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Performance of the Okwawuman Mutual Health Insurance Scheme and Impact on the Utilization and Outcome of Maternal Care Services in Ghana
(University of Ghana, 2008-09) Gyakobo, M.K.; Gemegah, A.; Enyimayew, N.; Kunfaa, E.; Adei, S.
Background: The Okwawuman Mutual Health Insurance Scheme (OMHIS) had been operating since 2002. However, performance reviews have reported mainly on deficits/surpluses, coverage rates and effects on health services utilization. Objective: The study seeks to assess the performance of the scheme with respect to the performance ratios and its impact on the utilization of differential components of health services and also on maternal care outcomes including caesarean section, vacuum extraction, stillbirth and maternal mortality. Method: A cross-sectional and time series study design was used to collect both primary and secondary data through self administered questionnaires, structured interview guides and checklists. Secondary data were collected from the District Health Directorates and the District Hospitals spanning a period of eight years: Four years before and after the introduction of the OMHIS. The financial and membership records of the OMHIS were also studied. Primary data were gathered through a cross-sectional community survey, hospital exit interviews and key informant interviews. Logistic regression was employed for the test of associations. Results: The overall combined ratio of the OMHIS for the period under review was <1.0 making it a viable scheme. Health services utilization was generally increased against a declining length of stay which was influenced by complications of caesarean section and vacuum extraction (p= 0.000) rather than mode of payment. Drug availability was 95.29% and the prescription of generic (rINN) or proprietary drugs was not influenced by insurance status (P rINN = 0.777; P Proprietary = 0.213). The mean annual caesarean section rate was high, 21-22% and that for vacuum extraction was low, 0.95- 1.35%. There was a mean annual excess caesarean section of 151 cases. Caesarean section and vacuum extraction were not significantly affected by health insurance [OR C/S = 0.337, 95% CI= 0.025-4.493 (Vs. Uninsured); OR V/E = 2.970, 95% CI= 0.223- 39.627 (Vs. Uninsured)]. Insurance impacted significantly on stillbirth (OR= 3.223, 95% CI= 1.527-6.800). Among the medical determinants of stillbirth, low birth weight (<2.5kg) had the strongest impact (OR= 89.979, 95% CI= 12.002-674.564). Stillbirth was more affected by per capita ANC attendance than supervised delivery. Insurance did not impact significantly on maternal mortality [OR= 1.587, 95% CI= 0.325-7.761 (Vs. Insured)] but rather medical determinants; with complications of labour having the strongest impact (OR= 30.320, 95% CI= 9.748-94.309). Supervised delivery played a more pivotal role in influencing maternal mortality than per capita ANC attendance. Conclusion: The Okwawuman Mutual Health Insurance Scheme was viable with government subvention. The scheme caused an increased utilization of the health services but did not influence length of stay in hospital and prescription pattern. The scheme also significantly impacted on stillbirth but was not significantly associated with maternal mortality, caesarean section and vacuum extraction.
Malaria and HIV Infections in Pregnancy: Maternal, Perinatal and Infant Health Issues
(University of Ghana, 2009-01) Laar, A. K.
In sub-Saharan Africa, several hundreds of pregnancies are exposed to both malaria and HIV infections annually. Consequences of these infections include maternal anemia, immunosuppression, preterm delivery, low birth weight, low Apgar score, and cord malaria. Unfortunately, these infections in relation to these adverse outcomes are not well characterized in Ghana. This study determined whether maternal malaria and HIV infections during pregnancy are associated with increased risk of these outcomes. The study enrolled 1154 (443 HIV-positive and 711 HIV-negati ve) women at their first antenatal visit, and prospectively collected data at delivery on 761 mother-infant pairs. Maternal and cord blood malaria parasitemia status were determined using a Rapid Immunochromatographic Test Kit. Hemoglobin concentrations were determined using an automated hematologic analyzer, and CD4+ count determined using the Becton Dickinson F ACScount system. This study demonstrates a significantly increased risk of LBW among HIV-positive women who had malaria at recruitment; odds ratio (OR) = 4.4, 95% Confidence Interval [CI] (2.3 - 8.4), at delivery; OR = 2.5, 95% CI (1.1 - 3.7), and at both time points; OR = 11.3, 95% CI (4.6 - 27.4). Women dually-infected with HIV and malaria'at both time points had a 4-fold risk of delivering preterm; OR = 3.96, 95% CI (1.8 - 8.5). Neonates with cord malaria were more likely to be born to women dually-infected with HIV and malaria at recruitment and at delivery; OR = 10.5, 95% CI (4.5 - 24.0). Maternal anemia and immunosuppression (as measured by reduced CD4+ count) were significantly associated with maternal infection with malaria and HIV (p < 0.05) in each case. These findings suggest that maternal infection with HIV and/or malaria is associated with increased risk of adverse maternal and perinatal outcomes. Routine screening of pregnant women for both malaria and HIV at antenatal visits, and successful treatment of malaria may reduce these adverse outcomes.
Ghana’s public health and legal preparedness for disaster and emergencies
(University of Ghana, 2009-12) Norman, I.D.
Ghana has over thirty separate legislations that provide the legislative Framework for disaster and emergency management as well as the general Administration of public health. These laws include the 1992 Constitution, Emergency Powers Act, 1994, (Act 472), the: National Disaster Management Organization Act, 1996, (Act 517), the National Building Code, LI 1630, the Local Government Act, 1993, (462), Road Traffic Act, 2004, (Act 683), the Quarantine Act, 19 15, (CAP 77) as amended in 1938 and many others that are Provided in Chapter 12 of this thesis. These many laws on a broad, inter-disciplinary area such as public health Administration naturally create systemic and administrative problems in Emergency management and intervention programs. Despite this situation, there has been no attempt to incorporate these many laws into one legislative Instrument or even by reference to each other Additionally, Ghana’s public health legislations on disaster and emergency Management have not been reviewed since 1996. The review process could have been initiated, when the nation first created its National Disaster Management Organization, (NADMO). This would have helped to determine whether or not the laws are adequate to address the needs of the nation in the face of rapid Economic development, the spread of human settlements and increased Population. In the interim, the nation has experienced quite a number of limited and localized regional emergencies such as seasonal flooding. Civil unrest, and Bushfires that have confounded the national emergency responses and intervention programs to these limited emergencies. Which have rather short lifespan in terms of the the threat they posed to life, property and economic progress the outcome from these experiences is the exposure of the apparent weaknesses of the national emergency preparedness programs en masse. This development has raised public health concerns as 10 what would be the national response in the case of a major natural emergency such as an earthquake with characteristically long lifespan in terms of the threat it poses 10 human settlements and economic progress. A major natural emergency could potentially create mass casualties leading to complications in the health concerns of the communities that could be impacted. Even during these limited and localized district and regional emergencies, the role of the executive in performing the first most critical task of declaring a regional or district state of emergency was muddled by conflict of laws problems., confusion over the constitutional mandate 10 the executive in such situations and the role of NADMO in the coordination of the intervention programs. These shortfalls call for changes in the legislative framework as it currently is. A review of Ike legal framework is., therefore. Required the periodic review of Ghana's public health and legal preparedness for disasters and emergency management, general risk and crisis intervention capabilities is good in helping to identify Ghana's vulnerabilities in managing both natural and human caused disasters and emergencies. Due to rapid changes in economic development, population growth and the spread of human settlements. The frequency of disasters and emergencies have attracted much public attention. Considering the fact that the cost of emergency intervention and the level of damages have been escalating steadily in Ghana in the last eleven years since the creation of the NAOMO in 1996 by an act t of Parliament, the national programs for emergency intervention may have, by now, outlived their effectiveness. The review of the legal framework naturally segues into calls for a series of new approaches to address the apparent weaknesses such as. (1) The role of the executive in the declaration of the State of national, regional and district emergency, (2) consequence management of the impacted area Of the nation after the declaration, (3) the constitutional limitations on the declarative process, (4) the conflict of laws and the management of emergencies, (5) revamping the laws on disasters and emergencies to bring them to the current needs of the Ghanaian society, (6) Conducting quality improvement measures on the organizational and administrative