Co-designing and pilot testing a digital game to improve vaccine attitudes and misinformation resistance in Ghana.

Misinformation related to vaccines has been shown to potentially negatively impact public perceptions and intentions to vaccinate in many contexts including COVID-19 vaccination in Ghana. Psychological inoculation - where recipients are warned about the misleading techniques used in misinformation - is a potential intervention which could preemptively boost public resistance against misinformation. Cranky Uncle Vaccine is an interactive, digital game that applies inoculation, offering a scalable tool building public resilience against vaccine misinformation and promoting positive health-related behaviors. In this study, we document the process of developing and testing a West African version of Cranky Uncle Vaccine, with co-design workshops and a pilot test conducted in urban and peri-urban areas of the Greater Accra region of Ghana with 829 young people who had access to mobile and computer devices. The average age was 21.8 and participants were highly educated (median education level "Some/all university") with slightly more females (51.2%) than males (48.4%). Pilot participants filled out surveys before and after playing the game, measuring vaccine attitudes (pre-game M = 3.4, post-game M = 3.6), intent to get vaccinated (pre-game M = 3.5, post-game M = 3.6), and discernment between vaccine facts and fallacies (pre-game AUC = 0.72, post-game AUC = 0.75). We observed a significant improvement in attitudes toward vaccines, with players demonstrating increased likelihood to get vaccinated after completing the game. Among players who indicated that they were unlikely to get vaccinated in the pre-game survey (N = 52, or 6.3% of participants), just over half of these participants (53%) switched to likely to get vaccinated after playing the game. Perceived reliability of vaccine facts remained the same, while perceived reliability of vaccine fallacies significantly decreased, indicating improved ability to spot misleading arguments about vaccines. These results demonstrate the effectiveness of a digital game in building public resilience against vaccine misinformation as well as improving vaccine attitudes and intent to get vaccinated.

Reducing stunting and underweight through mother's birth spacing: evidence from Ghana.

BACKGROUND: Researchers over the years have underscored the role of birth spacing on maternal health, however, inadequate maternal repletion due to shorter birth intervals could also affect the health of the child. Even so, limited studies exist on the linkage between birth spacing and child nutrition. This study examines the association between birth spacing and child stunting and underweight using the 2014 Ghana Demographic and Health Survey. METHODS: The study sourced data on 1, 904 children less than 59 months from the 2014 Ghana Demographic and Health Survey. The study employed bivariate analysis and logistic regressions to establish the association between birth spacing, and child stunting and underweight. RESULTS: The analyses reveal that childbirth spacing between 24 and 35 months (OR = 0.62, 95% CI: 0.38-0.99; p < 0.05), 36 to 47 months (OR = 0.42, 95% CI: 0.25-0.70; p < 0 0.01), and beyond 47 months (OR = 0.47, 95% CI: 0.28-0.78; p < 0.01) have lower odds of child stunting than children with birth spacing less than 24 months. Children with birth spacing between 24 and 35 months (OR = 0.53, 95% CI: 0.29-0.98; p < 0.05), 36 to 47 months (OR = 0.44, 95% CI: 0.22-0.90; p < 0.01) and beyond 47 months (OR = 0.49, 95% CI: 0.26-0.94; P < 0.05) have lower odds of being underweight than those with birth spacing less than 24 months. CONCLUSION: The study reveals that mothers with a birth spacing of at least two to three years compared to their counterparts with less than two years of birth spacing have lower odds of having a stunted and underweight child under age five. The study recommends that Ghana Health Service and other healthcare providers should educate mothers on the gains of birth spacing of at least two years on their children.

Impact of COVID-19 lockdown measures on mother and child health - the case of Ghana.

