Age of Menarche among basic level school girls in Madina, Accra

The current study was designed to determine the age at which menarche occurs among school girls in Madina, Accra. A survey was conducted among 529 girls selected using multi-stage sampling from basic schools in Madina, Accra. Respondents completed a questionnaire that recorded age-at-first menstruation by recall, household characteristics, and anthropometry. Mean age at menarche was 12.74 + 1.15 years; probit analysis yielded a median age of 12.09 years. Menarcheal age was significantly correlated with current age (r=0.48; p<0.01). Most girls (90%) had first menstruation before age 13. Their mothers' mean age at menarche was 13.6 + 1.08 years. In a multivariate linear regression model, household wealth (p<0.01) and body mass index (p<0.01) were the main modifiable independent predictors of age at onset of menarche. School girls in Madina attained menarche earlier than previously estimated. Our study suggests an influence of household level improvement in socio-economic status on menarcheal age.L'étude actuelle a été conçue en vue de déterminer l'âge auquel la menstruation s'établit chez les écolières à Medina, Accra. Une enquête a été menée auprès des 529 filles à l'aide d'un échantillon à multiples étapes tirée des écoles à Medina, Accra. Les enquêtées ont rempli un questionnaire qui a enregistré l'âge à la première menstruation à travers le rappel, les caractéristiques familiales et l'anthropométrie. L'âge moyen à la première menstruation était 12,74±1,15 ans ; une analyse par la méthode des probits a donné un âge médian de 12,09 ans. L'âge qui se rapporte à l'établissement de la menstruation était remarquablement corrélé avec l'âge actuel (r=0, 48 ; p<0,01). La plupart des filles (90%) avaient leur première menstruation à l'âge de 13ans. L'âge moyen de leurs mères au moment de la menstruation était 13,61±08 ans Dans un modèle de régression linéaire multifactoriel, la richesse du ménage (p<0,01) et l'indice de masse corporelle (p<0,01) ont été les principaux indices modifiables de l'âge au commencement de la menstruation. Quelques écolières à Medina ont commencé la menstruation plus tôt qu'on avait prévue. Notre étude montre qu'il y a une influence de l'amélioration du niveau du ménage dans l'état socio-économique sur l'âge qui se rapporte à l'établissement de la menstruation.Key words: menarche, Ghana, school, menstruation, teenag

Mortality in a seven-and-a-half-year follow-up of a trial of insecticide-treated mosquito nets in Ghana

A 17% efficacy in preventing all-cause mortality in children aged 6-59 months was previously reported from a cluster-randomized controlled trial of insecticide-treated mosquito nets (ITNs) carried out in the Kassena-Nankana District of northern Ghana from July 1993-June 1995. A follow-up until the end of 2000 found no indication in any age group of increased mortality in the ITN group after the end of the randomized intervention. These results should further encourage the use of ITNs as a malaria control tool in areas of high endemicity of Plasmodium falciparu

Determinants of Under-Five Mortality in Builsa District, Upper East Region, Ghana

Under-five mortality rate is an important indicator of a community’s social development. The Upper East region, one of the most poverty-stricken regions in Ghana, has however recorded a dramatic decline in its under-five mortality rate since 1993; from 180 per 1000 live births to 79 per 1000 live births in 2003. The aim was to identify the determinants of under-five mortality in Builsa district. A case-control study was used to collect data from mothers of 60 cases and 120 controls matched for age, sex and place of residence. Even though 70% of mothers were illiter-ate, the educational level of mothers did not influence the child’s risk of death (OR 1.1). Chil-dren of mothers who had had previous child deaths were about 8 times more likely to die (OR 7.45,) while those who had not had vitamin A supplementation were about 10 times more likely to die (OR 9.57). Over 90% of mothers had an insecticide-treated bednet and more than 50% of them exclusively breastfed their children for the first 6 months of life. Protective risk factors identified included: exclusive breastfeeding (OR 0.72), use of an insecticide-treated bednet (OR 0.12), the number of live children a mother had (OR 0.54) and immunization (OR 0.53). Even in poverty, it is possible to improve the child health status of communities. Health staff should be equipped to pay special attention to mothers with previous child deaths in order to assist them to prevent further deaths.Keywords: Under-five mortality, determinants, case-control study, Builsa distric

