Navrongo Health Research Centre Research Articles

Community perceptions and willingness to participate in COVID-19 vaccine trials: a qualitative study in Northern Ghana

Background: Several COVID-19 vaccines were developed and are being tested to find effective vaccine to control the COVID-19 pandemic. The Navrongo health research centre was engaged to conduct trials on the safety and efficacy of some of the COVID-19 vaccines to inform policy in Ghana. This study explored perceptions and willingness to participate in the COVID-19 vaccine trials that were conducted in the Kassena-Nankana districts of Northen Ghana. Methods: This study used qualitative research approach where 10 focus group discussions and 30 in-depth interviews were conducted with participants. The data were coded into themes using QSR NVivo 12 software before thematic analysis. Results: The majority of participants perceived that the COVID-19 vaccine trial was a good initiative, which had helped people to get access to the vaccines to boost their immunity against the virus. However, some participants felt that it was not appropriate for NHRC to conduct the trials because of the perceived risks associated with the vaccines. Most participants said they were ready to participate in the trials if they were invited with many of them mentioning good health and compensation as the main factors that could influence their decision. Nonetheless, a good number of them maintained that they were not ready to participate because of perceived risks resulting from receiving the COVID-19 vaccines. Conclusion: Our recommendation is that effective community engagement strategies by researchers such as collaborating with key community leaders, to actively get involved during community education prior to conducting clinical trials, could improve understanding and participation.

Effect of national immunisation campaigns with oral polio vaccine on all-cause mortality in children in rural northern Ghana: 20 years of demographic surveillance cohort data

Studies from Guinea-Bissau and Bangladesh have shown that campaigns with oral polio vaccine (C-OPV) may be associated with 25-31% lower child mortality. Between 1996 and 2015, Ghana had 50 national C-OPVs and numerous campaigns with vitamin A supplementation (VAS), and measles vaccine (MV). We investigated whether C-OPVs had beneficial non-specific effects (NSEs) on child survival in northern Ghana. We used data from a health and demographic surveillance system in the Navrongo Health Research Centre in rural northern Ghana to examine mortality from day 1-5 years of age. We used Cox models with age as underlying time scale to calculate hazard ratios (HR) for the time-varying covariate "after-campaign" mortality versus "before-campaign" mortality, adjusted for temporal change in mortality, other campaign interventions and stratified for season at risk. From 1996 to 2015, 75,610 children were followed for 280,156 person-years between day 1 and 5 years of age. In initial analysis, assuming a common effect across all ages, we did not find that OPV-only campaigns significantly reduced all-cause mortality, the HR being 0.96 (95% CI: 0.88-1.05). However, we subsequently found the HR differed strongly by age group, being 0.92 (0.75-1.13), 1.29 (1.10-1.51), 0.79 (0.66-0.94), 0.67 (0.53-0.86) and 1.03 (0.78-1.36) respectively for children aged 0-2, 3-5, 6-8, 9-11 and above 12 months of age (p<0.001). Triangulation of the evidence from this and previous studies suggested that increased frequency of C-OPVs and a different historical period could explain these results. In Ghana, C-OPVs had limited effects on overall child survival. However, triangulating the evidence suggested that NSEs of C-OPVs depend on age of first exposure and routine vaccination programs. C-OPVs had beneficial effects for children that were not exposed before 6 months of age. These non-specific effects of OPV should be exploited to further reduce child mortality. DANIDA; Else og Mogens Wedell Wedellsborgs Fond.

Tweedie Regression Analysis of Determinants of Birth Weight in Navrongo

Abstract The study modelled and investigated the determinants of infant birth weight by considering maternal and infant factors as predictors. Monthly data spanning for a period of 37 months were obtained from the Navrongo Health Research Centre of the Navrongo Municipality of the Upper East region of Ghana. In modelling the birth weight of infants, the Tweedie regression model and its counterparts of exponential families (Gaussian, Gamma and inverse Gaussian) of distribution were developed. The performances of these models were evaluated using the Akaike Information Criterion. Based on the Akaike Information Criterion, the Tweedie regression model showed superiority in modelling the determinants of infant birth weight as compared to the other counterparts of the exponential families of distributions. The parameter estimates of the Tweedie regression model found child’s gender and maternal factors (religion, marital status and educational level) to contribute substantially to the birth weight of infants. Also, the study recommends that except for the status of antenatal care, emphasis must be placed on determining the reasons for the decrease in infant birth weight as a result of the maternal factors; parity, delivery type and the age of the mother.

