Accelerating reproductive and child health program development: The Navrongo initiative in Ghana

Successive global health and development agendas have been embraced by African governments—Alma Ata in 1978, the Bamako Initiative in 1987, the 1994 Cairo International Conference on Population and Development, and more recently the Millennium Development Goals (MDGs)—only to be followed by widespread implementation failure. This paper presents an approach to program development in Ghana that is using research to accelerate policy implementation. Originally launched in 1994 as a participatory pilot project of the Navrongo Health Research Centre, a controlled experimental study was initiated in 1996 to assess the fertility and child-survival impact of alternative community health and family planning service strategies. Posting nurses to communities reduced childhood mortality rates by half, accelerating attainment of the childhood-survival MDG within five years. Adding community-mobilization strategies and volunteer outreach to this approach led to a 15-percent reduction in fertility. When a replication project in the Volta Region demonstrated that the Navrongo service model could be transferred to a nonresearch setting, the Government of Ghana adopted the Navrongo approach as the health component of its national poverty-reduction strategy. In 2000, the Community-based Health Planning and Services (CHPS) initiative was launched to accelerate implementation of this policy. By mid-2005, CHPS was fully operational in 20 districts and under development in nearly every other district of Ghana. Analysis of successive phases of the Ghana program-development process demonstrates feasible means of improving national access to reproductive and child health services

Malaria vaccine deployment in Africa: focus on Ghana

The announcement by the Ghana Health Service /Ministry of Health at the beginning of May to begin the pilot implementation of the malaria vaccine – RTS,S/AS01 (Mosquirix®) – manufactured by GSK Biologicals was greeted with rumours about conspiracy theories of secretagenda to depopulate Africa through the use of vaccines and all the other stories that are often propagated by the anti vaxxers. This was not unlike the fear and panic spread throughout the country that prevented investigators from conducting clinical trials on new vaccines against the Ebola virus disease a few years ago

Geophagia: A cultural-nutrition health-seeking behaviour with no redeeming psycho-social qualities

Aim: We investigated if Geophagia is restricted to only pregnant and lactating women in Ghana. We also investigated if the key driver of Geophagia is poverty and other socio-cultural factors. Methods: This analysis was part of a broader national study of resilience among thepopulation of Ghana (N=2,000). Regional comparisons were made possible due to the stratified and random selection of representations that were similar in characteristics such as being urban or rural, ethnicity, religion and gender. Results: It was found that Geophagia was present among both females and males and was not restricted to pregnant and lactating women. Geophagia was not driven by poverty or the lack of formal education or the presence of gainful employment. Geophagia was practiced by both urban and rural residents irrespective of religious proclivities and devotion. The assertion that Geophagia was an instinctive primordial response to gastro-intestinal disturbances was not sustained by the data in this study, although the literature review suggested such in calves and lambs. Conclusion: In order to address the potential health threats posed by Geophagia, the key cultural drivers need to be studied and understood. We also need to appreciate the shocks and stresses that create such desires. It is not a case of mental illness and it cannot be concluded that Geophagia is driven by a psychiatric disorder. This paper would be disseminated to inform policy in Ghana and beyond

Multimorbidity of chronic diseases among adult patients presenting to an inner-city clinic in Ghana.

BACKGROUND: Very little is known about multimorbidity and chronic diseases in low and middle income countries, particularly Sub-Saharan Africa, and more information is needed to guide the process of adapting the health systems in these countries to respond adequately to the increasing burden of chronic diseases. We conducted a hospital-based survey in an urban setting in Ghana to determine the prevalence of multimorbidity and its associated risk factors among adult patients presenting to an inner city clinic. METHODS: Between May and June 2012, we interviewed adult patients (aged 18 years and above) attending a routine outpatient clinic at an inner-city hospital in Accra using a structured questionnaire. We supplemented the information obtained from the interviews with information obtained from respondents' health records. We used logistic regression analyses to explore the risk factors for multimorbidity. RESULTS: We interviewed 1,527 patients and retrieved matching medical records for 1,399 (91.6%). The median age of participants was 52.1 years (37-64 years). While the prevalence of multimorbidity was 38.8%, around half (48.6%) of the patients with multimorbidity were aged between 18-59 years old. The most common combination of conditions was hypertension and diabetes mellitus (36.6%), hypertension and musculoskeletal conditions (19.9%), and hypertension and other cardiovascular conditions (11.4%). Compared with patients aged 18-39 years, those aged 40-49 years (OR 4.68, 95% CI: 2.98-7.34), 50-59 years (OR 12.48, 95% CI: 8.23-18.92) and 60 years or older (OR 15.80, 95% CI: 10.66-23.42) were increasingly likely to present with multimorbidity. While men were less likely to present with multimorbidity, (OR 0.71, 95% CI: 0.45-0.94, p = 0.015), having a family history of any chronic disease was predictive of multimorbidity (OR 1.43, 95% CI: 1.03-1.68, p = 0.027). CONCLUSIONS: Multimorbidity is a significant problem in this population. By identifying the risk factors for multimorbidity, the results of the present study provide further evidence for informing future policies aimed at improving clinical case management, health education and medical training in Ghana

