Options for the Delivery of Intermittent Preventive Treatment for Malaria to Children: A Community Randomised Trial

Intermittent preventive treatment for malaria in children (IPTc) is a promising new intervention for the prevention of malaria but its delivery is a challenge. We have evaluated the coverage of IPTc that can be achieved by two different delivery systems in Ghana.IPTc was delivered by volunteers in six villages (community-based arm) and by health workers at health centres or at Expanded Programme on Immunisation outreach clinics (facility based) in another six communities. The villages were selected randomly and drugs were administered in May, June, September and October 2006. The first dose of a three-dose regimen of amodiaquine plus sulphadoxine-pyrimethamine was administered under supervision to 3-59 month-old children (n = 964) in the 12 study villages; doses for days 2 and 3 were given to parents/guardians to administer at home.The proportion of children who received at least the first dose of 3 or more courses of IPTc was slightly higher in the community based arm (90.5% vs 86.6%; p = 0.059). Completion of the three dose regimen was high and similar with both delivery systems (91.6% and 91.7% respectively).Seasonal IPTc delivered through community-based or facility-based systems can achieve a high coverage rate with the support and supervision of the district health management team. However, in order to maximise the impact of IPTc, both delivery systems may be needed in some settings.ClinicalTrials.gov NCT00119132

Exploring the feasibility of eHealth solutions to decrease delays in maternal healthcare in remote communities of Ghana

Background: Despite the introduction of the Millennium Development Goal to reduce maternal deaths from 400 to 100 per 100,000 live births, the proportion of maternal deaths is still much higher in most developing countries like Ghana. Various interventions have been implemented in Ghana that focus on increasing skilled maternal care. These are especially needed in rural areas. EHealth has the potential to contribute to reducing the challenges in maternal healthcare (MHC) that poor areas suffer. This paper analyzes the potential of eHealth solutions to improve maternal health in rural Ghana as well as the challenges to their implementation. The work was carried out in cooperation with the local health directorate of Kpando Municipality, one of the administrative areas in the Volta Region. Methods: The study is focused on remote peninsulas and islands in Kpando Municipality. Data was gathered through triangulated research methods. Maternal health challenges were identified using the Three Delays Model for MHC. The three delays are delay in seeking care, delay accessing health facilities, and delay receiving adequate care. Challenges to the implementation of eHealth solutions in remote communities were analyzed using the Drury\u27s 5C eHealthmodel for developing countries. The 5Cs correspond to context, community, capacity, connectivity, and content. Results: The results show that financial dependence of women, a decision-making process based on previous experiences and traditional beliefs, competitiveness between facilities, organizational loopholes, lack of equipment, and geographical situations directly influence MHC outcomes. EHealth solutions, thanks to the high number of health workers with basic IT skills, have high potential to reduce MHC delays. However, poverty, cultural beliefs, organizational issues, connectivity, and lack of human resources were identified as main challenges to the implementation of eHealth solutions. Conclusion: In Ghana\u27s rural areas the three delays proposed in the model affect the outcomes of MHC. These delays are influenced by socio-economic status, access to facilities, and quality of care. EHealth solutions show great potential to reduce the delays. Based on the 5C model, a mHealth solution aiming to improve guidance during pregnancy was outlined