Effect of delivery care user fee exemption policy on institutional maternal deaths in the central and volta regions of Ghana

Background: To improve access to skilled attendance at delivery and thereby reduce maternal mortality, the Government of Ghana introduced a policy exempting all women attending health facilities from paying delivery care fees. Objective: To examine the effect of the exemptionpolicy on delivery-related maternal mortality. Methods: Maternal deaths in 9 and 12 hospitals in the Central Region (CR) and the Volta Region(VR) respectively were analysed. The study covered a period of 11 and 12 months before and after the introduction of the policy between 2004 and 2006. Maternal deaths were identified by screening registers and clinical notes of all deaths in women aged 15-49 years in all units of the hospitals. These deaths were further screened for those related to delivery. The total births in the study period were also obtained in order to calculate maternal mortality ratios (MMR). Results: A total of 1220 (78.8%) clinical notes of 1549 registered female deaths were retrieved. A total of 334 (21.6%) maternal deaths were identified. The delivery-related MMR decreased from 445 to 381 per 100,000 total births in the CR and from 648 to 391 per 100,000 total births in the VR following the implementation of the policy. The changes in the 2 regions were not statistically significant (p=0.458) and (p=0.052) respectively. Nosignificant changes in mean age of delivery-related deaths, duration of admission and causes of deaths before and after the policy in both regions. Conclusion: The delivery-related institutional maternal mortality did not appear to have been significantly affected after about one year of implementation of the policy

Hypertension in older adults in Africa: A systematic review and meta-analysis

YesBackground: Hypertension is the leading driver of cardiovascular disease deaths in Africa. Its prevalence is highest in older populations. Yet, this group has received little attention in many African countries. We conducted a systematic review and meta-analysis (PROSPERO registration: CRD42017056474) to estimate the prevalence of hypertension in older adults living in Africa. Methods: We searched grey literature and major electronic databases including PubMed and Embase for population-based studies and published between 1 January 1980 to 28 May 2018 reporting the prevalence of hypertension for adults aged ≥50 years living in Africa. We employed a random effects model to estimate the pooled prevalence across included studies. Findings: We screened 10,719 articles and retrieved 103 full-text articles to evaluate for inclusion in the review. Thirty-four unique studies providing 37 data points on 43,025 individuals in 15 African countries were analyzed. The prevalence of hypertension ranged from 22.3% to 90.0% from the individual studies while the overall pooled prevalence was 57.0% (95% CI 52%-61%). The prevalence was not statistically significantly different by sex, residence, or African sub-region. In individual studies, older age and overweight/obesity were independently associated with hypertension. Twenty-nine (78%) data points were deemed to be of low- or moderate-risk of bias. Eliminating high-risk bias studies made little difference to the pooled estimate of hypertension. Sensitivity analyses, omitting one study at a time, identified three studies with significant but relatively small impact on the pooled estimate. We observed substantial heterogeneity (I2 = 98.9%) across the studies which was further explored by meta-regression analyses. Overall, the GRADE assessment suggested moderate quality evidence in the results. Conclusion: The persistent high prevalence of hypertension among older adults in Africa, even in rural populations warrants more attention to the cardiovascular health of this group by public health authoritie

Determinants of systemic hypertension in older adults in Africa:A systematic review

