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1.
West Afr J Med ; 37(3): 281-283, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32476123

RESUMO

BACKGROUND: Ventricular Septal Defect (VSD) is the commonest congenital heart disease. Without appropriate treatment, it is associated with significant morbidity and mortality. Surgical repair under cardiopulmonary bypass has been the standard treatment. Results of such treatment is not readily available from the West African sub region. We analysed the outcome of surgical repair of VSDs carried out in this Centre over a 20-year period. PATIENTS AND METHODS: A retrospective study was done for all patients who had surgical repair of VSD from January 1993 to December 2012. RESULTS: There were a total of 207 patients, with 6 and 23 of them operated on in the first and last years of the study respectively. There were 121 (58.5%) males and 86 (41.5%) females. The mean age was 10.0 ± 10.5 (11 months - 55 years), with a median of 7 years. The modal class interval was 0 - 5 years (46.4%). Most of the VSDs were perimembranous 168 (81.1%), followed by outlet VSDs 19 (9.2%), muscular VSDs 11 (5.3%) and inlet VSDs 9 (4.4%). Fifty-four cases (26%) had associated congenital cardiac anomalies that needed concomitant surgical intervention, with the commonest being Pulmonary Stenosis (PS) 21 (10.1%), followed by Patent Ductus Ateriosus (PDA) 10 (4.8%). The complication rate was 6.4% (13 cases), comprising a morbidity of 4.4 % (9 cases) and early mortality of 2.0% (4 cases). The morbidity was due to bleeding requiring re-exploration 2 (1.0%), residual VSD requiring re-do 3 (1.4%), complete heart block requiring permanent pacemaker implantation 2 (1.0%), acute renal failure requiring dialysis 1 (0.5%), sternal wound infection requiring debridement 1 (0.5%). The mortality was due to pulmonary hypertension. CONCLUSION: With a morbidity of 4.4% and early mortality of 2.0%, the outcome of surgical repair of VSDs from this study is good. Children with VSDs must be offered repair as soon as possible to avoid the numerous complications that usually follow untreated VSDs.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Septos Cardíacos/cirurgia , Hipertensão Pulmonar/complicações , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Gana/epidemiologia , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
Bull World Health Organ ; 98(6): 382-393, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32514212

RESUMO

Objective: To develop a method to assess the cost of extending the duration of maternity leave for formally-employed women at the national level and apply it in Brazil, Ghana and Mexico. Methods: We adapted a World Bank costing method into a five-step method to estimate the costs of extending the length of maternity leave mandates. Our method used the unit cost of maternity leave based on working women's weekly wages; the number of additional weeks of maternity leave to be analysed for a given year; and the weighted population of women of reproductive and legal working age in a given country in that year. We weighted the population by the probability of having a baby that year among women in formal employment, according to individual characteristics. We applied nationally representative cross-sectional data from fertility, employment and population surveys to estimate the costs of maternity leave for mothers employed in the formal sector in Brazil, Ghana and Mexico for periods from 12 weeks up to 26 weeks, the WHO target for exclusive breastfeeding. Findings: We estimated that 640 742 women in Brazil, 33 869 in Ghana and 288 655 in Mexico would require formal maternity leave annually. The median weekly cost of extending maternity leave for formally working women was purchasing power parity international dollars (PPP$) 195.07 per woman in Brazil, PPP$ 109.68 in Ghana and PPP$ 168.83 in Mexico. Conclusion: Our costing method could facilitate evidence-based policy decisions across countries to improve maternity protection benefits and support breastfeeding.


Assuntos
Aleitamento Materno/economia , Licença Parental/economia , Mulheres Trabalhadoras , Brasil , Estudos Transversais , Feminino , Gana , Humanos , México , Modelos Econométricos , Fatores Socioeconômicos
5.
J Gerontol Soc Work ; 63(4): 254-256, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32326853

RESUMO

Undoubtedly, the ongoing COVID-19 pandemic has brought both systemic, practice changes and limitations to social workers' commitment to the welfare of vulnerable populations such as older people. A golden preventive rule of the COVID-19 pandemic; maintaining physical and social distancing, has limited social workers' direct practice support for older people who are considered as an at-risk population. Within jurisdictions such as Ghana where kinship care practices are culturally engrained, social workers should promote kinship care support as substitute mechanisms and pathways to safeguard or meet the welfare needs of older people.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Apoio Social , Serviço Social/organização & administração , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/transmissão , Gana/epidemiologia , Humanos , Pandemias , Pneumonia Viral/transmissão , Fatores de Risco
6.
Mar Pollut Bull ; 153: 110998, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32275547

