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Parents’ perceptions, attitudes and acceptability of Treatment of childhood malaria with artemisinin combination therapies in Ghana
G.O Adjei, A.K Darkwah, B.Q Goka, C Bart-plang
Ghana Medical Journal , 2009,
Abstract: Background: There is little information on sociocultural and contextual factors that may influence attitudes of patients to new treatments, such as artemisinin combination therapies (ACT). Methods: Semi-structured questionnaires and focus group discussions were used to assess views of parents of children with uncomplicated malaria treated with ACT in a low socio-economic area in Accra, Ghana. Results: The majority of parents reported a favourable experience, in terms of perceived i) rapidity of symptom resolution, compared to their previous experience of other therapies for childhood malaria, or ii) when their experience was compared that of parents of children treated with monotherapy. The parents of children treated with ACT were more willing to pay for the treatment, or adhere to the full treatment course. The explanations given for adherence were consistent with conventional biomedical explanations. Although careseeking practices for childhood malaria were considered appropriate, perceived or real barriers to accessible health care were also important factors in the decision to seek treatment. Household dynamics and perceived inequities at the care-provider-patient interface were identified as having potential negative impact on care-seeking practices and adherence. Conclusions: Health education messages aimed at improving the response to childhood febrile illness should include other strategic stakeholders, such as decisionmakers at the household level. The effectiveness and implementation success of the ACT policy could be enhanced by highlighting and reinforcing messages intrinsic to these regimens. Integrating the views of caretakers during the clinical encounter was validated as an empowerment tool that could aid in the appropriate responses to childhood illness.
Insecticide resistance profiles for malaria vectors in the Kassena-Nankana district of Ghana
Francis Anto, Victor Asoala, Thomas Anyorigiya, Abraham Oduro, Martin Adjuik, Seth Owusu-Agyei, Dominic Dery, Langbong Bimi, Abraham Hodgson
Malaria Journal , 2009, DOI: 10.1186/1475-2875-8-81
Abstract: Indoor resting Anopheles mosquitoes were collected. Blood-fed and gravid females were allowed to oviposit, eggs hatched and larvae reared to 1–3 days old adults and tested against permethrin 0.75%, deltamethrin 0.05%, cyfluthrin 0.15%, lambdacyhalothrin 0.1% and DDT 4%, based on WHO methodology. PCR analyses were carried out on a sub-sample of 192 of the An. gambiae for sibling species complex determination. Resistance to pyrethroids and DDT was determined by genotyping the knock-down resistance kdr gene mutations in the study area.A total of 9,749 1–3 days-old F1 female Anopheles mosquitoes were exposed to the insecticides. Among the pyrethroids, permethrin, 0.75% had the least knockdown effect, whilst cyfluthrin 0.15%, had the highest knock-down effect. Overall, no difference in susceptibility between An. gambiae 93.3% (95% CI: 92.5–94.1) and An. funestus 94.5% (95% CI: 93.7–95.3) was observed when exposed to the pyrethroids. Similarly, there was no difference in susceptibility between the two vector species (An. gambiae = 79.1% (95% CI: 76.6–81.8) and An. funestus = 83.5% (95% CI: 80.2–86.4) when exposed to DDT. Overall susceptibility to the insecticides was between 80% and 98%, suggesting that there is some level of resistance, except for cyfluthrin 0.15%. The kdr PCR assay however, did not reveal any kdr mutations. The analysis also revealed only the molecular M (Mopti) form.The findings in this study show that An. gambiae and An. funestus, the main malaria vector mosquitoes in the Kassena-Nankana district are susceptible to the insecticides being used in the treatment of bed nets in the malaria control programme. There is however, the need for continuous monitoring of the pyrethroids as the efficacy is not very high.Malaria is a major public health problem in Ghana. The strategy of the National Malaria Control Programme is based on effective case management and the use of insecticide treated bed nets among vulnerable groups, such as children under five years o
Severe falciparum malaria in young children of the Kassena-Nankana district of northern Ghana
Abraham R Oduro, Kwadwo A Koram, William Rogers, Frank Atuguba, Patrick Ansah, Thomas Anyorigiya, Akosua Ansah, Francis Anto, Nathan Mensah, Abraham Hodgson, Francis Nkrumah
Malaria Journal , 2007, DOI: 10.1186/1475-2875-6-96
