Background: The exposure–response association between prenatal and postnatal household air pollut... more Background: The exposure–response association between prenatal and postnatal household air pollution (HAP) and infant growth trajectories is unknown. Objectives: To evaluate associations between prenatal and postnatal HAP exposure and stove interventions on growth trajectories over the first year of life. Methods: The Ghana Randomized Air Pollution and Health Study enrolled n=1,414 pregnant women at ≤24wk gestation from Kintampo, Ghana, and randomized them to liquefied petroleum gas (LPG), improved biomass, or open fire (control) stoves. We quantified HAP exposure by repeated, personal prenatal and postnatal carbon monoxide (CO) and, in a subset, fine particulate matter [PM with an aerodynamic diameter of ≤2.5μm (PM2.5)] assessments. Length, weight, mid-upper arm circumference (MUAC) and head circumference (HC) were measured at birth, 3, 6, 9, and 12 months; weight-for-age, length-for-age (LAZ), and weight-for-length z (WLZ)-scores were calculated. For each anthropometric measure, w...
Most parametric methods rely on the assumption of normality. Results obtained from these methods ... more Most parametric methods rely on the assumption of normality. Results obtained from these methods are more powerful compared to their non-parametric counterparts. However for valid inference, the assumptions underlying the use of these methods should be satisfied. Many published statistical articles that make use of the assumption of normality fail to guarantee it. Hence, quite a number of published statistical results are presented with errors. As a way to reduce this, various approaches used in assessing the assumption of normality are presented and illustrated in this paper. In assessing both univariate and multivariate normality, several methods have been proposed. In the univariate setting, the Q-Q plot, histogram, box plot, stem-and-leaf plot or dot plot are some graphical methods that can be used. Also, the properties of the normal distribution provide an alternative approach to assess normality. The Kolmogorov-Smirnov (K-S) test, Lilliefors corrected K-S test, Shapiro-Wilk ...
ObjectiveIn Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimetha... more ObjectiveIn Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended for the prevention of malaria-related adverse outcomes. This study demonstrates the coverage of IPTp-SP use among pregnant women over a period (2011–2015) and the impact of various sociodemographic groups on the uptake of IPTp-SP.DesignRetrospective analysis using data from all pregnant women in the Kintampo Health and Demographic Surveillance System area on the uptake of IPTp-SP.SettingKintampo North Municipality and Kintampo South District of Ghana.ParticipantsAll pregnant women in the Kintampo Health and Demographic Surveillance System area.Primary and secondary outcome measuresThe number of doses of IPTp-SP taken by pregnant women were examined. Logistic regression was used to assess the determinant of uptake of IPTp-SP while adjusting for within-subject correlation from women with multiple pregnancies.ResultsData from 2011 to 2015 with a total of 17 484...
Objective: This study examined whether the open-defecation (OD) free target is achievable by 2030... more Objective: This study examined whether the open-defecation (OD) free target is achievable by 2030.Design: Longitudinal studySetting: Seven sub-Districts of Kintampo North Municipal, and five sub-Districts of Kintampo South DistrictData source: Kintampo health and demographic surveillance systemParticipants: Data was collected from household heads or their representatives over a 12-year period from 2005 to 2016.Main outcome: Open-defecation and attainment of OD free by 2030Results: In an exploratory analysis, the correlation between the total number of households, year, and total number of OD households was obtained. The average percentage yearly increase or decrease in OD was computed and used to project the percentage of OD for the years 2020, 2025 and 2030. In addition, geo-spatial technology was used to visualize variability in OD across the twelve sub-Districts. The results showed that the OD free target is not achievable in 2030 or even if the current trend continues. In 2016, ...
