Department of Epidemiology and Disease Control
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Item Caregiver Acceptability Of Seasonal Malaria Chemoprevention In Two Districts In The Upper West Region, Ghana: A Cross-Sectional Study.(Springer Nature, 2025-01-14) Diarra, Y.; Bonful, H. A.; et alAbstract Background Acceptability of malaria chemoprevention interventions by caregivers is crucial for overall programme success. This study assessed coverage and acceptability of Seasonal Malaria Chemoprevention (SMC) in selected com munities in the Northern part of Ghana. Methods An analytical cross-sectional design was conducted from“July 23rd to August 4th, 2020—a 12-day period that covered 5 days of the frst SMC implementation cycle and 7 days post-implementation. Using a stratifed multi stage sampling technique, a total of 495 caregivers providing care for 569 eligible children aged 3–59 months from randomly selected households in the study communities were enrolled into the study. Acceptability of SMC was assessed on a set of 19 questionnaire items-8 of the items measured caregivers’ perceptions and 11 items meas ured children’s reaction to administered medicines. Univariable and stepwise multivariable logistic regression analyses were performed to assess the predictors of acceptability of SMC at a 95% confdence interval and a p-value of 0.05. Results SMC coverage was 95.1% (541/569). Caregivers had a good level of knowledge of SMC (n=475; 96.0%; 95% CI 94.2—97.7%) and a good perception of SMC (n=471; 95.2%; 95% CI 93.3–97.0). Seven out of ten caregivers (70.9%; 95% CI 66.9–74.9%) had good acceptability of SMC. For 7 out of 28 children who did not receive the SMC interven tion, their caregivers intentionally refused them the intervention. Of those that received the treatment, 17.2% (n=85; 95%CI 13.8–20.5%) of caregivers had at least one leftover amodiaquine tablet after the third day of treatment. Caregiv ers who practice Christianity or Islam had better acceptability than caregivers who practice African traditional religion (p<0.001). Conclusion Health authorities and stakeholders can work towards bridging the gap between knowledge and SMC treatment practices of caregivers through continuous education, adherence counseling, and efective monitoring of SMC practices in malaria-endemic countries. Keywords SMC, Caregivers, Malaria, Acceptability, Ghana, Upper West region, Amodiaquine–sulfadoxine– pyrimethamineItem Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion(BMJ Open, 2024) Cavalar, C. A.A.; Mehrtash, H.; Govule, P.; et al.Introduction There are limited global data on ectopic pregnancy (EP) and molar pregnancy (MP), making it important to understand their epidemiology and management across different regions. Our study aimed to describe their prevalence for both conditions, severity of their complications and management among women in selected health facilities across 17 countries in Africa and Latin America and the Caribbean (LAC). Methods This is a secondary analysis of the WHO multi country survey on abortion. Data were collected from 280 healthcare facilities across 11 countries in Africa and 6 in LAC. Sociodemographic information, signs and symptoms, management and clinical outcomes were extracted from medical records. Facility-level data on post-abortion care (PAC) capabilities were also collected, and facilities were classified accordingly. χ2 or Fisher’s exact tests were used to compare categorical data. Results The total number of women with EP and MP across both regions was 9.9% (2 415/24 424) where EP accounted for 7.8% (1 904/24 424) and MP for 2.1% (511/24 424). EP presented a higher severity of complications than MP. At admission, 49.8% of EP had signs of peritoneal irritation. The most common surgical management for EP was laparotomy (87.2%) and for MP, uterine evacuation (89.8%). Facilities with higher scores in infrastructure and capability to provide PAC more frequently provided minimal invasive management using methotrexate/other medical treatment (34.9%) and laparoscopy (5.1%). Conclusion In Africa and LAC, EP and MP cause significant maternal morbidity and mortality. The disparity in the provision of good quality care highlights the need to strengthen the implementation of evidence-based recommendations in the clinical and surgical management of EP and MPItem Safety of mRNA COVID-19 vaccines among persons 15- years and above in Ghana: A cohort event