Short-term chemotherapy-related complications and undernutrition in children diagnosed with cancer at Korle Bu Teaching Hospital, Accra, Ghana: A prospective cohort study.

Undernutrition in children with cancer is associated with complications during cancer therapy. The study objective was to determine the association between specific anthropometric parameters and short-term chemotherapy-related complications and mortality. This was a hospital-based, prospective cohort study of children, age ≤12 years, with a new cancer diagnosis at the Paediatric Oncology Unit, Korle Bu Teaching Hospital, Ghana. Socio-demographic information, cancer characteristics and anthropometric measurements were obtained at enrolment. Participants were followed up for twelve weeks from commencement of chemotherapy and selected treatment-related complications such as anaemia and thrombocytopenia requiring transfusions, prolonged neutropenia resulting in treatment delays, febrile neutropenia, mucositis and death were recorded. A total of 133 participants were recruited with a median age of 4.5 years. Eighty-one (60.9%) were diagnosed with solid tumours, 31 (23.3%) had leukaemias and 21 (15.8%) had lymphomas. Of the anthropometric parameters assessed, only arm anthropometry using upper arm muscle area (UAMA) and mid-upper arm circumference (MUAC) were associated with complications. Participants with wasting were more likely to develop anaemia and mucositis. However, the incidence of prolonged neutropenia was significantly higher among participants with average UAMA (p = 0.043) and low average UAMA (p = 0.049) compared to those with low UAMA. Risk of neutropenia was also significantly less among those with wasting by MUAC compared to those well-nourished (p = 0.045). Twenty-three participants (17.3%) died with a greater proportion (11/44; 25%) occurring in those who were wasted using MUAC. These findings underscore the need for nutritional surveillance at diagnosis and during chemotherapy, particularly where co-morbid disease is prevalent.

Asymptomatic malaria parasitaemia and virological non-suppression among children living with HIV in Accra, Ghana: a cross-sectional study.

Background: Human Immunodeficiency Virus (HIV) and malaria are two major diseases in sub-Saharan Africa, with coinfections having an impact on the outcomes of both. We assessed the association between asymptomatic malaria parasitaemia and virological non-suppression among children living with HIV attending a clinic at the Korle Bu Teaching Hospital (KBTH) and the Princess Marie Louis Hospital (PML) in the city of Accra, Ghana. Methods: This was a cross-sectional study of asymptomatic malaria in children receiving care at paediatric HIV clinics at KBTH and PML conducted from September to November 2022. Patients who had been on ART for at least 6 months were eligible to participate. Structured questionnaires were used to collect socio-demographic, malaria prevention behaviors, and ART-related data using in-person interviews. Microscopy and PCR were used to screen for malaria and GeneXpert to determine viral load. To examine the determinants of malaria PCR positivity and virological non-suppression, Chi-square tests and logistic regression were utilized. Results: The participants' median age was 9 years with a range of 6 to 12 years. Males made up 57% of the population. We detected 3.6% (10 of 277) and 7.6% (21 of 277) cases of malaria using microscopy and PCR, respectively. Virological non-suppression (VL > 1000 copies/ml) was seen in 82 (29.6%) of the 277 participants. Among the suppressed individuals, 62 (22.4%) exhibited low-level viraemia (VL level 40-1000 copies/ml) and 133 (48%) had non-detectable viral load levels. There were no factors associated with malaria PCR positivity carriage. Poor adherence to antiretroviral therapy was associated with a fivefold increase in the risk of viral load non-suppression (AOR = 4.89 [CI = 2.00-11.98], p = 0.001). Conclusion: The study showed that the proportion of children living with HIV with asymptomatic malaria parasitaemia was low, with about one third of the study population having virological non suppression. The interaction between malaria parasitemia and viral replication may not be the main culprit for virological non suppression.

Factors Contributing to Malnutrition among Children Under 5 Years at St. Elizabeth Catholic Hospital, Ahafo Hwidiem.

