Improving access to lymphatic filariasis MMDP services through an enhanced evidence-based, cascaded training model for health worker capacity strengthening in Ghana: an evaluation study

IntroductionGhana has made significant progress in reducing the transmission rate of lymphatic filariasis. However, very little progress has been made in the provision of morbidity management and disability prevention (MMDP) services, which is one of the key requirements for certification of elimination as a disease of public health importance. This study was designed to compare pre-post- intervention to determine the feasibility and effectiveness of a cascade training model for health worker capacity strengthening in Ghana, using the WHO recommended minimum intervention package to improve access to MMDP services.MethodsThis study used a quasi-experimental design to assess the impact of evidence-based training of patients with lymphatic filariasis (LF) in the Upper West region of Ghana. All lymphedema patients who were available at the time of data collection participated in the study before and after the training.ResultsThe mean age of respondents was 54.67 years (SD ± 16.89 years) at baseline and 54.70 years (SD ± 15.80 years) at evaluation. The majority (i.e., 76.30% at baseline and 80.50% at evaluation) of the respondents were female. Most of the respondents had not completed primary school (83.82% at baseline and 85.40% at evaluation). We found an improvement in the quality of life among LF patients, that is, the proportion of respondents who reported having a high quality of life increased from 2.9% at baseline to 20.12% at evaluation (p < 0.001). The lymphedema management practice of “hygiene/washing and drying of affected limb” was reported by 73.17% of respondents at evaluation compared with only 32.95% of respondents at baseline (p < 0.001). The acute attack management technique of “cooling the affected limb in cool water/cold compress” was reported by 70.15% of respondents at evaluation compared with 23.70% of respondents at baseline (p < 0.001).ConclusionThe research confirmed that LF-related perceptions remained generally the same at baseline and evaluation among community members. The implementation of the LF-related morbidity management (MMDP) project has led to a significant improvement in the morbidity management practices among patients at evaluation compared with baseline. Our findings also showed that self-care led to an improvement in patients’ quality of life. This justifies the need for investment in morbidity management interventions in endemic communities

Anemia prevalence and its predictors among children under‐five years in Ghana. A multilevel analysis of the cross‐sectional 2019 Ghana Malaria Indicator Survey

Abstract Background and Aims Despite the implementation of anemia control interventions in Ghana, anemia prevalence is still high in children under‐fives. Reducing the prevalence of anemia requires identifying and targeting associated critical risk factors. This study seeks to identify predictors of anemia among children under‐fives in Ghana. Methods Nationally representative data from the 2019 Ghana Malaria Indicator Survey was used in this study. Both fixed and random effects (multilevel) logistic regression models were applied to 2434 children to identify critical factors associated with anemia. Results In this study, 54% (95% confidence interval [CI] 52.0–57.0) of children under‐5 years were anemic. Infants were more likely to be anemic (66.7%) compared with other children below 5 years. In the multivariable multilevel model, the risk of anemia was found to be higher in younger children especially 6–11 months old (adjusted odds ratio [aOR] = 3.59, CI: 2.54–5.08) and 12–23 months old (aOR = 2.97, CI: 2.08–4.23), children who had malaria (aOR = 1.53, CI: 1.13–2.06), children whose mothers were not registered but not covered with health insurance (aOR = 1.45, CI: 1.21–1.74) or were not even registered for insurance (aOR = 1.49, CI: 1.15–1.93), children born to adolescent mothers (aOR = 2.21, CI: 1.36–3.57), children born to non‐Christian mothers (Islam [aOR = 1.53, CI: 1.17–2.00]), children born to families of poorer households (poorest [aOR = 3.01, CI: 1.64–5.51]; poorer [aOR = 2.56, CI: 1.65–3.98]); middle (aOR = 2.03, CI: 1.32–3.11) and richer (aOR = 1.78, CI: 1.19–2.64), and children who lived in either Upper East (aOR = 2.03, CI: 1.26–3.26) or Central (aOR = 2.52, CI: 1.42–4.47) regions. Significant unobserved community‐level differences in anemia prevalence were observed. Conclusion The probability of anemia in children under‐fives differs substantially from one community to another, and the prevalence remains high. The identified critical risk factors should be addressed. Multifaceted and targeted approaches are needed to help reduce the anemia prevalence in this setting to achieve the multiple United Nation's Sustainable Development Goals, which are related to risk and prevalence of anemia by 2030

