Browsing by Author "Wurapa, F."

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Bovine Tuberculosis Surveillance System Evaluation, Greater-Accra Region, Ghana, 2006-2011
(2016) Lopes, P.H.; Akweongo, P.; Wurapa, F.; Afari, E.; Sackey, S.; Ocansey, D.; Nyarko, K.M.
INTRODUCTION: Bovine tuberculosis (bTB) is a chronic, zoonotic, multi-species disease of cattle caused by Mycobacterium bovis. In developed countries, effective surveillance and enforcement of regulations on bTB control resulted in significant reduction of infections in cattle and hence, humans. However, in developing countries, weak surveillance systems affect accurate and timely reporting of bTB in humans and cattle. In Ghana, transhumance movement of cattle increases the risk of bTB importation and spread, however, the extent to which surveillance detects bTB is unknown. We therefore evaluated the bTB surveillance system in the Greater-Accra Region to determine its performance and assessed its attributes.METHODS: We interviewed stakeholders, and reviewed bTB surveillance data for all ten districts in the region from 2006-2011 using the CDC Guidelines for Evaluation of public health surveillance systems.RESULTS: From 2006-2011, bTB was suspected in 284/244,576 (0.12%) cattle slaughtered, of which 7/284 (2.5%) were submitted for laboratory confirmation and all tested positive. Predictive value positive was 100%. There is no standard case definition which guides bTB detection. Fifty percent of carcasses slip through inspection, and confirmed cases are not traced back. There were 99/284 (34.9%) condemnations from suspected carcasses and 57/97 (58.8%) from positive reactors from screening. Ninety percent (9/10) of districts submitted reports late to the region whereas representativeness was 30%. Regional and district data were manually stored with no electronic backups. The region's cattle population is unknown.CONCLUSION: Although the bTB surveillance system is sensitive, it is under performing, and the possibility of bTB transmission from cattle to humans is high.
Direct observation of outpatient management of malaria in a rural ghanaian district
(Pan African Medical Journal, 2014-12) Ameme, D.K.; Afari, E.A.; Nyarko, K.M.; Malm, K.L.; Sackey, S.; Wurapa, F.
Introduction: in Ghana, malaria continues to top outpatient morbidities; accounting for about 40% of all attendances. Effective case-management is key to its control. We evaluated case-management practices of uncomplicated malaria in Kwahu South District (KSD) health facilities to determine their conformity to guidelines.Methods: we conducted a cross sectional survey at all public health facilities in three randomly selected sub-districts in KSD. A non-participatory observation of suspected malaria consultations was conducted. Suspected malaria was defined as any person with fever (by history or measured axillary temperature > or equal 37.5 oC) presenting at the selected health facilities between 19th and 29th April 2013. Findings were expressed as frequencies, relative frequencies, mean (± standard deviation) and median.Results: of 70 clinical observations involving 10 prescribers in six health facilities, 40 (57.1%) were females and 16 (22.9%) were below five years. Median age was 18 years (interquartile range: 5-33). Overall, 63 (90.0%) suspected case-patients had diagnostic tests. Two (3.6%) were treated presumptively. All 31 confirmed and 10 (33.3%) of the test negative case-patients received Artemisinin-based Combination Therapies (ACTs). However, only 12 (27.9%) of the 43 case-patients treated with ACT received Artesunate-Amodiaquine (AA). Only three (18.8%) of the under-fives were examined for non-malarial causes of fever. Mean number of drugs per patient was 3.7 drugs (± 1.1). Only 45 (64.3%) patients received at least one counseling message.Conclusion: conformity of malaria case-management practices to guidelines in KSD was suboptimal. Apart from high rate of diagnostic testing and ACT use, prescription of AA, physical examination and counseling needed improvement. © Donne Kofi Ameme et al.
Dog Bites and Rabies in the Eastern Region of Ghana in 2013–2015: A Call for a One-Health Approach
(Journal of Tropical Medicine, 2018-07) Adomako, B.Y.; Baiden, F.; Sackey, S.; Ameme, D.K.; Wurapa, F.; Nyarko, K.M.; Kenu, E.; Afari, E.
Background. A One-Health approach is advocated to ensure effective rabies surveillance in sub-Saharan Africa. Information is needed to assess the current state of dog bites and rabies in Ghana. We analyzed data on reported events in the Eastern Region of Ghana from 2013 to 2015 to generate information that can be used for rabies elimination in Ghana through the One-Health approach. Method. We extracted data on dog bites and rabies from the database of the regional health service and performed descriptive analysis using Epi Info version 7™. We followed up with interviews with three key informants from the health and veterinary services on issues related to surveillance and data quality. Results. Overall, 4821 dog bites were reported over the three-year period. This translated into an annual incidence of 172 cases per a population of 100,000. Most of cases were in children aged less than 10 yrs. Fifteen (53.3% males) cases of rabies were recorded in seven out of the 26 municipalities and districts, translating into a rabies to dog bite ratio of 3: 1000. The median age of victims was 9 years (range: 3-72 years). A parallel and uncoordinated system of rabies surveillance is maintained by the health and veterinary services, with gross disparities in the number of reported events and overall impression of underreporting. Conclusion. Rabies remains an important cause of preventable deaths in this region. An integrated approach to surveillance based on the One-Health concept needs to be adopted.
