Browsing by Author "Loag, W."
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Item Area-based socioeconomic conditions and urban malaria and diarrhea mortalities in Accra, Ghana.(2012) Fobil, J.N.; Loag, W.; Schwarz, N.; Rodrigues, F.; Meyer, C.G.; Kraemer, A.; May, J.Health inequalities are linked to inequalities in Socioeconomic Status (SES). While infant malaria/diarrhea mortality is widely studied, not very much is known about the influence of area-based measures of SES and all age urban malaria and diarrhea mortalities. To assess the relationship between area-based SES and malaria/diarrhea mortalities and whether these differed across SE-classes in an urban area in a low income country. Proportional mortality rates, computed from 24716 reported death records, collected from Accra over the period 1998-2002 were compared with area-based socioeconomic data in multivariate linear regression analyses in an ecological study design. While malaria mortality showed strong evidence of significant differences across the SE-quintiles (Mean PMRfd = 0.030; 95% CI = 0.010 0.049 p = 0.0008), no such differences in diarrhea mortality were observed (Mean PMRfd = 0.027; 95% CI = 0.014 0.040; p = 0.288). Analyses showed weaker associations between area-based SE-conditions and diarrhea mortality than that observed for malaria mortality. We conclude that all age urban malaria mortalities were more sensitive to changing area-based SE-conditions than diarrhea mortalities suggesting perhaps that social interventions were more effective in diarrhea control compared to malaria.Item Mapping urban malaria and diarrhea mortality in Accra, Ghana: Evidence of vulnerabilities and implications for urban health policy.(2012) Fobil, J.N.; Levers, C.; Lakes, T.; Loag, W.; Kraemer, A.; May, J.Historic increase in urban population numbers in the face of shrinking urban economies and declining social services has meant that a large proportion of the urban population lives in precarious urban conditions, which provide the grounds for high urban health risks in low income countries. This study aims to identify, investigate, and contrast the spatial patterns of vulnerability and risk of two major causes of mortality, viz malaria and diarrhea mortalities, in order to optimize resource allocation for effective urban environmental management and improvement in urban health. A spatial cluster analysis of the observed urban malaria and diarrhea mortalities for the whole city of Accra was conducted. We obtained routinely reported mortality data for the period 1998-2002 from the Ghana Vital Registration System (VRS), computed the fraction of deaths due to malaria and diarrhea at the census cluster level, and analyzed and visualized the data with Geographic Information System (GIS, ArcMap 9.3.1). Regions of identified hotspots, cold spots, and excess mortalities were observed to be associated with some socioeconomic and neighborhood urban environmental conditions, suggesting uneven distribution of risk factors for both urban malaria and diarrhea in areas of rapid urban transformation. Case-control and/or longitudinal studies seeking to understand the individual level factors which mediate socioenvironmental conditions in explaining the observed excess urban mortalities and to establish the full range of risk factors might benefit from initial vulnerability mapping and excess risk analysis using geostatistical approaches. This is key to evidence-based urban health policy reforms in rapidly urbanizing areas in low income economies.Item Modeling the relationship between precipitation and malaria incidence in children from a holoendemic area in Ghana.(2011) Kriefis, A.C.; Schwarz, N.G.; Kruger, A.; Fobil, J.N.; Nkrumah, B.; Acquah, S.; Loag, W.; Sarpong, N.; Adu-Sarkodie, Y.; Ranft, U.; May, J.Climatic factors influence the incidence of vector-borne diseases such as malaria. They modify the abundance of mosquito populations, the length of the extrinsic parasite cycle in the mosquito, the malarial dynamics, and the emergence of epidemics in areas of low endemicity. The objective of this study was to investigate temporal associations between weekly malaria incidence in 1,993 children < 15 years of age and weekly rainfall. A time series analysis was conducted by using cross-correlation function and autoregressive modeling. The regression model showed that the level of rainfall predicted the malaria incidence after a time lag of 9 weeks (mean = 60 days) and after a time lag between one and two weeks. The analyses provide evidence that high-resolution precipitation data can directly predict malaria incidence in a highly endemic area. Such models might enable the development of early warning systems and support intervention measures.Item National health insurance coverage and socio-economic status in a rural district of Ghana.(2010) Sarpong, N.; Loag, W.; Fobil, J.N.; Meyer, C.G.; Adu-Sarkodie, Y.; May, J.; Schwarz, N.G.OBJECTIVE: To explore the association between socio-economic status (SES) and health insurance subscription to the Ghanaian National Health Insurance Scheme (NHIS) of residents of the Asante Akim North district of the Ashanti Region, Ghana. METHODS: In the course of a community survey, data on asset variables (e.g. electricity, housing conditions and other variables) and on NHIS subscription were collected on the household level in 99 villages. Using principal components analysis, households were classified into three categories of SES (20% high, 40% middle and 40% low SES). Odds ratios of NHIS subscription were calculated for all SES categories, using the low category as the reference group and adjusting for travelling time to health facilities by public transport. RESULTS: Of the 7223 households surveyed, 38% subscribed to the NHIS, of these 21% were low, 43% middle and 60% high SES households. SES was significantly associated with NHIS subscription (high SES: OR 4.9, 95% CI 4.3-5.7; middle SES: OR 2.5, 95% CI 2.2-2.9; low SES: OR 1, reference group). CONCLUSION: Four years after its introduction, the NHIS has reached subscription rates of 38% in the district surveyed. However, to achieve the aim of assuring universal access to health care facilities for all residents of Ghana, in particular for individuals living under socio-economic constraints, increasing subscription rates are necessary.Item Systemic bacteraemia in children presenting with clinical pneumonia and the impact of non-typhoid salmonella (NTS).(2010) Schwarz, N.G.; Sarpong, N.; Hunger, F.; Acquah, S.E.K.; Agyekum, A.; Nkrumah, B.; Loag, W.; Hagen, R.M.; Evans, J.A.; Dekker, D.; Fobil, J.N.; Meyer, C.G.; May, J.; Adu-Sarkodie, Y.BACKGROUND: The diagnosis and antimicrobial treatment of pneumonia in African children in the absence of diagnostic means such as x-ray facilities or microbiological laboratories relies primarily on clinical symptoms presented by the patients. In order to assess the spectrum of bacterial pathogens, blood cultures were performed in children fulfilling the clinical criteria of pneumonia. METHODS: In total, 1032 blood cultures were taken from children between 2 months and 5 years of age who were admitted to a rural hospital in Ghana between September 2007 and July 2009. Pneumonia was diagnosed clinically and according to WHO criteria classified as "non-severe pneumonia" and "severe pneumonia" ("severe pneumonia" includes the WHO categories "severe pneumonia" and "very severe pneumonia"). RESULTS: The proportion of bacteriaemia with non-typhoid salmonella (NTS) was similar in children with pneumonia (16/173, 9.2%) compared to children hospitalized for other reasons (112/859, 13%). NTS were the predominant organisms isolated from children with clinical pneumonia and significantly more frequent than Streptococcus pneumoniae (8/173, 4.6%). Nine percent (9/101) of children presenting with severe pneumonia and 10% (7/72) of children with non-severe pneumonia were infected with NTS. Nineteen out of 123 NTS isolates (15%) were susceptible to aminopenicillins (amoxycillin/ampicillin), 23/127 (18%) to chlorampenicol, and 23/98 (23%) to co-trimoxazole. All NTS isolates were sensitive to ceftriaxone and ciprofloxacin. CONCLUSION: In Sub-saharan Africa, sepsis with NTS should be considered in children with symptoms of pneumonia and aminopenicillins might often not be the adequate drugs for treatment.