RESUMO

We present data on the occurrence of microplastics in fish from the Guinea current region off Ghana's Coast. Frequency of occurrence of microplastics in the fish species followed the order: Sardinella maderensis (41%) > Dentex angolensis > (33%) > Sardinella aurita (26%). Mean numbers of microplastics ingested were 40.0 ± 3.8, 32.0 ± 2.7 and 25.7 ± 1.6 for S. maderensis, D. angolensis and S. aurita respectively. Industrially produced pellets were the most dominant (31%) microplastic type followed by microbeads (29%), burnt film plastics (22%) and unidentified fragments (9%). Microfibers (2%), threads (2%) and foams (<0.1%) were the least occurring microplastics in the fish species. Condition factors estimated for D. angolensis and S. aurita were >1 and below 1 for S. maderensis. The findings of the study show the common occurrence of microplastics in fish stocks and pave the way for future studies on microplastics in this Region.


Assuntos
Monitoramento Ambiental , Peixes , Microplásticos , Poluentes Químicos da Água , Animais , Oceano Atlântico , Gana , Plásticos
7.
Chemosphere ; 254: 126845, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32334242

RESUMO

Registration of pesticides for use in Ghana is based on prospective environmental risk assessment (ERA) to assess the risks of future pesticide use on the environment. The present study evaluated whether pesticides currently used by Ghanaian farmers may harm the aquatic and terrestrial environment under day-to-day farm practice by performing a 1st tier ERA for terrestrial and aquatic environment and a 2nd tier ERA for the aquatic environment using existing scenarios and models. Results of the 1st tier risk assessment indicated that in the investigated regions in south Ghana, many pesticides might pose an acute risk to aquatic ecosystems adjacent to the treated fields while lambda cyhalothrin, chlorpyrifos, cypermethrin, dimethoate, mancozeb, carbendazim, sulphur, maneb and copper hydroxide may pose the highest chronic risks. Butachlor, dimethoate and carbendazim may pose acute risks to the terrestrial soil ecosystem, while glyphosate, chlorpyrifos, imidacloprid, dimethoate, mancozeb, carbendazim, maneb, copper hydroxide and cuprous oxide may pose the highest chronic risks. Many insecticides and some fungicides may pose acute risks to bees and terrestrial non-target arthropods. The 2nd tier acute aquatic risk assessment showed that most risks were substantiated using species sensitivity distribution (SSD). Actual pesticide use was a factor of 1.3-13 times higher than the recommended label instructions, indicating a general practice of overdosing. The case study shows that the PRIMET model in combination with the SSD concept may offer pesticide registration authorities in Ghana a means to assess environmental risks associated with pesticide usage in a user-friendly and cost-effective manner.


Assuntos
Monitoramento Ambiental , Poluentes Ambientais/análise , Praguicidas/análise , Animais , Abelhas , Ecossistema , Fazendeiros , Fungicidas Industriais , Gana , Inseticidas , Neonicotinoides , Nitrilos , Nitrocompostos , Estudos Prospectivos , Piretrinas , Medição de Risco , Solo
8.
PLoS Negl Trop Dis ; 14(4): e0007973, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32339185

RESUMO

BACKGROUND: This paper reports on the baseline prevalence and associated risk factor findings of a pilot, longitudinal study exploring community-wide treatment of schistosomiasis and soil-transmitted helminthiasis, using albendazole plus praziquantel in the Greater Accra region of Ghana. METHOD: From three communities, at least, 658 individuals were enrolled into the study via random household selection. Prevalence and intensity of schistosomiasis and STH infection were determined from stool and urine samples with a questionnaire being administered in order to explore other morbidities and risk factors. Factor analysis of household demographic variables was undertaken to generate a socioeconomic score; this was then further categorised into tertiles. Proportional-odds cumulative logit generalised estimating equation (GEE) models were used to investigate categorical ordinal intensity of infection associations with morbidity. Separately, logistic GEE models were used to investigate risk factor associations with infection prevalence. RESULTS: Both Schistosoma haematobium and S. mansoni were prevalent in the three communities, with the prevalence of S. haematobium ranging from 3.3% (24/679; 95% CI = 1.9-4.7) to 19% (114/632; 95% CI = 15.8-22.2) and S. mansoni ranging from 30% (202/679; 95% CI = 26.5-33.5) to 78.3% (409/536; 95% CI = 74.7-81.9). The total prevalence of STH across all three sites was negligible at 1.3% (24/1847; 95% CI = 0.8-1.9) comprising mainly hookworm (10/1847). Multivariable statistical models indicated males to be 2.3 (95% CI = 1.7-3.3) times more likely to have a high intensity S. mansoni infection and 1.5 (95% CI = 1.1-2) times more likely to have a high intensity of S. haematobium infection compared to females. There was no significant difference in the likelihood of infection with S. mansoni between adults and school age children (SAC), however S. haematobium infections were found to be 2.5 (95% CI = 1.8-3.5) times more likely to occur in school age children than in adults. Multivariable statistical models (adjusted for age and sex) indicated an association between schistosomiasis and a number of self-reported morbidity indicators (notably diarrhoea and blood in stool and urine). Low socio-economic status was also associated with SCH infection (OR: 2; 95% CI = 1.3-3.2). CONCLUSION: The communities targeted by this study showed a range of Schistosoma prevalence's of infection, from hypo-endemic through to meso-endemic and hyper-endemic. The prevalence of SCH across the different age groups in the study locations highlights the large number of individuals currently being left out of the standard morbidity control method of annual treatment of the SAC.


