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Narh-Bana S.A.,Dodowa Health Research Center | Narh-Bana S.A.,Dangme West District Health Administration | Narh-Bana S.A.,University of Witwatersrand | Narh-Bana S.A.,Ifakara Health Institute | And 3 more authors.
Tropical Medicine and International Health | Year: 2012

Objectives To determine patterns and risk factors for cause-specific adult mortality in rural southern Tanzania. Methods The study was a longitudinal open cohort and focused on adults aged 15-59years between 2003 and 2007. Causes of deaths were ascertained by verbal autopsy (VA). Cox proportion hazards regression model was used to determine factors associated with cause-specific mortality over the 5-year period. Results Thousand three hundred and fifty-two of 65548 adults died, representing a crude adult mortality rate (AMR) of 7.3 per 1000 person years of observation (PYO). VA was performed for 1132 (84%) deaths. HIV/AIDS [231 (20.4%)] was the leading cause of death followed by malaria [150 (13.2%)]. AMR for communicable disease (CD) causes was 2.49 per 1000 PYO, 1.21 per 1000 PYO for non-communicable diseases (NCD) and 0.53 per 1000 PYO for accidents/injury causes. NCD deaths increased from 16% in 2003 to 24% in 2007. High level of education was associated with a reduction in the risk of dying from NCDs. Those with primary education (HR=0.67, 95% CI: 0.49, 0.92) and with education beyond primary school (HR=0.11, 95% CI: 0.02, 0.40) had lower mortality than those who had no formal education. Compared with local residents, in-migrants were 1.7 (95% CI: 1.37, 2.11) times more likely to die from communicable disease causes. Conclusion NCDs are increasing as a result of demographic and epidemiological transitions taking place in most African countries including Tanzania and require attention to prevent increased triple disease burden of CD, NCD and accident/injuries. © 2012 Blackwell Publishing Ltd.


Ackumey M.M.,University of Ghana | Ackumey M.M.,Swiss Tropical and Public Health Institute | Gyapong M.,Dodowa Health Research Center | Pappoe M.,University of Ghana | Weiss M.G.,Swiss Tropical and Public Health Institute
American Journal of Tropical Medicine and Hygiene | Year: 2011

This study examined sociocultural features of help-seeking for Buruli ulcer-affected persons with pre-ulcers and ulcers in a disease-endemic area in Ghana. A sample of 181 respondents were purposively selected. Fisher's exact test was used to compare help-seeking variables for pre-ulcers and ulcers. Qualitative phenomenologic analysis of narratives clarified the meaning and content of selected quantitative help-seeking variables. For pre-ulcers, herbal dressings were used to expose necrotic tissues and subsequently applied as dressings for ulcers. Analgesics and left-over antibiotics were used to ease pain and reduce inflammation. Choices for outside-help were influenced by the perceived effectiveness of the treatment, the closeness of the provider to residences, and family and friends. Health education is required to emphasize the risk of self-medication with antibiotics and the importance of medical treatment for pre-ulcers, and to caution against the use of herbs to expose necrotic tissues, which could lead to co-infections. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene.


Ansah E.K.,Ghana Health Service | Narh-Bana S.,Dodowa Health Research Center | Affran-Bonful H.,Dangme West District Health Directorate | Bart-Plange C.,National Malaria Control Programme | And 3 more authors.
BMJ (Online) | Year: 2015