framework of emergency intervention agencies. There is also the need to introduce new programs like. (7) Protecting first responders against third party liabilities, (8) empowering first responders with knowledge, skills and abilities in emergency matters, (9) designing a comprehensive evacuation and resettlement programs for the community, (10) providing the modalities for disaster assistance to businesses and individuals to ensure business continuity. In terms of limiting societal suffering after a major disaster, the law provide for: ( 11) repetitive flood insurance to riparian communities and, (12) enhance the law to address specific disasters that confront the nation and find solutions to such challenges. Due to the inter-disciplinary nature of disaster and emergency management, it tends to overwhelm both the public and the practitioners. Part of this development is attributable to the complex socio-legal framework within which disasters and emergencies are managed. Therefore, there is the need to create an all-inclusive coordinative environment for emergency management. Emergency program coordination, however, is a challenging task which tends to complicate emergency intervention measures. Disaster risk reduction programs and the implementation of a coherent national platform for general risk, disaster and emergency management. By undertaking literature review of other jurisdictions after discovering over 30 various legislation affecting disasters and emergencies in Ghana and comparing them to those of other jurisdictions, it was found further that the national situation was not unique. Incidentally, other nations such as Venezuela. Canada and the United States, had similar legal challenges in their system of laws, but took steps to streamline the legal authorities necessary to handle disasters and emergencies into one legislative instrument such as the Stafford Act of 1988 establishing the U.S. disaster management agency. Federal Emergency Management Agency. (FEMA) Such examples are persuasive authorities for the Ghanaian situation to address the shortcomings identified in the old legislations dealing with emergency management in Ghana effectively, as well as the weaknesses of the national emergency preparedness program. This dissertation found that the specific weaknesses of Ghana's public health preparedness included the lack of a comprehensive program for both crisis management and consequence management after a national emergency as already listed above. The dissertation has provided a list of its objectives and has indicated the research methodology employed leading up to in theoretical legal framework and literature review. It has shown the breadth of information and research on emergency preparedness existing as well as legislation from other jurisdictions with similar socio-economic and political systems as that of Ghana Further research was conducted on the impact of disasters and emergencies on emerging economics in general together with the dual issues of immunity and indemnity of protection for emergency response workers, to ensure that first responders perform their roles without fear of legal suits and the threat of imprisonment. The 2007 floods in the Three Northern regions, Volta and Western regions was used as ease study to illustrate and examine political and legal consequence management of the nation after or during a national disaster. The question of whether or not the choice of model for disaster management organization has a direct impact on emergency preparedness program of a nation was investigated together with the types of disasters facing the nation, including hydro-meteorological, geological, pest, seismic disturbances, environmental degradation, armed conflict. Terrorism, fires, aviation fatalities and many others, I focused a large portion of the time for research and investigations exclusively on airport fires and the national emergency preparedness programs in place as of now, Additional y, the typology of the legal structure under which NAOMO was created, was subjected to review to assess responses of first responders and NAOMO to Act 517 of 1996 to see whether the core members of NAOMO thought the typology Was adequate or not and if not, what was the nature of the recommended organizational typology? This part of the investigation led to additional evidence in support for the unification of thirty odd legislations on disaster and emergency management in Ghana. It was also revealed from the data set that the majority of the practitioners in the field of disaster and emergency management were not well trained necessitating the call for the introduction of emergency and disaster management as an academic discipline into all levels of national education in Ghana. This further led to the need to develop a model act for tile introduction of emergency management education and has also provided a comprehensive blueprint for setting up Standard Operating Procedures and Emergency Operating Centres as a way of improving emergency response in the nation in the interim. At the end of this dissertation, conclusions and recommendations are provided on the issue of Ghana's public health legal preparedness and emergency management
Assessment Of Performance And Impact Of A Two-Year Nationwide Schistosomiasis Haematobia Control Programme In Burkina Faso (2004 - 2005)
(University of Ghana, 2010-08) Gabrielli, A.F.
Schistosoma haematobium infection or schistosomiasis haematobia or urinary schistosomiasis is the most common form of schistosomiasis affecting more than 60 million people in 46 sub-Saharan Africa countries. Symptoms and signs include chronic pain, anaemia, inflammation, haematuria, fibrosis and calcification of the bladder and the urinary and genital tracts, and ultimately bladder cancer. The disease is spreading as a result of increase in irrigation and water impoundment schemes that favours colonization by Bulinus spp. snail vectors. Treatment with praziquantel can prevent the development of chronic morbidity and forms the basis of the WHO-recommended preventive chemotherapy strategy for control of schistosomiasis. With this strategy, populations groups at-risk, especially school-age children, are treated at regular intervals, at frequencies determined by the levels of disease transmission. Treatment activities are usually carried out in schools which provide easy access to school-age children; nonenrolled school-age children, which can be many especially in rural areas, might however be left untreated. Issues of costs, manpower, expertise and the vast geographical areas have limited the implementation of disease control interventions in many countries to either small-scale or pilot projects. Most intervention programmes have also lacked a monitoring and evaluation framework which is key to achieving sustainability of control programmes. Thus most studies have reported on performance and impact extrapolated from results of small scale interventions. In 2003 the Ministry of Health of Burkina Faso opted to implement a nation-wide intervention to cover all school-age children irrespective of educational status, with support from the Schistosomiasis Control Initiative-Imperial College London, and the Bill & Melinda Gates Foundation. This decision offered the opportunity, and the subject of thesis, to investigate the performance and impact of a nation-wide programme relying on large-scale administration of praziquantel to control urinary schistosomiasis. A characteristic of this programme was its coordination by the Ministry of Health and use of only local human resources for its implementation that combined both school-based and community-based channels. The programme targeted each child eligible for treatment within a timeframe of 12 months during 2004-2005 in all 13 administrative regions of Burkina Faso. The present study investigated the programme's performance in terms of coverage and costs, and measured infection and morbidity indicators to determine its impact using both longitudinal cohorts and cross-sectional studies. Children aged 6-14 years were randomly selected from 16 sentinel schools in four regions located in the different ecological areas of Burkina Faso and were recruited into the longitudinal cohort at baseline, approximately six months before treatment. Infection indicators such as prevalence, intensity of infection and the proportion of heavy-intensity infections, as well as morbidity indicators such as haemoglobin concentration, anaemia status, microhaematuria and nutritional indexes, were all measured using recommended protocols. The study also measured these indicators cross-sectionally in newly enrolled children one year post-treatment to assess the quality of the community-based delivery channel and in school children randomly selected and matched by age and sex to those in the cohort in the second year, to validate the results obtained for the longitudinal study. A total of 3,322,564 school-age children were treated which was equivalent to a coverage of90.8% of the eligible population. 39.9% of the children were treated through schools whilst the majority, 60.1 %, through the community delivery channel. The total costs of the programme amounted to US$ 1,067,284, made up of delivery cost (US$ 325,936) and drug costs (US$ 741,348). The delivery cost per child treated was US$ 0.098 and the full cost of treating each child was US$ 0.32l. Out of 1,727 children recruited in the original baseline longitudinal cohort, 1,131 and 763 were followed up in the first and second years respectively, thus 596 and 368 respectively dropped out. Children that dropped out in the first year were mostly males (P<0.004), older (P
Socio-Cultural Determinants of Care of AIDS Orphaned Children among the Asante And Krobo Of Ghana
(University of Ghana, 2011-06) Yarney, L.
