Spatial patterns and trends of maternal mortality over a five year period and their associated risk factors in Ifakara Health and Demographic Surveillance Site (IHDSS)

Introduction Worldwide, 99% of deaths of women in their reproductive ages are due to childbirth and pregnancy complications. Maternal mortality is the subject of the fifth United Nations’ millennium development goal: the aim is to reduce the maternal mortality ratio by three quarters from 1990 to 2015. Although much research has been conducted in recent years, knowing the spatial pattern of maternal mortality in developing countries will help target scarce resources and intervention programs to high risk areas for the greatest impact, since nationwide interventions are costly. Objective This study assessed the spatial patterns and trends of, and causes and risk factors associated with, maternal mortality in the Ifakara Health and Demographic Surveillance Site (IHDSS) in Tanzania, from 2006 to 2010, with a view to providing information that may help reduce maternal mortality in this country. Method A secondary data analysis of a longitudinal study using data from the IHDSS was conducted. Inverse distance weighted (IDW) method of interpolation in ArcGIS was used to assess spatial patterns. Cox proportional hazards regression was used to identify and quantify risk factors associated with maternal mortality. Results A total of 36 792 women aged 15 to 49 were included in the study of which 77 died due to childbirth or pregnancy related complications. The overall maternal mortality rate for the five years was 0.79 per 1000 person years. The trend declined from 90.42 per 1000 person years in 2006 to 57.42 per person years in 2010. There were marked geographical differences in maternal mortality patterns with high levels of mortality occurring in areas with close proximity to health facilities in some instances. The main causes of maternal death were eclampsia (23%), haemorrhage (22%) and abortion-related complications (10%). Maternal age, marital status and socioeconomic status were found to be risk factors. There was a reduced risk of 82% (HR: 0.18, 95% CI: 0.05-0.74) and 78% (HR: 0.22, 95% CI: 0.05 – 0.92) for women aged 20-29 and 30-39 years, respectively, compared with those younger than 20 years. While being married had a protective effect of 94% (HR: 0.06, 95% CI: 0.01 - 0.51) compared to being single, women who were widowed had an increased risk of 813% (HR: 9.13, 95% CI: (1.017 – 81.942). Higher socioeconomic status had a protective effect on maternal mortality: women who were in the poorer and least poor socioeconomic groups were 70% (HR: 0.30, 95% CI: 0.11 – 0.81) and 75% (HR: 0.25, 95% CI: 0.06 - 1.09) less likely to die from maternal causes, respectively, compared to those in the poorest category. Conclusion There has been a decline in maternal mortality in rural southern Tanzania, with geographical differences in patterns of death. Eclampsia, haemorrhage and abortion-related complication are the three leading causes of maternal death in rural southern Tanzania, with risk factors being maternal age less than 20 years, marital status (single, widowed), and lower socioeconomic status. Keywords: maternal mortality, risk factors, spatial pattern, maternal mortality rate, verbal autops

COVID-19 vaccine hesitancy among the adult population in Ghana:evidence from a pre-vaccination rollout survey

Background: Coronavirus disease 2019 (COVID-19) has already claimed over four million lives globally and over 800 deaths in Ghana. The COVID-19 vaccine is a key intervention towards containing the pandemic. Over three billion doses of the vaccine have already been administered globally and over 800,000 doses administered in Ghana, representing less than 5% vaccination coverage. Fear, uncertainty, conspiracy theories and safety concerns remain important threats to, a successful rollout of the vaccine if not managed well.Objective: Ascertain the predictors of citizens’ probability of participating in a COVID-19 vaccine trial and subsequently accept the vaccine when given the opportunity.Methodology: The study was an online nation-wide survey among community members (n = 1556) from 18th September to 23rd October, 2020 in the 16 regions in Ghana. Binary probit regression analysis with marginal effect estimations was employed to ascertain the predictors of community members’ willingness to participate in a COVID-19 vaccine trial and uptake the vaccine.Results: Approximately 60% of respondents said they will not participate in a COVID-19 vaccine trial; 65% will take the vaccine, while 69% will recommend it to others. Willingness to voluntarily participate in COVID-19 vaccine trial, uptake the vaccine and advise others to do same was higher among adults aged 18–48 years, the unmarried and males (p < 0.05). Significant predictors of unwillingness to participate in the COVID-19 vaccine trial and uptake of the vaccine are: married persons, females, Muslims, older persons, residents of less urbanised regions and persons with lower or no formal education (p < 0.05). Predominant reasons cited for unwillingness to participate in a COVID-19 vaccine trial and take the vaccine included fear, safety concerns, lack of trust in state institutions, uncertainty, political connotations, spiritual and religious beliefs.Conclusion: The probability of accepting COVID-19 vaccine among the adult population in Ghana is high but the country should not get complacent because fear, safety and mistrust are important concerns that have the potential to entrench vaccine hesitancy. COVID-19 vaccine rollout campaigns should be targeted and cognisant of the key predictors of citizens’ perceptions of the vaccine. These lessons when considered will promote Ghana’s efforts towards vaccinating at least 20 million people to attain herd immunity

