Community-Based Strategies to Improve Health-Related Outcomes in People Living With Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

Background: Individuals living with hypertension are at an increased risk of cardiovascular- and cerebrovascular-related outcomes. Interventions implemented at the community level to improve hypertension control are considered useful to prevent cardiovascular and cerebrovascular events; however, systematic evaluation of such community level interventions among patients living in low- and middle-income countries (LMICs) is scarce. Methods: Nine databases were searched for randomized controlled trials (RCTs) and cluster randomized control trials (cRCTs) implementing community level interventions in adults with hypertension in LMICs. Studies were included based on explicit focus on blood pressure control. Quality assessment was done using the Revised Cochrane Risk of Bias tool for randomized trials (ROBS 2). Results were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Fixed-effect meta-analyses were conducted for studies that reported continuous outcome measures. Results: We identified and screened 7125 articles. Eighteen studies, 7 RCTs and 11 cRCTs were included in the analysis. The overall summary effect of blood pressure control was significant, risk ratio = 1.48 (95%CI = 1.40-1.57, n = 12). Risk ratio for RCTs was 1.68 (95%CI = 1.40-2.01, n = 5), for cRCTs risk ratio = 1.46 (95%CI = 1.32-1.61, n = 7). For studies that reported individual data for the multicomponent interventions, the risk ratio was 1.27 (95% CI = 1.04-1.54, n = 3). Discussion: Community-based strategies are relevant in addressing the burden of hypertension in LMICs. Community-based interventions can help decentralize hypertension care in LMIC and address the access to care gap without diminishing the quality of hypertension control.

Determinants of COVID-19 vaccine uptake: evidence from a vulnerable global South setting.

OBJECTIVE: Studies are paying increasing attention to complex social determinants in explaining the variation in the rates COVID-19 vaccine uptake. This study examines the influence of various individual, contextual, and vaccine-related factors on COVID-19 vaccine uptake behaviour in a resource-scarce and vulnerable setting using a quantitative research approach. Using a multi-staged cluster sampling approach, 408 individuals from 204 households in Cape Coast, Ghana's tourism hub, were surveyed. Probit and logistic regression models were estimated to test the vaccine-related factors. RESULTS: A significant difference is observed between wait time and vaccination status (χ2 = 21.17; p = 0.000). Moreover, age and religion, as controlled variables, equally played significant roles in influencing the adoption of the vaccine. Other factors encompass the perceived risk of contracting COVID-19, the perceived benefits of the vaccine in relation to its side effects, and the level of trust individuals have in the concern of vaccine producers for their health. These findings call for targeted campaigns by the Ministry of Health, health facilities and other institutions promoting the COVID-19 vaccine. These actors should emphasize the benefits of vaccination, prioritize trust-building initiatives, and provide clear guidance on vaccination schedules, and manage waiting time.

Health service factors affecting the COVID-19 vaccination campaign in a Ghanaian metropolis: A qualitative exploratory study.

OBJECTIVE: The study sought to explore the perspectives of vaccinators on the health system factors that impacted the COVID-19 vaccination campaign. DESIGN: The study employed an exploratory-descriptive qualitative design. Key-informants' interviews were conducted using semi-structured guide to gather the data. Thematic analysis following the steps of Braun and Clark was conducted using ATLAS.ti software. SETTING: The study setting was the Cape Coast Metropolis where the Central Regional Health Directorate is located. The Directorate initiates and implements policy decisions across the region. It is also the only metropolis in the region that recorded about 5970 of the total COVID-19 cases recorded in Ghana. PARTICIPANTS: Eleven vaccinators who had been trained for the COVID-19 vaccination and had participated in the campaign for at least 6 months were purposively sampled through the Regional Public Health Unit. RESULTS: Four themes were derived from the data after analysis; 'vaccine-related issues'; 'staffing issues'; 'organising and planning the campaign' and 'surveillance and response systems'. Subthemes were generated under each major theme. Our results revealed the health service promoted the COVID-19 vaccination campaign through public education and ensured access to COVID-19 vaccines through the use of community outreaches. Also, the health service ensured adequate logistics supply for carrying out the campaign as well as ensured vaccinators were adequately equipped for adverse incidence reporting and management. Dissatisfaction among COVID-19 vaccinators attributed to low remuneration and delays in receiving allowances as well as shortfalls in efforts at securing transportation and a conducive venue for the vaccination exercise also emerged. Other challenges in the vaccination campaign were attributed to poor data entry platforms and limited access to internet facilities. CONCLUSION: This study highlights the health system's strategies and challenges during the COVID-19 vaccination campaign, emphasising the need for critical interventions to prevent low vaccination rates.

