Time series analysis of the relationship between diarrhea in children and Rota 2 vaccine in the Fanteakwa District of the eastern region of Ghana.

BACKGROUND: Rotavirus is considered the main causal factor of severe gastroenteritis among infants and children globally. The association with severe rotavirus infection is mostly worse among the least developed countries, mainly due to inadequate access to medical care and poverty. This study was conducted to determine the seasonal effects in respect of diarrhea cases in children, the association between diarrhea cases and Rota2 vaccine in the Fanteakwa District of the Eastern Region of Ghana. METHODS: The study compares monthly diarrhea cases against children vaccinated with Rota2 extracted from DHIMS2 spanning May 2012 to December 2017 in Fanteakwa District. A univariate association between diarrhea cases and children vaccinated with Rota 2 was conducted using the R-software version 3.4.4 with the use of forecast, tseries and TSAPred. Pearson Correlation coefficient was also computed between monthly diarrhea cases and Rota 2 as well as lagged values of Rota 2 and Diarrhea cases. RESULTS: The study shows that February recorded the highest average number of diarrhea cases (172) over the period 2012 to 2017 with a standard deviation of 59. However, a one-way analysis of variance shows a significant difference amongst the monthly averages with an F-statistic of 0.042 and P-value of 0.064. It is observed that the correlations between each of the Rota2 doses and the lagged cases are positive, showing higher Rota2 doses a month ago ((Xt - 1),0.346 to 0.735), two months ago ((Xt - 2),0.383 to 0.746), three months ago ((Xt - 3), 0.330 to 0.737) and four months ago ((Xt - 4), 0.236 to 0.723) are associated with lower diarrhea cases. The results also show that an increase in the previous two month's Rota2 figures by 100 is associated with a significant decrease in the currently expected diarrhea cases by approximately 36. CONCLUSION: Seasonal variations exist in the occurrence of diarrhea in children, with January recording the highest number of diarrhea cases (172). There is a relationship between episodes of diarrhea in children and Rota2 (p-value = 0.064); thus, the more children are vaccinated with Rota2, the less diarrhea cases are recorded. Diarrhea cases in Fanteakwa district are generally low, except 2013 and 2016 where the cases are higher than the rest of the other years.

Assessing the knowledge of expectant mothers on mother-to-child transmission of viral hepatitis B in Upper West region of Ghana.

BACKGROUND: Viral Hepatitis B is of a major public health concern globally, especially in developing countries. Expectant mothers' knowledge of Mother-To-Child Transmission (MTCT) of the disease is significant in preventing the spread from an infected mother to her child. This study sought to assess the expectant mothers' knowledge of Mother-To-Child Transmission of viral hepatitis B in the Wa Municipality and Lawra District of Upper West Region, Ghana. METHODS: A descriptive cross-sectional study with a multi-stage sampling technique was employed to select a total of 450 study respondents (expectant mothers), and a semi-structured questionnaire was used for the data collection. Respondents were interviewed using face-to-face interview technique. RESULTS: Majority (54.0%) of the respondents were aged between 25 and 35 years and the results were similar in both districts. Overall, 62.4% (281/450) of the respondents had at least Junior High level education, and 76.2% (343/450) were multigravida. Educational levels among respondents in the two areas were above 50.0% and considered relatively high. Respondents' general knowledge of hepatitis B infection and disease was 46.0% (208/450). However, there was a slight difference between the two districts (40.1% in Lawra District and 51.6% in Wa Municipality). The overall knowledge level on MTCT of viral hepatitis B among the respondents was 34.7% (156/450): the Wa Municipality recorded higher knowledge (43.3%) compared to 24.8% in Lawra District. CONCLUSION: The knowledge level of the expectant mothers on MTCT of viral hepatitis B is relatively low in Upper West Region, Ghana. Majority of the respondents had some form of formal education. The age, marital status, education, occupation, gravity and family setup were found to be associated with knowledge of Hepatitis B infection and MTCT. Thus, there is urgent need to intensify efforts of health staff to educate expectant mothers. In addition, home education and outreach activities should be intensified on HBV infection as well as MTCT. Consequently, planning, implementation and execution of preventive activities, especially in the antenatal clinics should critically consider the social and demographic variations of mothers.

