Department of Community Health

Permanent URI for this collectionhttp://197.255.125.131:4000/handle/123456789/5005

Browse

Search Results

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Maternal Health Care Utilization through Community Based Initiatives in Periurban Accra
    (University of Ghana, 2018-07) Nwameme, A.U.
    Background: The availability of skilled care during pregnancy, childbirth, and the postpartum period ensures the best chances of delivering a healthy infant with no complication to the mother. Huge disparities in health exist between urban and rural dwellers but recent research has shown that the urban poor sometimes have worse maternal health outcomes than rural dwellers. Community-based interventions have been shown to foster interactions between pregnant women and health care providers and can go a long way in mitigating the adverse effects of urban poverty on maternal health. This study aimed to highlight how such innitiatives are able to improve maternal health care utilization in a peri-urban settlement in Accra. Methodology: This research was a cross-sectional study employing quantitative and qualitative methods of data collection and analysis. Four hundred and forty-one (441) women who delivered in the past 18 months were randomly sampled from two subdistricts of the Ga East Municipality for participation in the survey. The purposive sampling technique was then used to sample participants for the Focus Group Discussions and the In-depth Interviews. Five (5) FGDs (n=35) were conducted amongst mothers in the community depending on place of delivery (21), and with the Community Health Officers (14), whilst nine (9) lOIs were conducted with formal and informal health care providers in the communities. Analysis of the quantitative data was done using STATA 13 and univariable, bivariable and multi variable logistic analysis were carried out with p-value of <0.05 seen as significant. The qualitative data were audio recorded, transcribed verbatim and thematic analysis was done using the NVivo 11 software. Results: Socio-demographic characteristics such as employment (p--
  • Thumbnail Image
    Item
    Polivirus Antibody and Lameness among Individuals in the Three regions ogf Ghana
    (University of Ghana, 2017-07) Opare, J.K.L.
    Introduction: In 2008, Ghana recorded the last case of poliomyelitis or polio and the causative agent was the wild polio virus. The country has been certified free of polio and it is at the verge of polio eradication. High levels of polio neutralizing antibodies (immunity) must be maintained to prevent the importation of wild poliovirus. We determined the seroprevalence of polio viruses (P1, P2, and P3) antibodies and the risk factors for seronegativity in Greater Accra, Ashanti and Northern regions of Ghana in order to identify any gaps for system improvement. Methods: A cross-sectional, hospital-based seroprevalence study supplemented by a school lameness survey was undertaken in the three study regions in 2016. Individuals, who visited the three teaching hospitals of the regions and needed to give out blood samples for laboratory investigation, were invited to partake in the survey. Micro-neutralization test for poliovirus serotypes, 1, 2 and 3 antibodies was performed following WHO-standard procedures. Antibody titers of ≥ 1:8 were considered positive. Bivariate and multivariate analyses were conducted on subject characteristics to assess for potential factors for failure to sero-convert. Statistical significance was set at P -values <0.05 In the school lameness survey, clinical and epidemiological data were obtained from parents and their lamed children using a semi-structured questionnaire in the same three regions. School lameness data was descriptively analysed by person, place and time by employing frequency distributions, percentages, means, standard deviation and rates. Data was analysed using STATA version 13. Results: Neutralizing-antibodies against poliovirus types 1, 2 and 3 were detected in 86.0% (264/307), 84% (258/307) and 75% (230/307) of samples respectively. Overall, 60.1% (185/307) were seropositive and 2.9% (9/307) were seronegative for the three polio serotypes. Seroprevalence of polio-neutralizing antibodies among males (P1=51.9%, P2=51.6% and P3=52.6%) were higher than females. Seroprevalence rates of polio neutralizing antibodies (P1, P2 and P3) were highest in the Northern Region (91.8%, 82.4%, and 77.4%). Polio neutralizing-antibodies (P1 and P2) decreased with age [p<0.001]. Low seroprevalence of polio-neutralizing antibodies was significantly associated with low school attendance of mothers [p=0.003 for PV1 and p<0.001 for PV2]. Prevalence of residual paralysis was 0.58/1,000 or 5.8/10,000 children aged 0-15years in schools of the study regions. Conclusion: This study revealed a moderate level of seroprevalence of neutralizing antibodies to the three polio serotypes with some regional differences. Seropositivity was generally low with increasing age and the mother’s education level was crucial to seronegativity. The drastic reduction of paralytic poliomyelitis may be attributed to the moderate level of polio-neutralizing antibodies. To further strengthen the gains made in polio eradication, the Ghanaian government needs to increase and sustain budgetary allocation on polio eradication awareness and mass immunizations. The Expanded Programme on Immunization (EPI), Ghana, may consider young-adult booster-dose of polio vaccine, introduce inactivated polio vaccine (IPV) to supplement the oral polio vaccine and conduct a nationwide seroprevalence and community based lameness survey to gauge programme performance. Female child education and career counseling for Junior High School pupils and those older may be intensified by all District Assemblies and by churches
  • Thumbnail Image
    Item
    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
  • Thumbnail Image
    Item
    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.