Evaluating the Curtailment Risk of Non-Firm Utility-Scale Solar Photovoltaic Plants under a Novel Last-In First-Out Principle of Access Interconnection Agreement

With the increasing share of distributed energy resources on the electric grid, utility companies are facing significant decisions about infrastructure upgrades. An alternative to extensive and capital-intensive upgrades is to offer non-firm interconnection opportunities to distributed generators, via a coordinated operation of utility scale resources. This paper introduces a novel flexible interconnection option based on the last-in, first-out principles of access aimed at minimizing the unnecessary non-firm generation energy curtailment by balancing access rights and contribution to thermal overloads. Although we focus on solar photovoltaic (PV) plants in this work, the introduced flexible interconnection option applies to any distributed generation technology. The curtailment risk of individual non-firm PV units is evaluated across a range of PV penetration levels in a yearlong quasi-static time-series simulation on a real-world feeder. The results show the importance of the size of the curtailment zone in the curtailment risk distribution among flexible generation units as well as that of the “access right” defined by the order in which PV units connect to the grid. Case study results reveal that, with a proper selection of curtailment radius, utilities can reduce the total curtailment of flexible PV resources by up to more than 45%. Findings show that non-firm PV generators can effectively avoid all thermal limit-related upgrade costs

Evaluating the Curtailment Risk of Non-Firm Utility-Scale Solar Photovoltaic Plants under a Novel Last-In First-Out Principle of Access Interconnection Agreement

With the increasing share of distributed energy resources on the electric grid, utility companies are facing significant decisions about infrastructure upgrades. An alternative to extensive and capital-intensive upgrades is to offer non-firm interconnection opportunities to distributed generators, via a coordinated operation of utility scale resources. This paper introduces a novel flexible interconnection option based on the last-in, first-out principles of access aimed at minimizing the unnecessary non-firm generation energy curtailment by balancing access rights and contribution to thermal overloads. Although we focus on solar photovoltaic (PV) plants in this work, the introduced flexible interconnection option applies to any distributed generation technology. The curtailment risk of individual non-firm PV units is evaluated across a range of PV penetration levels in a yearlong quasi-static time-series simulation on a real-world feeder. The results show the importance of the size of the curtailment zone in the curtailment risk distribution among flexible generation units as well as that of the “access right” defined by the order in which PV units connect to the grid. Case study results reveal that, with a proper selection of curtailment radius, utilities can reduce the total curtailment of flexible PV resources by up to more than 45%. Findings show that non-firm PV generators can effectively avoid all thermal limit-related upgrade costs

Projet valorisation de l'igname pour les marchés urbains. Projet financé par le Ministère de la Coopération, référence : 9502111 00 230 75 01. Marché de clientèle n.9200114. Rapport final

L'igname est un aliment très apprécié en Afrique de l'Ouest mais sa consommation sous forme de tubercules frais présente, pour les consommateurs urbains, de fortes contraintes. Celles-ci sont liées aux caractères saisonnier et périssable du produit qui rendent irrégulière sa disponibilité sur les marchés urbains. Avec l'urbanisation, on observe dans certains pays, le développement d'une filière originale de cossettes d'igname. Il s'agit d'un produit stabilisé obtenu à partir de petits tubercules épluchés, précuits et séchés au soleil. Pour mieux estimer l'importance et comprendre le fonctionnement de cette filière encore mal connue, une enquête de consommation sur les produits à base d'igname a été menée en milieu urbain dans trois pays : Bénin, Nigeria, Togo. Les consommateurs expliquent leur consommation de produits dérivés des cossettes par leur qualité gustative, leur constante disponibilité, leur facilité de préparation et leur prix accessibl

A Comparative Study of Lymphatic Filariasis-Related Perceptions among Treated and Non-Treated Individuals in the Ahanta West Municipality of Ghana