BACKGROUND: The lockdown measures in response to the coronavirus disease (COVID-19) have led to a wide range of unintended consequences for women and children. Until the outbreak of COVID-19, attention was on reducing maternal and infant mortality due to pregnancy and delivery complications. The aim of this study was to interrogate the impact of lockdown measures on women and children in two contrasting districts in Ghana - Krobo Odumase and Ayawaso West Wuogon. METHODS: This study adopted the mixed-method approach using both qualitative and quantitative data. The qualitative study relied on two data collection methods to explore the impacts of COVID-19 control measures on women and children in Ghana. These were: Focus Group Discussions (FGDs; n = 12) and Key Informant Interviews (KIIs; n = 18). The study complemented the qualitative data with survey data - household surveys (n = 78) which were used to support the nutrition and school closure data; and policy data gathered from government websites consisting of government responses to COVID-19. The qualitative data was analysed using the thematic approach with codes generated apriori with the NVIVO software. The quantitative data used percentages and frequencies. RESULTS: Engagements with participants in the study revealed that the lockdown measures implemented in Ghana had consequences on child and maternal health, and the health care system as a whole. Our study revealed, for example, that there was a decrease in antenatal and postnatal attendance in hospitals. Childhood vaccinations also came to a halt. Obesity and malnutrition were found to be common among children depending on the location of our study participants (urban and rural areas respectively). Our study also revealed that TB, Malaria and HIV treatment seeking reduced due to the fear of going to health facilities since those ailments manifest similar symptoms as COVID 19. CONCLUSION: Government responded to COVID-19 using different strategies however the policy response resulted in both intended and unintended consequences especially for women and children in Ghana. It is recommended that national policy directions should ensure the continuous provision of child and maternal healthcare services which are essential health services during lockdowns.

Rising Cases of Motorcycle Wheel Spokes Injuries in A Tertiary Facility in Northern Ghana; A Policy Call.

Introduction: Motorcycle wheel spoke injuries refer to the entrapment of the foot and ankle of a rider or pillion rider into the spokes of a vehicle resulting in varied complex ankle-foot injuries. Case Reports: We report ten cases of motorcycle wheel spoke injuries between January 1, 2022, to December 31, 2023, majority of whom were children with the youngest being 4 years and the oldest 43 years. A few of the cases sustained both soft tissue injuries and fractures around the ankle while the rest sustained only soft tissue injuries. We believe a lot more of these cases do not get to the tertiary facility for varied reasons.The mean length of hospital stay was 19±13 days potential indirect negative economic impact on the state, patients, and their family/caregivers.These injuries can be prevented by developing policies aimed at public education, baring children from riding pillion, and designing protective wheel covering. Conclusion and Recommendation: Cases of motorcycle wheel spoke injuries are on the rise in the Northern part of Ghana. We recommend public education and awareness creation as well as stringent implementation of road traffic regulations.

Nocturnal blood pressure dipping and left ventricular hypertrophy among hypertensive outpatients in a Ghanaian hospital.

Objectives: To investigate the association between the extent of nocturnal systolic blood pressure decline and left ventricular hypertrophy in patients with primary hypertension who were receiving antihypertensive drug therapy. Design: This was a cross-sectional hospital-based study from November 2020 to March 2021. Setting: The study was conducted at the Polyclinic of Korle Bu Teaching Hospital, Ghana. Participants: Outpatients ≥18 years old with primary hypertension who were receiving antihypertensive drug therapy. Interventions: Each participant underwent a 24-hour ambulatory blood pressure monitoring and a transthoracic echocardiogram. Main outcome measures: Left ventricular hypertrophy and the extent of mean systolic blood pressure decline during sleep. Results: 180 participants were recruited, comprising 110 (61.1%) females. The participants' mean (±SD) age was 57.6 ± 11.0 years. 80% had a non-dipping blood pressure pattern, and 43.9% had left ventricular hypertrophy. Uncontrolled office blood pressure was an independent predictor of left ventricular hypertrophy in these patients (AOR 2.010, 95% CI 1.048-3.855, p=0.036); however, a non-dipping nocturnal systolic blood pressure status was not (AOR 1.849, 95% CI 0.850-4.022, p=0.121). 61.1% had abnormal left ventricular geometry, with concentric hypertrophy being the predominant geometric pattern. Conclusion: Left ventricular hypertrophy and non-dipping nocturnal blood pressure were common in these hypertensive Ghanaian patients on antihypertensive therapy. Left ventricular hypertrophy was associated with uncontrolled office blood pressure but not the extent of nocturnal systolic blood pressure declines during a single 24-hour ambulatory blood pressure recording. Funding: None declared.

Antibiotic use in surgical infections at a tertiary teaching hospital in Ghana.