Barriers and Facilitators to Community Acceptability of Integrating Point-of-Care Testing to Screen for Sickle Cell Disease in Children in Primary Healthcare Settings in Rural Northern Ghana

Introduction: Sickle cell disease (SCD) remains a public health problem especially in sub-Saharan Africa including Ghana. While pilot initiatives in Africa have demonstrated that neonatal screening coupled with early intervention reduces SCD-related morbidity and mortality, only 50-70% of screen-positive babies have been successfully retrieved to benefit from these interventions. Further, systematic newborn screening for SCD as public health programs is lacking. To address this problem, innovation is needed to bridge the diagnostic gap and develop sustainable care programs through universal health coverage. Point-of-care testing (POCT) with high specificity and sensitivity for SCD screening can be more easily integrated into existing immunization programs in Africa and are more likely to improve retrieval rates. This study explored community perceptions and acceptability of integrating POCT to screen for SCD in newborns and children under 5 years of age in primary healthcare facilities in rural Kassena-Nankana Districts of Northern Ghana. Method: This was an exploratory study using qualitative research approach where 10 focus group discussions and 20 in-depth interviews were conducted with community members and health workers between April and June 2022 covering major thematic areas such as community awareness and perceptions of SCD, their views on integrating POCT to screen for SCD, and barriers and facilitators of community acceptability and uptake of SCD screening in children under 5 years of age in primary care settings. The theoretical framework on acceptability of healthcare interventions validated by Sekhon et al. was adopted and used in this study. The interviews were recorded with participants’ consent and transcribed verbatim after repeatedly listening to the recordings. Data was coded into themes using Nvivo 12 software before thematic analysis. The study was approved by the Institutional Review Board of the Navrongo Health Research Centre. Results: Most participants (70.9 %) described SCD as serious and potentially life-threatening condition affecting children. Of 148 community members and health workers, 141 (95.2%) expressed positive views about the screening exercise, which could facilitate diagnosis of SCD in children for early management. However, discrimination, fear of being tested positive, stigmatization, negative health worker attitude linked with issues of maintaining confidentiality were reported by majority of participants as key factors that could negatively impact uptake of the screening exercise. Most participants suggested that health education (74.3 %), short duration of screening processes (74.3%), positive attitude of health workers (69.5%), and screening health workers not being biased (58.8%) as factors that could promote community acceptability. Conclusion: A large majority (over 95%) of participants viewed screening of SCD in children as very important. However, views expressed by most participants suggest that health education, short duration of the screening process, and professionalism of health workers in keeping patients’ information confidential could improve community acceptability. These findings have informed the implementation design for using POCT to screen for SCD in children under 5 years of age in primary care settings in rural Northern Ghana.

Impact of default rate of antiretroviral use on viral load among HIV/AIDS patients in Tamale and Sunyani

Background: Highly Active Antiretroviral Therapy (HAART) for persons living with HIV/AIDS (PLWHA) is the gold standard for the management of HIV patients. Purportedly, patients who are not on HAART or defaulted from its use have adverse effects compared to those who adhere to the intake of HAART. Compliant individuals have improved quality of life and show healthy hematological parameters and HIV load as compared to HAART naïve individuals and defaulters. Supplementary and supportive treatment is crucial in HIV/AIDS patients on patients on antiretroviral therapy? Objective: This study was conducted to assess the consistency and default of HAART intake and other supportive treatments and its relationship with viral load on hematological parameters in two different geographical sites. Methods: Ethical clearance was obtained from Navrongo Health Research Centre. Questionnaires were administered to participants for their consent, demographic data, consistency of taking antiretrovirals, and types of antiretrovirals used. Full blood count and HIV load tests were carried out using Urit 5250 and Cobas Taqman / Cobas ampliprep fully automated analysers respectively. Results: Defaulters had a significant (p value=0.003) rise in their viral load (845334.38±409285.62) copies/mL in comparison to adherents in HAART intake 49571.69±30548.89) copies/mL. The hemoglobin level (10.51±0.60 g/dL) of defaulters was significantly (p-value = 0.007) lower than that of adherent (12.04±0.17 g/dL). The default rates in the two study sites were close (9.8% in Sunyani and 9.4% in Tamale). Conclusion: Antiretroviral default does not only lead to an increase in HIV load but also causes a reduction in hemoglobin levels. Hematinics supplementation therapy may help normalize hematological parameters in HIV infection

Advancing non-communicable diseases research in Ghana: key stakeholders' recommendations from a symposium.