Economic Burden of Motorcycle Accidents in Northern Ghana
(Ghana medical journal, 2011-12) Kudebong, M.; Wurapa, F.; Nonvignon, J.; Norman, I.; Awoonor-Williams, J.K.; Aikins, M.
Background: Motorcycles are the most popular means of transportation in northern Ghana, and their accidents are major causes of out-patient attendance and admis-sions in the Bolgatanga Municipality. Objective: This paper estimates the economic burden of motorcycle accidents in the Bolgatanga Municipality in Northern Ghana. Design: Retrospective cross-sectional cost study. Methods: Data were collected from Drivers and Vehi-cle Licensing Authority, the Police, health facilities and motorcycle accident victims. Both quantitative and qualitative approaches were used for data collection. Cost analysis was based on the standard road accident cost conceptual framework. Results: Ninety-eight percent of vehicles registered in the municipality in 2004 – 2008 were motorcycles. The motorcycles were significantly more than the cars reg-istered. The economic burden of motorcycle accidents was estimated to be about US$1.2 million, of which, 52% were accident-related costs (i.e. property damage and administration) and 48% casualty-related costs (i.e. medical costs, out-of-pocket expenses, lost labour out-puts, intangible costs and funeral expenses). Most mo-torcycle accident victims were in their productive ages and were males. Only a third of the motorcycles were insured. Majority of the riders (71%) did not possess valid driving license and would want to avoid the po-lice. Main motorcycle injuries were head injuries, frac-tures, lacerations and contusions. Majority of the acci-dents were caused by lack of formal motorcycle riding training, abuse of alcohol, unrestrained animals and donkey carts. Conclusion: Motorcycle accidents could be reduced through law enforcement, continuous mass education and helmet use.
Factors Contributing to the High Default Rate Of the Dots System in the Yendi District
(University of Ghana, 2001-08) Marfo, B.A.; Bonsu, F.; Wurapa, F.; University of Ghana, College of Health Sciences, School of Public Health
This study was designed to elicit the factors that contributed to the high default rate of the DOTs system in the Yendi district. Questionnaires were administered to all patients who registered for DOTs in 1998. 1999 and 2000. Focus group discussions were also conducted to explore the underlying factors for the health seeking behaviors of the people. In-depth interviews were conducted with service providers so as to elicit the service related factors of default alongside the patient related factors of default. Case control study done for these patients showed vividly that lack of knowledge, long distances between home and clinic, poor family support, adverse effects of anti-TB drugs, long duration of treatment, Geographical inaccessibility and poor attitude of service providers were the contributing factors to default. In - depth interviews done elicited poor managerial control of drugs distribution and poor attitude of service providers as contributing factors of default Focus group discussions done showed that lack of knowledge was the main factor contributing to default in the communities. Results of the study call for a more holistic and better managerial approach towards the DOTs system. There is the need for the DHMT to undertake major IEC campaign to create awareness and reduce the myths and misconceptions that people have about TB in the general population. Schools, Churches, Mosques and open durbars may be good places to start educational campaigns in the district. The local dagbani name for Tuberculosis is itself a misconception to the true meaning of Tuberculosis and educational campaigns must also be geared towards this direction.
Home Based Care for HIV/AIDS in the Agogo Sub District
(University of Ghana, 2002-08) Kwakye-Maclean, K.; Tetteh, E.; Wurapa, F.; University of Ghana, College of Health Sciences, School of Public Health
AIDS is now a major cause of morbidity and mortality in most Sub-Saharan African countries, in the absence o f a cure, many adults suffer long chronic illness, medical services already inadequate are over stretched. Many hospitals are unable to deal with the huge caseload of patients with HIV/AIDS, this has necessitated strategies for AIDS management that combines Home-based care (HBC) with hospital intervention where required. The form that a HBC programme takes depends on the socio-cultural system prevailing in the area. This study examined the knowledge, attitudes, behaviour and practices of home-based care community volunteers, in- family caregivers of people living with HIV/AIDS, and family members without AIDS in eight communities with a home-based care programme in the Agogo sub district of the Ashanti Region of Ghana. The study further examined community participation in the home-based care programme and the effect of the programme on the lives of people living with HIV/AIDS. Both qualitative and quantitative methods were used to elicit information from participants. Thirty-two participants formed the Focus Group Discussion, while sixtyfive people were involved in the survey. In-depth interviews were held with the coordinators of the home-base care programme and people living with HIV/AIDS. The study found an increase in knowledge and positive attitude towards people living with HIV/AIDS amongst HBC community volunteers and in-family caregivers; this had translated into a change in sexual behaviour. Family members without AIDS had average knowledge and negative attitude towards people living with HIV/AIDS, fewer of them had changed sexual behaviour. Although the communities’ sense of ownership of the HBC programme was rather low, PLWHA who have accessed the HBC programme have free medical care and feel less stigmatised. The study recommends that government integrate home-based care into existing activities for HIV/AIDS in other to overcome social barriers to care, and to serve as a source of information, education, and communication on HIV/AIDS.