Objective To examine the impact of providing rapid diagnostic tests for malaria on fever management in private drug retail shops where most poor rural people with fever present, with the aim of reducing current massive overdiagnosis and overtreatment of malaria. Design Cluster randomized trial of 24 clusters of shops. Setting Dangme West, a poor rural district of Ghana. Participants Shops and their clients, both adults and children. Interventions Providing rapid diagnostic tests with realistic training. Main outcome measures The primary outcome was the proportion of clients testing negative for malaria by a double-read research blood slide who received an artemisinin combination therapy or other antimalarial. Secondary outcomes were use of antibiotics and antipyretics, and safety. Results Of 4603 clients, 3424 (74.4%) tested negative by double-read research slides. The proportion of slide-negative clients who received any antimalarial was 590/1854 (32%) in the intervention arm and 1378/1570 (88%) in the control arm (adjusted risk ratio 0.41 (95% CI 0.29 to 0.58), P<0.0001). Treatment was in high agreement with rapid diagnostic test result. Of those who were slide-positive, 690/787 (87.8%) in the intervention arm and 347/392 (88.5%) in the control arm received an artemisinin combination therapy (adjusted risk ratio 0.96 (0.84 to 1.09)). There was no evidence of antibiotics being substituted for antimalarials. Overall, 1954/2641 (74%) clients in the intervention arm and 539/1962 (27%) in the control arm received appropriate treatment (adjusted risk ratio 2.39 (1.69 to 3.39), P<0.0001). No safety concerns were identified. Conclusions Most patients with fever in Africa present to the private sector. In this trial, providing rapid diagnostic tests for malaria in the private drug retail sector significantly reduced dispensing of antimalarials to patients without malaria, did not reduce prescribing of antimalarials to true malaria cases, and appeared safe. Rapid diagnostic tests should be considered for the informal private drug retail sector.


Nonvignon J.,University of Ghana | Nonvignon J.,Dodowa Health Research Center | Aikins M.K.,University of Ghana | Chinbuah M.A.,Ghana Health Service | And 5 more authors.
Malaria Journal | Year: 2010

Background: Health care demand studies help to examine the behaviour of individuals and households during illnesses. Few of existing health care demand studies examine the choice of treatment services for childhood illnesses. Besides, in their analyses, many of the existing studies compare alternative treatment options to a single option, usually self-medication. This study aims at examining the factors that influence the choices that caregivers of children under-five years make regarding treatment of fevers due to malaria and pneumonia in a rural setting. The study also examines how the choice of alternative treatment options compare with each other. Methods: The study uses data from a 2006 household socio-economic survey and health and demographic surveillance covering caregivers of 529 children under-five years of age in the Dangme West District and applies a multinomial probit technique to model the choice of treatment services for fevers in under-fives in rural Ghana. Four health care options are considered: self-medication, over-the-counter providers, public providers and private providers. Results: The findings indicate that longer travel, waiting and treatment times encourage people to use self-medication and over-the-counter providers compared to public and private providers. Caregivers with health insurance coverage also use care from public providers compared to over-the-counter or private providers. Caregivers with higher incomes use public and private providers over self-medication while higher treatment charges and longer times at public facilities encourage caregivers to resort to private providers. Besides, caregivers of female under-fives use self-care while caregivers of male under-fives use public providers instead of self-care, implying gender disparity in the choice of treatment. Conclusions: The results of this study imply that efforts at curbing under-five mortality due to malaria and pneumonia need to take into account care-seeking behaviour of caregivers of under-fives as well as implementation of strategies. © 2010 Nonvignon et al; licensee BioMed Central Ltd.


Nonvignon J.,University of Ghana | Chinbuah M.A.,Ghana Health Service | Gyapong M.,Dodowa Health Research Center | Abbey M.,Ghana Health Service | And 3 more authors.
Tropical Medicine and International Health | Year: 2012

Objective To assess the cost-effectiveness of two strategies of home management of under-five fevers in Ghana - treatment using antimalarials only (artesunate-amodiaquine - AAQ) and combined treatment using antimalarials and antibiotics (artesunate-amodiaquine plus amoxicillin - AAQ+AMX). Methods We assessed the costs and cost-effectiveness of AAQ and AAQ+AMX compared with a control receiving standard care. Data were collected as part of a cluster randomised controlled trial with a step-wedged design. Approximately, 12000 children aged 2-59months in Dangme West District in southern Ghana were covered. Community health workers delivered the interventions. Costs were analysed from societal perspective, using anaemia cases averted, under-five deaths averted and disability-adjusted life years (DALYs) averted as effectiveness measures. Results Total economic costs for the interventions were US$ 204394.72 (AAQ) and US$ 260931.49 (AAQ+AMX). Recurrent costs constituted 89% and 90% of the total direct costs of AAQ and AAQ+AMX, respectively. Deaths averted were 79.1 (AAQ) and 79.9 (AAQ+AMX), with DALYs averted being 2264.79 (AAQ) and 2284.57 (AAQ+AMX). The results show that cost per anaemia case averted were US$ 150.18 (AAQ) and US$ 227.49 (AAQ + AMX) and cost per death averted was US$ 2585.58 for AAQ and US$ 3272.20 for AAQ+AMX. Cost per DALY averted were US$ 90.25 (AAQ) and US$ 114.21 (AAQ+AMX). Conclusion Both AAQ and AAQ+AMX approaches were cost-effective, each averting one DALY at less than the standard US$ 150 threshold recommended by the World Health Organisation. However, AAQ was more cost-effective. Home management of under-five fevers in rural settings is cost-effective in reducing under-five mortality. © 2012 Blackwell Publishing Ltd.