Funding for the symposium was provided by NIH Fogarty International Center-Grant number D43TW008330, under the Wits Non-Communicable Disease Research Leadership Training Program.

Inadequate Preparedness for Response to COVID-19 Is Associated with Stress and Burnout Among Healthcare Workers in Ghana

Background: The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers (HCWs). But few studies have empirically examined the factors driving these outcomes. We examined the association between perceived preparedness to respond to the pandemic and HCW stress and burnout and identified potential mediating factors among HCWs in Ghana.Methods: Data are from HCWs in Ghana who completed a cross-sectional self-administered online survey; 414 and 409 HCWs completed stress and burnout questions, respectively. Perceived preparedness, stress, and burnout were measured using validated psychosocial measures. We assessed associations using linear regressions with robust standard errors.Findings: The average score for preparedness was 24 (SD=8.8), 16.3 (SD=5.9) for stress, and 37.4 (SD=15.5) for burnout. In multivariate analysis, HCWs who felt somewhat prepared and prepared had lower stress (β=-1.89, 95%CI:-3.49 to -0.30 and β=-2.66, 95%CI:-4.48 to -0.84) and burnout (β=-7.74, 95%CI:-11.8 to -3.64 and β=-9.25, 95%CI:-14.1 to –4.41) scores than those who did not feel prepared. Appreciation from management and family support were associated with lower stress and burnout, while fear of infection was associated with higher stress and burnout. Fear of infection partially mediated the relationship between perceived preparedness and stress/burnout, accounting for about 16 to17% of the effect.Interpretation: Low perceived preparedness to respond to COVID-19 increases stress and burnout, and this is partly through fear of infection. Interventions to increase HCWs’ morale and capacity to respond to the pandemic are needed.Funding Statement: The UCSF COVID-19 Related Rapid Research Pilot Initiative (#2016796).Declaration of Interests: All authors declare that they have no conflict of interest.Ethics Approval Statement: Ethical approval was obtained from the University of California, San Francisco (#20-30656) and the Navrongo Health Research Centre (#NHRCIRB374).

The fertility impact of achieving universal health coverage in an impoverished rural region of Northern Ghana

Background: When a successful Navrongo Health Research Centre service experiment demonstrated means for reducing high fertility and childhood mortality in a traditional societal setting of northern Ghana, the Ministry of Health launched a program of national scaling up known as the Community-based Health Planning and Services (CHPS) initiative. For two decades, CHPS has been Ghana’s flagship program for achieving universal health coverage (UHC). When monitoring during its first decade determined that the pace of CHPS scale-up was unacceptably slow, the Ghana Health Service launched the Ghana Essential Health Interventions Program (GEHIP) in four Upper East Region districts to test means of accelerating to CHPS implementation and improving its quality of care. Methods: To evaluate GEHIP, a two-round randomized sample survey was fielded with clusters sampled at baseline that were reused in the endline to facilitate difference-in-difference estimation of changes in fertility associated with GEHIP exposure. Monitoring operations assessed the location, timing, and content of CHPS primary health care. Discrete time hazard regression analysis on merged baseline and endline birth history data permit estimation of GEHIP fertility and CHPS access effects, adjusting for hospital and clinical service access and household social and economic confounders. Results: GEHIP exposure was associated with an immediate acceleration of CHPS implementation and coverage. Women residing in households with CHPS services had only slightly lower fertility than women who lacked convenient access to CHPS. GEHIP impact on contraceptive use was statistically significant but marginal; GEHIP exposure was associated with increasing unmet need. Conclusion: Results challenge the assumption that achieving UHC will reduce excess fertility. Social mobilization, community-outreach, connection of family planning discussions with male social networks are elements of the Navrongo success story that have atrophied with CHPS scale-up. Achieving UHC does not address the need for renewed attention to these family planning focused strategies.

Adherence to Dihydroartemisinin-Piperaquine Treatment among Patients with Uncomplicated Malaria in Northern Ghana.