Objective: The study aimed to assess antibiotic prescribing and use patterns at the Department of Surgery, Korle Bu Teaching Hospital. Design: A cross-sectional study design was employed in this study. Setting: The study was conducted at the Department of Surgery, Korle Bu Teaching Hospital. Participants: Forty-two prescribers out of 63 (67%) at the Department of Surgery responded to questionnaires. Over the study period, prescriptions and medical records of 1715 patients from the general surgery, neurosurgery, and urology units were reviewed. Main Outcome Measures: Percentage of prescriptions with antibiotics, percentage of prescribers using guidelines for antibiotic prescriptions, and percentage using culture and sensitivity to inform antibiotic prescriptions. Results: Of the 1715 prescriptions assessed, 75% (1294/1715) were from inpatients, and 45% (772/1715) included an antibiotic. Ciprofloxacin and metronidazole constituted 54% of antibiotic prescriptions from general surgery. Amoxicillin/clavulanic acid and ceftriaxone constituted 64.7% of antibiotic prescriptions from neurosurgery, and ceftriaxone and ciprofloxacin made up 37.7% of antibiotic prescriptions from urology. Microbiology testing was done for only 14.5% (9/62) of inpatients who received antibiotics for treatment. The choice of antibiotics was influenced mainly by doctors' previous experience (37/42, 88.1%). Conclusion: Antibiotics are widely used. About half of all prescriptions had antibiotics, with ciprofloxacin and metronidazole constituting more than half of antibiotic prescriptions from general surgery. Doctors mainly based their antibiotic prescriptions on previous experience and occasionally on microbiological investigations. Funding: None declared.

Addressing the roadblocks to hypertension management in Ghana: proceedings of a roundtable discussion.

Hypertension is the top cause of preventable deaths in the African region. The burden of hypertension is increasing in Ghana, along with other countries in the African continent. Many people with hypertension in Ghana are unfortunately unaware of their diagnosis, and those who are aware often have poorly controlled blood pressure. The current situation is a signal of critical gaps in hypertension care in Ghana that need to be urgently addressed to curb this epidemic. The World Heart Federation (WHF), sponsored by Resolve to Save Lives, responded to this need by organising advocacy roundtables on hypertension in selected countries in sub-Saharan Africa to scale up hypertension management efforts in these countries. The roundtable on hypertension in Ghana was organised in collaboration with the Ghanaian Society of Cardiology (GSC) and the Stroke Association Support Network (SASNET) Ghana. A country mapping detailing the current situation and evolution of hypertension in Ghana over the years formed the basis of the roundtable discussions. The roundtable convened diverse stakeholders in hypertension care in Ghana to discuss the roadblocks to hypertension management in Ghana, proffer solutions to address them and chart a course with timelines for action. Major roadblocks to the management of hypertension in Ghana identified included inadequate financing for cardiovascular disease (CVD) care, inadequate capacity for CVD care across all levels of the healthcare system and insufficient education to empower people with hypertension for optimal self-care. Funding: The roundtable was funded through a grant by Resolve to Save Lives through the World Heart Federation.

A Systematic Review of the Burden of Stroke in Ghana.

Background: Stroke is considered a significant public health concern in sub-Saharan Africa and Ghana due to its impact on quality of life. However, there is a lack of comprehensive pooled data on the prevalence and incidence rates of stroke in Ghana. Updating this information would help inform decision-making bodies on measures to reduce the burden of stroke in Ghana. This systematic review is aimed at critically appraising evidence gathered from studies done in Ghana on the prevalence and incidence rates of stroke among the Ghanaian population. Method: Four databases (CINAHL via EBSCOhost, Web of Science, MEDLINE via PubMed, and PsycINFO via EBSCOhost) were searched, for articles published between May 2000 and May 2020 on stroke burden. The search was constrained to studies conducted in Ghana and published in English that have been peer reviewed. Cochrane risk of bias tool was used to assess the quality of evidence. Meta-analysis was conducted to estimate the pooled stroke prevalence and incidence in the country. Results: A total of three studies that documented 12,974 stroke cases in 1,197,498 participants based on the inclusion criteria were reviewed. The meta-analysis revealed that the overall national prevalence and incidence rate of stroke for the country were 7.96% and 1.17%, respectively, calculated at 95% confidence intervals. Conclusion: According to the review findings, the incidence and prevalence rates of stroke are high in Ghana or among the Ghanaian population, and they are increasing.

