Compliance with the WHO strategy of test, treat and track for malaria control at Bosomtwi District in Ghana

Background: We reviewed malaria morbidity data to assess compliance to malaria T3 strategy in Bosomtwi District, Ashanti Region, Ghana.Design: The study was descriptive secondary data analysisSetting: Bosomtwi DistrictData source: District Health Information Management Systems (DHIMS2)Main outcome: Proportion of recorded cases tested, proportion of tested cases treated and proportion of cases trackedResults: Data for suspected and tested malaria cases was complete for only 3 years (2014-2016). Malaria testing reduced from 84.4% in 2015 to 76.8% in 2016 (national average 77.3%; regional average 70%). The proportion of untested but treated malaria cases declined from 46.3% in 2015 to 4.9% in 2016. Proportion of confirmed malaria cases put on antimalarial drugs was highest in 2016 at 63.9%. Pramso sub-district although home to largest facility in the district, under prescribed antimalarial drugs. Reports generated on malaria showed information on only confirmed suspected cases, under five, and above five malaria mortalities. The district did not determine their malaria thresholds.Conclusion: The malaria-testing rate in the Bosomtwi District is higher than the regional average and close to the national average. About a third of confirmed malaria cases missed getting appropriate antimalarial drugs. Limited analysis on malaria data reduced the information required to inform policy.Keywords: Malaria, Test, Treat and Track (T3), DHIMS2, Bosomtwi, Ghana.Funding: Author GO was fully sponsored by President’s Malaria Initiative (PMI)-CDC CoAg 6NU2GGH00187

Progress towards eliminating tuberculosis in Ga West Municipality, Ghana: analysis of tuberculosis surveillance data, 2017

Objective: To assess the progress made towards the actualization of the 80% reduction in incident cases, monitor trends and to assess the quality of GWM TB surveillance data from 2012 to 2016.Design: The study was descriptive secondary data analysisData Source: Tuberculosis cases recorded in the District Health Information Management Systems (DHIMS) and municipal TB registers. The Municipal TB Coordinator was interviewed for clarification on the data. A TB patient was defined as one who coughed persistently for two weeks or more.Main outcome measure: Trend of TB cases in Ga West MunicipalityResults: A total of 441 TB cases were registered of which 68.9% were smear positive. Males were (67%). Age group 35-44 years were the most affected (28.6%). The incidence rose from 21.5 (2012) to 41.6 (2015). The 2016 incidence was 40.7 (± 5.63) per 100,000 population. This is significantly different from the current national incidence of 156 (p < 0.05). Data was 95% complete. Discrepancies existed between data in registers compared to the DHIMS but were not statistically significant.Conclusion: The 80% reduction in incident cases target may not be attained by the GWM due to the rising number of incident cases. However, data quality is good.Keywords: Tuberculosis, data analysis, DHIMS 2, tuberculosis, incident casesFunding: The study was funded by the author

Adverse drug reaction reporting by community pharmacists in the Greater Accra Region of Ghana, 2016

Objectives: To assess adverse drug reactions (ADRs) reporting and identify factors to improve ADR reporting among community pharmacists in the Greater Accra Region of Ghana.Design: A quantitative cross-sectional study.Setting: Community pharmacies in the Greater Accra Region of Ghana.Participants: We randomly selected 210 pharmacists from a list community of pharmacies in Accra, Ghana. All participants had been practicing in the past one year, with this study being conducted from June to July 2016.Main outcome measure: Prevalence of ADR reporting by community pharmacists in Accra, Ghana.Results: Of the 210 community pharmacists interviewed 54.0% were males. Mean age was 32±10 years. Majority (96.0%) had heard of ADR reporting in Ghana, yet 18% had never seen the ADR reporting form. Reasons given for failure to report suspected ADRs included unavailability of reporting forms (83.1%), uncertainty about a causal relationship between the drug and the suspected ADR and classification of the reaction as “normal” with the medication being taken (23.6%). Only 34.0% of pharmacists had the ADR reporting forms available in their facilities. Marital status was the only factor significantly associated with ADR reporting (OR 3.18, 95%CI 1.02 – 9.12).Conclusion: ADR reporting by community pharmacists in Ghana remains low. To improve the proportion of reporting, ADR forms should be made available in all pharmacies, pharmacists and the general public should be made aware of online reporting systems, with continuous professional development in Pharmacovigilance with the advice that all suspected ADRs should be reported irrespective of uncertainty about causality

