Attractive toxic sugar baits for controlling mosquitoes: a qualitative study in Bagamoyo, Tanzania

Malaria elimination is unlikely to be achieved without the implementation of new vector control interventions capable of complementing insecticide-treated nets and indoor residual spraying. Attractive-toxic sugar baits (ATSBs) are considered a new vector control paradigm. They are technologically appropriate as they are simple and affordable to produce. ATSBs kill both female and male mosquitoes attracted to sugar feed on a sugary solution containing a mosquitocidal agent and may be used indoors or outdoors. This study explored the views and perceptions on ATSBs of community members from three Coastal Tanzanian communities.; Three communities were chosen to represent coastal urban, peri-urban and rural areas. Sensitization meetings were held with a total of sixty community members where ATSBs were presented and explained their mode of action. At the end of the meeting, one ATSB was given to each participant for a period of 2 weeks, after which they were invited to participate in focus group discussions (FGDs) to provide feedback on their experience.; Over 50% of the participants preferred to use the bait indoors although they had been instructed to place it outdoors. Participants who used the ATSBs indoors reported fewer mosquitoes inside their homes, but were disappointed not to find the dead mosquitoes in the baits, although they had been informed that this was unlikely to happen. Most participants disliked the appearance of the bait and some thought it to be reminiscent of witchcraft. Neighbours that did not participate in the FGDs or sensitizations were sceptical of the baits.; This study delivers insight on how communities in Coastal Tanzania are likely to perceive ATSBs and provides important information for future trials investigating the efficacy of ATSBs against malaria. This new vector control tool will require sensitization at community level regarding its mode of action in order to increase the acceptance and confidence in ATSBs for mosquito control given that most people are not familiar with the new paradigm. A few recommendations for product development and delivery are discussed

Caregiver Perception of Sickle Cell Disease Stigma in Ghana: An Ecological Approach

Introduction: Sickle cell disease (SCD) stigma is a major community health issue. The challenges of caring for someone with SCD can be overwhelming. We explored stigma and related factors for caregivers of pediatric patients with SCD in Kumasi, Ghana. Method: Guided by the Ecological Systems Theory, we used indepth interviews with a semistructured guide to learn about the perception of stigmatization for Ghanaian caregivers of patients with SCD. Results: Overall, participants were knowledgeable about SCD. We identified three themes, including (1) blame for SCD, (2) public misconception about SCD, and (3) shame for the financial burden of SCD. Discussion: Findings demonstrate the need to design an SCD stigma reduction program for caregivers, families, and the community. Providers need to consider SCD stigma and interaction with multiple ecological levels, including the family, community, health care system, culture, and health policy in Ghana. Findings can be used as a catalyst to explore the reduction of stigmatization in other sub-Saharan countries

Stigma associated With sickle cell disease in Kumasi, Ghana

Introduction: People with sickle cell disease (SCD) often face stigmatization in Ghana and elsewhere in Africa. Research is needed to understand whether it is necessary to design an SCD stigma reduction program in the Ghanaian setting. The aim of this study was to explore the perception of stigmatization for adults with SCD in Kumasi, Ghana. Methodology: Using in-depth qualitative interviews, researchers conducted a phenomenological study to investigate the perception of stigmatization for people with SCD in Kumasi, Ghana. Snowball and purposive sampling was used to identify the participants. Results: Participants (n = 12) were mostly female, Akan, and Christian. Researchers categorized three main themes: (a) Feelings of social isolation, (b) Fear of disclosure, and (c) Bullying about physical appearance. Discussion: The findings highlight the need to develop effective strategies to counteract stigma. Transcultural health care providers can implement stigma reduction interventions that might be applicable throughout Africa where findings are likely to resonate with patients with SCD

Neonatal near-misses in Ghana: a prospective, observational, multi-center study

Abstract Background For every newborn who dies within the first month, as many as eight more suffer life-threatening complications but survive (termed ‘neonatal near-misses’ (NNM)). However, there is no universally agreed-upon definition or assessment tool for NNM. This study sought to describe the development of the Neonatal Near-Miss Assessment Tool (NNMAT) for low-resource settings, as well as findings when implemented in Ghana. Methods This prospective, observational study was conducted at two tertiary care hospitals in southern Ghana from April – July 2015. Newborns with evidence of complications and those admitted to the NICUs were screened for inclusion using the NNMAT. Incidence of suspected NNM at enrollment and confirmed near-miss (surviving to 28 days) was determined and compared against institutional neonatal mortality rates. Suspected NNM cases were compared with newborns not classified as a suspected near-miss, and all were followed to 28 days to determine odds of survival. Confirmed near-misses were those identified as suspected near-misses at enrollment who survived to 28 days. The main outcome measures were incidence of NNM, NNM:mortality ratio, and factors associated with NNM classification. Results Out of 394 newborns with complications, 341 (86.5%) were initially classified as suspected near-misses at enrollment using the NNMAT, with 53 (13.4%) being classified as a non-near-miss. At 28-day follow-up, 68 (17%) had died, 52 (13%) were classified as a non-near-miss, and 274 were considered confirmed near-misses. Those newborns with complications who were classified as suspected near-misses using the NNMAT at enrollment had 12 times the odds of dying before 28 days than those classified as non-near-misses. While most confirmed near-misses qualified as NNM via intervention-based criteria, nearly two-thirds qualified based on two or more of the four NNMAT categories. When disaggregated, the most predictive elements of the NNMAT were gestational age < 33 weeks, neurologic dysfunction, respiratory dysfunction, and hemoglobin < 10 gd/dl. The ratio of near-misses to deaths was 0.55: 1, yet this varied across the study sites. Conclusions This research suggests that the NNMAT is an effective tool for assessing neonatal near-misses in low-resource settings. We believe this approach has significant systems-level, continuous quality improvement, clinical and policy-level implications.http://deepblue.lib.umich.edu/bitstream/2027.42/173635/1/12887_2019_Article_1883.pd

Excerpts from the semi-structured interview tool used with providers.

<p>Excerpts from the semi-structured interview tool used with providers.</p

Health care provider demographics.

<p>Health care provider demographics.</p