No Association between SARS-CoV-2 Infection and Quality of Life 6- and 12-Months After Infection.

OBJECTIVE: To assess the association between SARS-CoV-2 infection and long-term quality of life (QoL). METHODS: Prospective cohort study with 6- and 12-month follow-up conducted in 14 Canadian institutions. Children tested for SARS-CoV-2 between August 2020 and February 2022 were eligible. QoL was measured using PedsQLTM-4.0, overall health status scores 6- and 12-months after testing. RESULTS: Among SARS-CoV-2 positive and negative participants eligible for long-term follow-up, 74.8% (505/675) and 71.8% (1106/1541) at 6- and 59.0% (727/1233) and 68.1% (2520/3699) at 12-months, completed follow-up, respectively. Mean ± SD PedsQL™ scores did not differ between positive and negative groups; difference: -0.86 (95%CI: -2.33, 0.61) at 6- and -0.48 (95%CI: -1.6, 0.64) at 12-months, respectively. SARS-CoV-2 test-positivity was associated with higher social subscale scores. Although in bivariate analysis, overall health status at 6-month was higher among SARS-CoV-2 cases [difference: 2.16 (95%CI: 0.80, 3.53)], after adjustment for co-variates, SARS-CoV-2 infection was not independently associated with total PedsQL™ or overall health status at either time point. Parental perception of recovery did not differ based on SARS-CoV-2 test-status at either time point. CONCLUSIONS: SARS-CoV-2 infection was not associated with QoL, overall health status, or parental perception of recovery 6- and 12-months following infection. CLINICAL TRIAL REGISTRATION (IF ANY): N/A.

Post-COVID-19 Condition in Children 6 and 12 Months After Infection.

Importance: There is a need to understand the long-term outcomes among children infected with SARS-CoV-2. Objective: To quantify the prevalence of post-COVID-19 condition (PCC) among children tested for SARS-CoV-2 infection in pediatric emergency departments (EDs). Design, Setting, and Participants: Multicenter, prospective cohort study at 14 Canadian tertiary pediatric EDs that are members of the Pediatric Emergency Research Canada network with 90-day, 6-month, and 12-month follow-up. Participants were children younger than 18 years who were tested for SARS-CoV-2 infection between August 2020 and February 2022. Data were analyzed from May to November 2023. Exposure: The presence of SARS-CoV-2 infection at or within 14 days of the index ED visit. Main Outcomes and Measures: Presence of symptoms and QoL reductions that meet the PCC definition. This includes any symptom with onset within 3 months of infection that is ongoing at the time of follow-up and affects everyday functioning. The outcome was quantified at 6 and 12 months following the index ED visit. Results: Among the 5147 children at 6 months (1152 with SARS-CoV-2 positive tests and 3995 with negative tests) and 5563 children at 12 months (1192 with SARS-CoV-2 positive tests and 4371 with negative tests) who had sufficient data regarding the primary outcome to enable PCC classification, the median (IQR) age was 2.0 (0.9-5.0) years, and 2956 of 5563 (53.1%) were male. At 6-month follow-up, symptoms and QoL changes consistent with the PCC definition were present in 6 of 1152 children with positive SARS-CoV-2 tests (0.52%) and 4 of 3995 children with negative SARS-CoV-2 tests (0.10%; absolute risk difference, 0.42%; 95% CI, 0.02% to 0.94%). The PCC definition was met at 12 months by 8 of 1192 children with positive SARS-CoV-2 tests (0.67%) and 7 of 4371 children with negative SARS-CoV-2 tests (0.16%; absolute risk difference, 0.51%; 95% CI, 0.06 to 1.08%). At 12 months, the median (IQR) PedsQL Generic Core Scale scores were 98.4 (90.0-100) among children with positive SARS-CoV-2 tests and 98.8 (91.7-100) among children with negative SARS-CoV-2 tests (difference, -0.3; 95% CI, -1.5 to 0.8; P = .56). Among the 8 children with SARS-CoV-2 positive tests and PCC at 12-month follow-up, children reported respiratory (7 of 8 patients [88%]), systemic (3 of 8 patients [38%]), and neurologic (1 of 8 patients [13%]) symptoms. Conclusions and Relevance: In this cohort study of children tested for SARS-CoV-2 infection in Canadian pediatric EDs, although children infected with SARS-CoV-2 reported increased chronic symptoms, few of these children developed PCC, and overall QoL did not differ from children with negative SARS-CoV-2 tests.

