Prevalence of sickle cell disorders and malaria infection in children aged 1-12 years in the Volta Region, Ghana: a community-based study.

BACKGROUND: Alterations in the structure of haemoglobin (Hb) are usually brought about by point mutations affecting one or, in some cases, two codons encoding amino acids of the globin chains. One in three Ghanaians are said to have sickle cell disorders, whereas malaria continues to be one of the leading causes of mortality among children. This study determined the prevalence of sickle cell disorders and malaria infection among children aged 1-12 years in the Volta Region. METHODS: This was a community-based cross-sectional survey that involved 938 children aged 1-12 years selected from three districts, one each from the 3 geographical zones of the Volta Region using a multistage sampling method. Demographic information was collected using a standard questionnaire and anthropometric indices were measured. Isoelectric focusing (IEF) electrophoresis was used to determine the Hb genotypes and sub-microscopic parasites were determined by PCR. RESULTS: The prevalence of sickling screening positive was 16.0% with an overall prevalence of sickle cell disorders being 2.0%. Among the individual genotypes making up the sickle cell disorders, genotype HbSF was the highest (0.9% as compared to 0.2%; HbSS, 0.6%; HbSC and 0.3%; HbSCF). Microscopic Plasmodium falciparum parasitaemia was detected among 5.5% of the children and 14.2% sub-microscopic prevalence by PCR. Children with sickle cell disorders were more likely to have sub-microscopic parasitaemia (AOR = 5.51 95%CI (2.15, 14.10), p < 0.001) as well as anaemia (AOR = 3.03 95% CI (1.04, 8.82), p = 0.042), compared to those with normal genotypes. There was no significant difference observed between sickle cell disorders and growth and development of the children screened. CONCLUSIONS: Sickle cell disorders were significantly associated with sub-microscopic parasitaemia as well as anaemia in this study. Establishment of sickle cell clinics in the district and regional hospitals will help in the management of children with the disorder and also generate a national database on sickle cell disorders. National neonatal screening policies must also be put in place to help in early detection and management of these disorders.

Potential health risk assessment of toxic metals contamination in clay eaten as pica (geophagia) among pregnant women of Ho in the Volta Region of Ghana.

INTRODUCTION: Geophagia although pleasurable and somewhat a necessity among pregnant women, also comes along with its own attendant problems such as exposure to potentially hazardous substances like bacteria, fungi, helminthes and ova, radioactive materials, and toxic elemental minerals in the soil depending on the geographical location. METHODOLOGY: This study evaluated the potential health risk involved during the exposure of pregnant women to toxic elemental minerals via the consumption of clay as pica (geophagia). Elemental mineral analysis was carried out using Buck Scientific 210VGP Flame Atomic Absorption Spectrophotometer (Buck Scientific, Inc. East Norwalk, USA). Risk assessment methods were also used to ascertain the various risks factors and the overall risk level. RESULTS: Concentrations of the macro elements investigated were 1.38 ± 1.5, 2.40 ± 1.5, 7.74 ± 1.5, 4.01 ± 1.0, 13.24 ± 2.2 and 13.76 ± 2.1 mg/Kg for iron (Fe), copper (Cu), zinc (Zn), potassium (K), magnesium (Mg) and sodium (Na) respectively. While that for the micro elements were 1.63 ± 0.03 µg/Kg, 4.72 ± 0.8, 0.53 ± 0.02 and 1.85 ± 0.3 mg/kg respectively for arsenic (As), manganese (Mn), lead (Pb) and nickel (Ni). Estimated Daily Intake (EDI), Hazard Quotient (HQ), Target Hazard Quotient (THQ) and Total Target Hazard Quotient (TTHQ) values ranged 0.611-5.44 (mg/kg Bw/day), 6.26 × 10- 4 - 106.5, 0.067-10.34 and 15 respectively. CONCLUSION: There is the likelihood of posing adverse health problems when clay samples obtained from Anfoega which is sited in the Volta region of Ghana is consumed due to the fact that the HQ's of these elemental minerals were > 1 which points to high content of Manganese (Mn) and Nickel (Ni). It is also likely to cause adverse health problems in an individual's life time since THQ for Arsenic, Lead and Nickel were above 1. Ultimately, the cumulative effect of these toxicants were exceedingly great (≤ 15) which implied a high level of unsafety associated with this clay. Per the results from this study, it is not safe for pregnant women to consume clay as pica since these toxic elements may cause detrimental effects on the foetus of the unborn child.

