Browsing by Author "Aikins, M.K."
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Item Analysis of the Financial Cost of Diabetes Mellitus in Four Cocoa Clinics of Ghana(Value in Health Regional Issues, 2015-09) Quaye, E.A.; Amporful, E.O.; Akweongo, P.; Aikins, M.K.Objective: To estimate the financial cost of managing diabetes mellitus in four Cocoa clinics of Ghana. Methods: A descriptive cross-sectional study of diabetes management was carried out in the four Cocoa clinics of Ghana from January to December 2009. The "cost-of-illness" approach from the institutional perspective was used. A pretested data extraction form was used to review the medical records of 304 randomly selected diabetic patients. Results: The patients' mean age was 55.4 ± 9.4 years. The mean annual financial cost of managing one diabetic case at the clinics was estimated to be Ghana cedi (GHS) 540.35 (US $372.65). Service cost constituted 22% of the cost, whereas direct medical cost constituted 78% of the cost. Drug cost was 71% of the financial cost. The cost of hospitalization per patient-day at Cocoa clinics was estimated at GHS 32.78 (US $22.61). The total financial cost of diabetes management was estimated at GHS 420,087.67 (US $289,715.63). This accounted for 8% of the total expenditure for the clinics in the year 2009. The study showed that facility type, type of diabetes, and presence of complication are associated with the cost of diabetes management to Cocoa clinics. Conclusions: The mean age of detection suggests delay in diagnosis of diabetes mellitus and accompanying complications, which has cost implications. Policy that enhances early detection of diabetes in clinical practice would therefore improve management and reduce costs. The financial cost of managing diabetes can be used to forecast the economic burden of the disease in the area. © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR).Item Attitudes to malaria, traditional practices and bednets (mosquito nets) as vector control measures: A comparative study in five West African countries(1994-04) Aikins, M.K.; Pickering, H.; Greenwood, B.M.Five West African communities were visited to assess the knowledge of the cause of malaria and to document traditional ways of treating and preventing the infection. Knowledge of the cause of malaria was low in the five communities visited. People were more concerned about mosquitoes being a nuisance than a cause of the infection. Various herbs were used as mosquito repellents. Malaria was treated by a number of traditional practices, including herbal remedies. Bednets were used to a varying extent, from 44% Ghana to 86% Gambia, in each community to protect against mosquito bites but also for other purposes such as privacy, decoration and protection from roof debris dropping on the bed. PIP: A previous study among Gambian children aged 1-4 years found that overall mortality was reduced by 63% after use of insecticide-treated bednets. In this study, the aim was to determine the degree to which bednets were used and the factors affecting their use in Farafenni, The Gambia; Navrongo in eastern Ghana; suburban Bandim outside Bissau Town, Guinea-Bissau; Niakhar in Senegal; and a rural village around Bo in Sierra Leone. Bednets were known and used to protect children from mosquito bites in the 5 West African countries; bednets were also used for privacy and to protect from falling roof debris. A structured questionnaire was administered. Background information had been collected prior to the survey administration on local terminology for symptoms of malaria, the extent of health education campaigns, availability of Western and traditional treatment regimens, use of bednets, and constraints to use. Each of the study areas was described in terms of the social and demographic characteristics of the population. The findings indicated that about 50% of people in Ghana Guinea-Bissau, and Sierra Leone were aware that mosquitoes caused malaria. Only about 25% were aware in The Gambia. Heavy rains and the cold weather that followed were also linked with malaria causes in Ghana and Guinea-Bissau. Stepping in goat urine was viewed as a cause of malaria in Senegal. In The Gambia, other causes indicated were eating of seasonally foods excessively, and an act of God. Fever was the most common symptom associated with malaria. Some differentiated in subtle ways between malaria fever and other fevers. Treatment was viewed in all countries as herbal, which was available from markets or traditional healers. About 50% of the 996 Ghana respondents used some form of traditional treatment for malaria. 86% used bednets in The Gambia and Guinea-Bissau. Only about 33% used them in Senegal, and very few used bednets in Sierra Leone and Ghana. Most were concerned about the irritation to sleep from mosquitoes. In all countries, cost of bednets was a constraint to use. Public health programs should stress the cost effectiveness and advantages of insecticide treated bednets, and information on malaria causes. Where Ghanians sleep on roofs, a new bednet design is needed.Item Extent of Integration of Priority Interventions into General Health Systems: A Case Study of Neglected Tropical Diseases Programme in the Western Region of Ghana(Public Library of Science, 2016) Mensah, E.O.; Aikins, M.K.; Gyapong, M.; Anto, F.; Bockarie, M.J.; Gyapong, J.O.Background: The global health system has a large arsenal of interventions, medical products and technologies to address current global health challenges. However, identifying the most effective and efficient strategies to deliver