Browsing by Author "Barnish, G."

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Cohort trial reveals community impact of insecticide-treated net son malaria metric indices in urban Ghana
(Transactions of the Royal Society of Tropical Medicine and Hygiene, 2010) Klinkenberg, E.; Onwona-Agyeman, K.A.; McCall, P.J.; Wilson, M.D.; Bates, I.; Verhoeffe, F.H.; Barnish, G.; Donnelly, M.J.
The efficacy of insecticide-treated nets (ITNs) in prevention of malaria and anaemia has been shown in rural settings, but their impact in urban settings is unknown. We carried out an ITN intervention in two communities in urban Accra, Ghana, where local malaria transmission is known to occur. There was evidence for amassor community effect, despite ITN use by fewer than 35% of households. Children living within 300m of a household with an ITN had higher haemoglobin concentrations (0.5g/dl higher, P = 0.011) and less anaemia (oddsratio2.21, 95%CI1.08–4.52, P = 0.031atmonth6), than children living more than 300m away from a household with an ITN, although malaria parasitaemias were similar. With urban populations growing rapidly across Africa, this study shows that ITNs will be an effective tool to assist African countries to achieve their Millennium Development Goals in urban settings.
Cohort trial reveals community impact of insecticide-treated nets on malariometric indices in urban Ghana
(Transactions of the Royal Society of Tropical Medicine and Hygiene, 2010-07) Klinkenberg, E.; Onwona-Agyeman, K.A.; McCall, P.J.; Wilson, M.D.; Bates, I.; Verhoeff, F.H.; Barnish, G.; Donnelly, M.J.
The efficacy of insecticide-treated nets (ITNs) in prevention of malaria and anaemia has been shown in rural settings, but their impact in urban settings is unknown. We carried out an ITN intervention in two communities in urban Accra, Ghana, where local malaria transmission is known to occur. There was evidence for a mass or community effect, despite ITN use by fewer than 35% of households. Children living within 300 m of a household with an ITN had higher haemoglobin concentrations (0.5. g/dl higher, P=0.011) and less anaemia (odds ratio 2.21, 95% CI 1.08-4.52, P=0.031 at month 6), than children living more than 300 m away from a household with an ITN, although malaria parasitaemias were similar. With urban populations growing rapidly across Africa, this study shows that ITNs will be an effective tool to assist African countries to achieve their Millennium Development Goals in urban settings. [Registered trial number ISRCTN42261314; http://www.controlled-trials.com/ISRCTN42261314]. © 2010 Royal Society of Tropical Medicine and Hygiene.
Feasibility and acceptability of ACT for the community case management of malaria in urban settings in five African sites
(2011-08-16) Akweongo, P.; Agyei-Baffour, P.; Sudhakar, M.; Simwaka, B.N.; Konaté, A.T.; Adongo, P.B.; Browne, E.N,; Tegegn, A.; Ali, D.; Amunyunzu-Nyamongo, M.; Pagnoni, F.; Barnish, G.
The community case management of malaria (CCMm) is now an established route for distribution of artemisinin-based combination therapy (ACT) in rural areas, but the feasibility and acceptability of the approach through community medicine distributors (CMD) in urban areas has not been explored. It is estimated that in 15 years time 50% of the African population will live in urban areas and transmission of the malaria parasite occurs in these densely populated areas. METHODS: Pre- and post-implementation studies were conducted in five African cities: Ghana, Burkina Faso, Ethiopia and Malawi. CMDs were trained to educate caregivers, diagnose and treat malaria cases in < 5-year olds with ACT. Household surveys, focus group discussions and in-depth interviews were used to evaluate impact. RESULTS: Qualitative findings: In all sites, interviews revealed that caregivers' knowledge of malaria signs and symptoms improved after the intervention. Preference for CMDs as preferred providers for malaria increased in all sites.Quantitative findings: 9001 children with an episode of fever were treated by 199 CMDs in the five study sites. Results from the CHWs registers show that of these, 6974 were treated with an ACT and 6933 (99%) were prescribed the correct dose for their age. Fifty-four percent of the 3,025 children for which information about the promptness of treatment was available were treated within 24 hours from the onset of symptoms.From the household survey 3700 children were identified who had an episode of fever during the preceding two weeks. 1480 (40%) of them sought treatment from a CMD and 1213 of them (82%) had received an ACT. Of these, 1123 (92.6%) were administered the ACT for the correct number of doses and days; 773 of the 1118 (69.1%) children for which information about the promptness of treatment was available were treated within 24 hours from onset of symptoms, and 768 (68.7%) were treated promptly and correctly. CONCLUSIONS: The concept of CCMm in an urban environment was positive, and caregivers were generally satisfied with the services. Quality of services delivered by CMDs and adherence by caregivers are similar to those seen in rural CCMm settings. The proportion of cases seen by CMDs, however, tended to be lower than was generally seen in rural CCMm. Urban CCMm is feasible, but it struggles against other sources of established healthcare providers. Innovation is required by everyone to make it viable.
Feasibility and acceptability of ACT for the community case management of malaria in urban settings in five African sites
(2011-08-16) Akweongo, P.; Agyei-Baffour, P.; Sudhakar, M.; Simwaka, B.N.; Konaté, A.T.; Adongo, P.B.; Browne, E.N.L.; Tegegn, A.; Ali, D.; Traoré, A.; Amuyunzu-Nyamongo, M.; Pagnoni, F.; Barnish, G.
