Browsing by Author "Biritwum, N.K."
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Item Assessing Lymphatic Filariasis Data Quality in Endemic Communities in Ghana, Using the Neglected Tropical Diseases Data Quality Assessment Tool for Preventive Chemotherapy(Public Library of Science, 2016) de Souza, D.K.; Yirenkyi, E.; Otchere, J.; Biritwum, N.K.; Ameme, D.K.; Sackey, S.; Ahorlu, C.; Wilson, M.D.Background: The activities of the Global Programme for the Elimination of Lymphatic Filariasis have been in operation since the year 2000, with Mass Drug Administration (MDA) undertaken yearly in disease endemic communities. Information collected during MDA–such as population demographics, age, sex, drugs used and remaining, and therapeutic and geographic coverage–can be used to assess the quality of the data reported. To assist country programmes in evaluating the information reported, the WHO, in collaboration with NTD partners, including ENVISION/RTI, developed an NTD Data Quality Assessment (DQA) tool, for use by programmes. This study was undertaken to evaluate the tool and assess the quality of data reported in some endemic communities in Ghana. Methods: A cross sectional study, involving review of data registers and interview of drug distributors, disease control officers, and health information officers using the NTD DQA tool, was carried out in selected communities in three LF endemic Districts in Ghana. Data registers for service delivery points were obtained from District health office for assessment. The assessment verified reported results in comparison with recounted values for five indicators: number of tablets received, number of tablets used, number of tablets remaining, MDA coverage, and population treated. Furthermore, drug distributors, disease control officers, and health information officers (at the first data aggregation level), were interviewed, using the DQA tool, to determine the performance of the functional areas of the data management system. Findings: The results showed that over 60% of the data reported were inaccurate, and exposed the challenges and limitations of the data management system. The DQA tool is a very useful monitoring and evaluation (M&E) tool that can be used to elucidate and address data quality issues in various NTD control programmes. © 2016 de Souza et al.Item Assessments of the transmission of Onchocerca volvulus by Simulium sanctipauli in the Upper Denkyira District, Ghana, and the intermittent disappearance of the vector(Parasitology Research, 2015-01) Garms, R.; Badu, K.; Owusu-Dabo, E.; Baffour-Awuah, S.; Adjei, O.; Debrah, A.Y.; Nagel, M.; Biritwum, N.K.; Gankpala, L.; Post, R.J.; Kruppa, T.F.Following studies on the transmission of Onchocerca volvulus (Leuckart) by Simulium sanctipauli Vajime & Dunbar (Diptera, Simuliidae) in Upper Denkyira District in Ghana in 2001 and 2002 (Kutin et al., Med Vet Ent 18:167–173, 2004), further assessments were carried out in 2006 and 2013/2014 to determine whether transmission parameters had changed since community-directed ivermectin treatment (CDTI) began in 1999. There were no marked changes of the transmission intensities in 2006. Only slight, but non-significant, reductions were observed in infection rates of parous flies with larval stages (L1–L3) of O. volvulus from 44.1 % (of 1672 parous flies) in 2001/2002 to 42.1 % (506) in 2006 and from 6.5 to 5.9 % of flies carrying infective larvae in their heads. This suggested that there was an ongoing transmission in the area and the parasite reservoir in the human population was still high. Unexpectedly, further assessments conducted in October 2013 and March and October 2014 revealed that the vector S. sanctipauli had apparently disappeared and transmission had ceased, probably as a result of intensified gold mining activities along the rivers Ofin and Pra. The water of both rivers was extremely turbid, heavily loaded with suspended solids, probably preventing the development of blackfly larvae. Some breeding and biting of Simulium yahense Vajime & Dunbar was observed in a small tributary of the Pra, the Okumayemfuo, which is not affected by gold mining. However, the infection rate of flies was low, only 3.7 % of 163 parous flies were infected with first stage (L1) larvae of O. volvulus. © 2015, Springer-Verlag Berlin Heidelberg.Item Contextualizing Schistosoma haematobium transmission in Ghana: Assessment of diagnostic techniques and individual and community water-related risk factors(Acta Tropica, 2019-03) Kulinkina, A.V.; Kosinski, K.C.; Adjei, M.N.; Osabutey, D.; Gyamfi, B.O.; Biritwum, N.K.; Bosompem, K.M.; Naumova, E.N.Objectives