Treatment adherence has been described as the process whereby patients take medications, follow diet, and effect other lifestyle changes that relate to agreed recommendations from healthcare providers. The determinants of such treatment adherence include patient, the health condition, therapy type, socioeconomic conditions, and the healthcare system. The study examined adherence in malaria patients treated with dihydroartemisinin-piperaquine in routine clinical care in northern Ghana. The study was conducted in Navrongo Health Research Centre in the Kassena-Nankana district of northern Ghana. Patients confirmed with uncomplicated malaria were prescribed dihydroartemisinin-piperaquine in blister packs to be taken daily for three days. Follow-up visits were made on days 3 and 28 after diagnosis to collect data on adherence, drug safety and therapeutic effectiveness. During follow-up visits, in-depth interviews were conducted and the blister packs directly observed for the number of tablets remaining. The in-depth interviews documented day-by-day account of doses taken, number of tablets taken during each dose, time of each dose, reasons for any leftover or missed dose, and whether or not there was vomiting. Treatment adherence was classified as definitely nonadherent, incomplete adherence, and completely adherent. A total of 405 patients were screened; 299 were positive by rapid diagnostic testing and 216 by microscopy. The average age was 12 years and females represented 54.0%. All participants completed day 3 follow-up but 12.7% had leftover pills. Treatment adherence was 50.9% (95% CI 44.1, 57.8), 36.1% (95% CI 29.7, 42.9), and 13.0% (95% CI 8.8, 18.2) for completely adherent, incomplete adherence, and definitely nonadherent, respectively. All completely adherent patients were free of parasitemia on day 28 of follow-up. A total of 49 adverse events related to malaria symptoms were documented. Effort to improve adherence should be individualized as it is dependent on a number of factors such as the patients' temperament, the disease, support at home, and complexity of treatment.

Decline of Yellow Fever Long-Term Immunity in Children Vaccinated During Infancy

Background: The vaccine against yellow fever is routinely administered to infants aged 9-12 months under the Expanded Programme on Immunization, but the long-term outcome of vaccination in this age group is unknown. This information is critical in the context of current guidelines recommending a single dose of the vaccine for life. Methodology: We used a microneutralization assay to measure protective antibodies against yellow fever in 587 Malian and 436 Ghanaian children vaccinated around age 9 months and followed for 4·5 years (Mali), or 2·3 and 6 years (Ghana). We standardized antibody concentrations with reference to the yellow fever WHO International Standard. Findings: In the Malian group, 50·4% of children (95% CI 46·4-54·5) were seropositive (antibody concentration =0·5 IU/ml) 4·5 years after vaccination. Among the Ghanaian children, only 27·8% (95% CI 23·5-32·0) were seropositive after 2·3 years. This represented a sharp drop from the rates reported for both populations 28 days postvaccination. Seropositivity increased to 43·1% (95% CI 38·5-47·8) in the Ghanaian group 6 years after vaccination, but this result is confounded by possible secondary exposure to yellow fever virus. Interpretation: Rapid waning of immunity during the early years after vaccination of 9-month-old infants argues for a revision of the single-dose recommendation for this target population in endemic countries. In addition, the short duration of immunity in many vaccinees suggests that booster vaccination is necessary to meet the 80% population immunity threshold for prevention of yellow fever outbreaks. Funding Statement: Wellcome Trust Foundation. Declaration of Interests: SOS received grants from PATH during the conduct of the present study. SOS is the Minister of Health and Public Hygiene of the Republic of Mali but was not at the time of the collection of the samples used in this study. NB and CK received grants from the Bill and Melinda Gates Foundation during the conduct of this study. CD, JF, POA, and JEM declare no conflicts of interest. Ethics Approval Statement: The study protocol was approved by the ethics committees for studies involving human subjects at the Navrongo Health Research Centre, Navrongo, Ghana, and the National Institute for Research in Public Health (INRSP), Bamako, Mali. All the procedures complied with the Declaration of Helsinki. Informed consent was provided in writing by the participants’ parents or legal guardians in accordance with international ethical guidelines for epidemiological studies and with applicable local ethical guidance and requirements.

Does the provision of community health services offset the effects of poverty and low maternal educational attainment on childhood mortality? An analysis of the equity effect of the Navrongo experiment in Northern Ghana

