Communication Experiences of Speech and Hearing Impaired Clients in Accessing Healthcare in Hohoe Municipality of Volta Region, Ghana

Background Access to healthcare for speech and hearing impaired clients can be difficult against the backdrop that healthcare providers are inadequately trained to work with Deaf clients whose primary mode of communication is sign language. Therefore, this study sought to explore communication experiences of deaf people and barriers affecting their access to healthcare in Hohoe municipality in Volta region of Ghana. Method: For this quantitative and qualitative cross-sectional study 40 participants were recruited through snowball sampling technique. Quantitative data was obtained through administration of semi-structured questionnaire to sixteen (16) willing participants. The information was triangulated with three (3) focus group discussions. The statistical software Epi Info version 7 and Stata version 11 was used to analyze the quantitative data and presented in graph and tables. Thematic analysis was adopted for analyzing the qualitative data. Findings: Majority (93%) of the study participants are deaf and 7% being hard of hearing. Half (20) of them were above 30 years. Male to female participants in the study were equal. Thirty-five percent of participants had at least primary education and 10.0% had no formal education however 28% of them were employed. Gestures, sign language, assistance from a family member/friend, lip reading and writing are the various methods used by the deaf in communicating with healthcare providers. Family member/friends assistance and gestures were the most frequently used methods of communicating. Due to communication difficulties, they experience disparity, discriminations, neglect and delays in receiving healthcare from providers. Financial difficulties was also identified as barrier in accessing health. Conclusions: Access to healthcare for hearing impaired clients is important to achieve health equity. However challenging it can be, due to communication gaps, efforts must be made to ensure that this group receive adequate health care

Dynamics of cholera epidemics from Benin to Mauritania.

The countries of West Africa are largely portrayed as cholera endemic, although the dynamics of outbreaks in this region of Africa remain largely unclear.To understand the dynamics of cholera in a major portion of West Africa, we analyzed cholera epidemics from 2009 to 2015 from Benin to Mauritania. We conducted a series of field visits as well as multilocus variable tandem repeat analysis and whole-genome sequencing analysis of V. cholerae isolates throughout the study region. During this period, Ghana accounted for 52% of the reported cases in the entire study region (coastal countries from Benin to Mauritania). From 2009 to 2015, we found that one major wave of cholera outbreaks spread from Accra in 2011 northwestward to Sierra Leone and Guinea in 2012. Molecular epidemiology analysis confirmed that the 2011 Ghanaian isolates were related to those that seeded the 2012 epidemics in Guinea and Sierra Leone. Interestingly, we found that many countries deemed "cholera endemic" actually suffered very few outbreaks, with multi-year lulls.This study provides the first cohesive vision of the dynamics of cholera epidemics in a major portion of West Africa. This epidemiological overview shows that from 2009 to 2015, at least 54% of reported cases concerned populations living in the three urban areas of Accra, Freetown, and Conakry. These findings may serve as a guide to better target cholera prevention and control efforts in the identified cholera hotspots in West Africa

Minimum Spanning Tree based on the MLVA types of 257 <i>V</i>. <i>cholerae</i> isolates from several recent West African cholera outbreaks.

<p>Each MLVA type is represented by a node (and a unique number), and the size of the nodes reflects the number of isolates of each MLVA type. The solid lines indicate the most likely single locus variant, while dashed lines indicate the most likely double locus variant. The colors reflect the distinct country and year of isolate origin. Pie charts indicate strains from different time periods or countries displaying an identical MLVA type. The two strains represented by MLVA types #1 and #44 were isolated from environmental samples in Guinea (encircled in red). Labels A through G indicate the isolates from Ghana, Togo, and Guinea included on the phylogenic tree in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006379#pntd.0006379.g004" target="_blank">Fig 4</a>.</p

Strains from Ghana, Togo, and Guinea situated on the maximum likelihood phylogenetic tree of the third wave of the seventh pandemic lineage of <i>V</i>. <i>cholerae</i>.

<p>The tree is based on the SNP differences across the whole core genome. An isolate from the first wave, Bangladesh 1975, was included as an outgroup to root the tree. An isolate from the second wave was also included (India 1990). The color of the branch tips indicates the country of origin, and the year of isolation is specified. The strains from Ghana, Togo, and Guinea are indicated using the same colors as in the Minimum Spanning Tree (Ghana in pink and red, Togo in orange and yellow, and Guinea in bright green). Labels A through G indicate the isolates from Ghana, Togo, and Guinea included on the MST in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006379#pntd.0006379.g003" target="_blank">Fig 3</a>. Scale is provided as the number of substitutions per variable site, and the SNPs are indicated on the branches.</p

Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea

Summary: Background: A dose of 30 mg/kg of azithromycin is recommended for treatment of yaws, a disease targeted for global eradication. Treatment with 20 mg/kg of azithromycin is recommended for the elimination of trachoma as a public health problem. In some settings, these diseases are co-endemic. We aimed to determine the efficacy of 20 mg/kg of azithromycin compared with 30 mg/kg azithromycin for the treatment of active and latent yaws. Methods: We did a non-inferiority, open-label, randomised controlled trial in children aged 6–15 years who were recruited from schools in Ghana and schools and the community in Papua New Guinea. Participants were enrolled based on the presence of a clinical lesion that was consistent with infectious primary or secondary yaws and a positive rapid diagnostic test for treponemal and non-treponemal antibodies. Participants were randomly assigned (1:1) to receive either standard-dose (30 mg/kg) or low-dose (20 mg/kg) azithromycin by a computer-generated random number sequence. Health-care workers assessing clinical outcomes in the field were not blinded to the patient's treatment, but investigators involved in statistical or laboratory analyses and the participants were blinded to treatment group. We followed up participants at 4 weeks and 6 months. The primary outcome was cure at 6 months, defined as lesion healing at 4 weeks in patients with active yaws and at least a four-fold decrease in rapid plasma reagin titre from baseline to 6 months in patients with active and latent yaws. Active yaws was defined as a skin lesion that was positive for Treponema pallidum ssp pertenue in PCR testing. We used a non-inferiority margin of 10%. This trial was registered with ClinicalTrials.gov, number NCT02344628. Findings: Between June 12, 2015, and July 2, 2016, 583 (65·1%) of 895 children screened were enrolled; 292 patients were assigned a low dose of azithromycin and 291 patients were assigned a standard dose of azithromycin. 191 participants had active yaws and 392 had presumed latent yaws. Complete follow-up to 6 months was available for 157 (82·2%) of 191 patients with active yaws. In cases of active yaws, cure was achieved in 61 (80·3%) of 76 patients in the low-dose group and in 68 (84·0%) of 81 patients in the standard-dose group (difference 3·7%; 95% CI −8·4 to 15·7%; this result did not meet the non-inferiority criterion). There were no serious adverse events reported in response to treatment in either group. The most commonly reported adverse event at 4 weeks was gastrointestinal upset, with eight (2·7%) participants in each group reporting this symptom. Interpretation: In this study, low-dose azithromycin did not meet the prespecified non-inferiority margin compared with standard-dose azithromycin in achieving clinical and serological cure in PCR-confirmed active yaws. Only a single participant (with presumed latent yaws) had definitive serological failure. This work suggests that 20 mg/kg of azithromycin is probably effective against yaws, but further data are needed. Funding: Coalition for Operational Research on Neglected Tropical Diseases