School of Public Health

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    Targeted gene panel sequencing of liquid and tissue biopsies reveals actionable genomic alterations in Ghanaian metastatic breast cancer cases
    (Translational Oncology, 2024-08-11) Amoako,E.; Amuzu,S.; Ofori,E.O.; Akligoh,S.H.; Tackie,R.; Ibrahim,B.A.; Quaye,E.K.; Akakpo,P.K.; Aniakwo,L.A; Jimah,B.; Appiah,K.U.; Hutchful,D.; Manu,A.; Ngoi,M.J.; Paemka,L.; Alhassan,Y.; Obeng,A.E.; Lim,N.; Rajah,L.; Pek,P.; Challis,J.; Adebisi,G.R.; Tan,H.M.; Bediako,Y.
    Purpose: Breast cancer is a major cause of cancer-related mortality among African women. The adoption of molecular genomic technologies in the management of cancer cases is limited in Africa. To provide much-needed insights on the feasibility and utility of such precision medicine paradigms in Africa, we conducted a prospective, non-interventional study involving combined tissue and plasma Next-generation sequencing (NGS)-based testing in cancer patients in Ghana. Methods: We recruited 20 newly diagnosed, histologically confirmed, treatment-naïve women with metastatic breast cancer at the Cape Coast Teaching Hospital in Ghana. Tissue (NGS) and cell-free DNA (cfDNA) liquid biopsy analysis were ordered on all 20 patients. Results: All 20/20 (100 %) liquid biopsy samples were acceptable for analysis, whereas only 6/20 (30 %) passed quality control for tissue NGS testing. Liquid biopsy detected 42 cfDNA mutations in 17/20 patients. Of the 17 patients, 3 (17.6 %) had mutations previously associated with African ancestry, including BRCA1 p.K719E, ARAF p.S262I and GATA3 p.G125dup. Eight potentially actionable alterations specific to breast cancer were found in 6/17 (35.3 %) liquid biopsy samples, while potentially actionable mutations non-specific to breast cancer were detected in 12/17 (70.6 %). Tissue biopsy analysis detected mutations in all 6 patients tested, with 3/6 (50 %) patients presenting potentially actionable mutations relevant to breast cancer. Conclusion: Liquid biopsy detected multiple additional actionable variants in Ghanaian women with breast cancer. Plasma cfDNA analysis featured fewer variations in sample preparation which is a key consideration in resource-limited settings. Liquid biopsy presents a great opportunity to improve cancer care in Africa
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    Availability, acceptability, and utilization of micronutrient fortification for children 6-23 months in three districts in Ghana
    (World Nutrition, 2024) Donkor, W.E.S.; Boadu, I.; Babae, P.; et al.
    Background Micronutrient deficiencies result from multiple factors, including inadequate intake of micronutrients (vitamins and minerals) from nutrient-rich diverse diets. Point-of-use fortification with a nutritional supplement powder is recommended to address micronutrient deficiencies and anemia among infants and young children (6-23 months), particularly, in low-income countries. In Ghana, about a quarter of children aged 6-59 months are anemic, or deficient in iron and vitamin A. World Vision Ghana (WVG) implemented the integrated Improved Feeding Practices (IFP) project between 2020 and 2023 in three districts in Ghana to improve diet quality and practices of women of reproductive age, and young children below age two years. One component of the project involved the distribution of a nutritional supplement powder (KOKO Plus). This is the second in a series of four papers that document the implementation and outcomes of the IFP project; the other papers are published in this journal. The current paper assessed the availability, acceptability, and utilization of KOKO Plus to households who participated in the IFP project as well as lessons learned from implementing the intervention. Methods A mixed-methods design was used, triangulating primary and secondary data. Secondary data originated from a review of IFP project documents, including project mid-year and annual reports, and implementation plans across the three interdependent components of the IFP project. Primary data were obtained from interviews in six purposively selected communities. Key informants included WVG staff, community volunteers, and local government agency staff from health and agriculture sector agencies, and beneficiaries of the intervention. Interview respondents answered questions on the project’s mechanism for KOKO Plus distribution, participant