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Lori JR, Kukula VA, Liu L, Apetorgbor VEA, Ghosh B, Awini E, Lockhart N, Amankwah G, Zielinski R, Moyer CA, Williams J. Improving health literacy through group antenatal care: results from a cluster randomized controlled trial in Ghana. BMC Pregnancy Childbirth 2024; 24:37. [PMID: 38182969 PMCID: PMC10768124 DOI: 10.1186/s12884-023-06224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Although the majority of Ghanaian women receive antenatal care (ANC), many exhibit low health literacy by misinterpreting and incorrectly operationalizing ANC messages, leading to poor maternal and newborn health outcomes. Prior research in low-resource settings has found group antenatal care (G-ANC) feasible for women and providers. This study aims to determine the effect of G-ANC on increasing maternal health literacy. We hypothesized that pregnant women randomized into G-ANC would exhibit a greater increase in maternal health literacy than women in routine, individual ANC. METHODS A 5-year cluster randomized controlled trial was conducted in 14 rural and peri-urban health facilities in the Eastern Region of Ghana. Facilities were paired based on patient volume and average gestational age at ANC enrollment and then randomized into intervention (G-ANC) vs. control (routine, individual ANC); 1761 pregnant women were recruited. Data collection occurred at baseline (T0) and post-birth (T2) using the Maternal Health Literacy scale, a 12-item composite scale to assess maternal health literacy. Logistic regression compared changes in health literacy from T0 to T2. RESULTS Overall, women in both the intervention and control groups improved their health literacy scores over time (p < 0.0001). Women in the intervention group scored significantly higher on 3 individual items and on overall composite scores (p < 0.0001) and were more likely to attend 8 or more ANC visits. CONCLUSION While health literacy scores improved for all women attending ANC, women randomized into G-ANC exhibited greater improvement in overall health literacy post-birth compared to those receiving routine individual care. Life-saving information provided during ANC must be presented in an understandable format to prevent women and newborns from dying of preventable causes. TRIAL REGISTRY Ethical approval for the study was obtained from the Institutional Review Boards of the University of Michigan (HUM#00161464) and the Ghana Health Service (GHS-ERC: 016/04/19).
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Affiliation(s)
- Jody R Lori
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America.
| | - Vida Ami Kukula
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Liya Liu
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | | | - Bidisha Ghosh
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Elizabeth Awini
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Nancy Lockhart
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Georgina Amankwah
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
| | - Ruth Zielinski
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Bldg, Ann Arbor, MI, United States of America
| | - Cheryl A Moyer
- Department of Learning Health Sciences, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, United States of America
| | - John Williams
- Dodowa Health Research Centre, Ghana Health Service, P.O.Box DD1, Dodowa, Ghana
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Zielinski R, Kukula V, Apetorgbor V, Awini E, Moyer C, Badu-Gyan G, Williams J, Lockhart N, Lori J. "With group antenatal care, pregnant women know they are not alone": The process evaluation of a group antenatal care intervention in Ghana. PLoS One 2023; 18:e0291855. [PMID: 37934750 PMCID: PMC10629640 DOI: 10.1371/journal.pone.0291855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/06/2022] [Accepted: 09/07/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND An essential component to improving maternal and newborn outcomes is antenatal care. A trial of group antenatal care was implemented in Ghana where 7 health care facilities were randomized to be intervention sites and 7 control sites continued traditional antenatal care. Group antenatal care, where 10-14 women with similar due dates meet together for visits, includes traditional components such as risk assessment with increased opportunity for education and peer support. The study aim was to assess and report the process evaluation of the implementation of a group antenatal care intervention. METHODS Process evaluation data were collected alongside intervention data and included both quantitative and qualitative data sources. Midwives at the health facilities which were randomized as intervention sites completed tracking logs to measure feasibility of the intervention. Research team members traveled to intervention sites where they conducted structured observations and completed fidelity and learning methods checklists to determine adherence to the model of group antenatal care delivery. In addition, midwives facilitating group antenatal care meetings were interviewed and focus groups were conducted with women participating in group antenatal care. RESULTS In the majority of cases, midwives facilitating group antenatal care completed all components of the meetings with fidelity, following best practices such as sitting with the group rather than standing. Across 7 intervention sites, 7 groups (622 pregnant women) were documented in the tracking logs and of these participants, the majority (74%) attended more than half of the meetings, with 32% attending all 8 group meetings. Three themes were identified in both the midwife interviews and focus groups with pregnant women: 1) information sharing, 2) sense of community, and 3) time management challenges. An additional theme emerged from the focus groups with the women: women who had already given birth noticed a disconnect between what they learned and treatment received during labor and birth. CONCLUSION This process evaluation determined that group antenatal care can be implemented with fidelity in low and middle-income countries. Time management was the biggest challenge, however both midwives and pregnant women found the model of care not only acceptable, but preferable to traditional care. The knowledge shared and sense of community built during the meetings was a valuable addition to the individual model of antenatal care.
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Affiliation(s)
- Ruth Zielinski
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Vida Kukula
- Ghana Health Service, Dodowa Health Research Centre, Dodowa, Ghana
| | | | - Elizabeth Awini
- Ghana Health Service, Dodowa Health Research Centre, Dodowa, Ghana
| | - Cheryl Moyer
- Department of Learning Health Sciences, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, United States of America
| | | | - John Williams
- Ghana Health Service, Dodowa Health Research Centre, Dodowa, Ghana
| | - Nancy Lockhart
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jody Lori
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America
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Kukula VA, Odopey S, Arthur E, Odonkor G, Awini E, Adjei A, Salami O, Nkeramahame J, Horgan P, Olliaro P, Williams J, Baiden R. Understanding Health Worker and Community Antibiotic Prescription-Adherence Practices for Acute Febrile Illness: A Nested Qualitative Study in the Shai-Osudoku District of Ghana and the Development of a Training-and-Communication Intervention. Clin Infect Dis 2023; 77:S182-S190. [PMID: 37490740 PMCID: PMC10368414 DOI: 10.1093/cid/ciad327] [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] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The aim was to explore behavioral factors relating to the prescription and communication of prescription-adherence messages for patients with acute febrile illness, from which to develop a training-and-communication (T&C) intervention to be delivered as part of a clinical trial. METHODS The study undertook a content analysis of primary, qualitative data collection using in-depth interviews and focus group discussions, informed by the Capability, Opportunity, Motivation (COM-B) theory of behavior, the Theoretical Domains Framework (TDF), and Behavior Change Wheel (BCW) approach, in health facilities (39 health workers) and communities (66 community members) in the Shai-Osudoku District of Ghana. RESULTS Health workers perceive that prescribers' and dispensers' communication with patients is influenced by the following factors: patient's educational level, existing disease conditions, health worker's workload, patient's religion, language barrier between health worker and patient, outcome of laboratory results, and medicine availability. Community members' adherence to prescription was influenced by the availability of money and affordability of medicine (outside of provision by the national health insurance scheme), the severity of the condition, work schedule, and forgetfulness. CONCLUSIONS Our study contributes to knowledge on nesting qualitative methods in a clinical trial and reveals factors that affect the antibiotic prescription communication process. Tailored messages for patient-specific needs can shape antibiotic prescription adherence behavior and ultimately contribute to decreasing the incidence of antibiotic resistance.
