Modelling spatiotemporal variation in under-five malaria risk in Ghana in 2016-2021.

BACKGROUND: Ghana is among the top 10 highest malaria burden countries, with about 20,000 children dying annually, 25% of which were under five years. This study aimed to produce interactive web-based disease spatial maps and identify the high-burden malaria districts in Ghana. METHODS: The study used 2016-2021 data extracted from the routine health service nationally representative and comprehensive District Health Information Management System II (DHIMS2) implemented by the Ghana Health Service. Bayesian geospatial modelling and interactive web-based spatial disease mapping methods were employed to quantify spatial variations and clustering in malaria risk across 260 districts. For each district, the study simultaneously mapped the observed malaria counts, district name, standardized incidence rate, and predicted relative risk and their associated standard errors using interactive web-based visualization methods. RESULTS: A total of 32,659,240 malaria cases were reported among children < 5 years from 2016 to 2021. For every 10% increase in the number of children, malaria risk increased by 0.039 (log-mean 0.95, 95% credible interval = - 13.82-15.73) and for every 10% increase in the number of males, malaria risk decreased by 0.075, albeit not statistically significant (log-mean - 1.82, 95% credible interval = - 16.59-12.95). The study found substantial spatial and temporal differences in malaria risk across the 260 districts. The predicted national relative risk was 1.25 (95% credible interval = 1.23, 1.27). The malaria risk is relatively the same over the entire year. However, a slightly higher relative risk was recorded in 2019 while in 2021, residing in Keta, Abuakwa South, Jomoro, Ahafo Ano South East, Tain, Nanumba North, and Tatale Sanguli districts was associated with the highest malaria risk ranging from a relative risk of 3.00 to 4.83. The district-level spatial patterns of malaria risks changed over time. CONCLUSION: This study identified high malaria risk districts in Ghana where urgent and targeted control efforts are required. Noticeable changes were also observed in malaria risk for certain districts over some periods in the study. The findings provide an effective, actionable tool to arm policymakers and programme managers in their efforts to reduce malaria risk and its associated morbidity and mortality in line with the Sustainable Development Goals (SDG) 3.2 for limited public health resource settings, where universal intervention across all districts is practically impossible.

Multilevel modelling of neonatal mortality in Ghana: Does household and community levels matter?

Background: Neonatal mortality accounts for an increasing share of under-five deaths, and they are declining at a slower rate than postnatal deaths. Apparently, neonatal mortality is increasingly becoming a major public health problem in Ghana and the world over. The current study sought to analyze neonatal mortality as a function of predictor variables and to estimate and understand unobserved household and community-level residual effects on neonatal mortality to provide data driven evidence to shape informed policies and interventions aimed at reducing the neonatal mortality burden. Methods: The current study extracted three-level complex data on 5884 children born in the five years preceding the 2014 Ghana Demographic and Health Survey. A two-level and three-level multilevel logistic models were applied to estimate unobserved household and community-level variations in neonatal mortality in the presence of set of predictor variables. Sampling weights were incorporated in both the descriptive and inferential analysis since the data used emanated from a complex survey. Model fit statistics such as AIC scores for a weighted two-level and three-level random intercept logistic models were compared. The model with the lowest AIC score was considered the most preferred model. Results: The household-level random intercept model suggested that the odds of neonatal mortality was higher among multiple births [OR = 3.15 (95% CI: 1.17, 8.50)], babies born to mothers who received prenatal care from non-skilled worker [OR = 5.88 (95% CI: 2.90, 11.91)], babies delivered through caesarian section [OR = 2.47 (95% CI: 1.06, 5.79)], a household with 1-4 members [OR = 10.23 (95% CI: 4.17, 25.50)], a short preceding birth interval (<24 months) [OR = 3.05 (95% CI: 1.18, 7.88)], and preceding birth interval between 24 and 47 months [OR = 2.88 (95% CI: 1.41, 5.91)]. Substantial unobserved household-level residual variations in neonatal mortality were observed. Conclusion: The findings of the current study provide an actionable information to be used by government and other stakeholders in the health sector to renew commitment to reduce neonatal mortality to an acceptable level. There is the need to intensify maternal health education by health providers to encourage pregnant women to visit antenatal clinics at least four times so they could benefit substantially from ANC services.

Joint modelling of systolic and diastolic blood pressure and its associated factors among women in Ghana: Multivariate response multilevel modelling methods.

