Browsing by Author "Lamptey, P."
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Item Barriers and facilitators to the implementation of a community-based hypertension improvement project in Ghana: a qualitative study of ComHIP(BMC Health Services Research, 2020-01-30) Laar, A.K.; Adler, A.J.; Kotoh, A.M.; Legido-Quigley, H.; Perel, P.; Lamptey, P.; Lange, I.L.Background: Globally, hypertension is a leading cause of cardiovascular disease and mortality, with the majority of deaths occurring in low- and middle-income countries. Because the burden of hypertension is increasing in low resource settings with restricted infrastructure, it is imperative that new models for hypertension care are realised. One such model is the Community-based Hypertension Improvement Project (ComHIP) which employs a community-based method of task-shifting for managing hypertension. This study is a qualitative analysis of the barriers and facilitators of the main components of ComHIP. Methods: We purposively selected 55 informants for semi-structured interviews or focus group discussions, which were carried out bythree trained local researchers in Krobo, Twi or English. Informants included patients enrolled in ComHIP, health care providers and Licensed Chemical Sellers trained by ComHIP, and Ghana Health Service employees. Data were analysed using a multi-step thematic analysis. Results: While results of the effectiveness of the intervention are pending, overall, patients and nurses reported positive experiences within ComHIP, and found that it helped enable them to manage their hypertension. Healthcare providers appreciated the additional training, but had some gaps in their knowledge. Ghana Health Service employees were cautiously optimistic about the programme, but expressed some worries about the sustainability of the programme. Many informants expressed concerns over the inability of community nurses and workers to dispense anti-hypertensives, due to legal restrictions. Conclusions: The WHO recommends task-sharing as a technique for managing chronic conditions such as hypertension in resource constrained settings. ComHIP presents an example of a task-sharing programme with a high level of acceptability to all participants. Going forward, we recommend greater levels of communication and dialogue to allow community-based health workers to be allowed to dispense anti-hypertensives.Item Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study(BMJ Open, 2019-04) Adler, A.J.; Laar, A.; Prieto-Merino, D.; Der, R.M.M.; Mangortey, D.; Dirks, R.; Lamptey, P.; Perel, P.Objectives To evaluate the effectiveness of the Community-based Hypertension Improvement Project (ComHIP) in increasing hypertension control. Setting Lower Manya Krobo, Eastern Region, Ghana. Participants All adult hypertensive community members, except pregnant women, were eligible for inclusion in the study. We enrolled 1339 participants, 69% of whom were female. A total of 552 had a 6-month visit, and 338 had a 12-month visit. Interventions We report on a package of interventions where community-based cardiovascular disease (CVD) nurses were trained by FHI 360. CVD nurses confirmed diagnoses of known hypertensives and newly screened individuals. Participants were treated according to the clinical guidelines established through the project’s Technical Steering Committee. Patients received three types of reminder and adherence messages. We used CommCare, a cloud-based system, as a case management and referral tool. Primary outcome Hypertension control defined as blood pressure (BP) under 140/90 mm Hg. Secondary outcomes: changes in BP and knowledge of risk factors for hypertension. Results After 1 year of intervention, 72% (95% CI: 67% to 77%) of participants had their hypertension under control. Systolic BP was reduced by 12.2 mm Hg (95% CI: 14.4 to 10.1) and diastolic BP by 7.5 mm Hg (95% CI: 9.9 to 6.1). Due to low retention, we were unable to look at knowledge of risk factors. Factors associated with remaining in the programme for 12 months included education, older age, hypertension under control at enrolment and enrolment date. The majority of patients who remained in the programme were on treatment, with two-thirds taking at least two medications. Conclusions Patients retained in ComHIP had increased BP control. However, high loss to follow-up limits potential public health impact of these types of programmes. To minimise the impact of externalities, programmes should include standard procedures and backup systems to maximise the possibility that patients stay in the programme.Item Contributions of Bioarchaeology to Understanding the Past: A Study of Excavated Human Skeletons from Hani-Begho, Ghana.