The Government of Ghana has instituted a National Poverty Reduction Program with an initiative known as the Community-based Health Planning and Services (CHPS) as its core health development strategy. CHPS was derived from a plausibility trial of the Navrongo Health Research Centre testing four contrasting primary health care strategies: i) Training unpaid volunteers to promote health in communities, ii) placing nurses in communities with training and supplies for treating childhood illnesses, iii) combining the nurse and volunteer approaches, and iv) sustaining a comparison condition whereby clinic services were provided without community resident workers. This paper presents an age-conditional proportional hazard analysis of the long term impact of community health worker exposure among 94,599 children who were ever under age five over the January 1, 1995 to December 2010 period, adjusting for age conditional effects of shifts in exposure type as CHPS was scaled up in Navrongo project area over the 1995–2000 period. Results show that children whose parents are uneducated and relatively poor experience significantly higher mortality risks than children of the educated and less poor. Conditional hazard regression models assess the impact of CHPS on health equity by estimating the interaction of equity indicators with household exposure to CHPS service operations, adjusting for age conditional exposure to original Community Health and Family Planning Project (CHFP) service strategies as scale-up progressed. The association of mortality risk among children with uneducated and relatively impoverished mothers is offset by exposure to community health nursing services. If exposure is limited to volunteer-provided services alone, survival benefits arise only among children of relatively advantaged households. Findings lend support to policies that promote the CHPS nurse approach to community-based services as a core health component of poverty reduction programs.

Geographical Accessibility of Antenatal Diagnostic Services in Rural Ghana' Primary Health Care Clinics: The Role of District Hospitals/Medical Laboratories Locations in the Upper East Region

Background: Efforts to reduce maternal mortality to less than 70 per 100000 live births is a priority of the Government of Ghana and globally. Access to district hospitals/medical laboratories from rural primary healthcare (PHC) clinics for antenatal diagnostic services is critical for improving pregnancy outcomes and reducing maternal mortality. We assessed the geographical accessibility of district hospitals/medical laboratories for antenatal diagnostic services in Upper East Region, Ghana. Methods: We assembled detailed spatial data on weighted 100 rural clinics and their district hospitals/medical laboratories; and landscape features influencing journeys in the region. These were used in a geospatial model to estimate actual distance and travel time from a PHC facility to the nearest district hospital/medical laboratory for diagnostic services. Distribution of facilities was done using spatial autocorrelation (Global Moran's I) run in ArcMap 10.4.1. Logistics regression analysis was done utilizing STATA 14 to determine the strength of association between geographical accessibility and pregnancy outcome predictors. Findings: Of the 100 rural clinics included in the analysis, only 15% were located less than 10km (travel time: 5-30 minutes) to their nearest referral health facilities. The likelihood of a pregnant woman accessing a referral facility for diagnostic services in the region was after every 25 km (range: 0.2-62). Spatial distribution of the referral facilities was shown to be dispersed (MI= -0.69, z-score= -2.05, p=0.04). Likewise, the spatial distribution of the PHC clinics appeared to be at random (MI=0.01, z-score = 0.33, p=0.74). Logistic regression showed maternal mortality (OR=1.25, [95%CI=1.1-1.4] p<0.05); stillbirth (OR=1.1, [95%CI= 1.0-1.2], p=0.01); and miscarriage/abortion (OR=1.13, [95%CI=1.1-1.2]; p<0.05) were significantly associated with poor geographical accessibility. nterpretation: Geographical location of a district hospital/medical laboratory affected geographical accessibility of antenatal diagnostic services for rural populations in Upper East Region, Ghana. Targeted improvement of essential point-of-care diagnostics in rural primary health care clinics is recommended for both maternal healthcare and the general population. Funding: University of KwaZulu-Natal, College of Health Sciences Research Scholarship. Declaration of Interest: None declared. Ethical Approval: This study was approved by the Navrongo Health Research Centre Institutional Review Board/Ghana Health Service (approval number: NHRCIRB291) and the University of KwaZulu-Natal Biomedical Research Ethics Committee (approval number: BE565/17). Permission was obtained from the Upper East Regional Health Directorate prior to conducting the study. All study participants signed an informed consent prior to participating in this study.

Geographical Accessibility of Referral Health Facilities from Rural Primary Healthcare Clinics for Antenatal Diagnostic Services in the Upper East Region, Ghana