The study assessed associations between Schistosoma haematobium infection (presence of parasite eggs in urine or hematuria) and self-reported metrics (macrohematuria, fetching surface water, or swimming) to evaluate their performance as proxies of infection in presence of regular preventive chemotherapy. It also examined community water characteristics (safe water access, surface water access, and groundwater quality) to provide context for schistosomiasis transmission in different types of communities and propose interventions. Methods Logistic regression was used to assess the associations between the various measured and self-reported metrics in a sample of 897 primary school children in 30 rural Ghanaian communities. Logistic regression was also used to assess associations between community water characteristics, self-reported water-related behaviors and S. haematobium infection. Communities were subsequently categorized as candidates for three types of interventions: provision of additional safe water sources, provision of groundwater treatment, and health education about water-related disease risk, depending on their water profile. Results Microhematuria presence measured with a reagent strip was a good proxy of eggs in urine at individual (Kendall’s τb = 0.88, p < 0.001) and at school-aggregated (Spearman’s rs = 0.96, p < 0.001) levels. Self-reported macrohematuria and swimming were significantly associated (p < 0.05) with egg presence, but self-reported fetching was not. Of the community water characteristics, greater surface water access and presence of groundwater quality problems were significantly associated with increased likelihood of fetching, swimming, and S. haematobium infection. Access to improved water sources did not exhibit an association with any of these outcomes. Conclusions The study illustrates that in presence of regular school-based treatment with praziquantel, microhematuria assessed via reagent strips remains an adequate proxy for S. haematobium infection in primary schoolchildren. Community water profiles, in combination with self-reported water-related behaviors, can help elucidate reasons for some endemic communities continuing to experience ongoing transmission and tailor interventions to these local contexts to achieve sustainable control.Item Fifteen years of programme implementation for the elimination of Lymphatic Filariasis in Ghana: Impact of MDA on immunoparasitological indicators(Public Library of Science, 2017) Biritwum, N.K.; Souza, S.K.; Marfo, B.; Odoom, S.; Alomatu, B.; Asiedu, O.; Yeboah, A.; Hervie, T.E.; Mensah, E.O.; Yikpotey, P.; Koroma, J.B.; Molyneux, D.; Bockarie, J.M.; Gyapong, J.O.Item Improving drug delivery strategies for lymphatic filariasis elimination in urban areas in Ghana(Public Library of Science, 2017) Biritwum, N.K.; Garshong, B.; Alomatu, B.; Souza, D.K.; Gyapong, M.The Global Program to Eliminate Lymphatic Filariasis (GPELF) advocates for the treatment of entire endemic communities, in order to achieve its elimination targets. LF is predominantly a rural disease, and achieving the required treatment coverage in these areas is much easier compared to urban areas that are more complex. In Ghana, parts of the Greater Accra Region with Accra as the capital city are also endemic for LF. Mass Drug Administration (MDA) in Accra started in 2006. However, after four years of treatment, the coverage has always been far below the 65% epidemiologic coverage for interrupting transmission. As such, there was a need to identify the reasons for poor treatment coverage and design specific strategies to improve the delivery of MDA. This study therefore set out to identify the opportunities and barriers for implementing MDA in urban settings, and to develop appropriate strategies for MDA in these settings. An experimental, exploratory study was undertaken in three districts in the Greater Accra region. The study identified various types of non-rural settings, the social structures, stakeholders and resources that could be employed for MDA. Qualitative assessment such as in-depth interviews (IDIs) and focus group discussions (FGDs) with community leaders, community members, health providers, NGOs and other stakeholders in the community was undertaken. The study was carried out in three phases: pre-intervention, intervention and post-intervention phases, to assess the profile of the urban areas and identify reasons for poor treatment coverage using both qualitative and quantitative research methods. The outcomes from the study revealed that, knowledge, attitudes and practices of community members to MDA