Elevated blood pressure is the leading cause of cardiovascular diseases related mortality and a major contributor to non-communicable diseases globally, especially in sub-Saharan Africa where about 74.7 million people live with hypertension. In Ghana, hypertension is epidemic with prevalence of over 30% and experiencing continuing burden with its associated morbidity and mortality. Using the 2014 Ghana Demographic and Health Survey, we analyzed data on 4744 women aged 15-49 years residing in 3722 households. We employed univariate and multivariate response multilevel linear regression models to analyze predictors of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Geospatial maps were produced to show the regional distribution of hypertension prevalence in Ghana. Stata version 17 and R version 4.2.1 were used to analyze the data. Of the 4744 woman, 337 (7.1%) and 484 (10.2%) were found to be hypertensive on SBP and DBP, respectively. A combined prevalence of 12.3% was found. Older ages 25-34 (OR 2.45, 95%CI: 1.27, 3.63), 35-44 (OR 8.72, 95%CI: 7.43, 10.01), 45-49 (OR 15.85, 95%CI: 14.07, 17.64), being obese (OR 5.10, 95%CI: 3.62, 6.58), and having no education (OR -2.05, 95%CI: -3.40, -0.71) were associated with SBP. For DBP, we found the associated factors to be older ages 25-34 (OR 3.29, 95%CI: 2.50, 4.08), 35-44 (OR 6.78, 95%CI: 5.91, 7.64), 45-49 (OR 10.05, 95%CI: 8.85, 11.25), being obese (OR 4.20, 95%CI: 3.21, 5.19), and having no education (OR -1.23, 95%CI: -2.14, -0.33). Substantial residual household level differences in SBP (15%) and DBP (14%) were observed. We found strong residual correlation of SBP and DBP on individual women (r = 0.73) and household-level (r = 0.81). The geospatial maps showed substantial regional differences in the observed and reported hypertension prevalence. Interventions should be targeted at the identified high-risk groups like older age groups and those who are obese, and the high-risk regions.

The efficacy of pharmacological interventions to improve cognitive and behavior symptoms in people with dementia: A systematic review and meta-analysis.

Background and Aims: Dementia is becoming a major global public health menace in the aging population affecting 47 million people globally. Dementia has no cure and effective interventions. Treatment of dementia is a big problem. The most common symptomatic medications for cognition, behavior, and global functioning among patients with dementia currently are cholinesterase inhibitors and memantine. However, Information on the effectiveness of cholinesterase inhibitors for dementia is conflicting and controversial. Thus, this makes it difficult for decision-makers, healthcare providers, patients, and caregivers to decide on the most effective intervention. The current meta-analysis sought to investigate the efficacy of pharmacologic interventions to improve cognitive and behavioral symptoms in people with living dementia. Methods: This current systematic review and meta-analysis used the preferred reporting items for systematic reviews and meta-analyses to ensure accuracy and comprehensiveness. The Cochrane MEDLINE, Database of Systematic Reviews, and other databases were thoroughly searched for relevant studies. We selected Studies such as randomized controlled trials published in English with a sample size of at least 20 subjects. We selected and applied the random-effects meta-analysis as the most preferred model because of the heterogeneity across studies. The computation of the weighted effect size was based on the result from the test of heterogeneity. Results: Twenty-two studies were finally used in the meta-analysis. The study subjects who received donepezil 5 mg/day, donepezil 10 mg/day, and galantamine 24 mg/day had improved cognition symptoms (ADAS-cog) score of -1.46 (95% CI = -2.24, -0.68, z = 3.67, p < 0.001), -2.31 (95% CI = -3.30, -1.31, z = 5.45, p < 0.001) and -3.04 (95% CI = -4.16, -1.92, z = 5.31, p < 0.001) respectively. Conclusion: The current meta-analysis suggests significant benefits of cholinesterase inhibitors such as donepezil (5 and 10 mg/day) and galantamine on cognitive symptoms.

Spatio-temporal variations in neonatal mortality rates in Ghana: An application of hierarchical Bayesian methods.

Ghana might not meet the SDGs target 3.2 of reducing neonatal mortality to 12 deaths per 1000 live births by 2030. Identifying core determinants of neonatal deaths provide policy guidelines and a framework aimed at mitigating the effect of neonatal deaths. Most studies have identified household and individual-level factors that contribute to neonatal mortality. However, there are relatively few studies that have rigorously assessed geospatial covariates and spatiotemporal variations of neonatal deaths in Ghana. This study focuses on modeling and mapping of spatiotemporal variations in the risk of neonatal mortality in Ghana using Bayesian Hierarchical Spatiotemporal models. This study used data from the Ghana Demographic and Health Surveys (GDHS) conducted in 1993, 1998, 2003, 2008, and 2014. We employed Bayesian Hierarchical Spatiotemporal regression models to identify geospatial correlates and spatiotemporal variations in the risk of neonatal mortality. The estimated weighted crude neonatal mortality rate for the period under consideration was 33.2 neonatal deaths per 1000 live births. The results obtained from Moran's I statistics and CAR model showed the existence of spatial clustering of neonatal mortality. The map of smooth relative risk identified Ashanti region as the most consistent hot-spot region for the entire period under consideration. Small body size babies contributed significantly to an increased risk of neonatal mortality at the regional level [Posterior Mean: 0.003 (95% CrI: 0.00,0.01)]. Hot spot GDHS clusters exhibiting high risk of neonatal mortality were identified by LISA cluster map. Rural residents, small body size babies, parity, and aridity contributed significantly to a higher risk of neonatal mortality at the GDHS cluster level. The findings provide actionable and insightful information to prioritize and distribute the scarce health resources equitably to tackle the menace of neonatal mortality. The regions and GDHS clusters with excess risk of neonatal mortality should receive optimum attention and interventions to reduce the neonatal mortality rate.