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Affiliation(s)
- Vida Ami Kukula
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Selase Odopey
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Emmanuel Arthur
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Gabriel Odonkor
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Elizabeth Awini
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Alexander Adjei
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | | | | | - Philip Horgan
- Department of Medicine, FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Department of Medical Affairs, Evidence and Impact Oxford, Oxford, United Kingdom
| | - Piero Olliaro
- Department of Medicine, FIND, Geneva, Switzerland
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - John Williams
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
| | - Rita Baiden
- Social Science Department, Dodowa Health Research Centre, Dodowa, Ghana
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Adjei A, Kukula V, Narh CT, Odopey S, Arthur E, Odonkor G, Mensah MM, Olliaro P, Horgan P, Dittrich S, Moore CE, Salami O, Awini E, Nkeramahame J, Williams J, Baiden R. Impact of Point-of-Care Rapid Diagnostic Tests on Antibiotic Prescription Among Patients Aged <18 Years in Primary Healthcare Settings in 2 Peri-Urban Districts in Ghana: Randomized Controlled Trial Results. Clin Infect Dis 2023; 77:S145-S155. [PMID: 37490745 PMCID: PMC10368405 DOI: 10.1093/cid/ciad328] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Inappropriate antibiotic prescriptions are a known driver of antimicrobial resistance in settings with limited diagnostic capacity. This study aimed to assess the impact of diagnostic algorithms incorporating rapid diagnostic tests on clinical outcomes and antibiotic prescriptions compared with standard-of-care practices, of acute febrile illness cases at outpatient clinics in Shai-Osudoku and Prampram districts in Ghana. METHODS This was an open-label, centrally randomized controlled trial in 4 health facilities. Participants aged 6 months to <18 years of both sexes with acute febrile illness were randomized to receive a package of interventions to guide antibiotic prescriptions or standard care. Clinical outcomes were assessed on day 7. RESULTS In total, 1512 patients were randomized to either the intervention (n = 761) or control (n = 751) group. Majority were children aged <5 years (1154 of 1512, 76.3%) and male (809 of 1512, 53.5%). There was 11% relative risk reduction of antibiotic prescription in intervention group (RR, 0.89; 95% CI, .79 to 1.01); 14% in children aged <5 years (RR, 0.86; 95% CI, .75 to .98), 15% in nonmalaria patients (RR, 0.85; 95% CI, .75 to .96), and 16% in patients with respiratory symptoms (RR, 0.84; 95% CI, .73 to .96). Almost all participants had favorable outcomes (759 of 761, 99.7% vs 747 of 751, 99.4%). CONCLUSIONS In low- and middle-income countries, the combination of point-of-care diagnostics, diagnostic algorithms, and communication training can be used at the primary healthcare level to reduce antibiotic prescriptions among children with acute febrile illness, patients with nonmalarial fevers, and respiratory symptoms. CLINICAL TRIALS REGISTRATION NCT04081051.
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Affiliation(s)
- Alexander Adjei
- Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana
| | - Vida Kukula
- Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana
| | - Clement Tetteh Narh
- Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Selase Odopey
- Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana
| | - Emmanuel Arthur
- Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana
| | - Gabriel Odonkor
- Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana
| | | | - Piero Olliaro
- Department of Medical Affairs, FIND, Geneva, Switzerland
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | - Philip Horgan
- Department of Medical Affairs, FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Evidence & Impact Oxford, Oxford, United Kingdom
| | - Sabine Dittrich
- Department of Medical Affairs, FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
| | - Catrin E Moore
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom
| | - Olawale Salami
- Department of Medical Affairs, FIND, Geneva, Switzerland
| | - Elizabeth Awini
- Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana
| | | | - John Williams
- Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana
| | - Rita Baiden
- Department of Epidemiology, Dodowa Health Research Centre, Dodowa, Ghana
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Awini E, Agyepong IA, Owiredu D, Gyimah L, Ashinyo ME, Yevoo LL, Aye SGEV, Abbas S, Cronin de Chavez A, Kane S, Mirzoev T, Danso-Appiah A. Burden of mental health problems among pregnant and postpartum women in sub-Saharan Africa: systematic review and meta-analysis protocol. BMJ Open 2023; 13:e069545. [PMID: 37286328 DOI: 10.1136/bmjopen-2022-069545] [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] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Pregnancy and postpartum-related mental health problems pose serious public health threat to the society, but worryingly, neglected in sub-Saharan Africa (SSA). This review will assess the burden and distribution of maternal mental health (MMH) problems in SSA, with the aim to inform the implementation of context sensitive interventions and policies. METHODS AND ANALYSIS All relevant databases, grey literature and non-database sources will be searched. PubMed, LILAC, CINAHL, SCOPUS and PsycINFO, Google Scholar, African Index Medicus, HINARI, African Journals Online and IMSEAR will be searched from inception to 31 May 2023, without language restriction. The reference lists of articles will be reviewed, and experts contacted for additional studies missed by our searches. Study selection, data extraction and risk of bias assessment will be done independently by at least two reviewers and any discrepancies will be resolved through discussion between the reviewers. Binary outcomes (prevalence and incidence) of MMH problems will be assessed using pooled proportions, OR or risk ratio and mean difference for continuous outcomes; all will be presented with their 95% CIs. Heterogeneity will be investigated graphically for overlapping CIs and statistically using the I2 statistic and where necessary subgroup analyses will be performed. Random-effects model meta-analysis will be conducted when heterogeneity is appreciable, otherwise fixed-effect model will be used. The overall level of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION Although no ethical clearance or exemption is needed for a systematic review, this review is part of a larger study on maternal mental health which has received ethical clearance from the Ethics Review Committee of the Ghana Health Service (GHS-ERC 012/03/20). Findings of this study will be disseminated through stakeholder forums, conferences and peer review publications. PROSPERO REGISTRATION NUMBER CRD42021269528.