Improving Medical Records Filing in a Municipal Hospital in Ghana
(Ghana medical journal, 2012-09) Teviu, E.A.A.; Aikins, M.; Abdulai, T.I.; Sackey, S.; Boni, P.; Afari, E.; Wurapa, F.
Background: Medical records are kept in the interest of both the patient and clinician. Proper filing of patient’s medical records ensures easy retrieval and contributes to decreased patient waiting time at the hospital and continuity of care. This paper reports on an intervention study to address the issue of misfiling and multiple patient folders in a health facility. Design: Intervention study. Setting: Municipal Hospital, Goaso, Asunafo North District, Brong Ahafo Region, Ghana. Methods: Methods employed for data collection were records review, direct observation and tracking of folders. Interventions instituted were staff durbars, advocacy and communication, consultations, in-service trainings, procurement and monitoring. Factors contributing to issuance of multiple folders and misfiling were determined. Proportion of multiple folders was estimated. Results: Results revealed direct and indirect factors contributing to issuance of multiple patient folders and misfiling. Interventions and monitoring reduce acquisition of numerous medical folders per patient and misfiling. After the intervention, there was significant reduction in the use of multiple folders (i.e., overall 97% reduction) and a high usage of single patient medical folders (i.e., 99%). Conclusion: In conclusion, a defined medical records filing system with adequate training, logistics and regular monitoring and supervision minimises issuance of multiple folders and misfiling.
One Health concept for strengthening public health surveillance and response through Field Epidemiology and Laboratory Training in Ghana.
(The Pan African medical journal, 2011) Wurapa, F.; Afari, E.; Ohuabunwo, C.; Sackey, S.O.; Clerk, C.; Kwadje, S.; Yebuah, N.; Amankwa, J.; Amofah, G.; Appiah-Denkyira, E.
The lack of highly trained field epidemiologists in the public health system in Ghana has been known since the 1970s when the Planning Unit was established in the Ghana Ministry of Health. When the Public Health School was started in 1994, the decision was taken to develop a 1 academic-year general MPH course. The persisting need for well-trained epidemiologists to support the public health surveillance, outbreak investigation and response system made the development of the Field Epidemiology and Laboratory Training Programme (FELTP) a national priority. The School of Public health and the Ministry of Health therefore requested the technical and financial assistance of the United States Centers for Disease Control and Prevention (CDC) in organizing the Programme. The collaboration started by organizing short courses in disease outbreak investigations and response for serving Ghana Health Service staff. The success of the short courses led to development of the FELTP. By October 2007, the new FELTP curriculum for the award of a Masters of Philosophy in Applied Epidemiology and Disease Control was approved by the Academic Board of the University of Ghana and the programme started that academic year. Since then five cohorts of 37 residents have been enrolled in the two tracks of the programme. They consist of 12 physicians, 12 veterinarians and 13 laboratory scientists. The first two cohorts of 13 residents have graduated. The third cohort of seven has submitted dissertations and is awaiting the results. The fourth cohort has started the second year of field placement while the fifth cohort has just started the first semester. The field activities of the graduates have included disease outbreak investigations and response, evaluation of disease surveillance systems at the national level and analysis of datasets on diseases at the regional level. The residents have made a total of 25 oral presentations and 39 poster presentations at various regional and global scientific conferences. The Ghana FELTP (GFELTP) has promoted the introduction of the One Health concept into FELTP. It hosted the first USAID-supported workshop in West Africa to further integrate and strengthen collaboration of the animal and human health sectors in the FETP model. GFELTP has also taken the lead in hosting the first AFENET Center for Training in Public Health Leadership and Management, through which the short course on Management for Improving Public Health Interventions was developed for AFENET member countries. The GFELTP pre-tested the Integrated Avian Influenza Outbreak and Pandemic Influenza course in preparation for introducing the materials into the curriculum of other FELTP in the network. The leadership positions to which the graduates of the program have been appointed in the human and animal Public Health Services, improvement in disease surveillance, outbreak investigation and response along with the testimony of the health authorities about their appreciation of the outputs of the graduates at various fora, is a strong indication that the GFELTP is meeting its objectives.
Outbreak Of Cholera in the East Akim Municipality of Ghana Following Unhygienic Practices by Small-Scale Gold Miners, November 2010
(Ghana medical journal, 2012-09) Opare, J.K.L.; Ohuabunwo, C.; Afari, E.; Wurapa, F.; Sackey, S.D.; Der, J.; Afakye, K.; Odei, E.