Peripheral Plasmodium Falciparum Infection and Antibody Levels among Pregnant Women on Intermittent Preventive Treatment In Ghana: Implications For Malaria and Transfer of Immunity to Babies
(University of Ghana, 2011-06) Koryo, S.J.
The effect of pregnancy associated malaria (PAM) differs according to the level of malaria endemicity and the level of immunity to infection acquired by pregnant woman. Generally, the incidence as well as severity of PAM is parity-linked. Immunologically naive primigravid women are at greater risk compared to multigravida who have some level of immunity against the specific malaria parasites which colonize the placenta. The adverse consequences of PAM which include maternal anaemia, complications at delivery and infants with low birth weight (LBW) are preventable by intermittent preventive treatment (JPT p), however, the IPTp may interfere with the acquisition of protective immunity against PAM as well as passive transfer of antibodies to infants in utero. In a longitudinal study, 320 pregnant women at an urban antenatal clinic in Madina, a suburb of Accra, Ghana were studied. Malaria infection, maternal anaemia, IPTp and other antimalarial practices, and the acquisition and transfer of antimalarial antibody immunity to infants were documented. Venous blood samples were collected at first ANC registration and four weeks post-TPTp administration and at delivery. Infants were followed monthly for six months. Anti-IgG and IgM antibodies against a crude antigen preparation as well as the Glutamate Rich Protein (GLlJRP) of P. falciparum were quantified by the enzyme linked immunosorbent assay (ELISA). The prevalence of peripheral blood infection with P. falciparum among the pregnant women was very low, 5.0% mean haemoglobin level at registration was normal, 11.4gdL. The mean gestation at registration was 18.5 weeks. The first dose of IPTp was administered at a mean gestation age of 24.4weeks, above the recommended 16 weeks Knowledge of bednets and experience in bednet usage were relatively high, 97.3% and 60.5% respectively but ITN possession and use were only 31.6% and 17.5% respectively. Both IgG and IgM antibodies against crude antigen and GLURP were high at first ANC visit, peaking at 4 weeks after the first dose of IPTp and dropping gradually up to delivery. Rise in IgM antibodies post-IPTpl confirmed new infections and a possible increase in susceptibility despite IPTp. Levels of antibodies in cord blood and placenta were well correlated and IPTp did not interfere with transfer of antibodies to infants in utero. There were 4 infants with LBW out of 121 who were delivered at the clinic. None of the children had fever, throughout the first six months of life. IPTp reduces the amount of malaria acquired antibody immunity among pregnant women during pregnancy. However, the study was not able to conclude that the levels of maternal and cord blood antibodies at delivery had adverse implications on malaria among the children at six months. A significant positive correlation was found between the number of IPTp doses taken in pregnancy and the weight of the baby at delivery.
The Quality of Prescribing and Dispensing In Public and Private Health Care Facilities in South West Cameroon
(University of Ghana, 2011-08) Ndeso-Atanga, S.
Medicines are an integral part of patient care, but their inappropriate use by clients can have serious medical, economic, and social consequences. Previous studies in public health services report multiple medicine prescription and misuse of antibiotics and injections. This study investigated the quality of prescribing and dispensing by public and private health providers. Methods: A Simulated client study to assess the quality of prescribing for diarrhoea, malaria and URTI,; a cross sectional descriptive study of actual prescribing and dispensing in health care settings; and a comparative analysis of the quality of prescribing and dispensing between public and private health care providers. Results Simulated Client Study: Less than 50% of the cases (diarrhoea, malaria and upper respiratory tract infection in that order) were accurately diagnosed by health staff (45 .5 vs. 47.3 vs. 42, respectively, p=O.O IS); less than 30% received the recommended treatment (14 vS.24 vs. 12.7 respectively, p=O.OO I); and less than 40% received the appropriate advice (16 .3 vs.39.3 vs. 39.3 respectively, p=O.OO]). The quality of prescribing was poor. No significant differences were found between public and private care providers. Actual Prescribing and Dispensing Study: The quality of actual prescribing was below acceptable standards, but the quality of dispensing was within acceptable limits. An average of 3.4 products per encounter was noted; and high rates of antibiotics prescribed. No significant differences in prescribing patterns between public and private care providers, but there were significant differences in dispensing patterns, with private providers dispensing a higher proportion of prescribed drugs (p=O.OO I). Conclusion: The quality of prescribing and dispensing in South West Cameroon is poor. No best practices were observed. Health Staff demonstrated low knowledge levels of prescribing and dispensing. There is need to improve drug prescribing and dispensing in this region of Cameroon.
Acute Febrile Illness: The Role of Respiratory Syncytial Virus and Malaria in an Urban Peadiatric Population in Ghana
(University of Ghana, 2011-10) Malm, K.L.; Koram, K.A.; Gyapong, J.
Introduction: Fever describes an increase in internal body temperature to levels that are above normal (commonly oral/axillary measurement of normal human body temperature is 36.8±0.7 °C or 98.2±1.3 °F) and is the most common response of the body to any insult to the body. The most common cause of fever in our setting is malaria and therefore children get treated for malaria once they have a fever whether the cause is proven (by laboratory confirmation) to be malaria or not. Other common causes of childhood fever, such as respiratory infections are not usually considered, although this has been found to be responsible for a high proportion of childhood illness in the West African Region in places such as The Gambia. Most of these respiratory infections are caused by viral agents including respiratory syncytial virus (RSV). Very little information exists on causes of fever in Ghana and therefore this study was conducted to determine the relative importance of RSV and malaria as causes of Acute Febrile Ilness in children under 5 years presenting at an urban hospital in Accra. Methods: The study recruited children under five years with an axillary temperature≥ 37.5°C who presented to the out-patients department of the La General Hospital from February 2009 to February 2010. A questionnaire was administered to their parents/caretakers (after consenting to allow their children to be part of the study) to elicit the demographic and socioeconomic characteristics of the recruited children and a physical examination conducted all children. Nasopharyngeal aspirates and blood samples were taken for polymerase chain reaction (PCR) for RSV and microscopy for malaria parasites respectively. A case control study was also undertaken to determine the risk factors for RSV infection among acute respiratory infection cases. Cases were children with acute respiratory infection who were positive for RSV and controls were children with acute respiratory infection who were negative for RSV. Results: Malaria, defined as presence of malaria parasites on microscopy, was found in 11.2% of all acute febrile illness. RSV was seen in 15.6% and 17.5% of acute febrile illness and respiratory infections respectively. Seven children representing 1.5% of children with acute febrile illness were positive for both malaria and RSV. Overcrowding and exclusive breastfeeding were significantly positively associated with RSV infection (p-value<0.01), whilst male gender, young age of less than one year and prematurity were also positively associated with RSV infection though not statistically significant. Discussion and Conclusion: The proportion of acute febrile illness due to malaria is lower than has been recorded routinely in children less than five years in this urban hospital. RSV is significantly prevalent in these children. Co-morbid infection with RSV and malaria was low. It is therefore important health practitioners support their diagnosis of malaria with laboratory confirmation, and also look out for other causes of fever such as RSV. The practice of treating almost all cases of fever as malaria needs to be examined critically.