We use methods developed by the Commitment to Equity Institute to assess the effects of governmen... more We use methods developed by the Commitment to Equity Institute to assess the effects of government taxation, social spending and indirect subsidies on poverty and inequality in Ghana. We also simulate several policy reforms to assess their distributional consequences. Results show that, although the country has some very progressive taxes and well-targeted expenditures, the extent of fiscal redistribution is small, but about what one would expect given Ghana's income level and relatively low initial inequality. Results for poverty reduction are less encouraging: were it not for the in-kind benefits from health and education spending, the overall effect of government spending and taxation would actually increase poverty in Ghana. Eliminating energy subsidies and at the same time reallocating part of the savings to well-targeted transfer programs could lower the fiscal deficit while reducing inequality and protecting the poor.
INTRODUCTION The Global Youth Tobacco Survey's findings have been used to support Ghana's tobacco... more INTRODUCTION The Global Youth Tobacco Survey's findings have been used to support Ghana's tobacco control legislation, monitor tobacco use among the youth and also used in meeting various Articles of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). These Articles include: Article 8 (Protection for exposure to tobacco smoke); Article 12 (Education, communication, training and public awareness); Article 13 (Tobacco advertising, promotion, and sponsorship); Article 14 (Demand reduction measures concerning tobacco dependence and cessation); and Article 16 (Sales to and by minors). Among the four waves of GYTS in Ghana, the 2017 GYTS was the first to assess waterpipe smoking, through optional questions included in the GYTS questionnaire. We assessed sex, age and regional differentials in waterpipe smoking among the youth in Ghana, and also explored the association between the use of other tobacco products and waterpipe use. METHODS The GYTS employs a standardized methodology with self-administered questionnaires, consisting of core, optional, and country specific questions. Fourteen questions, out of the seventy-four (74) questions administered for the entire GYTS, assessed waterpipe tobacco smoking (WTS). Chi-squared test was used to assess sex, age, grade/form and regional differentials in waterpipe use. Furthermore, the association between smoking cigarettes, smokeless tobacco, electronic cigarettes and waterpipe smoking, was explored by employing a chisquared test with a 5% significance level. RESULTS Of a total of 5664 students who participated in the study, 90.9% were aged 13-15 years. The respondents were almost equally distributed among males and females. Overall, 3.1% of the respondents had ever smoked waterpipe. The overall prevalence of current waterpipe use was 1.7%; with 2.1% in girls (95% CI: 0.9-4.7%) and 0.9% in boys (95% CI: 0.5-1.6%), p=0.033. Additionally, more than half (55.0%) of the current waterpipe users smoked three or more sessions per day. Surprisingly, close to half (46.9%) of the current waterpipe users smoked at home. CONCLUSIONS Waterpipe use, particularly among the female student population, represents an emerging tobacco epidemic and hence deserves immediate attention from authorities. This study revealed that waterpipe is being used among Junior High students in Ghana. Education on the health implications of waterpipe use should be intensified among the youth, to help minimize its use and to prevent its associated health harms.
Lead poisoning has been a major global health problem for decades, and blood transfusion has been... more Lead poisoning has been a major global health problem for decades, and blood transfusion has been suspected as a neglected potential source of lead exposure. Children and pregnant women are most vulnerable to the toxic effects of lead and over 40 percent of blood transfused in Ghana is given to children under 5 years. However, there is little data on the levels of lead in donor blood and the main sources of lead exposure in the Ghanaian population. This study compared blood lead levels (BLL) among selected occupations at risk of lead exposure with healthy blood donors in nonexposed occupations in a Ghanaian mining area. We enrolled 40 participants each from the following high-risk occupational groups: small scale miners, painters/sprayers, drivers/fuel station attendants, and auto-mechanics as well as 40 healthy blood donors (made up of teachers, traders, and office workers). One millilitre of blood was collected from each participant for determination of their BLL, haemoglobin conc...
