Kassena-Nankana District Research Articles

Women's cultural perceptions and attitudes towards breast cancer: Northern Ghana

This study investigates problems confronting breast cancer awareness in Ghana by ascertaining how societal perceptions and attitudes influence women's awareness of breast cancer in the Kassena-Nankana district. Data were gathered through focus group interviews and documentary analysis of current practices within the region. The data were then thematically analysed following an inductive analytical framework. The study concludes that women's perceptions of and attitudes towards breast cancer and its treatment are influenced by a myriad of economic and socio-cultural factors, which practitioners need to take into account when planning public health initiatives. There are a number of economic challenges facing breast cancer education and awareness programmes due to a lack of adequate numbers of specialized health personnel and breast cancer screening facilities in the district. Additionally, socio-cultural factors such as the absence of biomedical terminology in the local language, gender inequality and the prevailing influence of traditional health practitioners further compound the situation. Knowledge, awareness and attitudes of women towards breast cancer can also be improved if husbands of married women and respective community compound heads are targeted by public health educationists to get actively involved in education and awareness campaigns. The need to incorporate indigenous languages in public health educational materials for breast cancer in remote communities of deprived districts of Ghana is also recommended.

Childhood Activities and Schistosomiasis Infection in the Kassena-Nankana District of Northern Ghana

Schistosomiasis is a common cause of morbidity especially among rural children in less developed countries. The extent and distribution of schistosomiasis infection among school-age children was assessed and the association between some childhood activities and prevalence of infection was determined in northern Ghana. A cross-sectional study was conducted during which stool and urine samples were collected from children 6-15 years. Samples were analysed using the Kato-Katz technique and the 10 ml urine filtration methods respectively. Data on water contact activities were also collected. The level of infection was compared in relation to location and water contact activities. A total of 1,764 children participated in the study. Prevalence of Schistosoma haematobium infection was 18.9%. The highest level of infection (33.1%) was found among children resident in the southern part of the district, the lowest among those in the eastern (3.6%) and northern (3.8%) parts. S. mansoni infection was 10.9%. The highest level of S. mansoni infection (54.2%) was found among children resident in the central part of the district. The overall prevalence of infection (S. haematobium+S. mansoni) was moderate (27.1%). More males (32.5%) than females (20.2%) were infected (χ2=32.8, P<0.0001). Children aged 9-12 years had the highest prevalence of infection (31.8%; 95% CI: 28.4- 35.5) with the lowest among those aged 6-8 years (23.9%; 95% CI: 20.2-28.0). Swimming in the canals (χ2=404.4, P<0.0001) and working on tomato farms (χ2=37.7, P<0.0001) were risk factors for infection. Herding cattle appeared to have protected the children from infection (χ2=34.8, P=0.0001). Schistosomiasis is prevalent throughout the district with children resident in the central and southern parts of the district being more at risk of infection. There is the need to put in place an integrated and effective schistosomiasis control programme.

Irrigated Agriculture and Poverty Reduction in Kassena Nankana District in the Upper-East Region, Ghana

In northern Ghana, where the climatic conditions do not allow for an all-year-around rain-fed agriculture, irrigation is a necessary complement to enhance livelihoods security and poverty reduction. The knowledge gap regarding the contribution of existing irrigation facilities to poverty reduction occasioned the case study of the Tono irrigation scheme located in the Kassena Nankana District in the Upper East Region of Ghana. A treatment and control experimental approach was adopted in the investigation. The treatment group comprised a sample of 93 out of the 1,328 Tono irrigation tomato farmers and the control group sampled 86 out of 614 irrigation tomato farmers operating outside the Tono irrigation scheme. The Tono irrigated scheme has, to a considerable extent, created a platform for employment and high agricultural output. However, the high agricultural output has not been translated into increased income and improved livelihoods for the farmers and as such limits the impact of the efforts exerted towards poverty reduction amongst the farmers in the area. The challenges that led to this outcome include high cost of hiring farm machinery, inadequate access to credit, poor water supply for irrigation, ineffective technical assistance, lack of entrepreneurial skills, inability to store perishable products and inadequate ready market to translate the outputs into improved incomes for the farmers. Actors in the irrigated agriculture industry should pay equal attention to both the production and marketing aspects of their enterprises. The actors should ensure that the necessary inputs are available and affordable to farmersKeywords: Agriculture, Ghana Irrigation, Poverty, Tono Irrigation Scheme, Ghana

The economic burden of meningitis to households in Kassena-Nankana district of Northern Ghana.

