Isaac Boakye

Malaria and anaemia among children in two communities of Kumasi, Ghana: a cross-sectional survey.

BackgroundA survey in Kumasi, Ghana found a marked Plasmodium falciparum prevalence difference between two neighbouring communities (Moshie Zongo and Manhyia). The primary objective of this follow-up study was to determine whether this parasite rate difference was consistent over time. Secondary objectives were to compare prevalences of clinical malaria, anaemia, intestinal parasite infections, and malnutrition between these communities; and to identify potential risk factors for P. falciparum infection and anaemia.MethodsA cross-sectional house-to-house survey of P. falciparum parasitaemia, clinical malaria, anaemia, anthropometric indices, and intestinal helminths was conducted in April-May 2005. Data collection included child and household demographics, mosquito avoidance practices, distance to nearest health facility, childs travel history, symptoms, and anti-malarial use. Risk factors for P. falciparum and anaemia (Hb < 11 g/dl) were identified using generalized linear mixed models.ResultsIn total, 296 children were tested from 184 households. Prevalences of P. falciparum, clinical malaria, anaemia, and stunting were significantly higher in Moshie Zongo (37.8%, 16.9%, 66.2% and 21.1%, respectively) compared to Manhyia (12.8%, 3.4%, 34.5% and 7.4%). Of 197 children tested for helminths, four were positive for Dicrocoelium dendriticum. Population attributable risks (PAR%) of anaemia were 16.5% (P. falciparum) and 7.6% (malnutrition). Risk factors for P. falciparum infection were older age, rural travel, and lower socioeconomic status. Risk factors for anaemia were P. falciparum infection, Moshie Zongo residence, male sex, and younger age.ConclusionHeterogeneities in malariometric indices between neighbouring Kumasi communities are consistent over time. The low helminth prevalence, and the twofold higher PAR% of anaemia attributable to P. falciparum infection compared to malnutrition, indicate the importance of malaria as a cause of anaemia in this urban population.

Exploring the relationship between chronic undernutrition and asymptomatic malaria in Ghanaian children.

BackgroundA moderate association has been found between asymptomatic parasitaemia and undernutrition. However, additional investigation using the gold standard for asymptomatic parasitaemia confirmation, polymerase chain reaction (PCR), is needed to validate this association. Anthropometric measurements and blood samples from children less than five years of age in a rural Ghanaian community were used to determine if an association exists between chronic undernutrition and PCR-confirmed cases of asymptomatic malaria.MethodsThis was a descriptive cross-sectional study of 214 children less than five years of age from a community near Kumasi, Ghana. Blood samples and anthropometric measurements from these children were collected during physical examinations conducted in January 2007 by partners of the Barekuma Collaborative Community Development Programme.ResultsFindings from the logistic model predicting the odds of asymptomatic malaria indicate that children who experienced mild, moderate or severe stunting were not more likely to have asymptomatic malaria than children who were not stunted. Children experiencing anaemia had an increased likelihood (OR = 4.15; 95% CI: 1.92, 8.98) of asymptomatic malaria. Similarly, increased spleen size, which was measured by ultrasound, was also associated with asymptomatic malaria (OR = 2.17; 95% CI: 1.44, 3.28). Fast breathing, sex of the child, and age of the child were not significantly associated with the asymptomatic malaria.ConclusionsNo significant association between chronic undernutrition and presence of asymptomatic malaria was found. Children who experience anaemia and children who have splenomegaly are more likely to present asymptomatic malaria. Programmes aimed at addressing malaria should continue to include nutritional components, especially components that address anaemia.