Background In developed countries, prenatal maternal stress has been associated with poor fetal g... more Background In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana. Methods Leveraging a prospective, rural Ghanaian birth cohort, we ascertained prenatal maternal negative life events, categorized scores as 0-2 (low stress; referent), 3-5 (moderate), and > 5 (high) among 353 pregnant women in the Kintampo North Municipality and Kintampo South District located within the middle belt of Ghana. We employed linear regression to determine associations between prenatal maternal stress and infant birth weight, head circumference, and length. We additionally examined associations between prenatal maternal stress and adverse birth outcome, including low birth weight, small for gestational age, or stillbirth. Effect modification by infant sex was examined. Results In all children, high pr...
Background In developed countries, prenatal maternal stress has been associated with poor fetal g... more Background In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana. Methods Leveraging a prospective, rural Ghanaian birth cohort, we ascertained prenatal maternal negative life events, categorized scores as 0-2 (low stress; referent), 3-5 (moderate), and > 5 (high) among 353 pregnant women in the Kintampo North Municipality and Kintampo South District located within the middle belt of Ghana. We employed linear regression to determine associations between prenatal maternal stress and infant birth weight, head circumference, and length. We additionally examined associations between prenatal maternal stress and adverse birth outcome, including low birth weight, small for gestational age, or stillbirth. Effect modification by infant sex was examined. Results In all children, high pr...
Background: In developed countries, prenatal maternal stress has been associated with poor fetal ... more Background: In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana.
Objective:
In Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimet... more Objective: In Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended for the prevention of malaria-related adverse outcomes. This study demonstrates the coverage of IPTp-SP use among pregnant women over a period (2011–2015) and the impact of various sociodemographic groups on the uptake of IPTp-SP. Study Design: Retrospective analysis using data from all pregnant women in the Kintampo Health and Demographic Surveillance System area on the uptake of IPTp-SP. Study setting: Kintampo North Municipality and Kintampo South District of Ghana. Study participants: All pregnant women in the Kintampo Health and Demographic Surveillance System area. Primary and secondary outcome measures: The number of doses of IPTp-SP taken by pregnant women were examined. Logistic regression was used to assess the determinant of uptake of IPTp-SP while adjusting for within-subject correlation from women with multiple pregnancies. Results: Data from 2011 to 2015 with a total of 17 484 pregnant women were used. The coverage of the recommended three or more doses of IPTp-SP among all pregnant women was 40.6%, 44.0%, 45.9%, 20.9% and 32.4% in 2011, 2012, 2013, 2014 and 2015, respectively. In the adjusted analysis, age, household size, education, religion, number of antenatal care visits, ethnicity, marital status, wealth index and place of residence were significantly associated with the uptake of three or more doses of IPTp-SP. Having middle school education or higher, aged 20 years and above, visiting antenatal care five times or more (OR 2.83, 95% CI 2.64 to 3.03), being married (OR 1.10, 95% CI 1.02 to 1.19) and those in higher wealth quintiles were significantly more likely to take three or more doses of IPTp-SP. Conclusion: The uptake of the recommended three or more doses of IPTp-SP is low in the study area. We recommend a community-based approach to identify women during early pregnancy and to administer IPTp-SP.
Most parametric methods rely on the assumption of normality. Results obtained from these methods ... more Most parametric methods rely on the assumption of normality. Results obtained from these methods are more powerful compared to their non-parametric counterparts. However for valid inference, the assumptions underlying the use of these methods should be satisfied. Many published statistical articles that make use of the assumption of normality fail to guarantee it. Hence, quite a number of published statistical results are presented with errors. As a way to reduce this, various approaches used in assessing the assumption of normality are presented and illustrated in this paper. In assessing both univariate and multivariate normality, several methods have been proposed. In the univariate setting, the Q-Q plot, histogram, box plot, stem-and-leaf plot or dot plot are some graphical methods that can be used. Also, the properties of the normal distribution provide an alternative approach to assess normality. The Kolmogorov-Smirnov a starting point for assessing normality in the multivariate setting. A scatter plot for each pair of variables together with a Gamma plot (Chi-squared Q-Q plot) is used in assessing bivariate normality. For more than two variables, a Gamma plot can still be used to check the assumption of multivariate normality. Among the many test proposed for testing multivariate normality, Royston's and Mardia's tests are used more often and are implemented in many statistical packages. When the normality assumption is not justifiable, techniques for non-normal data can be used. Likewise, transformation to near normality is another alternative.