The changing social environment for adolescents in Kassena-Nankana District of northern Ghana: Implications for reproductive behavior

This study reports on a primarily qualitative investigation of adolescent reproductive behavior in the Kassena-Nankana District, a rural isolated area in northern Ghana, where traditional patterns of marriage, family formation, and social organization persist. The study is based on in-depth interviews and focus groups with adolescents, parents, chiefs and traditional leaders, teachers, youth leaders, and health workers, supplemented by quantitative data from the 1996 wave of a panel survey of reproductive-aged women conducted by the Navrongo Health Research Centre. The social environment faced by adolescent boys and girls in the Kassena-Nankana District and its links to reproductive behavior are described. The principal question is whether even in this remote, rural area, the environment has been altered in ways that have undermined traditional sexual and reproductive patterns. The survey data indicate a considerable increase in educational attainment among younger women. In addition, it appears that the incidence of early marriage has begun to decline. The qualitative data suggest that social institutions, systems, and practices such as female circumcision, which previously structured the lives of adolescent boys and girls, have eroded, leading to an apparent increase in premarital sexual activity. The implications of these developments for adolescent health and well-being in the District are discussed

How many years of life could be saved if malaria were eliminated from a hyperendemic area of northern Ghana?

For some time, Chinese government policies have treated rural and urban areas very differently, and a by-product of China’s rapid development seems to be an even greater differentiation between urban and rural social and economic life. Over the next several decades, in part because of rapid fertility declines and in part as a result of mortality declines at older ages, China and other developing countries will experience enormous increases in the proportion of older adults and the proportion of the “oldest-old.” It is reasonable to expect that these age structure changes will alter the provision of health care, making an understanding of the determinants of health at older ages critical for the development and implementation of policy. The analysis in this Population Council working paper describes differences in mortality and examines the extent to which variations are accounted for by socioeconomic and health-access and health-availability characteristics that are measured at individual and community levels. On the individual level, cadre status is influential and at the community level, the important measure is the number of amenities available to residents

Malaria Treatment in Northern Ghana: What is the Treatment Cost per Case to Households?

Although malaria is a major problem in Sub-Saharan African countries including Ghana, there has been little research on its economic impact, particularly the treatment cost at the household level. This study uses data collected from a random sample of 423 households in Kassena-Nankana district (KND) of northern Ghana. Malaria was ascertained through self-reporting of symptoms using a one-month recall period. The paper presents treatment cost analysis of seeking malaria care to households. Direct and indirect costs to households are estimated and examined in terms of location, severity, and wealth. The study shows that indirect cost accounts for 71 percent of total cost of a malaria episode. While cost of malaria care is estimated at 1 percent of the income of the rich, it is 34 percent of the poor households\u2019 income, suggesting that the burden of malaria is higher for poorer households. In order to reduce the cost of malaria to households, we recommend that the training of malaria volunteers to assist households in the communities to take more responsibility of the disease and also to intensify public education to promote the use of insecticide treated nets, as they have been found to be cost-effective in the prevention of malaria

