A study to evaluate WASH interventions and risk factors of diarrhoea among children under five years, Anloga district, Ghana: A research protocol.

INTRODUCTION: Good Water, Sanitation and Hygiene (WASH) practices, introduction of Rotavirus vaccination, zinc supplementation and improved nutrition have contributed significantly to the reduction of diarrhoea morbidity and mortality globally by 50%. In spite of these gains, diarrhoea still remains a leading cause of morbidity and mortality in children under-five. Causes of diarrhoea are multifaceted with many factors such as seasonality, behaviour, pathogenicity, epidemiology, etc. However, assessments on the causes of diarrhoea have generally been tackled in silos over the years focusing only on particular causes. In this study, we describe an integrated approach (evaluating WASH interventions implantation processes, assessing epidemiolocal risk factors, and identifying pathogens causing diarrhoea) for assessing determinants of diarrhoea. METHODS: The study has ethical approval from the Ghana Health Service Ethical Review Committee (GHSERC:020/07/22). It will employ three approaches; a process evaluation and a case-control study and laboratory analysis of diarrhoea samples. The process evaluation will assess the detailed procedures taken by the Anloga district to implement WASH interventions. A desk review and qualitative interviews with WASH stakeholders purposively sampled will be done. The evaluation will provide insight into bottlenecks in the implementation processes. Transcribed interviews will be analysed thematically and data triangulated with reviews. A 1:1 unmatched case-control study with 206 cases and 206 controls to determine risk factors associated with diarrhoea in children under-five will also be done. Odds ratios at 5.0% significance level would be calculated. Stool samples of cases will be taken and tested for diarrhoea pathogens using Standard ELISA and TAQMAN Array Card laboratory procedures. EXPECTED OUTCOME: It is expected that this framework proposed would become one of the robust approaches for assessing public health community interventions for diseases. Through the process evaluation, epidemiological case-control study and pathogen identification, we would be able to identify the gaps in the current diarrhoea assessments, come up with tailored recommendations considering the existing risk and assumptions and involve the relevant stakeholders in reducing the diarrhoea burden in a coastal setting in Ghana.

Predictors of quality of life of TB/HIV co-infected patients in the Northern region of Ghana.

BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) co-morbidity continues to be a serious worldwide health issue, particularly in Sub-Saharan Africa. Studies on the quality of life (QOL) of TB/HIV co-infected patients guide stakeholders on the delivery of patient-centred healthcare. This study evaluated QOL of TB/HIV co-infected individuals and its contributing factors. METHODS: We conducted a cross-sectional study among TB/HIV co-infected patients, receiving treatment at clinics in the Northern Region of Ghana. Simple random sampling technique was used to select 213 patients from 32 clinics. We gathered information on patients' QOL using the World Health Organization QOL-HIV BREF assessment tool. At a 5% level of significance, multiple logistic regression analyses were carried out to find correlates of QOL among the patients. RESULTS: The mean age of the patients was (38.99 ± 14.00) years with most, 33.3% (71/213) aged 30-39 years. Males constituted 54.9% (117/213). About 30.0% (64/213) of the patients reported a good QOL. Being employed (aOR = 5.23, 95% CI: 1.87 - 14.60), and adhering to treatment (aOR = 6.36, 95% CI: 1.51 - 26.65) were significantly associated with a good QOL. Being depressed (aOR = 0.02, 95% CI: 0.03 - 0.29), stigmatized (aOR = 0.31, 95% CI : 0.11 - 0.84), and not exercising (aOR = 0.28, 95% CI: 0.12 - 0.67) were negatively associated with a good QOL. CONCLUSION: Less than one-third of TB/HIV co-infected patients in the region have good QOL. To guarantee good QOL, modifiable predictors such as patients' physical activity and medication adherence should be targeted by the National AIDS and TB Control Programs.

Feasibility, safety, and impact of the RTS,S/AS01E malaria vaccine when implemented through national immunisation programmes: evaluation of cluster-randomised introduction of the vaccine in Ghana, Kenya, and Malawi.

