Browsing by Author "Gyapong, M."

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The burden of hydrocele on men in Northern Ghana
(2000-12) Gyapong, M.; Gyapong, J.; Weiss, M.; Tanner, M.
The social and economic impact of lymphatic filariasis was studied in Northern Ghana. Qualitative methods of gathering information revealed that even though the disease was a problem to both men and women, men with hydrocele suffered a greater psychosocial burden. Particular attention was paid to them, distinguishing men with small hydroceles and men with large ones. Out of frustration men with small hydroceles sought health care from a wider range of places than men with larger ones. The pain associated with adenolymphangitis (ADL) renders them inactive for up to 5 days. Complications of lymph scrotum and ridicule from community members were a problem. Unmarried men in particular found it difficult to find a spouse with their condition, and various degrees of sexual dysfunction were reported amongst married men. The clinical significance and the value of time and attention for counseling to mitigate the effects of the disease on damaged male identity and the need for gender studies to address male issues and the need for including psychosocial issues in the calculating of disability adjusted life years (DALY's) is also discussed. Copyright (C) 2000 Elsevier Science B.V.
Community Perception of Voluntary Counseling and Testing (VCT) in Dodowa Sub-District, Dangme West District, Greater Accra Region
(University of Ghana, 2008-08) Ofoe, V.E.; Gyapong, M.; Opoku-Mensah, K.
Introduction According to UNAIDS/WHO (2007) every day, over 6800 persons become infected with HIV and over 5700 persons die from AIDS globally, mostly because of inadequate access to HIV prevention and treatment services. In Ghana, compared with other African countries the HIV prevalence is low (2.7%), knowledge about the disease is high, and in 2007 the HIV and AIDS infected population was estimated at 312,030. The Ghana National AIDS/STI Control Programme provides treatment, care and support services as well as vital surveillance data. Dodowa as the district capital of the Dangme West District has no hospital nor HIV/AIDS facility but a long history of referring suspected AIDS patients to other district hospitals near by. Since the new facility was established early in 2008, patronage had been very poor and factors affecting this problem have not been fully investigated. Objectives The general objective of the study was to examine community perception of VCT and how this influences utilization of VCT services. Methods This was a cross sectional and descriptive study. It employed both qualitative and quantitative methods. Structured questionnaires were administered to a total of 200 males and females aged 15 years and above in 20 communities. The qualitative aspect of the study was carried out using In-depth interviews (IDIs), Focus Group Discussions (FGDs), Non Participant Observation and Exit Interview. Quantitative data was processed and analyzed using EPIINFO version 3.41 software. Descriptive statistics were run as well as test for association such as chi-square and logistic regression. For qualitative data, recorded interviews were transcribed, coded and analyzed manually. Results A total of 200 respondents made up of 90 males (45%) and 110 females (55%) participated in the quantitative aspect of the study. In the qualitative aspect of the study, four FGDs were done two female groups and two male groups with a maximum of eight in a group. Ten IDIs were also done. All the respondents interviewed had heard of HIV/AIDS. Regarding sources of information over eighty percent (89.5%) got the information from television programs. Knowledge on VCT was high as majority of respondents (83%) had heard about VCT. More than half of the respondents 88(53.0%) who had heard of VCT said they did not know VCT services were being offered in the Dodowa Health Centre. The young females who knew about the VCT services in Dodowa showed concern about the attitude of the nurses and would rather access VCT services outside the Dodowa sub-District. The majority (82.5%) mentioned that those diagnosed with HIV should be kept in isolation. Conclusion In spite of the level of awareness most of the respondents were not ready to do the HIV test due to fear of positive results and perception about VCT in general as it was perceived as psychological and emotional trauma when HIV status is ascertained. Moreover, awareness of VCT facilities was low (53%), this has affected patronage of the facilities. Recommendation Intensive education must be done in the communities to explain the importance of HIV test. Community members should be made aware of the new VCT facility created for an integrated health service. Community members should be assured of privacy and confidentiality during VCT session. The health staff should be educated on how to keep confidential information to themselves and respect the privacy of the individual. Community sensitization should be intensified by the District Health Management Team (DHMT) in collaboration with the District Assembly.