ObjectiveTo estimate the direct and indirect costs of meningitis to households in the Kassena-Nankana District of Ghana.MethodsA Cost of illness (COI) survey was conducted between 2010 and 2011. The COI was computed from a retrospective review of 80 meningitis cases answers to questions about direct medical costs, direct non-medical costs incurred and productivity losses due to recent meningitis incident.ResultsThe average direct and indirect costs of treating meningitis in the district was GH¢152.55 (US$101.7) per household. This is equivalent to about two months minimum wage earned by Ghanaians in unskilled paid jobs in 2009. Households lost 29 days of work per meningitis case and thus those in minimum wage paid jobs lost a monthly minimum wage of GH¢76.85 (US$51.23) due to the illness. Patients who were insured spent an average of GH¢38.5 (US$25.67) in direct medical costs whiles the uninsured patients spent as much as GH¢177.9 (US$118.6) per case. Patients with sequelae incurred additional costs of GH¢22.63 (US$15.08) per case. The least poor were more exposed to meningitis than the poorest.ConclusionMeningitis is a debilitating but preventable disease that affects people living in the Sahel and in poorer conditions. The cost of meningitis treatment may further lead to impoverishment for these households. Widespread mass vaccination will save households' an equivalent of GH¢175.18 (US$117) and impairment due to meningitis.

Cultural imperatives and the ethics of verbal autopsies in rural Ghana

BackgroundDue to a paucity of statistics from vital registration systems in developing countries, the verbal autopsy (VA) approach has been used to obtain cause-specific mortality data by interviewing lay respondents on the signs and symptoms experienced by the deceased prior to death. In societies where the culture of mourning is adhered to, the use of VA could clash with traditional norms, thus warranting ethical consideration by researchers.ObjectiveThe study was designed to explore the ethics and cultural context of collecting VA information through a demographic and health surveillance system in the Kassena-Nankana District (KND) of Ghana.Study DesignData were collected through qualitative in-depth interviews (IDIs) with four field staff involved in the routine conduct of VAs, four physicians who code VAs, 20 selected respondents to the VA tool, and eight opinion leaders in the KND. The interviews were supplemented with observation by the researchers and with the field notes of field workers. Interviews were audio-recorded, and local language versions transcribed into English. Thematic analysis was performed using QSR NVivo 8 software.ResultsThe data indicate that cultural sensitivities in VA procedures at both the individual and family levels need greater consideration not only for ethical reasons but also to ensure the quality of the data. Discussions of some deaths are culturally prohibited and therefore lead to refusal of interviews. Families were also concerned about the confidentiality of information because of the potential of blame for the death. VA teams do not necessarily engage in culturally appropriate bereavement practices such as the presentation of tokens. The desire by families for feedback on the cause of death, which is currently not provided by researchers, was frequently expressed. Finally, no standard exists on the culturally acceptable time interval between death and VA interviews.ConclusionEthical issues need to be given greater consideration in the collection of cause of death data, and this can be achieved through the establishment of processes that allow active engagement with communities, authorities of civil registrations, and Institutional Review Boards to take greater account of local contexts.

Cost of maternal health services in selected primary care centres in Ghana: a step down allocation approach

BackgroundThere is a paucity of knowledge on the cost of health care services in Ghana. This poses a challenge in the economic evaluation of programmes and inhibits policy makers in making decisions about allocation of resources to improve health care. This study analysed the overall cost of providing health services in selected primary health centres and how much of the cost is attributed to the provision of antenatal and delivery services.MethodsThe study has a cross-sectional design and quantitative data was collected between July and December 2010. Twelve government run primary health centres in the Kassena-Nankana and Builsa districts of Ghana were randomly selected for the study. All health-care related costs for the year 2010 were collected from a public service provider’s perspective. The step-down allocation approach recommended by World Health Organization was used for the analysis.ResultsThe average annual cost of operating a health centre was $136,014 US. The mean costs attributable to ANC and delivery services were $23,063 US and $11,543 US respectively. Personnel accounted for the largest proportion of cost (45%). Overall, ANC (17%) and delivery (8%) were responsible for less than a quarter of the total cost of operating the health centres. By disaggregating the costs, the average recurrent cost was estimated at $127,475 US, representing 93.7% of the total cost. Even though maternal health services are free, utilization of these services at the health centres were low, particularly for delivery (49%), leading to high unit costs. The mean unit costs were $18 US for an ANC visit and $63 US for spontaneous delivery.ConclusionThe high unit costs reflect underutilization of the existing capacities of health centres and indicate the need to encourage patients to use health centres .The study provides useful information that could be used for cost effectiveness analyses of maternal and neonatal care interventions, as well as for policy makers to make appropriate decisions regarding the allocation and sustainability of health care resources.

