Outreach Training and Supportive Supervision (OTSS) of malaria services at health facilities has been adopted by numerous malaria-endemic countries. The OTSS model is characterized by a hands-on method to enhance national guidelines and supervision tools, train supervisors, and perform supervision visits. An independent evaluation was conducted to evaluate the effectiveness of OTSS on health worker competence in the clinical management of malaria, parasitological diagnosis, and prevention of malaria in pregnancy. From 2018 to 2021, health facilities in Cameroon, Ghana, Niger, and Zambia received OTSS visits during which health workers were observed directly during patient consultations, and supervisors completed standardized checklists to assess their performance. Mixed-effects logistic regression models were developed to assess the impact of increasing OTSS visit number on a set of eight program-generated outcome indicators, including overall competency and requesting a confirmatory malaria test appropriately. Seven of eight outcome indicators showed evidence of beneficial effects of increased OTSS visits. Odds of health workers reaching competency thresholds for the malaria-in-pregnancy checklist increased by more than four times for each additional OTSS visit (odds ratio [OR], 4.62; 95% CI, 3.62-5.88). Each additional OTSS visit was associated with almost four times the odds of the health worker foregoing antimalarial prescriptions for patients who tested negative for malaria (OR, 3.80; 95% CI, 2.35-6.16). This evaluation provides evidence that successive OTSS visits result in meaningful improvements in indicators linked to quality case management of patients attending facilities for malaria diagnosis and treatment, as well as quality malaria prevention services received by women attending antenatal services.

Abstract Background: Lifestyle interventions are key to the control of diabetes and the prevention of complications, especially when used with pharmacological interventions. This protocol aims to review the effectiveness of lifestyle interventions in relation to nutrition and physical activity within the West African region. This systematic review and meta analysis seeks to understand which interventions for lifestyle modification are implemented for the control of diabetes in West Africa at the individual and community level; what evidence is available on their effectiveness in improving glycaemic control; and why these interventions were effective. Methods:We will review randomised control trials and quasi-randomised control trials on physical activity and nutrition interventions within adult populations from all 16 West-African countries. Language will be restricted to English and French as these are the most widely spoken languages in the region. No other filters will be applied. Searching will involve 4 electronic databases - Pubmed, Scopus, and Africa Journals Online and Cairn.info using natural-language phrases plus reference/citation checking. Two reviewers will independently screen results according to titles and abstracts against the inclusion and exclusion criteria to identify eligible studies. Upon full text review, all selected studies will be assessed using Cochrane’s Collaboration tool for assessing the risk of bias of a study and the data will be extracted. Evidence will be synthesised narratively and statistically where appropriate. We will conduct a meta-analysis when the interventions and contexts are similar enough for pooling and compare the treatment effects of the interventions in rural to urban settings and short term to long term wherever possible. Discussion: We anticipate finding a number of studies missed by previous reviews and providing evidence of the effectiveness of different nutrition and physical activity interventions within the context of West Africa. This knowledge will support practitioners and policymakers in the design of interventions that are fit for context and purpose within the West African region. Registration: This systematic review has been registered in the International Prospective Register for Systematic Reviews - PROSPERO, with registration number CRD42023435116. All amendments to this protocol during the process of the review will be explained accordingly.

Most hypertension-related genome-wide association studies (GWASs) focus on non-African populations, despite hypertension (a major risk factor for cardiovascular disease) being highly prevalent in Africa. The AWI-Gen study GWAS meta-analysis for blood pressure (BP)-related traits (systolic and diastolic BP, pulse pressure, mean-arterial pressure and hypertension) from three sub-Saharan African geographic regions (N = 10,775), identifies two novel genome-wide significant signals (p < 5E-08): systolic BP near P2RY1 (rs77846204; intergenic variant, p = 4.95E-08) and pulse pressure near LINC01256 (rs80141533; intergenic variant, p = 1.76E-08). No genome-wide signals are detected for the AWI-Gen GWAS meta-analysis with previous African-ancestry GWASs (UK Biobank (African), Uganda Genome Resource). Suggestive signals (p < 5E-06) are observed for all traits, with 29 SNPs associating with more than one trait and several replicating known associations. Polygenic risk scores (PRSs) developed from studies on different ancestries have limited transferability, with multi-ancestry PRS providing better prediction. This study provides insights into the genetics of BP variation in African populations.

