Browsing by Author "Binka, F.N."

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Accelerating reproductive and child health programme impact with community-based services: The Navrongo experiment in Ghana
(Bulletin of the World Health Organization, 2006-12) Phillips, J.F.; Bawah, A.A.; Binka, F.N.
Objective: To determine the demographic and health impact of deploying health service nurses and volunteers to village locations with a view to scaling up results. Methods: A four-celled plausibility trial was used for testing the impact of aligning community health services with the traditional social institutions that organize village life. Data from the Navrongo Demographic Surveillance System that tracks fertility and mortality events over time were used to estimate impact on fertility and mortality. Results: Assigning nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated the time taken for attainment of the child survival Millennium Development Goal (MDG) in the study areas to 8 years. Fertility was also reduced by 15%, representing a decline of one birth in the total fertility rate. Programme costs added US$ 1.92 per capita to the US$ 6.80 per capita primary health care budget. Conclusion: Assigning nurses to community locations where they provide basic curative and preventive care substantially reduces childhood mortality and accelerates progress towards attainment of the child survival MDG. Approaches using community volunteers, however, have no impact on mortality. The results also demonstrate that increasing access to contraceptive supplies alone fails to address the social costs of fertility regulation. Effective deployment of volunteers and community mobilization strategies offsets the social constraints on the adoption of contraception. The research in Navrongo thus demonstrates that affordable and sustainable means of combining nurse services with volunteer action can accelerate attainment of both the International Conference on Population and Development agenda and the MDGs.
Acceptability and use of insecticide impregnated bednets in northern Ghana
(1997) Binka, F.N.; Adongo, P.
A district-wide study was undertaken in a rural population of northern Ghana to identify factors influencing the acceptance and use of insecticide- impregnated bednets (IIBNs). A series of focus group discussions were conducted during 2 years of implementation of IIBNs to gauge community reactions to the introduction of the nets and a structured questionnaire was administered to approximately 2000 randomly selected individuals. Although the IIBNs were accepted and used because they provided protection from mosquito bites, seasonal factors, patterns of use, and questions of cost were key factors likely to influence the dissemination and effectiveness of bednets. Use of the bednets was highly seasonal. Almost all recipients used their IIBNs in the rainy season (99%), corresponding to the period of high mosquito density and 20% used them in the dry seasons, the period of low mosquito density. Mothers with young children were more likely to wash the bednets frequently (because the children soiled the bednets with faeces and urine), resulting in no protection from the insecticide. Provision of wider bednets, or the provision of plastic sheets with the bednets or possible incorporation of the insecticide in washing soaps could improve protection for young children. The success of the promotion of IIBNs in malaria control programmes will depend on the cost of the package and the time of year that it is delivered. Financing mechanisms for individual and village groups are discussed. Social research effectively monitored the intervention in this study, and it should be included as an important component of national malaria control programmes.
Antibiotic Treatment Outcomes of Buruli Ulcer in Akwapem South and Suhum-Kraboa-Coaltar Districts
(University of Ghana, 2013-06) Kotey, N.K.; Binka, F.N.; Junghanss, T.
