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 Pilot implementation of community health advocacy teams to improve the e(Frontiers in Public Health, 2023) Dako-Gyeke, P.; Hornuvo, R.; Glozah, F.N.; Asampong, E.; Tabong, P.T-N.; Nwameme, A.; Chandi, G.M.; Peprah, N.Y.; Gittelman, D.; Adongo, P.B.Introduction: In Ghana, the National Malaria Elimination Programme (NMEP) distributes long-lasting insecticide net (LLIN) to households for free through the periodic point mass distribution (PMD) campaign and continuous distribution to populations most vulnerable to malaria. Methods: A qualitative research approach was used among 43 CHAT members across six communities in the Eastern and Volta regions of Ghana. The CHAT constitutes significant community actors whose roles are centred on key elements of community/social mobilisation and capacity building, all nested in social and behaviour change communication (SBCC) strategies. The CHATs were pilot implemented in all study communities for 4 months after which we identified opportunities and barriers during implementation. CHAT members participated in six focus group discussions which were audio recorded, transcribed verbatim, and analysed thematically using the NVivo 13. Results: CHATs were instrumental in sensitising community members through SBCC strategies. Moreover, there were changes in the behaviour of community members who were receptive towards and participated in CHAT activities. Community members were accurately informed about malaria (e.g., causes and preventive measures). However, the CHAT experienced barriers during implementation, including a lack of financial support to aid in transportation, organisation of meetings, and outreach activities. Additionally, the level of participation by CHAT members in activities and the medium of communication among members were key areas of concern. Conclusion: The CHATs would be instrumental in promoting LLINs’ use during and after PMD campaigns through community outreaches. It is therefore necessary to provide resources to support their operations and a good network to address communication barriers. Finally, continuous capacity strengthening of CHAT members by the NMCP is important.Item Evaluation of the malaria surveillance system – Adaklu District, Volta Region, Ghana, 2019(Public Health in Practice, 2023) Agbemafle, E.E.; Kubio, C.; Bandoh, D.; Odikro, M.A.; Azagba, C.K.; Issahaku, R.G.Objectives: We evaluated the malaria surveillance system in Adaklu District of the Volta Region of Ghana to determine if the system was meeting its objectives and assessed its usefulness and attributes. Study design: Descriptive cross-sectional design was used in evaluating the surveillance system. Methods: We interviewed stakeholders using a semi-structured questionnaire on case detection and reporting. We assessed the system attributes using the Centers for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems. We extracted and reviewed malaria surveillance data from the District Health Management Information System 2. Summary statistics and direct content analysis were per formed on quantitative and qualitative data respectively. Results: Of the 80,441 suspected malaria cases recorded in Adaklu District from 2014 to 2018, 47,917 (59.6%) cases were confirmed. The system was meeting its objective of detecting malaria cases and monitoring trends in the population however, the system missed an epidemic in August 2016. Data generated from the surveillance system is used by the NMCP to aid in the distribution of logistics such as LLINs, RDT test kits, and track malaria control progress in the district. Staff at all levels were able to detect, confirm, treat and report malaria. All sub districts/health facilities reported to the district and reports were all accurate and timely. The predictive value positive was 62.9%. Conclusions: The malaria surveillance system in Adaklu District was useful and meeting its set objective of monitoring trends of malaria in the population. It was simple, flexible, acceptable and representative; however, the system was not detecting epidemics. The District Health Management Team should set alert and epidemic thresholds to help detect promptly epidemics of malaria in the district.Item Predictors of mosquito bed net use among children under-fves in Ghana: a multilevel analysis of the 2019 malaria indicator survey(Malaria Journal, 2023) Aheto, J.M.K.; Babah, R.; Dzokoto, M.K.; Kwarah, W.; Alhassan, Y.Background Morbidities and mortalities due to malaria can be prevented by the use of insecticide-treated mosquito bed nets (ITN), which has been