Background: Efforts to reduce maternal mortality to less than 70 per 100000 live births is a priority of the Government of Ghana and globally. Access to referral health facilities from rural primary healthcare (PHC) clinics for antenatal diagnostic services is critical for improving pregnancy outcomes and reducing maternal mortality. We assessed the geographical accessibility of referral health facilities from rural clinics for antenatal diagnostic services in Upper East Region, Ghana. Methods: We assembled detailed spatial data on weighted 100 rural clinics, referral health facilities, and landscape features influencing journeys in the region. These were used in a geospatial model to estimate actual distance and travel time from a PHC facility to the nearest referral facility for diagnostic services. Distribution of facilities was done using spatial autocorrelation (Global Moran's I) run in ArcMap 10.4.1. Logistics regression analysis was done utilizing STATA 14 to determine the strength of association between long distances and pregnancy outcome predictors. Findings: Of the 100 rural clinics included in the analysis, only 15% were located less than 10km (travel time: 5-30 minutes) to their nearest referral health facilities. The likelihood of a pregnant woman accessing a referral facility for diagnostic services in the region was after every 25 km (range: 0.2-62). Spatial distribution of referral facilities was found to be dispersed (p<0.05, z-score= -2.05). Likewise, the spatial distribution of the PHCs appear to be at random (p<0.05, z-score = 0.33). Logistic regression showed maternal mortality (OR=1.25, 95%CI=1.1-1.4); stillbirth (OR=1.1, 95%CI= 1.0-1.2); and miscarriage/abortion (OR=1.13, 95%CI=1.1-1.2) were significantly associated with long distance all p<0.05. Mean test results turnaround time from referred clients to the PHC clinic midwife was estimated at 15.4 (SD= 8.6, 95%CI= 13.7-17.1). No form of electronic option for communicating test results existed between the rural clinics and their referral facilities. Interpretation: There is poor geographical accessibility of referral health facilities from rural PHC clinics for antenatal diagnostic services in Upper East Region, Ghana. Targeted improvement of essential point-of-care diagnostics in rural clinics is recommended for both maternal healthcare and the general population. Funding: University of KwaZulu-Natal, College of Health Sciences Research Scholarship. Declaration of Interest: None declared. Ethical Approval: This study was approved by the Navrongo Health Research Centre Institutional Review Board/Ghana Health Service (approval number: NHRCIRB291) and the University of KwaZulu-Natal Biomedical Research Ethics Committee (approval number: BE565/17). Permission was obtained from the Upper East Regional Health Directorate prior to conducting the study. All study participants signed an informed consent prior to participating in this study.

Accessibility of Point-of-Care Diagnostic Services for Maternal Health in Lower Healthcare Facilities in Northern Ghana: A Cross-Sectional Survey

Background: Improving access to maternal healthcare in resource limited settings plays a critical role in improving maternal health outcomes and reducing maternal deaths. However, barriers and challenges may exist in rural clinics and could affect successful implementation. This study assessed the current accessibility of point-of-care (POC) diagnostic services for maternal healthcare in rural primary healthcare (PHC) clinics in Northern Ghana. Method: We randomly selected 100 PHC clinics providing maternal healthcare from a total list of 356 PHCs obtained from the regional health directorate. Selected clinics were surveyed from 15th February to 31st March, 2018 using an adopted survey tool. We obtained data for clinic-level staffing, availability, usage, and desired POC diagnostic tests. One antenatal clinic in-charge or a Physician Assistant from each facility was interviewed to assess their knowledge on POC diagnostic tests. Stata 14 was used for data analysis. Findings: Majority (64%) of the respondents were midwives. Average years of work experience and working hours per week were estimated at 5.6 (CI: 4.8-6.3) and 122 (CI: 111.9-132.6) respectively. Average antenatal clinic attendance per month was 65±67 (range 3-360). Mean POC tests available and use was 4.9 (CI: 4.5-5.4) out of 15 tests. Respondents' knowledge on POC test was 99.2 (CI: 99.7-100.5). The study found a positive correlation between availability and use though regression analysis showed no significance. POC test for malaria; HIV; urine pregnancy; and blood pressure were available in most clinics. Desired POC tests included: Glucose-6-phosphate dehydrogenase (95%); hepatitis c (94%); sickling (91%); tuberculosis, blood glucose and blood type (89%) each; urinary tract infection (87%), urine protein (81%); hepatitis b (78%); haemoglobin (76%); and syphilis (76%). Interpretation: There is poor accessibility of POC diagnostic services for maternal healthcare as results of low availability of POC tests in rural primary healthcare clinics in Northern Ghana. Funding: College of Health Sciences Scholarship. Declaration of interests: None declared. Ethics approval and consent to participate: This study was approved by the Navrongo Health Research Centre Institutional Review Board/Ghana Health Service (approval number: NHRCIRB291) and the University of KwaZulu-Natal Biomedical Research Ethics Committee (approval number: BE565/17). Permission was obtained from the Upper East Regional Health Directorate prior to conducting the study. All study participants signed an informed consent prior to participating in this study.