monitoring study(Vaccine, 2024) Darko, D.M.; Seaneke, S.K.; Bonful, H.A.; et al.Introduction: The development of COVID-19 vaccines during the pandemic occurred with an unprecedented speed, requiring extraordinary post-approval safety monitoring to facilitate ongoing evaluation of their benefit risk profile. In Ghana, the Food and Drugs Authority granted emergency use authorization to six of these vaccines including the two mRNA COVID-19 vaccines, namely, Pfizer-BioNTech and Moderna COVID-19 vaccines. The objective of the study was to estimate the incidence of adverse events following immunization (AEFIs) and adverse events of special interest (AESIs) in persons vaccinated with mRNA COVID-19 vaccines, and to identify factors associated with the development of AEFIs. Methods: We conducted a prospective cohort event monitoring study in seven selected static vaccination centers in six of Ghana's 16 regions. The choice of regions was based on their geographical locations and the incidence rate of COVID-19 at the time of the study. The study was conducted with people aged 15 years and older who were vaccinated with mRNA COVID-19 vaccines, including pregnant women. Study participants were recruited starting in November 2021, with the last participant followed up in August 2022. Persons vaccinated were followed up on days 1, 7, and 28 post-dose 1 and up to 91 days after dose 2. AEFIs were described with the most specific, or lowest-level, term using the Medical Dictionary for Regulatory Activities (MedDRA) version 26.1. Frequencies of AEFIs after each vaccine dose and vaccination center were determined. Cox-proportional hazard regression was used to assess the independent risk factors associated with the incidence of AEFI among the participants. Results: Overall, 4678 persons who received Pfizer-BioNTech or Moderna COVID-19 vaccines from the seven vaccination centers were enrolled in the study. The mean age of participants was 32.9 years (SD ± 14.4). A total of 17.4 % (95 % CI: 16.3 % to 18.5 %) of participants experienced AEFI, with a higher incidence among Moderna COVID-19 vaccine recipients (20.4 %) compared to Pfizer-BioNTech COVID-19 vaccine recipients (14.0 %). The top five common AEFIs included in ejection site pain, headache, dizziness, fatigue, and fever. No serious AEFIs were reported during the study. Factors such as vaccination center and history of chronic medical conditions influenced the risk of experiencing an AEFI. Cox-proportional hazard regression revealed a 37 % lower risk of AEFI with the Pfizer-BioNTech COVID-19 vaccine compared to the Moderna COVID-19 vaccine. Conclusion: The study on mRNA COVID-19 vaccines in Ghana showed that the vaccines are tolerated well with no significant safety concerns. Reports of systemic and local events were consistent with those reported in the summary of product characteristics of the two vaccines. The study's outcome showed that there were no safety issues with mRNA COVID-19 vaccines in Ghana. The results of this study can be used as a crucial advocacy tool to address vaccine hesitancy as countries plan to routinize COVID-19 vaccines. Additionally, the active monitoring study serves as a model for such studies in low- to middle-income countries (LMICs) with weak pharmacovigi lance systems during future pandemics.Item Adherence to sulfadoxine-pyrimethamine fve-dose policy among pregnant women in an urban slum in Ghana: a mixed-methods study(Malaria Journal, 2024) Iddrisu, H.; Tagoe, E.A.; Bonful, H.A.Background Malaria in pregnancy (MiP) is a public health concern especially for pregnant women living in slums. The World Health Organization recommends at least three doses of Sulfadoxine-Pyrimethamine (SP) to prevent MiP. In Ghana, it is recommended that pregnant women receive a minimum of fve doses of the medication. This study sought to determine the level of adherence to IPT5 policy and factors associated with adherence among pregnant women in a slum community in Ghana. Methods This was a cross-sectional study involving 232 nursing mothers and four healthcare workers at the St. Martin’s Memorial Hospital, Sukura, Ghana. Sociodemographic characteristics of nursing mothers were obtained using an interview-administered questionnaire. Data on the number of SP doses and other obstetrics characteristics were collected by reviewing the antenatal record books. To obtain information about healthcare and health system factors associated