Outbreak Response to Circulating Vaccine-Derived Poliovirus in Three Northern Regions of Ghana, 2019.

Background: Circulating Vaccine-Derived Poliovirus Type 2 (cVDPV2) was isolated in sewage and later in stool samples from children with acute flaccid paralysis (AFP) in northern Ghana. Method: A multidisciplinary and multisectoral team investigated this outbreak and reported on epidemiological and laboratory investigations. Sewage/wastewater samples were collected from the environment, while stool samples were collected from AFP/contact children under 5 years of age. The samples were processed for virus isolation, and positive isolates were sequenced. We also conducted a descriptive investigation involving a review of records, active case search, and Monovalent Oral Polio Vaccine 2 campaigns. Additionally, we interviewed caregivers about the vaccination status of their children, as well as their knowledge on polio prevention. Water quality, sanitation, hygiene practices, and health-seeking behaviours were also assessed. Results: A total of 18 cVDPV2 were confirmed in the three regions of Ghana during the outbreak in 2019-2020. All strains were genetically linked to a Nigerian cVDPV2 strain NIE-KWS-KSB-18-006HC29 that circulated in 2018. Evaluation of the surveillance system shows that officers have good knowledge of AFP and know how to collect samples, package them, and ship them to the laboratory. Few communities had access to potable water. Open defecation was common, and the water supply, sanitation, and hygiene practices of the communities were poor. Conclusion: The cVDPV2 outbreak represents the first time cVDPV2 has circulated in the country since Ghana embarked on the polio eradication program in 1996. However, with quality mOPV2 mop-up campaigns, a nationwide IPV catch-up campaign coupled with enhanced surveillance measures, transmission was interrupted.

A phenomenological investigation of kinship involvement in the lives of children whose parents have mental illness.

BACKGROUND AND PURPOSE: Mental health services rarely reach children whose parents have mental illness despite their poor outcomes. There is a need to consider how mental health practitioners can prioritize the needs of these children and their families. This study examined kinship involvement in the lives of children whose parents have mental illness. METHODS: A phenomenological design was used, interviewing 20 children (aged 10-17 years) in families with parental mental illness (PMI) in Ghana. The interview data was analysed to attain the essential features of what kinship support looks like for children and their families. RESULTS: The essential feature of kinship support for children and families with PMI is characterized by uncertainty. However, there is an overall impression that kinship is generally supportive to these families, providing respite services, assistance with daily living, emotional support and advice to children and families. Yet, there is a sense that kinship may not always be helpful to these families. CONCLUSIONS: Kinship support is integral in countries where formal mental health services are inadequate and should be explored/harnessed by mental health practitioners. The study provides directions into ways practitioners can utilize kinship as a resource when working with these families.

Why "free maternal healthcare" is not entirely free in Ghana: a qualitative exploration of the role of street-level bureaucratic power.

BACKGROUND: Ghana introduced a free maternal healthcare policy within its National Health Insurance Scheme (NHIS) in 2008 to remove financial barriers to accessing maternal health services. Despite this policy, evidence suggests that women incur substantial out-of-pocket (OOP) payments for maternal health care. This study explores the underlying reasons for these persistent out-of-pocket payments within the context of Ghana's free maternal healthcare policy. METHODS: Cross-sectional qualitative data were collected through interviews with a purposive sample of 14 mothers and 8 healthcare providers/administrators in two regions of Ghana between May and September 2022. All interviews were audio-recorded, transcribed and imported into the NVivo 14.0 software for analysis. An iteratively developed codebook guided the coding process. Our thematic data analysis followed the Attride-Sterling framework for network analysis, identifying basic, organising themes and global themes. RESULTS: We found that health systems and demand-side factors are responsible for the persistence of OOP payments despite the existence of the free maternal healthcare policy in Ghana. Reasons for these payments arose from health systems factors, particularly, NHIS structural issues - delayed and insufficient reimbursements, inadequate NHIS benefit coverage, stockouts and supply chain challenges and demand-side factors - mothers' lack of education about the NHIS benefit package, and passing of cost onto patients. Due to structural and system level challenges, healthcare providers, exercising their street-level bureaucratic power, have partly repackaged the policy, enabling the persistence of out-of-pocket payments for maternal healthcare. CONCLUSIONS: Urgent measures are required to address the structural and administrative issues confronting Ghana's free maternal health policy; otherwise, Ghana may not achieve the sustainable development goals targets on maternal and child health.