experiences of purchasing and using KOKO Plus, perceived benefits of using KOKO Plus, and lessons learned about KOKO Plus from the IFP project. Beneficiaries also provided information on their perceptions of KOKO Plus acceptability and adverse outcomes. Results The project distributed KOKO Plus free of charge to almost 14,000 (13,942) children, more than its target (4,900). In addition, Village-Based Entrepreneurs (VBE) sold 192,092 sachets of KOKO Plus in the project communities. The KOKO Plus value chain involved WVG purchased the KOKO Plus from the Ghanaian manufacturer and supplied it to VBEs either in their respective communities or at distribution centers in their respective WVG district office. KOKO Plus promotion and marketing were led by trained VBEs, VBE supervisors, and Community-Based Organizations across multiple settings (homes, child welfare clinics, markets, community durbars, and religious gatherings). There was high acceptability of KOKO Plus. Mothers attributed their acceptance of KOKO Plus to its a Corresponding author: raryeetey@ug.edu.gh 33 potential health and nutrition benefits for children. They also attributed increased child weight, and less frequent illness, to feeding meals that included KOKO Plus to their young children. KOKO Plus was added to the diverse local meals fed to young children. Diarrhea was the only mentioned adverse report, albeit rarely. At the end of the IFP project, WVG established a fund to ensure the sustainable distribution of KOKO Plus in the project communities. Conclusions The IFP project established a KOKO Plus value chain, increasing the availability, accessibility, acceptability, and utilization of KOKO Plus in the project communities. VBE successfully distributed KOKO Plus with support from community volunteers and healthcare workers. This approach to KOKO Plus distribution is feasible and sustainable and is recommended for similar contexts.
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    Strengthening Applied Epidemiology in West Africa: Progress, Gaps, and Advancing a Regional Strategy to Improve Health Security
    (Health Security, 2021) Lokossou, V.K.; Kenu, E.; Sombie, I.; et al.
    The ability to prevent, promptly detect, and appropriately respond to a public health threat is essential for health security. Field epidemiology training has helped increase the quality and quantity of the public health workforce to strengthen disease surveillance, outbreak preparedness and response, and general public health capacity. We conducted a desk review on the status of the Field Epidemiology and Laboratory Training Program model in 16 countries in West Africa. We also developed a questionnaire and shared it with West African Health Organization (WAHO) member states to document their experiences and the status of training in their countries. WAHO organized a regional 3-day consultative meeting with major stakeholders in the region to examine progress, gaps, and challenges, and outline a roadmap to strengthen the Field Epidemiology and Laboratory Training Program. Stakeholders shared their experiences, engaged in discussions to identify strengths and gaps, and made plans for a way forward. Member states are at different levels of implementing field epidemiology and laboratory training programs in their countries, and, therefore, major gaps remain in the number and distribution of trained episode biologists throughout West Africa. Member states implement different variants of the program and in some instances, the same cadre of health workers are trained in different but comparable programs with different funding streams. Two member states had not begun implementing the training program. Developing regional centers of excellence was recommended in the long term while collaboration among member states to train the required number of epidemiologists to fill the acute needs could be helpful in the short and medium term. Curriculum harmonization and expansion, deployment and use of trained epidemiologists, accreditation of training institutions, and generation of indigenous funding streams are recommended to improve the Field Epidemiology and Laboratory Training Program in West Africa.
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    Misconceptions, Misinformation and Politics of COVID-19 on Social Media: A Multi-Level Analysis in Ghana
    (Frontiers in Communication, 2021) Tabong, P.T.N.; Segtub, M.