proven for malaria control and elimination. The purpose of this study was to assess the critical factors that predict the use of ITN among children under-fives in Ghana. Methods The study utilized data from the 2019 Ghana Malaria Indicator Survey (GMIS). The outcome variable was mosquito bed net use among children under-fives. To determine critical factors that independently predict ITN use, multilevel multivariable logistic regression was employed using Stata version 16. Odds ratios and associated 95% confidence intervals and p-values were reported. A p<0.05 was used to declare statistical significance. Results The overall prevalence of ITN usage was 57.4%. Utilization of bed nets was 66.6% in the rural areas and 43.5% in the urban areas, was highest in the Upper West region (80.6%) even when stratified to rural (82.9%) and urban areas (70.3%) whilst Greater Accra region (30.5%, rural=41.7%, urban=28.9%) had the least. The community level multi level analysis showed that bed net utilization was higher among children in rural areas [AOR=1.99, 95% CI 1.32–3.01, p=0.001] and in household with wooden wall materials [AOR=3.29, 95% CI 1.15–9.40, p=0.027]. Bed net utilization was however, less for households with 3+children under-fve [AOR=0.29, 95% CI 0.19–0.46, p<0.001), 4 years old (AOR=0.66, 95% CI 00.48–00.92, p=0.014], without universal access to bed net [AOR=0.52, 95% CI 0.37–0.73, p<0.001], those in the Greater Accra [AOR=0.26, 95% CI 0.13–0.51, p<0.001], Eastern [AOR=0.47, 95% CI 0.23–0.95, p=0.036], Northern [AOR=0.42, 95% CI 0.20–0.88, p=0.022], middle [AOR=0.57, 95% CI 0.35–0.94, p=0.026] and rich/richest [AOR=0.51, 95% CI 0.29–0.92, p=0.025] household wealth quintile. Substantial unobserved household and community level differences in bed net use were found. Conclusion This study demonstrates the need to intensify promotion of ITN use to those in urban areas, Greater Accra, Eastern and Northern regions, houses without wooden wall materials, middle and rich/richest households. Interventions should be targeted at older children and households with more under-five children and to ensure full access and use of ITNs among all children under-fives in each household as part of the overall goal of achieving the health-related SDGs.Item Predictors of mosquito bed net use among children under-fives in Ghana: a multilevel analysis of the 2019 malaria indicator survey(BioMed Central Ltd, 2023) Dzokoto, M.K.; Aheto, J.M. K.; Babah, R.; et al.Abstract Background Morbidities and mortalities due to malaria can be prevented by the use of insecticide-treated mosquito bed nets (ITN), which has been proven for malaria control and elimination. The purpose of this study was to assess the critical factors that predict the use of ITN among children under-fves in Ghana. Methods The study utilized data from the 2019 Ghana Malaria Indicator Survey (GMIS). The outcome variable was mosquito bed net use among children under-fves. To determine critical factors that independently predict ITN use, multilevel multivariable logistic regression was employed using Stata version 16. Odds ratios and associated 95% confdence intervals and p-values were reported. A p<0.05 was used to declare statistical signifcance. Results The overall prevalence of ITN usage was 57.4%. Utilization of bed nets was 66.6% in the rural areas and 43.5% in the urban areas, was highest in the Upper West region (80.6%) even when stratifed to rural (82.9%) and urban areas (70.3%) whilst Greater Accra region (30.5%, rural=41.7%, urban=28.9%) had the least. The community level multilevel analysis showed that bed net utilization was higher among children in rural areas [AOR=1.99, 95% CI 1.32–3.01, p=0.001] and in household with wooden wall materials [AOR=3.29, 95% CI 1.15–9.40, p=0.027]. Bed net utilization was however, less for households with 3+children under-fve [AOR=0.29, 95% CI 0.19–0.46, p<0.001), 4 years old (AOR=0.66, 95% CI 00.48–00.92, p=0.014], without universal access to bed net [AOR=0.52, 95% CI 0.37–0.73, p<0.001], those in the Greater Accra [AOR=0.26, 95% CI 0.13–0.51, p<0.001], Eastern [AOR=0.47, 95% CI 0.23–0.95, p=0.036], Northern [AOR=0.42, 95% CI 0.20–0.88, p=0.022], middle [AOR=0.57, 95% CI 0.35–0.94, p=0.026] and rich/richest [AOR=0.51, 95% CI 0.29–0.92, p=0.025] household wealth quintile. Substantial unobserved household and community level diferences in bed net use were found. Conclusion This study demonstrates the need to intensify promotion of ITN use to those in urban areas, Greater Accra, Eastern and Northern regions, houses without wooden wall materials, middle and rich/richest