improved slightly from the pre-intervention phase to the post-intervention phase, in the districts where the interventions were readily implemented by health workers. Many factors such as adequate leadership, funding, planning and community involvement, were identified as being important in improving implementation and coverage of MDA in the study districts. Implementing MDA in urban areas therefore needs to be given significant consideration and planning, if the required coverage rates are to be achieved. This paper, presents the recommendations and strategies for undertaking MDA in urban areas. © 2017 Biritwum et al.Item Mapping helminth co-infection and co-intensity: geostatistical prediction in Ghana(PLoS Negl Trop Dis., 2011) Soares Magalhães, R.J.; Biritwum, N.K.; Gyapong, J.O.; Brooker, S.; Zhang, Y.; Blair, L.; Fenwick, A.; Clements, A.C.Background: Morbidity due to Schistosoma haematobium and hookworm infections is marked in those with intense coinfections by these parasites. The development of a spatial predictive decision-support tool is crucial for targeting the delivery of integrated mass drug administration (MDA) to those most in need. We investigated the co-distribution of S.haematobium and hookworm infection, plus the spatial overlap of infection intensity of both parasites, in Ghana. The aim was to produce maps to assist the planning and evaluation of national parasitic disease control programs. Methodology/Principal Findings: A national cross-sectional school-based parasitological survey was conducted in Ghana in 2008, using standardized sampling and parasitological methods. Bayesian geostatistical models were built, including a multinomial regression model for S. haematobium and hookworm mono- and co-infections and zero-inflated Poisson regression models for S. haematobium and hookworm infection intensity as measured by egg counts in urine and stool respectively. The resulting infection intensity maps were overlaid to determine the extent of geographical overlap of S.haematobium and hookworm infection intensity. In Ghana, prevalence of S. haematobium mono-infection was 14.4%, hookworm mono-infection was 3.2%, and S. haematobium and hookworm co-infection was 0.7%. Distance to water bodies was negatively associated with S. haematobium and hookworm co-infections, hookworm mono-infections and S. haematobium infection intensity. Land surface temperature was positively associated with hookworm mono-infections and S. haematobium infection intensity. While high-risk (prevalence .10–20%) of co-infection was predicted in an area around Lake Volta, co-intensity was predicted to be highest in foci within that area. Conclusions/Significance: Our approach, based on the combination of co-infection and co-intensity maps allows the identification of communities at increased risk of severe morbidity and environmental contamination and provides a platform to evaluate progress of control efforts.Item Onchocerciasis Transmission in Ghana: Persistence under Different Control Strategies and the Role of the Simuliid Vectors(Public Library of Science, 2015) Lamberton, P.H.L.; Cheke, R.A.; Winskill, P.; Tirados, I.; Walker, M.; Osei-Atweneboana, M.Y.; Biritwum, N.K.; Tetteh-Kumah, A.; Boakye, D.A.; Wilson, M.D.; Post, R.J.; Basañez, M.G.Background: The World Health Organization (WHO) aims at eliminating onchocerciasis by 2020 in selected African countries. Current control focuses on community-directed treatment with ivermectin (CDTI). In Ghana, persistent transmission has been reported despite long-term control. We present spatial and temporal patterns of onchocerciasis transmission in relation to ivermectin treatment history. Methodology/Principal Findings: Host-seeking and ovipositing blackflies were collected from seven villages in four regions of Ghana with 3–24 years of CDTI at the time of sampling. A total of 16,443 flies was analysed for infection; 5,812 (35.3%) were dissected for parity (26.9% parous). Heads and thoraces of 12,196 flies were dissected for Onchocerca spp. and DNA from 11,122 abdomens was amplified using Onchocerca primers. A total of 463 larvae (0.03 larvae/fly) from 97 (0.6%) infected and 62 (0.4%) infective flies was recorded; 258 abdomens (2.3%) were positive for Onchocerca DNA. Infections (all were O. volvulus) were more likely to be detected in ovipositing flies. Transmission occurred, mostly in the wet season, at Gyankobaa and Bosomase, with transmission potentials of, respectively, 86 and 422 L3/person/month after 3 and 6 years of CDTI. The numbers of L3/1,000 parous flies at these villages were over 100 times the WHO threshold of one L3/1,000 