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A long essay or dissertation or thesis involving personal research, written by postgraduates of University of Ghana for a university degree.
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Item Low Uptake Of Intermittent Preventive Treatment (IPT) For Malaria Among Pregnant Women In Selected Health Facilities In Shai-Osudoku District, Greater Accra, Ghana.(University Of Ghana, 2019-12) Camara, D.Background: Malaria remains a global public health issue despite increased efforts to control is transmission. In sub-Saharan Africa where malaria is endemic, incident malaria infecction during pregnancy has been reported to account for 20% of stillbirths and about 11% of the deaths of newborns. Since October 2012, Sulphadoxine-Pyrimethamine has been recommended by the World Health Organization for treatment of malaria infection during pregnancy usisg the intermittent preventive treatment (IPT) approach. Despite its effectiveness, uptake of Intermittent Preventive Treatment of Malaria in Pregnancy using Sulphadoxine-Pyrimethamine (IPTp-SP) is usually low. In the Shai-Osudoku District where the current study was conducted, uptake of three doses of IPT (IPT3) in pregnant women was as low as 37.9% with only 6.4% of registred ANC attendants receiving five doses of IPTp-SP in 2018. The present study therefore sought to evaluate the factors underpinning the prevailing low rates of IPTp-SP uptake in selected health facilities in the Shai-Osudoku. Methods: A cross-sectional study was conducted and included 400 registered mothers who had their anatenatal care (ANC) in the four selected health facilities. Health staff stationed at the ANC clinics were also included in the study. Between July and August 2019, data was collected from ANC records for all nursing mothers included in the study and a strucutred questionnaire was used to assess participants’ knowledge on IPTp-SP. Univariate analysis was conducted using the Chi-Square tests and logistic regression models were fitted to assess the association of predictor variables (factors) with low IPTp-SP uptake. Results Of the 400 registered mothers included in the study, only 11% received five doses of SP during the recent pregnancy as recommended by the Ghana Health Service whiles less than 61% received a minimum of three doses. In the adjusted logistic regression model, results showed that women who initiated ANC late in pregnancy or had fewer number of visits, experienced untoward effects after taking the medication and resides in urban areas had increased odds of low IPTp-SP uptake. Major predictors of low uptake of SP identified in this study were, knowledge on SP-IPTp, previous experience of side effects of SP-IPTp, age of pregnancy at ANC initiation and total number of ANC visits. A high proportion of nursing mothers in the study sample showed ’very good’ knowledge of malaria (75%, 95% CI: 70.7% -79.4%) with an even higher proportion (81.7%, 95% CI: 77.2%-85.6%) having ’good’ knowledge. For ANC health staff, 85.7% showed ’very good’ knowledge on the effects of incident malaria in pregnant women. Over 57% knew the meaning of IPTp-SP but all knew that Sulphadoxine-Pyrimethamine is the recommended drug for preventing malaria infection during pregnancy. Conclusion: Only 11% of the registered mothers in the present study received the recommended five doses of SP during pregnancy. Such a low rate of uptake could have severe consequences given the effects incident malaria infection during pregnancy. Though the findings of this study suggest that knowledge on malaria and IPTp-SP is high among women and ANC helath staff, efforts have to be intensified to rectify the disconnect between what is known and what is practiced.Item Assessment Of Antiplasmodial Activities Of Selected Herbal Products Used For The Treatment Of Malaria In Ghana(University Of Ghana, 2022-12) Zoiku, F.K.Malaria continues to be a menace in many parts of the world and remains a global public health problem, contributing to high morbidity and mortality especially in developing countries including Ghana. Even though Artermisinin-based Combination Therapies (ACTs) still remain efficacious in the treatment of malaria, most of the populace in Ghana rely heavily on medicinal plants and herbal preparations for the treatment of malaria and other infectious diseases. The seven