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

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

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

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

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

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

The impact of immunization on the association between poverty and child survival: Evidence from Kassena-Nankana District of northern Ghana

Research conducted in Africa has demonstrated consistently that parental poverty and low educational attainment adversely affect child survival. Relative poverty has a pronounced effect on the survival of children, even in a setting where nearly all families are poor. Results from the research presented in the working paper lend strong support to the United Nations’ goal of reducing excess childhood mortality among the poor by directing a particular focus on immunization. Findings in this working paper show that the adverse effects of poverty disappear and that the effects of educational attainment are reduced in survival models that control for immunization status. This finding lends empirical support to policies that promote immunization as a strategic component of poverty-reduction programs

Prospective Study of a Serogroup X Neisseria meningitidis Outbreak in Northern Ghana

After an epidemic of serogroup A meningococcal meningitis in northern Ghana, a gradual disappearance of the epidemic strain was observed in a series of five 6-month carriage surveys of 37 randomly selected households. As serogroup A Neisseria meningitidis carriage decreased, an epidemic of serogroup X meningococcal carriage occurred, which reached 18% (53/298) of the people sampled during the dry season of 2000, coinciding with an outbreak of serogroup X disease. These carriage patterns were unrelated to that of Neisseria lactamica. Multilocus sequence typing and pulsed-field gel electrophoresis of the serogroup X bacteria revealed strong similarity with other strains isolated in Africa during recent decades. Three closely related clusters with distinct patterns of spread were identified among the Ghanian isolates, and further microevolution occurred after they arrived in the district. The occurrence of serogroup X outbreaks argues for the inclusion of this serogroup into a multivalent conjugate vaccine against N. meningitidi