The World Health Organization (WHO) having recognized Buruli ulcer disease as an important cause of human suffering introduced treatment guidelines of a new protocol of 8-week initial therapy of intramuscular streptomycin and oral rifampicin in 2005. Although there has been some level of success in the treatment of Buruli ulcer with this new antibiotic protocol, some patients do not respond favourably as expected. Also, the response to chemotherapy of BU lesions including large ulcerated forms, which are currently the most common forms in Africa remains insufficiently documented. So this study set out to assess the treatment outcomes of all categories of BU lesions and determine factors that influence the healing of these lesions. This was implemented by employing a non-randomized clinical intervention design by serially recruiting 154 patients over a period of two years. Measurements of lesions were made using tracing sheets to obtain their respective surface areas. Swabs and fine needle aspirates were taken and confirmed by direct smear microscopy for acid-fast bacilli (AFB), polymerase chain reaction or culture. All patients were given a directly observed treatment (DOT) of a daily combination of intramuscular streptomycin (15mg/kg body weight) and oral rifampicin (10mg/kg body weight) for 8 weeks. There was also daily dressing for all wounds irrespective of size and weekly assessment for all forms of lesions. Patients were counseled regularly on BU management and the necessity for adhering to treatment. All patients were followed up for a minimum of 34 weeks. BU lesions were found among ages 2- 84 years. About 37% of the total study participants were less than 15 years and almost equal numbers in the age groups between 15 -49 years and over 50 years old. In those below 15 years of age there was an almost equal gender distribution whilst, in the older age groups more females than males were affected. It was found that 93.5% (144/154) of the study participants presented with ulcers. All those who reported within two months of noticing their lesions for the first time achieved 100% treatment success irrespective of category of lesion. There was 97.4% treatment success rate for all BU lesions with no recurrences within 34 weeks of treatment. About 30% of lesions showed an apparent deterioration response to treatment (paradoxical reactions) after an initial improvement at some points during treatment starting from week 2 to week 18 reaching a peak at week 10. Factors that hastened healing were smaller size of the initial lesion, regular wound dressing, removal of slough, treatment with topical antibiotics and absence of paradoxical reactions. We concluded that the combination of intramuscular streptomycin and oral rifampicin is efficacious in healing all forms of Buruli ulcer disease. Optimal and regular wound dressing regular counseling, consistent wound evaluation and timely interventions play important roles in the healing of BU lesions. In view of these findings we recommended that the National Buruli Ulcer Control Programme in collaboration with the District Assemblies and District Health Management Teams should organize regular health education activities to encourage patients to report early to health institutions and also ensure that drug treatment is combined with wound dressing effectively and efficiently in order to achieve the desired results.
Antimalarial drug use among caregivers in Ghana.
(2004) Abuaku, B.K.; Koram, K.A.; Binka, F.N.
Background: Chloroquine remains the first line antimalarial drug in Ghana. However, the emergence of Plasmodium falciparum resistance to chloroquine is a major obstacle to the national control strategy of case management. This study provides information on some of the reasons underlying chloroquine treatment failure in the country. Methodology: Household surveys, using multi-stage sampling , were conducted in 2 sentinel districts, Wassa West and Kassena Nankana, established to monitor chloroquine resistance in the country. Five hundred caregivers were interviewed in each district to determine patterns of antimalarial drug use among caregivers of children under 10 years. Inventory on home-kept drugs was conducted. Results: Two hundred and four households in the Wassa West district kept a cumulative total of 248 drugs, whereas 228 households in the Kassena Nankana district kept a cumulative total of 410 drugs. One hundred and ninety-nine (80.2%) of the drugs kept in the Wassa West district and 181 (44.2%) of drugs kept in the Kassena Nankana district were antimalarials. The most commonly kept antimalarial drug in homes was chloroquine (88% and 96% in the Wassa West and Kassena Nankana districts respectively). Reasons given for keeping antimalarials were mainly “leftover after previous treatment”. Caregivers’ descriptions of the amount of chloroquine given to family members suspected to have malaria within the 2-week period preceding the survey were mostly inappropriate in the 2 districts. However, the proportion of appropriateness of doses was significantly lower in the Wassa West district (11.1% vs 36.4%; p<0.0001). Conclusions: The significantly higher proportion of inappropriateness of chloroquine use in the Wassa West district could be a factor influencing the lower sensitivity of Plasmodium falciparum to chloroquine in the district compared to the Kassena Nankana district.
Antimalarial prescribing practices: A challenge to malaria control in Ghana.
(2005-09) Abuaku, B.K.; Koram, K.A.; Binka, F.N.