herbal products were selected based on a preliminary survey conducted on knowledge, perception and consumption of herbal products in Greater Accra Region. The most commonly used Antimalarial herbal medications selected were Away, Givers, Osompa, Typhofa, Malatyphs, Aseda and Geo Manuel Herbal drugs. These herbal drugs were therefore assessed for their antiplasmodial activities using in vitro and ex vivo sensitivity testing on chloroquine (CQ)-sensitive (3D7), CQ-resistant (Dd2) strains of Plasmodium falciparum and Plasmodium berghei. The SYBR-Green 1 fluorescence-based method was used for the analysis. The results showed IC50 values ranging from 1.16μg/ml to 56 μg/ml for all the Plasmodium strains. However, there was a significant difference between the IC50 values of the standard control drugs (p<0.05) for both 3D7 and Dd2 strains. For the mechanism of action, a simple colorimetric inhibition of heme crystallization method was used and the IC50 were determined which ranged from 1.86μg/ml to 122.2μg/ml for the herbal drugs. Cytotoxicity of the herbal drugs were assessed with MTT assay using human red cells and selectivity index ranged from 4.42 to 405.60 with cell viabilities above 60% indicating no in vitro cytotoxic effects to the human red cells. To determine the heavy metal and electrolyte contents of the herbal drugs, atomic spectrometry method was used and the results ranged from 0.1mg/Kg to 12.8mg/kg of the heavy metals with significant differences (p<0.05) among all the seven herbal products. For the electrolytes, results ranged from 1.1mg/kg to 1400mg/Kg with no significant difference (p>0.05) among the herbal drugs. The pH of the selected herbal drugs determined were below 5 (3.56-4.61) indicating acidic nature of the herbal products. High Performance Liquid Chromatography (HPLC) was used to determine the fingerprint of the seven herbal products and the result indicated the presence of varying active compounds from 9 to 16 with no similarities in retention times (min) as compared to other standard drugs used. In conclusion, these results show that the selected herbal drugs have antiplasmodial activities with no cytotoxic effect to human red cells but slightly acidic in natureItem Factors Influencing Health Workers’ Adherence To The Who Intermittent Preventive Treatment For Malaria In Pregnancy Recommendation, Northern Region, Ghana By(University of Ghana, 2021-12) Mohammed, A.GBackground: Although IPTp-SP is a lifesaving WHO recommended preventive intervention for pregnant women in malaria endemic regions, two-thirds of pregnant women do not receive the IPTp-SP doses during their visits to ANC units globally. Optimal health worker adherence to IPTp- SP recommended guidelines can reduce malaria cases, deaths and poor birth outcomes. Assessing the extent of adherence and its associated factors will generate useful pointers to be targeted at the program level. The study determined the factors influencing health workers adherence to the WHO IPTp-SP recommended guidelines in the Northern Region. Methods: A cross-sectional study among 315 health workers in the Northern region was conducted. Data was collected on health workers adherence to the recommended practices through observation using a checklist. A semi-structured questionnaire was used to collect data on health workers’ sociodemographic characteristics, facility-based factors and knowledge level. Facility observations were also conducted using a checklist. Crude and adjusted logistic regression were used at a 5% significance level to determine predictors of the health workers’ adherence, adjusting for clustering. Results: Of the 315 health workers studied, the median age was 29 years (26 – 34 years). Overall, 56.2% (CI 51.0 – 62.0) were adequately adhering to the recommended guidelines. Lower levels of adherence were recorded in health centers 15.6% (5.0 - 33.0) and CHPS compounds 21.2% (11.0 - 35.0). The factors associated with adherence included health workers’ knowledge (aOR 7.31, 95%CI 3.00 – 17.83, p<0.001), job satisfaction (aOR 6.13, 95%CI 4.95 - 7.60, p<0.001), in-service training (aOR 7.01, 95%CI 2.40 - 20.43, p<0.001), supervision (aOR 5.62, 95%CI 3.10 - 10.20,p<0.001), availability of job aids (aOR 3.79, 95%CI 2.82 - 5.10, p<0.001), health workers III experience (aOR 3.01, 95%CI 1.97 – 4.58, p<0.001) and educational level attained (aOR 2.53, 95%CI 1.12 – 5.71, p<0.025). Conclusion: Adherence to the recommended IPTp-SP guidelines is suboptimal in the region, with lower health facilities recording the least adherence levels. Health centers and CHPS facilities should be prioritized in the distribution of limited resources to improve health worker quality of care for antenatal care clients. Keywords: Adherence, Health workers, IPTp-SP, Ghana, Northern Region, Ghana, MalariaItem Factors Influencing Health Workers’ Adherence To The Who Intermittent Preventive Treatment For Malaria In Pregnancy Recommendation, Northern Region, Ghana(University Of Ghana, 2021-12) Mohammed, A.GBackground: Although IPTp-SP is a lifesaving WHO recommended preventive intervention for pregnant women in malaria endemic regions, two-thirds of pregnant women do not receive the IPTp-SP doses during their visits to ANC units globally. Optimal health worker adherence to IPTp- SP recommended guidelines can reduce malaria cases, deaths and poor birth outcomes. Assessing the extent of adherence and its associated factors will generate useful pointers to be targeted at the program level. The study determined the factors influencing health workers adherence to the WHO IPTp-SP recommended guidelines in the Northern Region. Methods: A cross-sectional study among 315 health workers in the Northern region was conducted. Data was collected on health workers adherence to the recommended practices through observation using a checklist. A semi-structured questionnaire was used to collect data on health workers’ sociodemographic characteristics, facility-based factors and knowledge level. Facility observations were also conducted using a checklist. Crude and adjusted logistic regression were used at a 5% significance level to determine predictors of the health workers’ adherence, adjusting for clustering. Results: Of the 315 health workers studied, the median age was 29 years (26 – 34 years). Overall, 56.2% (CI 51.0 – 62.0) were adequately adhering to the recommended guidelines. Lower levels of adherence were recorded in health centers 15.6% (5.0 - 33.0) and CHPS compounds 21.2% (11.0 - 35.0). The factors associated with adherence included health workers’ knowledge (aOR 7.31, 95%CI 3.00 – 17.83, p<0.001), job satisfaction (aOR 6.13, 95%CI 4.95 - 7.60, p<0.001), in-service training (aOR 7.01, 95%CI 2.40 - 20.43, p<0.001), supervision (aOR 5.62, 95%CI 3.10 - 10.20, p<0.001), availability of job aids (aOR 3.79, 95%CI 2.82 - 5.10, p<0.001), health workers III experience (aOR 3.01, 95%CI 1.97 – 4.58, p<0.001) and educational level attained (aOR 2.53, 95%CI 1.12 – 5.71, p<0.025). Conclusion: Adherence to the recommended IPTp-SP guidelines is suboptimal in the region, with lower health facilities recording the least adherence levels. Health centers and CHPS facilities should be prioritized in the distribution of limited resources to improve health worker quality of care for antenatal care clients.Item Factors Associated with Malaria Co-Infection in HIV Positive Children at a Health Facility in Accra(University of Ghana, 2019-07) Tibboh, A.M.Item Impact of Seasonal Malaria Chemoprevention (SMC) On Malaria Morbidity and Mortality Among Children < 5 Years Old in Upper West Region(University of Ghana, 2019-07) Anyagre, J.A.Item Influence of Environmental Sanitation Practices on Prevalence of Malaria Among Children Under Five Years Old in Bankuman in Tema New Town, Ghana(University of Ghana, 2020-10) Ackah, C.A.E.Introduction: In 2018, there was an estimated 219 million episodes of malaria globally, of which approximately 92% were in Africa (WHO, 2019). The poor standard of environmental sanitation plays a significant role in disease transmission, especially for endemic diseases such as malaria in sub-Saharan Africa (Amoran, Onwumbe, Salami & Mautin, 2014). Children under five years old are the most vulnerable group affected by malaria, as they account for over 60% of all malaria deaths worldwide (Ahmed, Mulatu, Elfu, 2021). According to the DHIMS (2019), outpatient malaria cases in children under five years old rose from 545 in 2017 (1.7%) to 612 (2.23%) in 2018 in Tema New Town. Knowledge of how environmental sanitation practices influence malaria prevalence among children under five years old in Tema New Town seems inadequate. Objective: To assess the influence of environmental sanitation practices on malaria prevalence among