Background: The exposure–response association between prenatal and postnatal household air pollut... more Background: The exposure–response association between prenatal and postnatal household air pollution (HAP) and infant growth trajectories is unknown. Objectives: To evaluate associations between prenatal and postnatal HAP exposure and stove interventions on growth trajectories over the first year of life. Methods: The Ghana Randomized Air Pollution and Health Study enrolled n=1,414 pregnant women at ≤24wk gestation from Kintampo, Ghana, and randomized them to liquefied petroleum gas (LPG), improved biomass, or open fire (control) stoves. We quantified HAP exposure by repeated, personal prenatal and postnatal carbon monoxide (CO) and, in a subset, fine particulate matter [PM with an aerodynamic diameter of ≤2.5μm (PM2.5)] assessments. Length, weight, mid-upper arm circumference (MUAC) and head circumference (HC) were measured at birth, 3, 6, 9, and 12 months; weight-for-age, length-for-age (LAZ), and weight-for-length z (WLZ)-scores were calculated. For each anthropometric measure, w...
Most parametric methods rely on the assumption of normality. Results obtained from these methods ... more Most parametric methods rely on the assumption of normality. Results obtained from these methods are more powerful compared to their non-parametric counterparts. However for valid inference, the assumptions underlying the use of these methods should be satisfied. Many published statistical articles that make use of the assumption of normality fail to guarantee it. Hence, quite a number of published statistical results are presented with errors. As a way to reduce this, various approaches used in assessing the assumption of normality are presented and illustrated in this paper. In assessing both univariate and multivariate normality, several methods have been proposed. In the univariate setting, the Q-Q plot, histogram, box plot, stem-and-leaf plot or dot plot are some graphical methods that can be used. Also, the properties of the normal distribution provide an alternative approach to assess normality. The Kolmogorov-Smirnov (K-S) test, Lilliefors corrected K-S test, Shapiro-Wilk ...
ObjectiveIn Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimetha... more ObjectiveIn Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended for the prevention of malaria-related adverse outcomes. This study demonstrates the coverage of IPTp-SP use among pregnant women over a period (2011–2015) and the impact of various sociodemographic groups on the uptake of IPTp-SP.DesignRetrospective analysis using data from all pregnant women in the Kintampo Health and Demographic Surveillance System area on the uptake of IPTp-SP.SettingKintampo North Municipality and Kintampo South District of Ghana.ParticipantsAll pregnant women in the Kintampo Health and Demographic Surveillance System area.Primary and secondary outcome measuresThe number of doses of IPTp-SP taken by pregnant women were examined. Logistic regression was used to assess the determinant of uptake of IPTp-SP while adjusting for within-subject correlation from women with multiple pregnancies.ResultsData from 2011 to 2015 with a total of 17 484...
Objective: This study examined whether the open-defecation (OD) free target is achievable by 2030... more Objective: This study examined whether the open-defecation (OD) free target is achievable by 2030.Design: Longitudinal studySetting: Seven sub-Districts of Kintampo North Municipal, and five sub-Districts of Kintampo South DistrictData source: Kintampo health and demographic surveillance systemParticipants: Data was collected from household heads or their representatives over a 12-year period from 2005 to 2016.Main outcome: Open-defecation and attainment of OD free by 2030Results: In an exploratory analysis, the correlation between the total number of households, year, and total number of OD households was obtained. The average percentage yearly increase or decrease in OD was computed and used to project the percentage of OD for the years 2020, 2025 and 2030. In addition, geo-spatial technology was used to visualize variability in OD across the twelve sub-Districts. The results showed that the OD free target is not achievable in 2030 or even if the current trend continues. In 2016, ...