BACKGROUND: The RTS,S/AS01E malaria vaccine (RTS,S) was introduced by national immunisation programmes in Ghana, Kenya, and Malawi in 2019 in large-scale pilot schemes. We aimed to address questions about feasibility and impact, and to assess safety signals that had been observed in the phase 3 trial that included an excess of meningitis and cerebral malaria cases in RTS,S recipients, and the possibility of an excess of deaths among girls who received RTS,S than in controls, to inform decisions about wider use. METHODS: In this prospective evaluation, 158 geographical clusters (66 districts in Ghana; 46 sub-counties in Kenya; and 46 groups of immunisation clinic catchment areas in Malawi) were randomly assigned to early or delayed introduction of RTS,S, with three doses to be administered between the ages of 5 months and 9 months and a fourth dose at the age of approximately 2 years. Primary outcomes of the evaluation, planned over 4 years, were mortality from all causes except injury (impact), hospital admission with severe malaria (impact), hospital admission with meningitis or cerebral malaria (safety), deaths in girls compared with boys (safety), and vaccination coverage (feasibility). Mortality was monitored in children aged 1-59 months throughout the pilot areas. Surveillance for meningitis and severe malaria was established in eight sentinel hospitals in Ghana, six in Kenya, and four in Malawi. Vaccine uptake was measured in surveys of children aged 12-23 months about 18 months after vaccine introduction. We estimated that sufficient data would have accrued after 24 months to evaluate each of the safety signals and the impact on severe malaria in a pooled analysis of the data from the three countries. We estimated incidence rate ratios (IRRs) by comparing the ratio of the number of events in children age-eligible to have received at least one dose of the vaccine (for safety outcomes), or age-eligible to have received three doses (for impact outcomes), to that in non-eligible age groups in implementation areas with the equivalent ratio in comparison areas. To establish whether there was evidence of a difference between girls and boys in the vaccine's impact on mortality, the female-to-male mortality ratio in age groups eligible to receive the vaccine (relative to the ratio in non-eligible children) was compared between implementation and comparison areas. Preliminary findings contributed to WHO's recommendation in 2021 for widespread use of RTS,S in areas of moderate-to-high malaria transmission. FINDINGS: By April 30, 2021, 652 673 children had received at least one dose of RTS,S and 494 745 children had received three doses. Coverage of the first dose was 76% in Ghana, 79% in Kenya, and 73% in Malawi, and coverage of the third dose was 66% in Ghana, 62% in Kenya, and 62% in Malawi. 26 285 children aged 1-59 months were admitted to sentinel hospitals and 13 198 deaths were reported through mortality surveillance. Among children eligible to have received at least one dose of RTS,S, there was no evidence of an excess of meningitis or cerebral malaria cases in implementation areas compared with comparison areas (hospital admission with meningitis: IRR 0·63 [95% CI 0·22-1·79]; hospital admission with cerebral malaria: IRR 1·03 [95% CI 0·61-1·74]). The impact of RTS,S introduction on mortality was similar for girls and boys (relative mortality ratio 1·03 [95% CI 0·88-1·21]). Among children eligible for three vaccine doses, RTS,S introduction was associated with a 32% reduction (95% CI 5-51%) in hospital admission with severe malaria, and a 9% reduction (95% CI 0-18%) in all-cause mortality (excluding injury). INTERPRETATION: In the first 2 years of implementation of RTS,S, the three primary doses were effectively deployed through national immunisation programmes. There was no evidence of the safety signals that had been observed in the phase 3 trial, and introduction of the vaccine was associated with substantial reductions in hospital admission with severe malaria. Evaluation continues to assess the impact of four doses of RTS,S. FUNDING: Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid.

Effectiveness of adjunct telephone-based postnatal care on maternal and infant illness in the Greater Accra Region, Ghana: a randomized controlled trial.

INTRODUCTION: Globally, postnatal care (PNC) is fraught with challenges. Despite high PNC coverages in Ghana's Greater Accra Region (GAR), maternal and newborn health outcomes are of great concern. In 2017, neonatal and post-neonatal mortality rates in GAR were 19 and 13 per 1000 live births respectively despite PNC coverages of 93% for at least one PNC and 87.5% for PNC within 48 hours post-delivery. Telephone follow-up has been used to improve health outcomes in some settings, however, its usefulness in improving maternal and infant health during the postnatal period is not well known in Ghana. We assessed effectiveness of telephone-based PNC on infant and maternal illness in selected hospitals in GAR. METHODS: An open-label, assessor-blinded, parallel-group, two-arm superiority randomized controlled trial with 1:1 allocation ratio was conducted from September 2020 to March 2021. Mother-baby pairs in intervention arm, in addition to usual PNC, received midwife-led telephone counselling within 48 hours post-discharge plus telephone access to midwife during postnatal period. In control arm, only usual PNC was provided. Descriptive and inferential data analyses were conducted to generate frequencies, relative frequencies, risk ratios and 95% confidence intervals. Primary analysis was by intention-to-treat (ITT), complemented by per-protocol (PP) analysis. RESULTS: Of 608 mother-baby pairs assessed for eligibility, 400 (65.8%) were enrolled. During 3 months follow-up, proportion of infants who fell ill was 62.5% in intervention arm and 77.5% in control arm (p = 0.001). Maternal illness occurred in 27.5% of intervention and 38.5% of control participants (p = 0.02). Risk of infant illness was 20% less in intervention than control arm in both ITT analysis [RR = 0.8 (95%CI = 0.71-0.92] and PP analysis [RR = 0.8 (95%CI = 0.67-0.89)]. Compared to controls, risk of maternal illness in intervention arm was 30% lower in both ITT [RR = 0.7 (95%CI = 0.54-95.00)] and PP analysis [RR = 0.7 (95%CI = 0.51-0.94)]. CONCLUSION: Telephone-based PNC significantly reduced risk of maternal and infant illness within first 3 months after delivery. This intervention merits consideration as a tool for adoption and scale up to improve infant and maternal health. TRIAL REGISTRATION: This trial was retrospectively registered with the International Standard Randomized Controlled Trial Number (ISRCTN) Registry with number ISRCTN46905855 on 09/04/2021.

Predictors of placental malaria in Upper West Regional Hospital-Ghana.

BACKGROUND: Placental malaria (PM) poses life-threatening complications to pregnant women as they are at increased risk of maternal and perinatal morbidity and mortality associated with malaria. This study examined the factors associated with placental malaria in the Upper West Regional Hospital (UWR). METHODS: A cross-sectional hospital-based study was carried out among pregnant women delivering at Upper West Regional Hospital. A cross-sectional screening survey was conducted from January 2019 to April 2019. Three hundred eligible mothers were consecutively recruited. A record review of their maternal and child history was assessed using a checklist. Placental blood samples were taken for microscopy to determine placental malaria parasitemia. Logistic regression analysis was done to determine the factors associated with placental malaria at 95 % confidence level. RESULTS: The proportion of mothers with placental malaria was 7 % (21/300), (95 % CI, 4.3-10.5 %). Plasmodium falciparum was the only species identified in those with PM. Majority of the women 66.7 % (14/21) with placental malaria had parasite density in the range 501 to 5,000 parasites/µL. Obstetric and health service factors that were significantly associated with placental malaria were gravidity and antenatal care (ANC) attendance. Primigravida (aOR = 3.48, 95 %CI = 1.01-12.01) and having less than 4 ANC attendance (aOR = 9.78, 95 %CI = 2.89-33.11) were found to be significantly associated with placental malaria. CONCLUSIONS: The proportion of women with PM was relatively low. Primigravid mothers reporting less than 4 ANC visits had the highest risk of placental malaria. Expectant mothers should be encouraged to attend at least 4 ANC visits prior to delivery.

High frequency of the Duffy-negative genotype and absence of Plasmodium vivax infections in Ghana.

BACKGROUND: Recent studies from different malaria-endemic regions including western Africa have now shown that Plasmodium vivax can infect red blood cells (RBCs) and cause clinical disease in Duffy-negative people, though the Duffy-negative phenotype was thought to confer complete refractoriness against blood invasion with P. vivax. The actual prevalence of P. vivax in local populations in Ghana is unknown and little information is available about the distribution of Duffy genotypes. The aim of this study was to assess the prevalence of P. vivax in both asymptomatic and symptomatic outpatients and the distribution of Duffy genotypes in Ghana. METHODS: DNA was extracted from dried blood spots (DBS) collected from 952 subjects (845 malaria patients and 107 asymptomatic persons) from nine locations in Ghana. Plasmodium species identification was carried out by nested polymerase chain reaction (PCR) amplification of the small-subunit (SSU) rRNA genes. For P. vivax detection, a second PCR of the central region of the Pvcsp gene was carried out. Duffy blood group genotyping was performed by allele-specific PCR to detect the presence of the FYES allele. RESULTS: No cases of P. vivax were detected in any of the samples by both PCR methods used. Majority of infections (542, 94.8%) in the malaria patient samples were due to P. falciparum with only 1 infection (0.0017%) due to Plasmodium malariae, and 2 infections (0.0034%) due to Plasmodium ovale. No case of mixed infection was identified. Of the samples tested for the FYES allele from all the sites, 90.5% (862/952) had the FYES allele. All positive samples were genotyped as FY*B-33/FY*B-33 (Duffy-negative homozygous) and therefore classified as Fy(a-b-). CONCLUSIONS: No cases of P. vivax were detected by both PCRs and majority of the subjects tested carried the FYES allele. The lack of P. vivax infections observed can be attributed to the high frequency of the FYES allele that silences erythroid expression of the Duffy. These results provide insights on the host susceptibility for P. vivax infections that had not been investigated in Ghana before.

Factors associated with culture proven neonatal sepsis in the Ho municipality 2016.