with adherence to the five-dose policy, four healthcare providers were interviewed. A data extraction form was used to obtain information about the availability of SP at the facility. Results The level of adherence to IPT5 was 8.6% (20/232) (95% CI 5.0–12.3) among the participants. Only 8.4% of the participants received their first dose at 16 weeks. Respondents who began ANC in the second trimester were 81% less likely to adhere to IPT5 than those who began in the first trimester (aOR=0.19, 95% CI 90.01–0.65, p<0.008). Healthcare provider and health system factors that influence IPT5 uptake include healthcare providers’ knowledge of IPTp-SP guidelines, the practice of Directly Observed Therapy, education of pregnant women, training of healthcare providers, and availability of water. SP was available at the facility during the period of review. Conclusion Adherence to the IPTp-SP five-dose policy was suboptimal. Pregnant women who started ANC early were more likely to adhere to the policy. Provider knowledge, DOT practice, training, education of pregnant women and water availability were also found to influence adherence. Encouraging early ANC visits and providing healthcare workers with necessary training can substantially improve adherence in slum areas.Item Adherence to antiretroviral therapy among HIV patients in Ghana: A systematic review and meta-analysis(Plos Global Public Health, 2024) Boadu, I.; Manu, A.; Abdulai, M.; et al.Maintaining a high level of adherence to antiretroviral therapy (ART) is critical to limiting rapid viral replication, drug resistance, and viral transmission. However, ART adherence remains a major challenge in HIV/AIDS treatment success. This systematic review and meta-analysis was aimed to synthesize available evidence on adherence to ART among HIV/AIDS patients in Ghana.This review followed the preferred reporting item for systematic review and meta-analysis (PRISMA) criteria. A comprehensive literature search was done using five online databases (PubMed, Google Scholar, Medline, Africa Index Medicus, and Willey Online Library) from 25th- 30th April 2023 to identify potential studies. In addition, references of related articles were manually searched to further identify relevant studies. Search records were managed in Endnote library where duplicates were removed prior to screening. Studies were eligible for inclusion if they were conducted in Ghana, designed as an observational or experimental study, and explicitly measured adherence to ART, either as a primary or secondary outcome. Studies were excluded if the proportion or prevalence of adherence to ART was not reported.A total number of 126 potential studies were identified from the literature search. Of these, 14 met the inclusion criteria and were included in the Meta-analysis. The studies involved a total number of 4,436 participants. The pooled estimate of adherence to ART was 70% (CI: 58–81%). In subgroup analysis, adolescents and young adults had a lower adherence rate (66%, CI: 46–84%) compared with adults (70%; CI: 58–81%). Publication bias was not observed among studies. The pooled estimate of optimal adherence to ART among HIV patients in Ghana was lower than is recommended (95%) to achieve viral suppression. Adherence was lower among young persons living with HIV/AIDS. To achieve the United Nation’s Sustainable development goals and the UNAIDS “95-95-95” targets, there is a need to focus on improving adherence interventions among persons living with HIV/AIDS, especially among the younger cohort.Item Factors influencing integrated disease surveillance and response system in selected districts in the Eastern Region of Ghana(Plos One, 2024) Twene, P.; Sarfo, B.; Yawson, A.A.E.; Otoo, J. E.; Asraku, A.Background Ghana adopted the Integrated Disease Surveillance and Response (IDSR) system, which is an integration of the various programs in the surveillance system and can contain disease outbreaks and pandemics. Implementation of the IDSR is influenced by several factors which can affect its functionality and ability to contain disease outbreaks. This study assessed the factors influencing the IDSR system in selected districts in the Eastern Region of Ghana. Method A cross-sectional study was conducted between February-March, 2022 in Fanteakwa North, Abuakwa South and New Juaben South districts in the Eastern Region of Ghana among health care workers who are involved in IDRS activities. Both