Assuntos
Esquistossomose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Anti-Helmínticos/administração & dosagem , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/métodos , Demografia , Transmissão de Doença Infecciosa/prevenção & controle , Fezes/parasitologia , Gana/epidemiologia , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Administração Massiva de Medicamentos/métodos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Esquistossomose/prevenção & controle , Urina/parasitologia , Adulto Jovem
9.
PLoS One ; 15(4): e0230117, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32302319

RESUMO

BACKGROUND: Regardless of the importance of preschool vision screening (PSVS), there is limited data on the current state of these programs in Africa (particularly Ghana). This study sought to investigate the level of awareness and perception of stakeholders regarding PSVS, its availability and related policies/programmes in the Kumasi Metropolis, Ghana. METHODS: This descriptive cross-sectional study included 100 systematically sampled preschools in the metropolis (using probability proportional-to-size method); 72 private schools and 28 public schools. Convenience sampling was used to recruit stakeholders of preschools (teachers, head teachers, proprietors, administrators, directors, and educationists), and were interviewed using a well-structured questionnaire. Questionnaires were administered to all eligible respondents who were present at the time of data collection. RESULTS: A total of 344 respondents participated in the study; 123 (35.8%) males and 221 (64.2%) females. The overall mean age of respondents was 37.63 ±12.20 years (18-71 years). Of the respondents, 215 (62.5%), 94 (27.3%), and 35 (10.2%) were enrolled from private schools, public schools, and Metropolitan Education Directorate, respectively. 73.8% of respondents reported the absence of routine PSVS in schools whereas 90.1% reported no written policies for PSVS in schools. Only 63.6% of respondents were aware of PSVS whereas more than half (59.6%) of all respondents perceived PSVS to be very important for preschoolers. Private school ownership was significantly associated with availability of PSVS whereas age, teachers, private school ownership, and preschool experience > 10 years were significantly associated with awareness of PSVS (P < 0.05). However, there was no significant association between sociodemographic factors and perception of PSVS. CONCLUSION: PSVS is largely unavailable in most Ghanaian schools. Majority of stakeholders were aware of PSVS and agreed to its implementation and incorporation into schools' health programmes. There is the need to implement a national programme/policy on preschool vision screening in Ghana.


Assuntos
Serviços de Saúde Escolar , Instituições Acadêmicas , Inquéritos e Questionários , Seleção Visual , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Gana , Humanos , Masculino , Pessoa de Meia-Idade , Participação dos Interessados
10.
BMC Infect Dis ; 20(1): 301, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321418