Objective: The study was conducted to determine antimalarial prescribing practices among prescribers in 2 of the 6 sentinel sites established to document antimalarial drug efficacy in Ghana in order to provide some explanation underlying chloroquine treatment failures in the country. Subjects and Methods: The study was descriptive combining both qualitative and quantitative designs. The qualitative design involved in-depth interviews of general prescribers in the Wassa West and Kassena Nankana districts using an interview guide. The quantitative design involved a review of Outpatient Department prescriptions of 100 patients clinically diagnosed as having malaria within the year 2000 in each of the 7 selected health care facilities. Results: The overall number of drugs prescribed per patient encounter was 4.3 in the Wassa West district and 3.0 in the Kassena Nankana district. The number of drugs per patient encounter was 5.4 and 3.7 in private and government health care facilities, respectively. The commonly prescribed antimalarial drug in all the health care facilities visited was chloroquine. However, only 9.8% of prescriptions in private health care facilities contained correct doses of chloroquine compared to 54% in government health care facilities (p = 0.000). Prescriptions containing chloroquine injections were least likely to have correct doses of chloroquine. Conclusion: The find ings indicate that although chloroquine remained the first-line drug in the treatment of uncomplicated malaria in the two districts, the level of appropriateness of doses prescribed was generally low. Inappropriate doses of chloroquine prescribed were more prevalent in private than government health care facilities, and among prescriptions containing injections. Copyright © 2005 S. Karger AG.
Changing patterns of rotavirus genotypes in Ghana: Emergence of human rotavirus G9 as a major cause of diarrhea in children.
(2003) Armah, G.E.; Steele, A.D.; Binka, F.N.; Esona, M.D.; Asmah, R.H.; Anto, F; Brown, D.; Cutts, F.; Green, J.; Hall, A.
Genotyping of human rotaviruses was performed on 312 rotavirus-positive samples collected from 2,205 young children with diarrhea in the Upper East District of Ghana, a rural community. Of the 271 (86.9%) rotavirus strains that could be VP7 (G) or VP4 (P) characterized, 73 (26.9%) were of G9 specificity. The predominant G9 genotype was G9P[8], which constituted 79.5% of all G9 strains detected, followed by G9P[6] (12.3%), G9P[10] (2.7%), and G9P[4] (1.3%). G9 strains with mixed P types constituted 2.7% of all G9 strains found in the study. All the G9P[8] strains had a long RNA electrophoretic pattern with VP6 subgroup II specificity. Four G9 isolates, GH1319, GH1416, GH3550, and GH3574, which were selected based on the abundance of stool material and were representative of the three electropherotypes observed, were cloned and sequenced. The Ghanaian isolates shared more than 98% sequence nucleotide homology with other G9 strains from the United States (US1205), Malawi (MW69), Brazil (R160), Japan (95H115), and Nigeria (Bulumkutu). However, they showed only 95% nucleotide homology with the Thai G9 strain Mc345. Phylogenetic analysis of the nucleic acid sequence revealed the existence of at least three clusters, with Ghanaian strains forming one cluster, Nigerian and Brazilian strains forming a second cluster, and U.S., Malawian, and Japanese strains forming a third.
Characterisation of norovirus strains in rural Ghanaian children with acute diarrhoea.
(2006-11) Armah, G.E.; Gallimore, C.I.; Binka, F.N.; Asmah, R.H.; Green, J.; Ugoli, U.; Anto, F.; Brown, D.W.G.; Gray, J.J.
The incidence of calicivirus infection in Ghana and many other African countries is not known. Thirteen (15.9%) of the 82 diarrhoeic stool samples tested for caliciviruses were positive for noroviruses (NoVs). NoVs were present in all age groups and were detected only during the diarrhoea peak that coincided with the peak rotavirus season. Ten (76.9%) of the NoV detected were genogroup II (GII) NoVs and the remaining three (23.1%) genogroup I (GI) NoVs. The predominant GII detected was GII-4 (60%, 6/10). Three of the GII NoVs were determined to be recombinants of GII-8/GII-14 as deduced from the sequencing of the region spanning the Orf1/2 junction. The GII genotypes formed four clusters with published GII sequences. The data shown enhances understanding of NoV diversity in Ghanaian children and demonstrate the global spread of distinct common genotypes to African countries. © 2006 Wiley-Liss, Inc.