Absence of measurable quantities of Candida auris and Cryptococcus spp. in the gut microbiota of Ghanaian individuals with and without HIV infection as confirmed by applying multiple real-time PCR assays.

Introduction. Fungal infections are relevant health risks for individuals with acquired immunodeficiency in the resource-limited tropics, but available surveillance data are scarce. For Candida auris and Cryptococcus spp., the evolution from environmental reservoirs to human pathogens causing life-threatening diseases is currently discussed as a public health concern in the context of climate change and limited treatment options.Gap statement. Uncovering the gastrointestinal tract as an epidemiological niche of fungi emerging from the environment into individuals for whom fungal infections are not diagnosed.Aim. To contribute to data on the local epidemiology of C. auris and Cryptococcus spp. in Western African Ghana by analysing gastrointestinal samples of Ghanaian individuals.Methodology. Four real-time PCR assays targeting C. auris and five real-time PCR assays targeting Cryptococcus spp. were applied with stool samples of 875 non-age-stratified Ghanaian HIV patients and 30 Ghanaian control individuals without known HIV infection. Also, 664 samples from Ghanaian children under 2 years of age were investigated. The true abundance of the target micro-organism was considered as unlikely in the case of one or fewer positive signals, likely in the case of two to three positive signals and highly likely in the case of four or more positive signals per sample in the real-time PCR assays.Results. The combined application of sensitive, target-specific real-time PCR assays indicates that neither C. auris, Cryptococcus neoformans complex nor Cryptococcus gattii complex were part of the gut microbiota of Ghanaian individuals with or without HIV infection.Conclusion. Despite the significant disease burden from these pathogens in immunosuppressed Ghanaian individuals, detection from gastrointestinal samples was unlikely, which should be taken into account when discussing screening strategies for these fungi of public health concern. In contrast, the detection of these fungi from such samples should not routinely be considered as commensal colonization flora.

The Bacterial Species Behind the Wound and Their Antibacterial Resistant Pattern: A Three-Year Retrospective Study at St. Dominic Hospital, Akwatia, Ghana.

BACKGROUND: Wound infections are often underestimated issues that can lead to chronic illnesses, and since the introduction of antibiotics, wound complications have become less common. However, due to the increased and irrational use of these antibiotics, the resistance in the bacterial isolates has become very common. This has led to reduced treatment options, delay in wound healing, and high treatment costs. This study aimed to investigate bacterial wound infections and their antibiotic resistance at St. Dominic Hospital, Ghana. METHODS: A total of 517 records of wound swab culture and susceptibility testing, and patient demographics from 2020 to 2022 were collected from the microbiology unit of St. Dominic Hospital in the Eastern Region of Ghana. The data were entered into Microsoft Excel 2019, cleaned, and exported into IBM SPSS v26 for the statistical analysis. p < 0.05 was considered statistically significant for all analyses. RESULTS: The overall prevalence of bacteriological agents causing wound infection in individuals who visited the St. Dominic Hospital from 2020 to 2022 was 70.21% (363/517), with S. aureus 79/363 (21.76%) being the most abundant isolate. Out of the 79 S. aureus isolated, 40 (50.63%) and 39 (49.37%) were resistant to ampicillin and cephalexin, respectively. More than 50% of the predominant Gram-negative isolate, K. pneumoniae, were resistant to clindamycin 45/72 (62.50%) but susceptible to levofloxacin 70/72 (97.22%), cefotetan 69/72 (95.83%), and chloramphenicol 67/72 (93.06%). CONCLUSION: Antibacterial susceptibility patterns revealed significant resistance trends, particularly among Gram-negative isolates, emphasizing the urgent need for prudent antibiotic use and ongoing surveillance to combat resistance.

Hepatitis B virus (HBV) viremia despite tenofovir disoproxil fumarate-containing antiretroviral therapy in persons with HBV/HIV coinfection.

