Integrated Community Case Management And Community-Based Health Planning And Services In Ghana: Assessment Of The National Implementation For The Prevention And Management Of Malaria, Diarrhoea And Suspected Pneumonia.

Background: Ghana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia, and to improve household and family practices: Home-based Care (HBC) and Community-based Health Planning and Services (CHPS). After two and eight years of HBC implementation in the Volta and the Northern Regions respectively, and more than 10 years of CHPS implementation in both regions, there was the need to assess the performance of these strategies in delivering care and preventive messages for children under-five with fever, diarrhoea or cough. Objectives: To assess (i) the curative component in terms of utilization, appropriate treatment given and client satisfaction; (ii) the preventive component in terms of carers’ disease knowledge and health behaviour and (iii) to determine the cost per case appropriately diagnosed and treated under the HBC and CHPS. Methods: A household survey was conducted in the Volta and Northern Regions. The study population were carers of children under- five who had a fever, diarrhoea and/or cough in the last 2 weeks previous to the survey. In addition, a cost analysis was conducted. Results: HBC utilization was 17.3% and 1.0% in the Volta and Northern Regions respectively, while CHPS utilization was 11.8% and 31.3%, respectively. HBC in the Volta Region was successful in reaching the poorest, contributing to health equity. Less than 50% of malaria, diarrhoea and suspected pneumonia cases received appropriate treatment in both regions and under both strategies. Health education messages from community-based agents (CBAs) in the Northern Region were associated with the identification of at least two signs of severe malaria (adjusted Odds Ratio (OR) 1.8, 95%CI 1.0, 3.3, p=0.04), two practices that can cause diarrhoea (adjusted OR 4.7, 95%CI 1.4, 15.5, p=0.02) and two signs of severe pneumonia (adjusted OR 7.7, 95%CI2.2, 26.5, p=0.01)-the later also associated with prompt treatment (p<0.5). In addition, HBC was associated with prompt care seeking behaviour in the Volta Region and CHPS with prompt care seeking behaviour in the Northern Region. The cost per case appropriately diagnosed and treated was lower under the HBC than under CHPS in the Volta Region. HBC unit costs from the societal perspective were higher in the Northern Region than in the Volta Region and than CHPS due to a high number of CBAs and low preventive and curative activities. However, household costs under the HBC strategy were lower than under CHPS in both regions, reducing the burden of health care cost for families. Conclusions: Several actions should be undertaken to improve HBC and CHPS performance ensuring the availability of drugs and CBAs (particularly in the Northern Region). The contribution of HBC to health equity, reduced household costs, disease knowledge and healthy behaviours may justify the inclusion of HBC (preventive and curative services) in the National Health Insurance Scheme benefit package

Quality of Health Care in Ghana: Mapping of Interventions and the Way Forward

Background. Ghana has made major strides in improving access to health services. Despite these improvements, Ghana did not meet the Millennium Development Goals 4 and 5. Quality of care is a major factor that could explain this shortfall.Objective. To understand current practice and to identify needs in the area of quality of care in Ghana for improving health outcomes and to guide the National Institute for Health and Care Excellence (NICE) in supporting the care quality improvement efforts in Ghana.Methods. The directory of existing standards, guidelines and protocols of the Ghana Health Service was reviewed and sixteen in-depth interviews were conducted to identify interventions that addressed quality of care. Additional information was obtained during a NICE scoping visit to Accra followed by a study tour of Ghanaian stakeholders to NICE and to the National Health Service.Results. Since 1988, 489 policy interventions have been identified that address quality of care. Among them, the development of health protocols and guidelines were the most frequent interventions (n=150), followed by health policies and strategies (n=106); interventions related to health information (n=77); development of training manuals and staff training (n=69); development of regulations (n=38) and interventions related to organisation of services (n=15).Conclusions. Ghana has made significant efforts in developing guidelines, policies and conducting in-service training.Supervision, monitoring and evaluation have also received attention. However, less effort has been made in developing processes and systems and involving communities and service users. Some recommendations were made to guide the future work on quality of care.Funding: Rockefeller FoundationKeywords: quality of health care; policy; guideline/clinical protocol; regulations; Technology Assessments/ biomedical; in-service training; supervision; Ghan

Effectiveness of two community-based strategies on disease knowledge and health behaviour regarding malaria, diarrhoea and pneumonia in Ghana.