INTRODUCTION: Neonatal Sepsis (NNS) is a public health problem which causes death or disability unless appropriate antibiotic treatment is given promptly. Globally, sepsis is an important cause of morbidity and mortality in neonates despite recent progress in health care delivery. We assessed the factors associated with culture proven sepsis among neonates in the Ho Municipality, Ghana. METHODS: a cross-sectional study was conducted in two public hospitals in the Ho Municipality between January and May, 2016. All neonates who were clinically suspected with sepsis in the Neonatal Intensive Care Unit (NICU) and their mothers were recruited. A 2ml blood sample was taken aseptically and dispensed into a mixture of thioglycollate and tryptone soy broth in a 1: 10 dilution and microbiological procedures performed. Case notes of both neonates and their mothers were reviewed and interviews conducted to collect both clinical and socio-demographic data. We determined the factors associated with culture proven neonatal sepsis using logistic regression model and statistical significance was determined at 95% confidence intervals. RESULTS: out of 150 neonates, 26 (17%) had laboratory confirmed sepsis. The most common pathogen isolated was Staphylococcus epidermidis 14, (54%). Neonates whose mothers were primigravida (OR=2.74; 95% CI: 1.12-6.68), and those who attended antenatal clinics (ANC) fewer than three schedules (OR=2.90; 95% CI: 1.06-7.96) had higher odds of developing culture proven sepsis. CONCLUSION: neonates who were the first babies of their mothers were more likely to develop laboratory confirmed sepsis. Also, neonates of mothers who attended ANC less than 3 times were more likely to develop laboratory confirmed sepsis. High index of suspicion is required to diagnose neonatal sepsis among neonates of primigravida mothers and mothers who attend fewer than three ANC schedules.

Antimicrobial resistance and molecular detection of extended spectrum ß-lactamase producing Escherichia coli isolates from raw meat in Greater Accra region, Ghana.

BACKGROUND: Typically, raw meat can be contaminated with antibiotic resistant pathogens at unhygienic slaughter and sale points. Consumption of meat contaminated with antibiotic resistant E. coli is associated with grave health care consequences. The aim of this study was to determine the microbial quality of raw meat, the antimicrobial susceptibility and Extended Spectrum Beta Lactamase (ESBL) production in E. coli isolates from raw meat. RESULTS: Total Plate Counts exceeded the acceptable limit of 5.0 log CFU/ cm2 in 60.5% (124/205) of raw meat samples. Total Coliform Counts in 70.7% (145/205) of samples were in excess of the acceptable limit of 2.5 log CFU/cm2. E. coli was detected in about half of raw meat samples (48%), ranging from 9.5-79.0% among the slaughter sites. Isolates were susceptible to meropenem (100%), ceftriaxone (99%), cefotaxime (98%), chloramphenicol (97%), gentamycin (97%), ciprofloxacin (92%) and amikacin (92%), but resistant to ampicillin (57%), tetracycline (45%), sulfamethoxazole-trimethoprim (21%) and cefuroxime (17%). Multi-drug resistance (MDR) was identified in 22% of the isolates. The blaTEM gene was detected in 4% (4/98) of E. coli isolates in this study. CONCLUSION: The levels of microbial contamination of raw meat in this study were unacceptable. Meat handlers and consumers are at risk of foodborne infections from E. coli including ESBL producing E. coli that are resistant to most antibiotics in use. We recommend an enhanced surveillance for antibiotic resistance in food products for the early detection of emerging resistant bacteria species in the food chain.

Poor mental health of livestock farmers in Africa: a mixed methods case study from Ghana.

BACKGROUND: Agriculture represents the mainstay of African economies and livestock products are essential to the human population's nutritional needs. However, in many developing countries, including Ghana, livestock production fails to meet demand due to population growth and negative effects of climate change. One of the challenges to production is livestock loss affecting farmers. However, despite stressful events experienced, livestock farmers' mental health is poorly documented. This study aims to identify the root causes of livestock losses and their influence on pastoralists' mental health. METHODS: We conducted a mixed methods study in two districts in the Northern and Southern Belts of Ghana. Using the Depression Anxiety and Stress Scale-21 and guided interviews, we collected quantitative and qualitative data from 287 livestock farmers and 24 key-informants respectively. Mental health scores were categorized using standard guidelines. We evaluated the factors that explained variations in mental wellbeing using general linear models (α = 0.05). RESULTS: About 85% (240/287) of the livestock farmers lost cattle within 1 year. Of these, 91% lost cattle to animal diseases, 50% to theft and 27% to pasture shortages. Qualitative findings reveal that due to poor access to veterinary services, farmers treat livestock diseases themselves with drugs from unregulated sources and often sell diseased cows for meat to recover losses. Findings showed that 60% of livestock farmers had poor mental health. Of those, 72% were depressed, 66% anxious and 59% stressed. Mental wellbeing was negatively associated with the number of adverse events experienced, proportion of livestock lost to most of the major loss factors, emotional attachment to livestock and self-reported physical illnesses in farmers, but positively associated with increasing herd size [F (8,278) = 14.18, p < 0.001, R2 = 0.29]. CONCLUSIONS: Livestock diseases are the leading cause of losses to livestock farmers, whose mental wellbeing is negatively affected by these losses. Although an adaptive strategy by farmers to compensate for poor veterinary services, the arbitrary use of veterinary drugs and sale of diseased cattle pose health risks to the public. Further research to evaluate the performance of veterinary services in Ghana, mental health problems and risk to human health due to potential high-risk meat entering the food chain, is needed.

Capacity building for implementation research: a methodology for advancing health research and practice.