Community utilisation and satisfaction with the community-based health planning and services initiative in Ghana: a comparative study in two system learning districts of the CHPS+ project.

BACKGROUND: To strengthen the implementation of the Community-based Health Planning and Services (CHPS) programme which is Ghana's key primary health care delivery strategy, the CHPS+ Project was initiated in 2017. We examined community utilisation and satisfaction with CHPS services in two System Learning Districts (SLDs) of the project. METHODS: This community-based descriptive study was conducted in the Nkwanta South Municipality and Central Tongu District of Ghana. Data were collected from 1008 adults and analysed using frequency, percentage, chi-square, and logistic regression models. RESULTS: While the level of utilisation of CHPS services was 65.2%, satisfaction was 46.1%. Utilisation was 76.7% in Nkwanta South and 53.8% in Central Tongu. Satisfaction was also 55.2% in Nkwanta South and 37.1% in Central Tongu. Community members in Nkwanta South were more likely to utilise (AOR = 3.17, 95%CI = 3.98-9.76) and be satisfied (AOR = 2.77, 95%CI = 1.56-4.90) with CHPS services than those in Central Tongu. Females were more likely to utilise (AOR = 1.75, 95%CI = 1.27-2.39) but less likely to be satisfied [AOR = 0.47, 95%CI = 0.25-0.90] with CHPS services than males. Even though subscription to the National Health Insurance Scheme (NHIS) was just 46.3%, NHIS subscribers were more likely to utilise (AOR = 1.51, 95%CI = 1.22-2.03) and be satisfied (AOR = 1.45, 95%CI = 0.53-1.68) with CHPS services than non-subscribers. CONCLUSION: Ghana may not be able to achieve the goal of universal health coverage (UHC) by the year 2030 if current levels of utilisation and satisfaction with CHPS services persist. To accelerate progress towards the achievement of UHC with CHPS as the vehicle through which primary health care is delivered, there should be increased public education by the Ghana Health Service (GHS) on the CHPS concept to increase utilisation. Service quality should also be improved by the GHS and other stakeholders in Ghana's health industry to increase satisfaction with CHPS services. The GHS and the National Health Insurance Authority (NHIA) should also institute innovative strategies to increase subscription to the NHIS since it has implications for CHPS service utilisation and satisfaction.

Factors influencing adherence to the new intermittent preventive treatment of malaria in pregnancy policy in Keta District of the Volta region, Ghana.

BACKGROUND: About 25% of pregnant women in malaria-endemic areas are infected with malaria and this accounts for about 15% of maternal deaths globally. Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is one of the main strategies for prevention of malaria in pregnancy. A new recommendation was made by the World Health Organization (WHO) that at least three doses of IPTp-SP should be administered before delivery. This study sought to determine the factors influencing adherence to the new IPTp-SP policy in Keta District, Volta region, Ghana. METHODS: A cross-sectional quantitative study among 375 nursing mothers at four selected health facilities in Keta district, Ghana was conducted using a structured questionnaire to interview participants. Sampling proportionate to the size of facility was used to determine the number of nursing mothers from each facility based on the caseload. For each facility systematic random sampling was used to select eligible nursing mothers. Data was analyzed using STATA 15. Chi-square was used to test bivariate association between categorical variables and adherence. Logistic regression analysis was used to examine sociodemographic, individual and institutional factors influencing adherence to IPTp-SP. RESULT: About 82.1% of participants adhered to the WHO policy recommendations of at least three doses of IPTp-SP. However, only 17.1% received Ghana's five dose coverage recommendation. The proportion of IPTp-SP coverage for IPTp1 was 98.9%; IPTp2 95.5%; IPTp3 80.8%; IPTp4 39.5%; IPTp5 17.1%. CONCLUSION: Adherence to IPTp-SP was satisfactory according to WHO's policy recommendation, however, majority of the participants had less than the five doses recommended in Ghana. Number of Antenatal Care (ANC) visits and knowledge of malaria were the main determinants of adherence to IPTp-SP.

The burden of HIV on Tuberculosis patients in the Volta region of Ghana from 2012 to 2015: implication for Tuberculosis control.

BACKGROUND: The impact of HIV on TB, and the implications for TB control, has been acknowledged as a public health challenge. It is imperative therefore to assess the burden of HIV on TB patients as an indicator for monitoring the control efforts of the two diseases in this part of the world. This study aimed at determining the burden of HIV infection in TB patients. METHODS: We conducted a retrospective review of TB registers in five districts of the Volta Region of Ghana. Prevalence of TB/HIV co-infection was determined. Bivariate and multivariate logistic regression were used to identify the predictors of HIV infection among TB patients and statistical significance was set at p-value <0.05. RESULTS: Of the 1772 TB patients, 1633 (92.2%) were tested for HIV. The overall prevalence of TB/HIV co-infection was (18.2%; 95% CI: 16.4-20.1). The prevalence was significantly higher among females (24.1%; 95%CI: 20.8-27.7), compared to males (15.1%; 95% CI: 13.1-17.4) (p < 0.001) and among children <15 years of age (27.0%; 95% CI: 18.2-38.1), compared to the elderly ≥70 years (3.5%; 95% CI: 1.6-7.4) (p < 0.001). Treatment success rate was higher among patients with only TB (90%; 95% CI: 88.1-91.5) than among TB/HIV co-infected patients (77.0%; 95% CI: 71.7-81.7) (p < 0.001). Independent predictors of HIV infection were found to be: being female (AOR: 1.79; 95% CI: 1.38-2.13; p < 0.001); smear negative pulmonary TB (AOR: 1.84; 95% CI: 1.37-2.47; p < 0.001); and patients registered in Hohoe, Kadjebi, and Kpando districts with adjusted odds ratios of 1.69 (95% CI: 1.13-2.54; p = 0.011), 2.29 (95% CI: 1.46-3.57; p < 0.001), and 2.15 (95% CI: 1.44-3.21; p < 0.001) respectively. Patients ≥70 years of age and those registered in Keta Municipal were less likely to be HIV positive with odds ratios of 0.09 (95% CI: 0.04-0.26; p < 0.001) and 0.62 (95% CI: 0.38-0.99; p = 0.047) respectively. CONCLUSION: TB/HIV co-infection rate in five study districts of the Volta region is quite high, occurs more frequently in female patients than males; among smear negative pulmonary TB patients, and children <15 years of age. Findings also demonstrate that HIV co-infection affects TB treatment outcomes adversely. Strengthening the TB/HIV collaborative efforts is required in order to reduce the burden of co-infection in patients.

Lay beliefs of COVID-19 vaccine refusal among intercity commercial drivers in the Volta region of Ghana: recommendations for improved vaccine uptake.

BACKGROUND: The COVID-19 vaccine has faced increased hesitancy in Ghana and the Volta region in particular since its rollout. Acceptance of the vaccine among intercity commercial drivers is crucial, especially in the Volta region, as they transport people within and outside the country and could fuel the transmission of the virus if not vaccinated. OBJECTIVE: We therefore established lay beliefs surrounding COVID-19 vaccine refusal among intercity commercial drivers in the Volta region of Ghana, as well as their recommendations for improved vaccine uptake. METHODS: We purposively interviewed twenty-five (25) intercity commercial drivers who had not been vaccinated for COVID-19 in the Volta region of Ghana using a semi-structured interview guide and analysed their responses thematically using the ATLAS.ti software. RESULTS: Various (ten) beliefs surrounding COVID-19 vaccine refusal were identified. These include the nonexistence of COVID-19, being immune to COVID-19, and the belief in the nonexistence of vaccines and vaccines being meant for the sick. Other beliefs identified were the belief that the COVID-19 vaccine is meant to reduce Africa's population, that the vaccine triggers other health complications leading to death, the belief that vaccination could cause financial loss, political mistrust, that the COVID-19 vaccine is not permitted by God, and the belief that prayer prevents COVID-19 infection. They also suggested that the adoption of persuasive communication techniques, the publication of information on those who died of COVID-19, providing evidence of tests conducted on the vaccine, testing people before vaccination, provision of care to those who may experience side effects from the vaccine, and being able to explain why varied vaccines are used for the same virus could help improve vaccine uptake. CONCLUSION: Our findings show that there is a general lack of understanding and mistrust surrounding the COVID-19 vaccine among intercity commercial drivers in the Volta region. Hence, health promotion officers and communicators in the region need to be knowledgeable on the vaccine as well as on the conspiracy theories thwarting its uptake to provide comprehensive education to the public and intercity commercial drivers to improve its uptake.