RESUMO

BACKGROUND: In Ghana, pre-school-aged children (PSAC) are at risk of intestinal schistosomiasis and are living in need of praziquantel treatment. To better assess the infection burden within this vulnerable demographic group, we have provided a comparative assessment of the prevalence of Schistosoma mansoni in pre-school-aged children by urine circulating cathodic antigen (CCA) dipsticks, real-time PCR Taqman® faecal assays and Kato-Katz coproscopy. METHODS: In all, 190 pre-school-aged children were sampled from three endemic communities (viz. Tomefa, Torgahkope/Adakope, and Manheam) around Weija dam, Southern Ghana. Fresh stool and urine samples were collected from all participants for diagnosis. RESULTS: Among all the three communities, the urine-CCA assay recorded the highest prevalence values of 90.5% (95% CI 80.4-96.4), 87.9% (95% CI 76.7-95), and 81.2% (95% CI 69.9-89.6) in Tomefa, Torgahkope/Adakope, and Manheam respectively. Prevalence by real-time PCR was 50% (95% CI 35.5-64.5), 8% (95% CI 2.2-19.2) and 16.7% (95% CI 8.3-28.5), while by Kato-Katz was 55.6% (95% CI 42.5-68.1), 8.6% (95% CI 2.9-19) and 11.6% (95% CI 5.1-21.6) respectively. Children aged 1 year and over were found to be positive with the urine-CCA assay; by the ages of 3-4, over 50% were urine-CCA patent. The sensitivity and specificity of the POC-CCA dipsticks, when compared against the combined results of Kato-Katz/TaqMan results was found to be 84.1% (95% CI = 72.7-92.1) and 12.9% (95% CI = 6.6-22) respectively. CONCLUSIONS: We propose that the urine-CCA dipstick may be a useful rapid diagnostic tool to estimate the prevalence of intestinal schistosomiasis in PSAC, particularly in rapid identification of at-risk areas. However, our assessment has shown that it possible to record false positives when compared to combined Kato-Katz and qPCR results. To guide PSAC praziquantel treatment needs, we propose the urine CCA assay should be included in routine surveillance of intestinal schistosomiasis alongside other diagnostics such as Kato-Katz and urine filtration.


Assuntos
Antígenos de Helmintos/urina , Testes Diagnósticos de Rotina/métodos , Fezes/parasitologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Esquistossomose mansoni/diagnóstico , Urinálise/métodos , Animais , Antígenos de Helmintos/análise , Bioensaio/métodos , Líquidos Corporais/química , Líquidos Corporais/imunologia , Líquidos Corporais/parasitologia , Pré-Escolar , Fezes/química , Feminino , Gana/epidemiologia , Humanos , Lactente , Masculino , Sistemas Automatizados de Assistência Junto ao Leito , Praziquantel/uso terapêutico , Prevalência , Schistosoma mansoni/genética , Schistosoma mansoni/imunologia , Schistosoma mansoni/isolamento & purificação , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/parasitologia , Esquistossomose mansoni/urina , Sensibilidade e Especificidade
11.
Infect Dis Poverty ; 9(1): 26, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32160927

RESUMO

BACKGROUND: Yaws is a chronic relapsing disease caused by Treponema pallidum subspecies pertunue, which can result in severe disability and deformities. Children below the age of 15 years in resource-poor communities are the most affected. Several non-specific factors facilitate the continuous transmission and resurgence of the disease. Endemic communities in rural Ghana continue to report cases despite the roll out of several intervention strategies in the past years. The objective of this study was to determine the factors associated with cutaneous ulcers among children in two yaws-endemic districts in Ghana. METHODS: A community-based unmatched 1:2 case-control study was conducted among children between 1 and 15 years. Data on socio-demographic, environmental and behavioral factors were collected using a structured questionnaire. Active case search and confirmation was done using the Dual Path Platform (DPP) Syphilis Screen and Confirm test kit. Data were analyzed using STATA 15. Logistic regression was done to determine the exposures that were associated with yaws infection at 0.05 significant level. RESULTS: Sixty-two cases and 124 controls were recruited for the study. The adjusted multivariable logistic regression model showed that yaws infection was more likely among individuals who reside in overcrowded compound houses (aOR = 25.42, 95% CI: 6.15-105.09) and with poor handwashing habits (aOR = 6.46, 95% CI: 1.89-22.04). Male (aOR = 4.15, 95% CI: 1.29-13.36) and increasing age (aOR = 5.90, 95% CI: 1.97-17.67) were also associated with yaws infection. CONCLUSIONS: Poor personal hygiene, overcrowding and lack of access to improved sanitary facilities are the factors that facilitate the transmission of yaws in the Awutu Senya West and Upper West Akyem districts. Yaws was also more common among males and school-aged children. Improving living conditions, access to good sanitary facilities and encouraging good personal hygiene practices should be core features of eradication programs in endemic communities.