Background An estimated 55% of older adults in Africa have systemic hypertension, a major risk factor for stroke, heart failure and dementia in the region. The risk factors associated with hypertension in this population group in Africa have not been systematically evaluated. We, therefore, undertook a systematic review to identify these risk factors. Methods We searched for population-based studies of adults aged ≥50 years living in Africa and reporting an estimate of hypertension and associated risk factors. We included articles published in any language between January 1980 and May 2018 using a comprehensive search strategy. We extracted data including the sample characteristics, prevalence of hypertension and risk factors with their effect sizes. Results From an initial 10,719 records, we retained 63 eligible full text articles for review out of which we analyzed 23 studies made up of 19 primary and four multiple publications which had data on risk factors from bivariate or multivariable analysis. The primary studies, published from 2010 to 2018, involved a total of 30,500 participants in 12 different countries with mean ages ranging from 62.7 ± 9 years to 76.9 ± 8.4 years. Through narrative synthesis, we found consistent determinants of hypertension (overweight/obesity and history of stroke), less consistent but frequent determinants (including older age group, female sex and urban residence), inconsistent determinants (including education, wealth index, alcohol intake and physical activity) and nonsignificant covariates (marital status and having health insurance). Overall, the highest adjusted odds ratios were those associated with obesity and history of stroke. Conclusion The key determinants of systemic hypertension in older adults in Africa are older age group, overweight/obesity, history of stroke and female sex. Health programmes should promote weight reduction throughout the life course, including during the middle and older age of African adults

EPIDEMIOLOGY OF MEASLES IN THE CENTRAL REGION OF GHANA: A FIVE-YEAR CASE REVIEW IN THREE DISTRICT HOSPITALS

ABSTRACTObjective: As part of a national accelerated campaign to eliminate measles, we conducteda study, to define the epidemiology of measles in the central region.Design: A descriptive survey, was carried out on retrospective cases of measles.Setting: Patients were drawn from the three district hospitals (Assin, Asikuma andWinneba hospitals) with the highest number of reported cases in the region.Subjects: Records of outpatient and inpatient measles patients attending the selectedhealth facilities between 1996 and 2000. Data on reported measles cases in all healthfacilities in the three study, districts were also analysed.Main outcome measures: The distribution of measles cases in person (age and sex), time(weekly, or monthly, trends) and place (residence), the relative frequency, of cases, andthe outcome of treatment.Results: There was an overall decline in reported cases of measles between 1996 and2000 both in absolute terms and relative to other diseases. Females constituted 48%-52% of the reported 1508 cases in the hospitals. The median age of patients was 36months. Eleven percent of cases were aged under nine months; 66% under five yearsand 96% under 15 years. With some minor variations between districts, the highestand lowest transmission occurred in March and September respectively. Withinhospitals, there were sporadic outbreaks with up to 34 weekly cases.Conclusion: In Ghana, children aged nine months to 14 years could be appropriately,targeted for supplementary, measles immunization campaigns. The best period for thecampaigns is during the low transmission months of August to October. Retrospectivesurveillance can expediently inform decisions about the timing and target age groupsfor such campaigns

Epidemiology of measles in the central region of Ghana: a five-year case review in three district hospitals

Objective: As part of a national accelerated campaign to eliminate measles, we conducted a study, to define the epidemiology of measles in the central region. Design: A descriptive survey, was carried out on retrospective cases of measles. Setting: Patients were drawn from the three district hospitals (Assin, Asikuma and Winneba hospitals) with the highest number of reported cases in the region. Subjects: Records of outpatient and inpatient measles patients attending the selected health facilities between 1996 and 2000. Data on reported measles cases in all health facilities in the three study, districts were also analysed. Main outcome measures: The distribution of measles cases in person (age and sex), time (weekly, or monthly, trends) and place (residence), the relative frequency, of cases, and the outcome of treatment. Results: There was an overall decline in reported cases of measles between 1996 and 2000 both in absolute terms and relative to other diseases. Females constituted 48%- 52% of the reported 1508 cases in the hospitals. The median age of patients was 36 months. Eleven percent of cases were aged under nine months; 66% under five years and 96% under 15 years. With some minor variations between districts, the highest and lowest transmission occurred in March and September respectively. Within hospitals, there were sporadic outbreaks with up to 34 weekly cases. Conclusion: In Ghana, children aged nine months to 14 years could be appropriately, targeted for supplementary, measles immunization campaigns. The best period for the campaigns is during the low transmission months of August to October. Retrospective surveillance can expediently inform decisions about the timing and target age groups for such campaigns. (East African Medical Journal: 2003 80(6): 312-317