for transmission control. Vector species influenced transmission parameters. At Asubende, the number of L3/1,000 ovipositing flies (1.4, 95% CI = 0–4) also just exceeded the threshold despite extensive vector control and 24 years of ivermectin distribution, but there were no infective larvae in host-seeking flies. Conclusions/Significance: Despite repeated ivermectin treatment, evidence of O. volvulus transmission was documented in all seven villages and above the WHO threshold in two. Vector species influences transmission through biting and parous rates and vector competence, and should be included in transmission models. Oviposition traps could augment vector collector methods for monitoring and surveillance. © 2015 Lamberton et al.Item Progress towards lymphatic filariasis elimination in Ghana from 2000-2016: Analysis of microfilaria prevalence data from 430 communities(PLoS Neglected Tropical Diseases, 2019-06-05) Frempong, K.K.; Biritwum, N.K.; Verver, S.; Odoom, S.; Alomatu, B.; Asiedu, O.; Kontoroupis, P.; Yeboah, A.; Hervie, E.T.; Marfo, B.; Boakye, D.A.; De Vlas, S.J.; Gyapong, J.O.; Stolk, W.A.BACKGROUND: Ghana started its national programme to eliminate lymphatic filariasis (LF) in 2000, with mass drug administration (MDA) with ivermectin and albendazole as main strategy. We review the progress towards elimination that was made by 2016 for all endemic districts of Ghana and analyze microfilaria (mf) prevalence from sentinel and spot-check sites in endemic districts. METHODS: We reviewed district level data on the history of MDA and outcomes of transmission assessment surveys (TAS). We further collated and analyzed mf prevalence data from sentinel and spot-check sites. RESULTS: MDA was initiated in 2001-2006 in all 98 endemic districts; by the end of 2016, 81 had stopped MDA after passing TAS and after an average of 11 rounds of treatment (range 8-14 rounds). The median reported coverage for the communities was 77-80%. Mf prevalence survey data were available for 430 communities from 78/98 endemic districts. Baseline mf prevalence data were available for 53 communities, with an average mf prevalence of 8.7% (0-45.7%). Repeated measurements were available for 78 communities, showing a steep decrease in mean mf prevalence in the first few years of MDA, followed by a gradual further decline. In the 2013 and 2014 surveys, 7 and 10 communities respectively were identified with mf prevalence still above 1% (maximum 5.6%). Fifteen of the communities above threshold are all within districts where MDA was still ongoing by 2016. CONCLUSIONS: The MDA programme of the Ghana Health Services has reduced mf prevalence in sentinel sites below the 1% threshold in 81/98 endemic districts in Ghana, yet 15 communities within 13 districts (MDA ongoing by 2016) had higher prevalence than this threshold during the surveys in 2013 and 2014. These districts may need to intensify interventions to achieve the WHO 2020 target.Item A Review of the Prevention of Maternal Mortality Programme in Ejisu – Juaben District(University of Ghana, 2001-08) Biritwum, N.K.; Tetteh, E.; Senah, K.A.; University of Ghana, College of Health Sciences, School of Public HealthThe issue of maternal mortality continues to plague many developing countries including Ghana. To address this problem the Prevention of Maternal Mortality (PMM) programme was established in two districts in Ghana by a team of both local and foreign researchers in 1989. They constituted themselves into two teams in Accra and Kumasi. However actual work on the field by the Kumasi team in the Ejisu- Juaben district where they concentrated their activities was started in 1993 and ended in 1997 when the programme became a local entity and part of the Regional Prevention of Maternal Mortality programme. There has since been no evaluation of this programme. Their approach was through the establishment of both facility-based and community-based interventions. These facilities were aimed at catering for the critically ill pregnant woman and specifically addressed obstetric bleeding. The intervention site was the Juaben health centre, which was upgraded to a district hospital. A theatre and a blood bank were provided and nurses trained in life-saving skills. The community programmes put in place included the setting up of a community fund to cater for these women. Bicycles were also provided to be used to call vehicles to transport obstetric emergencies to the hospital for care. This study therefore set out to review the Prevention of Maternal Mortality Programme in the Ejisu- Juaben district with special emphasis on obstetric emergencies. The specific objectives were: 1. To describe the emergency obstetric care activities of the Prevention of Maternal Mortality programme in the district in the management of obstetric haemorrhage. 