Kintampo Health Research Articles

The feasibility and acceptability of clean fuel use among rural households. A pilot study in Central Ghana.

Background76% of the population in Ghana uses solid fuels as their primary source of cooking energy, including 41.3% firewood and 31.5% charcoal. Consequently, household air pollution (HAP) continues to be the leading risk factor for the majority of illness burden in the country. In the past, aggressive LPG distribution and adoption schemes have been implemented to reduce HAP in Ghana. Nevertheless, just 22% of Ghanaian households utilize LPG for cooking.AimsThe purpose of this study was to determine the viability and acceptability of four clean fuels among rural households in central Ghana, both separately and in combination.MethodsQuantitative and qualitative methods were used to conduct this study. The Kintampo Health Demographic Surveillance System was used to randomly pick ten homes who exclusively utilized biomass fuel. For each family (n = 10), we gave four stove and fuel combinations that were both clean. The stoves were utilized for two weeks, and free fuel was supplied. After each two-week trial period, interviews were conducted to gauge stove acceptance, with an emphasis on finding the specific energy requirements that each stove satisfied.ConclusionsLPG and ethanol stoves were the most popular among rural families, according to our data. In comparison to Mimi Moto and electric induction stoves, the two stoves were favoured because they were easier to use and clean, cooked faster, were deemed safer, and enabled a variety of cooking styles. Participants’ stove preferences appear to be primarily influenced by two domains: 1) realizing the benefits of clean stove technology and 2) overcoming early anxiety of clean stove use, particularly LPG.

Head Injury Prevalence in a Population of Injured Patients Seeking Care in Ghana, West Africa.

Background/Significance:Much of the literature on head injury (HI) prevalence comes from high-income countries (HICs), despite the disproportionate burden of injuries in low to middle-income countries (LMICs). This study evaluated the HI prevalence in the Kintampo Injury Registry, a collaborative effort between Kintampo Health Research Centre (KHRC) in Ghana and the sidHARTe Program at Columbia University Mailman School of Public Health. In our first aim, we characterize the HI prevalence in the registry. In aim 2, we examine if there are any sex (male/female) differences in head injury outcomes in these populations for points of potential intervention.MethodsSecondary analysis of data from the Kintampo Injury Registry which had 7,148 registered patients collected during January 2013 to January 2015. The definition of a case was adopted to ensure consistency with the International Statistical Classification of Diseases and Related Health Problems, revision 10 (ICD-10). A 3-page questionnaire was used to collect data from injured patients to include in the registry. The questions were designed to be consistent with the World Health Organization (WHO) guidelines on injury surveillance and were adapted from the questionnaire used in a pilot, multi-country injury study undertaken in other parts of Africa. The questionnaire collected information on the anatomic site of injury (e.g., head), mechanism of injury (e.g., road traffic injuries, interpersonal injuries (including domestic violence), falls, drowning, etc.), severity and circumstances of the injury, as well as precipitating factors, such as alcohol and drug use. The questionnaire consisted mainly of close-ended questions and was designed for efficient data entry. For the secondary data analyses for this manuscript, we only included those with “1st visit following injury” and excluded all transfers and follow-up visits (n = 834). We then dichotomized the remaining 6,314 patients to head injured and non-head injured patients based on responses to the variable “Nature of injury =Head Injury”. We used chi-square and Fisher's exact tests with p < 0.05 as cut-off for statistical significance. Logistic regression estimates were used for effect estimates.ResultsOf the 6,314 patients, there were 208 (3.3%) head-injured patients and 6,106 (96.7%) patients without head injury. Head-injured patients tended to be older (Mean age: 28.9 +/-13.7; vs. 26.1 +/- 15.8; p = 0.004). Seven in 10 head injured patients sustained their injuries via transport/road traffic accidents, and head-injured patients had 13 times the odds of mortality compared with those without head injuries (OR: 13.3; 95% CI: 8.05, 22.0; p < 0.0001) even though over half of them had mild or moderate injury severity scores (p < 0.001). Evaluation of sex differences amongst the head-injured showed that in age-adjusted logistic regression models, males had 1.4 times greater odds of being head injured (OR: 1.4; 95% CI: 1.04, 2.00; p = 0.03) and over twice the risk of mortality (OR: 2.7; 95% CI: 0.74, 10.00; p = 0.13) compared to females.ConclusionIn these analyses, HI was associated with a higher risk of mortality, particularly amongst injured males; most of whom were injured in transport/road-traffic-related accidents. This study provides an impetus for shaping policy around head injury prevention in LMICs like Ghana.