Background: In October 2010 an outbreak of cholera began among a group of small-scale gold miners in the East-Akim Municipality (EAM), Eastern Region. We investigated to verify the diagnosis, identify risk factors and recommend control measures. Methods: We conducted a descriptive investigation, active case-search and an unmatched case-control study. A cholera case-patient was a person with acute watery diarrhoea, with or without vomiting in EAM from 1st October to 20th November, 2010. Stool from case-patients and water samples were taken for laboratory diagnosis. We performed univariate and bivariate analysis using epi-info version 3.3. Results: Of 136 case-patients, 77 (56.6%) were males, of which 40% were miners or from miners households. Index case, a 20 yr-old male miner from Apapam village reported on October 13th, and case-patients peaked (18.4%) 20 days later. Attack rate was 2/1000 population with no fatality. Ages ranged from 1-84 years; mean of 34±18 yrs. Age-group 20-29 yrs was mostly affected (30.1%) with Apapam village having most case-patients (19.9%). Vibrio cholera serotype ogawa was isolated from stool samples. The main water source, Birim river was polluted by small-scale miners through defecation, post-defecation baths and sand-washings. Compared to controls, case-patients were more likely to have drunk from Birim-River [OR= 6.99, 95% CI: 2.75-18]. Conclusion: Vibrio cholera serotype ogawa caused the EAM cholera-outbreak affecting many young adultmales. Drinking water from contaminated communitywide -River was the major risk factors. Boiling or chlorination of water was initiated based on our recommendations and this controlled the outbreak.
Outbreak of cholera in the East Akim Municipality of Ghana following unhygienic practices by small-scale gold miners, November 2010.
(Ghana medical journal, 2012-09) Opare, J.; Ohuabunwo, C.; Afari, E.; Wurapa, F.; Sackey, S.; Der, J.; Afakye, K.; Odei, E.
In October 2010 an outbreak of cholera began among a group of small-scale gold miners in the East-Akim Municipality (EAM), Eastern Region. We investigated to verify the diagnosis, identify risk factors and recommend control measures. We conducted a descriptive investigation, active case-search and an unmatched case-control study. A cholera case-patient was a person with acute watery diarrhoea, with or without vomiting in EAM from 1st October to 20(th) November, 2010. Stool from case-patients and water samples were taken for laboratory diagnosis. We performed univariate and bivariate analysis using epi-info version 3.3. Of 136 case-patients, 77 (56.6%) were males, of which 40% were miners or from miners households. Index case, a 20 yr-old male miner from Apapam village reported on October 13(th), and case-patients peaked (18.4%) 20 days later. Attack rate was 2/1000 population with no fatality. Ages ranged from 1-84 years; mean of 34±18 yrs. Age-group 20-29 yrs was mostly affected (30.1%) with Apapam village having most case-patients (19.9%). Vibrio cholera serotype ogawa was isolated from stool samples. The main water source, Birim river was polluted by small-scale miners through defecation, post-defecation baths and sand-washings. Compared to controls, case-patients were more likely to have drunk from Birim-River [OR= 6.99, 95% CI: 2.75-18]. Vibrio cholera serotype ogawa caused the EAM cholera-outbreak affecting many young adult-males. Drinking water from contaminated community-wide -River was the major risk factors. Boiling or chlorination of water was initiated based on our recommendations and this controlled the outbreak.
Outbreak of foodborne gastroenteritis in a senior high school in South-eastern Ghana: A retrospective cohort study
(BioMed Central Ltd., 2016) Ameme, D.K.; Alomatu, H.; Antobre-Boateng, A.; Zakaria, A.; Addai, L.; Fianko, K.; Janneh, B.; Afari, E.A.; Nyarko, K.M.; Sackey, S.O.; Wurapa, F.
Background: On 4th February 2015, a group of Senior High School students from Fanteakwa district presented to the emergency unit of the district hospital with complaints of abdominal pain, vomiting and diarrhoea. All the students had eaten from a specific food vendor and had neither eaten any other common meal that day nor the previous day. A foodborne disease outbreak was suspected. We investigated to verify the outbreak, determine its magnitude, identify the source and implement control measures. Methods: A retrospective cohort study was conducted. We reviewed medical records and interviewed patrons of the food vendor. We collected data on age, sex, signs and symptoms, date of illness onset, date of admission, date of discharge, treatments given and outcome. A case of foodborne disease was any person in the school with abdominal pain, vomiting and or diarrhoea from 4th to 11th February 2015 and had eaten from the food vendor. We conducted active case search to identify more cases. We conducted environmental assessment and collected clinical and food samples for laboratory testing. Descriptive and inferential statistical analyses were performed using Stata 12.0. Results: A total of 68 cases were recorded giving overall attack rate of 35.79 % (68/190) with no death. Of these, 51.47 % (35/68) were males. Mean age of case-patients was 17.8 (standard deviation +/-1.62). The index case, a 17-year-old female student ate from the food vendor on 4th February at 9:00 am and fell ill at 3:40 pm later that day. Compared to those who ate other food items, students who drank water from container at the canteen were more likely to develop foodborne disease at statistically significant levels [RR = 2.6, 95 % CI = (2.11-3.15)]. Clostridium perfringens (C. perfringens) and Salmonella species (Salmonella spp) were isolated from water and stew respectively. Clinical features of case-patients were compatible with both organisms. Conclusion: A foodborne gastroenteritis outbreak occurred in a Senior High School in Fanteakwa District from 4th to 7th February 2015. The most probable aetiologic agent was C. perfringens with contaminated water at canteen as the vehicle of transmission. Concurrent Salmonella spp infection could not be ruled out. Rapid outbreak response helped in controlling the outbreak.