Neonatal mortality rates, characteristics, and risk factors for neonatal deaths in Ghana:analyses of data from two health and demographic surveillance systems

BACKGROUND: Reducing neonatal mortality rates (NMR) in developing countries is a key global health goal, but weak registration systems in the region stifle public health efforts. OBJECTIVE: To calculate NMRs, investigate modifiable risk factors, and explore neonatal deaths by place of birth and death, and cause of death in two administrative areas in Ghana. METHODS: Data on livebirths were extracted from the health and demographic surveillance systems in Navrongo (2004-2012) and Kintampo (2005-2010). Cause of death was determined from neonatal verbal autopsy forms. Univariable and multivariable logistic regression were used to analyse factors associated with neonatal death. Multiple imputations were used to address missing data. RESULTS: The overall NMR was 18.8 in Navrongo (17,016 live births, 320 deaths) and 12.5 in Kintampo (11,207 live births, 140 deaths). The annual NMR declined in both areas. 54.7% of the births occurred in health facilities. 70.9% of deaths occurred in the first week. The main causes of death were infection (NMR 4.3), asphyxia (NMR 3.7) and prematurity (NMR 2.2). The risk of death was higher among hospital births than home births: Navrongo (adjusted OR 1.14, 95% CI: 1.03-1.25, p = 0.01); Kintampo (adjusted OR 1.76, 95% CI: 1.55-2.00, p < 0.01). However, a majority of deaths occurred at home (Navrongo 61.3%; Kintampo 50.7%). Among hospital births dying in hospital, the leading cause of death was asphyxia; among hospital and home births dying at home, it was infection. CONCLUSION: The NMR in these two areas of Ghana reduced over time. Preventing deaths by asphyxia and infection should be prioritised, centred respectively on improving post-delivery care in health facilities and subsequent post-natal care at home

Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites.

BACKGROUND: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings. OBJECTIVE: To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories. DESIGN: All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex. CONCLUSIONS: The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs

Sexual behaviours and their associated factors among young people in the Dodowa Health and Demographic Surveillance Site (DHDSS) in Ghana.

OBJECTIVE: This paper describes sexual behaviours and their associated factors among young people. DESIGN: The study design is cross-sectional. SETTING: Dodowa Health and Demographic Surveillance Site (DHDSS) in Ghana's Shai-Osudoku and Ningo Prampram districts. PARTICIPANTS: Young people aged 10 to 24 years, median age 17 years. OUTCOME MEASURES: Self-reported to have ever had sex, non-use of a condom at last sex, and ever been pregnant or gotten someone pregnant. RESULTS: Of the 1689 young people; 42% reported having ever had sex, not using a condom at last sexual activity (64%), and ever been pregnant or gotten someone pregnant (41%). The proportion of non-use of condoms at last sex was high across all age groups but was highest (93%) in a small proportion of 10 to 14-year-olds who have ever had sex. Higher proportions of females than males; were reported to have ever had sex (46%), not using a condom at their last sex (66%) and ever been pregnant or getting someone pregnant (56%). Age group (20 to 24), females, primary or junior high school, living alone and lower household socio-economic status were risk factors associated with all three outcome measures. CONCLUSION: Risky sexual behaviour is high among young people in the Dodowa HDSS. Therefore, interventions that promote safer sexual practices and help young people make timely decisions on their sexual and reproductive health care needs are required. FUNDING: No funding was obtained for this paper

Maternal risk factors and neonatal outcomes associated with low birth weight in a secondary referral hospital in Ghana

Over the past decade, the incidence of low birth weight (LBW) in sub-Saharan Africa has not seen any decline and this is a matter of grave concern for healthcare providers, policymakers, and researchers. Therefore, this study aimed to assess the incidence of LBW and related maternal risk factors (during pregnancy or delivery) as well as neonatal outcomes.info:eu-repo/semantics/publishedVersio

Aspects of Kono phonology

This work is a descriptive analysis of the Kono sound system. Kono is a Sierra Leonean language belonging to the Mande family of languages. The work is divided into two parts. The first part consists of three chapters, and deals mainly with non-tonal phonology. Chapter 1 discusses possible social and historical factors that may have affected the development of the culture and the language of the Kono people, the classification and possible origin of Kono particularly, and the Mande languages generally, a brief survey of previous work on Yono, and the theoretical framework, upon which this work is based. This is followed in the next two chapters by a discussion of various sound segments with a view to establishing a phoneme inventory of the language. Problems of phonemic interpretation relating to the establishment of such an inventory are discussed. The vowel-consonant dichotomy is discussed in Chapter 2. So also are the problems relating to vowel length, dissimilar vowels in sequence, and vowel nasalisation. Chapter 3 deals with problems posed by the distribution of consonant segments, particularly those relating to palatalisation, labialisation, prenasalisation, and nasalisation. Part Two deals with tone, and starts with a general review of studies in tonal phonology in Chapter 4. Syllable Structure is considered in Chapter 5, with particular consideration of how such a structure may be affected by its relationship with tone. The lexical and grammatical functions of tone form the basis of the discussion in Chapter 6. Finally in this part, there is in Chapter 7 an acoustic analysis of, fundamental frequency in relation to tone in Kono. This analysis was carried out with the object of Providing additional data to supplement our auditory analysis

Maternal mortality in Ifakara Health and Demographic Surveillance System: Spatial patterns, trends and risk factors, 2006 - 2010.