Abstract: Of the total children screened, 45.2% (868/1921) satisfied the criteria for severe malaria. Estimated incidence of severe malaria was 3.4% (range: 0.4–8.3%) cases per year. The disease incidence was seasonal: 560 cases per year, of which 70.4% occurred during the wet season (June-October). The main manifestations were severe anaemia (36.5%); prolonged or multiple convulsions (21.6%); respiratory distress (24.4%) and cerebral malaria (5.4%). Others were hyperpyrexia (11.1%); hyperparasitaemia (18.5%); hyperlactaemia (33.4%); and hypoglycaemia (3.2%). The frequency of severe anaemia was 39.8% in children of six to 24 months of age and 25.9% in children of 25–60 months of age. More children (8.7%) in the 25–60 months age group had cerebral malaria compared with 4.4% in the 6–24 months age group. The overall case fatality ratio was 3.5%. Cerebral malaria and hyperlactataemia were the significant risk factors associated with death. Severe anaemia, though a major presentation, was not significantly associated with risk of death.Severe malaria is a frequent and seasonal childhood disease in northern Ghana and maybe an adequate endpoint for future malaria vaccine trials.Globally, an estimated 350–500 million clinical malaria episodes occur annually; most of these are caused by infection with Plasmodium falciparum with more than one million deaths each year. About 60% of the clinical episodes and more than 80% of the deaths occur in young children in Africa, south of the Sahara, where malaria accounts for 25–35% of all outpatients visits, 20–45% of hospital admissions and 15–35% of hospital deaths [1,2]. Despite the introduction in recent years of more rational antimalarial regimens and the increasing use of the most rapidly parasiticidal artemisinin derivatives [3,4], the malaria risk and mortality has not seen significant reductions yet [5,6]. Studies on factors associated with increased risk of developing severe malaria and death, may provide additional understanding of t
Haplotype Analyses of Haemoglobin C and Haemoglobin S and the Dynamics of the Evolutionary Response to Malaria in Kassena-Nankana District of Ghana  [PDF]
Anita Ghansah, Kirk A. Rockett, Taane G. Clark, Michael D. Wilson, Kwadwo A. Koram, Abraham R. Oduro, Lucas Amenga-Etego, Thomas Anyorigiya, Abraham Hodgson, Paul Milligan, William O. Rogers, Dominic P. Kwiatkowski
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0034565
Abstract: Background Haemoglobin S (HbS) and C (HbC) are variants of the HBB gene which both protect against malaria. It is not clear, however, how these two alleles have evolved in the West African countries where they co-exist at high frequencies. Here we use haplotypic signatures of selection to investigate the evolutionary history of the malaria-protective alleles HbS and HbC in the Kassena-Nankana District (KND) of Ghana. Methodology/Principal Findings The haplotypic structure of HbS and HbC alleles was investigated, by genotyping 56 SNPs around the HBB locus. We found that, in the KND population, both alleles reside on extended haplotypes (approximately 1.5 Mb for HbS and 650 Kb for HbC) that are significantly less diverse than those of the ancestral HbA allele. The extended haplotypes span a recombination hotspot that is known to exist in this region of the genome Significance Our findings show strong support for recent positive selection of both the HbS and HbC alleles and provide insights into how these two alleles have both evolved in the population of northern Ghana.
Knowledge, Perceptions and Ever Use of Modern Contraception among Women in the Ga East District, Ghana
R Aryeetey, AM Kotoh, MJ Hindin
African Journal of Reproductive Health , 2011,
Abstract: A survey of 332 women, ages 15-49 years, was carried out in the Ga East district of Ghana to identify community knowledge, perceptions, and factors associated with ever using modern family planning (FP). Knowledge of modern FP was almost universal (97 percent) although knowledge of more than three methods was 56 percent. About 60 percent of all, and 65 percent of married respondents reported ever use of a modern method. Among ever users, 82 percent thought contraceptives were effective for birth control. However, one-third did not consider modern FP safe. About 20 percent indicated their male partner as a barrier, and 65 percent of users reported at least one side effect. In a multivariate model that controlled for age, education, religion, and occupation, being married remained significantly associated (OR=2.14; p=0.01) with ever use of a modern contraceptive method. Interventions are needed to address service- and knowledge-related barriers to use (Afr J Reprod Health 2010; 14[4]: 27-32).