households. Interventions should be targeted at older children and households with more under-fve children and to ensure full access and use of ITNs among all children under-fves in each household as part of the overall goal of achieving the health-related SDGs.Item Prevalence of malaria infection and the impact of mosquito bed net distribution among children aged 6–59 months in Ghana: Evidence from the Ghana demographic health and malarial indicator surveys(Parasite Epidemiology and Control, 2023) Tetteh, J.; Yorke, E.; Boima, V.; Yawson, A.E.Objective: To assess the prevalence of malaria infection and further quantify the impact of mosquito bed net distribution on malaria infection among children aged 6–59 months in Ghana. Methods: A cross-sectional study using Ghana Demographic Health (GDHS) and Malaria Indicator (GMIS) surveys (2014 GDHS, 2016 GMIS, and 2019 GMIS). The exposure and the main outcomes were mosquito bed net use (MBU) and malaria infection (MI). Relative percentage change (Δ) and prevalence ratio (PR) were estimated to assess the changes and the risk of MI by MBU respec tively. The Propensity-score matching treatment effect model was employed to estimate the average treatment effect (ATE) of MBU on MI. All analyses were performed using Stata 16.1 and p-value<0.05 was deemed significant. Results: The study involved 8781 children aged 6–59 months. MI ranged from 25.8%(22.3–29.7) in 2019 GMIS to 40.6%(37.0–44.2) in 2014 GDHS and the prevalence was significantly high among children who used mosquito bed net. The relative percentage change in MI prevalence showed a significant reduction rate and was high among non-MBU (p-value<0.05). In all, the adjusted PR of MI among children exposed to MBU was 1.21(1.08–1.35), 1.13(1.01–1.28), and 1.50(1.20–1.75) in 2014 GDHS, 2016 GMIS, and 2019 GMIS respectively. The average MI among participants who slept in mosquito bed net significantly increased by 8%(0.04 to 0.12), 4%(0.003 to 0.08), and 7%(0.03 to 0.11) in 2014 GDHS, 2016 GMIS, and 2019 GMIS respectively. Conclusion: Even though malaria infection prevalence among children aged 6–59 months is decreasing, the reduction rate seems not to be directly linked with mosquito bed nets distribution and/or use in Ghana. For a continued distribution of mosquito bed nets, and for Ghana to achieve her Malaria Strategic Plan (NMSP) 2021–2025, program managers should ensure effective use of the distributed nets in addition to other preventive measures and nuanced consideration of community behaviours in Ghana. The effective use and care of bed nets should be emphasized as part of the distribution.Item Cost of inappropriate prescriptions for uncomplicated malaria in Ghana(Malaria Journal, 2023) Aryeetey, G.C.; Nonvignon, J.; Malm, K.; et al..Background Malaria remains a common course of morbidity in many sub-Saharan African countries. While treatment options have improved in recent times, inappropriate prescription seems conventional among providers, increasing the burden on patients and society. This study examined the cost of inappropriate prescriptions for uncomplicated malaria treatment in Ghana. Methods This study used retrospective data collected from January to December 2016 in 27 selected facilities, under different ownership in three regions of the country, mainly Volta, Upper East and Brong Ahafo. Stratified random sampling technique was used to extract 1625 outpatient folders of patients diagnosed and treated for malaria. Two physicians independently reviewed patient folders according to the stated diagnoses. Malaria prescriptions were described as inappropriate when they do not adhere to the standard treatment guidelines. The economic cost was mainly treatment cost which was sourced as medication cost. Total and average costs for country were calculated using sample estimates and the total number of uncomplicated malaria cases that received inappropriate prescriptions. Results The study revealed that patients received an average of two prescriptions per malaria episode. Artemether lumefantrine (AL) was the major malaria medication (79.5%) prescribed to patients. Other medications usually antibiotics and vitamins and minerals were included in the prescription. More than 50% of prescribers did not follow the guidelines for prescribing medications to clients. By facility type, inappropriate prescription was high in the CHPS compounds (59.1%) and by ownership, government (58.3%), private (57.5%) and mission facilities (50.7%). Thus, about 55% of malaria prescriptions were evaluated as inappropriate during the review period, which translates into eco nomic cost