Self-reported vision health status among older people in the Kassena-Nankana District, Ghana

BackgroundIf current trends continue, Ghana's aged population will increase in the coming decades. Currently, there is little knowledge on the health of the aged in Ghana. Research on vision problems among this group is virtually non-existent. This research gap needs to be filled immediately in order to promote the general health among older people in Ghana.ObjectiveThe objective of the study was to analyse vision health and its determinants among the older adult population in a district in one of the poorest regions in Ghana – the Kassena-Nankana district.MethodsData were obtained from the WHO multi-country studies unit (SAGE). A total of 4,294 people over the age of 50 responded to the survey. Data analysis was conducted using Stata statistical package. The aim of the analysis was to identify the prevalence of self-reported vision problems and assistive device use. Age, level of education, marital status, living arrangement, socio-economic status and proportion of people aged 50 and over in a household were used as determinants of vision health.ResultsIn total, 54 and 63% (p-value, 0.00) of men and women reported having far-sightedness, while 35% of men and 40.6% of women reported having near-sightedness (p-value, 0.00). In total, 33.5% of men and 38.6% of women reported having both near-sightedness and far-sightedness (p-value, 0.00). Of those who reported having either vision problems, 2.9% reported the use of visual assistive devices. Men had a higher assistive device use of 4.5% compared to 2.1% among women (p=0.002). Age and household socio-economic status was positively associated with reporting vision problems and assistive device use, respectively.ConclusionsThe results from this analysis showed that despite the high reporting of vision problems, only 2.9% reported using assistive devices. This outcome shows that there is a need to prevent vision problems and increase access to assistive devices among older people in the Kassena-Nankana district in Ghana.

‘They treat you like you are not a human being’: Maltreatment during labour and delivery in rural northern Ghana

Objectiveto explore community and health-care provider attitudes towards maltreatment during delivery in rural northern Ghana, and compare findings against The White Ribbon Alliance's seven fundamental rights of childbearing women. Designa cross-sectional qualitative study using in-depth interviews and focus groups. Settingthe Kassena-Nankana District of rural northern Ghana between July and October 2010. Participants128 community members, including mothers with newborn infants, grandmothers, household heads, compound heads, traditional healers, traditional birth attendants, and community leaders, as well as 13 formally trained health-care providers. Measurements and findings7 focus groups and 43 individual interviews were conducted with community members, and 13 individual interviews were conducted with health-care providers. All interviews were transcribed verbatim and entered into NVivo 9.0 for analysis. Despite the majority of respondents reporting positive experiences, unprompted, maltreatment was brought up in 6 of 7 community focus groups, 14 of 43 community interviews, and 8 of 13 interviews with health-care providers. Respondents reported physical abuse, verbal abuse, neglect, and discrimination. One additional category of maltreatment identified was denial of traditional practices. Key conclusionsmaltreatment was spontaneously described by all types of interview respondents in this community, suggesting that the problem is not uncommon and may dissuade some women from seeking facility delivery. Implications for practiceprovider outreach in rural northern Ghana is necessary to address and correct the problem, ensuring that all women who arrive at a facility receive timely, professional, non-judgmental, high-quality delivery care.