    Background: Ghana developed an Emergency Preparedness and Response Plan (EPRP) in response to the Severe Acute Respiratory Syndrome Coronavirus (SARS CoV-2) pandemic. A key strategy in the EPRP is to mobilize national resources and implement strategies for improved risk and behavioral change communication. Nonetheless, concerns have been raised on social media about COVID-19 misinformation and misconceptions. This study used social media content to determine the types, forms, and effects of the myths, misconceptions, and misinformation in Ghana’s COVID-19 containment. Method: The study was conducted in three phases involving the use of both primary and secondary data. A review of social media information on COVID-19 was done. This was complemented by document review and interviews with key stakeholders with expertise in managing public health emergencies and mass communication experts (N = 18). All interviews were transcribed verbatim and analyzed using NVivo 12. Results: The study showed a changing pattern in the misconceptions and misinformation about COVID-19. Initially, myths were largely on causes and vulnerability. It was widely speculated that black people had some immunity against COVID-19. Also, the condition was perceived to cause severe disease among the elderly. These misconceptions served as risk attenuators among Ghanaians, especially the younger generation. As the infection evolved in the country, another misconception emerged that the hot climate in Africa inhibited viral replication and transmission, followed by speculations and conjectures that COVID-19 was being used as a biological weapon to target developed economies. For the management of COVID-19, the use of local remedies such as Neem tree (Azadirachta indica) and herbal preparation also emerged. Myths about the efficacy of locally manufactured gin (akpeteshie) and hydroxychloroquine as prophylaxis led to the abuse of such substances. Interview segments revealed the use of myths to propagate political agendas in the country. Conclusion: The study concludes that COVID-19 misconceptions and misinformation are widespread and cover the course of the condition. These myths necessitate culturally sensitive health communication strategies that take into account local perceptions of COVID-19 to tackle the circulation of misconceived messages about the pandemic in Ghana.
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    Associated factors of diet quality among people living with HIV/AIDS in Ghana
    (BMC Nutrition, 2024) Abdulai, K.; Torpey, T.; Kotoh, A.M.; Laar, A.
    Introduction : Nutrition is a very important element of a comprehensive care for people living with HIV/AIDS (PLHIV), especially in resource-constrained settings where malnutrition and food insecurity are common. Dietary diversity is a useful indication of nutritional adequacy (diet quality) in people of all ages. An optimally diverse diet strengthens the body’s immune system. Objective This study aimed to assess diet quality and its associated factors among PLHIV. Methods A facility-based cross-sectional study design was employed to select 440 PLHIV from two hospitals in the Eastern Region of Ghana. Dietary intakes were determined using 24-hour recall. A stadiometer and bioimpedance analysis machine were used to obtain anthropometric and body composition data. Diet quality was assessed using FAO’s individual dietary diversity score (IDDS) as a proxy. SPSS version 20 was used for analysis. Odds ratios and ordinal logistic regression were used to identify factors associated with diet quality among the PLHIV. P-value was set at 0.05. Results Most of the PLHIV (73%) consumed from ‘Starchy staple” food group. Less than 20% of the study sample consumed ‘Fruits’ and ‘Vegetables’ (17% and 14% respectively) a day before the survey. The mean IDDS was 4.11 (SD=1.29). Overall, most of the PLHIV (56%) had medium IDDS which is equivalent to “diet needing improvement’, 14% had higher IDDS (good diet), whiles about 31% of the participants actually had poor diet (lower IDDS). Associated factors of diet quality were age (AOR=0.966: 95%CI: 0.936–0.997: p=0.031), married (AOR=4.634: 95%CI: 1.329– 16.157: p=0.0016), separated (AOR=0.0203: 95%CI: .036–0.994: p=0.049), and daily meal frequency (AOR=0.441: 95%CI: .478–1.948: p=0.020). Overall, the model accounts for about 20% of the variation in diet quality of the participants (pseudo-R square=0.196). Conclusion This study demonstrates that most of the PLHIV did not consume good diet which may have an implication on their immune system, which is already under attack by HIV, and probably emerging infections. Age, marital status, and meal frequency were the variables that predicted diet quality among the study participants.
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    Counting adolescents in: the development of an adolescent health indicator framework for population-based settings
    (Elsevier Ltd., 2023) Manu, A.