Implementing effective community-based surveillance in research studies of maternal, newborn and infant outcomes in low resource settings

BackgroundGlobally adopted health and development milestones have not only encouraged improvements in the health and wellbeing of women and infants worldwide, but also a better understanding of the epidemiology of key outcomes and the development of effective interventions in these vulnerable groups. Monitoring of maternal and child health outcomes for milestone tracking requires the collection of good quality data over the long term, which can be particularly challenging in poorly-resourced settings. Despite the wealth of general advice on conducting field trials, there is a lack of specific guidance on designing and implementing studies on mothers and infants. Additional considerations are required when establishing surveillance systems to capture real-time information at scale on pregnancies, pregnancy outcomes, and maternal and infant health outcomes.Main bodyBased on two decades of collaborative research experience between the Kintampo Health Research Centre in Ghana and the London School of Hygiene and Tropical Medicine, we propose a checklist of key items to consider when designing and implementing systems for pregnancy surveillance and the identification and classification of maternal and infant outcomes in research studies. These are summarised under four key headings: understanding your population; planning data collection cycles; enhancing routine surveillance with additional data collection methods; and designing data collection and management systems that are adaptable in real-time.ConclusionHigh-quality population-based research studies in low resource communities are essential to ensure continued improvement in health metrics and a reduction in inequalities in maternal and infant outcomes. We hope that the lessons learnt described in this paper will help researchers when planning and implementing their studies.

The use of Mobile Phones in Strengthening Health and Demographic Data Collection by Community key Informants : Experiences from the Kintampo Health and Demographic Surveillance System

Identification and reporting of vital events such as births and deaths remain a challenge within communities in low- and middle-income countries (LMICs). LMICs are recently experiencing high mobile phone penetration. This study, therefore, explored the feasibility of Community Key Informants (CKIs) using mobile phone technology to improve reporting of vital events at the community level. Sixty CKIs were purposively sampled from the Kintampo Health and Demographic Surveillance System (KHDSS) setting based on mobile phone ownership. CKIs were grouped into an intervention and a control group. The intervention arm was provided with mobile phone air time to report vital events that occurred in their communities. The control group used the routine system of reporting in the KHDSS. The number of vital events reported by CKIs increased at the end line compared to baseline: (pregnancy: 40.25% to 72.80%; birth: 56.52% to 69.80%; deaths: 33.33% to 68.60%). The time interval between event identification and reporting was much shorter for the intervention group at the end line compared to baseline: (Intervention: 95.06 days to 31.35 days, Control: 87.54 days to 80.57 days). This study demonstrated the feasibility of CKIs using a mobile phone in reporting vital events more timely and effectively.

Open defecation and attainment of Sustainable Development Goal Six: evidence from Kintampo Surveillance System, Ghana.

This study examined whether the open-defecation (OD) free target is achievable by 2030. Longitudinal study. Seven sub-Districts of Kintampo North Municipal, and five sub-Districts of Kintampo South District. Kintampo health and demographic surveillance system. Data was collected from household heads or their representatives over a 12-year period from 2005 to 2016. Open-defecation and attainment of OD free by 2030. In an exploratory analysis, the correlation between the total number of households, year, and total number of OD households was obtained. The average percentage yearly increase or decrease in OD was computed and used to project the percentage of OD for the years 2020, 2025 and 2030. In addition, geo-spatial technology was used to visualize variability in OD across the twelve sub-Districts. The results showed that the OD free target is not achievable in 2030 or even if the current trend continues. In 2016, 44.2 per cent of the 31,571 households defecated openly. In six out of the 12 sub-Districts, more than half of the households openly defecated. Four out of these six sub-Districts were in the Kintampo North Municipality. The 2030 OD free target is not achievable in the Kintampo districts of Ghana if the current trend continues. Kintampo Health Research Centre funded this work.