BACKGROUND: Implementation research is increasingly being recognised as an important discipline seeking to maximise the benefits of evidence-based interventions. Although capacity-building efforts are ongoing, there has been limited attention on the contextual and health system peculiarities in low- and middle-income countries. Moreover, given the challenges encountered during the implementation of health interventions, the field of implementation research requires a creative attempt to build expertise for health researchers and practitioners simultaneously. With support from the Special Programme for Research and Training in Tropical Diseases, we have developed an implementation research short course that targets both researchers and practitioners. This paper seeks to explain the course development processes and report on training evaluations, highlighting its relevance for inter-institutional and inter-regional capacity strengthening. METHODS: The development of the implementation research course curriculum was categorised into four phases, namely the formation of a core curriculum development team, course content development, internal reviews and pilot, and external reviews and evaluations. Five modules were developed covering Introduction to implementation research, Methods in implementation research, Ethics and quality management in implementation research, Community and stakeholder engagement, and Dissemination in implementation research. Course evaluations were conducted using developed tools measuring participants' reactions and learning. RESULTS: From 2016 to 2018, the IR curriculum has been used to train a total of 165 researchers and practitioners predominantly from African countries, the majority of whom are males (57%) and researchers/academics (79.4%). Participants generally gave positive ratings (e.g. integration of concepts) for their reactions to the training. Under 'learnings', participants indicated improvement in their knowledge in areas such as identification of implementation research problems and questions. CONCLUSION: The approach for training both researchers and practitioners offers a dynamic opportunity for the acquisition and sharing of knowledge for both categories of learners. This approach was crucial in demonstrating a key characteristic of implementation research (e.g. multidisciplinary) practically evident during the training sessions. Using such a model to effectively train participants from various low- and middle-income countries shows the opportunities this training curriculum offers as a capacity-building tool.

Self-Collected Specimens Revealed a Higher Vaccine- and Non-Vaccine-Type Human Papillomavirus Prevalences in a Cross-Sectional Study in Akuse.

BACKGROUND: Population-specific epidemiologic data on human Papillomavirus infection, which are limited in most of the SubSaharan African countries, are necessary for effective cervical cancer prevention. This study aimed to generate population-specific data on human Papillomavirus infections, and determine which of these, self-collected and provider-collected specimens, gives a higher estimate of the prevalence of human Papillomaviruses, including vaccine and non-vaccine-type human Papillomavirus. METHODS: In this cross-sectional study, following a questionnaire-based collection of epidemiological data, self-, and provider-collected specimens, obtained from women 15-65 years of age, were analysed for human Papillomavirus types by a nested-multiplex polymerase chain reaction, and for cervical lesions by Pap testing. HPV data were categorised according to risk type and vaccine types for further analysis. RESULTS: The difference between the overall human Papillomavirus infection prevalences obtained with the self-collected specimens, 43.1% (95% CI of 38.0-51.0%) and that with the provider-collected samples, 23.3% (95% CI of 19.0-31.0%) were significant (p ≤ 0.001). The prevalence of quadrivalent vaccine-type human Papillomaviruses was 12.3% with self-collected specimens, but 6.0% with provider-collected specimens. For the nonavalent vaccine-types, the prevalences were 26.6% and 16.7% respectively. There were multiple infections involving both vaccine-preventable and nonvaccine preventable high-risk human Papillomavirus genotypes. CONCLUSION: The Akuse subdistrict can, therefore, be said to have a high burden of human Papillomavirus infections, which included nonvaccine types, as detected with both self-collected and provider-collected specimens. These imply that self-collection is to be given a higher consideration as a means for a population-based high-risk human Papillomavirus infections burdens assessment/screening. Additionally, even with a successful implementation of the HPV vaccination, if introduced in Ghana, there is still the need to continue with the screening of women.

Progress towards eliminating tuberculosis in Ga West Municipality, Ghana: analysis of tuberculosis surveillance data, 2017.

OBJECTIVE: To assess the progress made towards the actualization of the 80% reduction in incident cases, monitor trends and to assess the quality of GWM TB surveillance data from 2012 to 2016. DESIGN: The study was descriptive secondary data analysis. DATA SOURCE: Tuberculosis cases recorded in the District Health Information Management Systems (DHIMS) and municipal TB registers. The Municipal TB Coordinator was interviewed for clarification on the data. A TB patient was defined as one who coughed persistently for two weeks or more. MAIN OUTCOME MEASURE: Trend of TB cases in Ga West Municipality. RESULTS: A total of 441 TB cases were registered of which 68.9% were smear positive. Males were (67%). Age group 35-44 years were the most affected (28.6%). The incidence rose from 21.5 (2012) to 41.6 (2015). The 2016 incidence was 40.7 (± 5.63) per 100,000 population. This is significantly different from the current national incidence of 156 (p < 0.05). Data was 95% complete. Discrepancies existed between data in registers compared to the DHIMS but were not statistically significant. CONCLUSION: The 80% reduction in incident cases target may not be attained by the GWM due to the rising number of incident cases. However, data quality is good. FUNDING: The study was funded by the authors.