BACKGROUND: The goal of treatment of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection is suppression of both viruses; yet incomplete HBV suppression on tenofovir (TFV) disoproxil fumarate (TDF)-based antiretroviral therapy (ART) is common. This study investigated TFV resistance-associated mutations (RAMs) in individuals with HBV/HIV coinfection with viremia on TDF/lamivudine (3TC)-containing ART. METHODS: Samples from individuals with HBV DNA levels ≥20 IU/mL in a cross-sectional study of 138 persons with HBV/HIV coinfection in Ghana were analyzed in the present study. HBV was sequenced for RAM analysis. TFV-diphosphate (TFV-DP) concentration in peripheral blood mononuclear cells (PBMCs) was used to assess ART adherence level. RESULTS: Nine of 138 participants (6.5 %) had detectable HBV DNA levels ≥20 IU/mL while on ART. Seven of the nine participants had TFV-DP concentrations commensurate with 7 doses per week, and six had suppressed HIV RNA. Phylogenetic analysis revealed that eight sequences were HBV genotype E, with one genotype E/A recombinant. Ten previously-reported TFV RAMs were present in the study samples; eight were wild-type for HBV genotype E. The non-genotype-E-wild-type point mutations M267L and K333Q were found in two and one patients, respectively. No 3TC RAMs were found. CONCLUSION: HBV viremia despite high adherence to TDF/3TC-based ART may be associated with the presence of TFV RAMs. These findings highlight the need for enhanced resistance monitoring and further research to examine the clinical significance of reported TFV RAMs. Individuals with HBV/HIV coinfection and TFV resistance on TDF-based ART may need alternative treatment strategies.

Larval habitat diversity, physicochemical characterization and their effect on the density of larval malaria vectors in the city of Accra, Ghana.

Background: Malaria is more prevalent in rural areas due to fewer mosquito breeding habitats in urban settings. However, urban factors such as irrigated farming, open sewers, and discarded containers create mosquito breeding sites. This study investigates the diversity and distribution of larval habitats and the impact of physicochemical characteristics on the presence and density of Anopheles gambiae s.l. larvae in Accra, Ghana. Methods: Larval surveys and collections were conducted at fifteen locations in Accra, divided into five categories: Irrigated Urban Farming (IUF), Lower Socioeconomic Status (LS), Middle Socioeconomic Status (MS), High Socioeconomic Status (HS), and Peri-urban (PU) areas. Physicochemical parameters were measured, and species identification was performed using morphological and molecular methods. Results: A total of 727 breeding habitats were identified, with 65.34% (475/727) positive for Anopheles larvae. Drainage ditches were the most common habitat type (48.21%, 229/475). The highest abundance of An. gambiae s.l. was found in IUF sites (6,244/22,919), especially during the rainy season (77.01%, 17,650/22,919; R2 = 3.46, P = 0.000). Polluted habitats, including household effluents, had higher ammonium levels (3.4 mg/L NH -N) compared to unpolluted ones (1.3 mg/L NH -N). Other distinguishing parameters included dissolved oxygen (34% vs 52.9%), conductivity (5106 µS/cm vs 2049 µS/cm), and total dissolved solids (3181 mg/L vs 1255 mg/L). The predominant malaria vector was An. coluzzii(54.4%, 368/677). Additionally, the invasive An. stephensi, previously unreported in Ghana, was detected. Conclusion: Malaria vectors breed in diverse and often polluted urban habitats, with high larval densities in urban agricultural areas. The detection of the invasive An. Stephensi highlights the need for continuous monitoring and vector control strategies in urban settings.

Association of breastfeeding duration with overweight and obesity among women in Ghana.

Background: There is a general concurrence on the health benefits that breastfeeding confers to children, including offering maximal protection against obesity across their life course. However, the scientific evidence on similar benefits for women who breastfeed their children remains inconclusive. This study contributes to the discourse by examining the association of breastfeeding duration with overweight and obesity among women in Ghana. Methods: Data on 8,516 women of reproductive age were pooled from the last five (5) Ghana Demographic and Health Surveys, and analysed using descriptive proportions and logistic regression models. Results: The prevalence of overweight and obesity was about 8% lower for women who breastfed their children beyond 18 months (overweight = 13%, obesity = 5%) compared with women who did not breastfeed (overweight = 21%, obesity = 13%) their children at all. With reference to women who did not breastfeed their children, a significant lower odds of obesity was observed for those who breastfed their children for 13-18 months (OR = 0.46, 95% CI = 0.268, 0.864) and >18 months (OR = 0.41, 95% CI = 0.216, 0.764), after adjusting for possible confounding factors. Discussion: Women who breastfeed their children for a minimum of 12 months have lower risk of developing obesity. Promoting prolonged breastfeeding among mothers could be an effective pathway to preventing obesity among women in Ghana.