of approximately US$4.52 million for the entire country in 2016. The total cost of inappropriate prescription within the study sample was estimated at US$1,088.42 while the average cost was US$1.20. Conclusion Inappropriate prescription for malaria is a major threat to malaria management in Ghana. It presents a huge economic burden to the health system. Training and strict enforcement of prescribers’ adherence to the standard treatment guideline is highly recommended..Item Nationwide Surveillance of Pfhrp2 Exon 2 Diversity in Plasmodium falciparum Circulating in Symptomatic Malaria Patients Living in Ghana(The America Journal of Hygiene and Health, 2022) Bredu, D.G.; Ahadzi, G.K.; Donu, D.; et al.Reports of increasing false-negative HRP2-based rapid diagnostic test results across Africa require constant monitoring of factors associated with these false-negative outcomes, as failure of this diagnostic tool will have severe conse quences on malaria treatment and control programs. This study characterized the extent of genetic diversity in the Plasmo dium falciparum histidine-rich protein 2 (Pfhrp2) gene in P. falciparum isolates from symptomatic malaria patients across the regions of Ghana. Exon 2 of Pfhrp2 was amplified from gDNA using polymerase chain reaction. All Pfhrp2-negative samples were subjected to Pf18S rRNA and Pfmsp2 gene amplifications. The amplified Pfhrp2 exon 2 fragments from clonal samples were sent for commercial Sanger sequencing. The type and number of PfHRP2 repeats, classified based on repeat types pre viously reported, were estimated from the sequence data and compared among geographical regions. About 81% (2,333/ 2,890) of the original microscopy positive dried blood spot (DBS) samples were available and used in this study. The Pfhrp2 exon 2 amplification was successful in 98.5% (2,297/2,333) of the tested samples, with band size ranging from 400 bp to 1,050 bp. A total of 13 out of the 24 previously reported repeat types were identified among the samples, with three samples lacking both type 2 and type 7 repeat motifs. This study suggested that the genetic diversity of Pfhrp2 exon 2 identified in P. falciparum circulating in symptomatic malaria patients in Ghana is unlikely to influence the sensitivity and specificity of HRP2 RDT-based diagnosis.Item Impact evaluation of long-lasting insecticidal nets distribution campaign on malaria cases reported at outpatient departments across all the regions in Ghana(Afagbedzi et al. Malaria Journal, 2022) Afagbedzi, S.K.; Alhassan, Y.; Guure, C.Background: Malaria remains the biggest public health challenge globally, and Ghana is among the 15 highest burden malaria countries in the world, with 2% of global malaria cases and 3% deaths in 2019. This study sought to assess the impact of mass LLIN distribution campaign on malaria morbidity using all health facilities outpatient data across 15 regions of Ghana. Methods: Data for this study was obtained from the DHIMS2 for health facilities providing OPD and malaria services in Ghana. This was an ecological study that employed the difference-in-difference approach to assess the change in proportion of uncomplicated confirmed malaria cases among OPDs in all types of health facilities in Ghana between 2015 and 2019 following the mass distribution campaign of LLINs in 2018. Malaria cases at the OPDs before and after the free LLIN mass distribution exercise were evaluated. Results: The trend of the proportion of OPD cases that were confirmed uncomplicated malaria cases increased from 14.8% in 2015 to 18.9% in 2019 at the national level. The average proportion of malaria cases among OPDs in Ghana in 2019 reduced against the expected by − 3.76% (95% CI − 4.69 to − 2.84], p<0.001) among all cases, − 4.52% (95% CI [− 5.70 to − 3.34], p<0.001) among children under-five years, − 4.10% (95% CI − 5.3 to 2.9], p<0.001) among female children under-five and − 5.18% (95% CI [− 6.33 to − 4.02], p<0.001) among male children under-five. The reduction on the average proportion of malaria cases among OPDs varied significantly across regions and the type of health facilities. Conclusion: The mass distribution of LLINs across Ghana in 2018 can be associated with reduction in the proportion of malaria cases among OPDs across health facilities in Ghana. The study recommends the biannual mass distribution campaigns especially in the high-density regionsItem Comparison of the impact of allelic polymorphisms in PfAMA1 on the induction of T Cell responses in high and low malaria endemic communities in Ghana(Springer Nature, 