    Changing realities in low- and middle-income countries (LMICs) in terms of inequalities, urbanization, globalization, migration, and economic adversity shape adolescent development and health, as well as successful transitions be tween adolescence and young adulthood. It is estimated that 90% of adolescents live in LMICs in 2019, but inade quate data exist to inform evidence-based and concerted policies and programs tailored to address the distinctive developmental and health needs of adolescents. Population-based data surveillance such as Health and Demographic Surveillance Systems (HDSS) and school-based surveys provide access to a well-defined population and provide cost-effective opportunities to fill in data gaps about adolescent health and well-being by collecting population representative longitudinal data. The Africa Research Implementation Science and Education (ARISE) Network, therefore, systematically developed adolescent health and well-being indicators and a questionnaire for measuring these indicators that can be used in population-based LMIC settings. We conducted a multistage collaborative and iterative process led by network members alongside consultation with health-domain and adolescent health experts globally. Seven key domains emerged from this process: socio-demographics, health awareness and behaviors; nutrition; mental health; sexual and reproductive health; substance use; and healthcare utilization. For each domain, we generated a clear definition; rationale for inclusion; sub-domain descriptions, and a set of questions for mea surement. The ARISE Network will implement the questionnaire longitudinally (i.e., at two time-points one year apart) at ten sites in seven countries in sub-Saharan Africa and two countries in Asia. Integrating the questionnaire within established population-based data collection platforms such as HDSS and school settings can provide measured experiences of young people to inform policy and program planning and evaluation in LMICs and improve adolescent health and well-being
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    Knowledge and use of information and communication technology by health sciences students of the University of Ghana
    (Ghana Medical Journal, 2016-09) Dery, S.; Vroom, F.D.; Godi, A.; Afagbedzi, S.; Dwomoh, D.
    Background: Studies have shown that ICT adoption contributes to productivity and economic growth. It is therefore important that health workers have knowledge in ICT to ensure adoption and uptake of ICT tools to enable efficient health delivery. Objective: To determine the knowledge and use of ICT among students of the College of Health Sciences at the University of Ghana. Methods: This was a cross-sectional study conducted among students in all the five Schools of the College of Health Sciences at the University of Ghana. A total of 773 students were sampled from the Schools. Sampling proportionate to size was then used to determine the sample sizes required for each school, academic programme and level of programme. Simple random sampling was subsequently used to select students from each stratum. . Results: Computer knowledge was high among students at almost 99%. About 83% owned computers (p < 0.001) and self-rated computer knowledge was also 87 % (p <0.001). Usage was mostly for studying at 93% (p< 0.001). Conclusions: This study shows students have adequate knowledge and use of computers. It brings about an opportunity to introduce ICT in healthcare delivery to them. This will ensure their adequate preparedness to embrace new ways of delivering care to improve service delivery.
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    Some Demographic Characteristics of two rural communities in Southern Ghana
    (Ghana Medical Journal, 1988-09) Afari, E.A.; Nakano, T.; Owusu-Adjei, S.
    A study of the demographic characteristics of two rural villages in Southern Ghana in 1987 showed an average rate of natural population increase of 3.8 percent compared to 3.2 per cent recorded nationally (1984 census data). The crude death rates and Infant Mortality rates were far lower than the figures usually quoted, although the birth rate was similar to the national average. It is suggested that if such rates exist in similar villages in Ghana, then official projections are underestimates and will have grave consequences on national development plans. It appears that Primary Health Care (PHC) has succeeded in reducing deaths but has not affected births. Family planning must, therefore, receive more attention.
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    Financing reproductive health services in Africa: The role of aid, insurance, user fees and general taxation
    (Reproductive Health, Economic Growth and Poverty Reduction in Africa: Frameworks of Analysis, 2010) Enyimayew, N.
