Malaria is a subtropical and tropical protozoan infection that accounts for nearly half a million... more Malaria is a subtropical and tropical protozoan infection that accounts for nearly half a million deaths each year. Most deaths occur in sub-Saharan Africa and are caused by Plasmodium falciparum. The least studied of the five Plasmodia species that cause malaria, P. knowlesi, along with P. vivax cause life-threatening disease, mostly in Southeast Asia. Children, pregnant women, and non-immune travellers to endemic countries are most vulnerable to severe malaria. Cerebral malaria and anaemia are complications that results in neurological deficit and death if treatment is delayed or inappropriately administered. Rapid diagnostic tests have emerged as accurate and reliable means to diagnosing malaria at point-of-care.
Introduction Clinical trials conducted in sub-Saharan Africa have helped to address the prevalent... more Introduction Clinical trials conducted in sub-Saharan Africa have helped to address the prevalent health challenges. The knowledge about how communities perceive clinical trials is however only now evolving. This study was conducted among parents whose children participated in past clinical trials in northern Ghana to assess their knowledge and perceptions of clinical trials and the use of biomedical samples. Method This was a qualitative study based on eighty in-depth interviews with parents. The participants were randomly selected from among parents whose children were enrolled in a clinical trial conducted in the Kassena-Nankana districts between 2000 and 2003. The interviews were transcribed and coded into emergent themes using Nvivo 9 software. The thematic analysis framework was used to analyze the data. Results Study participants reported that clinical trials were carried out to determine the efficacy of drugs and to make sure that these drugs were suitable for human beings to use. The conduct of clinical trials was perceived to have helped to reduce the occurrence of diseases such as malaria, cerebrospinal meningitis and diarrhea. Quality of care was reported to be better in clinical trials than in the routine care. Parents indicated that participation in clinical trials positively influenced their health-seeking behavior. Apprehensions about blood draw and the use to which samples were put were expressed, with suspicion by a few participants that researchers sold blood samples. The issue of blood draw was most contentious.
Introduction: Fresh vegetables are an important source of vital nutrients. Poor farming practices... more Introduction: Fresh vegetables are an important source of vital nutrients. Poor farming practices and improper washing put consumers at risk of parasitic infections. This study explored the presence of parasitic contamination of commonly-consumed vegetables procured from two markets in Ghana. It also explored the decontamination effects of washing vegetables with different concentrations of saline solution. Method: Vegetables were procured from two major open markets in Koforidua, Ghana. Vegetables were thoroughly washed twice using 0.0%, 0.45%, 0.9%, 1.5% concentrations of saline solutions. The deposits were examined under the light microscope for the presence of parasites. Smears were made from sediments, stained and observed with Fluorescence microscope to detect any spores or oocysts of Microsporidium sp., and Cryptosporidium sp. Result: Three hundred and sixty of five types of vegetables were procured. Two hundred and seven (57.5%, 95% Confidence Interval 52.2%-62.7%) were found to be contaminated with at least one type of parasite. The extent of vegetable contamination was 97.2% (90.3-99.7) of spring onions, 70.8% (58.9-81.0) of lettuce and 50.0% (38.0-62.0) of tomatoes. The commonest parasites were Strongyloides stercoralis (36.4%, 31.4-41.6), Balantidium coli (13.6%, 10.2-17.6) and Cryptosporidium oocyst (11.1%, 8.1-14.8). Parasite recovering rates were 57.5% (52.2-62.7) and 42.2% (37.1-47.5) after first and second washings respectively. Conclusion: The level of parasite contamination is high and consumption of raw vegetables procured from these markets carry a high risk of parasite infection. Washing vegetables twice with saline was not effective for parasite removal. Improved approaches for washing vegetables before consumption are needed.
Institutional maternal deaths in the Western Region of Ghana increased from 133 in 2011 to 150 de... more Institutional maternal deaths in the Western Region of Ghana increased from 133 in 2011 to 150 deaths per 100,000 live births in 2014. We reviewed available audit reports on deaths that occurred in 2014 in order to identify priorities for improvement. We undertook a manual search for audit reports and used a structured questionnaire to extract information on the sociodemographic characteristics of patients and the circumstances of care and death. We entered and analyzed the data using EPI-INFO (v.7). Analysis was largely descriptive. Audit reports were available for 75% of the 93 deaths recorded in the region in 2014. The mean (SD) age of death was 28 (±8) yrs. The majority (80%) involved women who made at least three Antenatal Clinic (ANC) visits. Hypertensive diseases (35.8%), hemorrhage (31.3%) and sepsis (7.5%) were the leading causes of death. Most (82%) deaths occurred in hospitals, with almost 75% after 24 hours of arrival. Data completeness and consistency were the major limitations in the analysis. There is a need to improve institutional maternal health care in the region, with interventions designed to address the causes of maternal deaths and to improve the survival of mothers and babies ultimately.