Sexual Communication Within Families And Influence On Sexual Behaviour And Contraception Among Young People In The Brong Ahafo Region
(University of Ghana, 2011-12) Manu, A.A
Background: Young people aged 10-24 years represent a significant proportion of the Ghanaian population. Many are sexually active and are at considerable risk of negative health outcomes due to lack of adequate sexual and reproductive health knowledge. Although growing international evidence suggests that parent-child communication about sex has significant positive influence on young people’s sexual behaviours, this subject has been poorly explored among Ghanaian families. Little is known about how sexual communication transpires, its determinants and the types of topics parents talk about when they engage their children in sexual discussion. Knowing the predictors of parental sexual communication, nature and the extent to which sexual communication influences young people’s sexual behaviours are important for any intervention to reduce sexual risk behaviours among young people. Objective: To explore the relationship between parental sexual communication and young people’s sexual behaviours and contraception in the Brong Ahafo region of Ghana. Methods: A cross-sectional design was used to sample 823 parent-child dyads through a two-stage systematic sampling technique with probability proportional to size. Interviewer-administered questionnaire method was used to gather quantitative data on parent-child communication and sexual behaviour. Twenty specific sexual topics categorized into biological/physical development, sexual risk prevention and experiential sex were investigated to describe the patterns, contents and frequency of communication. Congruence between parent and child reports about whether sexual discussions had occurred was also examined. The Pearson’s chi-square and hierarchical multiple regression techniques were utilized to analyse sexual topics and predictors of parental communications respectively. In-depth interviews were used collect qualitative data to flesh-out relevant issues that standard questionnaire could not cover satisfactorily. Results: Mean (SD) age of young people was 16.9 (4.0) years and 47.3(10.1) years for parents. Majority (74.4%) of parents had ever discussed sexual issues with their children. Mothers communicate more to children than fathers. Discussions centred on sexual risk prevention topics, including sexual abstinence, HIV/AIDS, STDs, puberty, menstruation, physical development, premarital sex, and substance use. Parents discussed different sexual topics at different child ages. About 43% (50% females and 36% males) of young people reported being sexually active, of which 65% had had multiple sexual partnerships. Young men were two times more likely than young women to have engaged multiple sex partners; odds ratio (95% confidence interval) = 1.9 (1.22 – 3.06). Multiple logistic regression revealed that family religiosity, parental sexual knowledge, parent discipline and parental trustworthiness increase the odds of parents discussing sexual issues with their children. Additionally, on-time communication (sexual discussion occurring before a child initiates sex) appeared to be protective against sexual activities. Conclusions: Parent-child sexual communication promises to be an important medium to effect protective behaviours and behavioural change among young people. Educational interventions for parents could enable parents to communicate more effectively with their children for healthy development.
Cost-Effectiveness Analysis Of Home Management Of Fevers In Children Under-Five Years In The Dangme West District Of Ghana
(University of Ghana, 2011-12) Nonvignon, J.
Background Home management of childhood illnesses has been promoted as a way of managing childhood illnesses within communities. This approach can be life-saving, especially in rural areas of developing countries where geographical access to essential health services is limited. Many sub-Saharan African countries have adopted this approach and developed policies on its implementation. Ghana is implementing this policy, targeting malaria, pneumonia and diarrhea. However, there is little empirical evidence on the cost-effectiveness of these interventions. The objective of this study was, therefore, to assess the cost-effectiveness of two strategies of home management of fevers in children under-five in Ghana using antimalarials only or in combination with antibiotics. Methods Data were collected as part of a cluster randomised controlled trial with a stepwedged design. Approximately 12,000 children aged two months to 59 months in the Dangme West District in southern Ghana were covered. The costs and costeffectiveness of the two interventions were assessed compared with the "control period" before the clusters were randomized as part of the step-wedged design. In addition, a three-year budget of the home-based care (HBC) currently being implemented nationally in Ghana were estimated by adjusting parameters from the trial. Costs were analyzed from societal perspective. Under-five anaemia cases averted, deaths averted and disability-adjusted life years (DALYs) averted were used as effectiveness measures. Results The total financial costs of the interventions were US$99,690.32 (antimalarial only) and US$138,321.21 (antimalarial plus antibiotic). The total economic costs for the interventions were US$204,394.72 (antimalarial only) and US$260,93 1.49 (antimalarial plus antibiotic). Recurrent costs constituted 89% and 90% of the total direct costs of antimalarials only and antimalarial plus antibiotic respectively. The number of eligible fever cases treated were 5,818 (antimalarial only) and 6,601 (antimalarial plus antibiotic). The anaemia cases averted were 1,361 (antimalarial only) and 1,147 (antimalarial plus antibiotics) and the deaths averted were 79.1 and 79.9 for antimalarial only and antimalarial plus antibiotic respectively. The DALYs averted were 2,264.8 (antimalarial only) and 2,284.6 (antimalarial plus antibiotic). The results show that cost per anaemia case averted was US$150.18 and US$227.49 for antimalarial only and antimalarial plus antibiotic respectively. The cost per death averted was US$2,585.58 for antimalarial only and US$3,272.20 for antimalarial plus antibiotic. Cost per DALY averted were US$90.25 (antimalarial only) and US$114.21 (antimalarial plus antibiotic). Further, the home management interventions together led to societal savings of about US$165,083. The results also show that caregivers of children under-five incur intangible costs such as pain and loss of leisure that are difficult to quantify. Additionally, the budgets to cover 50% of the target population under HBC for 2012 were also estimated to be about US$1.6m illion for antimalarial only and about US$3.4million for antimalarial plus antibiotic. Conclusion Home management of fevers is a cost-effective way of reducing morbidity and mortality in children under five years in Ghana.
Risk Profile for Transmission of Mycobacterium Ulcerans in Ghana
(University of Ghana, 2012-06) Kenu, E.; Adanu, R.; Afari, E.; Razum, O.