Background: Nutrition among children under 5 plays an important role in the overall development of children physically and psychologically. Nutritional deficiencies and malnutrition generally affect children. In this study, we estimate the prevalence of 3 malnutrition indicators underweight, stunting and wasting and to assess factors associated with them. Objective: The main objective of the study was to assess the factors contributing to malnutrition among children under 5 years old. Design: The study employed a descriptive cross-sectional study design to assess the factors contributing to malnutrition among children under 5 years of age. Methods: This is quantitative cross-sectional facility-based study of 245 children aged 11 to 49 months. A structured questionnaire was used, and anthropometric measurements were taken to collect data. The Pearson chi-square test was used to assess the bivariate association between the outcomes and the characteristics. The binary logistic regression model was employed to estimate the crude and adjusted odds of malnutrition indicators among the characteristics observed in the study. Results: The prevalence of underweight, stunting, and wasting were 35.9, 13.9, and 33.9%, respectively. Underweight was significantly higher among females compared to males (42.0% vs. 24.1%) and highest among children aged 11 to 23 months (53.6%). Female children had 3 times more odds of being underweight (AOR: 3.09, 95% CI: 1.56-6.12). Compared to children aged 11 to 23 months, the odds of being underweight were less among children aged 24 to 35 months (AOR: 0.26, 95% CI: 0.13-0.51, P < .001), and 36 to 47 months (AOR: 0.9, 95% CI: 0.03-0.29, P < .001). Wasting was less prevalent among children aged 11 to 23 months (4.8%). Also, wasting was high among children aged 24 to 35 months (AOR: 27.41, 95% CI: 9.12-82.37, P < .001), 36 to 47 months (AOR: 28.23, 95% CI: 7.59-104.94, P < .001), and 48 to 59 months (AOR: 18.10, 95% CI: 3.04-107.76, P < .001). None of the observed factors were associated with stunting in the study. Conclusion: This study concludes that child malnutrition was high among under-five children. Promoting the use of healthy complementary feeding, preventing diarrheal diseases, and vaccinating children integrated with access to nutrition education programs are vital interventions to improve the nutritional status of children.

Prevalence and determinants of diarrhoea and acute respiratory infections among children aged under five years in West Africa: evidence from demographic and health surveys.

BACKGROUND: Diarrhoea and pneumonia are the leading causes of morbidity and mortality in children aged <5 y (under five) globally. This study sought to investigate the prevalence and determinants of diarrhoea and acute respiratory infections (ARIs) among children under five in West Africa. METHODS: The most recent demographic and health survey (DHS) standard for 13 West African countries was used in the study. We calculated the prevalence of diarrhoea and ARIs (2 wk prior to the survey) and performed multivariable complex logistic regression analysis to identify possible predictors of diarrhoea and ARIs. RESULTS: The weighted prevalence of diarrhoea and ARI was 13.7% and 15.9%, respectively. The prevalence of comorbid diarrhoea and ARI was 4.4%. Children aged <2 y (p<0.001), mothers aged <30 y (p<0.003), mothers without formal education (p<0.001), poor households (p<0.001) and poor nutritional status, wasting (p=0.005) and underweight (p<0.001), were the independent predictors of diarrhoea. The independent predictors of ARIs were children with no childhood vaccinations (p=0.002), use of solid fuel in the household (p=0.007), being underweight (p=0.05) and diarrhoea (p<0.001). CONCLUSIONS: The findings imply the need for holistic public health interventions such as increased vaccination coverage, population-based nutritional programmes and campaigns on the use of cleaner cooking fuel targeted at high-risk subgroups in the population to reduce the burden and adverse effects of diarrhoea and ARIs in the West African region.

Anemia prevalence and its predictors among children under-five years in Ghana. A multilevel analysis of the cross-sectional 2019 Ghana Malaria Indicator Survey.

Background and Aims: Despite the implementation of anemia control interventions in Ghana, anemia prevalence is still high in children under-fives. Reducing the prevalence of anemia requires identifying and targeting associated critical risk factors. This study seeks to identify predictors of anemia among children under-fives in Ghana. Methods: Nationally representative data from the 2019 Ghana Malaria Indicator Survey was used in this study. Both fixed and random effects (multilevel) logistic regression models were applied to 2434 children to identify critical factors associated with anemia. Results: In this study, 54% (95% confidence interval [CI] 52.0-57.0) of children under-5 years were anemic. Infants were more likely to be anemic (66.7%) compared with other children below 5 years. In the multivariable multilevel model, the risk of anemia was found to be higher in younger children especially 6-11 months old (adjusted odds ratio [aOR] = 3.59, CI: 2.54-5.08) and 12-23 months old (aOR = 2.97, CI: 2.08-4.23), children who had malaria (aOR = 1.53, CI: 1.13-2.06), children whose mothers were not registered but not covered with health insurance (aOR = 1.45, CI: 1.21-1.74) or were not even registered for insurance (aOR = 1.49, CI: 1.15-1.93), children born to adolescent mothers (aOR = 2.21, CI: 1.36-3.57), children born to non-Christian mothers (Islam [aOR = 1.53, CI: 1.17-2.00]), children born to families of poorer households (poorest [aOR = 3.01, CI: 1.64-5.51]; poorer [aOR = 2.56, CI: 1.65-3.98]); middle (aOR = 2.03, CI: 1.32-3.11) and richer (aOR = 1.78, CI: 1.19-2.64), and children who lived in either Upper East (aOR = 2.03, CI: 1.26-3.26) or Central (aOR = 2.52, CI: 1.42-4.47) regions. Significant unobserved community-level differences in anemia prevalence were observed. Conclusion: The probability of anemia in children under-fives differs substantially from one community to another, and the prevalence remains high. The identified critical risk factors should be addressed. Multifaceted and targeted approaches are needed to help reduce the anemia prevalence in this setting to achieve the multiple United Nation's Sustainable Development Goals, which are related to risk and prevalence of anemia by 2030.