Characteristics of severe anemia and its association with malaria in young children of the Kassena-Nankana district of northern Ghana.
(American Journal of Tropical Medicine and Hygiene, 2002) Owusu-Agyei, S.; Fryauff, D.J.; Chandramohan, D.; Koram, K.A.; Binka, F.N.; Nkrumah, F.K.; Utz, G.C.; Hoffman, S.L.
Severe anemia is thought to be the principal underlying cause of malaria death in areas of intense seasonal malaria transmission such as the Kassena-Nankana District of northern Ghana. Factors associated with severe anemia in young children, 6-24 months old, were elucidated by analyzing results of 2 malaria-associated anemia surveys (1996, 2000), separated by 4 years, but conducted in the same community and at the same seasonal time point. Age-adjusted comparison confirmed that the proportion of severely anemic children and overall mean hemoglobin (Hb) levels in the November 2000 sample were significantly improved over those of the 1996 sample (17.5 versus 26.4%, P = 0.03; Hb 7.5 versus 6.9 g/dL, P = 0.002). Weight-for-age Z-scores also indicated a significant improvement in the 2000 sample (-1.93 versus -2.20, P < 0.05). Independently, each survey identified statistically significant associations between severe anemia and age, parasite rate, fever, and sex. Relative to children with Hb > or = 6.0 g/dL, those with severe anemia (Hb < 6.0 g/dL) were older, more frequently parasitemic (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.08-2.35), more often febrile (OR, 2.44; 95% CI, 1.71-3.48), and predominantly male (OR, 1.50; 95% CI, 1.05-2.13). An association was identified in both surveys between severe anemia and residence in the northern part of the district, but no clear link was observed in relation to irrigation. Blood transfusions, a likely surrogate index of severe anemia in young children, followed a distinct seasonal pattern. Evidence suggests that dramatic peaks and troughs of severe anemia are regular and possibly predictable events that may be used to gauge the health and survival of young children in this area.
Child morbidity and mortality following vitamin A supplementation in Ghana: time since dosing, number of doses, and time of year
(1995) Ross, D.A.; Kirkwood, B.R.; Binka, F.N.; Arthur, P.; Dollimore, N.; Morris, S.S.; Shier, R.P.; Gyapong, J.O.; Smith, P.G.
Objectives. The impact of large, dose vitamin A supplementation given at intervals of 4 months on child mortality and morbidity was examined according to the time interval since dosing, number of doses received previously, and time of year. Methods. Two double-blind, randomized, placebo-controlled trials of large doses of vitamin A administered at intervals of 4 months were conducted in adjacent populations in northern Ghana. Results. While vitamin A supplementation significantly reduced the overall incidence of severe illnesses (especially diarrhea with dehydration), clinic attendances, hospital admissions, and mortality, there was no evidence that the impact of each dose of vitamin A was related to the number of doses the child had received previously. There was no evidence that the effectiveness of the supplement waned over the 3 to 5 months between doses. The impact on mortality did not differ significantly by the month in which the supplement had been given. Conclusions. In the study population, there was no evidence that an interval between doses of less than 4 months would have had a greater impact on severe morbidity or mortality, and the effectiveness of supplementation did not vary by time of year.
Cultural factors constraining the introduction of family planning among the kassena-nankana of northern Ghana
(1997-12) Adongo, P.B.; Phillips, J.F.; Kajihara, B.; Fayorsey, C.; Debpuur, C.; Binka, F.N.