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Affiliation(s)
- Elizabeth Awini
- Research and Development Division, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
| | - Irene Akua Agyepong
- Research and Development Division, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - David Owiredu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Leveana Gyimah
- Department of Psychiatry, Pantang Hospital, Accra, Ghana
- Faculty of Psychiatry, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Linda Lucy Yevoo
- Research and Development Division, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
| | - Sorre Grace Emmanuelle Victoire Aye
- Research and Development Division, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Shazra Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Anna Cronin de Chavez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
- Centre for Evidence Synthesis and Policy, University of Ghana, Legon, Accra, Ghana
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Anto F, Ayepah C, Awini E, Bimi L. Determinants of uptake of intermittent preventive treatment for malaria with sulfadoxine pyrimethamine in pregnancy: a cross-sectional analytical study in the Sekondi-Takoradi Metropolis of Ghana. Arch Public Health 2021; 79:177. [PMID: 34649606 PMCID: PMC8515639 DOI: 10.1186/s13690-021-00694-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ghana malaria control programme recommends the uptake of five doses of sulfadoxine pyrimethamine (SP) during pregnancy following the review of the World Health Organization recommendations in 2012. The uptake of higher doses of SP since the implementation of the new policy in 2016, has been low across the country. The current study determined factors that can be improved to increase uptake of SP for intermittent preventive treatment of malaria in pregnancy (IPTp-SP). METHODS A cross-sectional analytical study was carried out among women who had just delivered in selected health facilities in the Sekondi-Takoradi Metropolis of Ghana. Participants were enrolled from the lying-in wards of the study facilities after delivery. Data including time of initiating antenatal care (ANC), number of visits, time of first dose of SP and number of doses were collected. ANC books were also reviewed. Logistic and ordered logistic regression analysis were done to determine respondent factors associated with uptake of IPTp-SP using Stata 15. RESULTS Out of the 496 mothers who participated in the study, 370 (74.60%) initiated ANC during the first trimester, 123 (24.80%) during the second, with only three (0.60%) starting during the third trimester. Majority (463/496, 93.35%) made > 4 visits. Uptake of at least one dose of SP was 98.79% (490/496), ≥ 2 doses was 92.75 (460/496), ≥ 3 doses was 80.65% (400/496) and ≥ 4 doses was 40.32% (200/496). Uptake of IPTp 5 was very low (6.65%, 33/490). A unit increase of one ANC visit was associated with 20% higher odds of receiving 3-4 doses of SP with respect to receiving 1-2 doses (p < 0.001). The probability of receiving 5 or more doses of SP with respect to 1-2 doses was 26% higher with a unit increase of one ANC visit. CONCLUSION Uptake of 3-4 doses and ≥ 5 doses of SP were associated with making more ANC visits. Encouraging and motivating expectant mothers to make more ANC visits can improve uptake of ≥5 doses of SP.
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Affiliation(s)
- Francis Anto
- School of Public Health, University of Ghana, Legon, Accra, Ghana.
| | - Christabel Ayepah
- School of Public Health, University of Ghana, Legon, Accra, Ghana.,Western Regional Health Directorate, Public Health Division, Takoradi, Ghana
| | | | - Langbong Bimi
- Department of Animal Biology and Conservation Science, University of Ghana, Legon, Accra, Ghana
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Mirzoev T, Cronin de Chavez A, Manzano A, Agyepong IA, Ashinyo ME, Danso-Appiah A, Gyimah L, Yevoo L, Awini E, Ha BTT, Do Thi Hanh T, Nguyen QCT, Le TM, Le VT, Hicks JP, Wright JM, Kane S. Protocol for a realist synthesis of health systems responsiveness in low-income and middle-income countries. BMJ Open 2021; 11:e046992. [PMID: 34112643 PMCID: PMC8194331 DOI: 10.1136/bmjopen-2020-046992] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Health systems responsiveness is a key objective of any health system, yet it is the least studied of all objectives particularly in low-income and middle-income countries. Research on health systems responsiveness highlights its multiple elements, for example, dignity and confidentiality. Little is known, however, about underlying theories of health systems responsiveness, and the mechanisms through which responsiveness works. This realist synthesis contributes to bridging these two knowledge gaps. METHODS AND ANALYSIS In this realist synthesis, we will use a four-step process, comprising: mapping of theoretical bases, formulation of programme theories, theory refinement and testing of programme theories using literature and empirical data from Ghana and Vietnam. We will include theoretical and conceptual pieces, reviews, empirical studies and grey literature, alongside the primary data. We will explore responsiveness as entailing external and internal interactions within health systems. The search strategy will be purposive and iterative, with continuous screening and refinement of theories. Data extraction will be combined with quality appraisal, using appropriate tools. Each fragment of evidence will be appraised as it is being extracted, for its relevance to the emerging programme theories and methodological rigour. The extracted data pertaining to contexts, mechanisms and outcomes will be synthesised to identify patterns and contradictions. Results will be reported using narrative explanations, following established guidance on realist syntheses. ETHICS AND DISSEMINATION Ethics approvals for the wider RESPONSE (Improving health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam) study, of which this review is one part, were obtained from the ethics committees of the following institutions: London School of Hygiene and Tropical Medicine (ref: 22981), University of Leeds, School of Medicine (ref: MREC19-051), Ghana Health Service (ref: GHS-ERC 012/03/20) and Hanoi University of Public Health (ref: 020-149/DD-YTCC).We will disseminate results through academic papers, conference presentations and stakeholder workshops in Ghana and Vietnam. PROSPERO REGISTRATION NUMBER CRD42020200353. Full record: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200353.
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Affiliation(s)
- Tolib Mirzoev
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Cronin de Chavez
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Irene Akua Agyepong
- Research and Development Division, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Mary Eyram Ashinyo
- Department of Quality Assurance, Institutional Care Directorate, Ghana Health Service, Accra, Ghana
| | | | | | - Lucy Yevoo
- Research and Development Division, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Elizabeth Awini
- Research and Development Division, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Bui Thi Thu Ha
- Department of Population and Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Trang Do Thi Hanh
- Department of Environmental Health, Hanoi University of Public Health, Hanoi, Viet Nam
| | | | - Thi Minh Le
- Department of Population and Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Vui Thi Le
- Department of Population and Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sumit Kane
- Nossal Institute for Global Health, University of Melbourne Queen's College, Parkville, Victoria, Australia
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Mirzoev T, Manzano A, Ha BTT, Agyepong IA, Trang DTH, Danso-Appiah A, Thi LM, Ashinyo ME, Vui LT, Gyimah L, Chi NTQ, Yevoo L, Duong DTT, Awini E, Hicks JP, Cronin de Chavez A, Kane S. Realist evaluation to improve health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam: Study protocol. PLoS One 2021; 16:e0245755. [PMID: 33481929 PMCID: PMC7822243 DOI: 10.1371/journal.pone.0245755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/24/2020] [Accepted: 12/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Socio-economic growth in many low and middle-income countries has resulted in more available, though not equitably accessible, healthcare. Such growth has also increased demands from citizens for their health systems to be more responsive to their needs. This paper shares a protocol for the RESPONSE study which aims to understand, co-produce, implement and evaluate context-sensitive interventions to improve health systems responsiveness to health needs of vulnerable groups in Ghana and Vietnam. METHODS We will use a realist mixed-methods theory-driven case study design, combining quantitative (household survey, secondary analysis of facility data) and qualitative (in-depth interviews, focus groups, observations and document and literature review) methods. Data will be analysed retroductively. The study will comprise three Phases. In Phase 1, we will understand actors' expectations of responsive health systems, identify key priorities for interventions, and using evidence from a realist synthesis we will develop an initial theory and generate a baseline data. In Phase 2, we will co-produce jointly with key actors, the context-sensitive interventions to improve health systems responsiveness. The interventions will seek to improve internal (i.e. intra-system) and external (i.e. people-systems) interactions through participatory workshops. In Phase 3, we will implement and evaluate the interventions by testing and refining our initial theory through comparing the intended design to the interventions' actual performance. DISCUSSION The study's key outcomes will be: (1) improved health systems responsiveness, contributing to improved health services and ultimately health outcomes in Ghana and Vietnam and (2) an empirically-grounded and theoretically-informed model of complex contexts-mechanisms-outcomes relations, together with transferable best practices for scalability and generalisability. Decision-makers across different levels will be engaged throughout. Capacity strengthening will be underpinned by in-depth understanding of capacity needs and assets of each partner team, and will aim to strengthen individual, organisational and system level capacities.
