Hospital based maternity care in Ghana : findings of a confidential enquiry into maternal deaths

Background: In Ghana, a universal free delivery policy was implemented to improve access to delivery care in health facilities, thereby improving access to skilled attendance and reducing maternal mortality. Objective: A confidential enquiry was conducted to ascertain if changes had occurred in the care provided by reviewing the care given to a sample of maternal deaths before and after introduction of the policy. Method: Twenty women who died as a result of pregnancy-related complications (maternal deaths) in selected hospitals in two regions were assessed by a clinical panel, guided by a maternal death assessment form. Unlike the traditional confidential enquiry process, both adverse and favourable factors were identified. Findings: Clinical care provided before and after the introduction of the fee exemption policy did not change, though women with complications were arriving in hospital earlier after the introduction of the policy. On admission, however, they received very poor care and this, the clinical panel deduced could have resulted in many avoidable deaths; as was the case before the implementation of the policy. Consumables, basic equipment and midwifery staff for providing comprehensive emergency obstetric care were however found to be usually available. Conclusion: Our findings suggest that the already poor delivery care services women received remained unchanged after introduction of the policy.This work was undertaken as part of an international research programme - Immpact (Initiative for Maternal Mortality Programme Assessment). See: http://www.abdn.ac.uk/immpact, funded by the Bill & Melinda Gates Foundation, the Department for International Development (DFID), the European Commission and the Unites States Agency for International Development (USAID)

Causes of and trends in childhood mortality in a rural South African sub-district

Student Number : 0310359D - MSc project report - School of Public Health - Faculty of Health SciencesBackground: Studies into childhood mortality present the opportunity to identify the leading and common causes of childhood mortality in different populations. Objectives: To study the trends in all-cause mortality, and patterns of cause-specific mortality, in children 0-14 years living in the Agincourt sub-district of South Africa over the period 1992-2000. Methods: Secondary data analysis based on the longitudinal database from the Agincourt Demographic and Health Surveillance System was used to study trends in childhood mortality between 1992 and 2000, and a comparison was made between the earlier period (1992-96) and the later period (1997-2000). Results: Seven hundred and twenty four deaths occurred over the 9 year period, 1992 to 2000, in children aged 0-14 years in the Agincourt sub-district of South Africa. Over 80% of the deaths occurred in children under-five years of age. Death rates in children under one year in the periods 1992-1996 and 1997-2000 were 8.9/1000 live births and 18.0/1000 live births respectively. Children under five years between 1992-1996 and 1997-2000 had death rates of 18.0/1000 live births and 35.0/1000 live births respectively. There was a statistically significant difference in death rate in infants, and in children less than five years, in those who died over the period 1992-1996 and those who died during the later period 1997-2000, with mortality showing an increasing trend (p-values <0.0001 for infants and for children under five years). Overall mortality rates in all children under 14 years between 1992-1996 and 1997-2000 were 26.4/10000 person-years and 37.7/10000 person-years respectively. There was no significant statistical difference in the overall mortality trend among children aged 0-14 years between the two periods of time (p-value 0.614). Infectious and communicable diseases were the leading causes of death with diarrhoeal deaths accounting for 15.2%, HIV/AIDS 9.7% and malnutrition 7.6%. Deaths from diarrhoeal disease between 1992-1996 and 1997-2000 were 481/million and 449/million person-years respectively. Deaths from HIV/AIDS within the same time periods were 107/million and 607/million person-years respectively. HIV/AIDS showed a statistically significant difference over the two periods with an increased risk ratio of 5.59 (95% confidence interval of 4.6 to 70). Conclusion: This analysis reinforced previous findings pointing to the fact that infectious and communicable diseases are the leading causes of childhood mortality in South Africa and other developing countries. HIV/AIDS and diarrhoeal diseases have emerged as major causes of mortality in this analysis. Efforts to control the HIV epidemic and prevent the spread of HIV/AIDS must be accelerated in the Agincourt sub-district

Evaluating Health Research Capacity Building: An Evidence-Based Tool

Bates and colleagues describe the development of a tool to assess capacity-building programs in health research, which they used in Kumasi, Ghana

A randomized trial on effectiveness of artemether-lumefantrine versus artesunate plus amodiaquine for unsupervised treatment of uncomplicated Plasmodium falciparum malaria in Ghanaian children

<p>Abstract</p> <p>Background</p> <p>Numerous trials have demonstrated high efficacy and safety of artemisinin-based combination therapy (ACT) under supervised treatment. In contrast, effectiveness studies comparing different types of ACT applied unsupervised are scarce. The aim of this study was to compare effectiveness, tolerability and acceptance of artesunate plus amodiaquine (ASAQ) against that of artemether-lumefantrine (AL) in Ghanaian children with uncomplicated <it>Plasmodium falciparum </it>malaria.</p> <p>Methods</p> <p>A randomized open-label trial was conducted at two district hospitals in the Ashanti region, Ghana, an area of intense malaria transmission. A total of 246 children under five years of age were randomly assigned to either ASAQ (Arsucam^®) or AL (Coartem^®). Study participants received their first weight-adjusted dose under supervision. After the parent/guardian was advised of times and mode of administration the respective three-day treatment course was completed unobserved at home. Follow-up visits were performed on days 3, 7, 14 and 28 to evaluate clinical and parasitological outcomes, adverse events, and haematological recovery. Length polymorphisms of variable regions of <it>msp1 </it>and <it>msp2 </it>were determined to differentiate recrudescences from reinfections. Acceptance levels of both treatment regimens were assessed by means of standardized interviews.</p> <p>Results</p> <p>Adequate clinical and parasitological responses after AL and ASAQ treatment were similar (88.3% and 91.7%, respectively). Interestingly, more late clinical failures until day 28 occurred in AL-treated children than in those who received ASAQ (17.5% and 7.3%, respectively; Hazard Ratio 2.41, 95% CI 1.00–5.79, p < 0.05).</p> <p>Haematological recovery and drug tolerability were not found to be significantly different in both study arms. The acceptance of treatment with ASAQ was higher than that with AL (rank-scores 10.6 and 10.3, respectively; p < 0.05).</p> <p>Conclusion</p> <p>Unobserved AL and ASAQ treatment showed high adequate clinical and parasitological responses, though AL was inferior in preventing late clinical failures.</p