The effects of road traffic accidents on society. The case of the Kassena Nankana districts, Ghana: a quantitative survey

BackgroundRoad traffic accidents (RTAs) pose a public health and development challenge and greatly affect the human capital development of every nation. This study determines the effects of RTAs on households and employers of RTA victims. It identifies factors that influence RTAs as well as the trends of deaths from RTAs in the Kassena Nankana districts (KNDs) in northern Ghana. MethodsVictims of RTAs were identified through household visits by the Navrongo Health and Demographic Surveillance System. In all, 123 RTA victims; 101 non-accident victims matched by age, sex, and location; and five key employers in the KNDs were interviewed. Individuals aged 15–59 years who died from RTAs as reported in verbal autopsy data between 2006 and 2011 were used to assess trends in RTA deaths. Knowledge, attitude, and practices about RTAs were compared between the victims and non-victims of RTAs. Socioeconomic statuses of victims and non-victims of RTAs were compared. Cost of RTAs to households and employers was determined by interviewing victims of RTAs in their households and employers on direct and indirect cost incurred during the accident period. FindingsThe average costs of RTAs to the household and employer were US$6007 and $7625, respectively. The annual mean cost of a RTA to a poor household was $49, representing 183% of its annual income; this cost represents only 5% of the average income of a rich household. There was an increasing trend of deaths due to RTAs, from 7·4% (95% CI 4·1–10·7) in 2006 to 10·9% (3·6–18·3) in 2011. Careless driving, indiscriminate crossing, mechanical fault, loss of control whilst driving/riding, and occupational status were the key determinants of RTAs in the area. InterpretationRTAs impose a substantial economic burden on victims, particularly the poor. The importance of the problem of RTAs warrants immediate interventions to reduce road traffic crashes in the districts. FundingThe Navrongo Health Research Center partly funded the project for the data collection. The rest of the funding was from personal savings.

Why Are Babies Dying in the First Month after Birth? A 7-Year Study of Neonatal Mortality in Northern Ghana

ObjectivesTo determine the neonatal mortality rate in the Kassena-Nankana District (KND) of northern Ghana, and to identify the leading causes and timing of neonatal deaths.MethodsThe KND falls within the Navrongo Health Research Centre’s Health and Demographic Surveillance System (HDSS), which uses trained field workers to gather and update health and demographic information from community members every four months. We utilized HDSS data from 2003–2009 to examine patterns of neonatal mortality.ResultsA total of 17,751 live births between January 2003 and December 2009 were recorded, including 424 neonatal deaths 64.8%(275) of neonatal deaths occurred in the first week of life. The overall neonatal mortality rate was 24 per 1000 live births (95%CI 22 to 26) and early neonatal mortality rate was 16 per 1000 live births (95% CI 14 to 17). Neonatal mortality rates decreased over the period from 26 per 1000 live births in 2003 to 19 per 1000 live births in 2009. In all, 32%(137) of the neonatal deaths were from infections, 21%(88) from birth injury and asphyxia and 18%(76) from prematurity, making these three the leading causes of neonatal deaths in the area. Birth injury and asphyxia (31%) and prematurity (26%) were the leading causes of early neonatal deaths, while infection accounted for 59% of late neonatal deaths. Nearly 46% of all neonatal deaths occurred during the first three postnatal days. In multivariate analysis, multiple births, gestational age <32 weeks and first pregnancies conferred the highest odds of neonatal deaths.ConclusionsNeonatal mortality rates are declining in rural northern Ghana, with majority of deaths occurring within the first week of life. This has major policy, programmatic and research implications. Further research is needed to better understand the social, cultural, and logistical factors that drive high mortality in the early days following delivery.

Spatio-temporal malaria transmission patterns in Navrongo demographic surveillance site, northern Ghana

BackgroundThe relationship between entomological measures of malaria transmission intensity and mortality remains uncertain. This is partly because transmission is heterogeneous even within small geographical areas. Studying this relationship requires high resolution, spatially structured, longitudinal entomological data. Geostatistical models that have been used to analyse the spatio-temporal heterogeneity have not considered the uncertainty in both sporozoite rate (SR) and mosquito density data. This study analysed data from Kassena-Nankana districts in northern Ghana to obtain small area estimates of malaria transmission rates allowing for this uncertainty.MethodsIndependent Bayesian geostatistical models for sporozoite rate and mosquito density were fitted to produce explicit entomological inoculation rate (EIR) estimates for small areas and short time periods, controlling for environmental factors.ResultsMosquitoes were trapped from 2,803 unique locations for three years using mainly CDC light traps. Anopheles gambiae constituted 52%, the rest were Anopheles funestus. Mean biting rates for An. funestus and An. gambiae were 32 and 33 respectively. Most bites occurred in September, the wettest month. The sporozoite rates were higher in the dry periods of the last two years compared with the wet period. The annual EIR varied from 1,132 to 157 infective bites. Monthly EIR varied between zero and 388 infective bites. Spatial correlation for SR was lower than that of mosquito densities.ConclusionThis study confirms the presence of spatio-temporal heterogeneity in malaria transmission within a small geographical area. Spatial variance was stronger than temporal especially in the SR. The estimated EIR will be used in mortality analysis for the area.