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Affiliation(s)
- Tolib Mirzoev
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
- * E-mail: (TM); (SK)
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds, United Kingdom
| | - Bui Thi Thu Ha
- Department of Population and Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Do Thi Hanh Trang
- Department of Undergraduate Education, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Le Minh Thi
- Department of Population and Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Mary Eyram Ashinyo
- Department of Quality Assurance, Institutional Care Directorate, Ghana Health Service, Accra, Ghana
| | - Le Thi Vui
- Department of Population and Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Nguyen Thai Quynh Chi
- Department of Population and Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Lucy Yevoo
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Doan Thi Thuy Duong
- Department of Population and Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Elizabeth Awini
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Anna Cronin de Chavez
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Sumit Kane
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
- * E-mail: (TM); (SK)
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9
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Chinbuah MA, Kager PA, Abbey M, Gyapong M, Awini E, Nonvignon J, Adjuik M, Aikins M, Pagnoni F, Gyapong JO. Impact of community management of fever (using antimalarials with or without antibiotics) on childhood mortality: a cluster-randomized controlled trial in Ghana. Am J Trop Med Hyg 2015; 87:11-20. [PMID: 23136273 PMCID: PMC3748510 DOI: 10.4269/ajtmh.2012.12-0078] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Malaria and pneumonia are leading causes of childhood mortality. Home Management of fever as Malaria (HMM) enables presumptive treatment with antimalarial drugs but excludes pneumonia. We aimed to evaluate the impact of adding an antibiotic, amoxicillin (AMX) to an antimalarial, artesunate amodiaquine (AAQ+AMX) for treating fever among children 2–59 months of age within the HMM strategy on all-cause mortality. In a stepped-wedge cluster-randomized, open trial, children 2–59 months of age with fever treated with AAQ or AAQ+AMX within HMM were compared with standard care. Mortality reduced significantly by 30% (rate ratio [RR] = 0.70, 95% confidence interval [CI] = 0.53– 0.92, P = 0.011) in AAQ clusters and by 44% (RR = 0.56, 95% CI = 0.41–0.76, P = 0.011) in AAQ+AMX clusters compared with control clusters. The 21% mortality reduction between AAQ and AAQ+AMX (RR = 0.79, 95% CI = 0.56 –1.12, P = 0.195) was however not statistically significant. Community fever management with antimalarials significantly reduces under-five mortality. Given the lower mortality trend, adding an antibiotic is more beneficial.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - John O. Gyapong
- *Address correspondence to John O. Gyapong, School of Public Health, University of Ghana, P. O. Box LG-13Legon, Accra, Ghana. E-mail:
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10
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Kukula VA, Dodoo AAN, Akpakli J, Narh-Bana SA, Clerk C, Adjei A, Awini E, Manye S, Nagai RA, Odonkor G, Nikoi C, Adjuik M, Akweongo P, Baiden R, Ogutu B, Binka F, Gyapong M. Feasibility and cost of using mobile phones for capturing drug safety information in peri-urban settlement in Ghana: a prospective cohort study of patients with uncomplicated malaria. Malar J 2015; 14:411. [PMID: 26481106 PMCID: PMC4615326 DOI: 10.1186/s12936-015-0932-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/07/2015] [Indexed: 11/28/2022] Open
Abstract
Background The growing need to capture data on health and health events using faster and efficient means to enable prompt evidence-based decision-making is making the use of mobile phones for health an alternative means to capture anti-malarial drug safety data. This paper examined the feasibility and cost of using mobile phones vis-à-vis home visit to monitor adverse events (AEs) related to artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria in peri-urban Ghana. Methods A prospective, observational, cohort study conducted on 4270 patients prescribed ACT in 21 health facilities. The patients were actively followed by telephone or home visit to document AEs associated with anti-malarial drugs. Call duration and travel distances of each visit were recorded. Pre-paid call cards and fuel for motorbike travels were used to determine cost of conducting both follow-ups. Ms-Excel 2010 and STATA 11.2 were used for analysis. Results Of the 4270 patients recruited, 4124 (96.6 %) were successfully followed up and analyzed. Of these, 1126/4124 (27.3 %) were children under 5 years. Most 3790/4124 (91.9 %) follow-ups were done within 7 days of ACT intake. Overall, follow up by phone (2671/4124—64.8 %) was almost two times the number done by home visits (1453/4124—35.2 %). Duration of telephone calls ranged from 38 s to 53 min, costing between GH¢0.26 (0.20USD) and GH¢41.70 (27.USD). On the average, the calls lasted 3 min 51 s (SD = 3 min, 21 s) costing GH¢2.70 (0.77USD). Distance travelled for home visit ranged from 0.65 to 62 km costing GH¢0.29 (0.20USD) and GH¢279.00 (79.70USD). Thirty-two per cent (1128/4124) of patients reported AEs. In total, 1831 AE were reported, 1016/1831(55.5 %) by telephone and 815/1831 (44.5 %) by home visits. Events such as nausea, dizziness, diarrhoea, and vomiting were commonly reported. Conclusion Majority of patients was successfully followed up by telephone and reported the most AEs. The cost of telephone interviewing was almost two times less than the cost of home visit. Telephone follow up should be considered for monitoring drug adverse events in low resource settings.
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Affiliation(s)
| | - Alexander A N Dodoo
- Centre for Tropical Clinical Pharmacology, College of Health Sciences, University of Ghana, Legon, Ghana.
| | | | | | - Christine Clerk
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.
| | | | | | - Simon Manye
- Dodowa Health Research Centre, Dodowa, Ghana.
| | | | | | | | | | - Patricia Akweongo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.
| | | | | | - Fred Binka
- INDEPTH-Network, Accra, Ghana. .,University of Science and Allied Sciences, Ho, Ghana.
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11
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Gyapong M, Sarpong D, Awini E, Manyeh AK, Tei D, Odonkor G, Agyepong IA, Mattah P, Wontuo P, Attaa-Pomaa M, Gyapong JO, Binka FN. Profile: the Dodowa HDSS. Int J Epidemiol 2014; 42:1686-96. [PMID: 24415607 DOI: 10.1093/ije/dyt197] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Dodowa Health and Demographic Surveillance System (DHDSS) operates in the south-eastern part of Ghana. It was established in 2005 after an initial attempt in 2003 by the Dodowa Health Research Centre (DHRC) to have an accurate population base for piloting a community health insurance scheme. As at 2010, the DHDSS had registered 111 976 residents in 22 767 households. The district is fairly rural, with scattered settlements. Information on pregnancies, births, deaths, migration and marriages using household registration books administered by trained fieldworkers is obtained biannually. Education, immunization status and household socioeconomic measures are obtained annually and verbal autopsies (VA) are conducted on all deaths. Community key informants (CKI) complement the work of field staff by notifying the field office of events that occur after a fieldworker has left a community. The centre has very close working relationships with the district health directorate and the local government authority. The DHDSS subscribes to the INDEPTH data-sharing policy and in addition, contractual arrangements are made with various institutions on specific data-sharing issues.