BACKGROUND: Ghana has developed two community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia, and to improve household and family practices: integrated Community Case Management (iCCM) and Community-based Health Planning and Services (CHPS). The objective of the study was to assess the effectiveness of iCCM and CHPS on disease knowledge and health behaviour regarding malaria, diarrhoea and pneumonia. METHODS: A household survey was conducted two and eight years after implementation of iCCM in the Volta and Northern Regions of Ghana respectively, and more than ten years of CHPS implementation in both regions. The study population included 1356 carers of children under- five years of age who had fever, diarrhoea and/or cough in the two weeks prior to the interview. Disease knowledge was assessed based on the knowledge of causes and identification of signs of severe disease and its association with the sources of health education messages received. Health behaviour was assessed based on reported prompt care seeking behaviour, adherence to treatment regime, utilization of mosquito nets and having improved sanitation facilities, and its association with the sources of health education messages received. RESULTS: Health education messages from community-based agents (CBAs) in the Northern Region were associated with the identification of at least two signs of severe malaria (adjusted Odds Ratio (OR) 1.8, 95%CI 1.0, 3.3, p = 0.04), two practices that can cause diarrhoea (adjusted OR 4.7, 95%CI 1.4, 15.5, p = 0.02) 0and two signs of severe pneumonia (adjusted OR 7.7, 95%CI2.2, 26.5, p = 0.01)-the later also associated with prompt care seeking behaviour (p = 0.04). In the Volta Region, receiving messages on diarrhoea from CHPS was associated with the identification of at least two signs of severe diarrhoea (adjusted OR 3.6, 95%CI 1.4, 9.0), p = 0.02). iCCM was associated with prompt care seeking behaviour in the Volta Region and CHPS with prompt care seeking behaviour in the Northern Region (p < 0.5). CONCLUSIONS: Both iCCM and CHPS were associated with disease knowledge and health behaviour, but this was more pronounced for iCCM and in the Northern Region. HBC should continue to be considered as the strategy through which community-IMCI is implemented

E14a2 Transcript Favors Treatment-Free Remission in Chronic Myeloid Leukemia When Associated with Longer Treatment with Tyrosine Kinase Inhibitors and Sustained Deep Molecular Response

e13a2 and e14a2 are the most frequent transcript types of the BCR::ABL1 fusion gene in chronic myeloid leukemia (CML). The current goal with tyrosine kinase inhibitors (TKI) is to achieve sustained deep molecular response (DMR) in order to discontinue TKI treatment and remain in the so-called treatment-free remission (TFR) phase, but biological factors associated with these goals are not well established. This study aimed to determine the effect of transcript type on TFR in patients receiving frontline treatment with imatinib (IM) or second-generation TKI (2G-TKI). Patients treated at least 119 months with IM presented less post-discontinuation relapse than those that discontinued IM before 119 months (p = 0.005). In addition, cases with the e14a2 transcript type treated at least 119 months with IM presented a better TFR (p = 0.024). On the other hand, the type of transcript did not affect the cytogenetic or molecular response in 2G-TKI treated patients; however, the use of 2G-TKI may be associated with higher and earlier DMR in patients with the e14a2 transcript

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Assessing the impact of health research on health policies: a study of the Dodowa Health Research Centre, Ghana

Abstract Background The importance of assessing research impact is increasingly recognised. Ghana has a long tradition of research dating from the 1970s. In the Ghana Health Service there are three health research centres under the Research and Development Division. Dodowa Health Research Centre (DHRC) is the youngest in the country dating from the 1990s. The objective of this study is to analyse the influence of the research conducted in DHRC on national and local health policies. Methods The study used the Research Impact Framework. Six projects were selected based on a set of criteria. Thirteen interviews were conducted with researchers and policy makers using a semi-structured interview guide. Results DHRC had numerous policy impacts in terms of researchers participating in policy networks, increasing political capital and influencing policy documents. Factors identified to be associated with policy impact included collaboration with policy makers at the design stage, addressing health priorities, and communicating results mainly through the participation in annual review meetings. Conclusions DHRC was successful in influencing health policies. Recommendations were made that could be included in the DHRC strategic planning to improve the research process and its policy impact

Additional file 1: Table S1. of Assessing the impact of health research on health policies: a study of the Dodowa Health Research Centre, Ghana

Individually randomized trial of rapid diagnostic tests in rural Ghana. Table S2. Home management of fevers in children under-five: a cluster randomized controlled trial in southern Ghana. Table S3. Assessments of male involvement in family planning decision making and practice and its influence on the uptake of family planning in the Dangme West district. Table S4. Examination of the TB enablers package in the Dodowa sub-district of the Dangme West district in the Greater Accra region of Ghana. Table S5. Mutual health organizations (MHO’s) in Ghana and implications for improving the success of health insurance in Ghana. (ODT 59.6 kb

Untersuchung von Moduln mit transparenter Waermedaemmung an der Testfassade des ISE

SIGLECopy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman