 infection. Risk factors identified were profession (doctor- aOR: 2.13, 95%CI: 1.54-2.94; radiographer-aOR: 1.16, 95% CI: 0.44-3.09)), presence of comorbidity (aOR: 1.89, 95%CI: 1.29-2.78), community exposure to virus (aOR: 1.26, 95% CI: 1.03-1.55), not performing hand hygiene before and after aseptic procedures performed (aOR: 1.6, 95% CI: 1.05-2.45); not frequently decontaminating high-touch surfaces always as recommended (aOR: 2.31, 95%CI: 1.65-3.22; p = 0.001) and contact with a confirmed COVID-19 patient (aOR: 1.39, 95% CI: 1.15-1.67). Among those who came into any form of contact with confirmed COVID-19 patient, providing direct care (aOR: 2.0, 95%CI: 1.36-2.94), face-to-face contact (aOR: 2.23, 95%CI: 1.41-3.51), contact with environment/materials used by COVID-19 patient (aOR: 2.25, 95%CI: 1.45-3.49) and presence during conduct of aerosol generating procedures (aOR: 2.73, 95%CI: 1.74-4.28) were associated with COVID-19 infection. CONCLUSION Non-adherence to IPC guidelines puts HCWs at increased risk of COVID-19 infection thus ensuring IPC adherence is key to reducing this risk.
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Affiliation(s)
- Margaret Lartey
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Ernest Kenu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | | | - Alfred Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Bonney JK, Adu B, Sanders T, Pratt D, Adams P, Asante IA, Bonney EY, Agbodzi B, Kumordjie S, Faye M, Obodai E, Ketorwoley P, Yeboah C, Tublu M, Diagne MM, Diallo A, Ofori M, Laryea D, Asiedu-Bekoe F, Kyei GB, Ohene SA, Boateng G, Chapman R, Faye O, Wiley M, Odoom J, Sall A, Kasolo FC, Yeboah-Manu D. Marburg Virus Disease in Ghana. N Engl J Med 2023; 388:2393-2394. [PMID: 37342928 DOI: 10.1056/nejmc2300867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Affiliation(s)
- Joseph K Bonney
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Bright Adu
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | - Deborah Pratt
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Patience Adams
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Ivy A Asante
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Evelyn Y Bonney
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | | | | | | | | | - Clara Yeboah
- U.S. Naval Medical Research Unit 3, Accra, Ghana
| | - Mildred Tublu
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | | | - Magdalene Ofori
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | | | | | | | - Gifty Boateng
- National Public Health Reference Laboratory, Accra, Ghana
| | - Ryan Chapman
- University of Nebraska Medical Center, Lincoln, NE
| | | | | | - John Odoom
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
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Owusu Donkor I, Mensah SK, Dwomoh D, Akorli J, Abuaku B, Ashong Y, Opoku M, Andoh NE, Sumboh JG, Ohene SA, Owusu-Asare AA, Quartey J, Dumashie E, Lomotey ES, Odumang DA, Gyamfi GO, Dorcoo C, Afatodzie MS, Osabutey D, Ismail RBY, Quaye I, Bosomprah S, Munster V, Koram KA. Modeling SARS-CoV-2 antibody seroprevalence and its determinants in Ghana: A nationally representative cross-sectional survey. PLOS Glob Public Health 2023; 3:e0001851. [PMID: 37145991 PMCID: PMC10162519 DOI: 10.1371/journal.pgph.0001851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/31/2023] [Indexed: 05/07/2023]
Abstract
Estimates of SARS-CoV-2 transmission rates have significant public health policy implications since they shed light on the severity of illness in various groups and aid in strategic deployment of diagnostics, treatment and vaccination. Population-based investigations have not been conducted in Ghana to identify the seroprevalence of SARS-CoV-2. We conducted an age stratified nationally representative household study to determine the seroprevalence of SARS-CoV-2 and identify risk factors between February and December 2021. Study participants, 5 years and older regardless of prior or current infection COVID-19 infection from across Ghana were included in the study. Data on sociodemographic characteristics, contact with an individual with COVID-19-related symptoms, history of COVID-19-related illness, and adherence to infection prevention measures were collected. Serum obtained was tested for total antibodies with the WANTAI ELISA kit. The presence of antibodies against SAR-COV-2 was detected in 3,476 of 5,348 participants, indicating a seroprevalence of 67.10% (95% CI: 63.71-66.26). Males had lower seroprevalence (65.8% [95% CI: 63.5-68.04]) than females (68.4% [95% CI: 66.10-69.92]). Seroprevalence was lowest in >20 years (64.8% [95% CI: 62.36-67.19]) and highest among young adults; 20-39 years (71.1% [95% CI 68.83,73.39]). Seropositivity was associated with education, employment status and geographic location. Vaccination status in the study population was 10%. Exposure is more likely in urban than rural areas thus infection prevention protocols must be encouraged and maintained. Also, promoting vaccination in target groups and in rural areas is necessary to curb transmission of the virus.
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Affiliation(s)
- Irene Owusu Donkor
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Sedzro Kojo Mensah
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Ghana
| | - Jewelna Akorli
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Benjamin Abuaku
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Yvonne Ashong
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Millicent Opoku
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Nana Efua Andoh
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Jeffrey Gabriel Sumboh
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Sally-Ann Ohene
- Emergency Preparedness and Response Unit, World Health Organization, Country Office, Accra, Ghana
| | | | - Joseph Quartey
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Edward Dumashie
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Elvis Suatey Lomotey
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Daniel Adjei Odumang
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Grace Opoku Gyamfi
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Christopher Dorcoo
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | - Dickson Osabutey
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Rahmat bint Yussif Ismail
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Isaac Quaye
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Samuel Bosomprah
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Ghana
| | - Vincent Munster
- Virus Ecology Section, Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States of America
| | - Kwadwo Ansah Koram
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
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Harden B, Gyimah L, Funk M, Drew-Bold N, Orrell M, Moro MF, Cole C, Ohene SA, Baingana F, Amissah C, Ansong J, Tawiah PE, Brobbey K, Carta MG, Osei A. Attitudes towards persons with mental health conditions and psychosocial disabilities as rights holders in Ghana: a World Health Organization study. BMC Psychiatry 2023; 23:142. [PMID: 36882751 PMCID: PMC9993713 DOI: 10.1186/s12888-023-04620-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND There are currently major efforts underway in Ghana to address stigma and discrimination, and promote the human rights of those with mental health conditions, within mental health services and the community, working with the World Health Organization's QualityRights initiative. The present study aims to investigate attitudes towards people with lived experience of mental health conditions and psychosocial disabilities as rights holders. METHODS Stakeholders within the Ghanaian mental health system and community, including health professionals, policy makers, and persons with lived experience, completed the QualityRights pre-training questionnaire. The items examined attitudes towards coercion, legal capacity, service environment, and community inclusion. Additional analyses explored how far participant factors may link to attitudes. RESULTS Overall, attitudes towards the rights of persons with lived experience were not well aligned with a human rights approach to mental health. Most people supported the use of coercive practices and often thought that health practitioners and family members were in the best position to make treatment decisions. Health/mental health professionals were less likely to endorse coercive measures compared to other groups. CONCLUSION This was the first in-depth study assessing attitudes towards persons with lived experience as rights holders in Ghana, and frequently attitudes did not comply with human rights standards, demonstrating a need for training initiatives to combat stigma and discrimination and promote human rights.
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Affiliation(s)
- Briony Harden
- Institute of Mental Health, University of Nottingham, Innovation Park, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, UK.
| | | | - Michelle Funk
- Policy, Law and Human Rights, Department of Mental Health & Substance Use, World Health Organisation, Geneva, CH, Switzerland
| | - Natalie Drew-Bold
- Policy, Law and Human Rights, Department of Mental Health & Substance Use, World Health Organisation, Geneva, CH, Switzerland
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Innovation Park, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, UK
| | | | - Celline Cole
- Charité University Medicine Berlin, Berlin, DE, Germany
| | | | | | - Caroline Amissah
- Ghana Ministry of Health - Mental Health Authority, Accra, GH, Ghana
| | | | | | - Kwaku Brobbey
- Ghana Ministry of Health - Mental Health Authority, Accra, GH, Ghana
| | | | - Akwasi Osei
- Ghana Ministry of Health - Mental Health Authority, Accra, GH, Ghana
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Ameme DK, Yeboah YO, Odoom JK, Djokoto SK, Akyereko E, Mamudu A, Diwura M, Opare W, Avevor P, Diamenu S, Ohene SA, Kenu E, Asiedu-Bekoe F. Response to back-to-back outbreaks of circulating vaccine-derived poliovirus type 2 in two nomadic pastoralist settlements in Oti Region, Ghana-2019. Arch Public Health 2023; 81:1. [PMID: 36600260 PMCID: PMC9811735 DOI: 10.1186/s13690-022-01021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The global switch from trivalent oral poliovirus vaccine (OPV) to bivalent OPV in April 2016 without corresponding co-administration of inactivated poliovirus vaccine (IPV) until June 2018, created a cohort of poliovirus type 2 naïve children with risk of developing vaccine-derived poliovirus type 2 (VDPV2). In November and December 2019, two cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were confirmed in quick succession through Acute Flaccid Paralysis (AFP) surveillance in two nomadic pastoralist settlements in Oti Region. We investigated to determine the outbreak extent, identify risk factors and implement control and preventive measures. METHODS We interviewed case-patients' families, abstracted immunization records, assessed AFP surveillance and conducted rapid OPV and IPV vaccination coverage surveys. Using AFP case definition of any child less than 15 years in the community with sudden onset of paralysis from July to November 2019 (in case-patient 1's district) and August to December 2019 (in case-patient 2's district), we conducted active case search. Stool samples from apparently healthy children and close contacts of the case-patients were collected and tested for poliovirus. We conducted environmental assessment of the community to identify potential risk factors. RESULTS Case-patient 1 was an eight-year-old female who had taken two doses of OPV while case-patient 2 was an eight-month-old male who had taken three out of required four OPV doses in addition to IPV at seven months. Families of both case-patients had either travelled to or received visitors from areas with confirmed cVDPV2. Of all children surveyed, eight (29.6%) of 27 and three (18.8%) of 16 eligible children in communities of case-patient 1 and 2 respectively had received required four doses of OPV. No AFP case was found in both communities and surrounding settlements. Both communities had no source of potable water and toilet facilities. A stool sample from a contact of case-patient 1 tested positive for cVDPV2. CONCLUSION Outbreaks of cVDPV2 occurred in insanitary, under-vaccinated nomadic pastoralist settlements in Oti Region. Three rounds of monovalent OPV vaccination campaigns for children under 5 years of age in the districts and region as well as countrywide IPV vaccination campaign for poliovirus type 2 naïve cohort were conducted.
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Affiliation(s)
- Donne Kofi Ameme
- Ghana Field Epidemiology and Laboratory Training Programme, University of Ghana School of Public Health, Accra, Legon, Ghana. .,Public Health Division, Ghana Health Service, Accra, Ghana.
| | - Yaw Ofori Yeboah
- grid.434994.70000 0001 0582 2706Volta Regional Health Directorate, Ghana Health Service, Ho, Ghana
| | - John Kofi Odoom
- grid.462644.60000 0004 0452 2500Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana
| | - Senanu Kwesi Djokoto
- grid.434994.70000 0001 0582 2706Volta Regional Health Directorate, Ghana Health Service, Ho, Ghana
| | - Ernest Akyereko
- grid.434994.70000 0001 0582 2706Public Health Division, Ghana Health Service, Accra, Ghana
| | - Abdulaziz Mamudu
- grid.434994.70000 0001 0582 2706Nkwanta North District Health Directorate, Ghana Health Service, Nkwanta, Ghana
| | - Mukaila Diwura
- grid.434994.70000 0001 0582 2706Krachi-Nchumuru District Health Directorate, Ghana Health Service, Krachi, Ghana
| | - William Opare
- grid.434994.70000 0001 0582 2706Expanded Programme on Immnunization, Ghana Health Service, Accra, Ghana
| | | | | | | | - Ernest Kenu
- grid.8652.90000 0004 1937 1485Ghana Field Epidemiology and Laboratory Training Programme, University of Ghana School of Public Health, Accra, Legon Ghana
| | - Franklin Asiedu-Bekoe
- grid.434994.70000 0001 0582 2706Public Health Division, Ghana Health Service, Accra, Ghana
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Kwabla MP, Nyasordzi J, Kye-Duodu G, Ananga MK, Amenuvegbe GK, Otoo J, Nuertey DD, Mensah EK, Asante-Afari K, Aboagye D, Ansong J, Ohene SA. Factors associated with COVID-19 knowledge among Ghanaians: A national survey. PLoS One 2022; 17:e0276381. [PMID: 36355696 PMCID: PMC9648720 DOI: 10.1371/journal.pone.0276381] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adequate knowledge about COVID-19 in a population may be relevant in the fight to control its spread among the populace. Thus, the aim of this study was to assess the factors associated with real knowledge of COVID-19 among Ghanaians to promote effective dissemination of appropriate information aimed at containing the spread. METHODS A cross-sectional online survey and computer assisted telephone interviews (CATI) was conducted among Ghanaians aged 18 years and above across the 260 districts of Ghana. The survey assessed the level of knowledge of COVID-19 and its associated factors and compared differences between perceived and real knowledge. One district health promotion officer per district was trained for the data collection. Participants were recruited via use of phone directories of both organized and non-organized local district groups. Phone calls were made to randomly selected phone contacts to schedule options for participation in the study. We used multivariable logistic regression to investigate the associated factors of COVID-19 knowledge among respondents. RESULTS Of the 2,721 participants who completed the survey, the majority (99.3%) were aware of the existence of the COVID-19 outbreak, had good knowledge on infection prevention (87.0%) and rated their knowledge about COVID-19 as good (81.7%). Factors associated with COVID-19 knowledge were: age ≥56 years (aOR = 0.5; CI: 0.3-0.8; p = 0.002), tertiary education (aOR = 1.8; CI: 1.2-2.6; p = 0.003), residing in Greater Accra region (aOR = 2.0; CI: 1.1-3.6; p = 0.019), not infected with the novel coronavirus (aOR = 1.5; Cl: 1.0-2.1; p = 0.045), knowing an infected person (aOR = 3.5; CI = 1.5-7.9; p = 0.003), good practice of effective preventive measures (aOR = 1.2: Cl: 1.1-1.5: 0.008), not misinformed (aOR = 0.7; Cl: 0.5-0.9; 0.015), and perceiving spreading speed of the virus as slow (aOR = 0.7; Cl: 0.5-0.9; 0.007). CONCLUSION The study found good knowledge regarding COVID-19, control measures, and preventive strategies. The Ghana Health Service should continuously provide accurate information to educate the media and citizens to prevent misinformation, which is vital in stopping the spread of the COVID-19 virus.
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Affiliation(s)
- Mavis Pearl Kwabla
- Department of Epidemiology and Biostatistics, F.N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
- * E-mail:
| | - Juliana Nyasordzi
- Department of Nutrition and Dietetics, School of Allied Health Sciences. University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Gideon Kye-Duodu
- Department of Epidemiology and Biostatistics, F.N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Mark Kwame Ananga
- Department of Population and Behavioural Sciences, F.N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Gregory Kofi Amenuvegbe
- Department of Health Policy Planning and Management, F.N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Joseph Otoo
- Statistics Department, University of Ghana, Legon, Ghana
| | | | | | | | - Dacosta Aboagye
- Ghana Health Service, Health Promotion Division, Headquarters, Accra, Ghana
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11
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Abstract
Background Data on active TB case finding activities among artisanal gold mining communities (AMC) is limited. The study assessed the yield of TB cases from the TB screening activities among AMC in Ghana, the factors associated with TB in these communities and the correlation between the screening methods and a diagnosis of TB. Methods We conducted secondary data analyses of NTP program data collected from TB case finding activities using symptom screening and mobile X-ray implemented in hard to reach AMC. Yield of TB cases, number needed to screen (NNS) and the number needed to test (NNT) to detect a TB case were assessed and logistic regression were conducted to assess factors associated with TB. The performance of screening methods chest X-ray and symptoms in the detection of TB cases was also evaluated. Results In total 10,441 people from 78 communities in 24 districts were screened, 55% were female and 60% (6,296) were in the aged 25 to 54 years. Ninety-five TB cases were identified, 910 TB cases per 100,000 population screened; 5.6% of the TB cases were rifampicin resistant. Being male (aOR 5.96, 95% CI 3.25–10.92, P < 0.001), a miner (aOR 2.70, 95% CI 1.47–4.96, P = 0.001) and age group 35 to 54 years (aOR 2.27, 95% CI 1.35–3.84, P = 0.002) were risk factors for TB. NNS and NNT were 110 and 24 respectively.; Cough of any duration had the strongest association with X-ray suggestive of TB with a correlation coefficient of 0.48. Cough was most sensitive for a diagnosis of TB; sensitivity of 86.3% (95% CI 79.4–93.2) followed by X-ray, sensitivity 81.1% (95% CI 71.7–88.4). The specificities of the symptoms and X-rays ranged from 80.2% (cough) to 97.3% (sputum). Conclusion The high risk of TB in the artisanal mining communities and in miners in this study reinforces the need to target these populations with outreach programs particularly in hard to reach areas. The diagnostic value of cough highlights the usefulness of symptom screening in this population that may be harnessed even in the absence of X-ray to identify those suspected to have TB for further evaluation.
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Affiliation(s)
- Sally-Ann Ohene
- World Health Organization Country Office, Accra, Ghana
- * E-mail:
| | - Frank Bonsu
- National Tuberculosis Control Program, Ghana Health Service, Accra, Ghana
| | - Yaw Adusi-Poku
- National Tuberculosis Control Program, Ghana Health Service, Accra, Ghana
| | - Francisca Dzata
- National Tuberculosis Control Program, Ghana Health Service, Accra, Ghana
| | - Mirjam Bakker
- KIT Royal Tropical Institute, Global Health Amsterdam, Amsterdam, The Netherlands
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12
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Phillips RO, Robert J, Abass KM, Thompson W, Sarfo FS, Wilson T, Sarpong G, Gateau T, Chauty A, Omollo R, Ochieng Otieno M, Egondi TW, Ampadu EO, Agossadou D, Marion E, Ganlonon L, Wansbrough-Jones M, Grosset J, Macdonald JM, Treadwell T, Saunderson P, Paintsil A, Lehman L, Frimpong M, Sarpong NF, Saizonou R, Tiendrebeogo A, Ohene SA, Stienstra Y, Asiedu KB, van der Werf TS. Rifampicin and clarithromycin (extended release) versus rifampicin and streptomycin for limited Buruli ulcer lesions: a randomised, open-label, non-inferiority phase 3 trial. Lancet 2020; 395:1259-1267. [PMID: 32171422 PMCID: PMC7181188 DOI: 10.1016/s0140-6736(20)30047-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/23/2019] [Accepted: 01/07/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifampicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions. METHODS We did an open-label, non-inferiority, randomised (1:1 with blocks of six), multicentre, phase 3 clinical trial comparing fully oral RC8 with RS8 in patients with early, limited Buruli ulcer lesions. There were four trial sites in hospitals in Ghana (Agogo, Tepa, Nkawie, Dunkwa) and one in Benin (Pobè). Participants were included if they were aged 5 years or older and had typical Buruli ulcer with no more than one lesion (caterories I and II) no larger than 10 cm in diameter. The trial was open label, and neither the investigators who took measurements of the lesions nor the attending doctors were masked to treatment assignment. The primary clinical endpoint was lesion healing (ie, full epithelialisation or stable scar) without recurrence at 52 weeks after start of antimicrobial therapy. The primary endpoint and safety were assessed in the intention-to-treat population. A sample size of 332 participants was calculated to detect inferiority of RC8 by a margin of 12%. This study was registered with ClinicalTrials.gov, NCT01659437. FINDINGS Between Jan 1, 2013, and Dec 31, 2017, participants were recruited to the trial. We stopped recruitment after 310 participants. Median age of participants was 14 years (IQR 10-29) and 153 (52%) were female. 297 patients had PCR-confirmed Buruli ulcer; 151 (51%) were assigned to RS8 treatment, and 146 (49%) received oral RC8 treatment. In the RS8 group, lesions healed in 144 (95%, 95% CI 91 to 98) of 151 patients, whereas lesions healed in 140 (96%, 91 to 99) of 146 patients in the RC8 group. The difference in proportion, -0·5% (-5·2 to 4·2), was not significantly greater than zero (p=0·59), showing that RC8 treatment is non-inferior to RS8 treatment for lesion healing at 52 weeks. Treatment-related adverse events were recorded in 20 (13%) patients receiving RS8 and in nine (7%) patients receiving RC8. Most adverse events were grade 1-2, but one (1%) patient receiving RS8 developed serious ototoxicity and ended treatment after 6 weeks. No patients needed surgical resection. Four patients (two in each study group) had skin grafts. INTERPRETATION Fully oral RC8 regimen was non-inferior to RS8 for treatment of early, limited Buruli ulcer and was associated with fewer adverse events. Therefore, we propose that fully oral RC8 should be the preferred therapy for early, limited lesions of Buruli ulcer. FUNDING WHO with additional support from MAP International, American Leprosy Missions, Fondation Raoul Follereau France, Buruli ulcer Groningen Foundation, Sanofi-Pasteur, and BuruliVac.
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Affiliation(s)
- Richard O Phillips
- Kwame Nkrumah University of Science and Technology, Kumasi Centre for Collaborative Research in Tropical Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Jérôme Robert
- Centre d'immunologie et des maladies infectieuses, Inserm, Sorbonne Université, Bactériologie site Pitié, AP-HP Sorbonne Université, Centre National de Référence des Mycobactéries, Paris, France
| | | | | | - Fred Stephen Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi Centre for Collaborative Research in Tropical Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | - Thierry Gateau
- Centre de diagnostic et de traitement de la lèpre et de l'Ulcère de Buruli Madeleine et Raoul Follereau, Ouémé-Plateau, Pobè, Bénin
| | - Annick Chauty
- Centre de diagnostic et de traitement de la lèpre et de l'Ulcère de Buruli Madeleine et Raoul Follereau, Ouémé-Plateau, Pobè, Bénin
| | - Raymond Omollo
- Drugs for Neglected Diseases initiative, Africa Regional Office, Nairobi, Kenya
| | | | - Thaddaeus W Egondi
- Drugs for Neglected Diseases initiative, Africa Regional Office, Nairobi, Kenya
| | - Edwin O Ampadu
- National Buruli ulcer Control Programme, Ghana Health Service, Accra, Ghana
| | - Didier Agossadou
- Programme National de Lutte contre la lèpre et l'Ulcère de Buruli, Cotonou, Benin
| | - Estelle Marion
- Centre de recherche en cancérologie et immunologie Nantes-Angers, French National Institute of Health and Medical Research, Université d'Angers, Angers, France
| | - Line Ganlonon
- Centre de diagnostic et de traitement de la lèpre et de l'Ulcère de Buruli Madeleine et Raoul Follereau, Ouémé-Plateau, Pobè, Bénin
| | | | - Jacques Grosset
- Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - John M Macdonald
- Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA; Hospital Bernard Meys Project Medishare, Port-au-Prince, Haiti
| | | | | | - Albert Paintsil
- Reconstructive and Plastic Surgery Unit, Korle-BU Teaching Hospital, Accra, Ghana
| | | | - Michael Frimpong
- Kwame Nkrumah University of Science and Technology, Kumasi Centre for Collaborative Research in Tropical Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Nanaa Francisca Sarpong
- Kwame Nkrumah University of Science and Technology, Kumasi Centre for Collaborative Research in Tropical Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | - Ymkje Stienstra
- Department of Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | | | - Tjip S van der Werf
- Department of Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands.
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13
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Ohene SA, Fordah S, Dela Boni P. Childhood tuberculosis and treatment outcomes in Accra: a retrospective analysis. BMC Infect Dis 2019; 19:749. [PMID: 31455234 PMCID: PMC6712824 DOI: 10.1186/s12879-019-4392-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/01/2019] [Accepted: 08/19/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a leading cause of death in children and adults. Unlike for adults, there is paucity of data on childhood TB in several countries in Africa. The study objective was to assess the characteristics and treatment outcomes of children with TB from multiple health facilities in Accra, Ghana. METHODS A retrospective analyses was conducted using secondary data on children less than 15 years collected from 11 facilities during a TB case finding initiative in Accra from June 2010 to December 2013. Demographic and clinical characteristics as well as treatment outcomes were assessed. Multivariable logistic regression was conducted to assess predictors of mortality. RESULTS Out of the total 3704 TB cases reported, 5.9% (219) consisted of children with a female: male ratio of 1:1.1. Children less than 5 years made up 56.2% of the patients while 44.2% were HIV positive. The distribution of TB type were as follows: smear positive pulmonary TB (SPPTB), 46.5%, clinically diagnosed pulmonary TB 36.4%.%, extra-pulmonary TB 17.4%. Among the 214 children (97.7%) for whom treatment outcome was documented, 194 (90.7%) were successfully treated consisting of 81.3% who completed treatment and 9.4% who were cured. Eighteen children (8.4%) died. Mortality was significantly higher among the 1-4 year group (p < 0.001), those with SPPTB (p < 0.001) and HIV positive children (p < 0.001). In logistic regression, SPPTB and HIV positivity were predictors of mortality. CONCLUSION The proportion of children in Accra successfully treated for TB met the target of END TB Strategy treatment success indicator. HIV positivity was a risk factor for death. Reducing mortality in TB-HIV co-infected children will further improve treatment outcomes of children with TB in Accra.