Maximizing community participation and engagement: lessons learned over 2 decades of field trials in rural Ghana

BackgroundSuccessful implementation of community-based research is dominantly influenced by participation and engagement from the local community without which community members will not want to participate in research and important knowledge and potential health benefits will be missed. Therefore, maximising community participation and engagement is key for the effective conduct of community-based research. In this paper, we present lessons learnt over two decades of conducting research in 7 rural districts in the Brong Ahafo region of Ghana with an estimated population of around 600,000. The trials which were mainly in the area of Maternal, Neonatal and Child Health were conducted by the Kintampo Health Research Centre (KHRC) in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM).MethodsThe four core strategies which were used were formative research methods, the formation of the Information, Education and Communication (IEC) team to serve as the main link between the research team and the community, recruitment of field workers from the communities within which they lived, and close collaboration with national and regional stakeholders.ResultsThese measures allowed trust to be built between the community members and the research team and ensured that potential misconceptions which came up in the communities were promptly dealt with through the IEC team. The decision to place field workers in the communities from which they came and their knowledge of the local language created trust between the research team and the community. The close working relationship between the District health authorities and the Kintampo Health Research Centre supported the acceptance of the research in the communities as the District Health Authorities were respected and trusted.ConclusionThe successes achieved during the past 2 decades of collaboration between LSHTM and KHRC in conducting community-based field trials were based on involving the community in research projects. Community participation and engagement helped not only to identify the pertinent issues, but also enabled the communities and research team to contribute towards efforts to address challenges.

Constructing clean cookstove stack in Ghana

BACKGROUND AND AIM: Transition to cleaner cooking technologies has the ability to increase economic and environmental benefits, studies have shown that adoption of improved cooking stoves is very low and those who adopt clean cooking stove/ fuels are likely to stack with biomass fuel. The aim of this study was to identify promising “clean stacks” of stoves and fuels that are relevant to household energy needs in middle belt of Ghana. METHODS: A mixed method approach was used in data collection. Ten households who were exclusive users of biomass fuel were randomly selected from the Kintampo Health Demography Surveillance Survey. We used questionnaires to collect information on sociodemographic characteristics, household energy needs, stove use, and acceptability of stoves. The stoves that were given to participants were Mimi motos (a forced draft pellet biomass stove), Electric induction, Ethanol stoves and LPG stoves. Fuel was provided at no cost to participants. Each stove was assigned to the households for a period of two weeks, one after the other. After the single technology assessment, two most preferred stoves were given back to participants to use simultaneously for a period of one month. During this one-month period, participants exposure to PM2.5 were assessed. RESULTS:LPG and Ethanol stoves were the two most preferred stoves. The participants noted inconveniences and numerous mechanical and operational difficulties with the mimi moto and the electric stove. Induction electric stove recorded a mean reading of 0.10 volts Forty-eight-hour personal PM2.5 assessed during the clean stack period was slightly higher with mean concentration of 10.82 μg/m3 (0.54) compared to WHO guideline (10 μg/m3), but was substantially lower than baseline. CONCLUSIONS:Of the four stoves tested, participants expressed satisfaction with LPG stove and Ethanol stove as it met their daily energy needs. Adoption and acceptability of the improved stoves varied with different dishes or cooking tasks. KEYWORDS: clean fuel stack, exposure assessment, Ghana

Neonatal mortality clustering in the central districts of Ghana.

Identifying high risk geographical clusters for neonatal mortality is important for guiding policy and targeted interventions. However, limited studies have been conducted in Ghana to identify such clusters. This study aimed to identify high-risk clusters for all-cause and cause-specific neonatal mortality in the Kintampo Districts. Secondary data, comprising of 30,132 singleton neonates between January 2005 and December 2014, from the Kintampo Health and Demographic Surveillance System (KHDSS) database were used. Verbal autopsies were used to determine probable causes of neonatal deaths. Purely spatial analysis was ran to scan for high-risk clusters using Poisson and Bernoulli models for all-cause and cause-specific neonatal mortality in the Kintampo Districts respectively with village as the unit of analysis. The study revealed significantly high risk of village-clusters for neonatal deaths due to asphyxia (RR = 1.98, p = 0.012) and prematurity (RR = 5.47, p = 0.025) in the southern part of Kintampo Districts. Clusters (emerging clusters) which have the potential to be significant in future, for all-cause neonatal mortality was also identified in the south-western part of the Kintampo Districts. Study findings showed cause-specific neonatal mortality clustering in the southern part of the Kintampo Districts. Emerging cluster was also identified for all-cause neonatal mortality. More attention is needed on prematurity and asphyxia in the identified cause-specific neonatal mortality clusters. The emerging cluster for all-cause neonatal mortality also needs more attention to forestall any formation of significant mortality cluster in the future. Further research is also required to understand the high concentration of prematurity and asphyxiated deaths in the identified clusters.