Outbreak of scabies among preschool children, Accra, Ghana, 2017
(BMC Public Health, 2019-05-31) Sackey, S.O.; Kaburi, B.B.; Ameme, D.K.; Adu-Asumah, G.; Dadzie, D.; Tender, E.K.; Addeh, S.V.; Aryee, T.; Addo-Lartey, A.; Wurapa, F.; Afari, E.A.; Kenu, E.
Background: Scabies occurs worldwide with a prevalence between 0.3 and 46.0%. In Ghana, even though a 5.1% proportion of scabies was reported in a retrospective review of skin diseases at the Korle Bu Teaching Hospital, the nationwide prevalence of scabies is unknown. Overall, its burden is higher in tropical regions. Scabies outbreaks mostly occur among children, the elderly in nursing homes, and prison inmates. Even though primary scabies hardly results in mortalities, the pain, itch, and systemic complications from secondary bacterial infections account for about 1.5 million years lived with disabilities. We investigated a scabies outbreak among school children in Ghana to determine its magnitude, stop the outbreak, and institute preventive measures to minimize risks of future outbreaks. Methods: The investigation was conducted between March 14 and May 17, 2017 among pupils of Presbyterian Secondary Staff Basic School in Accra. We defined a case as a school child who on clinical examination, had an intensely pruritic rash on at least one typical predilection site with or without a burrow, or positive skin scrapings on microscopy. We screened and line listed cases, performed laboratory investigations on skin scrapings and wound swaps, and conducted an environmental assessment. We performed descriptive statistics on data, and calculated attack rate ratios (ARR) at 95% confidence level. Results: Of 823 preschool children screened, 92 were cases. Median age of cases was 4 years (range 2–7 years) and their modal age was 3 years. The overall attack rate was 11.2% (92/823). The sex specific attack rate was 11.5% for males, and 10.8% for females (ARR: 0.93; CI: 0.67–1.28). Compared with the least affected class (crèche), the nursery one class was worst affected (ARR: 5.14; CI: 3.44–7.50). On microscopy, all skin scrapings were negative for scabies. Staphylococcus aureus and Streptococcus spp. were isolated from secondarily infected scabies lesions. Conclusions: A scabies outbreak with a propagated source occurred among preschool children. The 3-year-old pupils were most affected. It was controlled by mass treatment with benzyl benzoate and health education. Classrooms and sleeping mats were disinfected. We recommended the decongestion of classrooms and discouraged sharing of sleeping mats.
Performance of Community Based Agents In Home Based Care For Malaria in Under Fives in Jirapa and Lambussie Districts of the Upper West Region,Ghana
(University of Ghana, 2014-07) Balagumyetime, P.; Wurapa, F.