Buruli ulcer disease (BU) is a skin disease caused by Mycobacterium ulcerans. Currently, Buruli ulcer has been reported in over 30 countries, the subtropical regions of Asia, in Latin America, in the Western Pacific region and in Eastern and Central Africa. Even though it has been reported in other continents, West Africa is the region most affected. It is one of the neglected tropical diseases and second commonest disease caused by Mycobacterium in Ghana and third globally. Suhum-Kraboa-Coltar, Akuapem South districts in the Eastern region and Ga West and Ga South districts of Greater Accra region are some of the districts affected by Buruli ulcer. Unfortunately the exact mechanism of transmission is not known. Even though some risk factors associated with contracting the disease have been identified in previous studies, what pertains in Suhum-Kraboa-Coaltar and Akuapem South districts of the Eastern region is not known. In addition, there is lack of detailed understanding of how environmental and social conditions interact to cause the disease. Finally, the spatial distribution of BU within the communities along the course of Densu river in the study area is also not known. Spatial epidemiology has proven to be useful for understanding the geographical distribution of many diseases. Combining the Geographical Information System (GIS) technology for epidemiologic mapping of Buruli ulcer cases alongside with environmental features and a fine detail case-control study to identify risk factors associated with Buruli ulcer will provide current knowledge of the disease in the study area. This information is crucial in developing clear interventional messages for community education on the disease and which communities are most at risk. The absence of these hampers the prevention and control of BU within the municipalities and consequently leads to ineffective use of scarce resources hence the need for the research. This study sought to develop a risk profile for the transmission of Buruli Ulcer at the individual and at the Community level in Akuapem South and Suhum Kraboa Coaltar Districts and spatial distribution of Buruli ulcer in the communities along the entire course of the Densu river. A Case-control study with Spatial mapping was carried out. The cases were identified through active community case search. A case of Buruli ulcer was defined as any person aged 2 years or more who resides in the Suhum-Kraboa-Coaltar and Akuapem South districts diagnosed of Buruli ulcer meeting the WHO clinical case definition for M. ulcerans disease. A Control was defined as any person who resides in the same community/neighbourhood as the Buruli ulcer patient comes from but does not have the disease. Standardized questionnaires were administered to the cases as well as their controls. Geographic Positioning System (GPS) receiver was used to map the cases as well as environmental characteristics that are of particular interest in contracting BU. A backward elimination logistic regression analysis of the data indicated that presence of wetland in the neighborhood (OR=3.9, 95% CI=1.9 -8.2), insect bite in water/mud (OR=5.7, 95% CI = 2.5 -13.1), use of adhesive when injured (OR=2.7, 95% CI = 1.1- 6.8), washing in the Densu river (OR= 2.3, 95% CI = 1.1- 4.96) were significantly associated with the development of BU. Rubbing an injured area with alcohol (OR=0.21, 95% CI = 0.008-0.57) and wearing long sleeves to farm (OR=0.29, 95% CI =0.14 - 0.62) protects against BU. The mapping showed that communities upstream along the Densu River where the river is not polluted had no BU cases but BU cases were identified beyond the polluted area of the Densu river. There was clustering of cases of Buruli ulcer in some communities and these occurred in areas where the river was most contaminated .Hence to avoid contamination.
Intra-Family Communication and Reproductive Health Decision Making in the Volta Region of Ghana
(University of Ghana, 2012-10) Aglobitse, D.M.
At the centre of Ghanaian society is the institution of family. Sustained through a series of kinship, networks and marriages, the family is acknowledged as the bedrock of all social life where critical tasks including nurturing are organised. According to Segrin and Flora (2005), very few, if any, relationships are more important, salient, long lasting, and central to people's well-being than their family relationships. Although these relationships are often de fined by genes and in stitutionalised ceremonies such as marriage, they are built, maintained, and destroyed by communication (or its absence). Therefore. Communication in the family setting is critical, as it is the bedrock of human social relationships. Additionally, a variety of fa mil y-factors at the household and individual level exist that may have direct influence on poverty and health. The principal objective of the study was to identify some of the determinants of reproductive health decision making as well as the determinants of intra- family communication or discuss ion about reproductive health issues. Structured interviews were administered to a sample of 1.080 respondents representing a total of 360 households from six districts in the Volta Region of Ghana, namely Ho, Krachi , Kadjebi , Hohoe, Ketu and Akatsi. Two focus group discussions (with one peri-urban and one rural community) for each district and two Key Informant Interview (KII) per district were also held at the same stud y sites. The Statistical Package for the Social Sciences (S PSS) version 17 was used to analyse the data. Regression techniques were used to assess the effects of education and income on family discussion at one stage and family discuss ion and reproductive health usage at another stage. Responses and discussions from FGD and KII were transcribed and data analyzed based on the objectives of this study. Results of the analysis indicate that educational level is significantly related to all the elements of reproductive health examined. Income and education were positively correlated with family discuss ions about reproductive health issues such that higher income and higher educational level , were associated with greater likelihood of family discussions, and family discuss ion or intra-family communication was also positively correlated with reproductive health usage. Types of settlement (urban or rural) were only associated with family discussion about maternal health such that urban dwellers were more likely to engage in maternal health discussions than rural dwellers. Results also indicated that mass media. Health workers, friends, and schools were the major sources of information about reproductive health issues. Young people and adults did not differ in their response pattern. This study recommends further research to assess whether comprehensive sexual and reproductive health communication within families facilitates adolescents ' health care utilization. Examination of how intra-family communication quality and content are related to service use is needed to understand adolescents ' sexual and reproductive health knowledge and needs.
Evaluating and Improving Microbiological Methods for the Diagnosis of Buruli Ulcer Disease
(University of Ghana, 2013-03) Owusu, E.; Newman, M.J.; Pluschke, G.