PREventing Maternal And Neonatal Deaths (PREMAND): a study protocol for examining social and cultural factors contributing to infant and maternal deaths and near-misses in rural northern Ghana

Plain English SummaryThe Preventing Maternal And Neonatal Deaths (PREMAND) project works to understand the social and cultural factors that may contribute to the deaths and near-misses (people who almost die but end up surviving) of mothers and babies in four districts in Northern Ghana. Examples of these factors include such thing as treating a sick baby at home with traditional medicine instead of going to a hospital or health center, or pregnant women needing permission from several people before they can go to a hospital to deliver. These social and cultural factors will be placed on a map to understand where patterns and clusters of deaths and near-misses are present in these four communities. The final phase of the project will include support and small grants for community members and local leaders to use these maps and this information to create their own solutions that address the specific needs of each community.BackgroundWhile Ghana is a leader in some health indicators among West African nations, it still struggles with high maternal and neonatal morbidity and mortality rates, especially in the northern areas. The clinical causes of mortality and morbidity are relatively well understood in Ghana, but little is known about the impact of social and cultural factors on maternal and neonatal outcomes. Less still is understood about how such factors may vary by geographic location, and how such variability may inform locally-tailored solutions.Methods/DesignPreventing Maternal And Neonatal Deaths (PREMAND) is a three-year, three-phase project that takes place in four districts in the Upper East, Upper West, and Northern Regions of Ghana. PREMAND will prospectively identify all maternal and neonatal deaths and ‘near-misses’, or those mothers and babies who survive a life threatening complication, in the project districts. Each event will be followed by either a social autopsy (in the case of deaths) or a sociocultural audit (in the case of near-misses). Geospatial technology will be used to visualize the variability in outcomes as well as the social, cultural, and clinical predictors of those outcomes. Data from PREMAND will be used to generate maps for local leaders, community members and Government of Ghana to identify priority areas for intervention. PREMAND is an effort of the Navrongo Health Research Centre and the University of Michigan Medical School.DiscussionPREMAND uses an innovative, multifaceted approach to better understand and address neonatal and maternal morbidity and mortality in northern Ghana. It will provide unprecedented access to information on the social and cultural factors that contribute to deaths and near-misses in the project regions, and will allow such causal factors to be situated geographically. PREMAND will create the opportunity for local, regional, and national stakeholders to see how these events cluster, and place them relative to traditional healer compounds, health facilities, and other important geographic markers. Finally, PREMAND will enable local communities to generate their own solutions to maternal and neonatal morbidity and mortality, an effort that has great potential for long-term impact.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0142-z) contains supplementary material, which is available to authorized users.

Factors influencing willingness to participate in new drug trial studies: a study among parents whose children were recruited into these trials in northern Ghana.

BackgroundDuring the last decade, the number of clinical trials conducted in sub-Saharan Africa has increased significantly which has helped to address priority health problems in the region. Navrongo health research centre since it was established in 1989, has conducted several trial studies including rectal artesunate trial in the Kassena-Nankana districts. However, there is little evidence-based for assessing the impact of new drug trials. This study explored factors that motivate parents to allow their children to participate in new drug trials in northern Ghana.MethodThe study used both quantitative and qualitative methods. The participants were randomly selected from among parents whose children were enrolled in a new drug trial conducted in the Kassena-Nankana districts between 2000 and 2003. QSR Nvivo 9 software was used to code the qualitative data into themes before analysis while STATA software Version 11.2© was used to analyze the quantitative data.ResultsThe results showed that majority (95.9 %) of the parents were willing to allow their children to be enrolled in future new drug trials. The main factors motivating their willingness to allow their children to be enrolled in these trials were quality of health care services offered to trial participants (92.9 %), detail medical examination (90.8 %), promptness of care provided (94.4 %) and quality of drugs (91.9 %). Other factors mentioned included disease prevention (99.5 %) and improved living standard (96.1 %). Parents reported that the conduct of these trials had reduced the frequency of disease occurrences in the communities because of the quality of health care services provided to the children recruited into these trial studies.ConclusionThough the implementation of clinical trials in the study area is believed to have positive impact on health status of people particularly trial participants, measures should however be taken to address safety and likely side effects of new drugs given to trial participants during these trial studies.

Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana and Tanzania: an intervention study

To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care.

Catalyzing the scale-up of community-based primary healthcare in a rural impoverished region of northern Ghana.