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Affiliation(s)
| | | | - Prince Dela Boni
- Ghana Institute of Management and Public Administration, Accra, Ghana
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14
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Marks M, Mitjà O, Bottomley C, Kwakye C, Houinei W, Bauri M, Adwere P, Abdulai AA, Dua F, Boateng L, Wangi J, Ohene SA, Wangnapi R, Simpson SV, Miag H, Addo KK, Basing LA, Danavall D, Chi KH, Pillay A, Ballard R, Solomon AW, Chen CY, Bieb SV, Adu-Sarkodie Y, Mabey DCW, Asiedu K. Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea. Lancet Glob Health 2018; 6:e401-e410. [PMID: 29456191 PMCID: PMC7116878 DOI: 10.1016/s2214-109x(18)30023-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 09/14/2017] [Revised: 12/12/2017] [Accepted: 01/11/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND A dose of 30 mg/kg of azithromycin is recommended for treatment of yaws, a disease targeted for global eradication. Treatment with 20 mg/kg of azithromycin is recommended for the elimination of trachoma as a public health problem. In some settings, these diseases are co-endemic. We aimed to determine the efficacy of 20 mg/kg of azithromycin compared with 30 mg/kg azithromycin for the treatment of active and latent yaws. METHODS We did a non-inferiority, open-label, randomised controlled trial in children aged 6-15 years who were recruited from schools in Ghana and schools and the community in Papua New Guinea. Participants were enrolled based on the presence of a clinical lesion that was consistent with infectious primary or secondary yaws and a positive rapid diagnostic test for treponemal and non-treponemal antibodies. Participants were randomly assigned (1:1) to receive either standard-dose (30 mg/kg) or low-dose (20 mg/kg) azithromycin by a computer-generated random number sequence. Health-care workers assessing clinical outcomes in the field were not blinded to the patient's treatment, but investigators involved in statistical or laboratory analyses and the participants were blinded to treatment group. We followed up participants at 4 weeks and 6 months. The primary outcome was cure at 6 months, defined as lesion healing at 4 weeks in patients with active yaws and at least a four-fold decrease in rapid plasma reagin titre from baseline to 6 months in patients with active and latent yaws. Active yaws was defined as a skin lesion that was positive for Treponema pallidum ssp pertenue in PCR testing. We used a non-inferiority margin of 10%. This trial was registered with ClinicalTrials.gov, number NCT02344628. FINDINGS Between June 12, 2015, and July 2, 2016, 583 (65·1%) of 895 children screened were enrolled; 292 patients were assigned a low dose of azithromycin and 291 patients were assigned a standard dose of azithromycin. 191 participants had active yaws and 392 had presumed latent yaws. Complete follow-up to 6 months was available for 157 (82·2%) of 191 patients with active yaws. In cases of active yaws, cure was achieved in 61 (80·3%) of 76 patients in the low-dose group and in 68 (84·0%) of 81 patients in the standard-dose group (difference 3·7%; 95% CI -8·4 to 15·7%; this result did not meet the non-inferiority criterion). There were no serious adverse events reported in response to treatment in either group. The most commonly reported adverse event at 4 weeks was gastrointestinal upset, with eight (2·7%) participants in each group reporting this symptom. INTERPRETATION In this study, low-dose azithromycin did not meet the prespecified non-inferiority margin compared with standard-dose azithromycin in achieving clinical and serological cure in PCR-confirmed active yaws. Only a single participant (with presumed latent yaws) had definitive serological failure. This work suggests that 20 mg/kg of azithromycin is probably effective against yaws, but further data are needed. FUNDING Coalition for Operational Research on Neglected Tropical Diseases.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases; London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | - Oriol Mitjà
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain; Lihir Medical Centre, International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Christian Bottomley
- Clinical Research Department, Faculty of Infectious and Tropical Diseases and MRC Tropical Epidemiology Group, Faculty of Epidemiology and Public Health
| | | | - Wendy Houinei
- Department of Health, Port Moresby, Papua New Guinea
| | - Mathias Bauri
- Department of Health, Port Moresby, Papua New Guinea
| | | | | | | | | | - James Wangi
- World Health Organization Country Office, Port Moresby, Papua New Guinea
| | | | | | | | - Helen Miag
- Department of Health, Port Moresby, Papua New Guinea
| | - Kennedy K Addo
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Laud A Basing
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Damien Danavall
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention
| | - Kai H Chi
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention
| | - Allan Pillay
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention
| | - Ronald Ballard
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention Center for Global Health
| | - Anthony W Solomon
- Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Cheng Y Chen
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention
| | - Sibauk V Bieb
- Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland Department of Public Health, National Department of Health, Waigani, Papua New Guinea
| | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David CW Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases; London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | - Kingsley Asiedu
- Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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15
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Abdulai AA, Agana-Nsiire P, Biney F, Kwakye-Maclean C, Kyei-Faried S, Amponsa-Achiano K, Simpson SV, Bonsu G, Ohene SA, Ampofo WK, Adu-Sarkodie Y, Addo KK, Chi KH, Danavall D, Chen CY, Pillay A, Sanz S, Tun Y, Mitjà O, Asiedu KB, Ballard RC. Community-based mass treatment with azithromycin for the elimination of yaws in Ghana-Results of a pilot study. PLoS Negl Trop Dis 2018; 12:e0006303. [PMID: 29566044 PMCID: PMC5863939 DOI: 10.1371/journal.pntd.0006303] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 09/07/2016] [Accepted: 02/06/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The WHO yaws eradication strategy consists of one round of total community treatment (TCT) of single-dose azithromycin with coverage of > 90%.The efficacy of the strategy to reduce the levels on infection has been demonstrated previously in isolated island communities in the Pacific region. We aimed to determine the efficacy of a single round of TCT with azithromycin to achieve a decrease in yaws prevalence in communities that are endemic for yaws and surrounded by other yaws-endemic areas. METHODS Surveys for yaws seroprevalence and prevalence of skin lesions were conducted among schoolchildren aged 5-15 years before and one year after the TCT intervention in the Abamkrom sub-district of Ghana. We used a cluster design with the schools as the primary sampling unit. Among 20 eligible primary schools in the sub district, 10 were assigned to the baseline survey and 10 to the post-TCT survey. The field teams conducted a physical examination for skin lesions and a dual point-of-care immunoassay for non-treponemal and treponemal antibodies of all children present at the time of the visit. We also undertook surveys with non-probabilistic sampling to collect lesion swabs for etiology and macrolide resistance assessment. RESULTS At baseline 14,548 (89%) of 16,287 population in the sub-district received treatment during TCT. Following one round of TCT, the prevalence of dual seropositivity among all children decreased from 10.9% (103/943) pre-TCT to 2.2% (27/1211) post-TCT (OR 0.19; 95%CI 0.09-0.37). The prevalence of serologically confirmed skin lesions consistent with active yaws was reduced from 5.7% (54/943) pre-TCT to 0.6% (7/1211) post-TCT (OR 0.10; 95% CI 0.25-0.35). No evidence of resistance to macrolides against Treponema pallidum subsp. pertenue was seen. DISCUSSION A single round of high coverage TCT with azithromycin in a yaws affected sub-district adjoining other endemic areas is effective in reducing the prevalence of seropositive children and the prevalence of early skin lesions consistent with yaws one year following the intervention. These results suggest that national yaws eradication programmes may plan the gradual expansion of mass treatment interventions without high short-term risk of reintroduction of infection from contiguous untreated endemic areas.
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Affiliation(s)
- Abdul Aziz Abdulai
- West Akim District Health Administration, Ghana Health Service, Asamankese, Ghana
| | | | - Frank Biney
- District Hospital Laboratory, Ghana Health Service, Asamankese, Ghana
| | | | | | | | | | - George Bonsu
- Expanded Programme on Immunization, Ghana Health Service, Accra, Ghana
| | | | | | - Yaw Adu-Sarkodie
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kennedy Kwasi Addo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kai-Hua Chi
- Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Damien Danavall
- Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cheng Y. Chen
- Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Allan Pillay
- Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sergi Sanz
- Barcelona Institute for Global Health, Hospital Clinic – University of Barcelona, Barcelona, Spain
| | - Ye Tun
- Center for Global Health, Centers of Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Oriol Mitjà
- Barcelona Institute for Global Health, Hospital Clinic – University of Barcelona, Barcelona, Spain
- Department of Community Health, Lihir Medical Centre, Lihir Island, Papua, New Guinea
| | - Kingsley Bampoe Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
- * E-mail:
| | - Ronald C. Ballard
- Center for Global Health, Centers of Disease Control and Prevention, Atlanta, Georgia, United States of America
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Ohene SA, Bonsu F, Hanson-Nortey NN, Sackey A, Danso S, Afutu F, Klatser P, Bakker M. Yield of tuberculosis among household contacts of tuberculosis patients in Accra, Ghana. Infect Dis Poverty 2018; 7:14. [PMID: 29482625 PMCID: PMC5828410 DOI: 10.1186/s40249-018-0396-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 02/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background The End TB Strategy calls for systematic screening of selected high-risk groups including contacts of tuberculosis (TB) cases to facilitate early TB case detection. Contact investigation is not usually routinely practiced in low TB burden countries, such as Ghana, with consequent paucity of data on the yield of TB case detection from such interventions. This study’s objective was to document the outcomes and feasibility of implementing contact investigation activities under programmatic conditions in Ghana. Methods Retrospective analyses were conducted of abstracted data from the National TB Program, following a contact investigation intervention for TB cases diagnosed in 10 facilities in Accra from June 2010 to December 2014. Various proportions and yield from number of contacts needed to screen (NNS) and number needed to test (NNT) to detect a TB case were assessed. Results Overall, out of the 8519 listed contacts of 3267 index cases, 8166 (96%) were screened and 614 (7.5%) were identified as presumptive TB. Out of these, 438 (71%) underwent sputum smear microscopy/evaluation and 53 TB cases were diagnosed. Of these, 56.6% were males, and 49% had sputum smear-positive TB, 38% had sputum smear-negative TB, and 7% had extra-pulmonary TB. The NNS and NNT to detect a TB case of all forms were 154 and 8, respectively. The proportion of TB cases with contacts listed and proportion of contacts screened annually were 88–96% and 83–100%, respectively. The proportion of presumptive TB cases tested and proportion of TB cases diagnosed among contacts tested that were 100% and 36%, respectively, in 2010 dropped to 40% and 14%, respectively, by 2014. Conclusions The study demonstrates that contact identification and prioritization components of a contact investigation were feasible, but overall yield of TB cases may have been lower due to the declining rate of clinical evaluation of presumptive TB contacts over time. Addressing barriers to accessing appropriate diagnostic tests may enhance yield from contact investigation in Ghana. Electronic supplementary material The online version of this article (10.1186/s40249-018-0396-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sally-Ann Ohene
- World Health Organization Country Office, 29 Volta Street Airport, Airport Residential Area, P.O. Box MB 142, Accra, Ghana.