Background Challenges associated with early diagnosis of Buruli ulcer disease (BUD), an infection caused by Mycobacterium ulcerans (M. ulcerans) is a major setback in public health and disease control. Lack of simple, convenient, rapid and sensitive diagnostic procedures, readily available to rural endemic communities has hampered control efforts. Improving the sensitivity of simple diagnostic methods such as microscopy for AFB detection constitutes a crucial effort in this direction. M. ulcerans isolation by culture though slow, provides isolates critical to performing important investigations to provide information on drug susceptibility profiles of M. ulcerans isolates and molecular epidemiology of the disease. Techniques aimed at improving the sensitivities of the two diagnostic methods will facilitate early disease diagnosis and subsequently improve disease control. Objective This study assessed procedures aimed at improving the sensitivities of methods of AFB detection by microscopy and the isolation of M. ulcerans in culture. Methodology The performances of eight smear preparation protocols were assessed for the effective detection of acid fast bacilli (AFB). Swabbed samples from ulcer lesions of Buruli ulcer (BU) patients in two BU endemic districts of the Eastern region of Ghana were used. Smear preparation was based on physical and chemical modifications, of the conventional methods for Zeihl-Neelsen (ZN) staining protocols, for the detection of acid fast bacilli (AFB) from BU cases. Additionally, two dilutions of 5 selected chemical agents were investigated for their potential use as decontamination agents in M. ulcerans in culture. The activities of the chemical agents were preliminarily assessed against clinical isolates of potential skin contaminants. Effective chemical agents were simultaneously evaluated for (i) their decontamination activity against contaminants in BU samples and (ii) their effect on the growth of M. ulcerans in culture. Broth dilution methods were applied in these investigations. M. ulcerans from the study isolates were tested on rifampicin and streptomycin by the agar proportion method described by Canetti to assess the drug susceptibility. Results A total number of 135 clinically diagnosed BUD patients were recruited for the study. The age of the patients ranged between 1 to 92 years, with a mean age of 39 years. Swabs were taken form 123 cases whiles fine needle aspirates (FNAs) was taken from the 12 remaining BUD cases. Out of 123 swabs taken, PCR detected 111 positive cases, followed by microscopy with 62 cases and then culture with 52 cases. The observed differences between the three methods was statistically significant (p<0.001). Out of 12 FNA samples collected, PCR detected 10 positive cases, followed by microscopy with 6 cases, whiles laboratory diagnosis from culture detected 5 cases. The difference between the three methods for the detection of M. ulcerans in FNA samples was also statistically significant (p<0.001). Eight smear preparation protocols were investigated. Among the protocols, Ziehl-Neelsen (Z-N) stained smears from samples processed with 5% phenol in 4% ammonium sulphate (5%/4% phenol ammonium sulphate) and concentrated by gravitational sedimentation had the best outcome at a score rating of 686, whilst the least effective protocol was 3.5% sodium hypochlorite concentrated by gravitational sedimentation at a score rating of 360. Four (4) out of five (5) chemical agents at 2 dilutions each, tested on potential skin contaminants had activities against all. Povidone iodine at 0.5% and 1%, 2%CPC/4%NaCl, 1% virkon and 10% oxalic acid inhibited the growth of all microbes tested. Forty percent (40%) benzalkonium chloride , 1% CPC/2%NaCl, 5% oxalic acid could not inhibit the growth of two of the microbes. The least effective was twenty percent (20%) benzalkonium chloride (BC), inhibiting the growth of 6 out of 9 microbes tested. Of the 35 BU samples tested in duplicates against the selected chemical agents, 1% virkon and 1% povidone iodine (PI) recorded the highest activity of 99%.Whilst the least activity was recorded by 20% BC at 86%. Outcomes for assessing the usefulness of the selected chemical agents as decontamination agents in M. ulcerans culture indicated that, 2 % CPC / 4% NaCl and 0.5% virkon were the most effective at 52.8 %, and 51.4%, M. ulcerans recovery rates respectively. M. ulcerans recoveries were arithmetically higher than that of the conventional method (5% oxalic acid) at a yield of 44%. The observed differences were however not statistically significant (2 % CPC / 4% NaCl, p=0.7608 and 0.5% virkon, p=0.4070). The highest contamination rate of 29 % was exhibited by 5% oxalic acid and 1% CPC/2% NaCl of 21% in culture. Six (6) M. ulcerans isolates showed resistance to rifampicin, whilst 1 was resistant to streptomycin in-vitro. Resistance to both drugs was not observed among any of the isolates. Conclusions and recommendations It conclusion, BU specimens processed with 5% phenol /4% ammonium sulphate and concentration by gravitational sedimentation will improved AFB detection. In the peripheral centres where equipments like centrifuge may not be readily available, this sedimentation procedure can be used with adequate training. 2% CPC / 4% NaCl and 0.5% virkon are effective decontamination agents for the isolation M. ulcerans. Potential resistance to drugs (rifampicin and streptomycin), could also be a concern in the study area. In view of this, regular susceptibility testing of isolates and surveillance of susceptibility results (as is being done for Mycobacterium tuberculosis), is recommended.
Antibiotic Treatment Outcomes of Buruli Ulcer in Akwapem South and Suhum-Kraboa-Coaltar Districts
(University of Ghana, 2013-06) Kotey, N.K.; Binka, F.N.; Junghanss, T.
The World Health Organization (WHO) having recognized Buruli ulcer disease as an important cause of human suffering introduced treatment guidelines of a new protocol of 8-week initial therapy of intramuscular streptomycin and oral rifampicin in 2005. Although there has been some level of success in the treatment of Buruli ulcer with this new antibiotic protocol, some patients do not respond favourably as expected. Also, the response to chemotherapy of BU lesions including large ulcerated forms, which are currently the most common forms in Africa remains insufficiently documented. So this study set out to assess the treatment outcomes of all categories of BU lesions and determine factors that influence the healing of these lesions. This was implemented by employing a non-randomized clinical intervention design by serially recruiting 154 patients over a period of two years. Measurements of lesions were made using tracing sheets to obtain their respective surface areas. Swabs and fine needle aspirates were taken and confirmed by direct smear microscopy for acid-fast bacilli (AFB), polymerase chain reaction or culture. All patients were given a directly observed treatment (DOT) of a daily combination of intramuscular streptomycin (15mg/kg body weight) and oral rifampicin (10mg/kg body weight) for 8 weeks. There was also daily dressing for all wounds irrespective of size and weekly assessment for all forms of lesions. Patients were counseled regularly on BU management and the necessity for adhering to treatment. All patients were followed up for a minimum of 34 weeks. BU lesions were found among ages 2- 84 years. About 37% of the total study participants were less than 15 years and almost equal numbers in the age groups between 15 -49 years and over 50 years old. In those below 15 years of age there was an almost equal gender distribution whilst, in the older age groups more females than males were affected. It was found that 93.5% (144/154) of the study participants presented with ulcers. All those who reported within two months of noticing their lesions for the first time achieved 100% treatment success irrespective of category of lesion. There was 97.4% treatment success rate for all BU lesions with no recurrences within 34 weeks of treatment. About 30% of lesions showed an apparent deterioration response to treatment (paradoxical reactions) after an initial improvement at some points during treatment starting from week 2 to week 18 reaching a peak at week 10. Factors that hastened healing were smaller size of the initial lesion, regular wound dressing, removal of slough, treatment with topical antibiotics and absence of paradoxical reactions. We concluded that the combination of intramuscular streptomycin and oral rifampicin is efficacious in healing all forms of Buruli ulcer disease. Optimal and regular wound dressing regular counseling, consistent wound evaluation and timely interventions play important roles in the healing of BU lesions. In view of these findings we recommended that the National Buruli Ulcer Control Programme in collaboration with the District Assemblies and District Health Management Teams should organize regular health education activities to encourage patients to report early to health institutions and also ensure that drug treatment is combined with wound dressing effectively and efficiently in order to achieve the desired results.
Management of Childhood Burns and Fall-Related Injuries in the New Juaben Municipality of Ghana.
(University of Ghana, 2013-07) Siaw, A. N.; Pappoe, M.; Tetteh, E.; Senah, K.