A Competing Risk Analysis of Women Dying of Maternal, Infectious, or Non-Communicable Causes in the Kintampo Area of Ghana.

Background: Maternal, infectious, and non-communicable causes of death combinedly are a major health problem for women of reproductive age (WRA) in sub-Saharan Africa (SSA). Little is known about the relative risks of each of these causes of death in their combined form and their demographic impacts. The focus of studies on WRA has been on maternal health. The evolving demographic and health transitions in low- and middle-income countries (LMICs) suggest a need for a comprehensive approach to resolve health challenges of women beyond maternal causes.Methods: Deaths and person-years of exposure (PYE) were calculated by age for WRA within 15–49 years of age in the Kintampo Health and Demographic Surveillance System (KHDSS) area from January 2005 to December 2014. Causes of death were diagnosed using a standard verbal autopsy questionnaire and the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Identified causes of death were categorized into three broad areas, namely, maternal, infectious, and non-communicable diseases. Multiple decrements and associated single decrement life table methods were used.Results: Averting any of the causes of death was seen to lead to improved life expectancy, but eliminating infectious causes of death leads to the highest number of years gained. Infectious causes of death affected all ages and the gains in life expectancy, assuming that these causes were eliminated, diminished with increasing age. The oldest age group, 45–49, had the greatest gain in reproductive-aged life expectancy (RALE) if maternal mortality was eliminated.Discussion: This study demonstrated the existence of a triple burden. Infectious causes of death are persistently high while deaths from non-communicable causes are rising and the level of maternal mortality is still unacceptably high. It recommends that attention should be given to all the causes of death among WRA.

Potential effect modification of RTS,S/AS01 malaria vaccine efficacy by household socio-economic status

BackgroundIn the phase III RTS,S /AS01 trial, significant heterogeneity in efficacy of the vaccine across study sites was seen. Question on whether variations in socio - economic status (SES) of participant contributed to the heterogeinity of the vaccine efficacy (VE) remains unknown.MethodsData from the Phase III RTS,S /AS01 trial in children aged 5–17 months in Kintampo were re-analysed. SES of each child was derived from the Kintampo Health and Demographic Surveillance System, using principal component analysis of household assets. Extended Cox regression was used to estimate the interaction between RTS,S/AS01 VE and household SES.ResultsProtective efficacy of the RTS,S/AS0 vaccine significantly varied by participant’s household SES, thus increase in household SES was associated with an increase in protective efficacy (P-value = 0.0041). Effect modification persisted after adjusting for age at first vaccination, gender, distance from community to the health facility, child’s haemoglobin level, household size, place of residence and mothers’ educational level.ConclusionHousehold SES may be a proxy for malaria transmission intensity. The study showed a significant modification of the RTS,S/AS01 malaria vaccine efficacy by the different levels of child’s household socio - economic status.Trial registrationEfficacy of GSK Biologicals’ candidate malaria vaccine (25049) against malaria disease in infants and children in Africa. NCT00866619 prospectively registered on 20 March 2009.

Neonatal mortality in the central districts of Ghana: analysis of community and composition factors