Gyapong M.,Dodowa Health Research Center | Sarpong D.,Dodowa Health Research Center | Awini E.,Dodowa Health Research Center | Manyeh A.K.,Dodowa Health Research Center | And 8 more authors.
International Journal of Epidemiology | Year: 2013

The Dodowa Health and Demographic Surveillance System (DHDSS) operates in the south-eastern part of Ghana. It was established in 2005 after an initial attempt in 2003 by the Dodowa Health Research Centre (DHRC) to have an accurate population base for piloting a community health insurance scheme.As at 2010, the DHDSS had registered 111 976 residents in 22 767 households. The district is fairly rural, with scattered settlements. Information on pregnancies, births, deaths, migration and marriages using household registration books administered by trained fieldworkers is obtained biannually. Education, immunization status and household socioeconomic measures are obtained annually and verbal autopsies (VA) are conducted on all deaths. Community key informants (CKI) complement the work of field staff by notifying the field office of events that occur after a fieldworker has left a community.The centre has very close working relationships with the district health directorate and the local government authority.The DHDSS subscribes to the INDEPTH data-sharing policy and in addition, contractual arrangements are made with various institutions on specific data-sharing issues. © The Author 2013; all rights reserved.


Chinbuah M.A.,Ghana Health Service | Kager P.A.,University of Amsterdam | Abbey M.,Ghana Health Service | Gyapong M.,Ghana Health Service | And 5 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2012

Malaria and pneumonia are leading causes of childhood mortality. Home Management of fever as Malaria (HMM) enables presumptive treatment with antimalarial drugs but excludes pneumonia.We aimed to evaluate the impact of adding an antibiotic, amoxicillin (AMX) to an antimalarial, artesunate amodiaquine (AAQ+AMX) for treating fever among children 2-59 months of age within the HMM strategy on all-cause mortality. In a stepped-wedge clusterrandomized, open trial, children 2-59 months of age with fever treated with AAQ or AAQ+AMX within HMM were compared with standard care. Mortality reduced significantly by 30% (rate ratio [RR] = 0.70, 95% confidence interval [CI] = 0.53-0.92, P = 0.011) in AAQ clusters and by 44% (RR = 0.56, 95% CI = 0.41-0.76, P = 0.011) in AAQ+AMX clusters compared with control clusters. The 21% mortality reduction between AAQ and AAQ+AMX (RR = 0.79, 95% CI = 0.56-1.12, P = 0.195) was however not statistically significant. Community fever management with antimalarials significantly reduces under-five mortality. Given the lower mortality trend, adding an antibiotic is more beneficial. Copyright © 2012 by The American Society of Tropical Medicine and Hygiene.


Kikuchi K.,University of Tokyo | Ansah E.,Ghana Health Service | Okawa S.,University of Tokyo | Shibanuma A.,University of Tokyo | And 6 more authors.
Trials | Year: 2015

Background: The United Nations' Millennium Development Goals call for improving maternal and child health status. Their progress, however, has been minimal and uneven across countries. The continuum of care is a key to strengthening maternal, newborn, and child health. In this context, the Japanese government launched the Ghana Ensure Mothers and Babies Regular Access to Care (EMBRACE) Implementation Research Project in collaboration with the Ghanaian government. This study aims to evaluate the implementation process and effects of an intervention to increase the continuum of care for maternal, newborn, and child health status in Ghana. Methods/Design: We will conduct a cluster randomized controlled trial using an effectiveness-implementation hybrid design in Dodowa, Kintampo, and Navrongo, Ghana. We will provide an intervention package to women living in randomly allocated intervention clusters. The study population is women of reproductive age between the ages of 15 and 49 years. The package includes: 1) use of a new continuum of care card, 2) continuum of care orientation for health workers, 3) 24-hour health facility retention of mothers and newborns after delivery, and 4) postnatal care by home visits. We will measure maternal, newborn, and child health outcomes for both intervention and implementation impacts. The intervention outcomes are continuum of care completion rate, rate of postnatal care within 48 hours, complication rate requiring mothers' and newborns' hospitalizations, and perinatal and neonatal mortality. The implementation outcomes are intervention coverage of the target population, intervention adoption and fidelity, implementation cost, and sustainability. Discussion: In this trial, we will investigate how successful continuum of care can contribute to improving maternal, newborn, and child health outcomes. If successful, this model will then be implemented further in Ghana and other neighboring countries. Trial registration: Current Controlled Trials ISRCTN90618993. Registered on 3 September 2014. © Kikuchi et al.