Ghana's Community-based Health Planning and Services (CHPS) initiative develops accessible healthcare with participatory community support, using strategies developed and tested by a project of the Navrongo Health Research Centre. In 1996, the project was expanded to a district-wide four-celled trial. In response to evidence that strategies could reduce fertility and childhood mortality, a replication project was launched to develop methods for scale-up. Based on experience gained, CHPS scale-up was launched in 2000. Although CHPS now reaches all of Ghana's districts, the pace of scale-up within districts has been slow. In response, the Ministry of Health conducted a review of factors that constrain CHPS scale-up and problems that detract from its original evidence-based design. To resolve problems that were identified, a project was launched in 2010 to test means of accelerating CHPS scale-up and expand its range of care. Known as the Ghana Essential Health Interventions Program (GEHIP), the project provided catalytic revenue to four treatment district managers for 3 years, in conjunction with implementation of strategies for comprehensive leadership development and community partnership. Monitoring systems were developed to gauge CHPS coverage time trends in all nine study districts. GEHIP successfully accelerated CHPS implementation, producing 100% of its targeted community coverage within 5 years of implementation. Coverage in comparison districts also improved. However, the rate of coverage and per cent of the population reached by CHPS in comparison districts was only half that of GEHIP districts. GEHIP success in completing CHPS coverage represents the initial stage of a national program for strengthening community health systems in Ghana. Copyright © 2015 John Wiley & Sons, Ltd.

The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal &amp; child survival

BackgroundDuring the 1990s, researchers at the Navrongo Health Research Centre in northern Ghana developed a highly successful community health program. The keystone of the Navrongo approach was the deployment of nurses termed community health officers to village locations. A trial showed that, compared to areas relying on existing services alone, the approach reduced child mortality by half, maternal mortality by 40%, and fertility by nearly a birth — from a total fertility rate of 5.5 in only five years. In 2000, the government of Ghana launched a national program called Community-based Health Planning and Services (CHPS) to scale up the Navrongo model. However, CHPS scale-up has been slow in districts located outside of the Upper East Region, where the “Navrongo Experiment” was first carried out. This paper describes the Ghana Essential Health Intervention Project (GEHIP), a plausibility trial of strategies for strengthening CHPS, especially in the areas of maternal and newborn health, and generating the political will to scale up the program with strategies that are faithful to the original design.Description of the interventionGEHIP improves the CHPS model by 1) extending the range and quality of services for newborns; 2) training community volunteers to conduct the World Health Organization service regimen known as integrated management of childhood illness (IMCI); 3) simplifying the collection of health management information and ensuring its use for decision making; 4) enabling community health nurses to manage emergencies, particularly obstetric complications and refer cases without delay; 5) adding $0.85 per capita annually to district budgets and marshalling grassroots political commitment to financing CHPS implementation; and 6) strengthening CHPS leadership at all levels of the system.Evaluation designGEHIP impact is assessed by conducting baseline and endline survey research and computing the Heckman “difference in difference” test for under-5 mortality in three intervention districts relative to four comparison districts for core indicators of health status and survival rates. To elucidate results, hierarchical child survival hazard models will be estimated that incorporate measures of health system strength as survival determinants, adjusting for the potentially confounding effects of parental and household characteristics. Qualitative systems appraisal procedures will be used to monitor and explain GEHIP implementation innovations, constraints, and progress.DiscussionBy demonstrating practical means of strengthening a real-world health system while monitoring costs and assessing maternal and child survival impact, GEHIP is expected to contribute to national health policy, planning, and resource allocation that will be needed to accelerate progress with the Millennium Development Goals.

PHP160 - The Mobile Technology For Community Health (MOTECH) Initiative:An M-Health System Pilot In A Rural District Of Northern Ghana

ObjectivesGhana’s Community-based Health Planning and Service (CHPS) initiative to design a system for developing community based health care with full participation and support from community members. The CHPS initiative scales up strategies developed and tested by a project of the Navrongo Health Research Centre in northern Ghana. Launched in 1994 as a three village pilot to develop strategies for mobilizing volunteerism, resources, and cultural institutions for supporting community-based primary health care, the project was expanded to a district-wide four celled trial in 1996. When evidence demonstrated that Navrongo strategies reduced childhood mortality, a replication project was launched in Nkwanta district to test and develop methods for scale-up. Using evidence from Nkwanta, national scale-up was launched in 2000 as a program of exchanges for district teams to work with Navrongo and Nkwanta implementers on designing pilot implementation of CHPS elsewhere in Ghana. ResultsThis paper reviews operational determinants of this success and implications of the Upper East Region experience for efforts to develop evidence-based community health services elsewhere in Africa Although CHPS scale-up has been launched in all 170 districts, the Upper East Region remains its lead performing region, despite challenging economic, ecological, and social circumstances for health development.