The effect of medical therapy on IOP control in Ghana

Background: To investigate IOP control following twelve months of continuous medical therapy in Ghana.Methods: This retrospective case series included 163 glaucoma patients diagnosed at a referral eye center between 1996 and 2006. Information collected included age, gender, IOP at presentation, six months and oneyear post treatment and types of anti-glaucoma medications prescribed. Optimal IOP control was defined according to results from the Advanced Glaucoma Intervention Study (AGIS), which demonstrated arrest of visual field progression in patients with IOP < 18 mmHg at all visitations: Level 1 (post-treatment IOP . 21 mmHg); Level 2 (. 18 mmHg) and level 3 (. 16mmHg). The principal outcome measure was the achievement of IOP <18 mmHg at six months and twelve month visitations.Results: One hundred sixty three patients were analyzed. These included 68 males (41.7%) and 95 females (58.3%). The mean age was 57}16  (median 59 years; range 7 . 95 years). There was no significant difference in age (p=0.35) or mean IOP (p=0.08) between genders. The mean pre-treated IOP of 31.9}8.9 mmHg significantly decreased to 21.3}6.6  mmHg at 6 months (p=0.001), with 57.4% of eyes at Level 1 IOP control, 25.3% at Level 2 and 15.4% at Level 3 and decreased further at 12 months to 20.7}6.9 mmHg (p=0.48) with 69.7% of eyes at Level 1, 34.4% at Level 2, and 12.4% at Level 3.Conclusions: Current medical regimen is insufficient to reduce IOP to target levels as defined in the Advanced Glaucoma Intervention Study.Keywords: Glaucoma, POAG, IOP, Ghana, intraocular pressur

Comparison of Primary Open Angle Glaucoma Patients in Rural and Urban Ghana

Purpose: To compare the clinical features of glaucoma patients who present at a rural hospital in North Eastern Ghana and an urban hospital in the capital city of Accra.Methods: This is a multi-center retrospective case series involving records of newly diagnosed glaucoma patients with emphasis on primary open angle glaucoma (POAG). Information collected included basic demographic data, intraocular pressures and optic disc measurements.Results: A total of 949 patients (437 rural; 512 urban; 1868 eyes) were included. Rural vs. urban comparisons, respectively: mean age, 53.2 ± 16.3 vs. 54.5 ± 16.4 years; male: female ratio, 3:2 vs. 1:1; POAG, 78.1% vs. 50.6%; POAG suspect, 10.3% vs. 41.9%; IOP, 39.2 ± 7.1 vs. 31.8 ± 7.3 mmHg; bilateral blindness, 34.1% vs. 17.5%; uniocular blindness, 52.2% vs. 32.9%. Females at the rural hospital were twice as likely to present blind in at least one eye (OR 2.04, CI 1.36 - 3.07, p<0.001).Conclusions: Patients with POAG at the rural hospital present with more advanced disease characteristics.Keywords: glaucoma, open angle,Ghana, Urban, rura

Clustering of under-five mortality in the Navrongo HDSS in the Kassena-Nankana District of northern Ghana

Background: Under-five mortality is a major public health problem and one of the health indicators of health care in sub-Saharan Africa. In order to address inefficient health systems, there is a need to identify the spatial distribution of under-five mortality, especially areas of high mortality clustering. This study aimed to explore spatial and temporal clustering in under-five mortality in the Kassena-Nankana District of the Upper East region. Methods: We used data from the Navrongo Health and Demographic Surveillance System in the Kassena- Nankana District of northern Ghana, which had an average population of 140,000 of which about 18,400 were under five years of age. We analysed under-five mortality in 49 villages during the period 1997–2006. We calculated total under-five mortality rates and investigated their geographical distributions. A spatial scan statistic was used to test for clustering of the mortality in both space and time. Results: Under-five mortality has been declining during the period. However, the data show a persistently higher than average clustering of mortality over the period among villages mainly in the north-eastern parts of the district. Conclusion: There is a higher than average under-five mortality clustering in the villages in the north-east of the district and this may suggest a relatively poor health care system despite the many health interventions that took place over time in the district, including the Community Health and Family Planning Project, whose impact may not have been felt in these parts of the district between 1995 and 2004

Under-five mortality: spatial-temporal clusters in Ifakara HDSS in South-eastern Tanzania.