Universal coverage and utilization of free long-lasting insecticidal nets for malaria prevention in Ghana: a cross-sectional study.

Background: Malaria continues to be one of the leading causes of mortality and morbidity, especially among children and pregnant women. The use of Long-Lasting Insecticide Nets (LLINs) has been recognized and prioritized as a major intervention for malaria prevention in Ghana. This study aims to establish the factors influencing the universal coverage and utilization of LLINs in Ghana. Methods: The data used for this study was from a cross-sectional survey carried out to assess LLINs ownership and use in 9 out of the 10 old regions of Ghana from October 2018 to February 2019 where free LLIN distribution interventions were implemented. The EPI "30 × 7" cluster sampling method (three-stage sampling design) was modified to "15 × 14" and used for the study. A total of 9,977 households were interviewed from 42 districts. Descriptive statistics using percentages as well as tests of associations such as Pearson Chi-square and the magnitude of the associations using simple and multivariable logistic regression were implemented. Results: Of the 9,977 households in the study, 88.0% of them owned at least one LLIN, universal coverage was 75.6%, while utilization was 65.6% among households with at least one LLIN. In the rural and urban areas, 90.8% and 83.2% of households, respectively, owned at least one LLIN. The was a 44% increase in universal coverage of LLINs in rural areas compared to urban areas (AOR: 1.44, 95% CI: 1.02-2.02). There were 29 higher odds of households being universally covered if they received LLIN from the PMD (AOR: 29.43, 95% CI: 24.21-35.79). Households with under-five children were 40% more likely to utilize LLIN (AOR: 1.40, 95% CI: 1.26-1.56). Respondents with universal coverage of LLIN had 25% increased odds of using nets (AOR: 1.25 95% CI: 1.06-1.48). Rural dwelling influences LLIN utilization, thus there was about 4-fold increase in household utilization of LLINs in rural areas compared to urban areas (AOR: 3.78, 95% CI: 2.73-5.24). Household size of more than 2 has high odds of LLINs utilization and awareness of the benefit of LLINs (AOR: 1.42, 95% CI: 1.18-1.71). Conclusion: About nine in 10 households in Ghana have access at least to one LLIN, three-quarters had universal coverage, and over two-thirds of households with access used LLIN. The predictors of universal coverage included region of residence, rural dwellers, and PMD campaign, while households with child under-five, in rural areas, and with universal coverage were positively associated with utilization.

Predictors of mosquito bed net use among children under-fives in Ghana: a multilevel analysis of the 2019 malaria indicator survey.

BACKGROUND: Morbidities and mortalities due to malaria can be prevented by the use of insecticide-treated mosquito bed nets (ITN), which has been proven for malaria control and elimination. The purpose of this study was to assess the critical factors that predict the use of ITN among children under-fives in Ghana. METHODS: The study utilized data from the 2019 Ghana Malaria Indicator Survey (GMIS). The outcome variable was mosquito bed net use among children under-fives. To determine critical factors that independently predict ITN use, multilevel multivariable logistic regression was employed using Stata version 16. Odds ratios and associated 95% confidence intervals and p-values were reported. A p < 0.05 was used to declare statistical significance. RESULTS: The overall prevalence of ITN usage was 57.4%. Utilization of bed nets was 66.6% in the rural areas and 43.5% in the urban areas, was highest in the Upper West region (80.6%) even when stratified to rural (82.9%) and urban areas (70.3%) whilst Greater Accra region (30.5%, rural = 41.7%, urban = 28.9%) had the least. The community level multilevel analysis showed that bed net utilization was higher among children in rural areas [AOR = 1.99, 95% CI 1.32-3.01, p = 0.001] and in household with wooden wall materials [AOR = 3.29, 95% CI 1.15-9.40, p = 0.027]. Bed net utilization was however, less for households with 3 + children under-five [AOR = 0.29, 95% CI 0.19-0.46, p < 0.001), 4 years old (AOR = 0.66, 95% CI 00.48-00.92, p = 0.014], without universal access to bed net [AOR = 0.52, 95% CI 0.37-0.73, p < 0.001], those in the Greater Accra [AOR = 0.26, 95% CI 0.13-0.51, p < 0.001], Eastern [AOR = 0.47, 95% CI 0.23-0.95, p = 0.036], Northern [AOR = 0.42, 95% CI 0.20-0.88, p = 0.022], middle [AOR = 0.57, 95% CI 0.35-0.94, p = 0.026] and rich/richest [AOR = 0.51, 95% CI 0.29-0.92, p = 0.025] household wealth quintile. Substantial unobserved household and community level differences in bed net use were found. CONCLUSION: This study demonstrates the need to intensify promotion of ITN use to those in urban areas, Greater Accra, Eastern and Northern regions, houses without wooden wall materials, middle and rich/richest households. Interventions should be targeted at older children and households with more under-five children and to ensure full access and use of ITNs among all children under-fives in each household as part of the overall goal of achieving the health-related SDGs.