Assuntos
População Rural , Úlcera Cutânea/microbiologia , Treponema pallidum/isolamento & purificação , Bouba , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Aglomeração , Doenças Endêmicas , Feminino , Gana/epidemiologia , Humanos , Higiene , Lactente , Masculino , Vigilância da População , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/epidemiologia , Inquéritos e Questionários , Sorodiagnóstico da Sífilis , Bouba/diagnóstico , Bouba/epidemiologia , Bouba/prevenção & controle , Bouba/transmissão
12.
PLoS One ; 15(3): e0230139, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155217

RESUMO

The literature on spatial patterns and contextual factors affecting modern contraceptive use is not well-documented in Ghana. This study describes the spatial variations and estimates the socioeconomic determinants of modern contraception among women in reproductive age in Ghana. Using data from the 2014 Ghana Demographic and Health Survey, both global and local Moran's I test were performed to show spatial autocorrelation and Bayesian multilevel models estimated to determine socioeconomic factors affecting modern contraceptive use. The results show evidence of low prevalence and spatial clustering of modern contraception use across the country. There were also notable regional disparities in contraceptive use that favour mostly the southern regions. Modern contraceptive use is significantly associated with socioeconomic factors such as educational attainment, work status, and marital status, as well as age, religious affiliation, and parity. Contextual factors such as the convenient location of health facility and family planning messages exposure also have a considerable positive effect on modern contraceptive use. Uneducated, unemployed and never-married women are considerably disadvantaged in the utilisation of modern contraception in Ghana. Socioeconomic and contextual factors play a key role in modern contraceptive use in Ghana.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Adolescente , Adulto , Teorema de Bayes , Demografia/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Gana/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos/métodos , Humanos , Estado Civil , Pessoa de Meia-Idade , Análise Multinível , Paridade , Prevalência , Fatores Socioeconômicos
13.
PLoS One ; 15(3): e0230604, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32191768

RESUMO

BACKGROUND: Ghana's national prevalence survey showed higher than expected tuberculosis (TB) prevalence, indicating that many people with TB are not identified and treated. This study aimed to identify gaps in the TB diagnostic cascade prior to starting treatment. METHODS: A prospective cohort study was conducted in urban and rural health facilities in south-east Ghana. Consecutive patients routinely identified as needing a TB test were followed up for two months to find out if sputum was submitted and/or treatment started. The causal effect of health facility location on submitting sputum was assessed before risk factors were investigated using logistic regression. RESULTS: A total of 428 persons (mean age 48 years, 67.3% female) were recruited, 285 (66.6%) from urban and 143 (33.4%) from rural facilities. Of 410 (96%) individuals followed up, 290 (70.7%) submitted sputum, among which 27 (14.1%) had a positive result and started treatment. Among those who visited an urban facility, 245/267(91.8%) submitted sputum, compared to 45/143 (31.5%) who visited a rural facility. Participants recruited at the urban facility were far more likely to submit a sputum sample (odds ratio (OR) 24.24, 95%CI 13.84-42.51). After adjustment for confounding, there was still a strong association between attending the urban facility and submitting sputum (adjusted OR (aOR) 9.52, 95%CI 3.87-23.40). Travel distance of >10 km to the laboratory was the strongest predictor of not submitting sputum (aOR 0.12, 95%CI 0.05-0.33). CONCLUSION: The majority of presumptive TB patients attending a rural health facility did not submit sputum for testing, mainly due to the long travel distance to the laboratory. Bridging this gap in the diagnostic cascade may improve case detection.


Assuntos
Tuberculose/diagnóstico , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Gana/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/patologia , Instalações de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , População Rural , Escarro/microbiologia , Tuberculose/complicações , Tuberculose/epidemiologia , População Urbana , Adulto Jovem
14.
Int J Biometeorol ; 64(7): 1085-1101, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32130507

RESUMO

Increasing temperature and climate warming impacts are aggravating the vulnerability of workers to occupational heat stress. Adaptation and social protection strategies have become crucial to enhance workers' health, safety, productive capacity and social lives. However, the effective implementation of work-related heat stress adaptation mechanisms appears to be receiving little attention. This study assessed the barriers to occupational heat stress adaptation and social protection strategies of mining workers in Ghana. Based on a mixed methods approach, focus group discussions and questionnaires were used to elicit data from 320 mining workers. Workers' adaptation strategies (water intake, wearing loose and light-coloured clothing, participating in training programmes, taking regular breaks, use of mechanical equipment, use of cooling systems and housing designs) varied significantly across the type of mining activity (p < .001). Workers' social protection measures were adequate. The disparities in workers' social protection measures significantly differed across the type of mining activity (p < .001). Barriers of workers to the implementation of relevant adaptation strategies (inadequate knowledge of coping and adaptive behaviour, lack of regular training on adaptation measures, lack of specific heat-related policy regulations, lack of management commitment and the lack of access to innovative technology and equipment) also differed across the type of mining activity (p < .001). Adaptation policy options and recommendations centred on overcoming the barriers that constrain the adaptive capacity of workers and employers have the potential to reduce workers' vulnerability to occupational heat stress.