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Affiliation(s)
- Margaret Gyapong
- Dodowa Health Research Centre (DHRC), Ghana Health Service (GHS), Dodowa, University of Ghana, Legon, Accra, Ghana, Navrongo Health Research Centre (NHRC), Navrongo, Ghana and University of Health and Allied Sciences (UHAS), Ho, Ghana
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12
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Awini E, Sarpong D, Adjei A, Manyeh AK, Amu A, Akweongo P, Adongo P, Kukula V, Odonkor G, Narh S, Gyapong M. Estimating cause of adult (15+ years) death using InterVA-4 in a rural district of southern Ghana. Glob Health Action 2014; 7:25543. [PMID: 25377337 PMCID: PMC4220134 DOI: 10.3402/gha.v7.25543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 11/25/2022] Open
Abstract
Background Data needed to estimate causes of death and the pattern of these deaths are scarce in sub-Saharan Africa. Such data are very important for targeting, monitoring, and evaluating health interventions. Objective To estimate the mortality rate and determine causes of death among adults (aged 15 years and older) in a rural district of southern Ghana, using the InterVA-4 model. Design Data used were generated from verbal autopsies conducted for registered adult members of the Dodowa Health and Demographic Surveillance System who died between 2006 and 2010. The InterVA-4 model was used to assign the cause of death. Results Overall, the mortality rate for the period under review was 7.5/1,000 person-years (py) for the general population and 10.4/1,000 py for those aged 15 and older. The leading cause of death was communicable diseases (CDs), with a malaria-specific mortality rate of 1.06/1,000 py. Pulmonary tuberculosis (TB)-specific mortality rate was the next highest (1.01/1,000 py). HIV/AIDS attributed deaths were lower among males than females. Non-communicable diseases (NCDs) contributed to 28.3% of the deaths with cause-specific mortality rate of 2.93/1,000 py. Stroke topped the list with cause-specific mortality rate of 0.69/1,000 py. As expected, young males (15–49 years) contributed to more road traffic accident (RTA) deaths; they had a lower RTA cause-specific mortality rate than older males (50–64 years). Conclusions Data indicate that CDs (e.g. malaria and TB) remain the major cause of death with NCDs (e.g. stroke) following closely behind. Verbal autopsy data can provide the causes of mortality in poorly resourced settings where access to timely and accurate data is scarce.
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Affiliation(s)
- Elizabeth Awini
- Dodowa Health Research Centre, Dodowa, Ghana; School of Public Health, University of Ghana, Accra, Ghana; INDEPTH Network, Accra, Ghana;
| | - Doris Sarpong
- Dodowa Health Research Centre, Dodowa, Ghana; School of Public Health, University of Ghana, Accra, Ghana
| | - Alexander Adjei
- Dodowa Health Research Centre, Dodowa, Ghana; School of Public Health, University of Ghana, Accra, Ghana
| | - Alfred Kwesi Manyeh
- Dodowa Health Research Centre, Dodowa, Ghana; School of Public Health, University of Ghana, Accra, Ghana
| | - Alberta Amu
- Dodowa Health Research Centre, Dodowa, Ghana; School of Public Health, University of Ghana, Accra, Ghana
| | - Patricia Akweongo
- Dodowa Health Research Centre, Dodowa, Ghana; INDEPTH Network, Accra, Ghana
| | - Philip Adongo
- Dodowa Health Research Centre, Dodowa, Ghana; INDEPTH Network, Accra, Ghana
| | - Vida Kukula
- Dodowa Health Research Centre, Dodowa, Ghana; School of Public Health, University of Ghana, Accra, Ghana; INDEPTH Network, Accra, Ghana
| | - Gabriel Odonkor
- Dodowa Health Research Centre, Dodowa, Ghana; School of Public Health, University of Ghana, Accra, Ghana
| | - Solomon Narh
- Dodowa Health Research Centre, Dodowa, Ghana; School of Public Health, University of Ghana, Accra, Ghana
| | - Margaret Gyapong
- Dodowa Health Research Centre, Dodowa, Ghana; School of Public Health, University of Ghana, Accra, Ghana
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13
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Streatfield PK, Khan WA, Bhuiya A, Hanifi SMA, Alam N, Diboulo E, Sié A, Yé M, Compaoré Y, Soura AB, Bonfoh B, Jaeger F, Ngoran EK, Utzinger J, Melaku YA, Mulugeta A, Weldearegawi B, Gomez P, Jasseh M, Hodgson A, Oduro A, Welaga P, Williams J, Awini E, Binka FN, Gyapong M, Kant S, Misra P, Srivastava R, Chaudhary B, Juvekar S, Wahab A, Wilopo S, Bauni E, Mochamah G, Ndila C, Williams TN, Desai M, Hamel MJ, Lindblade KA, Odhiambo FO, Slutsker L, Ezeh A, Kyobutungi C, Wamukoya M, Delaunay V, Diallo A, Douillot L, Sokhna C, Gómez-Olivé FX, Kabudula CW, Mee P, Herbst K, Mossong J, Chuc NTK, Arthur SS, Sankoh OA, Tanner M, Byass P. Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Glob Health Action 2014; 7:25369. [PMID: 25377329 PMCID: PMC4220130 DOI: 10.3402/gha.v7.25369] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/06/2014] [Accepted: 09/06/2014] [Indexed: 11/14/2022] Open
Abstract
Background Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies. Objective To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions. Design From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992–2012, but two-thirds of the observations related to 2006–2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality. Results Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level. Conclusions The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology.