children under five years old in Bankuman in Tema New Town. Methods: An analytical cross-sectional study design with quantitative methods were used to conduct the study. A multi-stage sampling method was employed, and data were analyzed with STATA 16.0 with chi-square and simple logistic regression. Variables with a p-value less than 0.05 were statistically significant for multiple logistic regression with statistical significance set at Results: The prevalence of malaria among children under five in Tema New Town was 8.5%. Age (AOR: 0.97, 95% CI: 0.94-1.00), No open drainages (AOR: 0.06, 95% CI: 0.01-0.28) No uncovered dustbins (AOR: 0.13, 95% CI: 0.03-0.52), Always de-silting open drains (AOR: 0.07, 95% CI: 0.01-0.70) were found to be significant predictors of Malaria by RDT testing among children under five in Tema New-Town. Conclusion: Malaria prevalence was higher than previous figures reported in Tema New Town and the Greater Accra Region. The use of insecticide-treated mosquito nets, indoor residual spraying, the use of mosquito repellents, and antimalarial prophylaxis, as well as proper waste storage and disposal, proper covering, and regular de-silting of open drains or gutters should be encouraged among residents.Item Factors Associated with Malaria Vaccine Uptake in Sunyani Municipality(University of Ghana, 2020-10) Tabiri, D.Introduction: Malaria has and continues to be a major disease of public health concern affecting several million people worldwide. Ghana together with two other countries started a pilot study on a malaria vaccine (RTS,S) envisaged to prevent 4 in 10 malaria cases and 3 in 10 malaria deaths. However, there was an observed downward trend in monthly coverages of the vaccine in Sunyani Municipal. This study aimed at assessing the factors associated with malaria vaccine uptake in Sunyani Municipality. Methods: The study was a cross-sectional study employing a quantitative approach. A structured questionnaire was administered to parents/caregivers with children eligible to have taken the first three doses of the malaria vaccine by December 2019. Stratified sampling technique was used to select respondents. Ordinal logistic regression analysis was done to determine the association between independent variables and full vaccine uptake. Data was analyzed with STATA version 15 with statistical significance set at 5%. Results: Uptake of RTS,S 1 was 94.1%. However, this figure reduced to 90.6% for RTS,S 2, and 78.1% for RTS,S 3. Timeliness of uptake was 67.7% for RTS,S 1, 51.9% for RTS,S 2 and 54.7% for RTS,S 3. Children with a parent who had been educated up to the tertiary level had 4.72 [AOR: 4.72, 95%CI: 1.27 – 17.55] increased odds of full uptake as compared to those who completed secondary education. Children with parents who thought vaccines were becoming too many for children had 71% [AOR: 0.29, 95%CI: 0.14 – 0.61] reduced odds of full uptake as compared to those who thought otherwise. Parents whose children had suffered fever as an adverse reaction were more likely to send their kids for the malaria vaccine as compared to those who children had ever suffered abscess as an adverse reaction [AOR: 2.27, 95%CI: 1.13 – 5.10]. Conclusion: Uptake of RTS,S 1 and RTS,S 2 in Sunyani Municipality meets WHO’s target coverage for vaccines, however, RTS,S 3 uptake does not. Furthermore, children whose parents/caregivers thought that vaccines were becoming too many for children had comparatively reduced odds of full uptake. The Municipal Health Directorate should therefore put in measures to address this because it has the potential of eroding the gains made through childhood vaccination.Item Factors Associated with Malaria Vaccine Uptake in Sunyani Municipality(University of Ghana, 2020-10) Tabiri, D.Introduction: Malaria has and continues to be a major disease of public health concern affecting several million people worldwide. Ghana together with two other countries started a pilot study on a malaria vaccine (RTS,S) envisaged to prevent 4 in 10 malaria cases and 3 in 10 malaria deaths. This study aimed at assessing the factors associated with malaria vaccine uptake in Sunyani Municipality. Methods: The study was a cross-sectional study employing a quantitative approach. A structured questionnaire was administered to parents/caregivers with children eligible to have taken the first three doses of the malaria