Sociodemographic and health systems determinants of antiretroviral therapy adherence among human immunodeficiency virus-positive patients in the Volta Region of Ghana: A multi-centre study.

Objectives: Optimal adherence to antiretroviral therapy is required for viral load suppression. This study investigated the sociodemographic (age, sex, marital status, level of education, monthly income, settlement type, distance to the antiretroviral therapy-providing site, ethnicity) and health system (antiretroviral therapy-providing site) determinants of antiretroviral therapy adherence among human immunodeficiency virus-positive patients in the Volta Region, Ghana. Methods: A cross-section design was adopted, collecting data from 1729 human immunodeficiency virus patients and analysing them using STATA version 17 at level 0.05. Results: Antiretroviral therapy adherence was poor (51.2%). Being divorced (Adjusted odds ratio (AOR) = 0.65), widow (AOR = 0.58), cohabiting (AOR = 0.22), Ewe (AOR = 3.7), Ga/Dangbe (AOR = 2.27), living in a rural area (AOR = 1.54) and an urban area (AOR = 0.64), having a monthly income of GH₵1000 or less (AOR = 3.21), covering a distance of 51 km and above to the antiretroviral therapy centre (AOR = 1.79), receiving antiretroviral therapy from Ketu South Municipal Hospital (AOR = 0.09), Hohoe Municipal Hospital (AOR = 0.03), Ho Municipal Hospital (AOR = 0.02) and Ho Teaching Hospital (AOR = 0.09) were the determinants of antiretroviral therapy adherence. Conclusion: Antiretroviral therapy adherence was low. Interventions to improve antiretroviral therapy adherence should target these significant determinants.

Evaluation of the malaria surveillance system - Adaklu District, Volta Region, Ghana, 2019.

Objectives: We evaluated the malaria surveillance system in Adaklu District of the Volta Region of Ghana to determine if the system was meeting its objectives and assessed its usefulness and attributes. Study design: Descriptive cross-sectional design was used in evaluating the surveillance system. Methods: We interviewed stakeholders using a semi-structured questionnaire on case detection and reporting. We assessed the system attributes using the Centers for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems. We extracted and reviewed malaria surveillance data from the District Health Management Information System 2. Summary statistics and direct content analysis were performed on quantitative and qualitative data respectively. Results: Of the 80,441 suspected malaria cases recorded in Adaklu District from 2014 to 2018, 47,917 (59.6%) cases were confirmed. The system was meeting its objective of detecting malaria cases and monitoring trends in the population however, the system missed an epidemic in August 2016. Data generated from the surveillance system is used by the NMCP to aid in the distribution of logistics such as LLINs, RDT test kits, and track malaria control progress in the district. Staff at all levels were able to detect, confirm, treat and report malaria. All sub-districts/health facilities reported to the district and reports were all accurate and timely. The predictive value positive was 62.9%. Conclusions: The malaria surveillance system in Adaklu District was useful and meeting its set objective of monitoring trends of malaria in the population. It was simple, flexible, acceptable and representative; however, the system was not detecting epidemics. The District Health Management Team should set alert and epidemic thresholds to help detect promptly epidemics of malaria in the district.

Structural elements´ availability for the provision of Prevention of Mother-to-Child Transmission of HIV services among health facilities in the Volta Region of Ghana.

Introduction: despite advancement in global efforts to prevent mother-to-child transmission (PMTCT) of HIV, more work needs to be done to achieve the desired results in most African countries including Ghana. Inadequate structural elements can hinder the progress made so far in PMTCT of HIV. This study assessed the availability of structural elements for the provision of PMTCT of HIV services among health facilities in the Volta region of Ghana. Methods: a descriptive cross-sectional design was used among thirty-two health facilities. Data obtained were analysed using Stata version 14.0 and the Chi-square test was used to determine associations at the 0.05 level of significance. Results: a majority of the health facilities were Health Centers (50.0%) and most (43.8%) were located in rural areas. Only 9.5% of health practitioners at the Community Health Planning and Services (CHPS) Compounds and Mission-based Hospitals were trained in PMTCT, while 50.5% and 30.5% of health practitioners providing services at the Health Centers and District Hospitals respectively were trained in PMTCT. About 40.0% of District Hospitals had one room with auditory and visual privacy for PMTCT services. While all Mission-based and District Hospitals had ART regimens, no CHPS compound had, and only 8 (50.0%) of the Health Centers had ART regimens. Conclusion: there is a need for regular training of the health care practitioners providing PMTCT services. Also, programme managers should invest in PMTCT commodities, especially ART regimens, at the lower levels of healthcare for a holistic PMTCT service provision.