We use methods developed by the Commitment to Equity Institute to assess the effects of governmen... more We use methods developed by the Commitment to Equity Institute to assess the effects of government taxation, social spending and indirect subsidies on poverty and inequality in Ghana. We also simulate several policy reforms to assess their distributional consequences. Results show that, although the country has some very progressive taxes and well-targeted expenditures, the extent of fiscal redistribution is small, but about what one would expect given Ghana's income level and relatively low initial inequality. Results for poverty reduction are less encouraging: were it not for the in-kind benefits from health and education spending, the overall effect of government spending and taxation would actually increase poverty in Ghana. Eliminating energy subsidies and at the same time reallocating part of the savings to well-targeted transfer programs could lower the fiscal deficit while reducing inequality and protecting the poor.
INTRODUCTION The Global Youth Tobacco Survey's findings have been used to support Ghana's tobacco... more INTRODUCTION The Global Youth Tobacco Survey's findings have been used to support Ghana's tobacco control legislation, monitor tobacco use among the youth and also used in meeting various Articles of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). These Articles include: Article 8 (Protection for exposure to tobacco smoke); Article 12 (Education, communication, training and public awareness); Article 13 (Tobacco advertising, promotion, and sponsorship); Article 14 (Demand reduction measures concerning tobacco dependence and cessation); and Article 16 (Sales to and by minors). Among the four waves of GYTS in Ghana, the 2017 GYTS was the first to assess waterpipe smoking, through optional questions included in the GYTS questionnaire. We assessed sex, age and regional differentials in waterpipe smoking among the youth in Ghana, and also explored the association between the use of other tobacco products and waterpipe use. METHODS The GYTS employs a standardized methodology with self-administered questionnaires, consisting of core, optional, and country specific questions. Fourteen questions, out of the seventy-four (74) questions administered for the entire GYTS, assessed waterpipe tobacco smoking (WTS). Chi-squared test was used to assess sex, age, grade/form and regional differentials in waterpipe use. Furthermore, the association between smoking cigarettes, smokeless tobacco, electronic cigarettes and waterpipe smoking, was explored by employing a chisquared test with a 5% significance level. RESULTS Of a total of 5664 students who participated in the study, 90.9% were aged 13-15 years. The respondents were almost equally distributed among males and females. Overall, 3.1% of the respondents had ever smoked waterpipe. The overall prevalence of current waterpipe use was 1.7%; with 2.1% in girls (95% CI: 0.9-4.7%) and 0.9% in boys (95% CI: 0.5-1.6%), p=0.033. Additionally, more than half (55.0%) of the current waterpipe users smoked three or more sessions per day. Surprisingly, close to half (46.9%) of the current waterpipe users smoked at home. CONCLUSIONS Waterpipe use, particularly among the female student population, represents an emerging tobacco epidemic and hence deserves immediate attention from authorities. This study revealed that waterpipe is being used among Junior High students in Ghana. Education on the health implications of waterpipe use should be intensified among the youth, to help minimize its use and to prevent its associated health harms.
Lead poisoning has been a major global health problem for decades, and blood transfusion has been... more Lead poisoning has been a major global health problem for decades, and blood transfusion has been suspected as a neglected potential source of lead exposure. Children and pregnant women are most vulnerable to the toxic effects of lead and over 40 percent of blood transfused in Ghana is given to children under 5 years. However, there is little data on the levels of lead in donor blood and the main sources of lead exposure in the Ghanaian population. This study compared blood lead levels (BLL) among selected occupations at risk of lead exposure with healthy blood donors in nonexposed occupations in a Ghanaian mining area. We enrolled 40 participants each from the following high-risk occupational groups: small scale miners, painters/sprayers, drivers/fuel station attendants, and auto-mechanics as well as 40 healthy blood donors (made up of teachers, traders, and office workers). One millilitre of blood was collected from each participant for determination of their BLL, haemoglobin conc...