Community-directed treatment: The way forward to eliminating lymphatic filariasis as a public-health problem in Ghana
(2001) Gyapong, M.; Gyapong, J.O.; Owusu-Banahene, G.
The elimination of lymphatic filariasis as a public-health problem is currently dependent on the delivery of annual drug treatments to at least 80% of the eligible members of endemic populations for at least 5 years. However, for various reasons, this goal may not be achievable by the health systems of most endemic countries in sub-Saharan Africa, particularly if treatment is not community-directed. In Ghana, community-directed ivermectin treatment involving the regular public-health services at the implementation level (ComDT/HS) has recently been compared with mass-treatment in which only the health services participated (HST). Health staff and the target communities appreciated the ComDT/HS approach more than the HST approach and were more willing to participate in the community-directed scheme. The treatment coverage achieved by ComDT/HS (74.5%) was not only much higher than that of HST (43.5%) but also probably adequate for filariasis elimination. HST coverage was particularly poor in villages located > 5 km from a health facility, but distance from such a facility had no significant effect on treatment coverage in the ComDT/HS arm. As virtually all the subjects who received drugs swallowed them, compliance with treatment was not a problem. The ComDT/HS approach is therefore recommended, especially for areas where access to health facilities is poor and the health workers are over-stretched. The implications of these findings for the global programme for filariasis elimination are discussed.
Data reporting constraints for the lymphatic filariasis mass drug administration activities in two districts in Ghana: A qualitative study
(SAGE Open Medicine, 2015-07) da-Costa Vroom, F.B.; Aryeetey, R.; Boateng, R.; Anto, F.; Aikins, M.; Gyapong, M.; Gyapong, J.
Objectives: Timely and accurate health data are important for objective decision making and policy formulation. However, little evidence exists to explain why poor quality routine health data persist. This study examined the constraints to data reporting for the lymphatic filariasis mass drug administration programme in two districts in Ghana. This qualitative study focused on timeliness and accuracy of mass drug administration reports submitted by community health volunteers. Methods: The study is nested within a larger study focusing on the feasibility of mobile phone technology for the lymphatic filariasis programme. Using an exploratory study design, data were obtained through in-depth interviews (n = 7) with programme supervisors and focus group discussions (n = 4) with community health volunteers. Results were analysed using thematic content analysis. Results: Reasons for delays in reporting were attributed to poor numeracy skills among community health volunteers, difficult physical access to communities, high supervisor workload, poor adherence reporting deadlines, difficulty in reaching communities within allocated time and untimely release of programme funds. Poor accuracy of data was mainly attributed to inadequate motivation for community health volunteers and difficulty calculating summaries. Conclusion: This study has shown that there are relevant issues that need to be addressed in order to improve the quality of lymphatic filariasis treatment coverage reports. Some of the factors identified are problems within the health system; others are specific to the community health volunteers and the lymphatic filariasis programme. Steps such as training on data reporting should be intensified for community health volunteers, allowances for community health volunteers should be reevaluated and other non-monetary incentives should be provided for community health volunteers. ï¿½ The Author(s) 2015.
The epidemiology of acute adenolymphangitis due to lymphatic filariasis in northern Ghana
(1996) Gyapong, J.O.; Gyapong, M.
A study to investigate the socioeconomic impact of lymphatic filariasis was conducted in a rural community in northern Ghana. The incidence, severity, and duration of acute adenolymphangitis (ADL), as identified by local terminologies and confirmed using World Health Organization diagnostic criteria, were investigated. Local terminologies were found to be highly specific and sensitive for diagnosing ADL (sensitivity = 0.978, specificity = 0.980). The incidence of ADL was 95.9 per 1,000 per annum among adults more than 10 years of age, being much higher in females than in males. Among those with elephantiasis and other chronic filarial symptoms, there was no clear relationship between the stage of chronic lymphedema and the incidence of ADL. The incidence of ADL was found to be closely related to the rainfall pattern. The design of the study, its findings, and the public health implications of the findings are discussed in this paper.
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.