Medicated-related burden and adherence in patients with co-morbid type 2 diabetes mellitus and hypertension.

Background: Medication adherence is an integral component in the management of patients with co-morbid type 2 diabetes mellitus (T2DM) and hypertension. However due to their combined conditions, there is likelihood of polypharmacy and medication-related burden, which could negatively impact adherence to therapy. This study aimed to assess the perceived medication-related burden among patients with co-morbid T2DM and hypertension and to evaluate the association between the perceived burden and adherence to medication therapy. Methods: A cross-sectional study was conducted among adult patients with co-morbid T2DM and hypertension attending a primary health facility. The living with medicines questionnaire and the medication adherence report scale were used to assess extent of medication-related burden and adherence respectively. Binary logistic regression model was used to estimate the adjusted odds and their corresponding 95% confidence interval for medication-related burden and adherence outcomes. All observed categorical variables were considered for the multivariable binary logistic regression model. Results: The total number of participants was 329 with a median age of 57.5 ± 13.2 years. The median score for the overall burden was 99 (IQR: 93-113), and this significantly varied by sex (p = 0.012), monthly income (p = 0.025), monthly expenditure on medications (p = 0.012), frequency of daily dose of medications (p = 0.020) and family history of T2DM (p < 0.001). About 30.7% and 36.8% of participants reported moderate/high burden and medication adherence respectively. Uncontrolled diastolic blood pressure (AOR: 2.46, 95% CI: 1.20-5.05, p = 0.014), high glucose (AOR: 4.24, 95% CI: 2.13-8.46, p < 0.001) and no family history of T2DM (AOR: 2.14, 95% CI: 1.14-4.02, p = 0.026) were associated with moderate/high medication burden. Uncontrolled diastolic blood pressure (AOR: 0.48, 95% CI: 0.25-0.94, p = 0.031), at least 5 years since hypertension diagnosis (AOR: 0.55, 95% CI: 0.30-0.99, p = 0.045) and moderate/high medication-related burden (AOR: 0.33, 95% CI: 0.16-0.69, p = 0.003) were associated with lower odds of medication adherence. Conclusion: These findings suggest that to improve the preventive and optimal care of patients with T2DM and hypertension, interventions that aim to reduce medication-related burden and morbidity are recommended. The study proposes that health stakeholders such as clinicians, pharmacists, and policy makers, develop multidisciplinary clinical and pharmaceutical care interventions to include provision of counselling to patients on adherence. In addition, developing policies and sensitization activities on deprescribing and fixed-dose drug combinations aimed at reducing medication-related burden, while promoting better adherence, blood pressure and blood glucose outcomes are recommended.

Maternal factors and child health conditions at birth associated with preterm deaths in a tertiary health facility in Ghana: A retrospective analysis.

Background: Preterm birth continues to be a leading cause of death for children under the age of 5 globally. This issue carries significant economic, psychological, and social costs for the families affected. Therefore, it is important to utilize available data to further research and understand the risk factors for preterm death. Objective: The objective of this study was to determine maternal and infant complications that influence preterm deaths in a tertiary health facility in Ghana. Methods: A retrospective analysis of data on preterm newborns was conducted at the neonatal intensive care unit of Korle Bu Teaching Hospital (KBTH NICU) in Ghana, covering the period January 2017 to May 2019. Pearson's Chi-square test of association was used to identify factors that were significantly associated with preterm death after admission at the NICU. The Poisson regression model was used to determine the risk factors of preterm death before discharge after admission to the NICU. Results: Of the 1,203 preterm newborns admitted to the NICU in about two and half years, 355 (29.5%) died before discharge, 7.0% (n = 84) had normal birth weight (>2.5 kg), 3.3% (n = 40) had congenital anomalies and 30.5% (n = 367) were born between 34 and 37 gestational week. All 29 preterm newborns between the 18-25 gestational week died. None of the maternal conditions were significant risk factors of preterm death in the multivariable analysis. The risk of death at discharge was higher among preterm newborns with complications including hemorrhagic/hematological disorders of fetus (aRRR: 4.20, 95% CI: [1.70-10.35], p = 0.002), fetus/newborn infections (aRRR: 3.04, 95% CI: [1.02-9.04], p = 0.046), respiratory disorders (aRRR: 13.08, 95% CI: [5.50-31.10], p < 0.001), fetal growth disorders/restrictons (aRRR: 8.62, 95% CI: [3.64-20.43], p < 0.001) and other complications (aRRR: 14.57, 95% CI: [5.93-35.77], p < 0.001). Conclusion: This study demonstrate that maternal factors are not significant risk factors of preterm deaths. Gestational age, birth weight, presence of complications and congenital anomalies at birth are significantly associated with preterm deaths. Interventions should focus more on child health conditions at birth to reduce the death of preterm newborns.