Assuntos
Transtornos de Estresse por Calor , Exposição Ocupacional , Aclimatação , Gana , Resposta ao Choque Térmico , Humanos
15.
Value Health ; 23(2): 171-179, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32113622

RESUMO

OBJECTIVES: Universal healthcare coverage in low- and middle-income countries requires challenging resource allocation decisions. Health technology assessment is one important tool to support such decision making. The International Decision Support Initiative worked with the Ghanaian Ministry of Health to strengthen health technology assessment capacity building, identifying hypertension as a priority topic area for a relevant case study. METHODS: Based on guidance from a national technical working group of researchers and policy makers, an economic evaluation and budget impact analysis were undertaken for the main antihypertensive medicines used for uncomplicated, essential hypertension. The analysis aimed to address specific policy questions relevant to the National Health Insurance Scheme. RESULTS: The evaluation found that first-line management of essential hypertension with diuretics has an incremental cost per disability-adjusted life-year avoided of GH¢ 276 ($179 in 2017, 4% of gross national income per capita) compared with no treatment. Calcium channel blockers were more effective than diuretics but at a higher incremental cost: GH¢ 11 061 per disability-adjusted life-year avoided ($7189 in 2017; 160% of gross national income per capita). Diuretics provide better health outcomes at a lower cost than angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or beta-blockers. Budget impact analysis highlighted the potential for cost saving through enhanced price negotiation and increased use of better-value drugs. We also illustrate how savings could be reinvested to improve population health. CONCLUSIONS: Economic evaluation enabled decision makers to assess hypertension medicines in a Ghanaian context and estimate the impact of using such evidence to change policy. This study contributes to addressing challenges associated with the drive for universal healthcare coverage in the context of constrained budgets.


Assuntos
Anti-Hipertensivos/economia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Custos de Medicamentos , Hipertensão Essencial/tratamento farmacológico , Hipertensão Essencial/economia , Medicina Baseada em Evidências/economia , Alocação de Recursos para a Atenção à Saúde/economia , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Formulação de Políticas , Avaliação da Tecnologia Biomédica/economia , Anti-Hipertensivos/efeitos adversos , Orçamentos , Análise Custo-Benefício , Hipertensão Essencial/epidemiologia , Hipertensão Essencial/fisiopatologia , Feminino , Gana/epidemiologia , Nível de Saúde , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento
16.
PLoS One ; 15(3): e0230159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32142549

RESUMO

Adherence to antiretroviral therapy (ART) is essential to achieving an improved cluster of differentiation-4 (CD4) count, viral load, and quality of life while preventing drug resistance. Medication adherence among people living with Human Immunodeficiency Virus (HIV) is influenced by different factors. Several studies have identified adherence promoters and inhibitors that emanate from the internal and external environment. We conducted six (6) individual in-depth interviews and three (3) focus group discussions to explore adherence behaviour among patients diagnosed with HIV in a teaching hospital in Accra, Ghana. Participants were drawn from the intervention arm of a mobile phone adherence intervention program. They had been enrolled in the study for at least six (6) months before the interviews are conducted. Results revealed that participants adhered to treatment irrespective of prompts from significant others. Adherence promoters included perception of ART as part of daily routines, benefits of the ART, awareness of regimen, access to food, and transparency. Adherence inhibitors were forgetfulness, secrecy, waiting time, religious beliefs, and sleep. People living with HIV (PLWHIV) have the personal motivation to take medication; however, negative perceptions about HIV must be addressed to ensure optimum adherence behaviour.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Aconselhamento , Feminino , Grupos Focais , Gana , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Carga Viral , Populações Vulneráveis , Adulto Jovem
17.
PLoS One ; 15(3): e0229683, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163432

RESUMO

INTRODUCTION: Significant number of women present with advanced-stage breast cancer in Ghana. These women usually depend on family caregivers for their multi-dimensional needs. Yet, there are gaps in research about what motivates family caregivers to assume the caring role and their experiences with caregiving within the Ghanaian context. AIM: To explore and describe the caregiving motivations and experiences among family caregivers of patients living with advanced breast cancer. METHODS: In-depth, semi-structured qualitative interviews were conducted with 15 family caregivers who were providing unpaid care for women living with advanced breast cancer. Colaizzi's thematic analysis was used to analyze the data. RESULTS: Family relationship normally prescribed the caregiving role among family caregivers. Due to the lack of home-based palliative services in Ghana, findings suggest that family caregivers are the main managers of advanced breast cancer-related symptoms in the home. These findings are discussed under three major themes: (i) motivation for assuming the caregiving role; (ii) meeting self-care and psychosocial needs of the patient; and (iii) symptom management and monitoring. CONCLUSION: Socio-cultural values influence the role of family caregivers in Ghana. This presents opportunities for health professionals and relevant stakeholders to develop a culturally-appropriate intervention to support informal caregivers in their home-based care for women living with advanced breast cancer in Ghana.