African Journal of Reproductive Health, Mar 30, 2017
Maternal death audits are crucial to the reduction of maternal deaths. The aim of this study was ... more Maternal death audits are crucial to the reduction of maternal deaths. The aim of this study was to identity factors contributing to maternal deaths at Eastern Regional Hospital of Ghana. Quantitative and qualitative methods were used. Quantitative data on all the maternal deaths from January to December 2012 was extracted from completed audit forms and patients records using a standardized questionnaire. The data were analyzed in Epi-info. Qualitative data was collected through in-depth interviews and focus group discussions with health staff to assess care received and factors leading to death. A total of 43 maternal deaths occurred out of which 37 (86%) were audited. Major causes of deaths were pregnancy induced hypertension (27%) and abortion (21%). Late referrals, poor supervision of junior staff, inadequate numbers of senior clinicians, lack of intensive care facility as well as unavailability and insufficient blood and blood products were the main contributory factors to the deaths. Tertiary health institutions should be adequately equipped, staffed, and funded to address these causes of maternal death.
Background: Little is known about the economic burden of snakebites to households in Ghana. This ... more Background: Little is known about the economic burden of snakebites to households in Ghana. This study examined the economic burden of snakebites to victims of households in 2 snakebite endemic districts in the Oti Region of Ghana. Methods: STATA version 14 was used for the data analysis and the cost of treating snakebite was estimated from the patient perspective. In the study, we first present descriptive statistics of the variables used and then use the Kruskal-Wallis test to assess significant difference in the mean cost of snakebite across groups. We also used the Generalized Linear Model to establish the relationship between cost of treating snakebite versus potential risk factors associated with the cost. Results: A total of 373 respondents were involved in the study and the majority were males (68.36%). The mean non-medical cost incurred during treatment was USD 26.57 with feeding accounting for the largest non-medical cost (USD 17.97). The mean medical cost incurred was USD 70.60 with largest expenditures on medications (USD 49.70). The average indirect cost relating to productivity loss due to snakebite was USD 60.57 and the average number of days unable to work due to the snakebite was 39 days. The overall direct and indirect mean cost incurred by victims was USD 155.56. Of the total cost, direct medical cost accounted for 44.90%, indirect cost accounted for 38.52%, and non-medical cost accounted for 16.58%. The average cost incurred by the insured under the national insurance scheme (USD 154.07) was statistically lower (P-value = 0.017) than those uninsured under the scheme (USD 158.78). Conclusion: To assist reduce the economic burden of treating snakebites, antivenom should be included in the National Health Insurance Scheme benefit package and should be made readily available at health facilities.
E bola virus (EBOV) antibodies have been found in populations that have never experienced documen... more E bola virus (EBOV) antibodies have been found in populations that have never experienced documented Ebola outbreaks and in persons who reported no history of Ebola virus disease (EVD) (1). The clinical signifi cance of these fi ndings is unknown. We conducted a cross-sectional study in healthy adults and children from a population affected by the 2014-2016 EVD outbreak in Sierra Leone and explored the association of antibody seropositivity and concentration with potential risk factors for EBOV infection. The Study We conducted a seroprevalence study in Kambia District, Sierra Leone, during March 2016-June 2018. We nested the study within the screening visit of the EBO-VAC-Salone (https://www.ebovac.org) randomized controlled trial (RCT), which evaluated the safety and immunogenicity of the 2-dose Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen (ClinicalTrials.gov, no. NCT02509494) (2,3). Persons who reported having a previous EVD diagnosis and persons who previously received a candidate Ebola vaccine were ineligible for the RCT, and we excluded them from the seroprevalence study. We recruited adults fi rst, then recruited children in 3 age cohorts: 12-17, 4-11, and 1-3 years of age. We measured IgG to EBOV glycoprotein (GP) by using the Filovirus Animal Non-Clinical Group (FANG) ELISA (Q2 Solutions Vaccine Testing Laboratory, https://www.q2labsolutions.com). We determined seropositivity by using a cutoff of >607 ELISA units (EU)/ mL, which was calculated previously in an EBOV-naive population in West Africa (4) (Appendix, https://wwwnc.cdc.gov/EID/article/28/3/21-1496-App1.pdf). Among 1,282 study participants (Figure), 687 (53.6%) were <18 years of age (median 16 years, IQR 7-25 years), and 827 (64.5%) were male. Among 1,272 participants with antibody results, we considered 107 (8.4%, 95% CI 7.0%-10.0%) seropositive for EBOV GP IgG by using the prespecifi ed cutoff. Risk factor analysis showed that, after adjusting for age and sex, the only characteristic associated with seropositivity was living in a household compound with >1 pigs during the outbreak (adjusted odds ratio [OR] 4.5, 95% CI 1.6-13.0; p = 0.01) (Tables 1, 2; Appendix
Malaria is a subtropical and tropical protozoan infection that accounts for nearly half a million... more Malaria is a subtropical and tropical protozoan infection that accounts for nearly half a million deaths each year. Most deaths occur in sub-Saharan Africa and are caused by Plasmodium falciparum. The least studied of the five Plasmodia species that cause malaria, P. knowlesi, along with P. vivax cause life-threatening disease, mostly in Southeast Asia. Children, pregnant women, and non-immune travellers to endemic countries are most vulnerable to severe malaria. Cerebral malaria and anaemia are complications that results in neurological deficit and death if treatment is delayed or inappropriately administered. Rapid diagnostic tests have emerged as accurate and reliable means to diagnosing malaria at point-of-care.