(2019-07) Lamptey, P.The complexity of the archaeological record and its interpretation require a holistic comprehension of its makeup from an objective point of view rather than from a single subjective perspective. The analyses of materials recovered from the archaeological record of most sites in Ghana often neglect the analysis of human skeletal finds. This development affects the holistic interpretation of those sites. In view of such gaps, this research sought to subject the skeletal remains from Hani-Begho, within the Tain District of the Brong-Ahafo Region of Ghana, in the storage of the Museum of Archaeology, University of Ghana, to an in-depth bioarchaeological analysis. This was based on the idea that human skeletal remains have the potential to provide insights into the past. The research focused on the extent to which the bioarchaeological study of human remains from the Hani-Begho site can bolster understanding of the anthropology of death and archaeothanatological practices at the site. The study of the samples revealed eight individuals from Hani-Begho (five females and three males), which can be dated by reference to materials from the site to between the 11th and 15th centuries. Funeral treatments varied considerably in Hani-Begho’s social, cultural and religious parameters, for example Chromolaena odorata (Acheampong) leaves and schnapps were used to preserve dead bodies. The predominance of occlusal wear in molars and premolars could have resulted from masticatory behaviour. Additionally, evidence of ante-mortem teeth loss on the samples masked possible evidence of poor dental health. Also evident on some of the skeletons were blunt force trauma on skulls and the creation of artificial diastema and teeth filling within the community. The research forms the basis for sophisticated scientific analysis of human skeletal remains and the cataloguing and accessioning of these remains in the Museum of Archaeology.Item Evaluation of a community-based hypertension improvement program (ComHIP) in Ghana: data from a baseline survey(BioMed Central Ltd., 2017) Lamptey, P.; Laar, A.; Adler, A.J.; Dirks, R.; Caldwell, A.; Prieto-Merino, D.; Aerts, A.; Pearce, N.; Perel, P.Background: Ghana faces an increasing burden of non-communicable disease with rates of hypertension estimated as high as 36% in adults. Despite these high rates, hypertension control remains very poor in Ghana (4%). The current project aims to implement and evaluate a community-based programme to raise awareness, and to improve treatment and control of hypertension in the Eastern Region of Ghana. In this paper, we present the findings of the baseline cross-sectional survey focusing on hypertension prevalence, awareness, treatment, and control. Methods: To evaluate the ComHIP project, a quasi-experimental design consisted of a before and after evaluations are being implemented in the intervention and comparison districts. A cohort study component is being implemented in the intervention district to assess hypertension control. Background anthropometric and clinical data collected as part of the baseline survey were analyzed in STATA Version 11. We examined the characteristics of individuals, associated with the baseline study outcomes using logistic regression models. Results: We interviewed 2400 respondents (1200 each from the comparison and intervention districts), although final sample sizes after data cleaning were 1170 participants in the comparison district and 1167 in the intervention district. With the exception of ethnicity, the control and intervention districts compare favorably. Overall 32.4% of the study respondents were hypertensive (31.4% in the control site; and 33.4% in the intervention site); 46.2% of hypertensive individuals were aware of a previous diagnosis of hypertension (44.7% in the control site, and 47.7% in the intervention site), and only around 9% of these were being treated in either arm. Hypertension control was 1.3% overall (0.5% in the comparison site, and 2.1% in the intervention site). Age was a predictor of having hypertension, and so was increasing body mass index (BMI), waist, and hip circumferences. After adjusting for age, the risk factors with the greatest association with hypertension were being overweight (aOR = 2.30; 95% CI 1.53-3.46) or obese (aOR = 3.61; 95% CI 2.37-5.51). Older individuals were more likely to be aware of their hypertension status than younger people. After adjusting for age people with a family history of hypertension or CVD, or having an unhealthy waist hip ratio, were more likely to be aware of their hypertension status. Conclusions: The high burden of hypertension among the studied population, coupled with high awareness, yet very low level of hypertension treatment and control requires in-depth investigation of the bottlenecks to treatment and control. The low hypertension treatment and control rates despite current and previous general educational programs particularly in the intervention district, may suggest that such programs are not necessarily impactful on the health of the population.Item Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders(BMC Health Services Research, 