Browsing by Author "Agbenyega, T."
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Item A comparison of women with induced abortion, spontaneous abortion and ectopic pregnancy in Ghana.(Contraception, 2011-07) Schwandt, H.M.; Creanga, A.A.; Danso, K.A.; Adanu, R.M.K.; Agbenyega, T.; Hindin, M.J.Background Despite having one of the most liberal abortion laws in sub-Saharan Africa, complications from induced abortion are the second leading cause of maternal mortality in Ghana. Study Design The sample is composed of patients with pregnancy termination complications in Ghana between June and July 2008. The majority of patients report having had a spontaneous abortion (75%; n=439), while 17% (n=100) and 8% (n=46) report having had an induced abortion or an ectopic pregnancy, respectively. Factors associated with women in each of the three groups were explored using multinomial logistic regression. Results When compared to women with spontaneous abortions, women with induced abortions were younger, poorer, more likely to report no religious affiliation, less likely to be married, more likely to report making the household decisions and more likely to fail to disclose this pregnancy to their partners. Within the induced abortion subsample, failure to disclose the most recent pregnancy was associated with already having children and autonomous household decision making. Conclusion Identifying the individual and relationship characteristics of induced abortion patients is the first step toward targeted policies and programs aimed at reducing unsafe abortion in Ghana.Item Ethics: Fair benefits for research in developing countries: Participants in the 2001 conference on ethical aspects of research in developing countries.(2002-12-13) El Setouhy, M.; Agbenyega, T.; Anto, F.; Clerk, C.A.; Koram, K.A.; English, M.; Molyneux, C.; Peshu, N.; Juma, R.; Kumwend, N.; Mfutso-Bengu, J.; Molyneux, M.; Taylor, T.; Diarra, D.A.; Maiga, S.; Sylla, M.; Youssouf, D.; Falade, C.O.; Gbadegesin, S.; Lie, R.; Mugusi, F.; Ngassapa, D.; Ecuru, J.; Talisuna, A.; Emanuel, E.; Grady, C.; Wendler, D.; Higgs, E.; Plowe, C.; Sugarman, J.Item A global network for investigating the genomic epidemiology of malaria(Nature, 2008-01) Achidi, E.A.; Agbenyega, T.; Allen, S.; Amodu, O.; Bojang, K.; Conway, D.; Corran, P.; Deloukas, P.; Koram, A.K.et.alLarge-scale studies of genomic variation could assist efforts to eliminate malaria. But there are scientific, ethical and practical challenges to carrying out such studies in developing countries, where the burden of disease is greatest. The Malaria Genomic Epidemiology Network (MalariaGEN) is now working to overcome these obstacles, using a consortial approach that brings together researchers from 21 countries. © 2008 Macmillan Publishers Limited. All rights reserved.Item Group versus individual family planning counseling in Ghana: A randomized, noninferiority trial(Contraception, 2013-03) Schwandt, H.M.; Creanga, A.A.; Danso, K.A.; Adanu, R.M.K.; Agbenyega, T.; Hindin, M.J.Background Group, rather than individual, family planning counseling has the potential to increase family planning knowledge and use through more efficient use of limited human resources. Study Design A randomized, noninferiority study design was utilized to identify whether group family planning counseling is as effective as individual family planning counseling in Ghana. Female gynecology patients were enrolled from two teaching hospitals in Ghana in June and July 2008. Patients were randomized to receive either group or individual family planning counseling. The primary outcome in this study was change in modern contraceptive method knowledge. Changes in family planning use intention before and after the intervention and intended method type were also explored. Results: Comparisons between the two study arms suggest that randomization was successful. The difference in change in modern contraceptive methods known from baseline to follow-up between the two study arms (group-individual), adjusted for study site, was - 0.21, (95% confidence interval: - 0.53 to 0.12) suggesting