2. To study the trend of activities at the intervention site using hospital records from the theatre, maternity ward and the blood bank. 3. To describe the knowledge, attitudes and practices of the adult population (especially women in the reproductive age-group, household heads and other opinion leaders) to the emergencyobstetric care services in the district. 4. To undertake a confidential enquiry into five maternal deaths in the community and identify factors surrounding these deaths. The findings of the study showed that the facility based interventions put in place have been sustained, however there still remains aspects of the facility based interventions such as staffing and training that still need to be addressed. The impact of the programme has also been limited to the subdistrict where the intervention site is located and a few areas of adjacent sub-districts. The community based interventions are almost non-existent in all the communities surveyed. The knowledge of respondents from the communities and health providers about the availability and utilisation of the prevention of maternal mortality was also inadequate. From the study factors found to be associated with survival of obstetric emergencies in the Ejisu- Juaben district include geographic accessibility of health facilities, financial accessibility of health facilities, practices of health seeking behaviour of the people, knowledge of emergency obstetric cases, knowledge of the appropriate place to go for help, knowledge of the availability of a functioning blood bank, knowledge of the availability of drugs and the competence of health staff at handling emergency obstetric cases. These are important areas of the prevention of the maternal mortality programme, which need to be addressed in order that the programme would have the desired impact.Item Transmission Assessment Surveys (TAS) to Define Endpoints for Lymphatic Filariasis Mass Drug Administration: A Multicenter Evaluation(Public Library of Science, 2013) Chu, B.K.; Deming, M.; Biritwum, N.K.; Bougma, W.R.; Dorkenoo, A.M.; El-Setouhy, M.; Fischer, P.U.; Gass, K.; Gonzalez de Peña, M.; Mercado-Hernandez, L.; Kyelem, D.; Lammie, P.J.; Flueckiger, R.M.; Mwingira, U.J.; Noordin, R.; Offei Owusu, I.; Ottesen, E.A.; Pavluck, A.; Pilotte, N.; Rao, R.U.; Samarasekera, D.; Schmaedick, M.A.; Settinayake, S.; Simonsen, P.E.; Supali, T.; Taleo, F.; Torres, M.; Weil, G.J.; Won, K.Y.Background:Lymphatic filariasis (LF) is targeted for global elimination through treatment of entire at-risk populations with repeated annual mass drug administration (MDA). Essential for program success is defining and confirming the appropriate endpoint for MDA when transmission is presumed to have reached a level low enough that it cannot be sustained even in the absence of drug intervention. Guidelines advanced by WHO call for a transmission assessment survey (TAS) to determine if MDA can be stopped within an LF evaluation unit (EU) after at least five effective rounds of annual treatment. To test the value and practicality of these guidelines, a multicenter operational research trial was undertaken in 11 countries covering various geographic and epidemiological settings.Methodology:The TAS was conducted twice in each EU with TAS-1 and TAS-2 approximately 24 months apart. Lot quality assurance sampling (LQAS) formed the basis of the TAS survey design but specific EU characteristics defined the survey site (school or community), eligible population (6-7 year olds or 1st-2nd graders), survey type (systematic or cluster-sampling), target sample size, and critical cutoff (a statistically powered threshold below which transmission is expected to be no longer sustainable). The primary diagnostic tools were the immunochromatographic (ICT) test for W. bancrofti EUs and the BmR1 test (Brugia Rapid or PanLF) for Brugia spp. EUs.Principal Findings/Conclusions:In 10 of 11 EUs, the number of TAS-1 positive cases was below the critical cutoff, indicating that MDA could be stopped. The same results were found in the follow-up TAS-2, therefore, confirming the previous decision outcome. Sample sizes were highly sex and age-representative and closely matched the target value after factoring in estimates of non-participation. The TAS was determined to be a practical and effective evaluation tool for stopping MDA although its validity for longer-term post-MDA surveillance requires further investigation.