Technical Efficiency of Rice Production at the Tono Irrigation Scheme in Northern Ghana

Aim: To investigate the determinants of technical efficiency of rice farmers at Tono Irrigation Project. Study Design: Cross sectional. Place and Duration: The Kassena-Nankana District of Upper East Region of Ghana in the 2007/2008 cropping season. Methodology: One-step estimation of the Stochastic Frontier Model. Results: The technical efficiency estimates ranged from 0.41 to 1.00 with a mean value of 0.81. The factors that determined farmers’ technical efficiency included education and the adoption of modern inputs such as seeds and chemical fertilizers. Conclusion: The sustainability of the farmers’ high efficiency will be dependent on the continuous support they receive in the areas of input supply and education, among others.

Community perception of malaria and its influence on health-seeking behaviour in rural Ghana: a descriptive study.

Approximately 300 million clinical episodes of malaria occur globally, out of which an estimated 1 million persons die every year. Ninety per cent of these malaria deaths occur in tropical Africa. Despite decades of great effort to control malaria in Ghana, it still remains a serious public health problem affecting all ages. A descriptive cross-sectional study was conducted to assess local perceptions on malaria and health seeking behaviour among inhabitants in the Kassena-Nankana district in the Upper East Region of Ghana. A total of 120 respondents were included in the study through a systematic random sampling procedure of households. The head of a household or his/her partner was interviewed using a structured questionnaire. The majority (65%) of respondents had awareness about malaria and linked it to mosquito bites. They had knowledge about malaria through health workers including health professionals from the Navrongo Health Research Centre (NHRC) (83.3%), radio (7.3%), television (5.8%), friends (1.7%) or newspapers (0.8%). The results also showed that people incorporated traditional and modern elements into their concept of the disease and treatment strategies. Perceptions and health-seeking behaviour are critical to the success and sustainability of malaria management and control. Understanding local concepts of illness and their influence on health care-seeking behaviour can complement existing knowledge to help develop more effective malaria control interventions in these communities.

Water Contact Activities and Prevalence of Schistosomiasis Infection among School-age Children in Communities along an Irrigation Scheme in Rural Northern Ghana

Of the various trematodes that infect humans, schistosomes remain among the most prevalent, and the various forms of schistosomiasis still pose significant public health problems. The prevalence of schistosomiasis infection among in-school and not-in-school children resident in communities along the Tono irrigation canals in northern Ghana was determined. Stool and urine samples from random representative samples were parasitologically examined using the Kato-Katz and 10 ml urine filtration methods respectively. A total of 920 children (mean age: 11.0 yrs; range: 6-15 yrs; STD Dev: 4.6 yrs), 573 (62.3%) males and 347 (37.7%) females with 473 in-school and 447 not-in-school participated in the study. The prevalence of Schistosoma haematobium infection was 33.2% (305/920) whilst that of S. mansoni was 19.8% (95% CI: 17.3-22.5; 182/920). The overall prevalence of infection (S. haematobium plus S. mansoni) was 47.7% (439/920). Many more males (51.7%; 95% CI: 47.5-55.8) than females (41.2%; 95% CI: 36.0-46.6) were infected. Forty-six (5.0%, 46/920) children were infected with both S. haematobium and S. mansoni. There was no difference in the prevalence of infection (S. haematobium plus S. mansoni) among children in-school (48.4%; 95% CI: 43.8-53.0) and those not-in-school (46.5%; 95% CI: 41.8-51.3). There was a statistically significant difference in prevalence of infection among communities (P=0.0002); with the lowest level of infection in residents of Korania (29.9%; CI: 20.0- 41.4) and the highest among those resident in Kajelo (64.9%; CI: 51.1-77.1), with significant differences in levels of water contact activities (χ2 =6.69; P=0.04). The highest intensity of S. mansoni infection (115.6 epg) was in Bonia where the highest prevalence of blood stained stools was collected (5.5%). Overall, 2.8% (26/920; 95% CI: 1.9-4.2) of stool samples were blood stained, whilst 10% (92/920; 95% CI: 8.2-12.2) of children had haematuria. S. haematobium ova were detected in 98.9% (91/92) of blood stained urine samples. Children infected by S. mansoni were more likely to have blood stained stool (χ2 =32.7; P<0.0001). The prevalence of schistosomiasis infection in the irrigation project site is high, adding praziquantel to albendazole and ivermectin for distribution during the annual mass drug administration for filariasis and onchocerciasis control will be an effective way of reaching all at risk groups in the Kassena-Nankana district for the control of schistosomiasis.