Factors related to retention of community health workers in a trial on community-based management of fever in children under 5 years in the Dangme West District of Ghana
(International Health, 2014-02) Abbey, M.; Bartholomew, L.K.; Nonvignon, J.; Chinbuah, M.A.; Pappoe, M.; Gyapong, M.; Gyapong, J.O.; Bart-Plange, C.; van den Borne, B.
Background: In resource-constrained settings of developing countries, promotion of community-based health interventions through community health workers (CHWs) is an important strategy to improve child health. However, there are concerns about the sustainability of such programmes owing to the high rate of CHW attrition. This study examined factors influencing retention of volunteer CHWs in a cluster randomised trial on community management of under-5 fever in a rural Ghanaian district. Methods: Data were obtained from structured interviews (n=520) and focus group discussions (n=5) with CHWs. Factors influencing CHWs' decisions to remain or leave the programme were analysed using a probit model, and focus group discussion results were used to elucidate the findings. Results: The attrition rate among CHWs was 21.2%. Attrition was comparatively higher in younger age groups (25.9% in 15-25 years group, 18.2% in 26-45 years group and 16.5% in ≥46 years group). Approval of a CHW by the community (p<0.001) and the CHW's immediate family (p<0.05) were significant in influencing the probability of remaining in the programme. Motivation for retention was related to the desire to serve their communities as well as humanitarian and religious reasons. Conclusion: The relatively moderate rate of attrition could be attributed to the high level of community involvement in the selection process as well as other aspects of the intervention leading to high community approval and support. Attention for these aspects could help improve CHW retention in community-based health interventions in Ghana, and the lessons could be applied to countries within similar settings. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved.
Feasibility and acceptability of the use of artemether‐lumefantrine in the home management of uncomplicated malaria in children 6–59 months old in Ghana
(Blackwell Publishing Ltd, 2006-07) Chinbuah, A.M.; Gyapong, J.O.; Pagnoni, F.; Wellington, E.K.; Gyapong, M.
OBJECTIVE: We assessed the feasibility and acceptability of and the willingness to use artemether-lumefantrine (Coartem) during early, appropriate treatment of malaria/fever in children aged 6-59 months at the community and household level in a rural malaria-endemic area in Ghana. METHOD: In this descriptive study with a pre- post-evaluation of an intervention, community perceptions of fever, health-seeking behaviour and current treatment practices for children aged 6-59 months were ascertained through qualitative research and surveys. The children were counted in a household census and given identification cards. Community-based agents (who were supervised monthly) dispensed a 6-dose-treatment formulation of Coartem over a 4 months period and counseled caregivers on case management and referral. Caregivers who consulted were followed up after 4 days to determine adherence to the treatment regimen. Blister packs of the drugs were inspected where available. The performance of the agents in terms of counselling, advising on referral and reporting was evaluated. Community satisfaction was also assessed qualitatively through focus group discussions and interviews. RESULTS: Three hundred and sixty-three children sought care during the intervention period. All 235 children aged 6-35 months were correctly provided the one tablet per dose per treatment package compared with 119 of 125 children 36-59 months (95.2%). Only 5 of 17 children were referred appropriately. All 334 caregivers followed the correct drug administration schedule, i.e. twice a day for 3 days. Validation of drugs received indicates that all 204 children aged 6-35 months and 103/118 (87.3%) children aged 36-59 months received the correct drug dose. Adherence of agents and caregivers to the treatment was 308/334 (92.5%). Delay in seeking care was reduced from 3 to 2 days. No serious adverse drug reactions were reported. Community members were enthusiastic about the performance of the agents. CONCLUSION: A Home Management of Malaria (HMM) strategy with Coartem using trained community-based agents supervised monthly is feasible, acceptable, and can achieve high levels of compliance within Dangme, West District of Ghana. However, if the intervention is to be sustainable, the agents need to be paid.
Feasibility and cost of using mobile phones for capturing drug safety information in peri-urban settlement in Ghana: a prospective cohort study of patients with uncomplicated malaria.
(Malar J., 2015-10) Kukula, V.A.; Dodoo, A.A.; Akpakli, J.; Narh-Bana, S.A.; Clerk, C.; Adjei, A.; Awini, E.; Manye, S.; Nagai, R.A.; Odonkor, G.; Nikoi, C.; Adjuik, M.; Akweongo, P.; Baiden, R.; Ogutu, B.; Binka, F.; Gyapong, M.