Coagulation Factors and Natural Anticoagulants as Surrogate Markers of Preeclampsia and Its Subtypes: A Case-Control Study in a Ghanaian Population.

Preeclampsia (PE) is associated with endothelial injury and hemostatic abnormalities. However, the diagnostic role of coagulation parameters and natural anticoagulants in predicting PE has not been explored in Ghana. This study assessed plasma levels of these factors as surrogate markers of PE and its subtypes. This case-control study included 90 women with PE (cases) and 90 normotensive pregnant women (controls). Blood samples were drawn for the estimation of complete blood count and coagulation tests. The prothrombin time (PT), activated partial thromboplastin time (APTT), and the calculation of the international normalized ratio (INR) were determined by an ACL elite coagulometer while the levels of protein C (PC), protein S (PS), antithrombin III (ATIII), and D-dimers were also measured using the solid-phase sandwich enzyme-linked immunosorbent assay (ELISA) method. All statistical analyses were performed using the R Language for Statistical Computing. Results showed significantly (p < .05) shortened APTT (28.25 s) and higher D-dimer levels (1219.00 ng/mL) among PE women, as well as low levels of PC (1.02 µg/mL), PS (6.58 µg/mL), and ATIII (3.99 ng/mL). No significant difference was found in terms of PT and INR. From the receiver operating characteristic analysis, PC, PS, and ATIII could significantly predict PE and its subtypes at certain cutoffs with high accuracies (area under the curve [AUC] ≥0.70). Most women with PE are in a hypercoagulable state with lower natural anticoagulants. PC, PS, and ATIII are good predictive and diagnostic markers of PE and its subtypes (early-onset PE [EO-PE] and late-onset PE [LO-PE]) and should be explored in future studies.

Implementation outcomes and strategies for delivering evidence-based hypertension interventions in lower-middle-income countries: Evidence from a multi-country consortium for hypertension control.

Guidance on contextually tailored implementation strategies for the prevention, treatment, and control of hypertension is limited in lower-middle income countries (Lower-MIC). To address this limitation, we compiled implementation strategies and accompanying outcomes of evidence-based hypertension interventions currently being implemented in five Lower-MIC. The Global Research on Implementation and Translation Science (GRIT) Coordinating Center (CC) (GRIT-CC) engaged its global network sites at Ghana, Guatemala, India, Kenya, and Vietnam. Purposively sampled implementation science experts completed an electronic survey assessing implementation outcomes, in addition to implementation strategies used in their ongoing hypertension interventions from among 73 strategies within the Expert Recommendations for Implementing Change (ERIC). Experts rated the strategies based on highest priority to their interventions. We analyzed the data by sorting implementation strategies utilized by sites into one of the nine domains in ERIC and summarized the data using frequencies, proportions, and means. Seventeen implementation experts (52.9% men) participated in the exercise. Of Proctor's implementation outcomes identified across sites, all outcomes except for appropriateness were broadly assessed by three or more countries. Overall, 59 out of 73 (81%) strategies were being utilized in the five countries. The highest priority implementation strategies utilized across all five countries focused on evaluative and iterative strategies (e.g., identification of context specific barriers and facilitators) to delivery of patient- and community-level interventions, while the lowest priority was use of financial and infrastructure change strategies. More capacity building strategies (developing stakeholder interrelationships, training and educating stakeholders, and supporting clinicians) were incorporated into interventions implemented in India and Vietnam than Ghana, Kenya, and Guatemala. Although robust implementation strategies are being used in Lower -MICs, there is minimum use of financial and infrastructure change strategies. Our study contributes to the growing literature that demonstrates the use of Expert Recommendations for Implementing Change (ERIC) implementation strategies to deliver evidence-based hypertension interventions in Lower-MICs and will inform future cross-country data harmonization activities in resource-constrained settings.

Culture and pandemic control at cross-roads: navigating the burial guidelines for COVID-19-related deaths in a Ghanaian setting.