Predictive model and determinants of odds of neonates dying within 28 days of life in Ghana.

BACKGROUND: One of the priorities and important current problem in public health research globally is modeling of neonatal mortality and its risk factors in using the appropriate statistical methods. It is believed that multiple risk factors interplay to increase the risk of neonatal mortality. To understand the risk factors of neonatal mortality in Ghana, the current study carefully evaluated and compared the predictive accuracy and performance of two classification models. METHODS: This study reviewed the birth history data collected on 5884 children born in the 5 years preceding the 2014 Ghana Demographic and Health Survey (GDHS). The 2014 GDHS is a cross-sectional nationally representative household sample survey. The relevant variables were selected using leaps-and-bounds method, and the area under curves were compared to evaluate the predictive accuracy of unweighted penalized and weighted single-level multivariable logistic regression models for predicting neonatal mortality using the 2014 GDHS data. RESULTS: The study found neonatal mortality prevalence of 2.8%. A sample of 4514 children born in the 5 years preceding the 2014 GDHS was included in the inferential analysis. The results of the current study show that for the unweighted penalized single-level multivariable logistic model, there is an increased risk of neonatal death among babies born to mothers who received prenatal care from non-skilled worker [OR: 3.79 (95% CI: 2.52, 5.72)], multiple births [OR: 3.10 (95% CI: 1.89, 15.27)], babies delivered through caesarian section [OR: 2.24 (95% CI: 1.30, 3.85)], and household with 1 to 4 members [OR: 5.74 (95% CI: 3.16, 10.43)], respectively. The predictive accuracy of the unweighted penalized and weighted single-level multivariable logistic regression models was 82% and 80%, respectively. CONCLUSION: The study advocates that prudent and holistic interventions should be institutionalized and implemented to address the risk factors identified in order to reduce neonatal death and, by large, improve child and maternal health outcomes to achieve the SDG target 3.2.

Trends for Diarrhea Morbidity in the Jasikan District of Ghana: Estimates from District Level Diarrhea Surveillance Data, 2012-2016.

About 22% of childhood deaths in developing countries are attributable to diarrhea. In poor resource settings, diarrhea morbidities are correlated with poverty and socio-contextual factors. Diarrhea rates in Ghana are reported to be high, with cases estimated at 113,786 among children under-five years in 2011. This study analyzed the trends of diarrhea morbidity outcomes in the Jasikan District of Ghana. A retrospective analysis of records on diarrhea data for a five years' period (January 2012 to December 2016) was undertaken. There was a total of 17740 diarrhea case reports extracted from District Health Information Management System (DHIMS) II database in an Excel format which was then exported to Stata version 14 for data cleaning, verification, and analysis. Excel version 2016 was used to plot the actual observed cases by years to assess trends and seasonality. There was a period incidence rate of 272.02 per 1000 persons with a decreasing annual growth rate of 1.85%. Declines for diarrhea generally occurred from November to December and increased from January upwards, evidence that most cases of diarrhea in this study were reported in the harmattan season. High incidence of diarrhea was found to be common among under-five children and among females. Decreasing trend of diarrhea incidence which was identified in this research within the five years' period understudied shows that, by the year 2020, there will be a sharp decline in the incidence rate of diarrhea reported cases in Jasikan District, given improvements in the external environmental conditions in the district, all things being equal.

Assessing the ownership, usage and knowledge of Insecticide Treated Nets (ITNs) in Malaria Prevention in the Hohoe Municipality, Ghana.

INTRODUCTION: Malaria remains one of the top five killer diseases in sub-Saharan Africa (SSA) and its burden is skewed towards pregnant women and children under five. Insecticide Treated Bed-Net (ITN) usage is considered one of the most cost-effective, preventive interventions against malaria. This study sought to assess ownership, usage, effectiveness, knowledge, access and availability of ITNs among mothers with children under five in the Hohoe municipality. METHODS: In August 2010 a cross-sectional survey was carried out in 30 communities, selected using the WHO 30 cluster sampling technique. In the selected communities, mothers/caregivers with children under five years were selected using the snowball method. Data were collected through questionnaires and direct observation of ITN. Descriptive statistics was used to analyse the data collected. RESULTS: A total of 450 mothers/caregivers were interviewed and their mean age was 30 ± 7 years. ITN ownership was 81.3%, and usage was 66.4%. The majority (97.8%) of the mothers/caregivers said ITNs were effective for malaria prevention. Awareness about ITNs was high (98.7%) and the majority (52.9%) had heard about ITNs from Reproductive and Child Health (RCH) Clinic and antenatal care ANC clinic (33.6%). Over 60% of the ITNs were acquired through free distribution at RCH clinics, clinic and home distribution during mass immunization sessions. The majority of the mothers/caregivers (78.6%) knew the signs and symptoms of malaria, what causes malaria (82.2%) and who is most at risk (90%). CONCLUSION: Behaviour change communication strategies on ITN use may need to be further targeted to ensure full use of available ITNs.