ABSTRACT Over the past 70 years, significant advances have been made in determining the causes of... more ABSTRACT Over the past 70 years, significant advances have been made in determining the causes of death in populations not served by official medical certification of cause at the time of death using a technique known as Verbal Autopsy (VA). VA involves an interview of the family or caregivers of the deceased after a suitable bereavement interval about the circumstances, signs and symptoms of the deceased in the period leading to death. The VA interview data are then interpreted by physicians or, more recently, computer algorithms, to assign a probable cause of death. VA was originally developed and applied in field research settings. This paper traces the evolution of VA methods with special emphasis on the World Health Organization’s (WHO)’s efforts to standardize VA instruments and methods for expanded use in routine health information and vital statistics systems in low- and middle-income countries (LMICs). These advances in VA methods are culminating this year with the release of the 2022 WHO Standard Verbal Autopsy (VA) Toolkit. This paper highlights the many contributions the late Professor Peter Byass made to the current VA standards and methods, most notably, the development of InterVA, the most commonly used automated computer algorithm for interpreting data collected in the WHO standard instruments, and the capacity building in low- and middle-income countries (LMICs) that he promoted. This paper also provides an overview of the methods used to improve the current WHO VA standards, a catalogue of the changes and improvements in the instruments, and a mapping of current applications of the WHO VA standard approach in LMICs. It also provides access to tools and guidance needed for VA implementation in Civil Registration and Vital Statistics Systems at scale.
Background: Alcohol use among adolescents can result in many health issues and is linked to futur... more Background: Alcohol use among adolescents can result in many health issues and is linked to future health and economic problems, motor vehicle crash involvement and interpersonal violence. This study aimed to determine the prevalence of alcohol use among in-school adolescents and factors associated with its use in a Municipality in Ghana. Methods: A school-based cross-sectional survey was conducted among 700 students. A stratified random sampling method was applied to select the participants. Structured questionnaires were administered to collect information on demographic characteristics, students' behaviors, family, peer, school factors and engagement in economic activities. Univariate, bivariate and multivariate analysis were applied to determine prevalence and risk factors of alcohol use Results: The prevalence of lifetime alcohol use was 39% while current users were 27.6%. The odds of taking alcohol were highest among sexually active adolescent compared to those who were not sexually active
Maternal death audits are crucial to the reduction of maternal deaths. The aim of this study was ... more Maternal death audits are crucial to the reduction of maternal deaths. The aim of this study was to identity factors contributing to maternal deaths at Eastern Regional Hospital of Ghana. Quantitative and qualitative methods were used. Quantitative data on all the maternal deaths from January to December 2012 was extracted from completed audit forms and patients records using a standardized questionnaire. The data were analyzed in Epi-info. Qualitative data was collected through in-depth interviews and focus group discussions with health staff to assess care received and factors leading to death. A total of 43 maternal deaths occurred out of which 37 (86%) were audited. Major causes of deaths were pregnancy induced hypertension (27%) and abortion (21%). Late referrals, poor supervision of junior staff, inadequate numbers of senior clinicians, lack of intensive care facility as well as unavailability and insufficient blood and blood products were the main contributory factors to the deaths. Tertiary health institutions should be adequately equipped, staffed, and funded to address these causes of maternal death.
Safety and long-term immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola... more Safety and long-term immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in adults in Sierra Leone: a combined open-label, non-randomised stage 1, and a randomised, double-blind, controlled stage 2 trial. Lancet Infectious Diseases, 22 (1). pp. 97-109.
The private health sector is a major service provider group within the health systems of most sub... more The private health sector is a major service provider group within the health systems of most sub-Saharan African countries. Currently, 90% of COVID-19 cases in Ghana are in urban areas where private health facilities play a major role in service delivery. Yet, there is limited understanding of the issues mediating private health sector participation in public health emergency responses. Challenges related to its involvement in Ghana´s COVID-19 response include lack of clarity on its role, sub-optimal communication channels, inadequate personal protective equipment and fragmentation of the sector. Hence, operational and regulatory actions addressing these challenges will ensure the private sector is fully prepared to contribute to the COVID-19 response and future public health emergencies, thereby strengthening Ghana's health system. Commentary The emergence of the coronavirus disease 2019 (COVID-19) has challenged health systems worldwide. It has exerted unprecedented pressure on various components of the health system including availability of essential commodities such as protective masks and maintenance of adequate health workforce and essential services. To effectively address these challenges imposed by COVID-19 on the health systems of affected countries, there is the need to mobilise all available health resources, including that in the private sector and put them to optimal use. Ghana reported its first two cases of COVID-19 on March 12th, 2020. Since then, the infection has spread and as at 5th May, 2020, a total of 2,719 cases and 18 deaths have been reported [1]. In response, the government has initiated a comprehensive cross-sectoral response with the health sector as the pivot. Within the health sector, the core response has been centered on the public sector which traditionally leads key components of outbreak response such as diagnostics, resource management, health workforce trainings and data management. We outline the key issues related to private health sector participation that have emerged in Ghana´s COVID-19 response with the aim of informing policy formulation and implementation. These policies and interventions are expected to promote active participation of the private sector in the COVID-19 response and eventually, enhance Ghana´s health system performance. The private health sector in Ghana largely consists of privately-owned hospitals and clinics, pharmacy/chemical shops and
Introduction: The West African Ebola outbreak of 2014–2016 necessitated clinical trials in commun... more Introduction: The West African Ebola outbreak of 2014–2016 necessitated clinical trials in communities with limited health data. The EBOVAC-Salone Ebola vaccine trial is ongoing in the largely rural Kambia District in northern Sierra Leone. To gain a baseline insight into our local noncommunicable disease (NCD) epidemiology, we examined screening blood pressure (BP) measurements in trial volunteers. Methods: BP involved taking multiple readings using an Omron M6 sphygmomanometer in rested individuals. We classified BP by the European 2018 ESC/ESH guidelines: optimal BP, normal or high-normal BP, or hypertension (systolic ≥ 140 mmHg ± diastolic ≥ 90 mmHg) with Grade 1, 2, or 3 (G1HT, G2HT, G3HT) severity levels. Results: Of 870 volunteers, 220 (25.3%) had optimal BP, 236 (27.13%) had normal BP, and 250 (28.7%) had high-normal BP. The remaining 164 (18.9%) were hypertensive. By gender, 16.5% (109/668) of males and 27.2% (55/202) of females were hypertensive. Among hypertensives, 62.2%...
