Research Articles
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A research article reports the results of original research, assesses its contribution to the body of knowledge in a given area, and is published in a peer-reviewed scholarly journal. The faculty publications through published and on-going articles/researches are captured in this community
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Item Comparison of municipal solid waste management systems in Canada and Ghana: A case study of the cities of London, Ontario, and Kumasi, Ghana(Waste Management, 2009) Asase, M.; Yanful, E.K.; Mensah, M.; et al.Integrated waste management has been accepted as a sustainable approach to solid waste management in any region. It can be applied in both developed and developing countries. The difference is the approach taken to develop the integrated waste management system. This review looks at the integrated waste management system operating in the city of London, Ontario-Canada and how lessons can be drawn from the system’s development and operation that will help implement a sustainable waste man agement system in the city of Kumasi, Ghana. The waste management system in London is designed such that all waste generated in the city is handled and disposed of appropriately. The responsibility of each sector handling waste is clearly defined and monitored. All major services are provided and delivered by a combination of public and private sector forces. The sustainability of the waste management in the city of London is attributed to the continuous improvement strategy framework adopted by the city based on the principles of integrated waste man agement. It is perceived that adopting a strategic framework based on the principles of integrated waste management with a strong political and social will, can transform the current waste management in Kumasi and other cities in developing countries in the bid for finding lasting solutions to the problems that have plagued the waste management system in these cities.Item The investigation of a class of capacitated arc routing problems: the collection of garbage in developing countries(Waste Management, 2004) Amponsah, S.K.; Salhi, S.The collection, transport and disposal of solid waste, which is a highly visible and important municipal service, involves a large expenditure but receives, scant attention. This problem is even more crucial for large cities in developing countries due to the hot weather. A constructive heuristic which takes into account the environmental aspect as well as the cost is proposed to solve the routing aspect of garbage collection. This is based on a look-ahead strategy which is enhanced by two additional mechanisms. Interesting results were obtained when tested on instances with and without the presence of the effect of the environment.Item Violence against women in Ghana: a look at women's perceptions and review of policy and social responses(Social Science & Medicine, 2004) Amoakohene, M.I.This study examines violence against women in Ghana and how it affects and is perceived by them. It looks at violence as experienced by Ghanaian women of varying ages, socio-economic status and professional standing. It defines domestic violence as violence intentionally perpetrated by husbands or male partners-people known to be intimate associates. Domestic violence is approached from a multidimensional perspective by examining the multiple facets of violence against women: sexual, socio-economic. cultural, pseudo-religious and mental torture. Women's perceptions of their rights, responsibilities, duties and abuses or violations are evaluated using open-endedqualitative questions in two major cities in Ghana: Accra and Kurnasi, Policy responses to domestic violence are then examined by first reviewing what provisions exist in the country's constitution to address the problem and then the specific steps the government itself has taken. Civil society's response in the form of activities by non-governmental organizations is also reviewed. Finally, the effects of domestic violence on women's health and well-being are examined and suggestions for addressing the problem are made. 9 2004 Elsevier Ltd. All rights reserved.Item Researching Radio Audiences in an Emerging Pluralistic Media Environment: A Case for the Focus Group Discussion (FGD) Method(Africa Media Review, 2004) Amoakohene, M.I.The central thesis of this article is that the focus group discussion method of the qualitative research methodology has huge and largely unexploited potentials for use as a tool for audience research in a new democracy with a newly liberated media environment. It argues that the use of the method by Paul Lazarsfeld, Robert Merton and their colleagues at the Bureau of Applied Social Research at Columbia University to gauge audience responses and reactions to propaganda and radio broadcasts set the pace for its use in audience research. Through extensive use in, and adaptations to, different research environments, focus groups have demonstrated an ability to function as fully-fledged methods of data collection. The article examines literature on the history, development, and use of focus groups in many fields of study including media and communication to show that the method has advantages for audience research