| | - Frank Bonsu
- National Tuberculosis Control Program, Accra, Ghana
| | | | | | - Samuel Danso
- National Tuberculosis Control Program, Accra, Ghana
| | - Felix Afutu
- National Tuberculosis Control Program, Accra, Ghana
| | - Paul Klatser
- Department of Global Health, Academic Medical Centre, Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands
| | - Mirjam Bakker
- KIT Health, Royal Tropical Institute (KIT), Amsterdam, The Netherlands
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Ohene SA, Bonsu F, Hanson-Nortey NN, Toonstra A, Sackey A, Lonnroth K, Uplekar M, Danso S, Mensah G, Afutu F, Klatser P, Bakker M. Provider initiated tuberculosis case finding in outpatient departments of health care facilities in Ghana: yield by screening strategy and target group. BMC Infect Dis 2017; 17:739. [PMID: 29191155 PMCID: PMC5709967 DOI: 10.1186/s12879-017-2843-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 08/14/2016] [Accepted: 11/21/2017] [Indexed: 11/22/2022] Open
Abstract
Background Meticulous identification and investigation of patients presenting with tuberculosis (TB) suggestive symptoms rarely happen in crowded outpatient departments (OPDs). Making health providers in OPDs diligently follow screening procedures may help increase TB case detection. From July 2010 to December 2013, two symptom based TB screening approaches of varying cough duration were used to screen and test for TB among general outpatients, PLHIV, diabetics and contacts in Accra, Ghana. Methods This study was a retrospective analysis comparing the yield of TB cases using two different screening approaches, allocated to selected public health facilities. In the first approach, the conventional 2 weeks cough duration with or without other TB suggestive symptoms was the criterion to test for TB in attendants of 7 general OPDs. In the second approach the screening criteria cough of >24 hours, as well as a history of at least one of the following symptoms: fever, weight loss and drenching night sweats were used to screen and test for TB among attendants of 3 general OPDs, 7 HIV clinics and 2 diabetes clinics. Contact investigation was initiated for index TB patients. The facilities documented the number of patients verbally screened, with presumptive TB, tested using smear microscopy and those diagnosed with TB in order to calculate the yield and number needed to screen (NNS) to find one TB case. Case notification trends in Accra were compared to those of a control area. Results In the approach using >24-hour cough, significantly more presumptive TB cases were identified among outpatients (0.82% versus 0.63%), more were tested (90.1% versus 86.7%), but less smear positive patients were identified among those tested (8.0% versus 9.4%). Overall, all forms of TB cases identified per 100,000 screened were significantly higher in the >24-hour cough approach at OPD (92.7 for cough >24 hour versus 82.7 for cough >2 weeks ), and even higher in diabetics (364), among contacts (693) and PLHIV (995). NNS (95% Confidence Interval) varied from 100 (93-109) for PLHIV, 144 (112-202) for contacts, 275 (197-451) for diabetics and 1144 (1101-1190) for OPD attendants. About 80% of the TB cases were detected in general OPDs. Despite the intervention, notifications trends were similar in the intervention and control areas. Conclusion The >24-hour cough approach yielded more TB cases though required TB testing for a larger number of patients. The yield of TB cases per 100,000 population screened was highest among PLHIV, contacts, and diabetics, but the majority of cases were detected in general OPDs. The intervention had no discernible impact on general case notification.
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Affiliation(s)
- Sally-Ann Ohene
- World Health Organization Country Office, 29 Volta Street Airport, Airport Residential Area, P.O. Box MB 142, Accra, Ghana.
| | - Frank Bonsu
- National Tuberculosis Control Program, Accra, Ghana
| | | | - Ardon Toonstra
- KIT Health, Royal Tropical Institute (KIT), Amsterdam, The Netherlands
| | | | | | | | - Samuel Danso
- National Tuberculosis Control Program, Accra, Ghana
| | | | - Felix Afutu
- National Tuberculosis Control Program, Accra, Ghana
| | - Paul Klatser
- Department of Global Health, Academic Medical Centre, Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands
| | - Mirjam Bakker
- KIT Health, Royal Tropical Institute (KIT), Amsterdam, The Netherlands
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Aku FY, Lessa FC, Asiedu-Bekoe F, Balagumyetime P, Ofosu W, Farrar J, Ouattara M, Vuong JT, Issah K, Opare J, Ohene SA, Okot C, Kenu E, Ameme DK, Opare D, Abdul-Karim A. Meningitis Outbreak Caused by Vaccine-Preventable Bacterial Pathogens - Northern Ghana, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:806-810. [PMID: 28771457 PMCID: PMC5720875 DOI: 10.15585/mmwr.mm6630a2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Marks M, Kwakye-Maclean C, Doherty R, Adwere P, Aziz Abdulai A, Duah F, Ohene SA, Mitja O, Oguti B, Solomon AW, Mabey DCW, Adu-Sarkodie Y, Asiedu K, Ackumey MM. Knowledge, attitudes and practices towards yaws and yaws-like skin disease in Ghana. PLoS Negl Trop Dis 2017; 11:e0005820. [PMID: 28759580 PMCID: PMC5552343 DOI: 10.1371/journal.pntd.0005820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/01/2017] [Revised: 08/10/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Yaws is endemic in Ghana. The World Health Organization (WHO) has launched a new global eradication campaign based on total community mass treatment with azithromycin. Achieving high coverage of mass treatment will be fundamental to the success of this new strategy; coverage is dependent, in part, on appropriate community mobilisation. An understanding of community knowledge, attitudes and practices related to yaws in Ghana and other endemic countries will be vital in designing effective community engagement strategies. METHODS A verbally administered questionnaire was administered to residents in 3 districts in the Eastern region of Ghana where a randomised trial on the treatment of yaws was being conducted. The questionnaire combined both quantitative and qualitative questions covering perceptions of the cause and mechanisms of transmission of yaws-like lesions, the providers from which individuals would seek healthcare for yaws-like lesions, and what factors were important in reaching decisions on where to seek care. Chi-square tests and logistic regression were used to assess relationships between reported knowledge, attitudes and practices, and demographic variables. Thematic analysis of qualitative data was used to identify common themes. RESULTS A total of 1,162 individuals participated. The majority of individuals (n = 895, 77%) reported that "germs" were the cause of yaws lesions. Overall 13% (n = 161) of respondents believed that the disease was caused by supernatural forces. Participants frequently mentioned lack of personal hygiene, irregular and inefficient bathing, and washing with dirty water as fundamental to both the cause and the prevention of yaws. A majority of individuals reported that they would want to take an antibiotic to prevent the development of yaws if they were asymptomatic (n = 689, 61.2%), but a substantial minority reported they would not want to do so. A majority of individuals (n = 839, 72.7%) reported that if they had a yaws-like skin lesion they would seek care from a doctor or nurse. Both direct and indirect costs of treatment were reported as key factors affecting where participants reported they would seek care. DISCUSSION This is the first study that has explored community knowledge, attitudes and practices in relation to yaws in any endemic population. The belief that 'germs' are in some way related to disease through a variety of transmission routes including both contact and dirty water are similar to those reported for other skin diseases in Ghana. The prominent role of private healthcare providers is an important finding of this study and suggests engagement with this sector will be important in yaws eradication efforts. Strategies to address the substantial minority of individuals who reported they would not take treatment for yaws if they were currently asymptomatic will be needed to ensure the success of yaws eradication efforts. The data collected will be of value to the Ghana Health Service and also to WHO and other partners, who are currently developing community mobilisation tools to support yaws eradication efforts worldwide.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
- * E-mail:
| | | | - Rachel Doherty
- University College London Medical School, Gower Street, London, United Kingdom
| | | | | | | | | | - Oriol Mitja
- Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Blanche Oguti
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W. Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - David C. W. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
| | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Mercy M. Ackumey
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
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Mitjà O, Marks M, Bertran L, Kollie K, Argaw D, Fahal AH, Fitzpatrick C, Fuller LC, Garcia Izquierdo B, Hay R, Ishii N, Johnson C, Lazarus JV, Meka A, Murdoch M, Ohene SA, Small P, Steer A, Tabah EN, Tiendrebeogo A, Waller L, Yotsu R, Walker SL, Asiedu K. Integrated Control and Management of Neglected Tropical Skin Diseases. PLoS Negl Trop Dis 2017; 11:e0005136. [PMID: 28103250 PMCID: PMC5245794 DOI: 10.1371/journal.pntd.0005136] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Oriol Mitjà
- Skin NTDs Program, Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
| | - Laia Bertran
- Skin NTDs Program, Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Karsor Kollie
- Neglected Tropical and Non Communicable Diseases Program, Ministry of Health, Government of Liberia, Liberia
| | - Daniel Argaw
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Ahmed H. Fahal
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | - Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - L. Claire Fuller
- International Foundation for Dermatology, London, United Kingdom
| | | | - Roderick Hay
- International Foundation for Dermatology, London, United Kingdom
| | - Norihisa Ishii
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Jeffrey V. Lazarus
