Multimorbidity of chronic diseases among adult patients presenting to an inner-city clinic in Ghana.

BACKGROUND: Very little is known about multimorbidity and chronic diseases in low and middle income countries, particularly Sub-Saharan Africa, and more information is needed to guide the process of adapting the health systems in these countries to respond adequately to the increasing burden of chronic diseases. We conducted a hospital-based survey in an urban setting in Ghana to determine the prevalence of multimorbidity and its associated risk factors among adult patients presenting to an inner city clinic. METHODS: Between May and June 2012, we interviewed adult patients (aged 18 years and above) attending a routine outpatient clinic at an inner-city hospital in Accra using a structured questionnaire. We supplemented the information obtained from the interviews with information obtained from respondents' health records. We used logistic regression analyses to explore the risk factors for multimorbidity. RESULTS: We interviewed 1,527 patients and retrieved matching medical records for 1,399 (91.6%). The median age of participants was 52.1 years (37-64 years). While the prevalence of multimorbidity was 38.8%, around half (48.6%) of the patients with multimorbidity were aged between 18-59 years old. The most common combination of conditions was hypertension and diabetes mellitus (36.6%), hypertension and musculoskeletal conditions (19.9%), and hypertension and other cardiovascular conditions (11.4%). Compared with patients aged 18-39 years, those aged 40-49 years (OR 4.68, 95% CI: 2.98-7.34), 50-59 years (OR 12.48, 95% CI: 8.23-18.92) and 60 years or older (OR 15.80, 95% CI: 10.66-23.42) were increasingly likely to present with multimorbidity. While men were less likely to present with multimorbidity, (OR 0.71, 95% CI: 0.45-0.94, p = 0.015), having a family history of any chronic disease was predictive of multimorbidity (OR 1.43, 95% CI: 1.03-1.68, p = 0.027). CONCLUSIONS: Multimorbidity is a significant problem in this population. By identifying the risk factors for multimorbidity, the results of the present study provide further evidence for informing future policies aimed at improving clinical case management, health education and medical training in Ghana

Imminent meningitis outbreak prevented by early warning and response action: Nadowli-Kaleo District, Upper West Region, Ghana-2017

Introduction: On 20th February 2017, health officials in Nadowli-Kaleo District (NKD) of Ghana's Upper West Region received reports of an upsurge in the number of meningitis case-patients reporting to the district's health facilities. The number of cases had exceeded the alert but not epidemic threshold for meningitis for the district. We investigated to identify the aetiologic agent, determine the risk factors and implement control measures. Methods: We conducted an unmatched case-control study. A meningitis case-patient was any NKD resident with any of the following signs and symptoms: neck stiffness, convulsion, bulging fontanelle (infants), altered consciousness or other meningeal signs with or without fever, from 1st January to 30th March 2017. For each case-patient, 2 controls (neighbours of case-patients without meningitis signs and symptoms) were identified. Demographic and clinical data were obtained through records review and case-patient interviews. Cerebrospinal fluid (CSF) samples were collected for laboratory investigation. Significant risk factors were identified using multivariable logistic regression. Results: In all 67 case-patients comprising 35 (52.2%) males and two (3%) children aged < 5 years were identified. The median age of case-patients was 24 years (interquartile range: 15–46 years). Ten deaths were recorded (case fatality rate: 14.9%). Most affected age group was 15-24 years with 18 (26.9%) case-patients and an age-specific attack rate of 170.8/100000 population. Nadowli Central sub-district, the epicenter, recorded 14 (22.4%) cases. Dominant aetiologic agent was Neisseria meningitidis isolated from 17 (58.6%) of 29 culture-positive CSF samples. Compared to controls, meningitis case-patients had higher odds of living in single window rooms (adjusted odds ratio (aOR) =5.05; 95% confidence interval (CI) =1.35-11.66), or in rooms inhabited by more than two people (aOR=3.28, CI=1.57-7.73). Conclusion: Neisseria meningitidis caused the upsurge in meningitis cases in NKD, with the youth being the most affected age group. Living in poorly ventilated rooms and overcrowded rooms were risk factors. Prompt case-management and health education helped control the occurrence and prevented an outbreak