Prevalence of common adverse events experienced following COVID-19 vaccination and its associated factors in Ghana: Cross-sectional study design.

Background and Aims: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) pandemic devasted the general life of people and various human activities across the globe, and Ghana is of no exception. This led to development of vaccines within record time to combat morbidity and mortality associated with the virus. In Ghana, COVID-19 vaccines were introduced in addition to existing COVID-19 protocols. However, the vaccines have adverse events among those who received them. In this study, we determined the prevalence of some common adverse events of the COVID-19 vaccines and its associated sociodemographic factors in Ghana. Methods: An online snowball cross-sectional survey was conducted between April and June 2021 among 240 people who had taken at least one dose of any of the COVID-19 vaccines approved in Ghana. The penalized binary logistic regression model was used to assess the factors associated with experience of at least one adverse event and the experience of number of adverse events using Stata version 16. Results: Among the 240 participants, 88.2% had experienced at least one adverse event. The most common adverse event after the first dose was pain at injection site (65.8%), headache (57.5%), tiredness (55.8%), fever (51.7%), chills (39.6%), and muscle pains (38.3%). Experience of adverse events was 16 times higher among those who took their vaccines in Ghana (adjusted odd ratio [AOR]: 16.2, 95% confidence interval [CI]: 1.98-132.56, p = 0.009), 94% less among those who took AstraZeneca (India) compared to AstraZeneca (Oxford) (AOR: 0.06, 95% CI: 0.01-0.37, p = 0.002) and 86% less among 40-49 years compared with less than 30 years old (AOR: 0.14, 95% CI: 0.03-0.58, p = 0.007). Conclusion: Pain at the injection site, headache, tiredness, fever, chills, and muscle pains were the most frequently reported adverse events. The study identified country of vaccination, country of origin of AstraZeneca vaccine and age to be associated with adverse events of vaccination.

Impact evaluation of long-lasting insecticidal nets distribution campaign on malaria cases reported at outpatient departments across all the regions in Ghana.

BACKGROUND: Malaria remains the biggest public health challenge globally, and Ghana is among the 15 highest burden malaria countries in the world, with 2% of global malaria cases and 3% deaths in 2019. This study sought to assess the impact of mass LLIN distribution campaign on malaria morbidity using all health facilities outpatient data across 15 regions of Ghana. METHODS: Data for this study was obtained from the DHIMS2 for health facilities providing OPD and malaria services in Ghana. This was an ecological study that employed the difference-in-difference approach to assess the change in proportion of uncomplicated confirmed malaria cases among OPDs in all types of health facilities in Ghana between 2015 and 2019 following the mass distribution campaign of LLINs in 2018. Malaria cases at the OPDs before and after the free LLIN mass distribution exercise were evaluated. RESULTS: The trend of the proportion of OPD cases that were confirmed uncomplicated malaria cases increased from 14.8% in 2015 to 18.9% in 2019 at the national level. The average proportion of malaria cases among OPDs in Ghana in 2019 reduced against the expected by - 3.76% (95% CI - 4.69 to - 2.84], p<0.001) among all cases, - 4.52% (95% CI [- 5.70 to - 3.34], p<0.001) among children under-fives years, - 4.10% (95% CI - 5.3 to 2.9], p<0.001) among female children under-five and - 5.18% (95% CI [- 6.33 to - 4.02], p<0.001) among male children under-five. The reduction on the average proportion of malaria cases among OPDs varied significantly across regions and the type of health facilities. CONCLUSION: The mass distribution of LLINs across Ghana in 2018 can be associated with reduction in the proportion of malaria cases among OPDs across health facilities in Ghana. The study recommends the biannual mass distribution campaigns especially in the high-density regions.

Chronic comorbidities in persons living with HIV within three years of exposure to antiretroviral therapy at Pantang Antiretroviral Center in Ghana: a retrospective study.