    Financing Reproductive Health Services in Africa: The Role of Aid, Insurance, User fees and General Taxation Nana Enyimayew Without appropriate financial resources, scaling up effective reproductive health interventions in order to achieve the Millennium Development Goal for maternal health (MDG 5)1 will be virtually impossible. Yet little is known about how much is currently being invested in reproductive health services within African countries or whether levels of funding are changing. Estimates place the additional funding requirements to attain universal coverage at a minimum of US$7 billion per year. Other estimates suggest that even greater investments are needed. Irrespective of the precise figure, the conclusion is clear: the financing gap represents a substantial sum in relation to domestic budgets. Adequate, well-managed financing of public health systems in general continues to elude most countries. The difficulty is especially severe in low-income countries, most of which are in Africa, whose health systems struggle with meagre and inequitably distributed resources. Additionally, access to services for the most disadvantaged is usually very poor, further reducing the benefit of already scarce resources for those most in need. Success or otherwise of different health financing strategies is critical in determining the fate of such populations and therefore needs to be documented and presented to inform the development of right policies. Filling the information gaps requires appropriately designed and executed research. At minimum, reproductive health (RH) services may be defined as those activities whose primary purpose is to restore, improve and maintain the health of women and their newborns during pregnancy, childbirth and the seven-day postnatal period. This chapter provides an update of the current knowledge of financing of RH services in Africa and suggests a framework for further research in these areas. It also presents examples of national and regional efforts to adopt and implement financing policies that aim to address national objectives of access, equity, quality and appropriate utilisation of RH services to meet MDG 5 by 2015. Issues of exemptions, subsidies and efficiency are also discussed within the scope of financing RH services. A review of basic services is presented in Table 5.1. Reproductive Health, Economic Growth and Poverty Reduction in Africa 108 Table 5.1: Range of reproductive health services Category of care Interventions Antenatal care Basic antenatal care Management of severe anaemia Treatment of malaria Management of syphilis, gonorrhoea and Chlamydia Normal delivery care Clean and safe delivery Post-partum care Basic newborn care Essential obstetric care Management of eclampsia, sepsis, haemorrhage and abortion complications, plus provision of emergency caesarean section Family planning Family planning information and services Other Prevention and treatment of HIV/AIDS How Much Do Reproductive Health Services Cost? Information from various sources suggests that the per capita cost of providing a package of reproductive health services ranges between US$0.5 and US$6.0 (Weissman et al., 1999; World Bank, 1993). Global costs for reproductive health are estimated at US$7 billion dollars per year till 2015 while analyses done using the methodology of the UN Millennium Project suggest that family planning programmes in Africa alone would increase from US$270 million in 2006 to nearly US$500 million by 2015 (Cleland et al., 2006). A selection of per capita cost estimates is presented in Table 5.2. Table 5.2: Per capita cost estimates for reproductive health services Service Cost (US$) Mother and Baby package (1) 0.5 (current level of service provision) Uganda 1999 1.4–1.8 (standard level of service) WDR Global 1993 (2) 4.0 Making Motherhood Safe (3) 2.0–6.0 Range 0.5–6.0 Sources: (1) Weissman et al. (1999); (2) World Development Report (World Bank, 1993); (3) Ransom and Yinger (2002). Making Motherhood Safer. The wide range of costs reflects the practical difficulty facing service providers, researchers, policy makers and society in general in meeting the requirements for accurate estimates of reproductive health care costs. These include defining the boundaries of RH, and standardising the content and quality of a given package of care. Questions that continue to engage service providers and policy makers are; How much do reproductive health services at household, community and country level Financing Reproductive Health Services in Africa 109 cost? How much must governments and society spend on RH services to achieve national and global targets. What should be the minimum content of a standard package of care if countries in resource-constrained environments are to meet their targets? Global estimates provide a useful guide to...
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    Infectious Disease Control in Ghana: Government's Interventions and Challenges to Malaria Eradication
    (Water and Sanitation-Related Diseases and the Environment: Challenges, Interventions, and Preventive Measures, 2011-10) Fobil, J.N.; May, J.; Kraemer, A.
    Introduction Ghana Malaria Control Initiatives-Past and Present Successes, Challenges, and Weaknesses of Control Strategies Conclusion and Recommendations References