Introduction: The EBOVAC-Salone trial of a candidate Ebola two-dose vaccine regimen (Ad.ZEBOV/MVA... more Introduction: The EBOVAC-Salone trial of a candidate Ebola two-dose vaccine regimen (Ad.ZEBOV/MVA-BN-Filo) was conducted in a research-naïve setting in rural northern Sierra Leone, where no local laboratory reference values (LRV) had been established. In the first stage (n = 43) of the trial, laboratory screening was based on internationally-derived protocol LRV (PLRV). For postrecruitment participant care, LRV derived from a West African population (WALRV) were used. We assessed what difference using WALRV rather than PLRV for screening might have made to the eligibility of volunteers. METHODS: We reviewed the laboratory screening results of study volunteers. Red blood cells (RBC), white blood cells (WBC), platelets (PTT), haemoglobin, haematocrit, creatinine, and alanine (ALT) and aspartate (AST) transaminases were measured. Overall and for each parameter, we compared the actually eligible proportion of volunteers using PLRV with the potentially eligible proportion using WALRV. Re...
Pan African Medical Journal Conference Proceedings, 2018
Introduction : rabies is a zoonotic disease caused by the rabies virus. Domestic dogs are the mos... more Introduction : rabies is a zoonotic disease caused by the rabies virus. Domestic dogs are the most common reservoirs of the virus. Dog bites are responsible for over 95% of human rabies deaths. Rabies has the highest case-fatality rate of all infectious diseases of humans. About 95% of rabies cases are reported in Asia and Africa. In Ghana, rabies cases and deaths are under-reported. Hence, the true burden of the disease is usually underestimated. We analyzed data in Eastern Region of Ghana to characterize the trend of dog bites and human rabies and identify discrepancies in data for reporting cases. Methods : we analyzed recorded dog bites and human rabies cases from 2011 to 2015 in the Eastern Region. Data were collected from DHIMS, Regional Disease Control Unit and Regional Veterinary Unit. The results were expressed in frequencies, percentages and incidences. We used Stata version 13 for data analysis. Results : a total of 4821 dog bites/suspected rabies cases were recorded from 2011 to 2015. Children 5 to 9 years old were most affected. Males were more affected (51.2%) than females. Kwahu West District recorded the highest incidence of cases (625/100,000). Eighteen deaths from human rabies were recorded from 2011-2015. New Juaben Municipality recorded the highest number of deaths (6 deaths). Majority of rabies deaths (73%) occurred in urban areas. Eighty-two percent of those who died from rabies did not receive post exposure prophylaxis (PEP) also the vaccination status of the rest were unknown. The number of cases recorded for New Juaben Municipality at the Regional Health Directorate was 5.5 times that recorded at the veterinary unit for the same period. Conclusion : the burden of dog bites and human rabies is a public health problem in the Eastern Region and Ghana as a whole. The data underline the need for improved availability and timely administration of PEP in the treatment of dog bite victims. There is also the need for improved collaborative effort and effective communication between the various units within the health system of Ghana.
Background End-stage renal disease yields susceptibility to both ischemia and bleeding. The optim... more Background End-stage renal disease yields susceptibility to both ischemia and bleeding. The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is not established in dialysis patients, who are usually excluded from randomized studies. Since recent studies implied the benefits of prolonged DAPT >12 months in chronic kidney disease, we investigated the effectiveness and safety of prolonged DAPT in dialysis patients with higher cardiovascular risks. Methods In this nationwide population-based study, we analyzed dialysis patients who underwent DES implantation from 2008 to 2015. Continued DAPT was compared with discontinued DAPT using landmark analyses, including free-of-event participants at 12 (n = 2246), 15 (n = 1925) and 18 months (n = 1692) after DES implantation. The primary outcome was major adverse cardiovascular events (MACEs): a composite of mortality, nonfatal myocardial infarction, coronary revascularization and stroke. Major b...