2021) Ofori, E.A.; Tetteh, J.K.A.; Frimpong, A.; Ganeshan, H.; Belmonte, M.; Peters, B.; Villasante, E.; Sedegah, M.; Ofori, M.F.; . Kusi, K.A.Background: Malaria eradication requires a combined effort involving all available control tools, and these efforts would be complemented by an effective vaccine. The antigen targets of immune responses may show polymorphisms that can undermine their recognition by immune effectors and hence render vaccines based on antigens from a single parasite variant ineffective against other variants. This study compared the influence of allelic polymorphisms in Plasmodium falciparum apical membrane antigen 1 (PfAMA1) peptide sequences from three strains of P. falciparum (3D7, 7G8 and FVO) on their function as immunodominant targets of T cell responses in high and low malaria transmission communities in Ghana. Methods: Peripheral blood mononuclear cells (PBMCs) from 10 subjects from a high transmission area (Obom) and 10 subjects from a low transmission area (Legon) were tested against 15 predicted CD8 + T cell minimal epitopes within the PfAMA1 antigen of multiple parasite strains using IFN-γ ELISpot assay. The peptides were also tested in similar assays against CD8 + enriched PBMC fractions from the same subjects in an effort to characterize the responding T cell subsets. Results: In assays using unfractionated PBMCs, two subjects from the high transmission area, Obom, responded positively to four (26.7%) of the 15 tested peptides. None of the Legon subject PBMCs yielded positive peptide responses using unfractionated PBMCs. In assays with CD8 + enriched PBMCs, three subjects from Obom made positive recall responses to six (40%) of the 15 tested peptides, while only one subject from Legon made a positive recall response to a single peptide. Overall, 5 of the 20 study subjects who had positive peptide-specific IFN-γ recall responses were from the high transmission area, Obom. Furthermore, while subjects from Obom responded to peptides in PfAMA1 from multiple parasite strains, one subject from Legon responded to a peptide from 3D7 strain only. Conclusions: The current data demonstrate the possibility of a real effect of PfAMA1 polymorphisms on the induction of T cell responses in malaria exposed subjects, and this effect may be more pronounced in communities with higher parasite exposure.Item High frequency of the Dufy-negative genotype and absence of Plasmodium vivax infections in Ghana(Malaria Journal, 2021) Brown, C.A.; Pappoe‑Ashong, P.J.; Duah, N.; Ghansah, A.; Asmah, H.; Afari, E.; Koram, K.A.Background: Recent studies from diferent malaria-endemic regions including western Africa have now shown that Plasmodium vivax can infect red blood cells (RBCs) and cause clinical disease in Dufy-negative people, though the Dufy-negative phenotype was thought to confer complete refractoriness against blood invasion with P. vivax. The actual prevalence of P. vivax in local populations in Ghana is unknown and little information is available about the distribution of Dufy genotypes. The aim of this study was to assess the prevalence of P. vivax in both asymptomatic and symptomatic outpatients and the distribution of Dufy genotypes in Ghana. Methods: DNA was extracted from dried blood spots (DBS) collected from 952 subjects (845 malaria patients and 107 asymptomatic persons) from nine locations in Ghana. Plasmodium species identifcation was carried out by nested polymerase chain reaction (PCR) amplifcation of the small-subunit (SSU) rRNA genes. For P. vivax detection, a second PCR of the central region of the Pvcsp gene was carried out. Dufy blood group genotyping was performed by allele-specifc PCR to detect the presence of the FYES allele. Results: No cases of P. vivax were detected in any of the samples by both PCR methods used. Majority of infections (542, 94.8%) in the malaria patient samples were due to P. falciparum with only 1 infection (0.0017%) due to Plasmo dium malariae, and 2 infections (0.0034%) due to Plasmodium ovale. No case of mixed infection was identifed. Of the samples tested for the FYES allele from all the sites, 90.5% (862/952) had the FYES allele. All positive samples were genotyped as FY*B-33/FY*B-33 (Dufy-negative homozygous) and therefore classifed as Fy(a−b−). Conclusions: No cases of P. vivax were detected by both PCRs and majority of the subjects tested carried the FYES allele. The lack of P. vivax infections observed can be attributed to the high frequency of the FYES allele that silences erythroid expression of the Dufy. These results provide insights on the host susceptibility for P. vivax infections that had not been investigated in Ghana before.