Introduction: uptake of antiretroviral therapy (ART) and retention in care are associated with increased life expectancy but increased the risk of comorbid conditions in persons living with HIV (PLWH) and taking antiretroviral drugs. This study describes comorbid conditions among PLWH in Ghana. Methods: PLWH (n=222) out of a sample population of 900, randomly selected at Pantang ART Center participated in the study from June to July of 2020. Socio-demographic characteristics, HIV biomarkers, medication type and adherence, and diagnostic confirmed chronic conditions were extracted from medical records of PLWH. Cox proportional-hazard models and Kaplan-Meier curves graphing risk of experiencing comorbid conditions were performed. Log-rank test was performed at p<0.05. Results: fifty three point two percent of PLWH (222) experienced a comorbid condition including, respiratory conditions (17.6%), anaemia (12.2%), hypertension (12.2%), cardiovascular diseases (10.8%),and neurological conditions (10.8%).Factors associated with some of these conditions were medication adherence (aHR=0.43, 95% CI: 0.21-0.90) and visual changes (aHR=2.64, 95% CI: 1.08-6.45) for respiratory conditions, age (aHR=10.03, 95% CI; 1.22-82.37) for hypertension, and World Health Organization (WHO) clinical stages (stage II (aHR=13.36, 95% CI=1.54-115.63) and III (aHR=11.71, 95% CI=1.41-97.26))for peripheral neuropathy. Kaplan-Meier curves show significant risk of comorbid conditions for age, CD4 count ≤350 cells/mm2, WHO clinical stages III and IV, and ART non-adherence. Conclusion: understanding the types of comorbidities in PLWH is integral to providing feedback to primary care providers to monitor.

Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services.

INTRODUCTION: There are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women's, Children's and Adolescents' Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation. METHODS: Monthly routine health facility data by district for the period 2017-2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020. RESULTS: The completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March-December 2020 was 3.9% (range: -8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=-17.0%) and outpatient admissions (median=-7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from -2% to -6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March-June 2020 for general services, when the response was strongest as measured by a stringency index. CONCLUSION: The district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.

Impact of insecticide-treated nets and indoor residual spraying on self-reported malaria prevalence among women of reproductive age in Ghana: implication for malaria control and elimination.

BACKGROUND: The Global Fund alone contributed 56% of all international financing for malaria and has invested more than US$13.5 billion in malaria treatment, prevention, and control programmes by June 2021. These investments include interventions such as mosquito nets, indoor residual spraying, and preventive treatment for children and pregnant women. However, there is paucity of studies for assessment of such investments to a reduction in malaria prevalence. This study was aimed at quantifying the impact of household access to insecticide-treated nets (ITNs) and the indoor residual spraying (IRS) on self-reported malaria prevalence among women of reproductive age in Ghana. METHODS: The study analysed the 2016 Ghana Malaria Indicator Survey (MIS) data. The MIS is a nationwide survey that included women aged 15-49 years. Poisson regression model with inverse probability to treatment weighting was used to determine average treatment effect estimate of the two malaria interventions on self-reported malaria prevalence among women of reproductive age in Ghana. RESULTS: A total sample of 4861 women interviewed from the 2016 Ghana MIS was used for analysis. The prevalence of self-reported malaria in 2016 was 34.4% (95% CI [32.4%, 36.4%]). Approximately 80.0% of women lived in households with access to ITNs [Percentage (Pr) = 79.9%, (95% CI [78.0%, 81.7%])], 12.4% (95% CI [7.5%, 19.8%]) of the households had access to IRS and 11.4% (95% CI [7.0%, 18.0%]) of the households had access to both ITNs and IRS. Household access to only ITN contributed to 7.1 percentage point (pt) reduction in the self-reported malaria among women (95% CI [- 12.0%, - 2.1%], p = 0.005) whilst IRS at the households contributed to 6.8pt reduction in malaria prevalence (95% CI [- 12.0%, - 2.1%], p = 0.005). Households with access to both ITNs and IRS contributed to a 27.1pt reduction in self-reported malaria prevalence among women (95% CI [- 12.0%, - 2.1%], p = 0.005). CONCLUSION: Access to both ITNs and application of IRS at the household level contributed to a significant reduction in self-reported malaria prevalence among women of reproductive age in Ghana. This finding confirms the need for integration of malaria control interventions to facilitate attainment of malaria elimination in Ghana.

Childhood tuberculosis and factors associated with mortality and loss to follow-up at a major paediatric treatment centre in Southern Ghana.

Introduction: tuberculosis (TB) is a major cause of morbidity and mortality in children in low- and middle-income countries. This study described the clinical presentation and identified factors contributing to poor outcome of childhood TB at Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Methods: this was a retrospective cohort study of children aged ≤ 14 years with TB registered for treatment at KBTH from 2015 to 2019. Treatment outcomes were recorded as treatment success and unsuccessful outcomes (died and loss to follow-up). Multivariable logistics regression was conducted to assess factors associated with an unsuccessful outcome. Results: of 407 children with TB registered during the period, 269 (66.1%) patients had pulmonary tuberculosis (PTB). Of the 138 patients with extra-pulmonary TB (EPTB), 68 (49.3%) had TB lymphadenitis. The TB/HIV coinfection rate was 42.8%. The overall treatment success rate was 68.3%, whilst 71(17.4%) died, and 58 (14.3%) were lost to follow-up. Factors associated with death were age below 1 year (AOR: 3.46, 95% CI: 1.48-8.10, p=0.004) and having HIV coinfection (AOR: 1.89, 95% CI: 1.04-3.43, p=0.037). Factors associated with loss to follow-up were age below 1 year (AOR: 2.91, 95% CI: 1.12-8.59, p=0.029) and having EPTB (AOR: 2.40, 95% CI: 1.24-4.65, p=0.009). Conclusion: childhood TB treatment success in our population was below the national target of 85%, with high mortality and loss to follow-up rates, especially in younger children and those with HIV coinfection or EPTB. Tailored treatment strategies may be needed for children at risk of unsuccessful treatment outcome, especially among infants.