Malaria is a subtropical and tropical protozoan infection that accounts for nearly half a million... more Malaria is a subtropical and tropical protozoan infection that accounts for nearly half a million deaths each year. Most deaths occur in sub-Saharan Africa and are caused by Plasmodium falciparum. The least studied of the five Plasmodia species that cause malaria, P. knowlesi, along with P. vivax cause life-threatening disease, mostly in Southeast Asia. Children, pregnant women, and non-immune travellers to endemic countries are most vulnerable to severe malaria. Cerebral malaria and anaemia are complications that results in neurological deficit and death if treatment is delayed or inappropriately administered. Rapid diagnostic tests have emerged as accurate and reliable means to diagnosing malaria at point-of-care.
Introduction Clinical trials conducted in sub-Saharan Africa have helped to address the prevalent... more Introduction Clinical trials conducted in sub-Saharan Africa have helped to address the prevalent health challenges. The knowledge about how communities perceive clinical trials is however only now evolving. This study was conducted among parents whose children participated in past clinical trials in northern Ghana to assess their knowledge and perceptions of clinical trials and the use of biomedical samples. Method This was a qualitative study based on eighty in-depth interviews with parents. The participants were randomly selected from among parents whose children were enrolled in a clinical trial conducted in the Kassena-Nankana districts between 2000 and 2003. The interviews were transcribed and coded into emergent themes using Nvivo 9 software. The thematic analysis framework was used to analyze the data. Results Study participants reported that clinical trials were carried out to determine the efficacy of drugs and to make sure that these drugs were suitable for human beings to use. The conduct of clinical trials was perceived to have helped to reduce the occurrence of diseases such as malaria, cerebrospinal meningitis and diarrhea. Quality of care was reported to be better in clinical trials than in the routine care. Parents indicated that participation in clinical trials positively influenced their health-seeking behavior. Apprehensions about blood draw and the use to which samples were put were expressed, with suspicion by a few participants that researchers sold blood samples. The issue of blood draw was most contentious.
Introduction: Fresh vegetables are an important source of vital nutrients. Poor farming practices... more Introduction: Fresh vegetables are an important source of vital nutrients. Poor farming practices and improper washing put consumers at risk of parasitic infections. This study explored the presence of parasitic contamination of commonly-consumed vegetables procured from two markets in Ghana. It also explored the decontamination effects of washing vegetables with different concentrations of saline solution. Method: Vegetables were procured from two major open markets in Koforidua, Ghana. Vegetables were thoroughly washed twice using 0.0%, 0.45%, 0.9%, 1.5% concentrations of saline solutions. The deposits were examined under the light microscope for the presence of parasites. Smears were made from sediments, stained and observed with Fluorescence microscope to detect any spores or oocysts of Microsporidium sp., and Cryptosporidium sp. Result: Three hundred and sixty of five types of vegetables were procured. Two hundred and seven (57.5%, 95% Confidence Interval 52.2%-62.7%) were found to be contaminated with at least one type of parasite. The extent of vegetable contamination was 97.2% (90.3-99.7) of spring onions, 70.8% (58.9-81.0) of lettuce and 50.0% (38.0-62.0) of tomatoes. The commonest parasites were Strongyloides stercoralis (36.4%, 31.4-41.6), Balantidium coli (13.6%, 10.2-17.6) and Cryptosporidium oocyst (11.1%, 8.1-14.8). Parasite recovering rates were 57.5% (52.2-62.7) and 42.2% (37.1-47.5) after first and second washings respectively. Conclusion: The level of parasite contamination is high and consumption of raw vegetables procured from these markets carry a high risk of parasite infection. Washing vegetables twice with saline was not effective for parasite removal. Improved approaches for washing vegetables before consumption are needed.
Institutional maternal deaths in the Western Region of Ghana increased from 133 in 2011 to 150 de... more Institutional maternal deaths in the Western Region of Ghana increased from 133 in 2011 to 150 deaths per 100,000 live births in 2014. We reviewed available audit reports on deaths that occurred in 2014 in order to identify priorities for improvement. We undertook a manual search for audit reports and used a structured questionnaire to extract information on the sociodemographic characteristics of patients and the circumstances of care and death. We entered and analyzed the data using EPI-INFO (v.7). Analysis was largely descriptive. Audit reports were available for 75% of the 93 deaths recorded in the region in 2014. The mean (SD) age of death was 28 (±8) yrs. The majority (80%) involved women who made at least three Antenatal Clinic (ANC) visits. Hypertensive diseases (35.8%), hemorrhage (31.3%) and sepsis (7.5%) were the leading causes of death. Most (82%) deaths occurred in hospitals, with almost 75% after 24 hours of arrival. Data completeness and consistency were the major limitations in the analysis. There is a need to improve institutional maternal health care in the region, with interventions designed to address the causes of maternal deaths and to improve the survival of mothers and babies ultimately.