A Community-Wide Study of Malaria Reduction: Evaluating Efficacy and User-Acceptance of a Low-Cost Repellent in Northern Ghana

NO MAS (NM) mosquito repellent was evaluated in two farming villages (4 km apart) in the Kassena Nankana district of northern Ghana. We determined its efficacy against local malaria vectors, degree of user acceptance, and its effect on malaria prevalence in households using insecticide-treated bed nets. The average protective efficacy of NM against Anopheles mosquitoes over 9 hours was 89.6%. Controls averaged 86 bites/person/night versus 9 bites/person/night with the use of NM. Use of repellent was associated with a decrease of absolute malaria prevalence by 19.2% in the repellent village and by 6.5% in the control village (45.5 to 26.3, and 29.5 to 23.0, respectively). The user-acceptance rate of NM repellent was 96.1%. Ten percent (10%) of repellent users reported irritation as the main adverse effect during the period. Eighty-five percent (85%) of the users found the odor of NM appealing and 87% reported no inconvenience in applying the repellent daily.

English

&nbsp; The literature on development problems of small scale industries in Ghana tend to paint a broad brush picture that may lend less relevance to development planning specific to local situations. Drawing on the case of small scale agro-processing industries, this paper examines geo-specific constraints that affect the development of small scale industries in the kassena-Nankana District of North Eastern Ghana. The findings show that industrialists have limited economic access to raw materials and energy supplies owing to environmental factors and the impact of macro-economic policies. There is also spatial inequity in the utilization of engine powered agro-processing technologies as a result of which many rural industrialists depend on man powered agro-processing technologies which have multiple adverse implications for production and growth. The main issues that underpin access to technology are the level of service development at the community level and accessibility to urban towns. There is also limited utilization of credit for capitalization owing to the lack of accessible credit facilities and ignorance while marketing of industrial products is constrained by climatic variability and poor debt recovery. Within the social setting, multiple household roles reduce time allocation of female industrialists to industrial production, while the lack of formal education and over burdened social expenditures present difficult managerial challenges to rural industrialists in general. The authors recommend the promotion of industrial development through a holistic approach to district development planning and management. Given the nature of the local economy, the authors stress the need to facilitate the development of the agricultural sector as pre-conditional and complimentary to the industrial development process. &nbsp; Key words:&nbsp;Small-scale industries,&nbsp;agro-processing industries,&nbsp;industrial development,&nbsp;macro-economic policies, kassena-Nankana District.

Infant nutrition in the first seven days of life in rural northern Ghana

BackgroundGood nutrition is essential for increasing survival rates of infants. This study explored infant feeding practices in a resource-poor setting and assessed implications for future interventions focused on improving newborn health.MethodsThe study took place in the Kassena-Nankana District of the Upper East Region of northern Ghana. In-depth interviews were conducted with 35 women with newborn infants, 8 traditional birth attendants and local healers, and 16 community leaders. An additional 18 focus group discussions were conducted with household heads, compound heads and grandmothers. All interviews and discussions were audio taped, transcribed verbatim and analyzed using NVivo 9.0.ResultsCommunity members are knowledgeable about the importance of breastfeeding, and most women with newborn infants do attempt to breastfeed. However, data suggest that traditional practices related to breastfeeding and infant nutrition continue, despite knowledge of clinical guidelines. Such traditional practices include feeding newborn infants water, gripe water, local herbs, or traditionally meaningful foods such as water mixed with the flour of guinea corn (yara’na). In this region in Ghana, there are significant cultural traditions associated with breastfeeding. For example, colostrum from first-time mothers is often tested for bitterness by putting ants in it – a process that leads to a delay in initiating breastfeeding. Our data also indicate that grandmothers – typically the mother-in-laws – wield enormous power in these communities, and their desires significantly influence breastfeeding initiation, exclusivity, and maintenance.ConclusionPrelacteal feeding is still common in rural Ghana despite demonstrating high knowledge of appropriate feeding practices. Future interventions that focus on grandmothers and religious leaders are likely to prove valuable in changing community attitudes, beliefs, and practices with regard to infant nutrition.