Uptake challenges of intermittent preventive malaria therapy among pregnant women and their health care providers in the Upper West Region of Ghana: A mixed-methods study.

BACKGROUND: Malaria in pregnancy remains a major public health problem in endemic countries, especially in sub-Saharan Africa (SSA). Existing interventions such as intermittent preventive therapy in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) are effective against placental malaria. However, low uptake of this intervention is a challenge in SSA. This study assessed factors affecting IPTp-SP uptake among pregnant women as well as their health care providers, including health system-related factors. METHODS: From November 2018 until May 2019 a mixed-methods study was conducted in one urban and one rural district of the Upper West Region of Ghana. A multi-stage sampling technique was used to recruit 740 3rd trimester pregnant women and 74 health service providers from 37 antenatal care (ANC) facilities. Quantitative data was collected through a standard questionnaire from pregnant women and ANC service providers. Three focus group discussions (FGDs) were conducted in each district with pregnant women who had defaulted on their IPTp doses to collect information about the challenges in accessing IPTp-SP. The primary outcome was the uptake of IPTp-SP during antenatal care visits. In addition, the health care provider and health system-related factors on the administration of SP were assessed, as well as details of folic acid (FA) supplementation. Data were analysed using descriptive statistics and Poisson regression. RESULTS: Responses from 697 pregnant women were analysed. Of these, 184 (26.4%) had taken the third dose of SP (SP3) in line with international guidelines. IPTp-SP uptake was low and significantly associated with the number of maternal ANC contacts and their gestational age at 1st ANC contact. Most pregnant women were regularly co-administered SP together with 5 mg of FA, in contrast to the international recommendations of 0.4 mg FA. The main challenges to IPTp-SP uptake were missed ANC contacts, knowledge deficiencies among pregnant women of the importance of IPTp, and frequent drug stock outs, which was confirmed both from the ANC providers as well as from the pregnant women. Further challenges reported were provider negligence/absenteeism, adverse drug reactions, and mobile residency of pregnant women. CONCLUSIONS: The uptake of IPTp-SP in the study area is still very low, which is partly explained by frequent drug stock outs at health facilities, staff absenteeism, knowledge deficiencies among pregnant women, and missed ANC contacts. The high dosing of co-administered FA is against international recommendations. These observations need to be addressed by the national public health authorities.

Fear of infertility limits contraceptive usage among first-time mothers in Ghana: A cross-sectional study.

OBJECTIVES: This study aimed to determine postpartum modern contraceptive use among first-time young mothers attending child welfare clinics in the Eastern Region of Ghana and explore factors that influence family planning uptake after the first delivery, including fear of infertility. METHODS: This facility-based, cross-sectional study used interviewer-administered structured questionnaires. The study recruited 422 first-time young mothers aged 15-24 years, with 6- to 18-month-old babies attending child welfare clinics. RESULTS: Overall, less than half (44%) of first-time mothers used modern contraceptives within 18 months after delivery. Fear of infertility after contraceptive use (56%) is the main barrier reported as the reason for women's non-use of modern contraceptives. Mothers with tertiary education have higher odds of using postpartum contraceptives (adjusted odds ratio =1.6, 95% confidence interval: 0.4-2.0). Compared to mothers with younger children, those with children older than 6 months have higher odds of postpartum contraceptive use (adjusted odds ratio = 1.3, 95% confidence interval: 0.3-1.7). Nonspousal communication (adjusted odds ratio = 0.1, 95% confidence interval: 0.1-0.3) as compared to communication among partners about contraception and those in formal employment (adjusted odds ratio = 0.3, 95% confidence interval: 0.1-0.7), were less likely to use postpartum contraceptives. CONCLUSION: Considering that there is low postpartum contraceptive utilization, mostly due to concerns about fear of infertility after use, it is paramount to intensify education on actual side effects and reformulate policies that address specific concerns of infertility among mothers and contraceptive use.