African Journal of Reproductive Health, Mar 30, 2017
Maternal death audits are crucial to the reduction of maternal deaths. The aim of this study was ... more Maternal death audits are crucial to the reduction of maternal deaths. The aim of this study was to identity factors contributing to maternal deaths at Eastern Regional Hospital of Ghana. Quantitative and qualitative methods were used. Quantitative data on all the maternal deaths from January to December 2012 was extracted from completed audit forms and patients records using a standardized questionnaire. The data were analyzed in Epi-info. Qualitative data was collected through in-depth interviews and focus group discussions with health staff to assess care received and factors leading to death. A total of 43 maternal deaths occurred out of which 37 (86%) were audited. Major causes of deaths were pregnancy induced hypertension (27%) and abortion (21%). Late referrals, poor supervision of junior staff, inadequate numbers of senior clinicians, lack of intensive care facility as well as unavailability and insufficient blood and blood products were the main contributory factors to the deaths. Tertiary health institutions should be adequately equipped, staffed, and funded to address these causes of maternal death.
Background: Little is known about the economic burden of snakebites to households in Ghana. This ... more Background: Little is known about the economic burden of snakebites to households in Ghana. This study examined the economic burden of snakebites to victims of households in 2 snakebite endemic districts in the Oti Region of Ghana. Methods: STATA version 14 was used for the data analysis and the cost of treating snakebite was estimated from the patient perspective. In the study, we first present descriptive statistics of the variables used and then use the Kruskal-Wallis test to assess significant difference in the mean cost of snakebite across groups. We also used the Generalized Linear Model to establish the relationship between cost of treating snakebite versus potential risk factors associated with the cost. Results: A total of 373 respondents were involved in the study and the majority were males (68.36%). The mean non-medical cost incurred during treatment was USD 26.57 with feeding accounting for the largest non-medical cost (USD 17.97). The mean medical cost incurred was USD 70.60 with largest expenditures on medications (USD 49.70). The average indirect cost relating to productivity loss due to snakebite was USD 60.57 and the average number of days unable to work due to the snakebite was 39 days. The overall direct and indirect mean cost incurred by victims was USD 155.56. Of the total cost, direct medical cost accounted for 44.90%, indirect cost accounted for 38.52%, and non-medical cost accounted for 16.58%. The average cost incurred by the insured under the national insurance scheme (USD 154.07) was statistically lower (P-value = 0.017) than those uninsured under the scheme (USD 158.78). Conclusion: To assist reduce the economic burden of treating snakebites, antivenom should be included in the National Health Insurance Scheme benefit package and should be made readily available at health facilities.
E bola virus (EBOV) antibodies have been found in populations that have never experienced documen... more E bola virus (EBOV) antibodies have been found in populations that have never experienced documented Ebola outbreaks and in persons who reported no history of Ebola virus disease (EVD) (1). The clinical signifi cance of these fi ndings is unknown. We conducted a cross-sectional study in healthy adults and children from a population affected by the 2014-2016 EVD outbreak in Sierra Leone and explored the association of antibody seropositivity and concentration with potential risk factors for EBOV infection. The Study We conducted a seroprevalence study in Kambia District, Sierra Leone, during March 2016-June 2018. We nested the study within the screening visit of the EBO-VAC-Salone (https://www.ebovac.org) randomized controlled trial (RCT), which evaluated the safety and immunogenicity of the 2-dose Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen (ClinicalTrials.gov, no. NCT02509494) (2,3). Persons who reported having a previous EVD diagnosis and persons who previously received a candidate Ebola vaccine were ineligible for the RCT, and we excluded them from the seroprevalence study. We recruited adults fi rst, then recruited children in 3 age cohorts: 12-17, 4-11, and 1-3 years of age. We measured IgG to EBOV glycoprotein (GP) by using the Filovirus Animal Non-Clinical Group (FANG) ELISA (Q2 Solutions Vaccine Testing Laboratory, https://www.q2labsolutions.com). We determined seropositivity by using a cutoff of >607 ELISA units (EU)/ mL, which was calculated previously in an EBOV-naive population in West Africa (4) (Appendix, https://wwwnc.cdc.gov/EID/article/28/3/21-1496-App1.pdf). Among 1,282 study participants (Figure), 687 (53.6%) were <18 years of age (median 16 years, IQR 7-25 years), and 827 (64.5%) were male. Among 1,272 participants with antibody results, we considered 107 (8.4%, 95% CI 7.0%-10.0%) seropositive for EBOV GP IgG by using the prespecifi ed cutoff. Risk factor analysis showed that, after adjusting for age and sex, the only characteristic associated with seropositivity was living in a household compound with >1 pigs during the outbreak (adjusted odds ratio [OR] 4.5, 95% CI 1.6-13.0; p = 0.01) (Tables 1, 2; Appendix
Malaria is a subtropical and tropical protozoan infection that accounts for nearly half a million... more Malaria is a subtropical and tropical protozoan infection that accounts for nearly half a million deaths each year. Most deaths occur in sub-Saharan Africa and are caused by Plasmodium falciparum. The least studied of the five Plasmodia species that cause malaria, P. knowlesi, along with P. vivax cause life-threatening disease, mostly in Southeast Asia. Children, pregnant women, and non-immune travellers to endemic countries are most vulnerable to severe malaria. Cerebral malaria and anaemia are complications that results in neurological deficit and death if treatment is delayed or inappropriately administered. Rapid diagnostic tests have emerged as accurate and reliable means to diagnosing malaria at point-of-care.