Profile of the Navrongo Health and Demographic Surveillance System

Located in the Kassena-Nankana districts of northern Ghana, the Navrongo health and demographic surveillance system (NHDSS) was established in 1992 by the Navrongo health research centre (NHRC). The NHRC is one of three research centres of the Ghana health service. The activities and potential of the NHDSS for collaborative research are described. The NHDSS monitors health and demographic dynamics of the two Kassena-Nankana districts of northern Ghana and facilitates evaluation of the morbidity and mortality impact of health and social interventions. The total population currently under surveillance is 152 000 residing in 32 000 households. Events monitored routinely include pregnancies, births, morbidity, deaths, migration, marriages and vaccination coverage. Data updates are done every 4 months by trained fieldworkers. The NHRC also undertakes biomedical and socio-economic studies. Additional features of the NHDSS include the community key informant system where trained volunteers routinely report key events, such as births and deaths as they occur in their locality and the verbal autopsy (VA) system for determining the probable causes of deaths that occur at the community level. Data from the NHDSS are shared with funders and collaborators and partners in the INDEPTH Network. The Director of the NHDSS is the contact person for potential collaboration with the NHDSS and the use of its data.

Haplotype analyses of haemoglobin C and haemoglobin S and the dynamics of the evolutionary response to malaria in Kassena-Nankana District of Ghana.

BackgroundHaemoglobin S (HbS) and C (HbC) are variants of the HBB gene which both protect against malaria. It is not clear, however, how these two alleles have evolved in the West African countries where they co-exist at high frequencies. Here we use haplotypic signatures of selection to investigate the evolutionary history of the malaria-protective alleles HbS and HbC in the Kassena-Nankana District (KND) of Ghana.Methodology/Principal FindingsThe haplotypic structure of HbS and HbC alleles was investigated, by genotyping 56 SNPs around the HBB locus. We found that, in the KND population, both alleles reside on extended haplotypes (approximately 1.5 Mb for HbS and 650 Kb for HbC) that are significantly less diverse than those of the ancestral HbA allele. The extended haplotypes span a recombination hotspot that is known to exist in this region of the genomeSignificanceOur findings show strong support for recent positive selection of both the HbS and HbC alleles and provide insights into how these two alleles have both evolved in the population of northern Ghana.

Does supervision improve health worker productivity? Evidence from the Upper East Region of Ghana

To assess whether supervision of primary health care workers improves their productivity in four districts of Northern Ghana. We conducted a time-use study during which the activities of health workers were repeatedly observed and classified. Classification included four categories: direct patient care; documentation and reporting; staff development and facility operations; and personal time. These data were supplemented by a survey of health workers during which patterns of supervision were assessed. We used logistic regression models with health facility fixed effects to test the hypothesis that supervision increases the amount of time spent providing direct patient care (productivity). We further investigated whether these effects depend on whether or not supervision is supportive. Direct patient care accounted for <25% of observations. In bivariate analyses, productivity was higher among midwives and in facilities with a high volume of care. Supervisory visits were frequent in those four districts, but only a minority of health workers felt supported by their supervisors. Having been supervised within the last month was associated with a significantly higher proportion of time spent on direct patient care (OR = 1.57). The effects of supervision on productivity further depended on whether the health workers felt supported by their supervisors. Supportive supervision was associated with increased productivity. Investments in supervision could help maximize the output of scarce human resources in primary health care facilities. Time-use studies represent an objective approach in monitoring the productivity of health workers and evaluating the impact of health-system interventions on human resources.