"Choosing All Together" (CHAT), is a community engagement tool designed to give the public a voice in how best to allocate limited resources to improve population health. This process evaluation explored the mechanisms through which CHAT generates community engagement. The CHAT tool was adapted and implemented for use in two rural communities (Nanoro, Burkina Faso, and Navrongo, Ghana) and one urban township (Soweto, South Africa) to prioritize maternal and child nutrition interventions. Community discussions were audio-recorded, transcribed, and translated into English. Twenty-two transcripts, including six each from Navrongo and Soweto and 10 from Nanoro, were analysed thematically to generate data driven codes and themes to explain mechanisms underlying the CHAT process. The process evaluation was based on the UK MRC process evaluation guidance. Seven themes describing the functions and outcomes of CHAT were identified. Themes described participants deliberating trade-offs, working together, agreeing on priorities, having a shared vision, and increasing their knowledge, also the skills of the facilitator, and a process of power sharing between participants and researchers. Participants came to an agreement of priorities when they had a shared vision. Trained facilitators are important to facilitate meaningful discussion between participants and those with lower levels of literacy to participate fully. CHAT has been shown to be adaptable and useful in prioritising maternal and child nutrition interventions in communities in Burkina Faso, Ghana, and South Africa. Conducting CHAT in communities over a longer period and involving policy-makers would increase trust, mutual respect and develop partnerships.

AbstractBackgroundGhana adopted the Integrated Disease Surveillance and Response (IDSR) system, which is an integration of the various programs in the surveillance system and can contain disease outbreaks and pandemics. Implementation of the IDSR is influenced by several factors which can affect its functionality and ability to contain disease outbreaks. This study assessed the factors influencing the IDSR system in selected districts in the Eastern Region of Ghana.MethodA cross-sectional study was conducted between February-March, 2022 in Fanteakwa North, Abuakwa South and New Juaben South districts in the Eastern Region of Ghana among health care workers who are involved in IDRS activities. Both primary and secondary data were collected and analyzed using descriptive statistics and regression analysis at 0.05 significant level with 95% confidence interval.ResultsThree hundred and forty-seven (347) health care workers participated in the study with 56.2% (195/347) indicating that rumor registers were available at the health facilities. Most of the respondents (64.8%, 225/347) had means of transport for disease surveillance activities while majority (61.9%, 215/347) had case-based forms for case investigation. About half (51.9%, 180/347) of the participants revealed that they did not receive any feedback from the next higher level in the past year. Availability of transport for IDSR activities was almost 3.4 times more likely to contribute positively to IDSR system compared to facilities without transport (AOR= 3.36; 95% CI= 1.44-7.83; p=0.005). Respondents who have the capacity to apply case definition are 2 times more likely to contribute to an effective IDSR system compared to health workers who cannot apply case definition (AOR= 1.94; 95% CI= 1.17-3.21; p=0.013). Respondents who did not receive feedback from the next higher level were 52% less likely to have an effective IDSR system compared to respondents who received feedback from the next higher level (AOR= 0.48; 95% CI= 0.23-1.00; p= 0.05).ConclusionEffective operation of IDSR is affected by the application of case definition and means of transport at health facilities. In addition, the capacity of health care workers to provide feedback can influence the smooth operation of the IDSR in the studied area in Ghana.

Act to End NTDs | West, a USAID-funded program that supports national governments to eliminate or control five neglected tropical diseases (NTDs) in West Africa including trachoma, lymphatic filariasis (LF), onchocerciasis, schistosomiasis and soil-transmitted helminthiasis, conducted a gender and social inclusion analysis to determine how NTDs differentially impact various populations and how gender and social norms impact NTD programs to inform future programming. The study used a mixed methods approach including a literature review; primary qualitative data collection; and monitoring data in Côte d'Ivoire, Sierra Leone, and Ghana. Women and girls face additional health risks from many NTDs compared to men and boys. In addition to differential health burden, the social and economic impacts of NTD-related disability or infertility can be particularly dire for women and girls. Men were somewhat less likely to participate in mass drug administration (MDAs) due to: lack of information about campaigns, lack of access due to work, and higher levels of mistrust of the government and concerns about side effects of the medicines. Pregnant and breastfeeding women were sometimes excluded by community drug distributors (CDDs) from certain types of MDAs for which they are eligible. Training participation rates for CDDs and supervisors were universally higher for men than women, even though feedback on the effectiveness of female CDDs was overwhelmingly positive, and female CDDs often have more access to other women in conservative households. The role of a CDD can lead to career and social opportunities for women. However, challenges faced by CDDs were seen as a greater barrier for women, including transportation, safety, household responsibilities, lower education levels, and low or lack of wages. Programs to address NTDs can promote equity and improve programming by increasing women's participation as CDDs and providing financial compensation. Additionally, programs should prioritize inclusive training for CDDs, and inclusive messaging about MDA for communities.