BackgroundCommunities and their composition have an impact on neonatal mortality. However, considering the smallest health administrative units as communities and investigating the impact of these communities and their composition on neonatal mortality in Ghana have not been studied. Therefore, this study aimed to investigate the effect of community-, household- and individual-level factors on the risk of neonatal mortality in two districts in Ghana.MethodsThis was a longitudinal study that used the Kintampo Health and Demographic Surveillance System as a platform to select 30,132 neonatal singletons with 634 deaths. Multilevel cox frailty model was used to examine the effect of community-, household- and individual-level factors on the risk of neonatal mortality.ResultsRegarding individual-level factors, neonates born to mothers with previous adverse pregnancy (aHR = 1.38, 95% CI: 1.05–1.83), neonates whose mothers did not receive tetanus toxoid vaccine (aHR = 1.32, 95% CI: 1.08–1.60) and neonates of mothers with Middle, Junior High School or Junior Secondary School education (aHR = 1.30, 95% CI: 1.02–1.65) compared to mothers without formal education, had a higher risk of neonatal mortality. However, female neonates (aHR = 0.61, 95% CI: 0.51–0.73) and neonates whose mother had secondary education or higher (aHR = 0.37, 95% CI: 0.18–0.75) compared to those with no formal education had a lower risk of mortality. Neonates with longer gestation period (aHR = 0.95, 95% CI: 0.94–0.97) and those who were delivered at home (aHR = 0.56, 95% CI: 0.45–0.70), private maternity home (aHR = 0.45, 95% CI: 0.30–0.68) or health centre/clinic (aHR = 0.40, 95% CI: 0.26–0.60) compared to hospital delivery had lower risk of mortality. Regarding the household-level, neonates belonging to third quintile of the household wealth (aHR = 0.70, 95% CI: 0.52–0.94) and neonates belonging to households with crowded sleeping rooms (aHR = 0.91, 95% CI: 0.85–0.97) had lower risk of mortality.ConclusionThe findings of the study suggest the risk of neonatal mortality at the individual- and household-levels in the Kintampo Districts. Interventions and strategies should be tailored towards the high-risk groups identified in the study.

Geospatial analysis of malaria mortality in the kintampo health and demographic surveillance area of central Ghana

ABSTRACT Malaria remains a menace to the existence of humanity in most contexts. Geospatial analysis of malaria mortality is crucial to identifying clusters of high disease burden and areas with limited access to malaria care for targeted control and remedial interventions. This study identified spatial and space-time clusters of malaria mortality in the Kintampo area of central Ghana. We used 1301 malaria deaths archived from 2005 to 2017 and Global Positioning System (GPS) point locations of the sub-districts in which these deaths occurred for our analysis. Mortality risks were smoothed and mapped using the Spatial Empirical Bayesian smoothing technique in Geoda (version 1.12.1.161) whereas spatial and spatio-temporal clustering analysis was done using SaTScan (version 9.6). Malaria mortality risks ranged between 1.2 and 2.4 deaths per 1000 population for persons of all ages and between 3.3 and 6.0 deaths per 1000 population for children under five years of age by sub-district. Two spatial clusters were detected for all-age malaria mortality with only the primary cluster (RR = 1.42, p = 0.001) being statistically significant. Also, two statistically significant space-time clusters were detected for all-age malaria mortality in the study area. The most likely cluster occurred between 2006 and 2011 in five sub-districts with a relative risk of 2.12 (p < 0.001) whilst the secondary cluster which had a relative risk of 2.47 (p < 0.001) occurred between 2005 and 2010 in four sub-districts. Similarly, only the most likely spatial cluster of under-five malaria mortality was statistically significant (RR = 1.36, p = 0.024). Furthermore, three spatio-temporal clusters of under-five malaria mortality were detected in the study area. The primary and second secondary clusters were statistically significant whilst the first secondary cluster had borderline significance. The primary cluster (RR = 4.49, p = 0.002) occurred in two sub-districts between 2006 and 2007. The first secondary cluster (RR = 2.21, P = 0.005) covered four sub-districts and was detected between 2006 and 2011 whereas the second secondary cluster (RR = 2.51, p = 0.003) covered two sub-districts between 2008 and 2013. Ultimately, our analysis identified a number of substantial spatial and apace-time clusters of malaria mortality in the study context, which could aid in the strategic planning, implementation and monitoring of targeted malaria control interventions.

Open-defecation and Attainment of SDG Six - Evidence from Kintampo Health and Demographic Surveillance System in Ghana

BackgroundThe Sustainable Development Goal (SDG) six partly targets at ending open defecation (OD) by 2030. It is essential to assess progress towards this target in sub-Saharan Africa (SSA) where the sanitation target of the Millennium Development Goal (MDG) was largely not achieved. About 215 million people are involved in OD in SSA. In Ghana, it is estimated that three out of five Ghanaians practice OD. This study examined whether the OD free target is achievable by 2030.MethodThis study used longitudinal health and demographic surveillance data from two districts in Kintampo. Data were collected from household heads or their representatives over a 12-year period. In an exploratory analysis, the correlation between total number of households, year, and total number of OD households was obtained. The average percentage yearly increase in OD was computed and used to project the percentage of OD for the years 2020, 2025 and 2030. In addition, geo-spatial technology was used to visualize variability in OD across the twelve sub-Districts. ResultsThe results showed that the OD free target is not achievable in 2030 or even after if the current trend continues. In 2016, more than two out of five households defecate openly. In six out of the 12 sub-Districts, more than half of the households openly defecated. Four out of these six sub-Districts were in the Kintampo North Municipality.ConclusionThe 2030 OD free target is not achievable in the Kintampo districts of Ghana.