- Skin NTDs Program, Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Anthony Meka
- Medical Department, German Leprosy and TB Relief Association, Enugu, Nigeria
| | - Michele Murdoch
- Department of Dermatology, Watford General Hospital, Watford, United Kingdom
| | | | - Pam Small
- Department of Microbiology, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Andrew Steer
- Group A Streptococcal Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Earnest N. Tabah
- National Yaws, Leishmaniasis, Leprosy and Buruli ulcer Control Programme, Ministry of Public Health, Yaoundé, Cameroon
| | | | - Lance Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Rie Yotsu
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Stephen L. Walker
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Abstract
Background Despite recurring outbreaks of cholera in Ghana, very little has been reported on assessments of outbreak response activities undertaken in affected areas. This study assessed the response activities undertaken in two districts, Akatsi District in Volta Region and Komenda-Edina-Eguafo-Abirem (KEEA) Municipal in Central Region during the 2012 cholera epidemic in Ghana. Methods We conducted a retrospective assessment of the events, strengths and weaknesses of the cholera outbreak response activities in the two districts making use of the WHO cholera evaluation tool. Information sources included surveillance and facility records, reports and interviews with relevant health personnel involved in the outbreak response from both district health directorates and health facilities. We collected data on age, sex, area of residence, date of reporting to health facility of cholera cases, district population data and information on the outbreak response activities and performed descriptive analyses of the outbreak data by person, time and place. Results The cholera outbreak in Akatsi was explosive with a high attack rate (AR) of 374/100,000 and case fatality rate (CFR) of 1.2 % while that in KEEA was on a relatively smaller scale AR of 23/100,000 but with a high case fatality rate of 18.8 %. For both districts, we identified multiple strengths in the response to the outbreak including timely notification of the district health officials which triggered prompt investigation of the suspected outbreak facilitating confirmation of cholera and initiation of public health response activities. Others were coordination of the activities by multi-sectoral committees, instituting water, sanitation and hygiene measures and appropriate case management at health facilities. We also found areas that needed improvement in both districts including incomplete surveillance data, sub-optimal community based surveillance considering the late reporting and the deaths in the community and the inadequate community knowledge about cholera preventive measures. Conclusion The assessment of the cholera outbreak response in the two districts highlighted strengths in the epidemic control activities. There was however need to strengthen preparedness especially in the area of improving community surveillance and awareness about cholera prevention and the importance of seeking prompt treatment in health facilities in the event of an outbreak. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0192-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sally-Ann Ohene
- World Health Organization Country Office, 29 Volta Street Airport, Airport Residential Area, PO Box MB 142, Accra, Ghana.
| | - Wisdom Klenyuie
- School of Public Health, College of Health Science, University of Ghana, Accra, Ghana
| | - Mark Sarpeh
- Komenda-Edina-Eguafo-Abirem Municipal Health Directorate, Central Region, Ghana
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Kwambana-Adams BA, Asiedu-Bekoe F, Sarkodie B, Afreh OK, Kuma GK, Owusu-Okyere G, Foster-Nyarko E, Ohene SA, Okot C, Worwui AK, Okoi C, Senghore M, Otu JK, Ebruke C, Bannerman R, Amponsa-Achiano K, Opare D, Kay G, Letsa T, Kaluwa O, Appiah-Denkyira E, Bampoe V, Zaman SMA, Pallen MJ, D'Alessandro U, Mwenda JM, Antonio M. An outbreak of pneumococcal meningitis among older children (≥5 years) and adults after the implementation of an infant vaccination programme with the 13-valent pneumococcal conjugate vaccine in Ghana. BMC Infect Dis 2016; 16:575. [PMID: 27756235 PMCID: PMC5070171 DOI: 10.1186/s12879-016-1914-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [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: 06/17/2016] [Accepted: 10/11/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND An outbreak of pneumococcal meningitis among non-infant children and adults occurred in the Brong-Ahafo region of Ghana between December 2015 and April 2016 despite the recent nationwide implementation of a vaccination programme for infants with the 13-valent pneumococcal conjugate vaccine (PCV13). METHODS Cerebrospinal fluid (CSF) specimens were collected from patients with suspected meningitis in the Brong-Ahafo region. CSF specimens were subjected to Gram staining, culture and rapid antigen testing. Quantitative PCR was performed to identify pneumococcus, meningococcus and Haemophilus influenzae. Latex agglutination and molecular serotyping were performed on samples. Antibiogram and whole genome sequencing were performed on pneumococcal isolates. RESULTS Eight hundred eighty six patients were reported with suspected meningitis in the Brong-Ahafo region during the period of the outbreak. In the epicenter district, the prevalence was as high as 363 suspected cases per 100,000 people. Over 95 % of suspected cases occurred in non-infant children and adults, with a median age of 20 years. Bacterial meningitis was confirmed in just under a quarter of CSF specimens tested. Pneumococcus, meningococcus and Group B Streptococcus accounted for 77 %, 22 % and 1 % of confirmed cases respectively. The vast majority of serotyped pneumococci (80 %) belonged to serotype 1. Most of the pneumococcal isolates tested were susceptible to a broad range of antibiotics, with the exception of two pneumococcal serotype 1 strains that were resistant to both penicillin and trimethoprim-sulfamethoxazole. All sequenced pneumococcal serotype 1 strains belong to Sequence Type (ST) 303 in the hypervirulent ST217 clonal complex. CONCLUSION The occurrence of a pneumococcal serotype 1 meningitis outbreak three years after the introduction of PCV13 is alarming and calls for strengthening of meningitis surveillance and a re-evaluation of the current vaccination programme in high risk countries.
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Affiliation(s)
- Brenda Anna Kwambana-Adams
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | | | | | | | | | | | - Ebenezer Foster-Nyarko
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | | | | | - Archibald Kwame Worwui
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Catherine Okoi
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Madikay Senghore
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Jacob Kweku Otu
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Chinelo Ebruke
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Richard Bannerman
- Brong Ahafo Regional Health Directorate, Sunyani, Brong Ahafo, Ghana
| | | | - David Opare
- National Public Health Reference Laboratory, Ghana Health Service, Accra, Ghana
| | - Gemma Kay
- Microbiology and Infection Unit, Warwick Medical School, Warwick, UK
| | - Timothy Letsa
- Brong Ahafo Regional Health Directorate, Sunyani, Brong Ahafo, Ghana
| | | | | | | | - Syed M A Zaman
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Mark J Pallen
- Microbiology and Infection Unit, Warwick Medical School, Warwick, UK
| | - Umberto D'Alessandro
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia.,London School of Hygiene and Tropical Medicine, London, UK.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Jason M Mwenda
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Martin Antonio
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia. .,Microbiology and Infection Unit, Warwick Medical School, Warwick, UK. .,London School of Hygiene and Tropical Medicine, London, UK.
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Nyarko KM, Ameme DK, Ocansey D, Commeh E, Markwei MT, Ohene SA. Capacity assessment of selected health care facilities for the pilot implementation of Package for Essential Non-communicable Diseases (PEN) intervention in Ghana. Pan Afr Med J 2016; 25:16. [PMID: 28149441 PMCID: PMC5257011 DOI: 10.11604/pamj.supp.2016.25.1.6252] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/07/2015] [Indexed: 12/03/2022] Open
Abstract
Introduction Non-communicable diseases (NCDs) continue to pose threats to human health and development worldwide. Though preventable, NCDs kill more people annually than all other diseases combined. The four major NCDs namely cardiovascular diseases, chronic respiratory diseases, diabetes and cancers share common modifiable risk factors. In order to prevent and control NCDs, Ghana has adopted the World Health Organisation Package for Essential NCD (WHO-PEN) intervention, to be piloted in selected districts before a nationwide scale-up. We assessed the capacity of these facilities for the implementation of the WHO-PEN pilot. Methods We conducted a cross-sectional health facility-based survey using a multistage sampling technique. We collected data on human resource, equipment, service utilization, medicines availability and health financing through interviews and observation. Descriptive data analysis was performed and expressed in frequencies and relative frequencies. Results In all, 23 health facilities comprising two regional hospitals, three district hospitals, nine health centres and nine Community-based Health Planning and Services (CHPS) compounds from three regions were surveyed. All the hospitals had medical officers whilst 4 (44.4%) of the health centres had physician assistants. Health financing is mainly by the National Health Insurance Scheme (NHIS). None of the health facilities had spacers and only one health centre had oxygen cylinder, glucometer and nebulizer. Conclusion Gaps exist in the human resource capacity and service delivery at the primary care levels, the focus of WHO-PEN intervention. Adequately equipping the primary health care level with trained health workers, basic equipment, medications and diagnostics will optimize the performance of WHO-PEN intervention when implemented.