IntroductionMaternal mortality was the subject of the United Nations' fifth Millennium Development Goal which was to reduce the maternal mortality ratio by three quarters from 1990 to 2015. The Sustainable Development Goals (SDGs), target 3.1 requires participating countries to reduce their maternal mortality ratio to less than 70 deaths per 100,000 live births by 2030. Although much research has been conducted, knowing the spatial patterns and risk factors associated with maternal mortality in developing countries helps target scarce resources and intervention programmes to high risk areas for the greatest impact.MethodsData were analysed from a longitudinal open cohort of women aged 15 to 49 years, enrolled from 2006 to 2010. An inverse distance weighted method of interpolation was used to assess spatial patterns of maternal mortality. Cox proportional hazards regression analysis was used to identify risk factors associated with maternal mortality.ResultsThe overall maternal mortality rate for the 36 792 study participants for the five years was 0.79 per 1000 person years. The trend declined from 90.42 in 2006 to 57.42 in 2010. Marked geographical differences were observed in maternal mortality patterns. The main causes of maternal death were eclampsia (23%), haemorrhage (22%) and abortion-related complications (10%). There was a reduced risk of 82% (HR = 0.18, 95% CI:0.05-0.74) and 78% (HR = 0.22, 95% CI:0.05-0.92) for women aged 20-29 and 30-39 years, respectively, compared with those younger than 20 years. While being married had a protective effect of 94% (HR = 0.06, 95% CI: 0.01-0.51) compared with being single, women who were widowed had an increased risk of maternal death of 913% (HR = 9.13, 95% CI: 1.02-81.94). Women who belong to poorer, poor and least poor socioeconomic quintile had 84%, 71% and 72% reduction in risk of maternal mortality respectively compared to those in the poorest category (HR = 0.16, 95% CI: 0.06-0.42; HR = 0.29, 95% CI: 0.12-0.69; HR = 0.28, 95% CI: 0.10-0.80).ConclusionMaternal mortality has declined in rural southern Tanzania since 2006, with geographical differences in patterns of death. Eclampsia, haemorrhage and abortion-related complications are the three leading causes of maternal death in the region, with risk factors being younger than 20 years, being single or widowed, and having a low socioeconomic status

Prevalence, trends and associated factors of malaria in the Shai-Osudoku District Hospital, Ghana

Abstract Background Even though malaria is easily preventable and treatable, it continues to have a devastating impact on people’s health and livelihoods around the world. Sub-Saharan Africa carries a disproportionately high share of the global malaria burden. This study seeks to assess the prevalence, trends and factors associated with malaria in the Shai-Osudoku District Hospital, Ghana. Methods A cross-sectional study was conducted to determine the prevalence, trend, and factors associated with malaria in the Shai-Osudoku District Hospital; a 10-month secondary data was extracted from February to November 2020. The extracted data were entered into Epi Data version 6 and analysed using STATA version 16. Descriptive analysis was performed to determine the prevalence, trend and socio-demographic characteristics of study participants. Simple logistic regression at a 95% confidence level was performed to investigate socio-demographic factors associated with malaria infection. Tables and charts with summary statistics were used to present the results. Results Secondary data from 3896 individuals were included in the study. The age of the participants range from 0.8 to 101 years with a mean age of 32.5. The estimated prevalence of malaria during the study period is 20.9%. A majority (79.1%) of the participants who presented signs and symptoms of malaria were negative after testing. The prevalence of malaria cases increased progressively from 6.7 to 55.4% across the ten months. The simple logistic regression at a 95% confidence level revealed that age group, sex, residential status, religion, occupation and marital status were statistically significantly associated with malaria. The results shows that persons who tested positive for malaria were mostly treated with artemether-lumefantrine (46.1%), some malaria positive cases were given artesunate injection (11.6%), dihydroartemisinin-piperaquine (16.2%) and oral artemether-lumefantrine (6.5%). Surprisingly 19.6% of the malaria-positive cases were not given any form of malaria medication. Conclusion Factors found to influence malaria infection in the Shai-Osudoku District Hospital include participant’s age, sex, residential status, religious affiliation occupation and marital status. The findings of this study showed that malaria remains a serious public health problem in the Shai Osudoku District Hospital. The information obtained from this study can guide the implementation of malaria prevention, control and elimination strategies in Ghana