This study presents a focus group investigation of reasons why women in a rural, Sahelian community are reluctant to adopt family planning even when convenient services are made freely available. First, women opting to practice contraception must do so at considerable risk of social ostracism or familial conflict. Implementing individual preference is something that must be done without the support of others. Second, few women view personal decisions about contraceptives as theirs to make. Women and children are the property of the corporate family-kin and community militate against reproductive control. Third, although children are highly valued for a variety of economic, social, and cultural reasons, mortality risks remain extremely high. Low fertility imposes the unacceptable risk that a woman will have no surviving children at the end of her reproductive life. Taken together, these findings attest to the inadequacy of service strategies focused on the contribution of distribution, individual agency, or personal choice. Outreach should also build a sense of community legitimacy for the program, collective health action, and traditional leadership support for family planning behavior.
Developing a culturally appropriate family planning program for the navrongo experiment
(1995) Nazzar, A.; Adongo, P.B.; Binka, F.N.; Phillips, J.F.; Debpuur, C.
This article describes the first six months of the strategic planning process to develop a culturally appropriate community health and family planning program for a traditional community in a district of northern Ghana, served by the Navrongo Health Research Centre. To explain the context within which fertility decisions are made, this article describes the district's severe ecological, social, economic, and health constraints to family planning. It discusses related programmatic obstacles and presents the strategies developed to respond to them. A system of care has been developed that is closely coordinated with traditional leaders and communication networks. Management systems support outreach workers by emphasizing the importance of peer leadership, supervisory support, and community liaison in the implementation of village-based services. A large-scale experiment will be fielded to test the demographic impact of this approach. -Authors
Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting: the case of Ghana¿s Community-based Health Planning and Services (CHPS)
(2014-04-01) Adongo, P.B.; Phillips, J.F.; Aikins, M.; Arhin, D.A.; Schmitt, M.; Nwameme, A.U.; Tabong, P. T.N.; Binka, F.N.
Abstract Background Rapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana. Methods This research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones. Results The findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban residents also requires a broader expertise and training of the CHOs. Conclusions Access to improved urban health services remains a challenge. However, current policy guidelines for the implementation of a primary health model based on rural experiences and experimental design requires careful review and modifications to meet the needs of the urban settings.
Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial
(American Journal of Clinical Nutrition, 2009-08) Benn, C.S.; Aaby, P.; Nielsen, J.; Binka, F.N.; Ross, D.A.
Background: The World Health Organization recommends vitamin A supplementation (VAS) at vaccination contacts after 6 mo of age to reduce mortality. However, it is unknown whether the effect of VAS is independent of vaccinations. One of the original VAS trials from Ghana had collected vaccination information. Objective: We reanalyzed the data to explore the hypothesis that VAS reduces mortality in children who had bacille Calmette-Guérin or measles vaccine as their most recent vaccine but increased mortality when diphtheria-tetanus-pertussis vaccine (DTP) was the most recent vaccine. On the basis of previous studies, we expected the effects to be strongest in girls. Design: At enrollment, children aged 6-90 mo were randomly assigned to receive VAS or placebo every 4 mo for 2 y. Vaccination status was assessed at enrollment and after 1 and 2 y by reviewing the children's health cards. Lack of a health card was presumed to mean that the child had not been vaccinated. Results: VAS had a beneficial effect only in children with no record of vaccination at enrollment (n = 5066); the mortality rate ratio (MRR) was 0.64 (95% CI: 0.47, 0.88) compared with 0.95 (95% CI: 0.72, 1.26) in children with one or more vaccinations (n = 6656). Among vaccinated children, the effect of VAS differed between boys (MRR: 0.74; 95% CI: 0.51, 1.08) and girls (MRR: 1.18; 95% CI: 0.84, 1.67) (P = 0.046 for interaction). VAS had a negative effect in measles-vaccinated girls who were missing one or more doses of DTP at enrollment, a group who often received DTP during follow-up (MRR: 2.60; 95% CI: 1.41, 4.80). Conclusions: The effect of VAS differed by vaccination status. This is potentially problematic because VAS is provided at vaccination contacts. © 2009 American Society for Nutrition.