Background In developed countries, prenatal maternal stress has been associated with poor fetal g... more Background In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana. Methods Leveraging a prospective, rural Ghanaian birth cohort, we ascertained prenatal maternal negative life events, categorized scores as 0-2 (low stress; referent), 3-5 (moderate), and > 5 (high) among 353 pregnant women in the Kintampo North Municipality and Kintampo South District located within the middle belt of Ghana. We employed linear regression to determine associations between prenatal maternal stress and infant birth weight, head circumference, and length. We additionally examined associations between prenatal maternal stress and adverse birth outcome, including low birth weight, small for gestational age, or stillbirth. Effect modification by infant sex was examined. Results In all children, high pr...
Background In developed countries, prenatal maternal stress has been associated with poor fetal g... more Background In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana. Methods Leveraging a prospective, rural Ghanaian birth cohort, we ascertained prenatal maternal negative life events, categorized scores as 0-2 (low stress; referent), 3-5 (moderate), and > 5 (high) among 353 pregnant women in the Kintampo North Municipality and Kintampo South District located within the middle belt of Ghana. We employed linear regression to determine associations between prenatal maternal stress and infant birth weight, head circumference, and length. We additionally examined associations between prenatal maternal stress and adverse birth outcome, including low birth weight, small for gestational age, or stillbirth. Effect modification by infant sex was examined. Results In all children, high pr...
Background: In developed countries, prenatal maternal stress has been associated with poor fetal ... more Background: In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana.
Objective:
In Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimet... more Objective: In Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended for the prevention of malaria-related adverse outcomes. This study demonstrates the coverage of IPTp-SP use among pregnant women over a period (2011–2015) and the impact of various sociodemographic groups on the uptake of IPTp-SP. Study Design: Retrospective analysis using data from all pregnant women in the Kintampo Health and Demographic Surveillance System area on the uptake of IPTp-SP. Study setting: Kintampo North Municipality and Kintampo South District of Ghana. Study participants: All pregnant women in the Kintampo Health and Demographic Surveillance System area. Primary and secondary outcome measures: The number of doses of IPTp-SP taken by pregnant women were examined. Logistic regression was used to assess the determinant of uptake of IPTp-SP while adjusting for within-subject correlation from women with multiple pregnancies. Results: Data from 2011 to 2015 with a total of 17 484 pregnant women were used. The coverage of the recommended three or more doses of IPTp-SP among all pregnant women was 40.6%, 44.0%, 45.9%, 20.9% and 32.4% in 2011, 2012, 2013, 2014 and 2015, respectively. In the adjusted analysis, age, household size, education, religion, number of antenatal care visits, ethnicity, marital status, wealth index and place of residence were significantly associated with the uptake of three or more doses of IPTp-SP. Having middle school education or higher, aged 20 years and above, visiting antenatal care five times or more (OR 2.83, 95% CI 2.64 to 3.03), being married (OR 1.10, 95% CI 1.02 to 1.19) and those in higher wealth quintiles were significantly more likely to take three or more doses of IPTp-SP. Conclusion: The uptake of the recommended three or more doses of IPTp-SP is low in the study area. We recommend a community-based approach to identify women during early pregnancy and to administer IPTp-SP.
Most parametric methods rely on the assumption of normality. Results obtained from these methods ... more Most parametric methods rely on the assumption of normality. Results obtained from these methods are more powerful compared to their non-parametric counterparts. However for valid inference, the assumptions underlying the use of these methods should be satisfied. Many published statistical articles that make use of the assumption of normality fail to guarantee it. Hence, quite a number of published statistical results are presented with errors. As a way to reduce this, various approaches used in assessing the assumption of normality are presented and illustrated in this paper. In assessing both univariate and multivariate normality, several methods have been proposed. In the univariate setting, the Q-Q plot, histogram, box plot, stem-and-leaf plot or dot plot are some graphical methods that can be used. Also, the properties of the normal distribution provide an alternative approach to assess normality. The Kolmogorov-Smirnov a starting point for assessing normality in the multivariate setting. A scatter plot for each pair of variables together with a Gamma plot (Chi-squared Q-Q plot) is used in assessing bivariate normality. For more than two variables, a Gamma plot can still be used to check the assumption of multivariate normality. Among the many test proposed for testing multivariate normality, Royston's and Mardia's tests are used more often and are implemented in many statistical packages. When the normality assumption is not justifiable, techniques for non-normal data can be used. Likewise, transformation to near normality is another alternative.