Introduction:Home-based Management of Malaria (HMM) is a strategy to increase access to malaria treatment in Africa. In 2006, the strategy was launched in the Upper West Region (UWR) of Ghana. Community Based Agents (CBAs) were trained and equipped to provide home-based treatment to children aged 6-59 months with malaria. HMM was expected to reduce the number of children seen in health facilities with malaria. However, there has been a consistent increase in the burden of malaria since 2009 despite the role CBAs are expected to play in reducing the burden of malaria. This study was conducted to assess the knowledge and performance of CBAs on HMM, eight years after it‟s implementation and to assess the perception of community members and health workers about the services provided by CBAs in the region. Methods: A cross-sectional study was conducted in two purposive selected districts in the UWR.We interviewed 384 CBAs and 154 mothers/caregivers using a structured questionnaire.We conducted Key Informant Interviews (KII) with 13 community leaders and 15 health workers and held 2 Focus Group Discussions (FGDs) with mothers/caregivers. CBAs and health facility records were also reviewed and we observed the management practices of 37 CBAs offering services at the time of interviews. Variables obtained were age, sex, and indicators on knowledge and management practices. Data entry, cleaning and analysis was done using SPSS software version 18.0. Descriptive data analysis was done and categorical variables expressed as frequencies and relative frequencies. For bi-variate analysis, cross tabulation was undertaken to establish associations and results presented in tables. Significance level of 5% (0.05) was used. Qualitative data from KII and FGDs were translated and transcribed into English, coded and thereafter analysed and separated into the emerging themes. Results:The mean age of CBAs was 42.71(+/- 9.62) with 369(96%) being females. Majority of the CBAs 352 (91.7%) knew the cause of malaria and 318(82.8%) knew that, fever is the most common symptom of malaria. However, very few, 171(44.5%) knew the correct dosage of Artemisinin-based Combination Therapy (ACTs) for children aged 6-11 months. Out of the 37 CBAs observed, 86.5% (32/37), (95% CI: 74.2 –97.7) gave correct age appropriate dose, but only 10(27%) observed the children for danger signs. There was no significant association between formal education and knowledge of the correct dosage of ACTs for children aged 6-59 months. Residing in Jirapa was positively associated with knowledge on the correct dosage of ACTs for children 6-11 months old (P-value 0.00). Of the 12,128 children who reported with malaria in 2012, only 5,343 (44%) were seen by CBAs. This was lower than the target of 60% in the guidelines. Monthly reporting rate of CBAs ranged from 53% to 79% in Jirapa and 43% to 88% in Lambussie. Only196 (51%) of the CBAs had supervisory visits. Of the 154 mothers/caregivers interviewed, 116(75.3%) had utilized the services of CBAs. Among the 116 who utilized the services of CBAs; 95(81.9%) reported that CBAs took history, 86(74.1%) said their children were assessed before receiving treatment and 66(56.9%) were counseled on treatment compliance. Only 9(7.7%) were educated on malaria prevention in their communities. In all, 104(67.5%) of mothers/caregivers and 12(92.3%) of opinion leaders had good opinions about the role and performance of CBAs in the management of sick children. Mothers/caregivers at the FGDs were however of the view that CBAs are doing well in community education on malaria prevention. Conclusion: A high proportion of CBAs do not know the correct dosage of ACTs for children aged 6-11 months. Many CBAs were not supervised. Although most CBAs took history and examined children before giving treatment, observing for danger signs, client counseling and reporting on activities was not done regularly. We recommend re-training and regular supervision of all CBAs
Predictors of placental malaria in Upper West Regional Hospital-Ghana
(BMC Pregnancy and Childbirth, 2021) Mwin, P.K.; Kuffuor, A.; Nuhu, K.; Okine, R.; Kubio, C.; Wurapa, F.; Osei, F.A.; Afari, E.
Background: Placental malaria (PM) poses life-threatening complications to pregnant women as they are at increased risk of maternal and perinatal morbidity and mortality associated with malaria. This study examined the factors associated with placental malaria in the Upper West Regional Hospital (UWR). Methods: A cross-sectional hospital-based study was carried out among pregnant women delivering at Upper West Regional Hospital. A cross-sectional screening survey was conducted from January 2019 to April 2019. Three hundred eligible mothers were consecutively recruited. A record review of their maternal and child history was assessed using a checklist. Placental blood samples were taken for microscopy to determine placental malaria parasitemia. Logistic regression analysis was done to determine the factors associated with placental malaria at 95 % confidence level. Results: The proportion of mothers with placental malaria was 7 % (21/300), (95 % CI, 4.3–10.5 %). Plasmodium falciparum was the only species identified in those with PM. Majority of the women 66.7 % (14/21) with placental malaria had parasite density in the range 501 to 5,000 parasites/μL. Obstetric and health service factors that were significantly associated with placental malaria were gravidity and antenatal care (ANC) attendance. Primigravida (aOR = 3.48, 95 %CI = 1.01–12.01) and having less than 4 ANC attendance (aOR = 9.78, 95 %CI = 2.89–33.11) were found to be significantly associated with placental malaria. Conclusions: The proportion of women with PM was relatively low. Primigravid mothers reporting less than 4 ANC visits had the highest risk of placental malaria. Expectant mothers should be encouraged to attend at least 4 ANC visits prior to delivery.
Secondary analysis of snake bite data in the Western Region of Ghana: 2006-2010
(Ghana Medical Journal, 2016-06) Mensah, E.K.; Karikari, K.; Aikins, M.; Vanotoo, L.; Sackey, S.; Ohuabunwo, C.; Wurapa, F.; Sifah, T.K.; Afari, E.
Background: A snake bite is an injury caused by a bite from a snake, often resulting in puncture wounds, amputations and sometimes envenomation. Envenoming resulting from snake bite is a particularly important public health problem in rural areas of tropical and sub-tropical countries in Africa. This paper reports the incidence of snake bites and its associated mortality in the Western Region of Ghana. Method: The study was a descriptive cross-sectional review of 2006 - 2010 snake bite secondary data generated by the Western Regional Health Information Office in Ghana. Data was extracted from the District Health Information Management System (DHIMS) database. Data was managed and analyzed using SPSS Version 16.0. Univariate analyses were expressed as percentages and graphs. Results: The year 2009 recorded the highest incidence of Snake bites in the Western Region with Juabeso district recording the highest incidence of snake bites over the study period. Over the period about 55% of the incidence was between 50 – 100 per 100,000 population. The total number of snake bites recorded in the region for the period was 7,275, of which 52% (3,776) were males. About 60% of the patients were of the age group 15-49 years. A total of 12 reported snake bite deaths were recorded, of which 67% were men. This study recommends to the Districts Health Directorates in the Western Region to regularly organize community education on snake bite and the use of protective clothing by the farmers.