Evaluation of viral haemorrhagic fever surveillance system with focus on Ebola virus disease, Bawku municipality- Upper East Region, Ghana, 2011-2015.

BACKGROUND: We evaluated the Viral haemorrhagic fever (VHF) surveillance system from 2011 to 2015 in the Bawku Municipality, Upper East region, Ghana to determine whether the goals of the surveillance system are being met and to assess the performance of the system attributes. DESIGN: Descriptive secondary data analysis. SETTING: Bawku Municipality. DATA SOURCE: Review VHF surveillance records, interviewed community-based surveillance volunteers (CBSVs) and reviewed vital events registers. We also assessed the system attributes by reviewing records and interviewing key stakeholders involved in VHF surveillance system with focus on Ebola using checklist and semi structured questionnaire developed based on the Centers for Disease Control and Prevention (CDC) guidelines. MAIN OUTCOME MEASURE: System attributes of the VHF surveillance system. RESULTS: Population under surveillance was 105,849. The system required detail information about suspected cases. However, it had a simple and clear standard case definitions, and was well integrated with the IDSR. There is a regular and timely flow of information. The system captured 155 suspected cases nationwide from 2011 to 2015 and all tested negative. Of these, Upper East Region reported 10 suspected cases including 4 suspected cases from Bawku Municipality. CONCLUSION: The VHF surveillance system achieved its objectives. However, poor data quality, inadequately trained surveillance officers, and inadequate financial support are threats to the effectiveness of the system. FUNDING: This work was supported by Ghana Field Epidemiology and Laboratory Training Program (GFELTP), University of Ghana.

Compliance with the WHO strategy of test, treat and track for malaria control at Bosomtwi District in Ghana.

BACKGROUND: We reviewed malaria morbidity data to assess compliance to malaria T3 strategy in Bosomtwi District, Ashanti Region, Ghana. DESIGN: The study was descriptive secondary data analysis. SETTING: Bosomtwi District. DATA SOURCE: District Health Information Management Systems (DHIMS2). MAIN OUTCOME: Proportion of recorded cases tested, proportion of tested cases treated and proportion of cases tracked. RESULTS: Data for suspected and tested malaria cases was complete for only 3 years (2014-2016). Malaria testing reduced from 84.4% in 2015 to 76.8% in 2016 (national average 77.3%; regional average 70%). The proportion of untested but treated malaria cases declined from 46.3% in 2015 to 4.9% in 2016. Proportion of confirmed malaria cases put on antimalarial drugs was highest in 2016 at 63.9%. Pramso sub-district although home to largest facility in the district, under prescribed antimalarial drugs. Reports generated on malaria showed information on only confirmed suspected cases, under five, and above five malaria mortalities. The district did not determine their malaria thresholds. CONCLUSION: The malaria-testing rate in the Bosomtwi District is higher than the regional average and close to the national average. About a third of confirmed malaria cases missed getting appropriate antimalarial drugs. Limited analysis on malaria data reduced the information required to inform policy. FUNDING: Author GO was fully sponsored by President's Malaria Initiative (PMI)-CDC CoAg 6NU2GGH001876.

Probing the composition of Plasmodium species contained in malaria infections in the Eastern region of Ghana.

BACKGROUND: Asymptomatic falciparum and non-falciparum malaria infections are major challenges to malaria control interventions, as they remain a source of continual infection in the community. This becomes even more important as the debate moves towards elimination and eradication. This study sought to quantify the burden of Plasmodium malaria infection in seven communities in the Eastern Region of Ghana. METHODS: The cross-sectional study recruited 729 participants aged 85 years old and below from 7 closely linked communities. Finger pricked blood was used to prepare thick and thin blood smears as well as spot filter paper and an histidine rich protein 2 (HRP2) rapid diagnostic test kit (RDT). Genomic DNA was extracted from the filter paper dry blood spot (DBS) and used in PCR to amplify the Plasmodium 18S rRNA gene using species specific PCR. RESULTS: 96.6% of the participants were identified as afebrile, with axillary temperatures below 37.5 °C. PCR identified 66% of the participants to harbor malaria parasites, with 9 P. malariae and 7 P. ovale mono-infections accounting for 2.2% and P. falciparum combined with either 36 P. malariae or 25 P. ovale infections, accounting for 13.3%. Parasite prevalence by microscopy (32%) was similar to the RDT positivity rate (33%). False positive RDT results ranged from 64.6% in children aged between 5 and 9 years to 10% in adults aged 20 years and above. No significant differences were observed in falciparum and non-falciparum parasite carriage at the community level, however young adults aged between 15 and 19 years had the highest prevalence (34.8% (16/46)) of P. falciparum and P. malariae parasite carriage whilst children aged between 5 and 9 years had the highest level (11.4% (14/123)) of P. ovale carriage. CONCLUSION: The high rate of misidentification of non-falciparum parasites and the total absence of detection of P. ovale by microscopy suggests that more sensitive malaria diagnostic tools including molecular assays are required to accurately determine the prevalence of carriers of non-falciparum parasites and low density P. falciparum infections, especially during national surveillance exercises. Additionally, malaria control interventions targeting the non-falciparum species P. malariae and P. ovale parasites are needed.