Social Interaction and Contraceptive Change in Northern Ghana

The role of diffusion in reproductive change has received great attention in the literature. Underlying the various studies is the assumption that the information or behaviour of one person can have spillover effects on the motivations of another (Montgomery and Casterline, 1998). Two fundamental components of diffusion are identified: social learning and social influence. Social learning refers to the acquisition of information from others, which in the case of fertility control may include information on the types of contraceptive methods available, the health side effects of the methods and the cost of the methods. Social influence, on the other hand, refers to the power that individuals exercise over each other through authority, deference, and social conformity pressures. Using data obtained from the 1995 and 1998 demographic and health panel surveys we examine the impact of social interaction on the adoption of contraception in the Kassena-Nankana district of Northern Ghana. Three major distinct groups of respondents were defined by the social interaction variable: women whose family planning discussion partners are contraceptive users or encouragers (or both); women whose family planning conversational partners are neither users nor encouragers; women who reported never having discussed family planning with their social network partners. While the social interaction variable pertains to the time of the 1995 survey, contraceptive use is at the time of the 1998 survey. Results from this study suggest that social interaction about family planning triggers changes in contraceptive behaviour in the rural areas of Northern Ghana. For the majority of women, the decision to initiate family planning practice is facilitated by informal discussions with social network partners who encourage contraceptive adoption.Beaucoup a \ue9t\ue9 dit et \ue9crit sur le r\uf4le de la diffusion dans l'\ue9volution de la reproduction avec comme hypoth\ue8se sous-jacente que l'information \ue0 propos de ou le comportement d'une personne peut avoir des effets d'entra\ueenement sur les motivations d'une autre personne (Montgomery and Casterline, 1998). La diffusion comporte deux composantes principales : l'apprentissage social et l'impact social. L'apprentissage social porte sur l'acquisition de l'information \ue0 partir d'autres personnes, ce qui, en mati\ue8re de contr\uf4le de la f\ue9condit\ue9, concerne l'information sur les types de contraceptions disponibles, les effets secondaires sur la sant\ue9 des m\ue9thodes ainsi que le co\ufbt des m\ue9thodes. Pour ce qui concerne l'impact social, il s'agit du pouvoir que les personnes peuvent exercer les unes sur les autres par l'autorit\ue9, le respect, les pesanteurs de la conformit\ue9 sociale. En utilisant les donn\ue9es des Enqu\ueates d\ue9mographiques et de sant\ue9 de 1995 et 1998, nous examinons l'impact possible de l'interaction sociale sur l'adoption de la contraception dans la r\ue9gion Kassena-Nankana du Nord du Ghana. Pour les besoins de la variable interaction sociale, trois grands groupes de personnes ont \ue9t\ue9 interrog\ue9es : les femmes dont les partenaires dans les focus group utilisent et/ou encouragent l'utilisation de la contraception ; celles dont les partenaires dans les focus group ne sont ni utilisateurs ni n'encouragent l'utilisation de la contraception ; celles ayant admis n'avoir jamais discut\ue9 de la contraception avec les r\ue9seaux sociaux de leurs partenaires. Si la variable interaction sociale porte sur l'enqu\ueate de 1995, celle sur l'utilisation de la contraception porte sur l'enqu\ueate de 1998. Les r\ue9sultats obtenus montrent que l'interaction sociale en ce qui concerne le planning familial entra\ueene des changements dans le comportement en mati\ue8re de contraception dans les zones rurales du Nord du Ghana. Pour la majeure partie des femmes, la d\ue9cision de commencer le planning familial est largement facilit\ue9e par des discussions informelles avec les membres des r\ue9seaux sociaux qui encouragent l'adoption de la contraception

Patterns of age-specific mortality in children in endemic areas of sub-Saharan Africa.

Understanding of the age- and season- dependence of malaria mortality is an important prerequisite for epidemiologic models of malaria immunity. However, most studies of malaria mortality have aggregated their results into broad age groups and across seasons, making it hard to predict the likely impact of interventions targeted at specific age groups of children. We present age-specific mortality rates for children aged < 15 years for the period of 2001-2005 in 7 demographic surveillance sites in areas of sub-Saharan Africa with stable endemic Plasmodium falciparum malaria. We use verbal autopsies (VAs) to estimate the proportion of deaths by age group due to malaria, and thus calculate malaria-specific mortality rates for each site, age-group, and month of the year. In all sites a substantial proportion of deaths (ranging from 20.1% in a Mozambican site to 46.2% in a site in Burkina Faso) were attributed to malaria. The overall age patterns of malaria mortality were similar in the different sites. Deaths in the youngest children (< 3 months old) were only rarely attributed to malaria, but in children over 1 year of age the proportion of deaths attributed to malaria was only weakly age-dependent. In most of the sites all-cause mortality rates peaked during the rainy season, but the strong seasonality in malaria transmission in these sites was not reflected in strong seasonality in the proportion of deaths attributed to malaria, except in the two sites in Burkina Faso. Improvement in the specificity of malaria verbal autopsies would make it easier to interpret the age and season patterns in such data

Assessing the ownership, usage and knowledge of Insecticide Treated Nets (ITNS) in malaria prevention in the Hohoe Municipality, Ghana

Introduction: Malaria remains one of the top five killer diseases in sub-Saharan Africa (SSA) and its burden is skewed towards pregnant women and children under five. Insecticide Treated Bed-Net (ITN) usage is considered one of the most cost-effective, preventive interventions against malaria. This study sought to assess ownership, usage, effectiveness, knowledge, access and availability of ITNs among mothers with children under five in the Hohoe municipality.Methods: in August 2010 a cross-sectional survey was carried out in 30  communities, selected using the WHO 30 cluster sampling technique. In the  selected communities, mothers/caregivers with children under five years were selected using the snowball method. Data were collected through questionnaires and direct observation of ITN. Descriptive statistics was used to analyse the datacollected. Results: A total of 450 mothers/caregivers were interviewed and their mean age was 30 ± 7 years. ITN ownership was 81.3%, and usage was 66.4%. The majority (97.8%) of the mothers/caregivers said ITNs were effective for malaria prevention. Awareness about ITNs was high (98.7%) and the majority (52.9%) had heard about ITNs from Reproductive and Child Health (RCH) Clinic and antenatal care ANC clinic (33.6%). Over 60% of the ITNs were acquired through free distribution at RCH clinics, clinic and home distribution during mass immunization sessions. The majority of the mothers/caregivers (78.6%) knew the signs and symptoms of malaria, what causes malaria (82.2%) and who is most at risk (90%).Conclusion: Behaviour change communication strategies on ITN use may need to be further targeted to ensure full use of available ITNs