ABSTRACT Over the past 70 years, significant advances have been made in determining the causes of... more ABSTRACT Over the past 70 years, significant advances have been made in determining the causes of death in populations not served by official medical certification of cause at the time of death using a technique known as Verbal Autopsy (VA). VA involves an interview of the family or caregivers of the deceased after a suitable bereavement interval about the circumstances, signs and symptoms of the deceased in the period leading to death. The VA interview data are then interpreted by physicians or, more recently, computer algorithms, to assign a probable cause of death. VA was originally developed and applied in field research settings. This paper traces the evolution of VA methods with special emphasis on the World Health Organization’s (WHO)’s efforts to standardize VA instruments and methods for expanded use in routine health information and vital statistics systems in low- and middle-income countries (LMICs). These advances in VA methods are culminating this year with the release of the 2022 WHO Standard Verbal Autopsy (VA) Toolkit. This paper highlights the many contributions the late Professor Peter Byass made to the current VA standards and methods, most notably, the development of InterVA, the most commonly used automated computer algorithm for interpreting data collected in the WHO standard instruments, and the capacity building in low- and middle-income countries (LMICs) that he promoted. This paper also provides an overview of the methods used to improve the current WHO VA standards, a catalogue of the changes and improvements in the instruments, and a mapping of current applications of the WHO VA standard approach in LMICs. It also provides access to tools and guidance needed for VA implementation in Civil Registration and Vital Statistics Systems at scale.
Background: Alcohol use among adolescents can result in many health issues and is linked to futur... more Background: Alcohol use among adolescents can result in many health issues and is linked to future health and economic problems, motor vehicle crash involvement and interpersonal violence. This study aimed to determine the prevalence of alcohol use among in-school adolescents and factors associated with its use in a Municipality in Ghana. Methods: A school-based cross-sectional survey was conducted among 700 students. A stratified random sampling method was applied to select the participants. Structured questionnaires were administered to collect information on demographic characteristics, students' behaviors, family, peer, school factors and engagement in economic activities. Univariate, bivariate and multivariate analysis were applied to determine prevalence and risk factors of alcohol use Results: The prevalence of lifetime alcohol use was 39% while current users were 27.6%. The odds of taking alcohol were highest among sexually active adolescent compared to those who were not sexually active
Maternal death audits are crucial to the reduction of maternal deaths. The aim of this study was ... more Maternal death audits are crucial to the reduction of maternal deaths. The aim of this study was to identity factors contributing to maternal deaths at Eastern Regional Hospital of Ghana. Quantitative and qualitative methods were used. Quantitative data on all the maternal deaths from January to December 2012 was extracted from completed audit forms and patients records using a standardized questionnaire. The data were analyzed in Epi-info. Qualitative data was collected through in-depth interviews and focus group discussions with health staff to assess care received and factors leading to death. A total of 43 maternal deaths occurred out of which 37 (86%) were audited. Major causes of deaths were pregnancy induced hypertension (27%) and abortion (21%). Late referrals, poor supervision of junior staff, inadequate numbers of senior clinicians, lack of intensive care facility as well as unavailability and insufficient blood and blood products were the main contributory factors to the deaths. Tertiary health institutions should be adequately equipped, staffed, and funded to address these causes of maternal death.
Safety and long-term immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola... more Safety and long-term immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in adults in Sierra Leone: a combined open-label, non-randomised stage 1, and a randomised, double-blind, controlled stage 2 trial. Lancet Infectious Diseases, 22 (1). pp. 97-109.
The private health sector is a major service provider group within the health systems of most sub... more The private health sector is a major service provider group within the health systems of most sub-Saharan African countries. Currently, 90% of COVID-19 cases in Ghana are in urban areas where private health facilities play a major role in service delivery. Yet, there is limited understanding of the issues mediating private health sector participation in public health emergency responses. Challenges related to its involvement in Ghana´s COVID-19 response include lack of clarity on its role, sub-optimal communication channels, inadequate personal protective equipment and fragmentation of the sector. Hence, operational and regulatory actions addressing these challenges will ensure the private sector is fully prepared to contribute to the COVID-19 response and future public health emergencies, thereby strengthening Ghana's health system. Commentary The emergence of the coronavirus disease 2019 (COVID-19) has challenged health systems worldwide. It has exerted unprecedented pressure on various components of the health system including availability of essential commodities such as protective masks and maintenance of adequate health workforce and essential services. To effectively address these challenges imposed by COVID-19 on the health systems of affected countries, there is the need to mobilise all available health resources, including that in the private sector and put them to optimal use. Ghana reported its first two cases of COVID-19 on March 12th, 2020. Since then, the infection has spread and as at 5th May, 2020, a total of 2,719 cases and 18 deaths have been reported [1]. In response, the government has initiated a comprehensive cross-sectoral response with the health sector as the pivot. Within the health sector, the core response has been centered on the public sector which traditionally leads key components of outbreak response such as diagnostics, resource management, health workforce trainings and data management. We outline the key issues related to private health sector participation that have emerged in Ghana´s COVID-19 response with the aim of informing policy formulation and implementation. These policies and interventions are expected to promote active participation of the private sector in the COVID-19 response and eventually, enhance Ghana´s health system performance. The private health sector in Ghana largely consists of privately-owned hospitals and clinics, pharmacy/chemical shops and
Introduction: The West African Ebola outbreak of 2014–2016 necessitated clinical trials in commun... more Introduction: The West African Ebola outbreak of 2014–2016 necessitated clinical trials in communities with limited health data. The EBOVAC-Salone Ebola vaccine trial is ongoing in the largely rural Kambia District in northern Sierra Leone. To gain a baseline insight into our local noncommunicable disease (NCD) epidemiology, we examined screening blood pressure (BP) measurements in trial volunteers. Methods: BP involved taking multiple readings using an Omron M6 sphygmomanometer in rested individuals. We classified BP by the European 2018 ESC/ESH guidelines: optimal BP, normal or high-normal BP, or hypertension (systolic ≥ 140 mmHg ± diastolic ≥ 90 mmHg) with Grade 1, 2, or 3 (G1HT, G2HT, G3HT) severity levels. Results: Of 870 volunteers, 220 (25.3%) had optimal BP, 236 (27.13%) had normal BP, and 250 (28.7%) had high-normal BP. The remaining 164 (18.9%) were hypertensive. By gender, 16.5% (109/668) of males and 27.2% (55/202) of females were hypertensive. Among hypertensives, 62.2%...