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Affiliation(s)
- Kofi Mensah Nyarko
- Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Box LG 13, Legon, Accra, Ghana; Disease Control and Prevention Department, Ghana Health Service, Box KB 493, Korle-Bu, Accra, Ghana
| | - Donne Kofi Ameme
- Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Box LG 13, Legon, Accra, Ghana
| | - Dennis Ocansey
- Disease Control and Prevention Department, Ghana Health Service, Box KB 493, Korle-Bu, Accra, Ghana
| | - Efua Commeh
- Disease Control and Prevention Department, Ghana Health Service, Box KB 493, Korle-Bu, Accra, Ghana
| | | | - Sally-Ann Ohene
- World Health Organization, Ghana Country Office Box MB 42, Accra, Ghana
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Bonney JH, Nyarko EO, Ohene SA, Amankwa J, Ametepi RK, Nimo-Paintsil SC, Sarkodie B, Agbenohevi P, Adjabeng M, Kyei NN, Bel-Nono S, Ampofo WK. Molecular confirmation of Lassa fever imported into Ghana. Afr J Lab Med 2016; 5:288. [PMID: 28879105 PMCID: PMC5436394 DOI: 10.4102/ajlm.v5i1.288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/02/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Recent reports have shown an expansion of Lassa virus from the area where it was first isolated in Nigeria to other areas of West Africa. Two Ghanaian soldiers on a United Nations peacekeeping mission in Liberia were taken ill with viral haemorrhagic fever syndrome following the death of a sick colleague and were referred to a military hospital in Accra, Ghana, in May 2013. Blood samples from the soldiers and five asymptomatic close contacts were subjected to laboratory investigations. OBJECTIVE We report the results of these investigations to highlight the importance of molecular diagnostic applications and the need for heightened awareness about Lassa fever in West Africa. METHODS We used molecular assays on sera from the two patients to identify the causative organism. Upon detection of positive signals for Lassa virus ribonucleic material by two different polymerase chain reaction assays, sequencing and phylogenetic analyses were performed. RESULTS The presence of Lassa virus in the soldiers' blood samples was shown by L-gene segment homology to be the Macenta and las803792 strains previously isolated in Liberia, with close relationships then confirmed by phylogenetic tree construction. The five asymptomatic close contacts were negative for Lassa virus. CONCLUSIONS The Lassa virus strains identified in the two Ghanaian soldiers had molecular epidemiological links to strains from Liberia. Lassa virus was probably responsible for the outbreak of viral haemorrhagic fever in the military camp. These data confirm Lassa fever endemicity in West Africa.
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Affiliation(s)
- Joseph H.K. Bonney
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | - Sally-Ann Ohene
- World Health Organization Ghana Country Office, Accra, Ghana
| | - Joseph Amankwa
- Disease Surveillance Department, Ghana Health Service, Accra, Ghana
| | | | | | - Badu Sarkodie
- Disease Surveillance Department, Ghana Health Service, Accra, Ghana
| | | | - Michael Adjabeng
- Disease Surveillance Department, Ghana Health Service, Accra, Ghana
| | | | | | - William K. Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
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Ohene SA, Johnson K, Atunah-Jay S, Owusu A, Borowsky IW. Sexual and physical violence victimization among senior high school students in Ghana: Risk and protective factors. Soc Sci Med 2015; 146:266-75. [DOI: 10.1016/j.socscimed.2015.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 11/24/2022]
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Lartey M, Puplampu P, Seneadza NAH, Oliver-Commey J, Amoah S, Ohene SA. Preparing for Ebola, the experiences of a national training team (Ghana). Pan Afr Med J 2015; 22 Suppl 1:12. [PMID: 26740840 PMCID: PMC4695519 DOI: 10.11694/pamj.supp.2015.22.1.6320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/20/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Margaret Lartey
- Department of Medicine, University of Ghana School of Medicine and Dentistry, Ghana; Department of Medicine, Korle Bu Teaching Hospital, Ghana
| | - Peter Puplampu
- Department of Medicine, University of Ghana School of Medicine and Dentistry, Ghana; Department of Medicine, Korle Bu Teaching Hospital, Ghana
| | | | | | - Serwah Amoah
- Public Health Department, Korle Bu Teaching Hospital, Ghana
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Lartey M, Puplampu P, Seneadza NAH, Oliver-Commey J, Amoah S, Ohene SA. Preparing for Ebola, the experiences of a national training team (Ghana). Pan Afr Med J 2015. [DOI: 10.11604/pamj.supp.2015.22.1.6320] [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: 11/11/2022] Open
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Kyei NNA, Abilba MM, Kwawu FK, Agbenohevi PG, Bonney JHK, Agbemaple TK, Nimo-Paintsil SC, Ampofo W, Ohene SA, Nyarko EO. Imported Lassa fever: a report of 2 cases in Ghana. BMC Infect Dis 2015; 15:217. [PMID: 26022703 PMCID: PMC4448534 DOI: 10.1186/s12879-015-0956-2] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/20/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Lassa fever is a potentially fatal acute viral illness caused by Lassa virus which is carried by rodents and is endemic in some West African countries. Importation of emerging infections such as Lassa fever, Ebola Virus Disease and other viral hemorrhagic fevers into non endemic regions is a growing threat particularly as international travel and commitments in resolving conflicts in endemic countries in the West Africa sub-region continue. CASE PRESENTATION We report the first two recorded imported cases of Lassa fever among Ghanaian Peace keepers in rural Liberia, who became ill while on Peace keeping mission. They were subsequently evacuated to the UN level IV hospital in Accra, where their illnesses were laboratory confirmed. One of the patients recovered with ribavirin treatment and supportive therapy. No secondary clinical cases occurred in Ghana. CONCLUSIONS Healthcare providers at all levels of care should thus have a high index of suspicion for these infectious diseases and adopt standard infection control measures when treating patients in endemic regions or returning travelers from an endemic region with a febrile illness even of a known etiology.
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Affiliation(s)
| | - Mark M Abilba
- 37 Military Hospital, Neghelli Barracks, Accra, Ghana.
| | | | | | - Joseph H K Bonney
- Noguchi Memorial Research Institute for Medical Research, University of Ghana, P.O. Box LG 581, Legon, Ghana.
| | | | - Shirley C Nimo-Paintsil
- Noguchi Memorial Research Institute for Medical Research, University of Ghana, P.O. Box LG 581, Legon, Ghana.
| | - William Ampofo
- Noguchi Memorial Research Institute for Medical Research, University of Ghana, P.O. Box LG 581, Legon, Ghana.
| | - Sally-Ann Ohene
- World Health Organization Ghana Country Office, P. O Box MB 142, Accra, Ghana.
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Ohene SA, Addo NA, Zigah F, Newman M, Lartey M, Romero MA, Ofori S, Sheriff T, Ndanu T. Evaluation of antiretroviral therapy (ART) provision in an early cohort of patients initiating ART in Ghana. Pan Afr Med J 2013; 16:117. [PMID: 24778754 PMCID: PMC3998899 DOI: 10.11604/pamj.2013.16.117.3136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 07/23/2013] [Accepted: 11/10/2013] [Indexed: 11/11/2022] Open
Abstract
Introduction Against the background of Ghana's ART program which scaled up rapidly since inception in 2003, the study assessed outcomes of an early cohort of patients initiating ART. Methods The study utilized the following methods: a cross-sectional study involving patient interviews using a structured questionnaire, a review of records and a retrospective cohort analysis of adults initiating ART between 2003 and 2008 from four selected clinics. Results The 683 study participants consisted of 464 females (67.9%) and the mean age was 41 years. Mean duration of treatment was 25 months (SD =13). More than 95% were on a regimen as per national guidelines. Ninety-five (14.1%) of the respondents had one or two drugs substituted. Seventy-three% of the substitutions were due to adverse drug reactions. On at least one occasion, over half (350) had defaulted on a clinic appointment. In the 3 months preceding the survey, 21.4% (146) had missed treatment doses. About 49% (334) had challenges meeting financial obligations related to care. The median weight increased by 5.9kg and 8.0kg at 6 and 12 months after initiating ART respectively over the median baseline weight of 54kg, (p-value = 0.001). The median CD4 count increased by 128, 170 and 256 cells/µl respectively at 6, 12 and 24 months from the median baseline of 125 cell/µl, (p-value = 0.035). Conclusion This study of Ghanaian PLHIV on ART from four facilities showed encouraging immunological and clinical outcomes. There were however issues of appointment default, sub-optimum adherence to treatment and cost of care barriers needing attention.