The Influence of Apparent Temperature on Mortality in the Kintampo Health and Demographic Surveillance Area in the Middle Belt of Ghana: A Retrospective Time-Series Analysis.

Globally, studies have shown that diurnal changes in weather conditions and extreme weather events have a profound effect on mortality. Here, we assessed the effect of apparent temperature on all-cause mortality and the modifying effect of sex on the apparent temperature-mortality relationship using mortality and weather data archived over an eleven-year period. An overdispersed Poisson regression and distributed lag nonlinear models were used for this analysis. With these models, we analysed the relative risk of mortality at different temperature values over a 10-day lag period. By and large, we observed a nonlinear association between mean daily apparent temperature and all-cause mortality. An assessment of different temperature values over a 10-day lag period showed an increased risk of death at the lowest apparent temperature (18°C) from lag 2 to 4 with the highest relative risk of mortality (RR = 1.61, 95% CI: 1.2, 2.15, p value = 0.001) occurring three days after exposure. The relative risk of death also varied between males (RR = 0.31, 95% CI: 0.10, 0.94) and females (RR = 4.88, 95% CI: 1.40, 16.99) by apparent temperature and lag. On the whole, males are sensitive to both temperature extremes whilst females are more vulnerable to low temperature-related mortality. Accordingly, our findings could inform efforts at reducing temperature-related mortality in this context and other settings with similar environmental and demographic characteristics.

The influence of apparent temperature on mortality in the middle belt of Ghana

TPS 664: Climate change: temperature effects 2, Exhibition Hall, Ground floor, August 27, 2019, 3:00 PM - 4:30 PM Background/Aim: Globally, studies have shown that diurnal changes in weather conditions and extreme weather events have a profound effect on mortality. This notwithstanding, there is limited evidence of the effect of climatic factors on mortality in resource-poor settings whose populations could be excessively affected; especially in this era of climate change. The aim of this study was to assess the effect of apparent temperature on all-cause mortality and the modifying effect of sex on the apparent temperature-mortality relationship. Methods: We employed a retrospective time-series approach to assess the effect of a composite measure of temperature and relative humidity (apparent temperature) on all-cause mortality with over-dispersed Poisson regression and Distributed Lag-Nonlinear Models. Subsequently, we examined the relative risk of mortality at different temperature values over a 10 day lag period. We used daily counts of all-cause mortality archived by the Kintampo Health Research Centre’s Health and Demographic Surveillance System between 2005 and 2015 for the analysis. Besides, we obtained weather data from the Ghana Meteorological Agency and the United States’ National Oceanic and Atmospheric Administration’s National Climate Data Centre. Results: We observed a non-linear association between mean daily apparent temperature and all-cause mortality. At the lowest apparent temperature of 18 oC, an increased risk of death was observed from lag 2-4 with the highest relative risk of mortality (RR =1.61, 95% CI: 1.2, 2.15, p-value=0.001) occurring 3 days after exposure. At the lowest apparent temperature, the relative risk of death also varied between males (RR=0.31, 95% CI: 0.10, 0.94) and females (RR=4.88, 95% CI: 1.40, 16.99) from lag 0-1 and lag 2-4 respectively. Conclusions: The population of Kintampo is generally sensitive to both low and high apparent temperatures with males being prone to both temperature extremes whilst females are more susceptible to low temperature-related mortality.

Intermittent preventive treatment of pregnant women in Kintampo area of Ghana with sulphadoxine-pyrimethamine (SP): trends spanning 2011 and 2015

ObjectiveIn Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended for the prevention of malaria-related adverse outcomes. This study demonstrates the coverage of IPTp-SP use among pregnant women...

Post-licensure safety evaluation of dihydroartemisinin piperaquine in the three major ecological zones across Ghana.

