Browsing by Author "Duah, D."
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Item Factors infuencing health workers’ compliance with the WHO intermittent preventive treatment for malaria in pregnancy recommendations in the Northern Region, Ghana(Malaria Journal, 2022) Mohammed, A.G.; Duah, D.; Kenu, E.; Nonvignon, J.; Manu, A.; Bonful, H.A.Background: Although IPTp-SP is a lifesaving World Health Organization (WHO) recommended preventive interven tion for pregnant women in malaria-endemic regions, IPTp-SP uptake in the Northern region of Ghana is much lower than the sub-optimal national coverage level. Assessing the extent of health workers’ compliance and its associated factors will generate valuable pointers to be targeted at the program level. The study examined the factors infuenc ing health workers’ compliance with the WHO recommended guidelines for IPTp-SP in the Northern Region. Methods: A cross-sectional study among 315 health workers in the Northern region was conducted. Semi-structured questionnaires were used to collect data on health workers’ sociodemographic characteristics, facility-based factors and knowledge level. Data were collected on health workers’ compliance with the recommended practices through covert observations using a checklist. Facility observations were carried out using a checklist. Crude and adjusted logistic regression were used to determine predictors of health workers’ compliance, at a 5% signifcance level adjust ing for clustering. Results: Of the 315 health workers studied, the median age was 29 years (26–34 years). Females constituted (80.5%; 252) of the 313 workers. The majority (47.4%;148) of the 312 health workers were midwives. Overall, 56.2% (CI 51.0 – 62.0) were adequately complying with the recommended guidelines. Lower levels of compliance were recorded in health centres 15.6% (5.0 – 33.0) and CHPS compounds 21.2% (11.0 – 35.0). The factors associated with compliance included health workers’ knowledge (aOR=7.64, 95% CI 4.21 – 13.87, p<0.001), job satisfaction (aOR 10.87, 95% CI 7.04 – 16.79, p<0.001), in-service training (aOR 10.11, 95% CI 4.53 – 22.56, p<0.001), supervision (aOR 4.01, 95% CI 2.09 – 7.68, p<0.001), availability of job aids (aOR 3.61, 95% CI 2.44 – 5.35, p<0.001), health workers expe rience (aOR=10.64, 95% CI 5.99 – 18.91, p<0.001) and facility type (aOR 0.03, 95% CI 0.01–0.07, p<0.001). Conclusion: Compliance with the recommended IPTp-SP guidelines is suboptimal in the region, with lower-level health facilities recording the least compliance levels. Health centres and CHPS facilities should be prioritized in dis tributing limited resources to improve health worker quality of care for antenatal care clientsItem The President's Malaria Initiative contributed to reducing malaria burden in sub-Saharan Africa between 2004 and 2014: Evidence from generalized estimating equation analysis(PLOS ONE, 2019-05-03) Duah, D.; Ye, Y.The President’s Malaria Initiative (PMI) launched in 2005 as a key player in malaria prevention and treatment in sub-Saharan Africa (SSA). Several country-specific evaluations have demonstrated great progress in reducing under-five mortality associated with scaling up malaria interventions in PMI priority countries. Documentation of PMI’s specific contributions was limited, until the publication of Jakubowski, et al., which used difference-in-difference analysis to show a higher reduction of under-five mortality in PMI-supported countries than in others. To generate more evidence, this study used rigorous statistical analyses to assess the reduction in mortality attributable to PMI support. The study used generalized estimating equations and a series of matching procedures to evaluate the impact of PMI on under-five mortality and on population coverage of insecticide-treated nets (ITNs), indoor residual spraying (IRS), and artemisinin-based combination therapy (ACT) in SSA. The analyses used country-level secondary data and controlled for several country-level characteristics assumed to influence outcome measures of interest, PMI program participation, or both. The Mahalanobis distance metric, with 1:1 nearest neighbor matching adjusting for bias in population size in the particular country, showed a reduction in under-five mortality by approximately 12 per 1,000 live births (95% Confidence Interval [CI]: 20.6–3.1; p = 0.012). There were statistically significant increases in the population coverage of ITNs, IRS, and ACTs in PMI countries over the implementation period. ITN use in the population was 0.23% higher (95% CI average treatment effect on the treated: 0.17–0.30; p<0.001) in PMIrecipient countries than in non-PMI countries. The findings show that PMI contributed significantly to increasing the coverage of malaria control interventions and reducing under-five mortality in SSA.Item Validation of Malaria Predictive Model with Missing Covariates(2016-09-29) Duah, D.This study develops a statistical methodology for validating a predictive clinical malaria model when data has missing values in predictor variables. Using the logistic regression framework, multiple imputation techniques for missing values and a penalized likelihood approach to avoid overfitting of the data were adopted. Models with different functional forms were built using known predictors (age, sickle cell, blood group, parasite density, and mosquito bed net use) and some malaria antibody specific antigens and FCGR3B polymorphism. Models were assessed through visualization and differences between the Area Under the Receiver Operating Characteristic Curve (AUROC) and Brier Score (BS) estimated by suitable internal cross-validation designs. The contributions of this research are in three folds: (i) addresses the statistical question on how to build and validate a risk prediction model in the presence of missing explanatory variables (ii) improves the general statistical approach for malaria epidemiology (iii) identifies potential malaria antibodies and FCGR3B polymorphism which should be the research focus in the search for potential malaria vaccine candidate