no difference between the two arms. Conclusions: Group family planning counseling was as effective as individual family planning counseling in increasing modern contraceptive knowledge among female gynecology patients in Ghana. © 2013 Elsevier Inc. All rights reserved.Item The Malaria Genomic Epidemiology Network. A global network for investigating the genomic epidemiology of malaria(Nature 456(7223): 732-7, 2008) Achidi, E.A.; Agbenyega, T.; Allen, S.; Amodu, O.; Bojang, K.; Conway, D.; Corran, P.; Deloukas, P.; Djimde, A.; Dolo, A.; Doumbo, O.; Drakeley, C.; Duffy, P.; Dunstan, S.; Evans, J.; Farrar, J.; Fernando, D.; Tran, T.H.; Horstmann, R.; Ibrahim, M.; Karunaweera, N.; Kokwaro, G.; Koram, K.; Kwiatkowski, D.; Lemnge, M.; Makani, J.; Marsh, K.; Michon, P.; Modiano, D.; Molyneux, M.E.; Mueller, I.; Mutabingwa, T.; Parker, M.; Peshu, N.; Plowe, C.; Puijalon, O.; Ragoussis, J.; Reeder, J.; Reyburn, H.; Riley, E.; Rogers, J.; Wilson, M.; Ghansah, A.Large-scale studies of genomic variation could assist efforts to eliminate malaria. But there are scientific, ethical and practical challenges to carrying out such studies in developing countries, where the burden of disease is greatest. The Malaria Genomic Epidemiology Network (MalariaGEN) is now working to overcome these obstacles, using a consortial approach that brings together researchers from 21 countries.Item A novel locus of resistance to severe malaria in a region of ancient balancing selection.(Nature Publishing Group, 2015-09) Band, G.; Rockett, K.A.; Spencer, C.C.A.; Johnson, K.J.; Koram, K.A.; Wilson, M.D.; Agbenyega, T.; Malaria Genomic Epidemiology NetworkAbstract The high prevalence of sickle haemoglobin in Africa shows that malaria has been a major force for human evolutionary selection, but surprisingly few other polymorphisms have been proven to confer resistance to malaria in large epidemiological studies. To address this problem, we conducted a multi-centre genome-wide association study (GWAS) of life-threatening Plasmodium falciparum infection (severe malaria) in over 11,000 African children, with replication data in a further 14,000 individuals. Here we report a novel malaria resistance locus close to a cluster of genes encoding glycophorins that are receptors for erythrocyte invasion by P. falciparum. We identify a haplotype at this locus that provides 33% protection against severe malaria (odds ratio = 0.67, 95% confidence interval = 0.60-0.76, P value = 9.5 × 10(-11)) and is linked to polymorphisms that have previously been shown to have features of ancient balancing selection, on the basis of haplotype sharing between humans and chimpanzees. Taken together with previous observations on the malaria-protective role of blood group O, these data reveal that two of the strongest GWAS signals for severe malaria lie in or close to genes encoding the glycosylated surface coat of the erythrocyte cell membrane, both within regions of the genome where it appears that evolution has maintained diversity for millions of years. These findings provide new insights into the host-parasite interactions that are critical in determining the outcome of malaria infection.Item Pathways to unsafe abortion in Ghana: The role of male partners, women and health care providers(Contraception, 2013-10) Schwandt, H.M.; Creanga, A.A.; Adanu, R.M.K.; Danso, K.A.; Agbenyega, T.; Hindin, M.J.Background Despite abortion being legal, complications from induced abortion are the second leading cause of maternal mortality in Ghana. The objective of this study was to understand the decision-making process associated with induced abortion in Ghana. Study Design Data were collected from female postabortion patients, male partners, family planning nurses and obstetricians/gynecologists at two teaching hospitals in Ghana using in-depth interviews and focus group discussions. Results While experiences differ for married and single women, men are involved in abortion decision making directly, through "orders" to abort, or indirectly, through denying responsibility for the pregnancy. Health care providers can be