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Affiliation(s)
- Sally-Ann Ohene
- World Health Organization Ghana Country Office, Accra, Ghana
| | - Nii Akwei Addo
- National AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana
| | | | - Morkor Newman
- World Health Organization Inter-country Support Team, Harare, Zimbabwe
| | - Margaret Lartey
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | | | - Tom Ndanu
- University of Ghana Dental School, Accra, Ghana
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Abstract
BACKGROUND There is limited data on adolescent mortality particularly from developing countries with unreliable death registration systems. This calls for the use of other sources of data to ascertain cause of adolescent mortality. The objective of this study was to describe the causes of death among Ghanaian adolescents 10 to 19 years in Accra, Ghana utilizing data from autopsies conducted in Korle Bu Teaching Hospital (KBTH). FINDINGS Out of the 14,034 autopsies carried out from 2001 to 2003 in KBTH, 7% were among adolescents. Of the 882 deaths among adolescents analyzed, 402 (45.6%) were females. There were 365 (41.4%) deaths from communicable disease, pregnancy related conditions and nutritional disorders. Non-communicable diseases accounted for 362 (41%) cases and the rest were attributable to injuries and external causes of morbidity and mortality. Intestinal infectious diseases and lower respiratory tract infections were the most common communicable causes of death collectively accounting for 20.5% of total deaths. Death from blood diseases was the largest (8.5%) among the non-communicable conditions followed by neoplasms (7%). Males were more susceptible to injuries than females (χ2 = 13.45, p = .000). At least five out of ten specific causes of death were as a result of infections with pneumonia and typhoid being the most common. Sickle cell disease was among the top three specific causes of death. Among the females, 27 deaths (6.7%) were pregnancy related with most of them being as a result of abortion. CONCLUSIONS The autopsy data from the Korle-Bu Teaching Hospital can serve as a useful source of information on adolescent mortality. Both communicable and non-communicable diseases accounted for most deaths highlighting the need for health care providers to avoid complacency in their management of adolescents presenting with these diseases.
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Affiliation(s)
- Sally-Ann Ohene
- World Health Organization Country Office in Ghana, Accra, Ghana
| | - Yao Tettey
- Department of Pathology, University of Ghana Medical School, Korle Bu, Accra, Ghana
| | - Robert Kumoji
- Department of Pathology, University of Ghana Medical School, Korle Bu, Accra, Ghana
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Ohene SA, Tettey Y, Kumoji R. Injury-related mortality among adolescents: findings from a teaching hospital's post mortem data. BMC Res Notes 2010; 3:124. [PMID: 20444252 PMCID: PMC2874566 DOI: 10.1186/1756-0500-3-124] [Citation(s) in RCA: 12] [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: 01/18/2010] [Accepted: 05/05/2010] [Indexed: 12/02/2022] Open
Abstract
Background Injuries are noted to be an important cause of death among adolescents. There is however limited data on the injury related deaths among adolescents in Ghana. Findings Using data from post-mortem records derived from the Department of Pathology of the Korle-Bu Teaching Hospital (KBTH), Accra Ghana from 2001 to 2003, the causes of injury related deaths among adolescents 10 to 19 years were analyzed by gender and age groups 10 to 14 and 15 to 19 years. There were 151 injury-related deaths constituting 17% of the autopsies performed among adolescents in the study period. The male-to-female ratio was 2.1:1. Drowning was the most common cause of death (37%) in the study population. This was followed by road traffic accidents (RTA) (33%). Over 70% of the RTA victims were pedestrians knocked downed by a vehicle. Deaths from electrocution, poisoning, burns, stab/gunshot, hanging and other miscellaneous causes (example blast injury, traumatic injury from falling debris, fall from height) made up the remaining 30% of the injury related mortality. Among males and in both age categories, drowning was the leading cause of death. In females, the highest mortality was from road traffic accidents accounting for almost half (49%) of the deaths; significantly more than that occurring in males (25%, p = .004). Conclusions Findings from Korle-Bu Teaching Hospital post-mortem data on adolescents show that drowning and road traffic accidents are the leading causes of injury-related mortality. Appropriate injury reducing interventions are needed to facilitate a decrease in these preventable deaths.
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Affiliation(s)
- Sally-Ann Ohene
- World Health Organization Country Office in Ghana, Accra, Ghana.
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Ohene SA, Ireland M, McNeely C, Borowsky IW. Parental expectations, physical punishment, and violence among adolescents who score positive on a psychosocial screening test in primary care. Pediatrics 2006; 117:441-7. [PMID: 16452364 DOI: 10.1542/peds.2005-0421] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to examine the relationship between perceived and stated parental expectations regarding adolescents' use of violence, parental use of physical punishment as discipline, and young adolescents' violence-related attitudes and involvement. METHODS Surveys were completed by 134 youth and their parents attending 8 pediatric practices. All youth were 10 to 15 years of age and had scored positive on a psychosocial screening test. RESULTS Multivariate analyses revealed that perceived parental disapproval of the use of violence was associated with a more prosocial attitude toward interpersonal peer violence and a decreased likelihood of physical fighting by the youth. Parental report of whether they would advise their child to use violence in a conflict situation (stated parental expectations) was not associated with the adolescents' attitudes toward interpersonal peer violence, intentions to fight, physical fighting, bullying, or violence victimization. Parental use of corporal punishment as a disciplining method was inversely associated with a prosocial attitude toward interpersonal peer violence among the youth and positively correlated with youths' intentions to fight and fighting, bullying, and violence victimization. CONCLUSIONS Perceived parental disapproval of the use of violence may be an important protective factor against youth involvement in violence, and parental use of physical punishment is associated with both violence perpetration and victimization among youth. Parents should be encouraged to clearly communicate to their children how to resolve conflicts without resorting to violence and to model these skills themselves by avoiding the use of physical punishment.
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Affiliation(s)
- Sally-Ann Ohene
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
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Abstract
OBJECTIVE The objective of this study was to examine the relationship between age at onset of sexual abuse, risk behaviors, and a diagnosis of sexually transmitted disease (STD) in a clinic-attending adolescent population. METHODS Bivariate analyses were used to test association among age at onset of sexual abuse, risk behaviors, and STD diagnosis (n = 2175). Relationship between sexual abuse and STD acquisition was assessed by regression analysis. RESULTS More females than males reported sexual abuse, 26.75% and 5.4%, respectively. Abuse at or before 10 years of age was associated with more lifetime and recent partners. History of abuse was associated with higher rates of STD tests. In regression analysis, for males and females, the odds of having an STD were 2.5 times greater if abuse occurred at 10 years or younger. CONCLUSION Sexual abuse at a younger age is associated with more sexual risk behaviors and is a risk factor for STDs.
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Affiliation(s)
- Sally-Ann Ohene
- Center for Adolescent Health and Development, University of Minnesota, Minneapolis 55455, USA.
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Abstract
OBJECTIVE To examine the relationships among risk behaviors for Caribbean youth; and to determine the correlations between initiation of sexual activity and other risk behaviors. METHODS The associations between cigarette smoking, alcohol and marijuana use, early initiation of sexual intercourse, involvement in violence and delinquency were examined using odds ratios on data from the Caribbean Youth Health Survey (n = 15, 695). Survival analysis was then used to determine the association between initiation of sexual activity and the risk behaviors. FINDINGS There were statistically significant relationships between all pairs of risk behaviors for both male and female adolescents. Even though more males than females had engaged in each of the behaviors, the strengths of association were higher for females. From survival analysis, initiation of sexual activity was associated with gang involvement and weapon carrying among young adolescents and even more risk behaviors among the older adolescents. CONCLUSION Health compromising behaviors cluster among Caribbean youth with associations being stronger for females. Initiating sexual activity was a predictor of other risk behaviors with the likelihood increasing among older adolescents and females.
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Affiliation(s)
- Sally-Ann Ohene
- Center for Adolescent Health and Development, University of Minnesota, 200 Oak Street, SE, Suite 260, Minneapolis, MN 55455, USA.
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Goka BQ, Kwarko H, Kurtzhals JA, Gyan B, Ofori-Adjei E, Ohene SA, Hviid L, Akanmori BD, Neequaye J. Complement binding to erythrocytes is associated with macrophage activation and reduced haemoglobin in Plasmodium falciparum malaria. Trans R Soc Trop Med Hyg 2001; 95:545-9. [PMID: 11706671 DOI: 10.1016/s0035-9203(01)90036-7] [Citation(s) in RCA: 34] [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: 11/25/2022] Open
Abstract
We have examined IgG and complement factor C3d deposition on erythrocytes by means of the direct Coombs' test (DAT) and looked for an association with the anaemia seen in falciparum malaria in children living in an area of hyperendemic malaria transmission (in Ghana). In one study (in 1997), 53 out of 199 patients had a positive DAT. Of these, 45 samples reacted with anti-C3d antibodies, 2 with anti-IgG and 6 with both reagents. There were significantly lower haemoglobin (Hb)-levels and higher prevalence of spleen enlargement in DAT-positive than in DAT-negative patients. Hb-levels were independently associated with DAT and age. This initial study was designed to investigate the role of intravascular haemolysis (IVH), but we found no association between IVH and either DAT result or anaemia. Because of the risk of selection bias we repeated the study using consecutive enrollment of malaria patients and were able to confirm the results in a total of 49 DAT-positive and 183 DAT-negative patients. This second study (in 1998) was designed to look at the importance of erythrophagocytosis through measurement of plasma neopterin levels and total nitrite and nitrate as markers of NO-release. Both parameters were significantly higher in DAT-positive than in DAT-negative patients (P < 0.001), indicating that complement binding to erythrocytes was associated with macrophage activation. Plasma levels of haptoglobin, interleukin-10 and tumour necrosis factor-alpha did not vary between the groups. The studies support the role of complement activation and erythrophagocytosis in the pathogenesis of anaemia in falciparum malaria in African children.
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Affiliation(s)
- B Q Goka
- Department of Child Health, Korle-Bu Teaching Hospital, P.O. Box 4236, Accra, Ghana.
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