Effect of vitamin A supplementation on the growth of young children in northern Ghana.
(1996-05) Kirkwood, B.R.; Ross, D.A.; Arthur, P.; Morris, S.S.; Dollimore, N.; Binka, F.N.; Shier, R.P.; Gyapong, J.O.; Addy, H.A.; Smith, P.G.
The effect of prophylactic vitamin A supplementation on child growth was studied in two randomized, placebo-controlled trials carried out in adjacent areas of northern Ghana between 1989 and 1991. In the Health Study, the midupper arm circumference (MUAC) and weight of the ≃ 1500 children (aged 6- 59 mo) in the trial were measured every 4 wk for up to 52 wk. In addition, MUAC, weight, and height were measured at each of the four potential vitamin A or placebo dosing times, which were at 4-mo intervals. In the Survival Study, MUAC and weight were measured at 4-mo intervals at each of seven dosing rounds in the ≃15 000 children currently in the trial. Overall, there were > 90 000 observations of weight and MUAC in > 25 000 children, and 3347 observations of length/height in 1546 children. Within each study, the mean monthly weight, MUAC, and gains in length/height in each treatment group were compared by using multilevel modeling. There were no significant differences in either MUAC or gains in length/height. The only significant difference in weight gain was in the Survival Study: children in the vitamin A supplemented group who were ≥ 36 mo of age had a mean weight gain that was 3 g lower per month (95% CI: 0.4, 5.0, P = 0.02) than that in the placebo group; a difference that was unlikely to be functionally important in this age group. Vitamin A supplementation did not lead to any increased growth in this population of young children, in whom supplementation reduced mortality and severe morbidity substantially.
Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in sub-Saharan Africa: a randomised, double-blind, placebo-controlled trial
(Lancet, 2010) Armah, G.E.; Sow, S.O.; Breiman, R.F.; Dallas, M.J.; Tapia, M.D.; Feikin, D.R.; Binka, F.N.; Steele, D.A.; Laserson, K.F.; Ansah, N.A.; Levine, M.M.; Lewis, K.; Coia, M.L.; Attah-Poku, M.; Ojwando, J.; Rivers, S.B.; Victor, J.C.; Nyambane, G.; Hodgson, A.; Schödel, M.; Ciarlet, M.; Neuzil, K.M.
Background Rotavirus gastroenteritis causes many deaths in infants in sub-Saharan Africa. Because rotavirus vaccines have proven effective in developed countries but had not been tested in developing countries, we assessed efficacy of a pentavalent rotavirus vaccine against severe disease in Ghana, Kenya, and Mali between April, 2007, and March, 2009. Methods In our multicentre, double-blind, placebo-controlled trial, undertaken in rural areas of Ghana and Kenya and an urban area of Mali, we randomly assigned infants aged 4–12 weeks without symptoms of gastrointestinal disorders in a 1:1 ratio to receive three oral doses of pentavalent rotavirus vaccine 2 mL or placebo at around 6 weeks, 10 weeks, and 14 weeks of age. Infants with HIV infection were not excluded. Randomisation was done by computer-generated randomisation sequence in blocks of six. We obtained data for gastrointestinal symptoms from parents on presentation to health-care facilities and clinical data were obtained prospectively by clinicians. The primary endpoint was severe rotavirus gastroenteritis (Vesikari score ≥11), detected by enzyme immunoassay, arising 14 days or more after the third dose of placebo or vaccine to end of study (March 31, 2009; around 21 months of age). Analysis was per protocol; infants who received scheduled doses of vaccine or placebo without intervening laboratory-confirmed naturally occurring rotavirus disease earlier than 14 days after the third dose and had complete clinical and laboratory results were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT00362648. Findings 5468 infants were randomly assigned to receive pentavalent rotavirus vaccine (n=2733) or placebo (n=2735). 2357 infants assigned to vaccine and 2348 assigned to placebo were included in the per-protocol analysis. 79 cases of severe rotavirus gastroenteritis were reported in 2610・6 person-years in the vaccine group, compared with 129 cases in 2585・9 person-years in the placebo group, resulting in a vaccine efficacy against severe rotavirus gastroenteritis of 39・3% (95% CI 19・1–54・7, p=0・0003 for efficacy >0%). Median follow-up in both groups was 527 days starting 14 days after the third dose of vaccine or placebo was given. 42 (1・5%) of 2723 infants assigned to receive vaccine and 45 (1・7%) of 2724 infants assigned to receive placebo had a serious adverse event within 14 days of any dose. The most frequent serious adverse event was gastroenteritis (vaccine 17 [0・6%]; placebo 17 [0・6%]). Interpretation Pentavalent rotavirus vaccine is effective against severe rotavirus gastroenteritis in the first 2 years of life in African countries with high mortality in infants younger than 5 years. We support WHO’s recommendation for adoption of rotavirus vaccine into national expanded programmes on immunisation in Africa.
Ethics and electronic health information technology: Challenges for evidence-based medicine and the physician-patient relationship
(2011-09) Norman, I.D.; Aikins, M.A.; Binka, F.N.
OBJECTIVES: The National Health Insurance Scheme (NHIS), and the National Identification Authority (NIA), pose ethical challenges to the physician-patient relationship due to interoperability. This paper explores (1) the national legislation on Electronic Health Information Technology (EHIT), (2) the ethics of information technology and public health and (3) the effect on the Physician-patient relationship. METHOD: This study consisted of systematic literature and internet review of the legislation, information technology, the national health insurance program, and the physician-patient relationship. RESULT: The result shows that (1) EHIT have eroded a big part of the confidentiality between the physician and patient; (2) The encroachment on privacy is an inevitable outcome of EHIT; (3) Legislation on privacy, the collection, storage and uses of electronic health information is needed and; (4) the nexus between EHIT, NHIS, NHA, Ethics, the physician-patient relationship and privacy. CONCLUSION: The study highlights the lack of protection for physician-patient relationship as medical practice transitions from the conventional to the modern, information technology driven domain.
Evaluation of the Role of Community Health Officers in the Community Health and Family Planning Project in the Kassena Nakana District
(University of Ghana, 2002-08) Blantari, M.J.; Binka, F.N.; Ahiadeke, C.; University of Ghana, College of Health Sciences, School of Public Health
The success or otherwise of most health related programs in most developing countries are judged using many indicators, among which is the beneficiary communities’ perception of the program. This study examined or probed into the perceptions of the communities with regard to the services rendered by Community Health Officers (CHOs) as front liners in the Community Health and Family Planning (CHFP) project being executed by the Navrongo Health Research Center (NHRC) in the Kassena- Nankana District of Northern Ghana. The subjects of the study were adult males and females who were in three age categories; below thirty years, between thirty-one and forty-nine years and those who were fifty years and above. This was done in order to provide information that would help improve upon CHO services in the treatment cells to project implementers. Qualitative methods i.e. Focus Group Discussions, Key Informant Interviews and In-depth Interviews were mainly used to capture information related to the communities’ access to health information, health services, the nature of the referral system, treatment and preventive care, family planning services and general acceptability of the CHO services. The study also used Focus Group Discussions and structured questionnaire to examine the work, social and welfare concerns of the CHOs. Most discussants believed that the CHO services have brought a drastic improvement in their lives and have resulted in the elimination of most childhood killer diseases in the community. Family planning services have also improved lifestyles and they now have healthier mothers and children. However it is their wish that the CHOs spent more time with them in the community, make drugs available to them; put a good referral system in place and provide diversified family planning methods. The CHOs also expressed varying degrees of concerns that militated against their effectiveness. These concerns include their inability to have many basic tools to work with; the deplorable conditions of the Community Health Compounds; non-availability of drugs; marital insecurity and the lack of motivation in terms of letting them attend refresher courses. The conclusions drawn from this study are that communities in the project area recognize the immense contribution CHO services have brought to their lives. But there are certain basic issues that need to be tackled to ensure the desired results of the project. It is recommended that for the program to have its desired impact, the issue of payment for services has to be addressed, more efficient referral system should be put in place, the CHOs need to be given more training and their welfare concerns need to be adequately tackled.