BACKGROUND: Despite the large volume of scientific evidence on the rapid spread of the COVID-19 pandemic and associated high morbidity and mortality, little is known about the sociocultural disruptions which ensued. The current study explored the nuanced navigation of the COVID-19-related death and burial protocols and its impact on traditional burial and funeral rites in Ghana. METHODS: This qualitative study was based on the 'focused' ethnographic design. Data were collected using key informant interviews from nineteen COVID-19-related bereaved family members and public health officials involved in enforcing adherence to COVID-19-related death and burial protocols in the Cape Coast Metropolis of Central region of Ghana. Recursive analysis was conducted to generate the themes and sub-themes from the data. RESULTS: The overarching theme was "Uncultural" connotations ascribed to the COVID-19-related death and burial protocols. The COVID-19-related death and burial protocols were ubiquitously deemed by participants to be 'uncultural' as they inhibited deep-rooted indigenous and eschatological rites of separation between the living and the dead. This was fueled by limited awareness and knowledge about the COVID-19 burial protocols, resulting in fierce resistance by bereaved family members who demanded that public health officials release the bodies of their deceased relatives. Such resistance in the midst of resource limitation led to negotiated compromises of the COVID-19-related death and burial protocols between family members and public health officials. CONCLUSIONS: Insensitivity to socio-cultural practices compromised the implementation of the COVID-19 pandemic control interventions, particularly, the COVID-19-related death and burial protocols. Some compromises that were not sanctioned by the protocols were reached to allow health officials and families respectfully bury their dead. These findings call for the need to prioritize the incorporation of sociocultural practices in future pandemic prevention and management strategies.

Effects of COVID-19 on coastal livelihoods in the central region of Ghana.

The COVID-19 outbreak effects and related state responses, especially mobility restriction interventions, contributed to disruption in livelihoods in the coastal communities in Ghana. This paper uses an ethnographic approach to analyse the effects of the COVID-19 pandemic and coping strategies adopted by small-scale fishers, fish traders and processors. We argued that focusing solely on the livelihoods of formal sector workers is problematic because it fails to consider the dynamics of informal coastal workers. Findings indicate that fishers, fish traders and processors experienced various effects on food, income, police harassment, and coping strategies, including migration, resorting to reusable face masks and food-compromising practices. Infectious diseases such as COVID-19 impact coastal people and their livelihoods. Therefore, implementing social protection measures to mitigate the effects of pandemics on livelihoods should be better coordinated and well-targeted to reach the most vulnerable. Findings from this study offer pointers to position preparedness and response efforts to future outbreaks in a similar context.

Effects of a school-based intervention to reduce cardiovascular disease risk factors among secondary school students: A cluster-randomized, controlled trial.

BACKGROUND: Cardiovascular diseases (CVDs) are the number cause of death worldwide. In Ghana CVD has been the leading cause of death since 2001. The prevalence of CVD risk factors among adolescents in Ghana has been increasing. This study seeks to develop, implement and evaluate the effects of a behavioral modification intervention program to reduce CVD risk factors among secondary school students in Brong Ahafo, Ghana. METHODS: A cluster-randomized controlled trial was conducted with schools as clusters over a period of six-months with pre and post intervention evaluations. Participants were public secondary school students (14-19 years) from four schools in Brong Ahafo, Ghana. Students in the intervention group were trained by the researchers whereas those of the control group received no intervention. The intervention included health education and physical activity modules. Follow-up data using same questionnaire were collected within two weeks after the intervention was completed. Intention-to-treat analysis was performed after replacing missing values using the multiple imputation method. The generalized linear mixed model (GLMM) was used to assess the effects of the intervention study. RESULTS: The GLMM analyses showed the intervention was effective in attaining 0.77(p<0.001), 0.72(p<0.001), 0.47(p<0.001), 0.56(p<0.001), and 0.39(p = 0.045) higher total physical activity, fruits, vegetables, seafood, and water scores respectively for the intervention group over the control group. The intervention was also significant in reducing -0.15(p<0.001),-0.23(p<0.001),-0.50(p<0.001),-0.32(p<0.001),-0.90(p<0.001),-0.87(p<0.001),-0.38(p<0.001), -0.63(p<0.001), -1.63(p<0.001), 0.61(p<0.001), and -1.53(p = 0.005) carbohydrates, fats and oils, fried eggs, fried chicken, carbonated drinks, sugar, sweet snacks, salted fish, weight, BMI, and diastolic BP. The odds of quitting alcohol use in the intervention group were 1.06 times more than the control group. There was no significant effect on reducing smoking and systolic BP. CONCLUSION: There is an urgent need for the intervention program to be integrated into the existing curriculum structure of secondary school schools. Implementing the intervention will allow for longer and more consistent impact on the reduction of CVD risk factors among secondary school students.