The study explored how childhood burns and falls are managed in the New Juaben Municipality in the Eastern Region of Ghana. This was against the background that childhood burns and fall-related injuries are major public health concerns that manifest in frequent hospitalization, high treatment cost, long period of recovery, pain, scar and disabilities. To address these concerns, the study set out to determine the risk factors for these childhood mishaps, to explore the treatment practices and to determine parents’/caretakers’ preventive practices for childhood burns and falls with the aim of bridging the knowledge gap and to improve on management practices of such injuries. A cross-sectional descriptive design which employed both quantitative and qualitative methods of data collection was used for the study. Using the multi-stage sampling method as an overall sampling technique, the simple random sampling method was first used to select twelve out of the fifty-two communities in the New Juaben Municipality. The same simple random sampling method was employed at the second stage to select two enumeration areas from each community after which parents/caretakers were selected. A total of six hundred parents/caretakers of children from twenty-four enumeration areas in the municipality were selected for the community survey. Key informant interviews were also used to collect data to supplement information gathered from the survey. These sets of data were triangulated during the data analysis. The study revealed that parents/caretakers socio-economic backgrounds and the physical environment in which they live predispose children to burns and falls and that children living with parents/caretakers who are extremely poor (living below the daily minimum wage of GH¢ 5.24 per day as at July, 2013) were found to be 18.9 times more likely to be victims of burns compared to those who live above the daily minimum wage. Children living with parents who observe playground safety are 25 times more likely to prevent fall-related injuries as compared to children living with parents who do not observe playground safety. When home-based treatment practices for burns and fall-related injuries were explored, the most preferred treatment regimen was found to be first, traditional, followed by allopathic health care and then a blend of the two treatment regimens. Among the major reasons for the high utilization of traditional health practices are affordability, accessibility, availability of traditional medical services and the fact that diagnosis and treatment modes are related to the cultural beliefs of the people (acceptability). Three broad measures are adopted to prevent childhood burns but the most preferred measure is the practice of not leaving children alone at home. This practice was found to be 3.2 times more likely to prevent childhood burns compared to a practice where children are often left alone at home. It is recommended that the New Juaben Municipal Assembly should collaborate with the schools, families, religious groups, NGOs, and health institutions to educate parents and school age children on the significant risk factors to childhood burns and falls. In doing this, it is recommended that specific educational programmes targeting specific vulnerable groups, such as children in the different age cohorts and parents with different socio-economic status, should be promoted. Further research will be required to fill the gap created in the area of community and national initiatives that is aimed at preventing childhood burns and falls. This will compliment the current study in providing a holistic view on management practices for such injuries in Ghana.
The Role of Divination in Health Seeking Practices in the Talensi-Nabdam District of Northern Ghana
(University of Ghana, 2014-02) Azongo, T.B.; Adongo, P.B.; Pappoe, M.; Tetteh, E.; Gyapong, M.
In spite of the available modern technologies for dealing with ill-health, many people continue to resort to divination in the search for therapy. The persistence of the practice of divination in health seeking suggests that there is a considerable use derived from its practice. Against this background this study was conducted to assess the extent to which divination influences health-seeking behaviour as people utilise modern healthcare facilities in the Talensi-Nabdam district in Northern Ghana, findings of which could provide clues to some barriers to healthcare delivery and utilization in Ghana at large. A mixed-method approach involving Focus Group Discussions with community elders, in- depth interviews with practicing diviners and experienced healthcare practitioners, and a community survey using a questionnaire was used. Analysis involved triangulation of both the qualitative and quantitative data. Qualitative data was analysed by importing verbatim transcripts of all interviews and discussions into Nvivo-7 software, while quantitative analyses involved logistic regression procedures, using Stata-10 software. The use of divination in health seeking was found to be significantly correlated with age, sex, marital status, number of wives possessed by men, number of children, level of education and religious affiliation. Findings also suggest that on the pathway between symptoms recognition and therapy options divination is often employed to pin down supernatural and other causes of misfortunes and ill-health and to determine the appropriate patterns of resort. Patients with such diseases as burns, boils, anthrax, and snakebites tend to consult diviners first as they believe these conditions are of spiritual or supernatural origin. Diviners don’t consider themselves as healers, but rather consider themselves merely as custodians of the spiritual conduits by which people can find out the causes of ill-health and other misfortunes from the spiritual and ancestral world in order to determine the course of action. The findings have implications for healthcare service and utilization: delays in seeking and utilising modern healthcare services and the tendency for patients asking for “discharge against medical advice” to enable alternative treatment at home, as well as reasons for treatment failures at modern healthcare facilities. It is proposed that a bio-psycho-social-spiritual model should be integrated into clinical care of patients at modern healthcare facilities especially in diagnostic interviews and treatment regimes of patients. Collaboration between the Ghana Health Service and diviners together with other magico-religious healthcare practitioners could facilitate incorporation of this model into medical and nursing training curricular.
The Prevalences of Human Papillomavirus Infections and Cervical Lesions, and the Patterns of Risk Behaviour Characteristics of Women in a High Risk Community: Akuse sub-district, Ghana
(University of Ghana, 2014-06) Awuah, A.K.
Background: Ghana continues to lack population based empirical data on the burden of cervical pre-cancer lesions, HPV infection and the identification of communities at risk. These together are hampering the control of cervical cancer in Ghana. Therefore, this study was designed to determine the distribution of HPV infections, cervical lesions and the known ri sk factors for cervical cancer among women living in the Akuse sub-district, Ghana. Methods: A cross sectional study was designed with a house-based recruitment of women between the ages of 15 and 70 years. Although a single strategy was designed for reporting for specimen collection in the study, three strategies were used. The additional strategies were a result of an initial low response rate resulting from the women not making time off their daily and economic activities to attend the Hospital for specimen collection and also based on the information and suggestions from the subsequent interaction with the women. These strategies were, a) reporting to the hospital within a short time period after recruitment at home, b) reporting to the hospital within a long time period after recruitment at home and c) reporting at a location within a community after recruitment at home. Each participant had the option of providing a specimen by either or both self-specimen collection and health personnel specimen collection. Human Papillomaviruses were detected in each of the pair of the specimen by a multiplex-nested PCR amplification and genotyped by the xMAP technology. Results: Of the 38 genotypes detected with both specimen collection methods, the following were the commonest detected with self-specimen; HPV16 (5.9%; 95% C13.0% - 9.0%), HPV35 (4.7%; 95% C] 2.0% - 8.0%) and HPV40 (4.7%; 95% C] 2.0% - 8.0%). The commonest detected with the health-personnel collected specimen were HPV35 (2.8%; 95% C] 1.0%- 5.0%) and HPV58 (2.8%; 95% C] 1.0% - 5.0%). A significant difference was obtained between the overall HPV prevalence determined with the self-collected specimen [43 . 1 % (95% C] 38.0% - 51.0%)] and that with the health-personnel collected specimens [23.3% (95% C] of 19.0% - 31.0%)]. Varying reporting rates were observed for the three reporting strategies as well as varying preferences for the specimen collection methods. All the women were negative for cervical cancer and showed no dyskaryosis (intraepitheliallesion). Conclusion: The findings of this study provide the necessary baseline data needed to contribute to the development of a cervical cancer prevention plan and indicate that the Akuse sub-district is a high risk community for HPV infection and a low risk community for cervical cancer.
Molecular Epidemiology of Human Papillomavirus Infection of the Cervix in Women in North Tongu District, Volta Region, Ghana.