BACKGROUND: The growing need to capture data on health and health events using faster and efficient means to enable prompt evidence-based decision-making is making the use of mobile phones for health an alternative means to capture anti-malarial drug safety data. This paper examined the feasibility and cost of using mobile phones vis-à-vis home visit to monitor adverse events (AEs) related to artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria in peri-urban Ghana. METHODS: A prospective, observational, cohort study conducted on 4270 patients prescribed ACT in 21 health facilities. The patients were actively followed by telephone or home visit to document AEs associated with anti-malarial drugs. Call duration and travel distances of each visit were recorded. Pre-paid call cards and fuel for motorbike travels were used to determine cost of conducting both follow-ups. Ms-Excel 2010 and STATA 11.2 were used for analysis. RESULTS: Of the 4270 patients recruited, 4124 (96.6 %) were successfully followed up and analyzed. Of these, 1126/4124 (27.3 %) were children under 5 years. Most 3790/4124 (91.9 %) follow-ups were done within 7 days of ACT intake. Overall, follow up by phone (2671/4124-64.8 %) was almost two times the number done by home visits (1453/4124-35.2 %). Duration of telephone calls ranged from 38 s to 53 min, costing between GH¢0.26 (0.20USD) and GH¢41.70 (27.USD). On the average, the calls lasted 3 min 51 s (SD = 3 min, 21 s) costing GH¢2.70 (0.77USD). Distance travelled for home visit ranged from 0.65 to 62 km costing GH¢0.29 (0.20USD) and GH¢279.00 (79.70USD). Thirty-two per cent (1128/4124) of patients reported AEs. In total, 1831 AE were reported, 1016/1831(55.5 %) by telephone and 815/1831 (44.5 %) by home visits. Events such as nausea, dizziness, diarrhoea, and vomiting were commonly reported. CONCLUSION: Majority of patients was successfully followed up by telephone and reported the most AEs. The cost of telephone interviewing was almost two times less than the cost of home visit. Telephone follow up should be considered for monitoring drug adverse events in low resource settings.
Filariasis in northern Ghana: Some cultural beliefs and practices and their implications for disease control
(1996) Gyapong, M.; Gyapong, J.O.; Adjei, S.; Vlassoff, C.; Weiss, M.
This article reports on how some endemic rural communities in northern Ghana perceive and manage lymphatic filariasis. The disease was mainly attributed to supernatural and spiritual factors. Except for a few instances of neglect, the community was generally caring towards people with the disease. Issues related to marriage, stigma, concealment and leadership are discussed. On the whole, the importance of social and cultural perceptions of a disease and its relevance to control cannot be over emphasized.
Help-seeking for pre-ulcer and ulcer conditions of mycobacterium ulcerans disease (buruli ulcer) in Ghana
(2012) Gyapong, M.; Pappoe, M.; Weiss, M. G.
BACKGROUND: Ghana is a Buruli ulcer (BU) endemic country yet there is paucity of socio-cultural research on BU. Examining distinctive experiences and meanings for pre-ulcers and ulcers of BU may clarify the disease burden, illness experience and local perceptions of causes and spread, and environmental features of BU, which are useful to guide public health programmes and future research. This study aimed to explain local meanings and experiences of BU for persons with pre-ulcers and ulcers in the Ga-West and Ga-South municipalities in Accra. METHODS: Semi-structured interviews based on the Explanatory Model Interview Catalogue framework were administered to 181 respondents comprising 15 respondents with pre-ulcers and 166 respondents with ulcers. The Wilcoxon rank-sum test was used to compare categories of illness experiences (PD) and perceived causes (PC) among respondents with pre-ulcer and ulcer conditions. The Fisher's exact test was used to compare the most troubling PD and the most important PC variables. Qualitative phenomenological analysis of respondents' narratives clarified illness experiences and meanings with reference to PC and PD variables. RESULTS: Families of respondents with pre-ulcers and the respondents themselves were often anxious about disease progression, while families of respondents with ulcers, who had to give care, worried about income loss and disruption of school attendance. Respondents with pre-ulcers frequently reported swimming in ponds and rivers as a perceived cause and considered it as the most important PC (53.3%). Respondents with ulcers frequently attributed their BU illness to witchcraft (64.5%) and respondents who claimed they had no water contact, questioned the credibility of health messages CONCLUSIONS: Affected persons with pre-ulcers are likely to delay treatment because of social and financial constraints and the absence of pain. Scepticism on the role of water in disease contagion and prolonged healing is perceived to make ideas of witchcraft as a PC more credible, among respondents with ulcers. Health messages should address issues of locally perceived risk and vulnerability. Guided by study findings, further research on the role of environmental, socio-cultural and genetic factors in BU contagion, is also needed to clarify and formulate health messages and strengthen public health initiatives.