Frequencies and ethnic distribution of ABO and RhD blood groups in the Volta region of Ghana, towards effective blood bank services.

Background: Blood is an essential body fluid for the transport of substances to all parts of the body. Knowledge of blood group distribution within any population is important in determining the direction of blood bank inventory for emergency blood services. Objective: We report for the first time the blood group distribution pattern for the Volta region of Ghana. Method: Data were extracted and analyzed from 14,360 medical records of blood donors and recipients at seven major hospitals within the Volta region for a period of seven years (2012 to 2018). Results: ABO distribution within the region was 46.3%, 18.9%, 24.4%, 3.1%, 4.4%, 1.7%, 1.3% and 0.1% for O+, A+, B+, AB+, O-, A-, B- and AB- blood groups respectively. Rh (D)+ to Rh (D)- ratio was 92.5/7.5% respectively. Blood group O+ (>35 %) was highest in all ethnic groups in the region. Conclusion: Healthcare facilities in the region should adopt a strategy to stock-pile sufficient O+ blood which is the prevalent blood group in the region. All types of blood groups were reported hence our findings should provide information to guide clinical practice and/or blood transfusion services in the region.

Psychosocial factors influencing contraceptive use among adolescent mothers in the Volta Region of Ghana: application of the Health Belief Model.

Background: Globally, complications arising from pregnancy and childbirth are the leading cause of death among pregnant women aged 15 to 19 years. This study investigated the psychosocial factors influencing contraceptive use among adolescent mothers in the Volta Region using the Health Belief Model (HBM). Methods: This was a cross-sectional study conducted among 422 adolescent mothers. An interviewer-administered structured questionnaire was used to collect data. Binary logistic regression was used to determine the strength of association between the independent and the dependent variables at a p-value less than 0.05. Results: The prevalence of contraceptive use was 18.7%. Concerning perceived susceptibility, there was a significant association between contraceptive use and the perception of being at risk of pregnancy complications (p<0.001). Perceived barriers showed a significant association between fear of side-effects of contraceptives and contraceptive use (p=0.007). Concerning perceived self-efficacy, there was a significant association between contraceptive use and confidence to suggest to a partner to use contraceptives (p=0.003); confidence to ask for contraceptives from health facilities (p<0.001) and confidence to use contraceptives (p<0.001). Conclusion: Programmes to increase contraceptive use should aim at heightening the perception of risk of pregnancy complications, reduce barriers to contraceptive use and increase the skills in negotiating contraceptive use.

Predictors of adherence to HIV Post-Exposure Prophylaxis protocol among frontline healthcare workers at the Ho Teaching Hospital, Ghana.

BACKGROUND: Human Immunodeficiency Virus (HIV) is a global public health threat, and all frontline Health care workers (HCWs) are at a higher risk of exposure to body fluids from potential HIV patients and to sharp instruments. Though timely Post Exposure Prophylaxis (PEP) decreases the possibility of seroconversion to HIV after occupational exposure, most HCWs rarely adhere to the PEP protocol. This study aims to determine the predictors of adherence to PEP among frontline healthcare workers in the Ho Teaching Hospital, Ghana. METHODS: A facility-based cross-sectional study was conducted among 199 frontline HCWs. Data were collected using a pretested self-administered questionnaire and analyzed using STATA version 14 software. Binomial logistic regression was performed at the 0.05 level of significance and 95% confidence interval. FINDINGS: Overall, 17.9% of HCWs adhered to PEP. Frontline HCWs who perceived they had low and very low risk of occupational exposure to HIV transmission were 96% [AOR = 0.04 (95% C.I: 0.00, 0.39) P = 0.006] and 94% [AOR = 0.06 (95% C.I: 0.00, 0.62) P = 0.019] respectively less likely to adhere to PEP. HCWs who received training on PEP were 4 times more likely to adhere to PEP compared to those who had never received it [AOR = 4.24 (1.31, 13.19) P = 0.013]. CONCLUSION: Adherence to PEP protocol among HCWs was low. Therefore, there is a need for interventions to increase the perception of risk of occupational exposure to HIV transmission and to intensify training on PEP among frontline HCWs in the Ho Teaching Hospital. This will go a long way to increase their adherence to PEP.