(University of Ghana, 2014-06) Boateng, G.; Wiredu, E. K.; Binka, F.; University of Ghana, College of Health Sciences School of Public Health Department of Epidemiology and Disease Control
Background: Human papillomavirus (HPV) has been well established as the primary cause of cervical squamous intraepithelial lesion/cervical intraepithelial neoplasia and invasive cervical cancer. More than 100 genotypes of HPV have been identified and 40 types are sexually transmitted. Cervical cancer is the fourth most common cancer among women worldwide and about 85% of the cases occur in developing countries. In Ghana, cervical cancer ranks as the first most frequent cancer among women. Though cervical cancer is preventable, Ghana does not have an effective national cervical cancer screening programme for women to access. Prevalence and distribution of oncogenic HPV genotype varies greatly across inter and intra countries. In Ghana, few studies on the prevalence of HPV infection and pattern of risk factors have been conducted. There is also no knowledge of published data on the prevalence of HPV genotypes in general population. Therefore, this study sought to determine the prevalence and distribution of HPV genotypes in women in the North Tongu District. Method: Five hundred women aged 15 years or older attending gynaecological clinic at Battor hospital and from three selected villages in the district were interviewed and cervical samples obtained after they gave their consent. Papanicolau smear test was performed and HPV DNA extraction, detection and genotyping performed using nested multiplex PCR technique. Prevalence of HPV and associations between exposures were determined. Results: A total of 500 women with age range 15-70 years and a median age of 35 years were interviewed. The overall HPV prevalence among the women was 47.4% with 65% of these being infected with HR types only, 11.4% with LR types only and 23.6% with both HR/LR types. There was no age preference, HPV age-specific infection rate were young women (50%), middle aged women (49.6%) and old age (55%). Multiple HPV infection among the women was 51.9%. The five most common HR HPV types in either single or multiple infections were HPV-52 (13%), HPV-18 (11%), HPV-58 (8.6%), HPV-68 (7.2%) and HPV-51 (7.0%). HPV-43 (11.3) was the most common LR HPV type (58%). Cytology results were available for 453 (90.6%) women. Majority (98.9%) of the participants had normal Pap smears, with 0.4% presenting with high-grade squamous intraepithelial lesions, 0.2% ASCUS, 0.2% HPV infection and 0.2% squamous cell carcinoma. There was significant association between marital status and HPV positivity (χ2=3.9, p=0.05) and in an unconditional logistic model, singles were significantly more likely to be infected (OR=1.9, 95% CI 1.03-3.32). There was also significant association between age at first sexual intercourse and HPV positivity ((χ2=8.9, p=0.03) and in an unconditional logistic model, women aged 14-17 years were 3 times more at risk of acquiring HPV infection (OR=2.8, 95% CI 1.40-5.58). Conclusion: High HPV prevalence (47.3%) among women in North Tongu was detected. The five most frequent HR HPV types in the women were HPV-52, HPV-18, HPV-58, HPV-68 and HPV-51 in descending order. HPV-16 was detected in the only squamous cell carcinoma found. HPV-43 was the most frequent LR HPV and HPV-6/11 the least. Multiple HPV infection was seen in about 52% of the HPV positive women. Marital status and age at first sexual intercourse were significantly associated with HPV infection. It is recommended that, Ghana Health Service should implement a national cervical cancer screening and prevention programme to reduce the incidence of cervical cancer in the country. Xvi, 112p: ill
Determinants of Obesity among Basic School Pupils in the Ga-East Municipality
(University of Ghana, 2014-07) Alangea, D.O.; Adanu, R.M.K.; Aryeetey, R.; Laar, A.K.; University of Ghana, College of Health Sciences , School of Public Health , Department of Community Health; University of Ghana, College of Health Sciences , School of Public Health , Department of Community Health
Background: Overweight and obesity among children is a major public health concern globally. Childhood obesity is likely to persist into adulthood. Little is known about the prevalence and determinants of overweight and obesity among school-age children in Ghana. Knowing the determinants of overweight/obesity among basic school pupils is important for obesity intervention design. Objective: To determine overweight and obesity prevalence and its risk factors among basic school pupils in the Ga-East Municipality of Ghana. Methods: A cross-sectional study involving 24 private and public basic schools in the Ga-East Municipality; 487 pupils aged 9 - 15 years and 340 parents. Data collection involved interviews with pupils, parents and head teachers, a school environmental scan and an audit of school feeding and physical activity facilities. Dietary data was collected using a one-time 24 – hour meal recall and a 7–day Food Frequency assessment. Body weight and height of pupils and their parents were measured. Physical activity level of pupils was determined using the physical activity questionnaire for children. Associations between home and school food environments and child BMI and overweight status were tested using linear and logistic regressions respectively. Results: Total overweight prevalence among basic school pupils in the Ga-East Municipality was 17.7%; 8% were obese. Overweight prevalence among parents was 59.2%. Frequency of beverage consumption (p<0.01), least physical activity level (p<0.01) and being in the middle household wealth tertile (p=0.03) significantly predicted higher child BMI after controlling for parental BMI, age, sex, and calories consumed. None of the schools assessed had a written policy on eating at school and physical activity of pupils. Over 77% of all pupil purchases made during break time were from within the school compound. Foods associated with obesity formed 46.6% of all purchases. Schools which highly promoted healthier food options had over 5 times increased odds of child overweight [AOR=5.55; 95% CI = 1.430 – 21.511, p=0.013] than schools that least promoted. Schools‘ exerting moderate control over the food options available to pupils compared to those who had least control had 84.3% reduced odds of having overweight pupils. Parental use of snacks and sweetened drinks as reward from the least to the moderate category was associated with reduced odds of child overweight (AOR = 0.282, 95% CI = 0.105 – 0.759, p<0.05). High provision of a supporting environment for physical activity (open spaces, sports field) in a school was associated with an 80.2% reduced likelihood of pupils being overweight compared to the least provision. Conclusions: The school and home environments have significant influences on child weight status beyond the individual child behavioural and background factors. The school environment offers an opportunity to reach a large child population and changes made to improve physical activity and access to healthy food can have positive impacts on child weight status.
Parent Training and Parent-Adolescent Communication about Sexuality in Accra Metropolis, Ghana
(University of Ghana, 2014-07) Baku, E.A; Sally-Ann, O.; Laar, A.K.; Adanu, R.M.; University of Ghana, College of Health Sciences , School of Public Health , Department of Population, Family and Reproductive Health
Background: Talking about sexual issues with children is a difficult task for most parents. This is because most parents are not trained to talk to their children about sexual issues. Many parents also lack the knowledge and skills to talk to their children about sexual issues. Evidence shows that intervention studies that trained parents on how to communicate with their children about sexuality have shown positive results. Training parents to talk to their adolescents about sexual issues will reduce sexual risk behaviours among adolescents and young people. Objective: To assess the effects of training parents on parent-adolescent communication about sexuality in the Accra Metropolis, Ghana. Methods: An intervention study which consisted of 138 parent-adolescent pairs from 12 public Junior High Schools in two sub-metropolises in the Accra Metropolis answered baseline survey on parent-adolescent communication on sexual topics and were put into intervention and control groups (intervention group, 73 parent-adolescent pairs in 6 schools; control group, 72 parent-adolescent pairs in 6 schools). Parents and adolescents completed a follow up survey of questionnaires on parent-adolescent discussion about sexual topics three months after the programme. Results: The proportion of parents with very good knowledge increased more in the intervention group (37.0% to 60.0%) than the control group (27.7% to 34.7%). After the training, the parents in the intervention group (30.1% to 82.9%) had better attitudes towards adolescents’ use of reproductive health services than the control group. The proportion of parents in the intervention group who ever discussed sexual topics with their sons increased (60.3% to 88.6%) after the training. Most parents in both in the intervention (54.4%) and control (51.4%) groups would like to start talking to their children about sexual issues when the child is between 10 and 12 years old after the intervention. Mothers discussed more sexual topics with adolescents on all the categories of sexual topics than fathers. Sexual discussions focused mostly on sexual risk protection and risky sexual topics. Conclusion: The training increased the parents’ knowledge about sexuality, their ability and frequency of discussing sexual topics with their children. The training also improved the parents’ attitudes towards adolescent sexual issues. Key words: Adolescents, parents, sexuality, intervention and communication.

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