Social Cost of Motorcycle Accidents - A Case Study of the Bolgatanga Municipality
(University of Ghana, 2009-08) Kudebong, M.; Aikins, M.; Wurapa, F.
Background Road traffic accidents are the leading cause of fatal and non-fatal injuries in Ghana. The purpose of this study is to estimate the social costs of motorcycle accidents in the Bolgatanga Municipality.. Method The study was a retrospective cross-sectional cost study. Data on direct, indirect and intangible costs were obtained from patients and their families using a structured questionnaire. The costs are calculated from the social perspective which includes out-of- pocket expenditure and productivity loss to patients and families, and cost to health facilities Results One hundred and sixty (I60) motor cycle accident victims were interviewed. The social cost of motor cycle accidents was found to be GH ¢1,630,979.60 per annum. Direct cost accounted for 64% of the total cost whilst indirect cost accounted 36% and on average twenty (20) days school absenteeism per student was established. It also imposes suffering such as pain, mostly waist pain, chronic headache and anxiety on victims and families. The working ability of victims reduced whereas a few were permanently disabled, reducing their quality of life.On average, motor cycle accident victims incurred direct costs of GH¢187, GH¢15, and GH¢128.15 respectively at the in-patient, out- patient and household level treatment , with time lost for normal activities averaging 32.5 days and 31.7days respectively for victims and caretakers respectively. The average cost of repair and replacement of damaged motor bikes were GH¢120.4 and GH¢1,106.21 respectively whilst the average item lost by victims was valued on average at GH¢186.99. The average cost of traditional funeral also averaged GH¢640.15. Conclusion Motor cycle accident costs the Bolgatanga municipality GH¢1,630,979.60 in social cost per annum. It also imposes pain, grief and suffering on victims and relations and in extreme situations where it involved permanent disability, it impacts negatively on health related quality of life of the victims. This calls for the allocation of appropriate resources and the enforcement of the existing legislation to nib this emerging epidemic in the bud.
Sustainability of a field epidemiology and laboratory training programme: The ghanaian story
(The Pan African Medical Journal, 2019-05-29) Bandoh, D.A.; Kenu, E.; Ameme, D.K.; Sackey, S.O.; Wurapa, F.; Afari, E.A.
Introduction: Field Epidemiology Training Programmes (FETPs) are functional ways of strengthening epidemiology, surveillance and outbreak response capacity in countries. However, sustainability of FETPs is a major challenge facing most countries especially in Africa. The Ghana Field Epidemiology and Laboratory Training Program (GFELTP) started in 2007 in the University of Ghana School of Public Health as a solution to gaps in the public health workforce. This paper assessed the sustainability strategies embedded in the Ghana Field Epidemiology and Laboratory Training Programme. Methods: we assessed the sustainability of GFELTP by document reviews and interviews with programme staff and stakeholders to identify sustainability structures (programme, financial and institutional) that were in place. We grouped information into the following headings: programme structure, institutional, financial and political structures. Results: as of July 2017, a total of 350 public health experts have been trained in both frontline and advanced courses since the programme's inception. For funding structures, the programme is funded mainly by its partners and stakeholders who are local government organisations. They provide resources for running of programme activities. Under institutional and political structures, the programme was established as a Ministry of Health/Ghana Health Service programme based in the University of Ghana. The programme steering committee which is currently chaired by the Director Public Health of Ghana Health Service, jointly ensures its implementation. Other structures of sustainability observed were involvement of stakeholders and alumni in human resource of the programme; use of stakeholders as faculty for the programme. These stakeholders include staff from University of Ghana School of Public Health, Ghana Health Service and Veterinary Service Department, World Health Organization and Centers for Disease Control and Prevention. The programme showed evidence of stable sustainability strategies in all four structures evaluated. Conclusion: the assessment found the GFELTP to be sustainable. The main factors that contributed to rendering it sustainable were funding, programme, institutional and political structures embedded in the programme. One remarkable sustainability element observed was the strong collaboration that existed between stakeholders of the programme who worked hand in hand to ensure the programme runs smoothly. However, more sources of funding and other essential resources need to be considered to help the programme obtain a pool of resources for carrying out its activities.
Training Ghanaian frontline healthcare workers in public health surveillance and disease outbreak investigation and response
(2016) Ameme, D.K.; Nyarko, K.M.; Afari, E.A.; Antara, S.; Sackey, S.O.; Wurapa, F.