Trends in viral load suppression among HIV patients on antiretroviral therapy (ART) at Asante Mampong Municipal Hospital, Ghana: 2019-2023.

BACKGROUND: The Joint United Nations Programme on Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) (UNAIDS) aims to eradicate AIDS by 2030 through 95:95:95 targets: identifying 95% of persons living with HIV (PLHIV), initiating 95% of those identified on antiretroviral therapy (ART), and ensuring that 95% of those initiated on ART are virally suppressed. Virally suppressed patients pose minimal risk of HIV transmission. ART aims to suppress the HIV-viral load (VL) and increase immunity, reducing morbidity and mortality. This study aimed to determine the trends in VL suppression among HIV patients on ART from 2019 to 2023 at Asante Mampong Municipal Hospital. METHODS: This study adopted a retrospective Hospital-based design in which secondary data from 842 patients on ART from 2019 to 2023 were used. The study design specifically involved conducting serial cross-sectional studies to measure the prevalence of VL suppression each year from 2019 to 2023. This approach allowed the researchers to analyse the annual prevalence of VL suppression among study participants without following individual participants longitudinally throughout the entire period. The data were analysed via STATA version 17.0. Chi-square and logistic regressions were used to determine the associations between VL suppression and the independent variables at p < 0.05 and 95% confidence intervals (CIs). RESULTS: In 2019, VL suppression was 79.6%, decreasing to 40.0% in 2020 and then rising to 82.7% in 2021, dropping to 67.8% in 2022 and 66.7% in the first quarter of 2023. Clients aged 40-49, 50-59, and 60-69 years were more likely to have VL suppression [aOR = 4.4 (1.36-14.25), p = 0.013], [aOR = 5.5 (1.65-18.39), p = 0.006] and [aOR = 5.0 (1.42-17.46), p = 0.012], respectively. Clients who were consistently on the same type of ART for more than a year were more likely to have VL suppression [aOR = 10.6 (4.18-26.76), p < 0.001]. CONCLUSION: VL suppression was low among patients. Advanced age and being on the same ART for more than 12 months were significantly associated with VL suppression. Health promotion activities are needed for people who have been suppressed to maintain and achieve a lifetime undetectable VL, targeting the younger age group.

Daily exercises uptake and associated factors among Social Security and National Insurance Trust pensioners in the Greater Accra Region of Ghana.

BACKGROUND: With a growing body of evidence highlighting the positive impact of regular physical activity or exercise on achieving healthy aging, it is important to gain insight into the factors influencing daily exercises uptake. However, to the best of our knowledge, no study has been focused on factors predicting daily exercises uptake among pensioners, who form a substantial portion of Ghana's aging population. The goal of this preliminary study was to estimate the factors associated with daily exercises uptake among Social Security and National Insurance Trust (SSNIT) pensioners in Ghana. METHODS: Data for this study came from a cross-sectional study on survival strategies and quality of life among SSNIT pensioners in the Greater Accra Region of Ghana. Cluster and stratified sampling techniques were used to recruit the study participants. The analytic sample was 410 participants. Multivariable binary logistic regressions were used to estimate factors associated with daily exercises uptake among the participants. The significance of the test was pegged at a p-value of 0.05 or less. RESULTS: The results showed that 62% of the participants self-identified as male, 47.6% were aged between 60 and 64 years, 52.7% were employed in the public sector and 44.4% performed daily exercises. The results showed that those who were aged 60-64 years (AOR: 1.197, 95% CI: 1.019-1.405), aged 65-69 years (AOR:1.254, 95% CI: 1.071-1.468), who do not incur expenditure on their household in a month (AOR: 1.519, 95% CI: 1.127-2.046), earned less than GH¢260 (AOR: 1.221, 95% CI: 1.018-1.465), accessed/utilized herbalist medical services (AOR: 1.252, 95% CI: 1.129-1.388), very dissatisfied (AOR: 1.637, 95% CI: 1.242-2.157) and dissatisfied (AOR: 1.516, 95% CI: 1.212-1.896) with their sex life were more likely to undertake daily exercises and this was statistically significant. The results again demonstrated that participants who joined fitness club (AOR: 0.685, 95% CI: 0.614-0.764) and those who were very dissatisfied with their health services access/use (AOR: 0.598, 95% CI: 0.363-0.984) were less likely to undertake daily exercises and this was statistically significant. CONCLUSION: Findings of this study have provided important insights for policy makers and thus constitute a useful framework to help plan and shape future policies and programs on daily exercises uptake among pensioners in Ghana and other geographical contexts with similar cultural, demographic, and socio-economic characteristics.