BACKGROUND\ud \ud Childhood mortality remains an important subject, particularly in sub-Saharan Africa where levels are still unacceptably high. To achieve the set Millennium Development Goals 4, calls for comprehensive application of the proven cost-effective interventions. Understanding spatial clustering of childhood mortality can provide a guide in targeting the interventions in a more strategic approach to the population where mortality is highest and the interventions are most likely to make an impact.\ud \ud METHODS\ud \ud Annual child mortality rates were calculated for each village, using person-years observed as the denominator. Kulldorff's spatial scan statistic was used for the identification and testing of childhood mortality clusters. All under-five deaths that occurred within a 10-year period from 1997 to 2006 were included in the analysis. Villages were used as units of clusters; all 25 health and demographic surveillance sites (HDSS) villages in the Ifakara health and demographic surveillance area were included.\ud \ud RESULTS\ud \ud Of the 10 years of analysis, statistically significant spatial clustering was identified in only 2 years (1998 and 2001). In 1998, the statistically significant cluster (p < 0.01) was composed of nine villages. A total of 106 childhood deaths were observed against an expected 77.3. The other statistically significant cluster (p < 0.05) identified in 2001 was composed of only one village. In this cluster, 36 childhood deaths were observed compared to 20.3 expected. Purely temporal analysis indicated that the year 2003 was a significant cluster (p < 0.05). Total deaths were 393 and expected were 335.8. Spatial-temporal analysis showed that nine villages were identified as statistically significant clusters (p < 0.05) for the period covering January 1997-December 1998. Total observed deaths in this cluster were 205 while 150.7 were expected.\ud \ud CONCLUSION\ud \ud There is evidence of spatial clustering in childhood mortality within the Ifakara HDSS. Further investigations are needed to explore the source of clustering and identify strategies of reaching the cluster population with the existing effective interventions. However, that should happen alongside delivery of interventions to the broader population

SMS for Life: a pilot project to improve anti-malarial drug supply management in rural Tanzania using standard technology

Background: Maintaining adequate supplies of anti-malarial medicines at the health facility level in rural sub-Saharan Africa is a major barrier to effective management of the disease. Lack of visibility of anti-malarial stock levels at the health facility level is an important contributor to this problem. Methods: A 21-week pilot study, 'SMS for Life', was undertaken during 2009-2010 in three districts of rural Tanzania, involving 129 health facilities. Undertaken through a collaborative partnership of public and private institutions, SMS for Life used mobile telephones, SMS messages and electronic mapping technology to facilitate provision of comprehensive and accurate stock counts from all health facilities to each district management team on a weekly basis. The system covered stocks of the four different dosage packs of artemether-lumefantrine (AL) and quinine injectable. Results: Stock count data was provided in 95% of cases, on average. A high response rate (≥ 93%) was maintained throughout the pilot. The error rate for composition of SMS responses averaged 7.5% throughout the study; almost all errors were corrected and messages re-sent. Data accuracy, based on surveillance visits to health facilities, was 94%. District stock reports were accessed on average once a day. The proportion of health facilities with no stock of one or more anti-malarial medicine (i.e. any of the four dosages of AL or quinine injectable) fell from 78% at week 1 to 26% at week 21. In Lindi Rural district, stock-outs were eliminated by week 8 with virtually no stock-outs thereafter. During the study, AL stocks increased by 64% and quinine stock increased 36% across the three districts. Conclusions: The SMS for Life pilot provided visibility of anti-malarial stock levels to support more efficient stock management using simple and widely available SMS technology, via a public-private partnership model that worked highly effectively. The SMS for Life system has the potential to alleviate restricted availability of anti-malarial drugs or other medicines in rural or under-resourced areas

Monitoring the millennium development goals: the potential role of the INDEPTH Network

The Millennium Declaration, adopted by the United Nations (UN) in 2000, set a series of Millennium Development Goals (MDGs) as priorities for UN member countries, committing governments to realising eight major MDGs and 18 associated targets by 2015. Progress towards these goals is being assessed by tracking a series of 48 technical indicators that have since been unanimously adopted by experts. This concept paper outlines the role member Health and Demographic Surveillance Systems (HDSSs) of the INDEPTH Network could play in monitoring progress towards achieving the MDGs. The unique qualities of the data generated by HDSSs lie in the fact that they provide an opportunity to measure or evaluate interventions longitudinally, through the long-term follow-up of defined populations