2019-10-15) Laar, A.K.; Adler, A.J.; Kotoh, A.M.; Legido-Quigley, H.; Lange, I.L.; Perel, P.; Lamptey, P.Background: Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognized as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. Methods: A total of 55 informants – comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policymakers – were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after giving informed consent. Results: Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, and the benefits, as well as drawbacks, of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers – increasing providers’ knowledge on hypertension and patients’ awareness of same- there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence and the phenomenon of medical pluralism in Ghana were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and similarly designed programmes. Conclusions: This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.Item Location, biophysical and agronomic parameters for croplands in northern Ghana(Copernicus Publications, 2022) Gómez-Dan, J.L.; Lewis, P.E.; Yin, F.; Asare, K.; Lamptey, P.; Aidoo, K.K.Y.; MacCarth, D.S.; Ma, H.; et al.Smallholder agriculture is the bedrock of the food production system in sub-Saharan Africa. Yields in Africa are significantly below potentially attainable yields for a number of reasons, and they are particularly vulnerable to climate change impacts. Monitoring of these highly heterogeneous landscapes is needed to respond to farmer needs, develop an appropriate policy and ensure food security, and Earth observation (EO) must be part of these efforts, but there is a lack of ground data for developing and testing EO methods in western Africa, and in this paper, we present data on (i) crop locations, (ii) biophysical parameters and (iii) crop yield, and biomass was collected in 2020 and 2021 in Ghana and is reported in this paper. In 2020, crop type was surveyed in more than 1800 fields in three different agroecological zones across Ghana (the Guinea Savannah, Transition and Deciduous zones). In 2021, a smaller number of fields were surveyed in the Guinea Savannah zone, and additionally, repeated measurements of leaf area index (LAI) and leaf chlorophyll concentration were made on a set of 56 maize fields. Yield and biomass were also sampled at harvesting. LAI in the sampled fields ranged from 0.1 to 5.24 m2 m−2 , whereas leaf chlorophyll concentration varied between 6.1 and 60.3 µg cm−2 . Yield varied between 190 and 4580 kg ha−1 , with an important within-field variability (average per-field standard deviation 381 kg ha−1 ). The data are used in this paper to (i) evaluate the Digital Earth Africa 2019 cropland masks, where 61 % of sampled 2020/21 cropland is flagged as cropland by the data set, (ii) develop and test an LAI retrieval method from Earth observation Planet surface reflectance data (validation correlation coefficient R = 0.49, root mean square error (RMSE) 0.44 m2 m−2 ), (iii) create a maize classification data set for Ghana for 2021 (overall accuracy within the region tested: 0.84), and (iv) explore the relationship between maximum LAI and crop yield using a linear model (correlation coefficient R = 0.66 and R = 0.53 for in situ and Planet-derived LAI, respectively). The data set, made available here within the context of the Group on Earth Observations Global Agricultural Monitoring (GEOGLAM) initiative, is an important contribution to understanding crop evolution and distribution in smallholder farming systems and will be useful for researchers developing/validating methods to monitor these systems using Earth observation data. The data described in this paper are available from https://doi.org/10.5281/zenodo.6632083 (Gomez-Dans et al., 2022).Item Normal CD4+ T lymphocyte levels in HIV seronegative individuals in the Manya/Yilo krobo communities in the eastern region of Ghana.(Viral Immunology, 19(2), 260-266., 2006-07-03) Ampofo, W.; Torpey, K.; Mukadi, Y.D.; Koram, K.A.; Nolan, K.; Amenyah, R.; Lamptey, P.The goal of this study was to determine the normal levels of CD4+ T lymphocytes in healthy individuals who were HIV seronegative in the Manya and Yilo Krobo Districts of Ghana’s Eastern Region. This enabled comparisons with normal CD4 count ranges established by the World Health Organization (WHO). The study population consisted of 249 HIV-seronegative clients from a mobile free Voluntary Counseling and Testing (VCT) service in communities of the two districts during a one-month period. The mean CD4 count of these individuals was 1067 cells/µl with women demonstrating higher baseline CD4 counts than men. This study found a WHO comparable HIV seronegative baseline CD4 count as well as gender-based differences in the CD4 count and CD4/CD8 ratio. Establishment of the adult baseline for the country provides important demographic data and indicates the appropriateness of current global treatment guidelines with regards to CD4 levels in Ghana.