Febir L.G.,Kintampo Health Research Center | Asante K.P.,Kintampo Health Research Center | Afari-Asiedu S.,Kintampo Health Research Center | Abokyi L.N.,Kintampo Health Research Center | And 3 more authors.
Malaria Journal | Year: 2016

Background: Malaria accounts for many deaths and illnesses, mostly among young children and pregnant women in sub-Saharan Africa. An integrated approach is recommended to ensure effective malaria control. Socio-cultural factors continue to serve as determinants of malaria health-seeking behaviour. An INDEPTH effectiveness and safety study platform was established to unearth issues around the use of licensed and nationally recommended anti-malarials in real life settings. This study reports on treatment-seeking behaviour for uncomplicated malaria among community members. Methods: A qualitative study was conducted in the dry and rainy seasons in purposively selected communities in Kintampo north and south districts. This was based on distances to a health facility, ethnicity and availability of medicines at the sale outlets. Twenty-four focus group discussions were conducted among adult men, women care-takers of children less than 5 years and pregnant women. Ten INDEPTH interviews were also conducted among operators of medicine sale outlets and managers of health facilities. Fifty-one illnesses narrative interviews were conducted among adult men, women, women caretakers of children less than 5 years and pregnant women. Transcripts were transferred into Nvivo 8 software for data management and analysis. Results: The artemisinin-based combinations that were commonly known and used were artesunate-amodiaquine and artemether-lumefantrine. Use of herbal preparation to treat diseases including uncomplicated malaria is rife in the communities. Drug stores were not the main source of artemisinin-based combination sales at time of the study. Monotherapies, pain killers and other medicines were purchased from these shops for malaria treatment. Dizziness, general body weakness and sleepiness were noted among respondents who used artemisinin-based combination therapy (ACT) in the past. Conclusion: There is no clear cut trajectory for management of uncomplicated malaria in the study area. Different approaches are adopted when treating malaria. There is need for community education to influence behaviour on the management of malaria to achieve real gains from ACT use. © 2016 Febir et al.


Awini E.,Dodowa Health Research Center | Mattah P.,Dodowa Health Research Center | Gyapong M.,Dodowa Health Research Center
Tropical Medicine and International Health | Year: 2010

Objective: To determine the distribution of under-five deaths in Dodowa Health and Demographic Surveillance Area (DHDSA) and to identify possible clustering of deaths. Methods: Data from the Dodowa Health and Demographic Surveillance System (DHDSS) were used for the analysis. These data covered a population of about 89 371 in 371 communities in seven area councils from 2005-2006. Under-five crude mortality rates were calculated for each community and area council. The central feature command in ArcGIS 9.2 was used to locate the centroid of each community from a shapefile of housing structures of communities. A spatial scan statistic was used to identify and test for clusters of under-five deaths. Data on socioeconomic indicators and insecticide treated net (ITN) ownership were analysed to determine the status of the clustered communities. Results: Although several clusters of high under-five mortality were identified, only two were significant in two area councils: one cluster comprising three communities and another involving one community. Analysis of probable risk factors indicates that the single community which formed a significant cluster in Osuwem area council was seriously disadvantaged. About 71% of its households were in the poorest quintile, no household had ITN, electricity connection, good source of water or health insurance. The three communities that formed the significant cluster in Ningo area council, however, fared well in almost all indicators. Conclusion: The identified significant clustering of under-five mortality demands further studies to investigate the causes of the clustering, especially the Ningo area council. © 2010 Blackwell Publishing Ltd.

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