Determinants of blood pressure and blood glucose control in patients with co-morbid hypertension and type 2 diabetes mellitus in Ghana: A hospital-based cross-sectional study.

Hypertension and diabetes are major risk factors for cardiovascular diseases and optimal control of blood pressure (BP) and blood glucose are associated with reduced cardiovascular disease events. This study, therefore, sought to estimate the prevalence and associated factors of controlled BP and blood glucose levels among patients diagnosed with both hypertension and Type 2- diabetes mellitus (T2DM). A quantitative cross-sectional study was conducted in a primary health setting in Ghana among patients 18 years and older diagnosed with both hypertension and T2DM. Pearson's chi-square was used to assess the association between BP and blood glucose levels and the independent variables. The multivariable binary logistic regression model was used to assess the adjusted odds of controlled BP and blood glucose levels. Among the 329 participants diagnosed with both hypertension and T2DM, 41.3% (95% CI: 36.1-46.8%) had controlled BP, 57.1% (95% CI: 51.7-62.4%) had controlled blood glucose whilst 21.8% (95% CI: 17.7-26.7%) had both controlled BP and blood glucose levels. Increased age, non-formal education, non-married, employed, single-dose anti-hypertensives or anti-diabetic medications, and hyperlipidaemia or stroke co-morbidities were positively associated with controlled BP levels. Being female, married, taking 2 or more anti-hypertensive medications, and moderate to high medication-related burden were positively associated with controlled blood glucose levels. In terms of both controlled BP and blood glucose levels, being employed, reduced income level, being registered with national health insurance, single anti-diabetes or anti-hypertensive medications, hyperlipidaemia or stroke co-morbidities, and moderate to high medication-related burden were positively associated with having both controlled BP and blood glucose levels. One in five patients with hypertension and T2DM had both BP and blood glucose levels under control. The benefits and risks of blood pressure and blood glucose targets should thus be factored into the management of patients with hypertension and T2DM.

An 11-year trend of rubella incidence cases reported in the measles case-based surveillance system, Ghana.

INTRODUCTION: rubella is vaccine-preventable and vaccination is the most cost-effective approach to control the disease and avoid the management of congenital rubella syndrome cases. Ghana introduced the rubella vaccine into the routine immunization program in 2013. Since then there have not been any evaluation of the epidemiology of rubella. We determined the disease trends and the population demographics of rubella cases, in the Ghana national measles case-based surveillance system. METHODS: we reviewed the measles case-based surveillance data from 2007 to 2017. Descriptive data statistics was done and expressed as frequencies and proportions. Chi-square test was used to establish associations. RESULTS: a total of 11,483 suspected cases for measles received and tested for measles IgM antibodies and 1,137(12.98%) confirmed positive for the period. Of these 10,077 were negative and 250 indeterminate for measles and tested for rubella and 2,090 (20.23%) confirmed positive for rubella IgM antibodies. More females (21.45%) were affected than males (19.48%). Majority of the confirmed positives were recorded in the urban areas. Children aged 15 years or less were mostly affected. There was a statistical difference between incidence cases and sex (χ2=6.03, p-value = 0.014), or age (χ2=283.56, p-value < 0.001) or area (χ2= 6.17, p-value = 0.013). Most infections occurred during the dry season. CONCLUSION: children less than 15 years were mostly affected with majority being females. The highest incidence of cases was before the rains and occurred mostly in urban areas. The incidence of cases has declined significantly with the introduction of the rubella vaccine.

HIV virological non-suppression and its associated factors in children on antiretroviral therapy at a major treatment centre in Southern Ghana: a cross-sectional study.