Evaluation of the measles surveillance system of the Ga West Municipality, Ghana, 2017

Introduction: Over 140,000 people globally died from measles in 2018; most of which occurred in developing countries. In Ghana, measles is one of the diseases earmarked for elimination in the Integrated Disease Surveillance and Response (IDSR) strategy. The measles surveillance system seeks to monitor trends, detect outbreaks and report in a timely manner. In order to improve upon the performance of the Ga West Municipal Measles surveillance system, it was evaluated with the aim of determining its effectiveness. Methods: We used CDC updated guidelines for surveillance system evaluation to assess system attributes. Measles surveillance data from 2012 – 2016 were abstracted from the DHIMS. Case investigation forms, weekly and monthly IDSR reporting forms were reviewed to validate abstracted data. Key surveillance officers were interviewed on system operations. Data was analyzed descriptively to generate frequencies and relative frequencies. Results: The system operated with a reasonable number of disease variables and case definition was simple to apply. The system was found to be integrated with the national IDSR. Government facilities across all seven sub-districts, owned and contributed data to the system. Of the 48 suspected case-patients, 39 (81.0%) were investigated; none of which was positive giving a Predictive value positive (PVP) of 0%. Majority of facilities (though privately owned) did not contribute data to the system. All tested samples were received at the laboratory within the stipulated three (3) days. The system was stable with available case base forms. Over 56% (22/39) of the samples tested had no vaccination records. Data is used to guide routine and supplementary immunization activities. Conclusion: Ga west Municipal measles surveillance system is simple, flexible and generally acceptable. It is sensitive, timely, stable but with low representativeness. It is therefore effective. Municipal health officials have been sensitized on private sector participation and need for quality and timely data

Evaluation of the enhanced meningitis surveillance system, Yendi municipality, northern Ghana, 2010–2015

Abstract Background Meningitis is the inflammation of the meninges of the brain and or spinal cord. Global mortality rates vary from 2% to 30%. Epidemic meningitis remains a public health concern along the meningitis belt of Africa. Despite the operation of an enhanced meningitis surveillance system in Ghana, institutional mortality rates are estimated to range from 36% to 50%. In 2014, Yendi recorded 83 confirmed cases; with focal epidemics in some sub-municipals. We evaluated the system over a five-year period to find out whether it was achieving its objectives of systematic collection and analyses of data for the prevention or early detection of meningitis epidemics. Methods We used cross-sectional design. Both qualitative and quantitative data from Yendi Municipality between January 2010 and December 2015 were collected and analyzed. The updated guidelines for evaluating surveillance systems from Centers for Disease Control and Prevention were used. Content analysis was performed on the responses of key informants. Surveillance data was analyzed using MS-Excel. Results Fifteen healthcare workers were interviewed. For the period under evaluation, the annual incidence of meningitis ranged from 1.6/100,000 in 2012 to 62.6/100,000 in 2014. The average case fatality rate for the period was 8.3%. The system was sensitive, representative, and acceptable. The predictive value positive was 100% from 2010 to 2014 and 63.3% in 2015. Data quality was good, but timeliness of reporting was poor. Conclusions The enhanced meningitis surveillance system in Yendi Municipality is achieving most of its objectives. However, financial constraints and poor personnel motivation pose threats to the sustainability of the system

Adherence to the test, treat and track strategy for malaria control among prescribers, Mfantseman Municipality, Central Region, Ghana.