Household Perceptions, Treatment-Seeking Behaviors and Health Outcomes for Buruli Ulcer Disease in a Peri-Urban District in Ghana  [PDF]
Adobea Yaa Owusu, Clement Adamba
Advances in Applied Sociology (AASoci) , 2012, DOI: 10.4236/aasoci.2012.23024
Abstract: Buruli ulcer (BU) has been associated with very unimaginable outcomes. It is flesh eating, disfiguring and economically dehydrating. Yet the disease is still mostly shrouded in mystery. Consequently, people have different perceptions about it and hence adopt different treatment behaviorss towards it; notwithstanding the free treatment for it. The purpose of this paper is to identify and examine respondents’ perceptions and the influence these have on their health seeking behaviorss. Eighty-six BU patients who had been treated or were being treated of BU in the Ga West District Health Center in Ghana were sampled for this study. A structured questionnaire and a qualitative in-depth interview guide were used to elicit the data. Some of the interviewees held the belief that the disease is caused by their adversaries, including witches. More than half of the respondents, however, did not have any idea about the disease and thought it is just the work of God. The first point of call for health care for most of the patients studied was herbalists or else they used herbs. Nearly a quarter of them also engaged in self medication, including the use of ‘pain killers’ and ointments, since they took the first signs for ordinary boils. Perceptions of the cause of the disease influenced health seeking behaviors, which further influenced treatment outcomes. A lot of education is needed on the symptoms of the disease, including encouraging early seeking of care at the District Health Center.
Antibody levels to multiple malaria vaccine candidate antigens in relation to clinical malaria episodes in children in the Kasena-Nankana district of Northern Ghana
Daniel Dodoo, Frank Atuguba, Samuel Bosomprah, Nana Ansah, Patrick Ansah, Helena Lamptey, Beverly Egyir, Abraham R Oduro, Ben Gyan, Abraham Hodgson, Kwadwo A Koram
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-108
Abstract: In this longitudinal study, the multiplex assay was used to measure IgG antibody levels to 10 malaria antigens (GLURP R0, GLURP R2, MSP3 FVO, AMA1 FVO, AMA1 LR32, AMA1 3D7, MSP1 3D7, MSP1 FVO, LSA-1and EBA175RII) in 325 children aged 1 to 6 years in the Kassena Nankana district of northern Ghana. The antigen specific antibody levels were then related to the risk of clinical malaria over the ensuing year using a negative binomial regression model.IgG levels generally increased with age. The risk of clinical malaria decreased with increasing antibody levels. Except for FMPOII-LSA, (p = 0.05), higher IgG levels were associated with reduced risk of clinical malaria (defined as axillary temperature ≥37.5°C and parasitaemia of ≥5000 parasites/ul blood) in a univariate analysis, upon correcting for the confounding effect of age. However, in a combined multiple regression analysis, only IgG levels to MSP1-3D7 (Incidence rate ratio = 0.84, [95% C.I.= 0.73, 0.97, P = 0.02]) and AMA1 3D7 (IRR = 0.84 [95% C.I.= 0.74, 0.96, P = 0.01]) were associated with a reduced risk of clinical malaria over one year of morbidity surveillance.The data from this study support the view that a multivalent vaccine involving different antigens is most likely to be more effective than a monovalent one. Functional assays, like the parasite growth inhibition assay will be necessary to confirm if these associations reflect functional roles of antibodies to MSP1-3D7 and AMA1-3D7 in this population.In malaria endemic regions, clinical malaria is responsible for high morbidity and mortality in less than five year old children and pregnant women. In these regions, individuals develop a partial 'non-sterile' immunity against erythrocytic stage disease in an age and exposure dependent manner and, therefore, older individuals suffer less clinical symptoms and disease complications. Sero-epidemiological studies show three sequential phases of development of acquired immunity to malaria: first, immunity to lif
Pattern of drug utilization for treatment of uncomplicated malaria in urban Ghana following national treatment policy change to artemisinin-combination therapy
Alexander NO Dodoo, Carole Fogg, Alex Asiimwe, Edmund T Nartey, Augustina Kodua, Ofori Tenkorang, David Ofori-Adjei
Malaria Journal , 2009, DOI: 10.1186/1475-2875-8-2