Community-based active tuberculosis case finding using a symptom-based screening tool in the Volta Region, Ghana.

BACKGROUND: Early tuberculosis case detection is important for early commencement of treatment to improve treatment outcomes and also to prevent community spread of the disease. However, there is a paucity of data in Ghana on the efficiency of the symptom-based screening tool (SBS tool) to detect Mycobacterium tuberculosis in the communities. Therefore, this study assessed the usefulness of the SBS tool for community-based active case finding in the Volta Region of Ghana. METHODS AND MATERIALS: This cross-sectional study used house-to-house and durbar screening approaches for active tuberculosis (TB) case searching from six communities, three each from the Ketu South (high TB risk) and Akatsi North (low TB risk) districts in the Volta Region of Ghana. Random eligible participants were screened with the SBS tool to identify presumptive TB cases. One sputum sample was collected from each person with presumptive TB for detection of M. tuberculosis by the GeneXpert real-time technique. RESULTS: A total of 1,025 people were screened from a population of 40,462, from which 332 (32.4%) were presumed to have M. tuberculosis infection. Of the 332 presumptive TB cases, 63.9% were obtained through house-to-house screening, while 36.1% were obtained through community durbar screening. Six M. tuberculosis-positive cases (with one rifampicin resistance) were detected by house-to-house screening but not from community durbar samples, yielding an overall prevalence of 15 per 100,000 population. Among TB symptoms screened and analysed, association existed only between night sweat and TB case detection (χ2 = 3.9, P = 0.049). CONCLUSION: Although cumbersome and capital intensive, community-based active case searching through house-to-house screening using the SBS tool proved effective in detecting M. tuberculosis in the communities.

Longitudinal continuity of care during antenatal and delivery in the Volta Region of Ghana.

OBJECTIVE: To determine the extent of longitudinal continuity of care (CoC) during pregnancy and delivery in the Volta Region of Ghana. METHODS: Longitudinal data were used from the National Health Insurance Claims Dataset for the period January to December 2013 for pregnant women who sought antenatal and delivery care in the region. Pregnant women who delivered at a health facility with at least three visits were included in the study. Five CoC indices were calculated for each pregnant woman. RESULTS: Of the 14 474 pregnant women included in the study, 58.4% had perfect CoC. Mean CoC indices were: most frequent provider continuity (MFPC) 0.82 ± 0.25; modified, modified continuity index (MMCI) 0.86 ± 0.20; continuity of care index (COCI) 0.76 ± 0.30; sequential continuity index (SECON) 0.80 ± 0.28; and place of delivery continuity (PDC) 0.68 ± 0.41. CONCLUSION: There are relatively medium to high levels of CoC indices during pregnancy and delivery, with place of delivery CoC having the lowest score, an indication that more pregnant women switched providers during delivery. There is a need for policy to ensure CoC during pregnancy.

Patterns of Frequently Diagnosed Pediatric Morbidities in Hospitalized Children in the Volta Region of Ghana.

Background. The aim of this study was to identify the frequently diagnosed pediatric diseases in the Volta Region of Ghana, as well as to examine the burden of these diseases. The top pediatric diseases that were frequently diagnosed were malaria, gastroenteritis, systemic infection, anemia, pneumonia, and respiratory tract infection. Methods. Clearance was obtained from the Volta Regional Directorate of the Ghana Health Service to collect primary data on pediatric hospitalizations in the major hospitals in the Region. Diseases with more than 1000 recorded cases of hospitalizations were considered among the top frequently diagnosed childhood morbidities. Results. The data suggest that the Northern sector had different seasonal patterns of recorded diagnosed pediatric cases compared with the Central and Southern sectors, which had similar patterns of the reported diseases. Most of the pediatric diseases in the Volta Region were more prevalent during the dry seasons compared with the rainy seasons and resulting in seasonal patterns of hospitalizations. Conclusion. Although the frequently diagnosed pediatric diseases can be prevented and/or treated, many children are hospitalized, with a proportion of them dying. It is, therefore, important that efforts are made to reduce the burden of pediatric hospitalization.

Reflecting on tuberculosis case notification and treatment outcomes in the Volta region of Ghana: a retrospective pool analysis of a multicentre cohort from 2013 to 2017.