BackgroundThe test, treat, and track (T3) strategy is directed at ensuring diagnosis and prompt treatment of uncomplicated malaria cases. Adherence to T3 strategy reduces wrong treatment and prevents delays in treating the actual cause of fever that may otherwise lead to complications or death. Data on adherence to all three aspects of the T3 strategy is sparse with previous studies focusing on the testing and treatment aspects. We determined adherence to the T3 strategy and associated factors in the Mfantseman Municipality of Ghana.MethodsWe conducted a health facility based cross-sectional survey in Saltpond Municipal Hospital and Mercy Women's Catholic Hospitals in Mfantseman Municipality of the Central Region, Ghana in 2020. We retrieved electronic records of febrile outpatients and extracted the testing, treatment and tracking variables. Prescribers were interviewed on factors associated with adherence using a semi-structured questionnaire. Data analyses was done using descriptive statistics, bivariate, and multiple logistic regression.ResultsOf 414 febrile outpatient records analyzed, 47 (11.3%) were under five years old. About 180 (43.5%) were tested with 138 (76.7%) testing positive. All positive cases received antimalarials and 127 (92.0%) were reviewed after treatment. Of 414 febrile patients, 127 (30.7%) were treated according to the T3 strategy. Higher odds of adherence to T3 were observed for patients aged 5-25 years compared to older patients (AOR: 2.5, 95% CI: 1.27-4.87, p = 0.008). Adherence was low among physician assistants compared to medical officers (AOR 0.004, 95% CI 0.004-0.02, pConclusionAdherence to T3 strategy is low in Mfantseman Municipality of the Central Region of Ghana. Health facilities should perform RDTs for febrile patients at the OPD with priority on low cadre prescribers during the planning and implementation of interventions to improve T3 adherence at the facility level

The effect of malaria prevention and control interventions on malaria morbidity among children under 5 years and pregnant women in Kintampo North Municipality, Ghana

Background: Malaria prevention and control interventions have been scaled-up in the last decade in Ghana. We analysed the malaria surveillance data to assess the trends and the association between some malaria prevention interventions and malaria incidence in Kintampo North Municipality (KNM). Methods: We extracted data on malaria indicators and interventions from the District Health Information Management System 2 database for 2012–2016. Proportions and cumulative incidence of malaria episodes were computed using STATA 14 software. We performed correlation analysis between malaria interventions and malaria morbidity. We used linear regression models to determine the association between Long-Lasting Insecticide-treated Nets (LLINS) distribution, Intermittent Preventive Treatment in Pregnancy (IPTp) and episodes of malaria in children <5 years old and pregnant women. Results: A total of 280,890 episodes of malaria were recorded in the KNM from 2012–2016. Of the total malaria episodes, 64,953 (23.1%) were children <5 years and 57.5% (161,486/280,890) were females. The incidence of malaria in KNM declined from 650/1,000 population in 2012 to 444/1,000 population in 2016. The proportion of confirmed malaria increased from 35.2% in 2012 to 80.7% in 2015, and subsequently declined to 77.5% in 2016. The malaria Case Fatality Rate decreased by 65% in 2012 to 0.04% (16/37646) in 2016. Long Lasting Nets distribution to children showed a weak negative linear relationship with malaria morbidity in children <5 years (R= –0.20). IPTp1, IPTp2 showed a weak negative linear relationship with malaria morbidity in pregnancy, IPTp3 showed a weak positive linear relationship while IPTp4 and IPTp5 showed a negative moderate linear relationship with malaria morbidity in pregnancy. A unit increase in LLINs distribution to pregnant women was significantly associated with a reduction in malaria in pregnancy episodes by 0.21 (R2 = 0.19, 95% CI: -0.3 ─ -0.7). The IPTp first dose (IPTp1) coverage declined from 75.5% in 2012 to 69.0% in 2014, but rose to 80.9% in 2016. IPTp5 (fifth dose) increased from 0.7% in 2014 to 4.8% in 2016. A percentage increase in the coverage of only IPTp4 was associated with a reduction of malaria in pregnancy by two episodes (R2 = 0.34, 95% CI = ─ 1.68 – (─0.78). Conclusion: Malaria morbidity trend declined in the municipality. Increase coverage in LLINs and IPTp were associated with declines in malaria episodes in children <5years old and pregnancy women. Coverage of IPTp4 and IPTp5 were relatively low. Health staff should intensify promotion of the use of malaria prevention interventions among pregnant women and children < 5 years old. Midwives should promote uptake of optimal IPTp doses through health education and community antenatal outreach services