Abstract: Patients with diagnosis of uncomplicated malaria were recruited from pharmacies of health facilities throughout Accra in a cohort-event monitoring study. The main drug utilization outcomes were the relation of patient age, gender, type of facility attended, mode of diagnosis and concomitant treatments to the anti-malarial regimen prescribed. Logistic regression was used to predict prescription of nationally recommended first-line therapy and concomitant prescription of antibiotics.The cohort comprised 2,831 patients. Curative regimens containing an artemisinin derivative were given to 90.8% (n = 2,574) of patients, although 33% (n = 936) of patients received an artemisinin-based monotherapy. Predictors of first-line therapy were laboratory-confirmed diagnosis, age >5 years, and attending a government facility. Analgesics and antibiotics were the most commonly prescribed concomitant medications, with a median of two co-prescriptions per patient (range 1–9). Patients above 12 years were significantly less likely to have antibiotics co-prescribed than patients under five years; those prescribed non-artemisinin monotherapies were more likely to receive antibiotics. A dihydroartemisinin-amodiaquine combination was the most used therapy for children under five years of age (29.0%, n = 177).This study shows that though first-line therapy recommendations may change, clinical practice may still be affected by factors other than the decision or ability to diagnose malaria. Age, diagnostic confirmation and suspected concurrent conditions lead to benefit:risk assessments for individual patients by clinicians as to which anti-malarial treatment to prescribe. This has implications for adherence to policy changes aiming to implement effective use of ACT. These results should inform education of health professionals and rational drug use policies to reduce poly-pharmacy, and also suggest a potential positive impact of increased access to testing for malaria both within health facil
Community Knowledge and Perceptions about Buruli Ulcers in Obom Sub-District of the Ga South Municipality in the Greater Accra Region of Ghana  [PDF]
Eric Koka
Advances in Applied Sociology (AASoci) , 2018, DOI: 10.4236/aasoci.2018.89037
Abstract: Community knowledge and perceptions of the cause and consequently the appropriate measure to remedy an ailment determine whom people turn to for advice, help, information and treatment when bogged down with a disease. The role that community plays in the etiology, explanation, prognosis and treatment seeking behaviour cannot be underscored, because it provides indepth information on the burden of the disease, the local understanding of the causes of the disease and therefore its management. The purpose of the study was to describe community knowledge and perceptions about Buruli ulcer (BU) and how to prevent Buruli ulcer in the Obom sub-district of Ghana. Survey questionnaire was used as an instrument for data collection to solicit information on community knowledge and perceptions of Buruli ulcer in the communities. In selecting respondents for the community survey, systematic sampling was used to select 300 respondents for the study. The study revealed a high level of knowledge about Buruli ulcer in the selected endemic communities. However, Buruli ulcer patients were perceived as people who have been bewitched (36.7%). Others (21%) blamed them as people who did not take good care of themselves while another 11.1% saw Buruli ulcer infected people as having normal wounds. Findings therefore show that although there was a high knowledge of signs and symptoms of Buruli ulcer among community members in the Obom sub-district, their understandings and interpretations of its causative factors varied from those of the biomedical understandings. Based on the results of the study, it is recommended that community outreach and education on the treatment and management of Buruli ulcer should be continued on a sustainable basis in the endemic communities.
Prevalence of Parasitaemia, Anaemia and treatment outcomes of Malaria among School Children in a Rural Community in Ghana
E Otupiri, D Yar, J Hindin
Journal of Science and Technology (Ghana) , 2012,
Abstract: A cross-sectional survey was conducted in the Ejisu-Juaben District to determine the prevalence of asymptomatic malaria and anaemia, and treatment outcomes in pupils of seven public schools public schools in a rural community in the forest belt of Ghana. Children with confirmed malaria parasites were randomly assigned to be treated with Artemisinin-based combination therapies available on the Ghanaian market. Post-treatment days 14 and 28 follow-up blood samples were taken to determine the treatment outcomes on peripheral parasitaemia and haemoglobin (Hb) concentrations. Out of 812 pupils (without malaria symptoms) who were screened, the baseline parasitaemia prevalence was 58.6%. Parasitaemia prevalence across the seven (7) public schools ranged from 49.7% to 71.0% (p =0.002). Post-treatment parasitaemia among the different treatment regimes were significant only at day 28 (p<0.001). The mean Hb concentration on the screening day was 10.5g/dl and over 60% of pupils were mildly anaemic (Hb <11.0g/dl) whereas 14% had Hb <8.0g/dl. Post-treatment Hb concentrations of pupils by days 14 and 28 were 11.4g/dl and 11.7g/dl with an improvement of 0.7g/dl and 0.9g/dl respectively over the baseline Hb concentration (p<0.001). The overall proportion of children with Hb concentrations <11.0g/dl was 32.6% and 25.3% by days 14 and 28 respectively. The burden of malaria and anaemia among school children is high and warrants investment to reduce these levels. These findings could be a reflection of the health situation that pertains in the basic public schools especially in the rural forest areas of Ghana.
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