barriers to seeking safe abortions in this setting. Conclusions Women who choose to terminate a pregnancy without their male partners' knowledge should have the means (both financial and social) to do so safely. Interventions with health care providers should discourage judgemental attitudes and emphasize individually focused patient care. © 2013 Elsevier Inc.Item Pre-referral rectal artesunate to prevent death and disability in severe malaria: a placebo-controlled trial(Elsevier Ltd, 2009) Gomes, M.F.; Faiz, M.A.; Gyapong, J.O.; Warsame, M.; Agbenyega, T.; Babiker, A.; Baiden, F.; Yunus, E.B.; Binka, F.; Clerk, C.; Folb, P.; Hassan, R.; Hossain, M.A.; Kimbute, O.; Kitua, A.; Krishna, S.; Makasi, C.; Mensah, N.; Mrango, Z.; Olliaro, P.; Peto, R.; Peto, T.J.; Rahman, M.R.; Ribeiro, I.; Samad, R.; White, N.J.Background: Most malaria deaths occur in rural areas. Rapid progression from illness to death can be interrupted by prompt, effective medication. Antimalarial treatment cannot rescue terminally ill patients but could be effective if given earlier. If patients who cannot be treated orally are several hours from facilities for injections, rectal artesunate can be given before referral and acts rapidly on parasites. We investigated whether this intervention reduced mortality and permanent disability. Methods: In Bangladesh, Ghana, and Tanzania, patients with suspected severe malaria who could not be treated orally were allocated randomly to a single artesunate (n=8954) or placebo (n=8872) suppository by taking the next numbered box, then referred to clinics at which injections could be given. Those with antimalarial injections or negative blood smears before randomisation were excluded, leaving 12 068 patients (6072 artesunate, 5996 placebo) for analysis. Primary endpoints were mortality, assessed 7-30 days later, and permanent disability, reassessed periodically. All investigators were masked to group assignment. Analysis was by intention to treat. This study is registered in all three countries, numbers ISRCTN83979018, 46343627, and 76987662. Results: Mortality was 154 of 6072 artesunate versus 177 of 5996 placebo (2·5% vs 3·0%, p=0·1). Two versus 13 (0·03% vs 0·22%, p=0·0020) were permanently disabled; total dead or disabled: 156 versus 190 (2·6% vs 3·2%, p=0·0484). There was no reduction in early mortality (56 vs 51 deaths within 6 h; median 2 h). In patients reaching clinic within 6 h (median 3 h), pre-referral artesunate had no significant effect on death after 6 h or permanent disability (71/4450 [1·6%] vs 82/4426 [1·9%], risk ratio 0·86 [95% CI 0·63-1·18], p=0·35). In patients still not in clinic after more than 6 h, however, half were still not there after more than 15 h, and pre-referral rectal artesunate significantly reduced death or permanent disability (29/1566 [1·9%] vs 57/1519 [3·8%], risk ratio 0·49 [95% CI 0·32-0·77], p=0·0013). Interpretation: If patients with severe malaria cannot be treated orally and access to injections will take several hours, a single inexpensive artesunate suppository at the time of referral substantially reduces the risk of death or permanent disability. Funding: UNICEF/UNDP/World Bank Special Programme for Research and Training in Tropical Diseases (WHO/TDR); WHO Global Malaria Programme (WHO/GMP); Sall Family Foundation; the European Union (QLRT-2000-01430); the UK Medical Research Council; USAID; Irish Aid; the Karolinska Institute; and the University of Oxford Clinical Trial Service Unit (CTSU).Item Randomized controlled trial of RTS,S/AS02D and RTS,S/AS01E malaria candidate vaccines given according to different schedules in Ghanaian children(PLoS ONE, 2009) Owusu-Agyei, S.; Ansong, D.; Asante, K.; Kwarteng Owusu, S.; Owusu, R.; Wireko Brobby, N.A.; Dosoo, D.; Osei Akoto, A.; Osei-Kwakye, K.; Adjei, E.A.; Boahen, K.O.; Sylverken, J.; Adjei, G.; Sambian, D.; Apanga, S.; Kayan, K.; Vekemans, J.; Ofori-Anyinam, O.; Leach, A.; Lievens, M.; Demoitie, M.A.; Dubois, M.C.; Cohen, J.; Ballou, W.R.; Savarese, B.; Chandramohan, D.; Gyapong, J.O.; Milligan, P.; Antwi, S.; Agbenyega, T.; Greenwood, B.; Evans, J.Background: The target delivery channel of RTS,S candidate malaria vaccines in malaria-endemic countries in Africa is the World Health Organisation Expanded Program on Immunization. As an Adjuvant System, age de-escalation and schedule selection step, this study assessed 3 schedules of RTS,S/AS01E and RTS,S/AS02D in infants and young children 5–17 months of age in Ghana. Methodology: A Phase II, partially-blind randomized controlled study (blind to vaccine, not to schedule), of 19 months duration was conducted in two (2) centres in Ghana between August 2006 and May 2008. Subjects were allocated randomly (1:1:1:1:1:1) to one of six study groups at each study site, each defining which vaccine should be given and by which schedule (0,1-, 0,1,2- or 0,1,7-months). For the 0,1,2-month schedule participants received RTS,S/AS01E or rabies vaccine at one center and RTS,S/AS01E or RTS,S/AS02D at the other. For the other schedules at both study sites, they received RTS,S/AS01E or RTS,S/AS02D. The primary outcome measure was the occurrence of serious adverse events until 10 months post dose 1. Results: The number of serious adverse events reported across groups was balanced. One child had a simple febrile convulsion, which evolved favourably without sequelae, considered to be related to RTS,S/AS01E vaccination. Low grade reactions occurred slightly more frequently in recipients of RTS,S/AS than rabies vaccines; grade 3 reactions were infrequent. Less local reactogenicity occurred with RTS,S/AS01E than RTS,S/AS02D. Both candidate vaccines were highly immunogenic for anti-circumsporozoite and anti-Hepatitis B Virus surface antigen antibodies. Recipients of RTS,S/AS01E compared to RTS,S/AS02D had higher peak anti-circumsporozoite antibody responses for all 3 schedules. Three dose schedules were more immunogenic than 2 dose schedules. Area under the curve analyses for anti-circumsporozoite antibodies were comparable between the 0,1,2- and 0,1,7-month RTS,S/AS01E schedules. Conclusions: Both candidate malaria vaccines were well tolerated. Anti-circumsporozoite responses were greater with RTS,S/AS01E than RTS,S/AS02D and when 3 rather than 2 doses were given. This study supports the selection of RTS,S/AS01E and a 3 dose schedule for further development in children and infants.Item Strengthening public health education in population and reproductive health through an innovative academic partnership in Africa: The gates partners experience(Global Public Health, 2011) Oni, G.; Fatusi, A.; Tsui, A.; Enquselassie, F.; Ojengbede, O.; Agbenyega, T.; Quakyi, I.A.Poor reproductive health constitutes one of the leading public health problems in the world, particularly in sub-Saharan Africa (SSA). We report here an academic partnership that commenced in 2003 between a US institution and six universities in SSA. The partnership addresses the human resources development challenge in Africa by strengthening public health education and research capacity to improve population and reproductive health (PRH) outcomes in low-resource settings. The partnership's core activities focused on increasing access to quality education, strengthening health research capacity and translating scholarship and science into policy and practices. Partnership programmes focused on the educational dimension of the human resources equation provide students with improved learning facilities and enhanced work environments and also provide faculty with opportunities for professional development and an enhanced capacity for curriculum delivery. By 2007, 48 faculty members from the six universities in SSA attended PRH courses at Johns Hopkins University, 93 PRH courses were offered across the six universities, 625 of their master's students elected PRHconcentrations and 158 had graduated. With the graduation of these and future student cohorts, the universities in SSA will systematically be expanding the number of public health practitioners and strengthening programme effectiveness to resolve reproductive health needs. Some challenges facing the partnership are described in this article. © 2010 Taylor & Francis.