Barriers to early infant diagnosis of HIV in the Wa Municipality and Lawra District of Upper West Region, Ghana

Objective: We identified socio-demographic, health system and psycho-social barriers to Early Infant Diagnosis (EID) of HIV in the Upper West Region of Ghana.Design: An unmatched case control study of 96 cases and 96 controls was conducted in the ART centers in Lawra district and Wa Municipality between December 2014 and April 2015.Setting: A public health facilityParticipants: We defined a case as an HIV positive mother with an exposed infant who received EID service between January 2011 and December 2014. A control was defined as HIV Positive Mother with an exposed infant who did not receive EID services between January 2011 and December 2014.Main outcome: EID by dry blood spot Deoxyribonucleic acid Polymerase chain reaction.Results: A total of 192 mother-infant pairs were assessed. The mean age of infants at testing for cases was 17.3±14.9 weeks. Mother-to-child-transmission-rate was 2.3%. Factors associated with EID testing included: mother being formallyemployed (cOR=2.0: 95%CI:1.1-3.8), maternal formal education (cOR=2.0, 95%CI: 1.1-3.6) and maternal independent source of income (cOR 2.2, 95%CI 1.2-4.1). After adjusting for confounders, maternal independent incomebsource was associated with EID testing (aOR 2.2, 95%CI 1.2-4.1). Median turn-around time of EID result was 11 weeks (IQR 4-27weeks).Conclusion: Women need to be empowered to gain an independent source of income. This can help maximize the benefits of e-MTCT and increase EID in the Upper West Region of Ghana.Keywords: Barriers; HIV; early infant diagnosis; DNA-PCR; GhanaFunding: This work was funded by the author

Analysis of meningitis outbreak data, Jaman North District, Brong Ahafo Region, Ghana

Background: Descriptive analysis of meningitis outbreak in Jaman North districts of Brong Ahafo Region.Design: Descriptive secondary data analysisData Source: records of meningitis cases were extracted from case-based forms and line list.Main outcome measure: The source and pattern of outbreakResults: A total of 367 suspected cases with 44 confirmed were recorded from Jaman North during the period of January to March 2016. The mean age of those affected was 58 ± 13years. The case fatality rate was 0.82% and the proportion of males to females was 1:1.3 (160/207). The age group most affected was 15-29 years (54.7%) and the least was 45-49 years (3.0%). Streptococcus pneumoniae formed 77.3% of confirmed cases whilst Neisseria meningitides was 20.5%. Cases with Neisseria meningitides came from a border town in La Côte d’Ivoire.Conclusion: A protracted propagated meningitis outbreak occurred; and the predominant bacteria strain among confirmed cases was Streptococcus pneumoniae. Cases were mainly females and the most vulnerable group were people aged 15-29 years.Keywords: Streptococcus pneumoniae, Neisseria meningitides, meningitis outbreak, Jaman North District, GhanaFunding: This work was funded by the authors. Author BKD was sponsored under CDC (Frontline FETP)-CDC CoAg 6NU2GGH001876

Farm-related determinants of food insecurity among livestock dependent households in two agrarian districts with varying rainfall patterns in Ghana