primary and secondary data were collected and analyzed using descriptive statistics and regression analysis at 0.05 significant level with 95% confidence interval. Results Three hundred and forty-seven (347) health care workers participated in the study with 56.2% (195/347) indicating that rumor registers were available at the health facilities. Most of the respondents (64.8%, 225/347) had means of transport for disease surveillance activi ties while majority (61.9%, 215/347) had case-based forms for case investigation. About half (51.9%, 180/347) of the participants revealed that they did not receive any feedback from the next higher level in the past year. Availability of transport for IDSR activities was almost 3.4 times more likely to contribute positively to IDSR system compared to facilities without transport (AOR = 3.36; 95% CI = 1.44–7.83; p = 0.005). Respondents who have the capacity to apply case definition are 2 times more likely to contribute to an effective IDSR system compared to health workers who cannot apply case definition (AOR = 1.94; 95% CI = 1.17–3.21; p = 0.013). Respondents who did not receive feedback from the next higher level were 52% less likely to have an effective IDSR system compared to respondents who received feedback from the next higher level (AOR = 0.48; 95% CI = 0.23–1.00; p = 0.05). Conclusion Effective operation of IDSR is affected by the application of case definition and means of transport at health facilities. In addition, the capacity of health care workers to provide feed back can influence the smooth operation of the IDSR in the studied area in Ghana.Item Availability of published evidence on coverage, cost components, and funding support for digitalisation of infectious disease surveillance in Africa, 2003–2022: a systematic review(BMC Public Health, 2024) Kaburi, B.B.; Harries, M.; Kenu, E.; et al.Background The implementation of digital disease surveillance systems at national levels in Africa have been challenged by many factors. These include user applicability, utility of IT features but also stable financial support. Funding closely intertwines with implementations in terms of geographical reach, disease focus, and sustainability. However, the practice of evidence sharing on geographical and disease coverage, costs, and funding sources for improving the implementation of these systems on the continent is unclear. Objectives To analyse the key characteristics and availability of evidence for implementing digital infectious disease surveillance systems in Africa namely their disease focus, geographical reach, cost reporting, and external funding support. Methods We conducted a systematic review of peer-reviewed and grey literature for the period 2003 to 2022 (PROSPERO registration number: CRD42022300849). We searched five databases (PubMed, MEDLINE over Ovid, EMBASE, Web of Science, and Google Scholar) and websites of WHO, Africa CDC, and public health institutes of African countries. We mapped the distribution of projects by country; identified reported implementation cost components; categorised the availability of data on cost components; and identified supporting funding institutions outside Africa. Results A total of 29 reports from 2,033 search results were eligible for analysis. We identified 27 projects implemented in 13 countries, across 32 sites. Of these, 24 (75%) were pilot projects with a median duration of 16 months, (IQR: 5–40). Of the 27 projects, 5 (19%) were implemented for HIV/AIDs and tuberculosis, 4 (15%) for malaria, 4 (15%) for all notifiable diseases, and 4 (15%) for One Health. We identified 17 cost components across the 29 reports. Of these, 11 (38%) reported quantified costs for start-up capital, 10 (34%) for health personnel compensation, 9 (31%) for training and capacity building, 8 (28%) for software maintenance, and 7(24%) for surveillance data transmission. Of 65 counts of external funding sources, 35 (54%) were governmental agencies, 15 (23%) foundations, and 7 (11%) UN agencies. Conclusions The evidence on costing data for the digitalisation of surveillance and outbreak response in the published literature is sparse in quantity, limited in detail, and without a standardised reporting format. Most initial direct project costs are substantially donor dependent, short lived, and thus unsustainable.Item Ration health resources to save more statistical lives from cervical cancer death in Africa: Why are we allowing them to die?