these resources to where they are most needed has been a challenge. Targeted and integrated interventions have been the main delivery strategies. However, the health system discourse increasingly favours integrated strategies in the context of functionally merging targeted interventions with multifunctional health care delivery systems with a focus on strengthening country health systems to deliver needed interventions. Neglected Tropical Diseases (NTD) have been identified to promote and perpetuate poverty hence there has been global effort to combat these diseases. The Neglected Tropical Diseases Programme (NTDP) in Ghana has a national programme team and office, however, it depends on the multifunctional health delivery system at the regional and district level to implement interventions. The NTDP seeks further health system integration to accelerate achievement of coverage targets. The study estimated the extent of integration of the NTDP at the national, regional and district levels to provide evidence to guide further integration. Methodology/Principal Findings: The research design was a descriptive case study that interviewed key persons involved in the programme at the three levels of the health system as well as extensive document review. Integration was assessed on two planes—across health system functions–stewardship and governance, financing, planning, service delivery, monitoring and evaluation and demand generation; and across three administrative levels of the health system–national, regional and district. A composite measure of integration designated Cumulative Integration Index (CII) with a range of 0.00–1.00 was used to estimate extent of integration at the three levels of the health system. Service delivery was most integrated while financing and planning were least integrated. Extent of integration was partial at all levels of the health system with a CII of 0.48–0.68; however it was higher at the district compared to the national and regional levels. Conclusions/Significance: To ensure further integration of the NTDP, planning and finance management activities must be decentralized to involve regional and district levels of the health system. The study provides an empirical measure of extent of integration and indicators to guide further integration. © 2016 Mensah et al.Item The Gambian national impregnated bednet programme: Costs, consequences and net cost-effectiveness(1998-01) Aikins, M.K.; Fox-Rushby, J.; D'Alessandro, U.; Langerock, P.; Cham, K.; New, L.; Bennett, S.; Greenwood, B.; Mills, A.Clinical trials have indicated that treating mosquito nets with insecticide could be a potentially cost-effective method of preventing malaria. As malaria is one of the most common causes of death in children under five in developing countries, there has been substantial interest in whether such findings can be replicated for a country's control programme in practice. The cost-effectiveness of the Gambian National Insecticide-impregnated Bednet Programme (NIBP), from the viewpoint of providers (government and non-governmental agencies) and the community, has been calculated. Information was collected from existing records, interviews with NIBP personnel, observation and household surveys. Information is provided on the resource use consequences of the NIBP in terms of reduced expenditure on anti-malaria preventive measures, treatment in government health services, household financed treatment and "charity" (burial, funeral and mourning activities), as well as cash income lost as a result of child death. The annual implementation cost of the NIBP was D757,875 (US$91,864), of which 86% was recurrent cost. The estimated number of death averted was 40.56. The net implementation cost-effectiveness ratio per death averted and discounted life years gained were D3884 (US$471) and D260 (US$31.5), respectively. Adding the cost of all mosquito nets would increase the cost-effectiveness ratios by over five times, which is an important consideration for countries with a lower coverage of mosquito nets per capita. It is concluded that insecticide-impregnated mosquito nets are one of the more efficient ways of reducing deaths in children under 10 years in rural Gambia.Item A malaria control trial using insecticide-treated bed nets and targeted chemoprophylaxis in a rural area of the Gambia, West Africa 4. perceptions of the causes of malaria and of its treatment and prevention in the study area(1993-06) Aikins, M.K.; Pickering, H.; Alonso, P.L.; D'Alessandro, U.; Lindsay, S.W.; Todd, J.; Greenwood, B.M.Perceptions of the causes of malaria, its treatment and prevention were studied among 996 adults, selected randomly from 73 villages and hamlets in a rural area of The Gambia. Structured questionnaires and other interview techniques were used for data collection. Malaria has no specific name in the study area; it is referred to commonly as Fula kajewo (Fula fever). Only 28% of the respondents knew that mosquitoes transmitted malaria. However, most people believed correctly that August to October was the main malaria season. Eighty-six per cent of the subjects were bed net users. The majority of nets were produced locally, usually white in colour and made of sheeting fabrics. Usage of nets was correlated with ethnic group, age and polygamy but not with education, income, occupation or ownership of certain items which indicate high social status. Analysis of expenditure on mosquito coils indicated that non-users of nets spent 43% more on coils than did users. Bed nets have been used for a long time in the study area; 98% of users saw their parents using them during their childhood. PIP: In the Gambia, malaria specialists at the Medical Research Council Laboratories oversaw interviews of 996 men and women from, 73 villages and hamlets on the south bank of the River Gambia to learn their perceptions of the causes of malaria and of its treatment and prevention. No specific local term for malaria existed. The most common term used by all ethnic groups, except the Fulas, was Fula kejewo (Fula fever). Just 28% of all adults knew that mosquitoes transmit malaria. Men were more likely to know the real cause of malaria than women (p .001). Knowledge about the cause of malaria increased with education p =.01). Most people (90%) knew that malaria transmission occurs most often during August-October. 