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Affiliation(s)
- P Kim Streatfield
- Matlab HDSS, Bangladesh; International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana
| | - Wasif A Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh; INDEPTH Network, Accra, Ghana; Bandarban HDSS, Bangladesh
| | - Abbas Bhuiya
- INDEPTH Network, Accra, Ghana; Chakaria HDSS, Bangladesh; Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Syed M A Hanifi
- INDEPTH Network, Accra, Ghana; Chakaria HDSS, Bangladesh; Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nurul Alam
- INDEPTH Network, Accra, Ghana; AMK HDSS, Bangladesh; Centre for Population, Urbanisation and Climate Change, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Eric Diboulo
- INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso
| | - Ali Sié
- INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso
| | - Maurice Yé
- INDEPTH Network, Accra, Ghana; Nouna HDSS, Burkina Faso; Nouna Health Research Centre, Nouna, Burkina Faso
| | - Yacouba Compaoré
- INDEPTH Network, Accra, Ghana; Ouagadougou HDSS, Burkina Faso; Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Burkina Faso
| | - Abdramane B Soura
- INDEPTH Network, Accra, Ghana; Ouagadougou HDSS, Burkina Faso; Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Burkina Faso
| | - Bassirou Bonfoh
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; , Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Fabienne Jaeger
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Eliezer K Ngoran
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; Université Félix Houphoët-Boigny, Abidjan, Côte d'Ivoire
| | - Juerg Utzinger
- INDEPTH Network, Accra, Ghana; Taabo HDSS, Côte d'Ivoire; Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Yohannes A Melaku
- INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Afework Mulugeta
- INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Berhe Weldearegawi
- INDEPTH Network, Accra, Ghana; Kilite-Awlaelo HDSS, Ethiopia; Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Pierre Gomez
- INDEPTH Network, Accra, Ghana; Farafenni HDSS, The Gambia; Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - Momodou Jasseh
- INDEPTH Network, Accra, Ghana; Farafenni HDSS, The Gambia; Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - Abraham Hodgson
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - Abraham Oduro
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - Paul Welaga
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - John Williams
- INDEPTH Network, Accra, Ghana; Navrongo HDSS, Ghana; Navrongo Health Research Centre, Navrongo, Ghana
| | - Elizabeth Awini
- INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; Dodowa Health Research Centre, Dodowa, Ghana; School of Public Health, University of Ghana, Legon, Ghana
| | - Fred N Binka
- INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; School of Public Health, University of Ghana, Legon, Ghana
| | - Margaret Gyapong
- INDEPTH Network, Accra, Ghana; Dodowa HDSS, Ghana; School of Public Health, University of Ghana, Legon, Ghana
| | - Shashi Kant
- INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India
| | - Puneet Misra
- INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Srivastava
- INDEPTH Network, Accra, Ghana; Ballabgarh HDSS, India; All India Institute of Medical Sciences, New Delhi, India
| | - Bharat Chaudhary
- INDEPTH Network, Accra, Ghana; Vadu HDSS, India; Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Sanjay Juvekar
- INDEPTH Network, Accra, Ghana; Vadu HDSS, India; Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Abdul Wahab
- INDEPTH Network, Accra, Ghana; Purworejo HDSS, Indonesia; Department of Public Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Siswanto Wilopo
- INDEPTH Network, Accra, Ghana; Purworejo HDSS, Indonesia; Department of Public Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Evasius Bauni
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - George Mochamah
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Carolyne Ndila
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Thomas N Williams
- INDEPTH Network, Accra, Ghana; Kilifi HDSS, Kenya; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Medicine, Imperial College, St. Mary's Hospital, London
| | | | - Mary J Hamel
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Kim A Lindblade
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Frank O Odhiambo
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Laurence Slutsker
- INDEPTH Network, Accra, Ghana; Kisumu HDSS, Kenya; KEMRI/CDC Research and Public Health Collaboration and KEMRI Center for Global Health Research, Kisumu, Kenya
| | - Alex Ezeh
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Catherine Kyobutungi
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Marylene Wamukoya
- INDEPTH Network, Accra, Ghana; Nairobi HDSS, Kenya; African Population and Health Research Center, Nairobi, Kenya
| | - Valérie Delaunay
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - Aldiouma Diallo
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - Laetitia Douillot
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - Cheikh Sokhna
- INDEPTH Network, Accra, Ghana; Niakhar HDSS, Senegal; Institut de Recherche pour le Developpement (IRD), Dakar, Sénégal
| | - F Xavier Gómez-Olivé
- INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chodziwadziwa W Kabudula
- INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul Mee
- INDEPTH Network, Accra, Ghana; Agincourt HDSS, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kobus Herbst
- INDEPTH Network, Accra, Ghana; Africa Centre HDSS, South Africa; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa
| | - Joël Mossong
- INDEPTH Network, Accra, Ghana; Africa Centre HDSS, South Africa; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa; National Health Laboratory, Surveillance & Epidemiology of Infectious Diseases, Dudelange, Luxembourg
| | - Nguyen T K Chuc
- INDEPTH Network, Accra, Ghana; FilaBavi HDSS, Vietnam; Health System Research, Hanoi Medical University, Hanoi, Vietnam
| | | | - Osman A Sankoh
- INDEPTH Network, Accra, Ghana; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hanoi Medical University, Hanoi, Vietnam;
| | - Marcel Tanner
- WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Peter Byass
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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14
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Smith Paintain L, Awini E, Addei S, Kukula V, Nikoi C, Sarpong D, Kwesi Manyei A, Yayemain D, Rusamira E, Agborson J, Baffoe-Wilmot A, Bart-Plange C, Chatterjee A, Gyapong M, Mangham-Jefferies L. Evaluation of a universal long-lasting insecticidal net (LLIN) distribution campaign in Ghana: cost effectiveness of distribution and hang-up activities. Malar J 2014; 13:71. [PMID: 24581249 PMCID: PMC3944985 DOI: 10.1186/1475-2875-13-71] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Between May 2010 and October 2012, approximately 12.5 million long-lasting insecticidal nets (LLINs) were distributed through a national universal mass distribution campaign in Ghana. The campaign included pre-registration of persons and sleeping places, door-to-door distribution of LLINs with 'hang-up' activities by volunteers and post-distribution 'keep-up' behaviour change communication activities. Hang-up activities were included to encourage high and sustained use. METHODS The cost and cost-effectiveness of the LLIN Campaign were evaluated using a before-after design in three regions: Brong Ahafo, Central and Western. The incremental cost effectiveness of the 'hang-up' component was estimated using reported variation in the implementation of hang-up activities and LLIN use. Economic costs were estimated from a societal perspective assuming LLINs would be replaced after three years, and included the time of unpaid volunteers and household contributions given to volunteers. RESULTS Across the three regions, 3.6 million campaign LLINs were distributed, and 45.5% of households reported the LLINs received were hung-up by a volunteer. The financial cost of the campaign was USD 6.51 per LLIN delivered. The average annual economic cost was USD 2.90 per LLIN delivered and USD 6,619 per additional child death averted by the campaign. The cost-effectiveness of the campaign was sensitive to the price, lifespan and protective efficacy of LLINs.Hang-up activities constituted 7% of the annual economic cost, though the additional financial cost was modest given the use of volunteers. LLIN use was greater in households in which one or more campaign LLINs were hung by a volunteer (OR=1.57; 95% CI=1.09, 2.27; p=0.02). The additional economic cost of the hang-up activities was USD 0.23 per LLIN delivered, and achieved a net saving per LLIN used and per death averted. CONCLUSION In this campaign, hang-up activities were estimated to be net saving if hang-up increased LLIN use by 10% or more. This suggests hang-up activities can make a LLIN campaign more cost-effective.