(Developing World Bioethics, 2023) Awua, A.K.Public health interventions, particularly in low- and middle-income countries (LMICs) are implemented with the never-ending challenge of limited resources and the ever-present challenge of choosing between interventions. While necessary, the application of ethical analysis is absent in most of such decisions making, resulting in fewer favourable consequences. In applying ethical principles to the saving of women from the burden of cervical cancer, I argue in favour of saving statistical lives (investing in prevention) in LMICs, by mapping the principles of justice in resource allocation to the prevailing circumstance. The key facts in this circumstance are that providing treatment (which is saving identified lives), involves mostly providing palliative treatment, which is associated with a high likelihood of death among the identified lives while undergoing treatment or shortly thereafter. I focus on the dilemma of having a national cancer prevention program versus the expansion of cancer treatment facilities.Item Structural equation modeling of pedestrian behavior at footbridges in Ghana(International Journal of Injury Control and Safety Promotion, 2022) Ojo, T.K.; Appiah, A.B.; Obiri-Yeboah, A.; et al.This study was undertaken to fill the information gap by exploring pedestrian behavior at footbridges in the Greater Accra and Kumasi Metropolitan areas of Ghana. Further, the study modelled the behavior of 69,840 pedestrians at the footbridges using Structural Equation Modeling (SEM). Pedestrians were observed as users and non-users of seven selected footbridges in the morning (7:00 a.m.–9:00 a.m.), afternoon (11:00 a.m.–1:00 am–1:00pm) and evening (3:00 p.m.–5:00 p.m.) periods for seven consecutive days (Monday to Sunday). Selected footbridges were characterized by traffic generators such as schools, shopping malls, bus stops, office complexes, and restaurants in different matrices. The results showed that 30.7% of the observed pedestrians did not use the footbridges, males and young pedestrians were more likely not to use the footbridges as opposed to females and the elderly, with more than half of observed pedestrians carrying luggage or loads. Footbridge users were more likely to talk and hold phones than non-users and the elderly were more likely to run and ride compared to young pedestrians. Officials of the National Road Safety Authority should carry out effective public education on pedestrian safety targeting males and young pedestrians to encourage the use of pedestrian footbridges.Item An intercept survey of the use and non-use of footbridges in Ghana(Case Studies on Transport Policy, 2022) Ojo, T.K.; Appiah, A.B.; Obiri-Yeboah, A.; et al.Footbridges reduce pedestrian-vehicular interaction and the incidence of pedestrian crashes. Their use significantly reduce the incidence of pedestrian crashes along major highways in low- and middle-income countries like Colombia, Ghana, Jordan, Malaysia, and Nigeria. This study seeks to investigate the use of footbridges in Ghana. A survey was conducted among pedestrians using and not using footbridges at six locations in Greater Accra and Kumasi Metropolitan areas, respectively. The pedestrians were intercepted in the vicinity of footbridges as users and non-users from 7:00 a.m.–9 a.m., 11:00am-1:00 pm and 3:00 p.m.–5:00 pm daily for seven days. In all, 1852 pedestrians were surveyed. The quantitative data was analysed using SPSS v.21 and Structural Equation modeling (SEM). The study showed a higher prevalence among male non-users than females. Those with secondary education, and those who had been previously involved in a pedestrian crash used footbridges the most. The SEM results revealed that age, gender, training in pedestrian safety, frequency of use, and walking distance, how often one crosses the stretch road, and length of stay in an area affect the use of footbridges. An approach by city managers in low- and middle-income countries, including Colombia, Ghana, Jordan, Malaysia, Mexico and Nigeria are required to improve the use of footbridges to reduce the incidence of pedestrian crashes. Specifically, officials of the National Road Safety Authority, Ghana Highway Authority, Motor Transport and Traffic Department of the Ghana Police Service should consider these factors affecting footbridge usage in addressing pedestrian safety on Ghanaian highways.