BackgroundThere is paucity of hepatitis B virus (HBV) data among student populations although Ghana is HBV endemic. Screening and identification of factors associated with HBV transmission in schools will support the intervention in the elimination of the virus by 2030. This study assessed the seroprevalence and factors associated with HBV among students in two Senior High Schools in the Krachi Nchumuru District in Ghana.MethodsThrough cross-sectional design and simple random sampling technique, 300 first-year students were enrolled from selected Senior High Schools. Structured questionnaires were used to collect data on demographic and exposure factors while rapid test kit was used to detect HBV infections. Chi-square/Fisher exact test and multivariable logistic regression were performed to determine the association between the variables at a 95% confidence interval and 0.05 significant level.ResultsSeroprevalence of HBV was 14% (42/300) among the students. The prevalence was significantly (p = 0.001) higher in males 19.4% (34/175) than females 6.4% (8/125). 77.7% (233/300) were aware of HBV infection. Males who were circumcised were 4 times more likely to be infected with HBV (AOR = 4.09, 95%CI = 1.82–9.19) (p = 0.001) compared with those uncircumcised.ConclusionHBV screening and education on hygienic genital circumcision practices must be prioritized in endemic countries.

BackgroundImmunisation remains an indispensable tool in preventing infectious diseases. A robust pharmacovigilance system assures the public of vaccine safety, particularly in countries like Ghana where there is relatively low reporting of adverse events following immunisation (AEFIs). We explored the experiences of health workers in Ghana to ascertain the existing capacity for data collection and information reporting flows for health events associated with vaccination in the country.MethodsWe conducted a cross-sectional quantitative survey among healthcare workers (HCWs) in Ghana between December 2020 and April 2021. We documented their experiences with regard to knowledge, perceptions and practice of reporting AEFIs to the national pharmacovigilance centre (Ghana Food and Drugs Authority).ResultsOut of 851 participants, 49.2% said their institutions had processes for AEFI reporting. Additionally, 25% of participants had encountered an AEFI within the past year. Out of this number, 55% reported the AEFI. Only 31.2% of community health nurses (vaccinators) considered AEFI reporting part of their job description. Most HCWs (59.34%) had fair to poor knowledge of AEFIs. The main factors affecting AEFI reporting were heavy workload and lack of time (54.1%) and unavailability of reporting forms (57.5%). Only 2% of participants were aware AEFIs could be reported online. Logistic regression analysis revealed female gender as a negative factor influencing AEFI reporting. Training (p<0.0001) and profession (p=0.006) significantly influenced knowledge level of AEFIs. Results of the multiple binary logistic regression indicate that the age and profession of HCWs are the main factors influencing knowledge of reporting AEFIs.ConclusionThe vaccine pharmacovigilance system in Ghana can be strengthened with targeted regular training on AEFI reporting, guidelines for reporting in all health facilities and prompt feedback from the national pharmacovigilance centre to health workers.

Determined factors associated with semantic (SM) and episodic memory (EM) among older adults aged 50years and older in Ghana. Data from WHO Study on Global AGEing and Adult Health (SAGE) Ghana Wave 2 was used for this study. Semantic memory (SM) and Episodic memory (EM) were the main study outcomes separately. The study employed Nested Ordinary Least Square regression analysis by sequentially adding 6 blocks of variables and comparison tests between the nested models. The study involved 3575 adult Ghanaians aged 50years and older with a mean±standard deviation of 62.6±18.4years. The overall mean±SD of EM and SM were 5.86±2.51 and 11.69±8.59 respectively. Overall, analysis from block 6 showed a significant variation in SM by approximately 16.9%(ΔR2=1.17%) where increasing age, never married (β=-1.55; 95% CI=-2.41-0.69), being resident in Greater Accra (regional disparity) (β=-3.45; 95% CI=-4.73-2.20), underweight (β=-0.81;95% CI=-1.34-0.27), and moderate self-rated health (SRH) (β=-0.98; 95% CI=-1.52-0.45) significantly decreased SM. Similarly, increasing age, separated/divorced (β=-0.22; 95% CI=-0.35-0.87), being resident in Greater Accra (β=-0.53; 95% CI=-0.80-0.26), and moderate SRH (β=-0.20; 95% CI=-0.36--0.04) significantly decrease EM with an overall significant variation of approximately 22.9%(ΔR2=2.7%). Increasing age, sex, marital status, regional disparity, and poor SRH significantly decreased both Semantic memory and Episodic memory. Higher educational attainment and life satisfaction significantly influenced SM and EM. These provide pointers to important socio-demographic determinants of SM and EM with implications for the implementation of the Ghana national ageing policy 2010, 'ageing with security and dignity', and as a key consideration for healthy ageing towards 2030.