Faith-based organizations: Sexual harassment and health in Accra- Tema metropolis.
(Springer US, 2013-03) Norman, I.D.; Aikins, M.; Binka, F.N.
Sexual harassment occurs frequently in many faith-based organizations (FBOs). This study investigated whether sexual harassment in FBOs was a public health concern in Ghana. A cross-sectional exploratory approach was used to assess the prevalence and incidence of traditional or contrapower sexual harassment in FBOs. We also investigated the correlation between sexual harassment and health. Respondents completed a self-administered open-ended questionnaire in an anonymous survey about sexual harassment during the 12 months preceding the study. We hypothesized that both traditional and contrapower harassment were prevalent in FBOs of Ghana and also that the health effects were the same for both sexes in both forms of harassment. The two hypotheses were generally supported. We found that sexual harassment is a public health concern. Women were more likely to be sexually harassed (73%) than men were (27%). Sexual harassment negatively affects the victims’ health outcome. Secondly, both the traditional and contrapower forms of sexual harassment were prevalent in FBOs in Ghana. The health consequences of sexual harassment in Ghana are the same as in an industrialized country. The implications for policy and research are discussed.
Gate-keeping and women's health seeking behaviour in navrongo, northern Ghana
(2003-04) Ngom, P.; Debpuur, C.; Akweongo, P.; Adongo, P.; Binka, F.N.
Among the Kassena-Nankana of northern Ghana, compound heads and husbands impede women's prompt access to modern health care. This paper shows that such gate-keeping systems have a negative effect on child survival. To investigate the social construction of compound-based gate-keeping systems, the authors relied on a series of qualitative interviews conducted in the Kassena-Nankana district These data reveal that whilst compound heads are gate-keepers for spiritual reasons, husbands play such role for economic reasons. But more important, this article presents health interventions that are on trial in Navrongo (northen Ghana) and how they undermine such gate-keeping systems.
Hospital All-Risk Emergency Preparedness in Ghana
(Ghana medical journal, 2012-03) Norman, I.D.; Aikins, M.; Binka, F.N.; Nyarko, K.M.
Objective: This paper assessed the emergency preparedness programs of health facilities for all-risks but focused on Road Traffic Accidents, (RTA) resulting in surge demand. It adopted W. H. O checklist covering hospital preparedness, equipment, manpower and surge capacity planning as best practices for the mitigation of public health emergencies. Method: This is a cross-sectional study of purposively selected health facilities. The method used consisted of site visit, questionnaire survey, literature and internet review. The W. H. O. standard for emergency preparedness of health facilities was used to evaluate and assess the nation’s hospitals surge capacity programs. The study was conducted between March-June, 2010. A total of 22 district and regional health facilities including teaching hospitals participated in the study. All 10 regions of the country were covered. Result: These were: (1) many of the nation’s hospitals were not prepared for large RTA’s resulting in surge demands, and did not possess general emergency preparedness programs. (2) The hospitals’ respective abilities to handle large scale RTA’s were compromised by the lack of competent medical and allied health personnel and adequate supplies. Discussion: The inadequacies of the hospital system in responding to emergencies raise serious public health concerns. The biggest challenge facing the hospitals in their emergency intervention is the lack of preemergency and emergency preparedness plans as well as the coordination of the hospitals response mechanisms. Conclusion: The paper ended with recommendations on how the nation’s hospitals and their supervisory agencies could improve emergency preparedness.