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Affiliation(s)
- Lucy Smith Paintain
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Elizabeth Awini
- Dodowa Health Research Centre, Dodowa, Dangme West District, Ghana
| | - Sheila Addei
- Dodowa Health Research Centre, Dodowa, Dangme West District, Ghana
| | - Vida Kukula
- Dodowa Health Research Centre, Dodowa, Dangme West District, Ghana
| | - Christian Nikoi
- Dodowa Health Research Centre, Dodowa, Dangme West District, Ghana
| | - Doris Sarpong
- Dodowa Health Research Centre, Dodowa, Dangme West District, Ghana
| | | | | | | | | | - Aba Baffoe-Wilmot
- National Malaria Control Programme, Ghana Health Service, PO Box KB493, Accra, Greater Accra, Ghana
| | - Constance Bart-Plange
- National Malaria Control Programme, Ghana Health Service, PO Box KB493, Accra, Greater Accra, Ghana
| | | | - Margaret Gyapong
- Dodowa Health Research Centre, Dodowa, Dangme West District, Ghana
| | - Lindsay Mangham-Jefferies
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Mauch V, Bonsu F, Gyapong M, Awini E, Suarez P, Marcelino B, Melgen RE, Lönnroth K, Nhung NV, Hoa NB, Klinkenberg E. Free tuberculosis diagnosis and treatment are not enough: patient cost evidence from three continents. Int J Tuberc Lung Dis 2013; 17:381-7. [PMID: 23407227 DOI: 10.5588/ijtld.12.0368] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The National Tuberculosis Programs of Ghana, Viet Nam and the Dominican Republic. OBJECTIVE To assess the direct and indirect costs of tuberculosis (TB) diagnosis and treatment for patients and households. DESIGN Each country translated and adapted a structured questionnaire, the Tool to Estimate Patients' Costs. A random sample of new adult patients treated for at least 1 month was interviewed in all three countries. RESULTS Across the countries, 27-70% of patients stopped working and experienced reduced income, 5-37% sold property and 17-47% borrowed money due to TB. Hospitalisation costs (US$42-118) and additional food items formed the largest part of direct costs during treatment. Average total patient costs (US$538-1268) were equivalent to approximately 1 year of individual income. CONCLUSION We observed similar patterns and challenges of TB-related costs for patients across the three countries. We advocate for global, united action for TB patients to be included under social protection schemes and for national TB programmes to improve equitable access to care.
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Affiliation(s)
- V Mauch
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
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Nonvignon J, Chinbuah MA, Gyapong M, Abbey M, Awini E, Gyapong JO, Aikins M. Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District. Trop Med Int Health 2012; 17:951-7. [PMID: 22643324 DOI: 10.1111/j.1365-3156.2012.03018.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of two strategies of home management of under-five fevers in Ghana - treatment using antimalarials only (artesunate-amodiaquine - AAQ) and combined treatment using antimalarials and antibiotics (artesunate-amodiaquine plus amoxicillin - AAQ + AMX). METHODS We assessed the costs and cost-effectiveness of AAQ and AAQ + AMX compared with a control receiving standard care. Data were collected as part of a cluster randomised controlled trial with a step-wedged design. Approximately, 12,000 children aged 2-59 months in Dangme West District in southern Ghana were covered. Community health workers delivered the interventions. Costs were analysed from societal perspective, using anaemia cases averted, under-five deaths averted and disability-adjusted life years (DALYs) averted as effectiveness measures. RESULTS Total economic costs for the interventions were US$ 204,394.72 (AAQ) and US$ 260,931.49 (AAQ + AMX). Recurrent costs constituted 89% and 90% of the total direct costs of AAQ and AAQ + AMX, respectively. Deaths averted were 79.1 (AAQ) and 79.9 (AAQ + AMX), with DALYs averted being 2264.79 (AAQ) and 2284.57 (AAQ + AMX). The results show that cost per anaemia case averted were US$ 150.18 (AAQ) and US$ 227.49 (AAQ + AMX) and cost per death averted was US$ 2585.58 for AAQ and US$ 3272.20 for AAQ + AMX. Cost per DALY averted were US$ 90.25 (AAQ) and US$ 114.21 (AAQ + AMX). CONCLUSION Both AAQ and AAQ + AMX approaches were cost-effective, each averting one DALY at less than the standard US$ 150 threshold recommended by the World Health Organisation. However, AAQ was more cost-effective. Home management of under-five fevers in rural settings is cost-effective in reducing under-five mortality.
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Affiliation(s)
- Justice Nonvignon
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
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Asante KP, Abokyi L, Zandoh C, Owusu R, Awini E, Sulemana A, Amenga-Etego S, Adda R, Boahen O, Segbaya S, Mahama E, Bart-Plange C, Chandramohan D, Owusu-Agyei S. Community perceptions of malaria and malaria treatment behaviour in a rural district of Ghana: implications for artemisinin combination therapy. BMC Public Health 2010; 10:409. [PMID: 20624306 PMCID: PMC2914078 DOI: 10.1186/1471-2458-10-409] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Accepted: 07/12/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Artesunate-amodiaquine (AS-AQ) was introduced in Ghana as the first line drug for treatment of uncomplicated malaria in 2004. We report the perceptions of malaria and malaria treatment behaviour, the community awareness of and perceptions about AS-AQ two years after the introduction of this ACT treatment for malaria. METHODS Two surveys were conducted; a cross-sectional survey of 729 randomly selected household heads (urban-362, rural-367) and 282 women with children < 5 years (urban-121, rural-161) was conducted in 2006. A district wide survey was conducted in 2007 to assess awareness of AS-AQ. These were complemented with twenty-eight focus group discussions (FGDs) and 16 key informant interviews (KII) among community members and major stakeholders in the health care delivery services. All nine (9) health facilities and five (5) purposively selected drug stores were audited in order to identify commonly used anti-malarials in the study area at the time of the survey. RESULTS Majority of respondents ( > 75%) in the sampled survey mentioned mosquito bites as the cause of malaria. Other causes mentioned include environmental factors (e.g. dirty surroundings) and standing in the sun. Close to 60% of the household heads and 40% of the care-givers interviewed did not know about AS-AQ. The community respondents who knew about and had ever taken AS-AQ perceived it to be a good drug; although they mentioned they had experienced some side effects including headaches and body weakness. Co-blistered AS-AQ was available in all the government health facilities in the study area. Different formulations of ACTs were however found in urban chemical shops but not in rural chemical stores where monotherapy antimalarials were predominant. CONCLUSION The knowledge of fever as a symptom of malaria is high among the study population. The awareness of AS-AQ therapy and its side-effect was low in the study area. Community education and sensitization, targeting all categories of the population, has to be intensified to ensure an efficient implementation process.