vaccine by December 2019. Stratified sampling technique was used to select respondents. Ordinal logistic regression analysis was done to determine the association between the independent variables and full vaccine uptake. Results: Uptake of RTS,S 1 was 94.1%. However, this figure reduced to 90.6% for RTS,S 2, and 78.1% for RTS,S 3. Timeliness of uptake was 67.7% for RTS,S 1, 51.9% for RTS,S 2 and 54.7% for RTS,S 3. Children with a parent who had been educated up to the tertiary level had 4.72 [AOR: 4.72, 95%CI: 1.27 – 17.55] increased odds of full uptake as compared to those who completed secondary education. Children with parents who thought vaccines were becoming too many for children had 71% [AOR: 0.29, 95%CI: 0.14 – 0.61] reduced odds of full uptake as compared to those who thought otherwise. Parents whose children had suffered fever as an adverse reaction were more likely to send their kids for the malaria vaccine as compared to those who children had ever suffered abscess as an adverse reaction [AOR: 2.27, 95%CI: 1.13 – 5.10]. Conclusion: Uptake of RTS,S 1 and RTS,S 2 in Sunyani Municipality meets WHO’s target coverage for vaccines, however, RTS,S 3 uptake does not. Furthermore, there is a growing perception amongst parents/caregivers that vaccines are becoming too many for children which negatively affects uptake. The Municipal Health Directorate should therefore put in measures to address this because it has the potential of eroding the gains made through childhood vaccination.Item Assessment of the Quality of Health Care Rendered to Children Under- Five with Malaria at the Princess Marie Louis Hospital, Accra(University of Ghana, 2017-06) Yahaya, H.Background: In Ghana, there have been gradual declines in malaria mortality over the years, with the institutional case fatality rate among children under five falling from 14.1% in 2000 to 0.6% in 2012 and recently 0.5% in 2015. it is contended that the amount of resources committed to malaria prevention and case management is higher than the gains made. This has raised concerns about the quality of Intervention delivered to patients with or at risk of malaria While there is increasing policy and research interest in this field, there is little attention paid to the quality of care for under-five children suffering from malaria. This study. thus, assesses the quality of care delivered to children under five with malaria at the Princess Marie Louis hospital. Methodology: A quantitative approach using cross-sectional survey design was used to examine the quality of care delivered to children under five diagnosed with malaria A computer generated random sample of 74 staff and 301 parents of children under five who were treated for malaria at the hospital were recruited for the study. The data was statistically analysed with using the Statistical Package for Social Sciences (SPSS) software version 20. Descriptive summary statistics was complemented with regression analysis preceded by Pearson's correlation analyses to draw inferences. Results: The study showed that overall, inputs availability for standard malaria case management was as high as 81.1% and highest in the area of general inputs such as staff, triaging and basic equipment including weighing scales and thermometers (88.8%) whilst anti-malaria medications was the least available (66.6%.). Also, staff compliance with the Ghana Health Service standard protocols for malaria case management was quite high (89.4%) but less than previously reported rate of 90.8%. Parental caretaker satisfaction (as proxy for patient satisfaction) was also moderate (66.1%) and lower than national average. Finally, technical quality indicators had no significant influence on patient satisfaction as pustulated in quality of care models. Conclusion: Staff adherence to standard treatment malaria case management protocols is high but appears to be declining when compared with other studies. Also, anti-malarial availability is much lower than the 98% availability of essential drugs in public health institutions as estimated by the Ghana health service. Addressing these would improve technical quality of care; they may not necessarily impact positively on subjective quality which was moderate and below reported national average. In-depth exploration for innovative and customer-oriented approaches is recommended to boost patient satisfaction.