A multi-center prospective cohort study to evaluate the effect of differential pricing and health systems strengthening on access to medicines and management of hypertension and diabetes in Ghana: A study protocol [version 2; referees: 3 approved]

Background: There is evidence to suggest that the prevalence of non-communicable diseases (NCDs), in particular cardiovascular diseases and diabetes, are being recognized as forming a substantial proportion of the burden of disease among populations in Low- and Middle-Income Countries (LMICs).  Access to treatment is likely a key barrier to the control and prevention of NCD outcomes.  Differential pricing, an approach used to price drugs based on the purchasing power of patients in different socioeconomic segments, has been shown to be beneficial and leads to improved access and affordability. Methods: This is a quasi-experimental study, with a pragmatic trial design, to be conducted over the course of three years. A mixed methods design will be used to evaluate the effects of health systems strengthening and differential pricing on the management of diabetes, hypertension and selected cancers in Ghana. A public private partnership was established between all sites that will receive multi-level interventions, including health systems strengthening  and access to medicines interventions. Study populations and sites: Study participants will include individuals with new or previously diagnosed hypertension and diabetes (n=3,300), who present to two major referral hospitals, Komfo Anokye Teaching Hospital and Tamale Teaching Hospital, as well as three district hospitals, namely Kings Medical Centre, Agogo Presbyterian District Hospital, and Atua Government Hospital. Discussion: The objective of this study aims to test approaches intended to improve access to drugs for the treatment of hypertension and diabetes, and improve disease control. Patients with these conditions will benefit from health systems strengthening interventions (education, counseling, improved management of disease), and increased access to innovative medicines via differential pricing. Pilot programs also will facilitate health system strengthening at the participating institutions, which includes training of clinicians and updating of guidelines and production of protocols for the treatment of diabetes, hypertension and cancer

Identification of Widespread Adenosine Nucleotide Binding in Mycobacterium tuberculosis

SummaryComputational prediction of protein function is frequently error-prone and incomplete. In Mycobacterium tuberculosis (Mtb), ∼25% of all genes have no predicted function and are annotated as hypothetical proteins, severely limiting our understanding of Mtb pathogenicity. Here, we utilize a high-throughput quantitative activity-based protein profiling (ABPP) platform to probe, annotate, and validate ATP-binding proteins in Mtb. We experimentally validate prior in silico predictions of >240 proteins and identify 72 hypothetical proteins as ATP binders. ATP interacts with proteins with diverse and unrelated sequences, providing an expanded view of adenosine nucleotide binding in Mtb. Several hypothetical ATP binders are essential or taxonomically limited, suggesting specialized functions in mycobacterial physiology and pathogenicity

Connexin Genes Variants Associated with Non-Syndromic Hearing Impairment: A Systematic Review of the Global Burden

Mutations in connexins are the most common causes of hearing impairment (HI) in many populations. Our aim was to review the global burden of pathogenic and likely pathogenic (PLP) variants in connexin genes associated with HI. We conducted a systematic review of the literature based on targeted inclusion/exclusion criteria of publications from 1997 to 2020. The databases used were PubMed, Scopus, Africa-Wide Information, and Web of Science. The protocol was registered on PROSPERO, the International Prospective Register of Systematic Reviews, with the registration number &ldquo;CRD42020169697&rdquo;. The data extracted were analyzed using Microsoft Excel and SPSS version 25 (IBM, Armonk, New York, United States). A total of 571 independent studies were retrieved and considered for data extraction with the majority of studies (47.8% (n = 289)) done in Asia. Targeted sequencing was found to be the most common technique used in investigating connexin gene mutations. We identified seven connexin genes that were associated with HI, and GJB2 (520/571 publications) was the most studied among the seven. Excluding PLP in GJB2, GJB6, and GJA1 the other connexin gene variants (thus GJB3, GJB4, GJC3, and GJC1 variants) had conflicting association with HI. Biallelic GJB2 PLP variants were the most common and widespread variants associated with non-syndromic hearing impairment (NSHI) in different global populations but absent in most African populations. The most common GJB2 alleles found to be predominant in specific populations include; p.Gly12ValfsTer2 in Europeans, North Africans, Brazilians, and Americans; p.V37I and p.L79Cfs in Asians; p.W24X in Indians; p.L56Rfs in Americans; and the founder mutation p.R143W in Africans from Ghana, or with putative Ghanaian ancestry. The present review suggests that only GJB2 and GJB3 are recognized and validated HI genes. The findings call for an extensive investigation of the other connexin genes in many populations to elucidate their contributions to HI, in order to improve gene-disease pair curations, globally