Illness meanings and experiences for pre-ulcer and ulcer conditions of Buruli ulcer in the Ga-West and Ga-South Municipalities of Ghana
(2012-04-03) Ackumey, M.M.; Gyapong, M.; Pappoe, M.; Kwakye-Maclean, C.; Weiss, M.G.
AbstractBackgroundGhana is a Buruli ulcer (BU) endemic country yet there is paucity of socio-cultural research on BU. Examining distinctive experiences and meanings for pre-ulcers and ulcers of BU may clarify the disease burden, illness experience and local perceptions of causes and spread, and environmental features of BU, which are useful to guide public health programmes and future research. This study aimed to explain local meanings and experiences of BU for persons with pre-ulcers and ulcers in the Ga-West and Ga-South municipalities in Accra.MethodsSemi-structured interviews based on the Explanatory Model Interview Catalogue framework were administered to 181 respondents comprising 15 respondents with pre-ulcers and 166 respondents with ulcers. The Wilcoxon rank-sum test was used to compare categories of illness experiences (PD) and perceived causes (PC) among respondents with pre-ulcer and ulcer conditions. The Fisher’s exact test was used to compare the most troubling PD and the most important PC variables. Qualitative phenomenological analysis of respondents’ narratives clarified illness experiences and meanings with reference to PC and PD variables.ResultsFamilies of respondents with pre-ulcers and the respondents themselves were often anxious about disease progression, while families of respondents with ulcers, who had to give care, worried about income loss and disruption of school attendance. Respondents with pre-ulcers frequently reported swimming in ponds and rivers as a perceived cause and considered it as the most important PC (53.3%). Respondents with ulcers frequently attributed their BU illness to witchcraft (64.5%) and respondents who claimed they had no water contact, questioned the credibility of health messagesConclusionsAffected persons with pre-ulcers are likely to delay treatment because of social and financial constraints and the absence of pain. Scepticism on the role of water in disease contagion and prolonged healing is perceived to make ideas of witchcraft as a PC more credible, among respondents with ulcers. Health messages should address issues of locally perceived risk and vulnerability. Guided by study findings, further research on the role of environmental, socio-cultural and genetic factors in BU contagion, is also needed to clarify and formulate health messages and strengthen public health initiatives.
Illness meanings and experiences for pre-ulcer and ulcer conditions of buruli ulcer in the Ga-west and Ga-south municipalities of Ghana.