BACKGROUND: Tuberculosis (TB) remains a petrified condition with a huge economic and health impact on families and health systems in Ghana. Monitoring of TB programme performance indicators can provide reliable data for direct measurement of TB incidence and mortality. This study reflects on the trends of TB case notification and treatment outcomes and makes comparison among 10 districts of the Volta region of Ghana. METHODS: This was a retrospective analysis of surveillance data of a cohort of TB cases from 2013 to 2017. Trends of case notification and treatment outcomes were examined and compared. Logistic regression was used to determine the independent relationship between patients and disease characteristics and unsuccessful treatment outcomes. Odds ratios, 95% confidence intervals and p-values were estimated. RESULTS: A gradual declining trend of case notification of all forms of TB was noticed, with an overall case notification rate (CNR) of 65 cases per 100,000 population during the period. A wide variation of case notification of TB was observed among the districts, ranging from 32 to 124 cases per 100,000 population. Similarly, treatment success rate decreased slightly from 83.1% during the first year to 80.2% in 2017, with an overall treatment success rate of 82.5% (95% CI: 81.3-83.8%). Treatment failure, death, and lost to follow up rates were 0.8% (range 0.5-1.2%), 13.5% (range 12.4-14.7%), and 3.1% (range 2.6-3.8%) respectively. The treatment success rate among districts ranged from 70.5% in South Tongu to 90.8% in Krachi West district. Returned after treatment interruption (Adjusted odds ratio [AOR]: 3.62; 95% CI: 1.66-7.91; P < 0.001) and TB/HIV co-infection (AOR: 1.94; 95% CI: 1.57-2.40; P < 0.001) predicts poor treatment outcomes. CONCLUSION: Over the past five years, TB case notification and successful treatment outcomes did not significantly improve. Wide district variations in CNR was observed. The overall treatment success rate observed in this study is below the target of > 90% set by the World Health Organization's (WHO) end TB strategy. Additionally, patients who returned to continue treatment after interruption and those who were co-infected with HIV strongly predict unsuccessful treatment outcomes. Sustained interventions to prevent treatment interruptions and improved management of co-morbidities can enhance treatment outcomes, as required to achieve the elimination goal.

Comparison of maternal health services and indicators in three districts of the Volta Region, Ghana.

BACKGROUND: Ghana's maternal mortality ratio continues to decline, but is not expected to meet the Millennium Development Goal (MDG) 5 target. The Ghana Health Service and Ministry of Health have displayed a high commitment to the improvement of maternal health in the country. One of the most recent partnerships directed at this is with the Korea International Cooperation Agency. METHODS: This study was conducted among women between ages 15 and 49 resident in Keta Municipal, Ketu North and Ketu South districts in the Volta Region of Ghana who were pregnant or who had children aged less than five. Ethical approval was obtained from the Ghana Health Service Ethical Review Committee. Data were collected using questionnaires, entered into Stata version 12 and analyzed using frequency distribution and assessment of means. Comparisons among districts were conducted using chi square test and one way analysis of variance (ANOVA). RESULTS: The study covered 630 women whose mean age was 28.4 years. Almost all participants (99.1%) from Ketu North knew where to obtain family planning services. Use of modern contraception was highest in Ketu North with 31% of respondents using a modern method. Delivery in a health facility was highest in Keta Municipal (62.3%) with overall institutional delivery being 57.6%. Delivery by a skilled birth attendant (SBA) was also highest in Keta Municipal. CONCLUSION: Indicators used to assess maternal health services show a coverage of over 50% but we need to improve institutional delivery, use of modern contraception and education about danger signs in pregnancy. FUNDING: This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2013S1A5B8A01055336) and the Korea International Cooperation Agency(2013).

Factors associated with induced abortion at selected hospitals in the Volta Region, Ghana.