in a competitive media market. Through this perspective, and with reference to a number of studies carried out by the author in Ghana using this method, it recognises focus group research as an appropriate method for researching media, especially radio, audiences and recommends it to media owners.Item Application of the WHO Keys of Safer Food to Improve Food Handling Practices of Food Vendors in a Poor Resource Community in Ghana(International Journal of Environmental Research and Public Health, 2009) Donkor, E.S.; Kayang, B.B.; Quaye, J.; Akyeh, M.L.Data was collected from food vendors in a poor resource community in Ghana, which showed that the vendors constituted an important source of oro-faecal transmission. Following this, the WHO five keys of safer food were utilized in an evidence based training programme for the vendors to improve their food handling practices. Impact assessment of the food safety training showed that 67.6% of the vendors had acquired some knowledge from the workshop and were putting it into practice. Lack of food safety equipment was a major hinderance to behavioral change among the vendors as far food handling practices are concerned.Item TRIPS, the Doha Declaration and increasing access to medicines: policy options for Ghana(Globalization and Health, 2005) Cohen, J.C.; Gyansa-Lutterodt, M.; Torpey, K.; et al.There are acute disparities in pharmaceutical access between developing and industrialized countries. Developing countries make up approximately 80% of the world's population but only represent approximately 20% of global pharmaceutical consumption. Among the many barriers to drug access are the potential consequences of the Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Many developing countries have recently modified their patent laws to conform to the TRIPS standards, given the 2005 deadline for developing countries. Safeguards to protect public health have been incorporated into the TRIPS Agreement; however, in practice governments may be reluctant to exercise such rights given concern about the international trade and political ramifications. The Doha Declaration and the recent Decision on the Implementation of Paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health may provide more freedom for developing countries in using these safeguards. This paper focuses on Ghana, a developing country that recently changed its patent laws to conform to TRIPS standards. We examine Ghana's patent law changes in the context of the Doha Declaration and assess their meaning for access to drugs of its population. We discuss new and existing barriers, as well as possible solutions, to provide policy-makers with lessons learned from the Ghanaian experience.Item Task-shifting HIV counselling and testing services in Zambia: the role of lay counsellor(Human Resources for Health, 2009) Sanjana, P.; Torpey, K.; Schwarzwalder, A.; et al.Background: The human resource shortage in Zambia is placing a heavy burden on the few health care workers available at health facilities. The Zambia Prevention, Care and Treatment Partnership began training and placing community volunteers as lay counsellors in order to complement the efforts of the health care workers in providing HIV counselling and testing services. These volunteers are trained using the standard national counselling and testing curriculum. This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. Methods: Quantitative and qualitative data were collected by means of semistructured interviews from all active lay counsellors in each of the facilities and a facility manager or counselling supervisor overseeing counseling and testing services and clients. At each of the 10 selected facilities, all counselling and testing record books for the month of May 2007 were examined and any recordkeeping errors were tallied by cadre. Qualitative data were collected through focus group discussions with health care workers at each facility. Results: Lay counsellors provide counselling and testing services of quality and relieve the workload of overstretched health care workers. Facility managers recognize and appreciate the services provided by lay counsellors. Lay counsellors provide up to 70% of counselling and testing services at health facilities. The data review revealed lower error rates for lay counsellors, compared to health care workers, in completing the counselling and testing registers. Conclusion: Community volunteers, with approved training and ongoing supervision, can play a major role at health facilities to provide counselling and testing services of quality, and relieve the burden on already overstretched health care workers.Item Prevention of mother-to-child transmission of HIV in Zambia: implementing efficacious ARV regimens in primary health center(BMC Public Health, 2009) Mandala, J.; Torpey, K.; Kasonde, P.; et al.Background: Safety and effectiveness of efficacious antiretroviral (ARV) regimens beyond single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (PMTCT) have been demonstrated in well-controlled clinical studies or in secondary- and tertiary-level facilities in developing countries. This paper reports on implementation of and factors associated with efficacious ARV regimens among HIV-positive pregnant women attending antenatal clinics in primary health