(BMC Public Health, 2012) Ackumey, M.M.; Gyapong, M.; Pappoe, M.; Kwakye-Maclean, C.; Weiss, M.G.;
Background: Ghana is a Buruli ulcer (BU) endemic country yet there is paucity of socio-cultural research on BU. Examining distinctive experiences and meanings for pre-ulcers and ulcers of BU may clarify the disease burden, illness experience and local perceptions of causes and spread, and environmental features of BU, which are useful to guide public health programmes and future research. This study aimed to explain local meanings and experiences of BU for persons with pre-ulcers and ulcers in the Ga-West and Ga-South municipalities in Accra. Methods: Semi-structured interviews based on the Explanatory Model Interview Catalogue framework were administered to 181 respondents comprising 15 respondents with pre-ulcers and 166 respondents with ulcers. The Wilcoxon rank-sum test was used to compare categories of illness experiences (PD) and perceived causes (PC) among respondents with pre-ulcer and ulcer conditions. The Fisher’s exact test was used to compare the most troubling PD and the most important PC variables. Qualitative phenomenological analysis of respondents’ narratives clarified illness experiences and meanings with reference to PC and PD variables. Results: Families of respondents with pre-ulcers and the respondents themselves were often anxious about disease progression, while families of respondents with ulcers, who had to give care, worried about income loss and disruption of school attendance. Respondents with pre-ulcers frequently reported swimming in ponds and rivers as a perceived cause and considered it as the most important PC (53.3%). Respondents with ulcers frequently attributed their BU illness to witchcraft (64.5%) and respondents who claimed they had no water contact, questioned the credibility of health messages Conclusions: Affected persons with pre-ulcers are likely to delay treatment because of social and financial constraints and the absence of pain. Scepticism on the role of water in disease contagion and prolonged healing is perceived to make ideas of witchcraft as a PC more credible, among respondents with ulcers. Health messages should address issues of locally perceived risk and vulnerability. Guided by study findings, further research on the role of environmental, socio-cultural and genetic factors in BU contagion, is also needed to clarify and formulate health messages and strengthen public health initiatives.
Impact of community management of fever (using antimalarials with or without antibiotics) on childhood mortality: a cluster-randomized controlled trial in Ghana
(2012-11) Chinbuah, M.A.; Kager, P.A.; Abbey, M.; Gyapong, M.; Awini, E.; Nonvignon, J.; Adjuik, M.; Aikins, M.; Pagnoni, F.; Gyapong, J.O.
Malaria and pneumonia are leading causes of childhood mortality. Home Management of fever as Malaria (HMM) enables presumptive treatment with antimalarial drugs but excludes pneumonia. We aimed to evaluate the impact of adding an antibiotic, amoxicillin (AMX) to an antimalarial, artesunate amodiaquine (AAQ + AMX) for treating fever among children 2-59 months of age within the HMM strategy on all-cause mortality. In a stepped-wedge cluster-randomized, open trial, children 2-59 months of age with fever treated with AAQ or AAQ + AMX within HMM were compared with standard care. Mortality reduced significantly by 30% (rate ratio [RR] = 0.70, 95% confidence interval [CI] = 0.53-0.92, P = 0.011) in AAQ clusters and by 44% (RR = 0.56, 95% CI = 0.41-0.76, P = 0.011) in AAQ + AMX clusters compared with control clusters. The 21% mortality reduction between AAQ and AAQ + AMX (RR = 0.79, 95% CI = 0.56-1.12, P = 0.195) was however not statistically significant. Community fever management with antimalarials significantly reduces under-five mortality. Given the lower mortality trend, adding an antibiotic is more beneficial.
Impact of treating young children with antimalarials with or without antibiotics on morbidity: A cluster-randomized controlled trial in ghana
(Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene., 2013-09) Chinbuah, M.A.; Adjuik, M.; Cobelens, F.; Koram, K.A.; Abbey, M.; Gyapong, M.; Kager, P.A.; Gyapong, J.O.
Background: Community health workers in Dangme-West district, Ghana, treated children aged 2-59 months with fever with either artesunate-amodiaquine (AAQ) or AAQ plus amoxicillin (AAQ + AMX) within a clusterrandomized controlled trial (registration no. TDR/UNDP Trial registration A: 20189). The intervention was introduced in a stepped-wedge manner. The aim of the study was reduction of mortality. This paper reports on the reduction of morbidity, notably anaemia, severe anaemia and severe illness. Clusters of 100 children were randomized in to AAQ, AAQ + AMX and pre-intervention arms. Six months later the pre-intervention clusters were randomized in to the AAQ and AAQ + AMX arms. Methods: Data were collected in eight cross-sectional surveys. Using stratified sampling, 10 clusters were randomly selected per survey. Blood samples were taken to assess haemoglobin. Caregivers were interviewed about diseases (signs and symptoms) among their children in the preceding 14 days. Multivariate logistic regression analysis was used to determine the impact on anaemia, severe anaemia and severe illness. Results: Compared with the pre-intervention clusters, anaemia was reduced in the AAQ (OR=0.20, 95% CI 0.12-0.33) and AAQ+ AMX (OR=0.23, 95% CI 0.15-0.36) clusters, severe anaemia was reduced in the AAQ (OR=0.20, 95% CI 0.09-0.45) and AAQ+ AMX (OR=0.12, 95% CI 0.04-0.31) clusters and severe illness was reduced in the AAQ (OR=0.46, 95% CI 0.26-0.80) and AAQ+ AMX (OR= 0.38, 95% CI 0.22-0.63) clusters. No significant differences were found in outcome variables between the AAQ and AAQ+ AMX clusters. Conclusions: Treating fever with antimalarials significantly reduced the prevalence of anaemia, severe anaemia and severe illness.We found no significant reduction in outcomes when the AAQ and AAQ+AMX clusters were compared.