Background: Despite availability of sufficient arable land, many African countries continue to dawdle in agricultural productivity due to over-reliance on rainfall patterns. Thus, undernourishment levels are disproportionately high in Africa. Even though they play key roles in agricultural production, the food security (FS) levels of livestock dependent households are understudied. Our study assessed the FS level and its determinants in livestock farming households in Ghana. Methods: We compared the FS levels of 287 cattle producing households in two representative agrarian districts with varying rainfall patterns in Ghana (dry vs. wet), using a cross-sectional survey. We assessed household's FS using the Food Insecurity Experience Scale. FS scores and categories were computed, and using generalized linear models, we assessed factors that explained variations in the FS levels among households. Results: The median herd size of households was 31 cattle (lower quartile = 24, upper quartile = 60 cattle), with a majority (91%) engaged in crop cultivation. Households reported experiencing an average of eight adverse events over a five-year recall period (2014–2018) mainly from animal diseases, cattle theft, and pasture shortages. Most households (81%) were food insecure (moderate = 40%, severe = 41%). In an adjusted model, households raising cattle in the dry district [adjusted Odds Ratio (aOR) = 5.43, 95% CI: 1.94, 15.2] and being married (aOR = 9.48, 95% CI: 2.35, 38.3) were associated with moderate food insecurity. While households raising cattle in the dry district [adjusted Odds Ratio (aOR) = 4.17, 95% CI: 1.44, 12.0], being married (aOR = 3.55, 95% CI: 1.03, 12.2), and increase in number of adverse events experienced (aOR = 1.53, 95% CI: 1.20, 1.96), were associated with increased odds of severe food insecurity. Household's odds of severe food insecurity decreased with each additional head of cattle in their herds (aOR = 0.97, 95% CI: 0.96, 0.99). We find no evidence of effect modification by farming district on other predictor's effect on food insecurity. Conclusion: Most of the livestock dependent households are food insecure. The food insecurity levels are worse for households farming in dry areas, those married and who experience increased frequency of adverse events. Government policy interventions focusing on maintaining healthy, secure, and productive animal herds would contribute to improving the productivity of household herds, food safety and food security

'What the herbal medicine can do for me in a week, the orthodox does in a year': Perceived efficacy of local alternative therapies influences medication adherence in patients with atherosclerotic cardiovascular disease.

BACKGROUND: There is strong evidence that anti-platelet therapy, ACE inhibitors, beta-blockers and statins are cost-effective in reducing subsequent cardiovascular disease (CVD) events in patients with atherosclerotic cardiovascular disease (ACVD). In some settings, only a low proportion of people have access to these medications, and even lower adhere to them. The current study explored and presents data on the causes of poor adherence to orthodox medication and motivations for alternative therapies in patients with established atherosclerotic cardiovascular disease (ACVD). METHODS: The study was conducted among city-dwelling adults with ACVD in Accra - Ghana's capital city. Eighteen interviews were conducted with patients with established ACVD. A follow-up focus group discussion was conducted with some of them. The protocol was approved by two ethics review committees based in Ghana and in the United Kingdom. All participants were interviewed after informed consent. Analysis was done with the Nvivo qualitative data analysis software. RESULTS: We identified motivations for use of alternatives to orthodox therapies. These cover the five dimensions of adherence: social and economic, health-care system, condition-related, therapy-related, and patient-related dimensions. Perceived inability of an orthodox medication to provide immediate benefit is an important motivator for use of alternative forms of medication. CONCLUSIONS: A multiplicity of factors precipitate non-adherence to orthodox therapies. Perceived efficacy and easy access to local alternative therapies such as herbal and faith-based therapies are important motivators

Use of Non-Prescription Remedies by Ghanaian Human Immunodeficiency Virus-Positive Persons on Antiretroviral Therapy

BackgroundInappropriate use of non-prescription remedies by persons living with human immunodeficiency virus (PLHIV) may result in adverse events or potentiate non-adherence to prescribed medications. This study investigated the use of non-prescription remedies among PLHIV receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana.MethodsA mixed method design using quantitative and qualitative methods was used. This article focuses on the quantitative survey of 540 respondents. Univariate analysis was used to generate descriptive tabulations of key variables. Bivariate analysis and logistic regression modeling, respectively, produced unadjusted and adjusted associations between background attributes of PLHIV and the use of non-prescription remedies. A p-value of < 0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics for Windows, Version 20.0.ResultsOne out of three respondents reported the use of non-prescription remedies at least once within 3 months of the survey. Most of these were locally made and included “Angel natural bitters, concoctions from the Christian prayer centers, garlic, and mahogany syrups.” These remedies were used concomitantly with antiretroviral medications (ARVs)—46% or administered with ARVs but at different times during the day (43%). Some of the remedies were reportedly prescribed by health workers, or self-initiated during periods of ARVs shortage. Others took them based on their perception of their efficacy. Bivariate level analysis identified ART clinic site, place of residence, and ARV adherence monitoring to be significantly associated with the use of non-prescription remedies (p < 0.05). Multiple logistic regression analysis controlling for covariates confirmed the location of ART clinic as the only predictor of the use of non-prescription remedies. Compared to clients at the large urban teaching hospital (Korle-Bu Fevers Unit ART center), those at the district level (Atua ART center) were ninefold more likely to use non-prescription remedies [adjusted odds ratio (AOR) = 8.84; 95% confidence interval (CI) 2.83–33.72]. Those from a district level mission hospital (St. Martin’s ART center) were threefold as likely to use these remedies (AOR = 2.610; 95% CI 1.074–9.120).ConclusionThe use of non-prescription remedies by PLHIV on ART is common in southern Ghana. Usage is mostly self-initiated because of perceived efficacy of remedy, and was more common among clients attending rural ART clinics