centers (PHCs) in Zambia. Methods: Blood sample taken for CD4 cell count, availability of CD4 count results, type of ARV prophylaxis for mothers, and additional PMTCT service data were collected for HIV-positive pregnant women and newborns who attended 60 PHCs between April 2007 and March 2008. Results: Of 14,815 HIV-positive pregnant women registered in the 60 PHCs, 2,528 (17.1%) had their CD4 cells counted; of those, 1,680 (66.5%) had CD4 count results available at PHCs; of those, 796 (47.4%) had CD4 count d 350 cells/mm3 and thus were eligible for combination antiretroviral treatment (cART); and of those, 581 (73.0%) were initiated on cART. The proportion of HIV-positive pregnant women whose blood sample was collected for CD4 cell count was positively associated with (1) blood-draw for CD4 count occurring on the same day as determination of HIV-positive status; (2) CD4 results sent back to the health facilities within seven days; (3) facilities without providers trained to offer ART; and (4) urban location of PHC. Initiation of cART among HIV positive pregnant women was associated with the PHC's capacity to provide care and antiretroviral treatment services. Overall, of the 14,815 HIV-positive pregnant women registered, 10,015 were initiated on any type of ARV regimen: 581 on cART, 3,041 on short course double ARV regimen, and 6,393 on sdNVP. Conclusion: Efficacious ARV regimens beyond sdNVP can be implemented in resource-constrained PHCs. The majority (73.0%) of women identified eligible for ART were initiated on cART; however, a minority (11.3%) of HIV-positive pregnant women were assessed for CD4 count and had their test results available. Factors associated with implementation of more efficacious ARV regimens include timing of blood-draw for CD4 count and capacity to initiate cART onsite where PMTCT services were being offered.Item Cost-Effectiveness of HIV Screening of Blood Donations in Accra (Ghana)(International Society for Pharmacoeconomics and Outcomes Research (ISPOR), 2008) Hulst, M.V; Sagoe, K.W.C.; Torpey, K.; et al.Objectives: Areas with high HIV-incidence rates compared to the developed world may benefit from additional testing in blood banks and may show more favorable cost-effectiveness ratios. We evaluated the cost-effectiveness of adding p24 antigen, mini pool nucleic acid amplification testing (MP NAT), or individual donation NAT (ID-NAT) to the HIV antibody screening at the Korle Bu Teaching Hospital (Accra, Ghana), where currently only HIV-antibody screening is undertaken. Methods: The residual risk of HIV transmission was derived from blood donations to the blood bank of the Korle Bu Teaching Hospital in 2004. Remaining life expectancies of patients receiving blood transfusion were estimated using the World Health Organization life expectancies. Cost effectiveness ratios for adding the tests to HIV-antibody screening only were determined using a decision tree model and a Markov model for HIV. Results: The prevalence of HIV was estimated at 1.51% in 18,714 donations during 2004. The incremental cost per disability-adjusted life-year (DALY) averted was US$1237 for p24 antigen, US$3142 for MP-NAT and US$7695 com pared to the next least expensive strategy. HIV-antibody screening itself was cost-saving compared to no screening at all, gaining US$73.85 and averting 0.86 DALY per transfused patient. Up to a willingness-to-pay of US$2736 per DALY averted, HIV-antibody screening without additional testing was the most cost-effective strategy. Over a willingness-to pay of US$11,828 per DALY averted, ID-NAT was signifi cantly more cost-effective than the other strategies. Conclusions: Adding p24 antigen, MP-NAT, or ID-NAT to the current antibody screening cannot be regarded as a cost effective health-care intervention for GhanaItem Improving the laboratory diagnosis of TB in Ghana: the impact of a quality assurance system(International Journal of Tuberculosis Lung Disease, 2006) Addo, K.K.; Minamikawa, M.; Lienhardt, C.; Akpedonu, P.; Ofori-Adjei, D.; et al.SETTING: Greater Accra Region, Ghana. OBJECTIVE: To establish a pilot quality assurance (QA) system in sputum smear microscopy and to evaluate its impact. DESIGN: Quarterly supporting visits were paid to participating laboratories between 2000 and 2002. Fifteen examined slides were selected randomly from each laboratory during the visits and blindly re-assessed. Feedback was given promptly to the various laboratories. Training and stakeholder workshops were organised whenever necessary. RESULTS: General improvements in smear preparation and staining as well as the reading ability of the laboratory personnel included in the study were observed. The average marks for specimen quality, staining ability, smear cleanness, thickness, size and evenness increased from 64%, 79%, 69%, 46%, 67% and 60% in the last quarter of 2000 to 81%, 90%, 86%, 79%, 80% and 74%, respectively, 24 months after the establishment of the QA system. Within the same period, the rate of false positives and -negatives decreased from respectively 14.8% and 20.5% to 0%, and agreements in positivity grade increased from 74% to 95%. The performance of the participating laboratories in keeping the laboratory registers up to date also improved. CONCLUSION: The QA system needs to be extended to the rest of the country.