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Affiliation(s)
- Kwaku P Asante
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana
- Infectious and Tropical Diseases Department, London School of Hygiene & Tropical Medicine, Keppel, WC1E 7HT St London, UK
| | - Livesy Abokyi
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana
| | - Charles Zandoh
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana
| | - Ruth Owusu
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana
| | - Elizabeth Awini
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1 Dodowa, Dangme West District, Accra Region, Ghana
| | - Abubakari Sulemana
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana
| | - Seeba Amenga-Etego
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana
| | - Robert Adda
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana
| | - Owusu Boahen
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana
| | - Sylvester Segbaya
- National Malaria Control Programme, Ghana Health Service, P. O. Box KB 493, Korle-Bu, Accra, Ghana
| | - Emmanuel Mahama
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana
| | - Constance Bart-Plange
- National Malaria Control Programme, Ghana Health Service, P. O. Box KB 493, Korle-Bu, Accra, Ghana
| | - Daniel Chandramohan
- Infectious and Tropical Diseases Department, London School of Hygiene & Tropical Medicine, Keppel, WC1E 7HT St London, UK
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana
- Infectious and Tropical Diseases Department, London School of Hygiene & Tropical Medicine, Keppel, WC1E 7HT St London, UK
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Awini E, Mattah P, Sankoh O, Gyapong M. Spatial variations in childhood mortalities at the Dodowa Health and Demographic Surveillance System site of the INDEPTH Network in Ghana. Trop Med Int Health 2010; 15:520-8. [DOI: 10.1111/j.1365-3156.2010.02492.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Owusu-Agyei S, Asante KP, Adjuik M, Adjei G, Awini E, Adams M, Newton S, Dosoo D, Dery D, Agyeman-Budu A, Gyapong J, Greenwood B, Chandramohan D. Epidemiology of malaria in the forest-savanna transitional zone of Ghana. Malar J 2009; 8:220. [PMID: 19785766 PMCID: PMC2765449 DOI: 10.1186/1475-2875-8-220] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [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: 01/30/2009] [Accepted: 09/28/2009] [Indexed: 11/10/2022] Open
Abstract
Background Information on the epidemiology of malaria is essential for designing and interpreting results of clinical trials of drugs, vaccines and other interventions. As a background to the establishment of a site for anti-malarial drugs and vaccine trials, the epidemiology of malaria in a rural site in central Ghana was investigated. Methods Active surveillance of clinical malaria was carried out in a cohort of children below five years of age (n = 335) and the prevalence of malaria was estimated in a cohort of subjects of all ages (n = 1484) over a 12-month period. Participants were sampled from clusters drawn around sixteen index houses randomly selected from a total of about 22,000 houses within the study area. The child cohort was visited thrice weekly to screen for any illness and a blood slide was taken if a child had a history of fever or a temperature greater than or equal to 37.5 degree Celsius. The all-age cohort was screened for malaria once every eight weeks over a 12-month period. Estimation of Entomological Inoculation Rate (EIR) and characterization of Anopheline malaria vectors in the study area were also carried out. Results The average parasite prevalence in the all age cohort was 58% (95% CI: 56.9, 59.4). In children below five years of age, the average prevalence was 64% (95% CI: 61.9, 66.0). Geometric mean parasite densities decreased significantly with increasing age. More than 50% of all children less than 10 years of age were anaemic. Children less than 5 years of age had as many as seven malaria attacks per child per year. The attack rates decreased significantly with increasing cut-offs of parasite density. The average Multiplicity of Infection (MOI) was of 6.1. All three pyrimethamine resistance mutant alleles of the Plasmodium falciparum dhfr gene were prevalent in this population and 25% of infections had a fourth mutant of pfdhps-A437G. The main vectors were Anopheles funestus and Anopheles gambiae and the EIR was 269 infective bites per person per year. Conclusion The transmission of malaria in the forest-savanna region of central Ghana is high and perennial and this is an appropriate site for conducting clinical trials of anti-malarial drugs and vaccines.
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Owusu-Agyei S, Awini E, Anto F, Mensah-Afful T, Adjuik M, Hodgson A, Afari E, Binka F. Assessing malaria control in the Kassena-Nankana district of northern Ghana through repeated surveys using the RBM tools. Malar J 2007; 6:103. [PMID: 17683584 PMCID: PMC2000886 DOI: 10.1186/1475-2875-6-103] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 08/04/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of Roll Back Malaria (RBM) is to reduce malaria morbidity and mortality by 50% by the year 2010, and still further thereafter until the disease becomes no more a threat to public health. To contribute to the monitoring and evaluation process of this goal, two surveys were carried out in 2000 and 2003 in households and health facilities in the Kassena-Nankana district, northern Ghana using the RBM-WHO/AFRO monitoring and evaluation tools for malaria control activities. METHODS Data were collected from mothers/caretakers on signs/symptoms of the most recent malaria attack for their under five year old children; the management actions that they took and their perception of health services provided at the health facilities, bednet use, antenatal attendance and place of delivery for the most recent pregnancy, malaria prophylaxis during their last pregnancy. Community health workers and herbalist/traditional healers were also interviewed about the types of health services they provide to community members. RESULTS The results revealed a significant improvement in knowledge among mothers/caretakers over the three-year period; this affected caretakers' initial management of illnesses of their young children. The management in terms of the type and dosage of drugs used also improved significantly (p < 0.0001) over the period. Reported insecticide-treated bed net use among children under-five years and pregnant women significantly increased between 2000 and 2003 (p < 0.0001). Health professionals had improved on adoption of their quality of care roles. The intensification of malaria control activities and awareness creation in this district over a three year period had started demonstrating positive results towards reducing malaria disease burden. CONCLUSION Periodic performance assessments through surveys as described and prompt feedback of results to stakeholders in the locality serves as a catalyst to improving malaria control in malaria-endemic countries.
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Affiliation(s)
| | - Elizabeth Awini
- Navrongo Health Research Centre, Navrongo, P.O. Box 114, Navrongo, Ghana
| | - Francis Anto
- Navrongo Health Research Centre, Navrongo, P.O. Box 114, Navrongo, Ghana
| | | | - Martin Adjuik
- Navrongo Health Research Centre, Navrongo, P.O. Box 114, Navrongo, Ghana
| | - Abraham Hodgson
- Navrongo Health Research Centre, Navrongo, P.O. Box 114, Navrongo, Ghana
| | - Edwin Afari
- School of Public Health, University of Ghana, Legon, Ghana
| | - Fred Binka
- School of Public Health, University of Ghana, Legon, Ghana
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Abstract
Emergency contraception (EC) refers to methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure, or incorrect use. There is growing worldwide acceptance and promotion of EC as a measure to reduce the level of unwanted pregnancies and, hence, unsafe abortions. The potential effect of EC in this regard could be most evident in sub-Saharan Africa. In Ghana, the Ministry of Health has since 1996 included EC in its reproductive health service policy and standards. The Planned Parenthood Association of Ghana is the only agency involved in the promotion of EC in the country. Very little is known about societal perception of EC. We undertook a study to assess knowledge and attitude toward EC among a sample of students at the University of Ghana. We used a two-page, self-administered questionnaire in a cross-sectional study among students chosen by random sampling. The aspects of EC assessed included level of knowledge, extent of use, common traditional methods of emergency contraception, as well as socially and culturally acceptable ways to promote EC in Ghana. We also assessed how the availability of EC could influence the use of condoms among male respondents. Less than half (43.2%) of the 194 respondents (88 males and 106 females) had heard of modern emergency contraceptive methods. Postinor-2, a dedicated emergency contraceptive product, which was already on the Ghanaian market, was known to 1.5% of respondents. Only 11.3% of respondents indicated correctly the recommended time within which emergency contraceptive pills (ECPs) are to be taken after unprotected sex. Taking concentrated sugar solutions, having an enema, and douching were commonly used traditional methods of EC. More than half (55.0%) of the male respondents indicated that they would either "certainly" or "probably" reduce how often they used condoms once they knew that EC was available. Almost all (97.4%) the respondents wanted to learn more about EC. The indications from this study are that the promotion of EC in Ghana is desired and must be encouraged. The fact that EC does not offer protection against sexually transmitted infections should always be emphasized.
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Affiliation(s)
- Frank Baiden
- Navrongo Health Research Center, Navrongo, UER, Ghana.
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