INTRODUCTION: Beyond initial formal academic education, the need for continuous professional development through in-service workforce capacity improvement programs that are aimed at enhancing knowledge and skills of public healthcare workers has assumed immense priority worldwide. This has been heightened by the on-going Ebola Virus Disease outbreak, which is exposing the weak public health systems in West Africa. In response to this need, the Ghana Field Epidemiology and Laboratory Program organized a short-course for frontline health workers in the Greater Accra region of Ghana in order to augment their surveillance and outbreak response capacity.METHODS: Human and veterinary health workers were trained using Field Epidemiology and Laboratory Training Program short course model. A two-week didactic course was conducted with a 10-week field placement. Evaluation of the course was done by assessment of participants' outputs during the training as well as pretest and posttest methods.RESULTS: A total of 32 frontline health workers from both the human and veterinary health services benefited from the two-week initial training of the 12-week course. There was a significant gain in knowledge by the participants after the training course. Participants developed concept papers and implemented their fieldwork projects. Overall assessment of the workshop by the participants was very good.CONCLUSION: Capacity of the health workers has been improved in the area of public health surveillance, outbreak investigation and response. We recommend a scale-up of this training course to other regions.
Uncommon Mixed Outbreak of Pneumococcal and Meningococcal Meningitis in Jirapa District, Upper West Region, Ghana, 2016
(Ghana medical journal, 2017-12) Domo, N.R.; Nuolabong, C.; Nyarko, K.M.; Kenu, E.; Balagumyetime, P.; Konnyebal, G.; Noora, C.L.; Ameme, K.D.; Wurapa, F.; Afari, E.
Objective: The Jirapa District in Ghana falls within the African meningitis belt where over 500 million people are at risk of epidemic meningitis. The district suffered an outbreak of Neisseria meningitides, W (NMW) in 2012 and a mixed outbreak of Streptococcus pneumonia and NMW in early 2016. We investigated the outbreak to identify the source, causative agents, and magnitude and assess health facility preparedness and propose control measures. Design and setting: We conducted a descriptive study in all sub-districts of Jirapa, between 28thFebruary to 10th April 2016. We reviewed records at health facilities, assessed health facility preparedness, searched for cases, traced contacts of case to administer chemoprophylaxis and collect CSF for laboratory analysis. Data were entered in Microsoft excel cleaned, and exported to stata-13 for analysis by person place and time. Results: A total 233 meningitis cases were reported with mean age of 22.4years and standard deviation 21.6. Males were (57%), females (43%) and 60.8% were less than 19 years. Attack rate of meningitis was 214/100,000 with case fatality rate (CFR) of 12.4% (29/233). Causative agents were NMW (69.5%) and streptococcus pneumonia (27.1%), mainly serotype STN1 and H. influenza (3.4%). The index case had travel history to dollar power, close to Tain District which is the epicentre for the 2016 meningitis outbreak in Ghana. Conclusion: The Jirapa district experienced a mixed outbreak of streptococcal and meningococcal meningitis in early 2016, facilitated by migration. Active surveillance and mass vaccination with multivalent vaccines is required to protect the population. Funding: Ghana Field Epidemiology and Laboratory Training Programme (GFELTP).
Why the Gap between Awareness (Knowledge) and Practice among the Youth in Hohoe District: HIV/AIDS and Condom Use
(University of Ghana, 2002) Ali, F. S.; Wurapa, F.; Laing, E.; Atimpo, S. K; University of Ghana, College of Health Sciences, School of Public Health
Since the beginning of the HIV/AIDS pandemic, more and more people get infected everyday worldwide. At the same time, there is increasing evidence that people become more and more aware of the causes and preventive methods of the scourge. Despite the high knowledge of HIV infection, and sexual health-enhancing benefits of condoms, condom use is still very low among the sexually active youth in Ghana It is against this background that this study was designed to assess knowledge on HIV/AIDS amongst the youth, to determine the preventive methods, and identify factor non-use of condoms. Methodology involved a combination of both quantitative and qualitative techniques. 364 questionnaire were administered to both males and females aged 15 to 24 years. This was to solicit responses on knowledge, types of preventive methods known to them and level of condom use among them. Also 220 questionnaire on sexual behaviour were administered to a separate youth within the same age group. In-depth interviews were done together with Focus Group Discussions. Qualitative data was analyzed manually after necessary translation and transcriptions were done. The quantitative data was analyzed using Epilnfo( version 6) computer programme. Major findings indicate that the main reason for lack of condom use despite the rather high awareness is that use of condoms reduces sexual satisfaction especially among the males. This is given more credence given the fact that the use condom males have more dominating decision-making power regarding sex than their male counterparts. Another significant finding is that the use of condoms generates suspicion that one has HIV/AAIIDS and since no one wants to be stigmatized, the tendency is to use of the condom. It is recommended that the youth be given social/political empowerment to youth organization that will address HIV/AIDS with special reference to condom use.