The impact of the RTS,S malaria vaccine on uncomplicated malaria: evidence from the phase IV study districts, Upper East Region, Ghana, 2020-2022.

BACKGROUND: The RTS,S malaria vaccine has been prequalified for use in endemic settings prioritizing areas with moderate to high disease transmission. The impact of a vaccine at the population level may differ from observations during clinical trial due to programmatic, and individual-related factors, among others. The objective of this study was to assess the impact of the RTS,S malaria vaccine on uncomplicated malaria among children aged 12-59 months in the Phase IV study districts, Upper East Region, Ghana. METHODS: A retrospective study was conducted using routine malaria surveillance data for the period 2020-2022. The burden of uncomplicated malaria was compared between the implementing (Kasena Nankana East and West districts) and comparator areas (Builsa North and South districts). The impact of RTS,S malaria vaccine was assessed by estimating the percentage reduction in uncomplicated malaria and incidence averted in the implementing area, accounting for the effect of confounders. RESULTS: Over 50,000 episodes of uncomplicated malaria among children aged 12-59 months were included in the study. Uncomplicated malaria was reduced by 33% (95%CI 29-36) over the entire study period, but the malaria incidence averted declined from 324/1,000 (95% CI 298-339; p < 0.0001) in 2020 to 287/1000 (95% CI 274-299; p < 0.0001) in 2022. CONCLUSION: The RTS,S malaria vaccine significantly reduced the burden of uncomplicated malaria among children aged 12-59 months in the implementing area. The sequential marginal declines in malaria incidence averted over the study period might be due to waning of protective immunity and acquisition of natural immunity as children age. Strengthening uptake of the currently recommended vaccines and other malaria control interventions is required to improve public health impact.

Predictors of measles-rubella vaccination status in the Savannah Region, Ghana: A cross-sectional study among caregivers of children aged 18-59 months.

Introduction: Savannah Region witnessed a decline in measles-rubella (MR) vaccination coverage prior to the measles outbreak in 2022. This study aimed to assess contributory factors of the low routine MR vaccination coverage and proffer recommendations to improve vaccination uptake. Methods: A cross-sectional study was conducted in two districts (Bole and Central Gonja) of Savannah Region from December 2022 to June 2023. Caregivers of children 18-59 months were randomly selected and interviewed using a structured questionnaire. Bivariate and multivariate logistic regression were performed to assess predictors of MR vaccination status. Results: Children of caregivers with inadequate knowledge of MR vaccination (AOR = 0.58, 95 %CI: 0.47-0.72), travelled more than five km to access health services (AOR = 0.48, 95 %CI: 0.39-0.59), described health workers attitude as poor (AOR = 0.44, 95 %CI: 0.26-0.74), and those who sought treatment for adverse events following immunization (AEFI) from the pharmacy (AOR = 0.65, 95 %CI: 0.51-0.84) were less likely to complete MR vaccination. On the contrary, children of female sex (AOR = 1.27, 95 %CI: 1.05-1.53), aged 24-59 month (AOR = 2.56, 95 %CI: 1.05-1.53), caregivers with primary or secondary education (AOR = 1.43, 95 %CI: 1.11-1.84; and AOR = 2.23, 95 %CI: 1.64-3.03 respectively), and those who did not experience rescheduling of vaccination sessions (AOR = 1.61, 95 % CI: 1.25-2.01) were more likely to complete routine MR vaccination schedule. Conclusion: Inadequate caregiver knowledge, poor geographical access to health services, poor healthcare worker attitude, and non-institutional management of AEFI significantly contributed to the low MR vaccination uptake in the Savannah Region. Adopting tailored approaches to addressing these factors could improve vaccination coverage.