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Papers by Felix B Oppong
In Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended for the prevention of malaria-related adverse outcomes. This study demonstrates the coverage of IPTp-SP use among pregnant women over a period (2011–2015) and the impact of various sociodemographic groups on the uptake of IPTp-SP.
Study Design:
Retrospective analysis using data from all pregnant women in the Kintampo Health and Demographic Surveillance System area on the uptake of IPTp-SP.
Study setting:
Kintampo North Municipality and Kintampo South District of Ghana.
Study participants:
All pregnant women in the Kintampo Health and Demographic Surveillance System area.
Primary and secondary outcome measures:
The number of doses of IPTp-SP taken by pregnant women were examined. Logistic regression was used to assess the determinant of uptake of IPTp-SP while adjusting for within-subject correlation from women with multiple pregnancies.
Results:
Data from 2011 to 2015 with a total of 17 484 pregnant women were used. The coverage of the recommended three or more doses of IPTp-SP among all pregnant women was 40.6%, 44.0%, 45.9%, 20.9% and 32.4% in 2011, 2012, 2013, 2014 and 2015, respectively. In the adjusted analysis, age, household size, education, religion, number of antenatal care visits, ethnicity, marital status, wealth index and place of residence were significantly associated with the uptake of three or more doses of IPTp-SP. Having middle school education or higher, aged 20 years and above, visiting antenatal care five times or more (OR 2.83, 95% CI 2.64 to 3.03), being married (OR 1.10, 95% CI 1.02 to 1.19) and those in higher wealth quintiles were significantly more likely to take three or more doses of IPTp-SP.
Conclusion:
The uptake of the recommended three or more doses of IPTp-SP is low in the study area. We recommend a community-based approach to identify women during early pregnancy and to administer IPTp-SP.
In Ghana, intermittent preventive treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended for the prevention of malaria-related adverse outcomes. This study demonstrates the coverage of IPTp-SP use among pregnant women over a period (2011–2015) and the impact of various sociodemographic groups on the uptake of IPTp-SP.
Study Design:
Retrospective analysis using data from all pregnant women in the Kintampo Health and Demographic Surveillance System area on the uptake of IPTp-SP.
Study setting:
Kintampo North Municipality and Kintampo South District of Ghana.
Study participants:
All pregnant women in the Kintampo Health and Demographic Surveillance System area.
Primary and secondary outcome measures:
The number of doses of IPTp-SP taken by pregnant women were examined. Logistic regression was used to assess the determinant of uptake of IPTp-SP while adjusting for within-subject correlation from women with multiple pregnancies.
Results:
Data from 2011 to 2015 with a total of 17 484 pregnant women were used. The coverage of the recommended three or more doses of IPTp-SP among all pregnant women was 40.6%, 44.0%, 45.9%, 20.9% and 32.4% in 2011, 2012, 2013, 2014 and 2015, respectively. In the adjusted analysis, age, household size, education, religion, number of antenatal care visits, ethnicity, marital status, wealth index and place of residence were significantly associated with the uptake of three or more doses of IPTp-SP. Having middle school education or higher, aged 20 years and above, visiting antenatal care five times or more (OR 2.83, 95% CI 2.64 to 3.03), being married (OR 1.10, 95% CI 1.02 to 1.19) and those in higher wealth quintiles were significantly more likely to take three or more doses of IPTp-SP.
Conclusion:
The uptake of the recommended three or more doses of IPTp-SP is low in the study area. We recommend a community-based approach to identify women during early pregnancy and to administer IPTp-SP.