Abstract Background The community case management of malaria (CCMm) is now an established route for distribution of artemisinin-based combination therapy (ACT) in rural areas, but the feasibility and acceptability of the approach through community medicine distributors (CMD) in urban areas has not been explored. It is estimated that in 15 years time 50% of the African population will live in urban areas and transmission of the malaria parasite occurs in these densely populated areas. Methods Pre- and post-implementation studies were conducted in five African cities: Ghana, Burkina Faso, Ethiopia and Malawi. CMDs were trained to educate caregivers, diagnose and treat malaria cases in < 5-year olds with ACT. Household surveys, focus group discussions and in-depth interviews were used to evaluate impact. Results Qualitative findings: In all sites, interviews revealed that caregivers' knowledge of malaria signs and symptoms improved after the intervention. Preference for CMDs as preferred providers for malaria increased in all sites. Quantitative findings: 9001 children with an episode of fever were treated by 199 CMDs in the five study sites. Results from the CHWs registers show that of these, 6974 were treated with an ACT and 6933 (99%) were prescribed the correct dose for their age. Fifty-four percent of the 3,025 children for which information about the promptness of treatment was available were treated within 24 hours from the onset of symptoms. From the household survey 3700 children were identified who had an episode of fever during the preceding two weeks. 1480 (40%) of them sought treatment from a CMD and 1213 of them (82%) had received an ACT. Of these, 1123 (92.6%) were administered the ACT for the correct number of doses and days; 773 of the 1118 (69.1%) children for which information about the promptness of treatment was available were treated within 24 hours from onset of symptoms, and 768 (68.7%) were treated promptly and correctly. Conclusions The concept of CCMm in an urban environment was positive, and caregivers were generally satisfied with the services. Quality of services delivered by CMDs and adherence by caregivers are similar to those seen in rural CCMm settings. The proportion of cases seen by CMDs, however, tended to be lower than was generally seen in rural CCMm. Urban CCMm is feasible, but it struggles against other sources of established healthcare providers. Innovation is required by everyone to make it viable.
Impact of prepackaging antimalarial drugs on cost to patients and compliance with treatment
(World Health Organisation, 2001) Yeboah-Antwi, K.; Gyapong, J.O.; Asare, I.K.; Barnish, G.; Evans, D.B.; Adjei, S.
Objective: To examine the extent to which district health teams could reduce the burden of malaria, a continuing major cause of mortality and morbidity, in a situation where severe resource constraints existed and integrated care was provided. Methods: Antimalarial drugs were prepackaged into unit doses in an attempt to improve compliance with full courses of chemotherapy. Findings: Compliance improved by approximately 20% in both adults and children. There were 50% reductions in cost to patients, waiting time at dispensaries and drug wastage at facilities. The intervention, which tended to improve both case and drug management at facilities, was well accepted by health staff and did not involve them in additional working time. Conclusion: The prepackaging of antimalarials at the district level offers the prospect of improved compliance and a reduction in the spread of resistance.
Incidence and management of malaria in two communities of different socio-economic level, in Accra, Ghana.
(Routledge, part of the Taylor & Francis Group, 2000-12-01) Biritwum, R.B.; Welbeck, J.; Barnish, G.
Two adjacent communities of differing socio-economic levels were selected, in Accra, Ghana, for the study of the home management of malaria. The youngest child in each selected household, each of which had a child aged < 5 years, was recruited for weekly follow-up, following informed consent. Malaria was the most common condition reported by the 'caregivers' (mothers of the subjects and others caring for the subjects) in each community, with 2.0 episodes of clinical malaria/child during the 9-month study. Most (89%) of the caregivers in the better-off community had been educated beyond primary-school level, but 55% of the caregivers in the poorer community had either received no formal education or only primary-school education. This difference was also reflected by the educational facilities provided to the children studied: 52% of the those in the better-off community attended nurseries, kindergartens or creches, compared with 8% of the children investigated in the poorer community. The proportion of caregivers who purchased drugs without prescription or used left-over drugs to treat clinical malaria in the children was higher in the poorer community (82% v. 53%), and a child from the poorer community was less likely to have been taken to a clinic or hospital to be treated for malaria than a child from the better-off community (27% v. 42%). During the follow-up period two children died, one from each community. Treatment of malaria in young children is likely to be less effective in the poorer community, where a lack of economic access to health services was demonstrated.
Urban malaria and anaemia in children: A cross-sectional survey in two cities of Ghana
(Tropical Medicine and International Health, 2006-05) Klinkenberg, E.; McCall, P.J.; Wilson, M.D.; Akoto, A.O.; Amerasinghe, F.P.; Bates, I.; Verhoeff, F.H.; Barnish, G.; Donnelly, M.J.
OBJECTIVE: To describe the epidemiology of urban malaria, an emerging problem in sub-Saharan Africa. METHOD: Cross-sectional surveys of communities in Accra and Kumasi, Ghana, determining risk factors for malaria infection and anaemia in children aged 6-60 months. RESULTS: Malaria prevalence rates ranged from 2% to 33% between urban communities. 47.1% of children were anaemic (Hb < 11.0 g/dl). Factors associated with malaria prevalence were low socio-economic status, age and anaemia. The attributable risks of anaemia and severe anaemia (Hb < 8.0 g/dl) caused by malaria were 5% and 23% respectively. CONCLUSIONS: Malaria in urban areas displayed a heterogeneity and complexity that differed from the rural environment, which has important implications for malaria control. Marked intra-city variation indicates the importance of targeting specific areas or districts. The most vulnerable group, the urban poor, should be prioritized when designing control measures. This would require careful assessment of the malaria risk pattern in any city to guide an integrated control program. © 2006 Blackwell Publishing Ltd.