Assuntos
Neoplasias da Mama/terapia , Cuidadores/psicologia , Adulto , Idoso , Neoplasias da Mama/psicologia , Família/psicologia , Relações Familiares/psicologia , Feminino , Gana , Serviços de Assistência Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Cuidados Paliativos , Sistemas de Apoio Psicossocial , Autocuidado
18.
AIDS Care ; 32(sup2): 107-118, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32164440

RESUMO

Person-centred care (PCC) for people living with HIV (PLWH) is a global goal for WHO and the UNAIDS strategy. We aimed to develop a novel person-centred intervention for community providers, test the feasibility of participant recruitment and retention, intervention delivery and to establish acceptability. Findings from qualitative interviews with PLWH and healthcare professionals were mapped onto a PCC theory in an expert intervention development workshop. A parallel feasibility cluster randomised controlled trial (cRCT) was conducted. We randomly assigned clusters (1:1) either to intervention or to standard care. The primary outcome was trial recruitment and retention. We screened 83 PLWH, enrolled 60 with 30 allocated to each arm. Recruitment and retention rates were 87% and 97%, respectively. Potential effect size achieved at final timepoint: a measure of person-centred outcomes [0.7 (95% CI 0.17-1.23) p < 0.001]; MOSHIV [0.7 (95% CI 0.17-1.23) p < 0.001]; Patient Experience Questionnaire [0.8 (95% CI 0.27-1.31) p < 0.001]; CARE Measure [1.0 (95% CI 0.45-1.55) p < 0.001], POSITIVE OUTCOMES [0.7 (95% CI 0.17-1.23) p < 0.001]. Post-trial interviews revealed general acceptability of the intervention. The results confirm the feasibility and justify a definitive cRCT of the enhanced care intervention to improve person-centred outcomes for PLWH.Trial registration number ISRCTN13630241.


Assuntos
Serviços de Saúde Comunitária/métodos , Infecções por HIV/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação do Paciente/psicologia , Satisfação do Paciente , Assistência Centrada no Paciente/organização & administração , Adulto , Pesquisa Participativa Baseada na Comunidade , Assistência à Saúde , Estudos de Viabilidade , Feminino , Gana , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Pessoal de Saúde , Humanos , Entrevistas como Assunto , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pesquisa Qualitativa , Qualidade de Vida , Autocuidado , Inquéritos e Questionários
19.
Lancet Glob Health ; 8(4): e555-e566, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32199123

RESUMO

BACKGROUND: An estimated 5·1 million stillbirths and neonatal deaths occur annually. Household surveys, most notably the Demographic and Health Survey (DHS), run in more than 90 countries and are the main data source from the highest burden regions, but data-quality concerns remain. We aimed to compare two questionnaires: a full birth history module with additional questions on pregnancy losses (FBH+; the current DHS standard) and a full pregnancy history module (FPH), which collects information on all livebirths, stillbirths, miscarriages, and neonatal deaths. METHODS: Women residing in five Health and Demographic Surveillance System sites within the INDEPTH Network (Bandim in Guinea-Bissau, Dabat in Ethiopia, IgangaMayuge in Uganda, Matlab in Bangladesh, and Kintampo in Ghana) were randomly assigned (individually) to be interviewed using either FBH+ or FPH between July 28, 2017, and Aug 13, 2018. The primary outcomes were stillbirths and neonatal deaths in the 5 years before the survey interview (measured by stillbirth rate [SBR] and neonatal mortality rate [NMR]) and mean time taken to complete the maternity history section of the questionnaire. We also assessed between-site heterogeneity. This study is registered with the Research Registry, 4720. FINDINGS: 69 176 women were allocated to be interviewed by either FBH+ (n=34 805) or FPH (n=34 371). The mean time taken to complete FPH (10·5 min) was longer than for FBH+ (9·1 min; p<0·0001). Using FPH, the estimated SBR was 17·4 per 1000 total births, 21% (95% CI -10 to 62) higher than with FBH+ (15·2 per 1000 total births; p=0·20) in the 5 years preceding the survey interview. There was strong evidence of between-site heterogeneity (I2=80·9%; p<0·0001), with SBR higher for FPH than for FBH+ in four of five sites. The estimated NMR did not differ between modules (FPH 25·1 per 1000 livebirths vs FBH+ 25·4 per 1000 livebirths), with no evidence of between-site heterogeneity (I2=0·7%; p=0·40). INTERPRETATION: FPH takes an average of 1·4 min longer to complete than does FBH+, but has the potential to increase reporting of stillbirths in high burden contexts. The between-site heterogeneity we found might reflect variations in interviewer training and survey implementation, emphasising the importance of interviewer skills, training, and consistent implementation in data quality. FUNDING: Children's Investment Fund Foundation.