BackgroundUncommon and rare adverse events (AEs), with delayed onset may not be detected before new drugs are licensed and deployed. The present study examined the post licensure safety of dihydroartemisinin-piperaquine (DHP) as an additional treatment for malaria in Ghana. The relationship between the incidence of AEs, treatment completion rate, participant characteristics and concomitant medications are reported.MethodsA study conducted from September 2013 to June 2014 in Navrongo, Kintampo and Dodowa health research centres in Ghana is presented. Participants had confirmed malaria and no known allergy to study drug. Patients provided informed consent and had their symptoms and results of their clinical examinations documented. Treatment with Eurartesim® (20/160mg dihydroartemisinin and 40/320mg piperaquine by Sigma-Tau Incorporated) was given, according to the body weight of patients. First treatment doses were under observation but the second and third doses were taken at home except in a sub-study involving a nested cohort. Patients were contacted at Day 5 (± 2 days) either on telephone or by a home visit to document any AEs experienced. Patients were asked to report to the study team any other AEs that occurred within 28 days post-treatment. All patients in the nested cohort had electrocardiogram (ECG).FindingsA total of 4563 patients, 52.1% females and 48.2% <6 years completed the study. A total of 444 patients were enrolled into the nested cohort. About 33% had temperature ≥ 37.5°C at enrolment. Approximately 3.4% reported taking prior antimalarials, 19.4% other medications and 86% took at least one concomitant medication. Incidence of AEs was 7.6% including infections (4.6%), gastrointestinal disorders (1.0%) and local reactions at the site of venesection (0.5%). Others were respiratory disorders (0.4%) and nervous system disorders (0.3%). There were nine adverse events of special interest (AESI); itching/pruritus (7), dizziness (1), and skin lesions (1). Patients who took medications prior to enrolment had higher incidence of AEs compared with those without (9.3% vs. 6.1%; P<0.001). Statistically significant associations were found between the reported AEs and age of patients (P<0.001), their body mass index (BMI) (P< 0.001) and parasite densities (P< 0.001).ConclusionDihydroartemisinin-Piperaquine was well tolerated with no serious safety concerns identified. Obesity and prior enrolment medication were among significant factors associated with increased AEs reporting.

\u201cMaking the Mentally Ill Count\u201d, lessons from a Health and Demographic Surveillance System for people with mental and neurological disorders in the Kintampo districts of Ghana

BackgroundPersons with mental and neurological disorders (PMNDs) are among the most marginalised groups in developing countries, as they are socially excluded and overlooked in most developmental efforts. Due to high levels of stigma and other operational difficulties, PMNDs are often marginalised in routine enumeration exercises. Health and Demographic Surveillance System is an important public health research platform especially in countries that lacks reliable data systems, as it registers and monitor basic demographic and health events such as births, deaths and migration in a geographically defined population. This information is essential for policy development and resource distribution and service delivery. We aim to document the reasons for not counting PMNDs in our communities and demonstrate the usefulness of the Kintampo Health and Demographic Surveillance Systems (KHDSS) platform in counting PMNDs over time. We also documented strategies in providing vital information that helps in establishing the rights of PMNDs.MethodsAs a longitudinal study, psychiatric case register was established. Both quantitative and qualitative data collection techniques were used to solicit responses from stakeholders regarding the non-consideration of PMNDs as part of household membership in the study area. PMNDs were identified using the KHDSS and followed every 6 months. The “targeted” (actively searching for PMNDs) and “service provision” (providing medical treatment for PMNDs) approaches were adopted to enhance the identification of PMNDs.ResultsStigma was the main reason cited for the non-counting of PMNDs in the area. Following a “targeted” and “service provision” approach, the number of PMNDs enrolled into the psychiatric case register went up to 68% in 2010; as against the previous levels of 49 and 54% in 2005 and 2008 respectively. The study highlights the intrinsic value of such an approach for social inclusion of PMNDs.ConclusionsStigma against PMNDs was report in this study. We provided evidence that the KHDSS platform is useful for identification of PMNDs for service provision. The paper highlights evidence for policy formulation and implementation.