Epidemiological link of a major cholera outbreak in Greater Accra region of Ghana, 2014

Abstract Background Cholera remains an important public health challenge globally. Several pandemics have occurred in different parts of the world and have been epidemiologically linked by different researchers to illustrate how the cases were spread and how they were related to index cases. Even though the risk factors associated with the 2014 cholera outbreak were investigated extensively, the link between index cases and the source of infection was not investigated to help break the transmission process. This study sought to show how the index cases from various districts of the Greater Accra Region may have been linked. Methods We carried out a descriptive cross sectional study to investigate the epidemiological link of the 2014 cholera outbreak in the Greater Accra region of Ghana. An extensive review of all district records on cholera cases in the Greater Accra region was carried out. Index cases were identified with the help of line lists. Univariate analyses were expressed as frequency distributions, percentages, mean ± Standard Deviation, and rates (attack rates, case-fatality rates etc.) as appropriate. Maps were drawn using Arc GIS and Epi info software to describe the pattern of transmission. Results Up to 20,199 cholera cases were recorded. Sixty percent of the cases were between 20 and 40 years and about 58% (11,694) of the total cases were males. Almost 50% of the cases occurred in the Accra Metro district. Two-thirds of the index cases ate food prepared outside their home and had visited the Accra Metropolis. Conclusions The 2014 cholera outbreak can be described as a propagated source outbreak linked to the Accra Metropolis. The link between index cases and the source of infection, if investigated earlier could have helped break the transmission process. Such investigations also inform decision-making about the appropriate interventions to be instituted to prevent subsequent outbreaks

Food elimination, food substitution, and nutrient supplementation among ARV-exposed HIV-positive persons in southern Ghana

Abstract Background Optimal nutrition is a determinant of health in all persons. In persons living with HIV (PLHIV), nutrition is particularly important. Various factors, including dietary practices, play a role in guaranteeing nutritional health. Objectives We investigated multiple non-prescription drugs use among HIV-positive persons receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. This paper, however, focuses on nutrient supplement use, food elimination, and food substitution practices by the PLHIV. Methods Using quantitative and qualitative methods, we collected data from 540 HIV-positive persons at the health facility level. This paper focuses on only the quantitative data. Individual study participants were selected using a systematic random sampling procedure. Participants were interviewed after informed consent. We used univariate analysis to generate descriptive tabulations for key variables. Multivariable logistic regression modeling identified predictors of three practices (nutrient supplementation, food elimination, and food substitution). P value less than 0.05 or 95% confidence intervals facilitated determination of statistical significance. All analyses were performed using IBM SPSS Statistics for Windows, version 20.0. Results The use of nutrient supplements was a popular practice; 72% of the PLHIV used various kinds. The primary motive for the practice was to boost appetite and to gain weight. A little over 20% of the participants reportedly eliminated certain foods and beverages, while 17% introduced new foods since their initial HIV diagnosis. All the three practices were largely driven by the quest for improved health status. We determined predictors of nutrient supplementation to be ART clinic location and having an ART adherence monitor. Having an ART adherence monitor was significantly associated with reduced odds of nutrient supplementation (AOR = 0.34; 95% CI 0.12–0.95). The only predictor for food elimination was education level (AOR = 0.29; 95% CI 0.30–0.92); predictors of food substitution were ART clinic location (AOR = 0.11; 95% CI 0.02–0.69) and anemia (defined as hemoglobin concentration less than 11.0 g/dl) (AOR = 0.21; 95% CI 0.12–0.85). Conclusions The practice of supplementation is popular among this group of PLHIV. Food elimination and substitution are practiced, albeit in moderation. The predictors identified may prove helpful in provider-client encounters as well as local HIV programming