Evaluation of Buruli Ulcer Disease Surveillance System in the Ga West Municipality, Ghana, 2011-2015.

BACKGROUND: Buruli ulcer (BU) is one of the most neglected tropical diseases caused by Mycobacterium ulcerans. M. ulcerans infection may manifest initially as a pre-ulcerative nodule, a plaque, or oedema which breaks down to form characteristic ulcers with undermined edges. The Ga West Municipality is an endemic area for Buruli ulcer, and we evaluated the BU surveillance system to determine whether the system is meeting its objectives and to assess its attributes. MATERIALS AND METHODS: We used a checklist based on Centers for Disease Control and Prevention (CDC) updated surveillance evaluation guidelines, 2006. We reviewed records and dataset on Buruli ulcer for the period 2011-2015. The evaluation was carried out at the national, regional, district, and community levels using the Ga West Municipality of the Greater Accra Region as a study site. Interviews with key stakeholders at the various levels were done using an interview guide, and observations were done with a checklist. Data were entered and analyzed using Epi info 7. RESULTS: A total of 594 cases of Buruli ulcer were reported from 2011 to 2015 in Ga West. The number of confirmed cases decreased from 109 in 2011 to 17 in 2015. The system was useful, fairly simple, flexible, representative, and fairly acceptable. The system was sensitive with a PVP of 45.3%. Although the data quality was good with 85% of case report forms completed, there was under-reporting (3.6%), some discrepancies of data at the district, regional, and national levels. The system was moderately stable, and timeliness of reporting was 30.7%. CONCLUSION: The Buruli ulcer surveillance system is meeting its set objectives, and the data generated are used to reliably describe the epidemiologic situation and evaluate the results for actions and plan future interventions. There is a need for timely submission of data. We recommend that the National Buruli Ulcer Control Program (NBUCP) provides logistical support to treatment centres.

Psychological working conditions and predictors of occupational stress among nurses, Salaga Government Hospital, Ghana, 2016.

INTRODUCTION: Occupational stress is a recognized health problem among nurses. Globally, its prevalence varies between 9.2% and 68.0%. It detracts from nurses' quality of life and efficiency of job performance. In Ghana, we do not know the important contributory factors to this problem. Our study sought to identify the important predictors of occupational stress among nurses. METHODS: In January 2016, we conducted an institutional-based survey among nurses of Salaga Government Hospital. They completed a five-point Likert type questionnaire adopted from the British Psychological Working Conditions Survey, and the Nurse Stress Index. Across 30 predictor variables, a mean score of 4.00 to 5.00 represented high to extreme occupational stress. We performed bivariate and multivariate analyses to identify important predictors of occupational stress at 95% confidence level. RESULTS: Of 167 nurses, 58.1% (97) were females. Respondents who experienced high to extreme stress levels had a 2.3 times odds of reporting sickness absence (CI: 1.03-5.14). Sources of occupational stress included: manual lifting of patients and pieces of equipment (OR: 16.23; CI: 6.28 - 41.92), the risks of acquiring infections (OR: 14.67; CI 5.90 - 36.46), receiving feedback only upon unsatisfactory performance (OR: 28.00; CI: 9.72 - 80.64), and inadequate opportunities for continuous professional development (OR: 63.50; CI: 19.99 - 201.75). CONCLUSION: The working conditions of nurses were stressful. The most significant predictors of occupational stress were poor supportive supervision by superiors, lack of adequate skills to perform routine tasks, uncertainty about their job role, and the lack of adequate opportunities for career advancements.

Poliovirus neutralizing antibody levels among individuals in three regions of Ghana.

INTRODUCTION: Ghana was declared polio-free in 2015 after the last polio case in 2008. We determined the poliovirus neutralizing antibody levels among individuals to identify possible immunity gaps. METHODS: A cross-sectional, hospital-based study was undertaken in Northern, Ashanti and Greater Accra regions of Ghana. Individuals referred for haematology at the teaching hospitals' laboratories were invited to participate in our study. Neutralizing-antibody titers to poliovirus serotypes 1,2 & 3 were assayed by WHO-standards. Antibody titers of ≥8 were considered protective. Bivariate and multivariate analyses were conducted on subject characteristics to assess potential factors for failure to seroconvert. P-values < 0.05 were considered statistically significant. RESULTS: Poliovirus (PV) neutralizing-antibody serotypes 1, 2 and 3 were detected in 86.0% (264/307), 84% (258/307) and 75% (230/307) of samples respectively. 60.1% (185/307) were seropositive for the three poliovirus serotypes. Neutralizing poliovirus antibodies for PV1 and PV2 were higher than for PV3. Seroprevalence of poliovirus-neutralizing antibodies among males (PV1=51.9%, PV2= 51.6% and PV3= 52.6%) were higher than in females. Seroprevalence rates of poliovirus-neutralizing antibodies (PV1, PV2, and PV3) were highest in the Northern region (90%, 81%, and 77%). Poliovirus neutralizing-antibodies (PV1and PV2) decreased with age [p< 0.001]. Low seroprevalence of poliovirus-neutralizing antibodies was significantly associated with low school attendance of mothers (p<0.001). CONCLUSION: Our study population has some protection from polio. However, immunity appears to be lower with a higher age or low Mother's education. This may suggest the need for young-adult booster-dose to minimize the risk of wild poliovirus infection. FUNDING: WHO Country Office Ghana.