86% of adults and 81% of their children less than 10 years old used bed nets. Girls were more likely to sleep under bed nets than boys (p = .005). Local tailors made most bed nets with either second hand or new fabrics. They tended to be made of sheeting fabrics and white in color. Most adults were willing to treat their bed nets with the insecticide permethrin to protect against mosquitoes. Ethnic group (Fulas less likely, p .001), age (older people more likely, p .001), and polygamy (p = .002) were correlated with bed net use. Education, income, and occupation or ownership of items indicating high social status were not correlated with bed net use. Nonusers of bed nets spent 43% more on mosquito coils, used to smoke out mosquitoes from rooms before going to sleep, than did users (p = .001). Almost all adults (98%) remembers their parents using bed nets when they were children. The bed nets users who were at least 70 years old said that the Mandinkas mainly used bed nets. These findings should prove useful to the government as it develops a national impregnated bed net program to control malaria in rural areas.Item Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bednetprogramme(1995-02) D'Alessandro, U.; Olaleye, B.O.; McGuire, W.; Langerock, P.; Bennett, S.; Aikins, M.K.; Thomson, M.C.; Cham, B.A.; Greenwood, B.M.After the success of a controlled trial of insecticide-treated bednets in lowering child mortality, The Gambia initiated a National Insecticide Impregnated Bednet Programme (NIBP) in 1992 with the objective of introducing this form of malaria control into all large villages in The Gambia. Five areas (population 115,895) were chosen as sentinel sites for evaluation of the NIBP. During the first year of intervention a 25% reduction was achieved in all-cause mortality in children 1-9 years old living in treated villages (rate ratio 0.75 [95% CI 0.57-0.98], p = 0.04). If one area where the programme was ineffective was excluded, the reduction was 38% (0.62 [0.46-0.83), p = 0.001). A decrease in rates of parasitaemia and high-density parasitaemia, an increase in mean packed-cell volume (rate ratio 0.75 [95% CI 0.59-0.98], p = 0.04) and an improvement in the nutritional status of children living in treated villages were also detected. In a country such as The Gambia, where nets were widely used and which has a good primary health care system, it is possible to achieve insecticide-treatment of bednets at a national level with a significant reduction in child mortality; but at a cost which the country cannot afford.Item Treatment choices for fevers in children under-five years in a rural Ghanaian district.(Malaria Journal, 2010) Nonvignon, J.; Aikins, M.K.; Chinbuah, M.A.; Abbey, M.; Gyapong, M.; Garshong, B.N.; Gyapong, J.O.Background: Health care demand studies help to examine the behaviour of individuals and households during illnesses. Few of existing health care demand studies examine the choice of treatment services for childhood illnesses. Besides, in their analyses, many of the existing studies compare alternative treatment options to a single option, usually self-medication. This study aims at examining the factors that influence the choices that caregivers of children underfive years make regarding treatment of fevers due to malaria and pneumonia in a rural setting. The study also examines how the choice of alternative treatment options compare with each other. Methods: The study uses data from a 2006 household socio-economic survey and health and demographic surveillance covering caregivers of 529 children under-five years of age in the Dangme West District and applies a multinomial probit technique to model the choice of treatment services for fevers in under-fives in rural Ghana. Four health care options are considered: self-medication, over-the-counter providers, public providers and private providers. Results: The findings indicate that longer travel, waiting and treatment times encourage people to use self-medication and over-the-counter providers compared to public and private providers. Caregivers with health insurance coverage also use care from public providers compared to over-the-counter or private providers. Caregivers with higher incomes use public and private providers over self-medication while higher treatment charges and longer times at public facilities encourage caregivers to resort to private providers. Besides, caregivers of female under-fives use self-care while caregivers of male under-fives use public providers instead of self-care, implying gender disparity in the choice of treatment. Conclusions: The results of this study imply that efforts at curbing under-five mortality due to malaria and pneumonia need to take into account care-seeking behaviour of caregivers of under-fives as well as implementation of strategies