Background: Ghana joined the Global Programme to Eliminate Lymphatic Filariasis (GPELF), established in the year 2000, with the aim of eliminating the disease as a public health problem through annual mass treatment of entire endemic populations. Since 2001, the country has implemented mass drug administration (MDA) in endemic districts, with great reductions in the population at risk for infection. However, in many districts, the elimination programme is faced with the presence of hotspots, which may be due in part to individuals not taking part in MDA (either intentionally or unintentionally) who may serve as reservoirs to sustain transmission. This paper compares the LF-related perceptions among individuals who regularly take the MDA drugs and those who seldom or never take part in the MDA in the Ahanta West Municipality of Ghana to determine community acceptable ways to implement an intervention aimed to track, engage, and treat individuals who regularly miss MDA or to test individuals who intentionally refuse MDA and treat them if positive for LF. Methods: This was a mixed method study employing questionnaire surveys and focus group discussions (FDG) for data collection. Survey participants were randomly selected from the 2019 treatment register to stratify respondents into treated and non-treated groups. FGD participants were selected purposively such that there are at least two non-treated persons in each discussion session. Results: Over 90% of the respondents were aware of the disease. Poor hygiene/dirty environment was wrongly reported by most respondents (76.8%) as the causes. MDA awareness was very high among both treated (96.9%) and non-treated (98.6%) groups. A low sense of vulnerability to LF infection was evident by a reduction in the number of people presenting clinical manifestations of the disease in communities. Slightly more, 65 (29.0%) of the non-treated group compared to the 42 (19.4%) treated group reported ever experiencing adverse effects of the MDA drugs. Barriers to MDA uptake reported in both groups were poor planning and implementation of the MDA, lack of commitments on the part of drug distributors, and adverse drug reactions. About 51% of the non-treated group reported never taking the drugs even once in the last five years, while 61% among the treated group took the MDA drug consistently in the past five years. Respondents in both groups believed that, when engaged properly, most non-treated persons will accept to take the drug but insisted community drug distributors (CDDs) must be trained to effectively engage people and have time for those they will be engaging in dialogue. The chiefs emerged as the most influential people who can influence people to take MDA drugs. Conclusions: The reduction in risk perception among respondents, adverse reactions and the timing of MDA activities may be influencing MDA non-participation in the study area; however, respondents think that non-treated individuals will accept the interventions when engaged properly by the CDDs

Low Microfilaremia Levels in Three Districts in Coastal Ghana with at Least 16 Years of Mass Drug Administration and Persistent Transmission of Lymphatic Filariasis

Ghana has been implementing mass drug administration (MDA) of ivermectin and albendazole for the elimination of lymphatic filariasis (LF) since the year 2000, as part of the Global Programme to Eliminate Lymphatic Filariasis (GPELF). It was estimated that 5–6 years of treatment would be sufficient to eliminate the disease. Tremendous progress has been made over the years, and treatment has stopped in many disease endemic districts. However, despite the successful implementation of MDA, there are districts with persistent transmission. In this study we assessed the epidemiology of LF in three adjoining districts that have received at least 16 years of MDA. The assessments were undertaken one year after the last MDA. 1234 adults and 182 children below the age of 10 years were assessed. The overall prevalence of circulating filarial antigen in the study participants was 8.3% (95% CI: 6.9–9.9), with an estimated microfilaria prevalence of 1.2%. The microfilarial intensity in positive individuals ranged from 1 to 57 microfilariae/mL of blood. Higher antigen prevalence was detected in males (13.0%; 95% CI: 10.3–16.2) compared to females (5.5%; 95% CI: 4.1–7.2). The presence of infection was also highest in individuals involved in outdoor commercial activities, with the risks of infection being four- to five-fold higher among farmers, fishermen, drivers and artisans, compared to all other occupations. Using bednets or participating in MDA did not significantly influence the risk of infection. No children below the age of 10 years were found with infection. Detection of Wb123 antibodies for current infections indicated a prevalence of 14.4% (95% CI: 8.1–23.0) in antigen-positive individuals above 10 years of age. No antibodies were detected in children 10 years or below. Assessment of infection within the An. gambiae vectors of LF indicated an infection rate of 0.9% (95% CI: 0.3–2.1) and infectivity rate of 0.5% (95% CI: 0.1–1.6). These results indicate low-level transmission within the districts, and suggest that it will require targeted interventions in order to eliminate the infection