Sustainability of a field epidemiology and laboratory training programme: the Ghanaian story.

INTRODUCTION: Field Epidemiology Training Programmes (FETPs) are functional ways of strengthening epidemiology, surveillance and outbreak response capacity in countries. However, sustainability of FETPs is a major challenge facing most countries especially in Africa. The Ghana Field Epidemiology and Laboratory Training Program (GFELTP) started in 2007 in the University of Ghana School of Public Health as a solution to gaps in the public health workforce. This paper assessed the sustainability strategies embedded in the Ghana Field Epidemiology and Laboratory Training Programme. METHODS: We assessed the sustainability of GFELTP by document reviews and interviews with programme staff and stakeholders to identify sustainability structures (programme, financial and institutional) that were in place. We grouped information into the following headings: programme structure, institutional, financial and political structures. RESULTS: As of July 2017, a total of 350 public health experts have been trained in both frontline and advanced courses since the programme's inception. For funding structures, the programme is funded mainly by its partners and stakeholders who are local government organisations. They provide resources for running of programme activities. Under institutional and political structures, the programme was established as a Ministry of Health/Ghana Health Service programme based in the University of Ghana. The programme steering committee which is currently chaired by the Director Public Health of Ghana Health Service, jointly ensures its implementation. Other structures of sustainability observed were involvement of stakeholders and alumni in human resource of the programme; use of stakeholders as faculty for the programme. These stakeholders include staff from University of Ghana School of Public Health, Ghana Health Service and Veterinary Service Department, World Health Organization and Centers for Disease Control and Prevention. The programme showed evidence of stable sustainability strategies in all four structures evaluated. CONCLUSION: The assessment found the GFELTP to be sustainable. The main factors that contributed to rendering it sustainable were funding, programme, institutional and political structures embedded in the programme. One remarkable sustainability element observed was the strong collaboration that existed between stakeholders of the programme who worked hand in hand to ensure the programme runs smoothly. However, more sources of funding and other essential resources need to be considered to help the programme obtain a pool of resources for carrying out its activities.

Obstetric determinants of preterm delivery in a regional hospital, Accra, Ghana 2016.

BACKGROUND: Globally, prematurity is a major determinant of morbidity and mortality contributing 30-40% of neonatal mortality. The consequences of preterm deliveries are enormous with developmental and childhood complications as well as high economic and psycho-social burden on the parents (family) and society. Some risk factors include ever having preterm delivery, multiple births and some medical conditions like sexually transmitted infection and urinary tract infections but these have not been ascertained in our study area. Much research into these risk factors is needed in Ghana. We assessed the obstetric determinants of preterm delivery. METHODS: We conducted a 1:2 unmatched case-control study in Greater Accra Regional Hospital (GARH) -Ridge, a secondary referral facility in Accra, Ghana (from October, 2015 -May, 2016). A case was a mother who delivered between 28 and 36 weeks of gestation (preterm) and a control was a mother who delivered after 37 to 42 completed weeks (term). We used structured questionnaire to collect data, reviewed maternal and foetal records using a checklist. Categorical variables were analysed and expressed as frequencies and proportions. We determined the association between obstetric factors and preterm delivery with multiple logistic regression. Significance level of the strength of association was determined at 95% CI and p-value < 0.05. RESULTS: We recruited 390 mothers, 130 had preterm deliveries (cases) and 260 had term deliveries (controls). Experiencing premature rupture of membrane (aOR: 2.3; 95% CI:1.0-5.5), pre-eclampsia/eclampsia (aOR: 3.4; 95% CI: 1.0-11.9) were found to be associated with preterm delivery. However, four or more ANC visit was protective factor for preterm delivery (aOR: 0.2; 95% CI: 0.1-0.4). CONCLUSION: Premature rupture of membrane, hypertensive complications and antepartum haemorrhage were found to be risk factors associated with preterm delivery in Ridge Hospital. Health workforce providing ANC services need to identify risk factors and refer these mothers to the doctor for early management and improved outcome decreasing preterm delivery.