Improving drug delivery strategies for lymphatic filariasis elimination in urban areas in Ghana
(PLoS Neglected Tropical Diseases, 2017) Biritwum, N.-K.; Garshong, B.; Alomatu, B.; de 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.
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.
Integration of control of neglected tropical diseases into health-care systems: challenges and opportunities
(Lancet, 2010) Gyapong, J.O.; Gyapong, M.; Yellu, N.; Anakwah, G.; Amofah, G.; Bockarie, M.; Adjei, S.
Although progress has been made in the fight against neglected tropical diseases, current financial resources and global political commitments are insufficient to reach the World Health Assembly’s ambitious goals. Increased efforts are needed to expand global coverage. These efforts will involve national and international harmonisation and coordination of the activities of partnerships devoted to control or elimination of these diseases. Rational planning and integration into regular health systems is essential to scale up these interventions to achieve complete eradication of these diseases. Programmes with similar delivery strategies and interventions—such as those for onchocerciasis, lymphatic filariasis, and soil-transmitted helminthiasis could be managed on the same platform and together. Furthermore, better-resourced programmes—such as those for malaria, HIV/AIDS, and tuberculosis—could work closely with those for neglected tropical diseases to their mutual benefi t and the benefit of the entire health system.
Integration of control of neglected tropical diseases into health-care systems: challenges and opportunities ( Review )
(2010) Gyapong, J.O.; Gyapong, M.; Yellu, N.; Anakwah, K.; Amofah, G.; Bockarie, M.; Adjei, S.
Although progress has been made in the fight against neglected tropical diseases, current financial resources and global political commitments are insufficient to reach the World Health Assembly's ambitious goals. Increased efforts are needed to expand global coverage. These efforts will involve national and international harmonisation and coordination of the activities of partnerships devoted to control or elimination of these diseases. Rational planning and integration into regular health systems is essential to scale up these interventions to achieve complete eradication of these diseases. Programmes with similar delivery strategies and interventions-such as those for onchocerciasis, lymphatic filariasis, and soil-transmitted helminthiasis-could be managed on the same platform and together. Furthermore, better-resourced programmes-such as those for malaria, HIV/AIDS, and tuberculosis-could work closely with those for neglected tropical diseases to their mutual benefit and the benefit of the entire health system. © 2010 Elsevier Ltd. All rights reserved.
Introducing insecticide impregnated bednets in an area of low bednet usage: an exploratory study in north‐east Ghana
(1996) Gyapong, M.; Gyapong, J.O.; Amankwa, J.; Asedem, J.; Sory, E.
To find out the acceptability of the use of insecticide impregnated bednets before launching a large-scale trial to evaluate their impact on child mortality, 96 permethrin impregnated bednets were distributed in 4 communities within the Kassena Nankana district of the Upper East Region of Ghana, where previously only 4% of the people had owned a mosquito net. The nets were readily accepted and used by the recipients. The major benefit perceived by the users was the reduction of the nuisance effect of mosquitoes and other insects. The people in the study area normally sleep on mats in either an open courtyard or a sleeping room depending on the weather but this did not deter them from using the nets. The white nets distributed for this study became dirty with use, and users thought they needed to be washed. In order to discourage this, it is recommended that dark coloured nets be used in the main intervention trial. After having used the nets for a year, the community members expressed willingness to buy the nets if they were made available after the harvest season when they had sold their crops and had enough money to pay for them. The results of this study have been used to plan and conduct a large intervention trial.