Introduction: The EBOVAC-Salone trial of a candidate Ebola two-dose vaccine regimen (Ad.ZEBOV/MVA... more Introduction: The EBOVAC-Salone trial of a candidate Ebola two-dose vaccine regimen (Ad.ZEBOV/MVA-BN-Filo) was conducted in a research-naïve setting in rural northern Sierra Leone, where no local laboratory reference values (LRV) had been established. In the first stage (n = 43) of the trial, laboratory screening was based on internationally-derived protocol LRV (PLRV). For postrecruitment participant care, LRV derived from a West African population (WALRV) were used. We assessed what difference using WALRV rather than PLRV for screening might have made to the eligibility of volunteers. METHODS: We reviewed the laboratory screening results of study volunteers. Red blood cells (RBC), white blood cells (WBC), platelets (PTT), haemoglobin, haematocrit, creatinine, and alanine (ALT) and aspartate (AST) transaminases were measured. Overall and for each parameter, we compared the actually eligible proportion of volunteers using PLRV with the potentially eligible proportion using WALRV. Re...
Pan African Medical Journal Conference Proceedings, 2018
Introduction : rabies is a zoonotic disease caused by the rabies virus. Domestic dogs are the mos... more Introduction : rabies is a zoonotic disease caused by the rabies virus. Domestic dogs are the most common reservoirs of the virus. Dog bites are responsible for over 95% of human rabies deaths. Rabies has the highest case-fatality rate of all infectious diseases of humans. About 95% of rabies cases are reported in Asia and Africa. In Ghana, rabies cases and deaths are under-reported. Hence, the true burden of the disease is usually underestimated. We analyzed data in Eastern Region of Ghana to characterize the trend of dog bites and human rabies and identify discrepancies in data for reporting cases. Methods : we analyzed recorded dog bites and human rabies cases from 2011 to 2015 in the Eastern Region. Data were collected from DHIMS, Regional Disease Control Unit and Regional Veterinary Unit. The results were expressed in frequencies, percentages and incidences. We used Stata version 13 for data analysis. Results : a total of 4821 dog bites/suspected rabies cases were recorded from 2011 to 2015. Children 5 to 9 years old were most affected. Males were more affected (51.2%) than females. Kwahu West District recorded the highest incidence of cases (625/100,000). Eighteen deaths from human rabies were recorded from 2011-2015. New Juaben Municipality recorded the highest number of deaths (6 deaths). Majority of rabies deaths (73%) occurred in urban areas. Eighty-two percent of those who died from rabies did not receive post exposure prophylaxis (PEP) also the vaccination status of the rest were unknown. The number of cases recorded for New Juaben Municipality at the Regional Health Directorate was 5.5 times that recorded at the veterinary unit for the same period. Conclusion : the burden of dog bites and human rabies is a public health problem in the Eastern Region and Ghana as a whole. The data underline the need for improved availability and timely administration of PEP in the treatment of dog bite victims. There is also the need for improved collaborative effort and effective communication between the various units within the health system of Ghana.
Background End-stage renal disease yields susceptibility to both ischemia and bleeding. The optim... more Background End-stage renal disease yields susceptibility to both ischemia and bleeding. The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is not established in dialysis patients, who are usually excluded from randomized studies. Since recent studies implied the benefits of prolonged DAPT >12 months in chronic kidney disease, we investigated the effectiveness and safety of prolonged DAPT in dialysis patients with higher cardiovascular risks. Methods In this nationwide population-based study, we analyzed dialysis patients who underwent DES implantation from 2008 to 2015. Continued DAPT was compared with discontinued DAPT using landmark analyses, including free-of-event participants at 12 (n = 2246), 15 (n = 1925) and 18 months (n = 1692) after DES implantation. The primary outcome was major adverse cardiovascular events (MACEs): a composite of mortality, nonfatal myocardial infarction, coronary revascularization and stroke. Major b...
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Papers by Frank Baiden