Assuntos
Mortalidade Infantil , Natimorto/epidemiologia , Inquéritos e Questionários , Adolescente , Adulto , Bangladesh/epidemiologia , Etiópia/epidemiologia , Feminino , Gana/epidemiologia , Guiné-Bissau/epidemiologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Uganda/epidemiologia , Adulto Jovem
20.
Lancet ; 395(10232): 1259-1267, 2020 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-32171422

RESUMO

BACKGROUND: Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifampicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions. METHODS: We did an open-label, non-inferiority, randomised (1:1 with blocks of six), multicentre, phase 3 clinical trial comparing fully oral RC8 with RS8 in patients with early, limited Buruli ulcer lesions. There were four trial sites in hospitals in Ghana (Agogo, Tepa, Nkawie, Dunkwa) and one in Benin (Pobè). Participants were included if they were aged 5 years or older and had typical Buruli ulcer with no more than one lesion (caterories I and II) no larger than 10 cm in diameter. The trial was open label, and neither the investigators who took measurements of the lesions nor the attending doctors were masked to treatment assignment. The primary clinical endpoint was lesion healing (ie, full epithelialisation or stable scar) without recurrence at 52 weeks after start of antimicrobial therapy. The primary endpoint and safety were assessed in the intention-to-treat population. A sample size of 332 participants was calculated to detect inferiority of RC8 by a margin of 12%. This study was registered with ClinicalTrials.gov, NCT01659437. FINDINGS: Between Jan 1, 2013, and Dec 31, 2017, participants were recruited to the trial. We stopped recruitment after 310 participants. Median age of participants was 14 years (IQR 10-29) and 153 (52%) were female. 297 patients had PCR-confirmed Buruli ulcer; 151 (51%) were assigned to RS8 treatment, and 146 (49%) received oral RC8 treatment. In the RS8 group, lesions healed in 144 (95%, 95% CI 91 to 98) of 151 patients, whereas lesions healed in 140 (96%, 91 to 99) of 146 patients in the RC8 group. The difference in proportion, -0·5% (-5·2 to 4·2), was not significantly greater than zero (p=0·59), showing that RC8 treatment is non-inferior to RS8 treatment for lesion healing at 52 weeks. Treatment-related adverse events were recorded in 20 (13%) patients receiving RS8 and in nine (7%) patients receiving RC8. Most adverse events were grade 1-2, but one (1%) patient receiving RS8 developed serious ototoxicity and ended treatment after 6 weeks. No patients needed surgical resection. Four patients (two in each study group) had skin grafts. INTERPRETATION: Fully oral RC8 regimen was non-inferior to RS8 for treatment of early, limited Buruli ulcer and was associated with fewer adverse events. Therefore, we propose that fully oral RC8 should be the preferred therapy for early, limited lesions of Buruli ulcer. FUNDING: WHO with additional support from MAP International, American Leprosy Missions, Fondation Raoul Follereau France, Buruli ulcer Groningen Foundation, Sanofi-Pasteur, and BuruliVac.


Assuntos
Úlcera de Buruli/tratamento farmacológico , Claritromicina/administração & dosagem , Rifampina/administração & dosagem , Estreptomicina/administração & dosagem , Administração Oral , Adolescente , Adulto , Antibacterianos , Benin , Criança , Claritromicina/efeitos adversos , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/efeitos adversos , Quimioterapia Combinada , Feminino , Gana , Humanos , Masculino , Rifampina/efeitos adversos , Estreptomicina/efeitos adversos , Cicatrização/efeitos dos fármacos , Adulto Jovem
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