BACKGROUND: Induced abortion rates remained persistently high in the Volta Region of Ghana in the 5 years from 2006 to 2011. Some hospitals, both rural and urban, report induced abortion-related complications as one of the top ten conditions in hospital admissions. This study explored demographic and other factors associated with induced abortion, and also assessed awareness of abortion-related complications among women of reproductive age in the Volta Region. METHODS: A quantitative, hospital-based, unmatched case-control study was performed. The Volta Region was stratified into two health administration zones, ie, north and south. For each zone, hospitals were stratified into government and private hospitals. Employing simple random sampling, one private and three government hospitals were selected from each zone. This study is therefore based on eight hospitals, ie, six government hospitals and two private hospitals. RESULTS: Marital status, employment status, number of total pregnancies, and knowledge about contraception were found to be associated with induced abortion. Multiple logistic regression showed a 4% reduction in the odds of induced abortion in married women compared with women who were single (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.07-0.22). Unemployed women of reproductive age were found to be 0.35 times less likely to seek induced abortion compared with their employed counterparts (OR 0.35, CI 0.19-0.65). It was also observed that women with their second pregnancies were 3.8 times more likely to seek induced abortion and women with more than two pregnancies were 6.6 times more likely to do so (OR 3.81, CI 1.94-7.49 and OR 6.58, CI 2.58-16.79, respectively). Women with no knowledge of contraceptive methods were 4.6 times likely to seek induced abortion (OR 4.64, CI 1.39-15.4). Compared with women who had not had induced abortion, women with a high number of pregnancies and no contraceptive knowledge were more likely to have induced abortion. CONCLUSION: It was found that lack of knowledge about contraceptives and being single or employed were associated with increased likelihood of induced abortion. It was also found that women with a higher number of pregnancies have a greater odds of induced abortion. No association was found between induced abortion and maternal age, education, contraceptive use, or religion.

An outbreak of suspected cutaneous leishmaniasis in Ghana: lessons learnt and preparation for future outbreaks.

Human cutaneous leishmaniasis (CL) has previously been reported in West Africa, but more recently, sporadic reports of CL have increased. Leishmania major has been identified from Mauritania, Senegal, Mali, and Burkina Faso. Three zymodemes (MON-26, MON-117, and MON-74, the most frequent) have been found. The geographic range of leishmaniasis is limited by the sand fly vector, its feeding preferences, and its capacity to support internal development of specific species of Leishmania. The risk of acquiring CL has been reported to increase considerably with human activity and epidemics of CL have been associated with deforestation, road construction, wars, or other activities where humans intrude the habitat of the vector. In the Ho Municipality in the Volta Region of Ghana, a localised outbreak of skin ulcers, possibly CL, was noted in 2003 without any such documented activity. This outbreak was consistent with CL as evidenced using various methods including parasite identification, albeit, in a small number of patients with ulcers. This paper reports the outbreak in Ghana. The report does not address a single planned study but rather a compilation of data from a number of ad-hoc investigations in response to the outbreak plus observations and findings made by the authors. It acknowledges that a number of the observations need to be further clarified. What is the detailed epidemiology of the disease? What sparked the epidemic? Can it happen again? What was the causative agent of the disease, L. major or some other Leishmania spp.? What were the main vectors and animal reservoirs? What are the consequences for surveillance of the disease and the prevention of its reoccurrence when the communities see a self-healing disease and may not think it is important?

Effect of delivery care user fee exemption policy on institutional maternal deaths in the central and volta regions of ghana.

SUMMARY BACKGROUND: To improve access to skilled attendance at delivery and thereby reduce maternal mortality, the Government of Ghana introduced a policy exempting all women attending health facilities from paying delivery care fees. OBJECTIVE: To examine the effect of the exemption policy on delivery-related maternal mortality. METHODS: Maternal deaths in 9 and 12 hospitals in the Central Region (CR) and the Volta Region (VR) respectively were analysed. The study covered a period of 11 and 12 months before and after the introduction of the policy between 2004 and 2006. Maternal deaths were identified by screening registers and clinical notes of all deaths in women aged 15-49 years in all units of the hospitals. These deaths were further screened for those related to delivery. The total births in the study period were also obtained in order to calculate maternal mortality ratios (MMR). RESULTS: A total of 1220 (78.8%) clinical notes of 1549 registered female deaths were retrieved. A total of 334 (21.6%) maternal deaths were identified. The delivery-related MMR decreased from 445 to 381 per 100,000 total births in the CR and from 648 to 391 per 100,000 total births in the VR following the implementation of the policy. The changes in the 2 regions were not statistically significant (p=0.458) and (p=0.052) respectively. No significant changes in mean age of delivery-related deaths, duration of admission and causes of deaths before and after the policy in both regions. CONCLUSION: The delivery-related institutional maternal mortality did not appear to have been significantly affected after about one year of implementation of the policy.