BACKGROUND: Children living with human immunodeficiency virus (HIV) infection require lifelong effective antiretroviral therapy (ART). The goal of ART in HIV-infected persons is sustained viral suppression. There is limited information on virological non-suppression or failure and its associated factors in children in resource limited countries, particularly Ghana. METHODS: A cross-sectional study of 250 children aged 8 months to 15 years who had been on ART for at least 6 months attending the Paediatric HIV clinic at Korle Bu Teaching hospital in Ghana was performed. Socio-demographic, clinical, laboratory and ART Adherence related data were collected using questionnaires as well as medical records review. Blood samples were obtained for viral load and CD4+ count determination. Viral load levels > 1000 copies/ml on ART was considered virological non-suppression. Logistic regression was used to identify factors associated with virological non-suppression. RESULTS: The mean (±SD) age of the study participants was 11.4 ± 2.4 years and the proportion of males was 53.2%. Of the 250 study participants, 96 (38.4%) had virological non-suppression. After adjustment for significant variables, the factors associated with non-suppressed viral load were female gender (AOR 2.51 [95% CI 1.04-6.07], p = 0.041), having a previous history of treatment of tuberculosis (AOR 4.95 [95% CI 1.58-15.5], p = 0.006), severe CD4 immune suppression status at study recruitment (AOR 24.93 [95% CI 4.92-126.31], p < 0.001) and being on a nevirapine (NVP) based regimen (AOR 7.93 [95% CI 1.58-1.15], p = 0.005). CONCLUSION: The prevelance of virological non-suppression was high. Virological non-suppression was associated with a previous history of TB treatment, female gender, severe CD4 immune suppression status at study recruitment and being on a NVP based regimen. Early initiation of ART and phasing out NVP-based regimen might improve viral load suppression in children. In addition, children with a history of TB may need focused measures to maximize virological suppression.

Treatment outcomes among children treated for uncomplicated severe acute malnutrition: a retrospective study in Accra, Ghana.

OBJECTIVES: The objectives of the study were to describe outcomes of children with uncomplicated severe acute malnutrition (SAM) attending community-based management of acute malnutrition (CMAM) treatment centres in Accra Metropolitan Area (AMA) and explore factors associated with non-adherence to clinic visits and defaulting from the treatment programme. DESIGN: A retrospective cohort study analysing routinely collected data on children with uncomplicated SAM enrolled into CMAM in 2017 was conducted. SETTING: Study was conducted at seven sites comprising Princess Marie Louise Children's Hospital, three sub-metropolitan health facilities and three community centres, located in five sub-metropolitan areas in AMA. PARTICIPANTS: Children with uncomplicated SAM aged 6-59 months, enrolled from community-level facilities (pure uncomplicated SAM, PUSAM) or transferred after completing inpatient care (post-stabilisation uncomplicated SAM, PSSAM), participated in the study. RESULTS: Out of 174 cases studied (105 PUSAM, sixty-nine PSSAM), 56·3 % defaulted, 34·5 % recovered and 8·6 % were not cured by 16 weeks. No deaths were recorded. Mid-upper arm circumference (MUAC) increased by 2·2 (95 % CI 1·8, 2·5) mm/week with full compliance and 0·9 (95 % CI 0·6, 1·2) mm/week with more than two missed visits. In breast-feeding children, MUAC increased at a slower rate than in other children by 1·3 (95 % CI 1·0, 1·5) mm/week. Independent predictors of subsequent missed visits were diarrhoea and fever, while children with MUAC < 110 mm on enrolment were at increased risk of defaulting. CONCLUSION: A high default rate and a long time to recovery are challenges for CMAM in AMA. Efforts must be made to improve adherence to treatment to improve outcomes.

Understanding the determinants of infant and under-five mortality rates: a multivariate decomposition analysis of Demographic and Health Surveys in Ghana, 2003, 2008 and 2014.

INTRODUCTION: Despite the decline in infant and under-five mortality rates since the last decade, Ghana did not meet the millennium development goal (MDG) 4 target. To implement effective interventions that could fast-track progress towards achieving the sustainable development goal 3 in 2030, factors contributing to the decline in child mortality throughout the MDG period and which factor(s) has/have been consistent in affecting child survival in the last decade need to be understood. METHODS: This study used Demographic and Health Surveys (DHS) from 2003, 2008 and 2014 and data from World Bank Development Indicators (2000-2018). We employed modified Poisson with robust SE and multivariate decomposition approach to assess risk factors of child mortality using DHS data from 2003, 2008 and 2014. Penalised regression was used assess the effect of 25 country-level contextual factors on child survival. RESULTS: The risk of infant mortality is approximately five times higher among mothers who had multiple births compared with mothers who had single birth over the last decade (adjusted relative risk 4.6, 95% CI 3.2 to 6.6, p<0.001). An increase in the annual percentage of female labour force participation (FLFP) is associated with the reduction of approximately 10 and 18 infant and under-five annual deaths per 1000 live births, respectively. CONCLUSIONS: This study found that multiple births and shorter birth spacing are associated with increased risk of infant and under-five deaths over the last decade. Increased in FLFP, and the proportion of children sleeping under bed-net are associated with reduced risk of both infants and under-five deaths.