7 A new, low-cost protein-to-creatinine strip dipstick to improve proteinuria screening for preeclampsia

Introduction Accurate and timely diagnosis of women at high risk for preeclampsia (PE) is key to accessing proper interventions and improving clinical outcomes. In collaboration with LifeAssay Diagnostics (LAD; South Africa), we have developed a new low-cost protein-to-creatinine (Pr/Cr) ratiometric strip test that improves the accuracy of proteinuria screening over the commonly-used protein-only dipstick by adjusting for urine dilution. Objectives Developmental efforts by PATH and its partners have focused on optimizing and evaluating the PrCr test characteristics to advance the prototype to downstream field validation and early introduction. Methods Performance evaluation : PATH and Magee Women’s Research Institute (USA) performed a laboratory-based evaluation of the LAD Pr/Cr test and the Siemens Multistix PRO LS, a commercial urinary dipstick that measures protein and creatinine but costs about US $7 per test. Each test was evaluated using 137 repository urine samples. Samples were selected across the capable dynamic range of the Pr/Cr test, based on protein and creatinine levels determined using a reference clinical laboratory analyzer. Usability : PATH, in collaboration with Kintampo Health Research Center (Ghana), conducted a field usability study with community antenatal care (ANC) providers. Data was collected through observation and interviews of 25 participants, including midwives and community health nurses, who performed and interpreted the test using urine control samples and multiple versions of prototype instructions. Thermal stability : A six-month longitudinal study is being conducted to evaluate both shelf-life stability of unopened product and in-use stability where the same product is repetitively opened over time. Three lots stored at 25 °C, 37 °C, and 45 °C were used for shelf-life evaluations, while the in-use stability study examined test performance on two manufacturing lots at either 25 °C or 45 °C. Results Performance evaluation : Compared to the reference standard assay, the LAD Pr/Cr dipstick demonstrated performance of 85% sensitivity and 71% specificity (95%CI) for proteinuria determination using a normal to abnormal cutoff of 0.19 Pr-to-Cr ratio. The Siemens Multistix demonstrated a 82% sensitivity and 79% specificity (95%CI). Usability : Participants found the test to be simple and easy to use. All participants accurately matched the color of the protein marker on the strip to the instructions, while 80% of participants correctly matched colors for the creatinine marker. Participants overwhelmingly preferred a linear test interpretation chart that outlines each possible permutation of Pr and Cr. Thermal stability : After four months, the Pr/Cr test strips demonstrated stable performance across all temperatures and manufacturing lots in both shelf-life and in-use stability testing. Conclusions The LAD Pr/Cr test provides a similar performance to the Siemens product as compared to the reference test at much lower cost comparable to the protein-only dipstick commonly used in low-resource countries. Other evaluation results indicate the test characteristics are compatible for field use. Additionally, the Pr/Cr test may offer additional advantages to the current protein-only dipstick in providing clearer interpretation to inform proper care.

Factors Influencing Health Facility Delivery in Predominantly Rural Communities across the Three Ecological Zones in Ghana: A Cross-Sectional Study.

BackgroundMaternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan African countries. Both maternal and neonatal health outcomes improve when skilled personnel provide delivery services within health facilities. Determinants of delivery location are crucial to promoting health facility deliveries, but little research has been done on this issue in Ghana. This study explored factors influencing delivery location in predominantly rural communities in Ghana.MethodsData were collected from 1,500 women aged 15–49 years with live or stillbirths that occurred between January 2011 and April 2013. This was done within the three sites operating Health and Demographic Surveillance Systems, i.e., the Dodowa (Greater Accra Region), Kintampo (Brong Ahafo Region), and Navrongo (Upper-East Region) Health Research Centers in Ghana. Multivariable logistic regression was used to identify the determinants of delivery location, controlling for covariates that were statistically significant in univariable regression models.ResultsOf 1,497 women included in the analysis, 75.6% of them selected health facilities as their delivery location. After adjusting for confounders, the following factors were associated with health facility delivery across all three sites: healthcare provider’s influence on deciding health facility delivery, (AOR = 13.47; 95% CI 5.96–30.48), place of residence (AOR = 4.49; 95% CI 1.14–17.68), possession of a valid health insurance card (AOR = 1.90; 95% CI 1.29–2.81), and socio-economic status measured by wealth quintiles (AOR = 2.83; 95% CI 1.43–5.60).ConclusionIn addition to known factors such as place of residence, socio-economic status, and possession of valid health insurance, this study identified one more factor associated with health facility delivery: healthcare provider’s influence. Ensuring care provider’s counseling of clients could improve the uptake of health facility delivery in rural communities in Ghana.