Anti-malarial market and policy surveys in sub-Saharan Africa

At a recent meeting (Sept 18, 2009) in which reasons for the limited access to artemisinin-based combination therapy (ACT) in sub-Saharan Africa were discussed, policy and market surveys on anti-malarial drug availability and accessibility in Burundi and Sierra Leone were presented in a highly interactive brainstorming session among key stakeholders across private, public, and not-for-profit sectors. The surveys, the conduct of which directly involved the national malaria control programme managers of the two countries, provides the groundwork for evidence-based policy implementation. The results of the surveys could be extrapolated to other countries with similar socio-demographic and malaria profiles. The meeting resulted in recommendations on key actions to be taken at the global, national, and community level for better ACT accessibility.At theglobal level, both public and private sectors have actions to take to strengthen policies that lead to the replacement of loose blister packs with fixed-dose ACT products, develop strategies to ban inappropriate anti-malarials and regulate those bans, and facilitate technology and knowledge transfer to scale up production of fixed-dose ACT products, which should be readily available and affordable to those patients who are in the greatest need of these medicines.At thenational level, policies that regulate the anti-malarial medicines market should be enacted and enforced. The public sector, including funding donors, should participate in ensuring that the private sector is engaged in the ACT implementation process. Research similar to the surveys discussed is important for other countries to develop and evaluate the right incentives at a local level.At the community level, community outreach and education about appropriate preventive and treatment measures must continue and be strengthened, with service delivery systems developed within both public and private sectors, among other measures, to decrease access to ineffective and inappropriate anti-malarial medicines.What was clear during the meeting is that continuing commitment, strengthened interaction and transparency among various stakeholders, with focus on communities, national governments, and evidence-based policy and action are the only way to sustainably address the control of malaria, a disease which continues to have a significant health and socio-economic impact worldwide, particularly in sub-Saharan Africa.Details on the methodology employed in carrying out the studies discussed at this meeting, as well as more detailed results, data analysis and discussion of the studies are soon to be published.

The burden and correlates of hypertension in rural Ghana: A cross-sectional study

AIM Cardiovascular diseases (CVDs), of which hypertension is a major risk factor, are predicted to account for four times as many deaths as from communicable diseases by the year 2020. Hypertension, once rare, is rapidly becoming a major public health burden in sub-Saharan Africa (SSA). However, data on its prevalence, awareness, treatment and control are paltry, especially for rural communities. This study was done to determine the burden and correlates of adult hypertension in the rural Barekese sub-district of Ghana. METHODS A cross-sectional survey was conducted on 425 adults aged ≥ 35 in the Barekese sub district (estimated population 18,510). Socio-demographic characteristics, modifiable and non-modifiable risk factors, blood pressure (BP) and anthropometric measurements were collected using standardized protocols. RESULTS Overall, the proportion of hypertension and isolated systolic hypertension is 44.7% and 32.7% respectively in the study population. However, 64.9% of these were on treatment, with only 8.9% having controlled blood pressure (<140/90 mmHg). The mean systolic and diastolic BP were 134.38 mmHg (standard deviation, SD: 21.46) and 84.32 mmHg (SD: 12.44). Obesity (Body Mass Index, BMI>30 kg/m²) was found in 37 (10.4% of the population), out of whom 7 (15.9%) were extremely obese (BMI> 40 kg/m²). Increasing age and level of education were positively correlated with increasing blood pressure. CONCLUSION The high burden of hypertension in this population along with the considerable less detection, treatment and control is of great concern. There is the need to promote health education measures that will foster prevention and early detection of hypertension.

EVALUATING INTERNATIONAL COLLABORATION: DIFFERENTIAL PERCEPTIONS OF PARTNERSHIP IN A CBPR PROJECT IN GHANA

Practitioners of community-based participatory research (CBPR) must overcome numerous barriers in order to include research participants as equal partners in decision-making. The decision-making processes of stakeholders (including research participants) of one international CBPR project based in the middle belt of Ghana were analyzed through qualitative focus group and interview data, as well as direct observation of formal meetings. Using modified grounded theory to interpret our data, we find that despite the intentions of extracommunity stakeholders, ordinary community members do not experience full ownership of the governance of the research enterprise. We conclude that organizational philosophy, cultural expectations, and environmental context can help to explain differential perceptions of stakeholders and function as barriers to full partnership.

Drinking water quality and source reliability in rural Ashanti region, Ghana

Site-specific information about local water sources is an important part of a community-driven effort to improve environmental conditions. The purpose of this assessment was to gather this information for residents of rural villages in Ghana. Sanitary surveys and bacteriological testing for total coliforms and Escherichia coli (EC) using Colilert(®) were conducted at nearly 80 water sources serving eight villages. A focus group was carried out to assess the desirability and perceived quality of water sources. Standpipes accounted for almost half of the available water sources; however, a third of them were not functioning at the time of the survey. EC bacteria were found in the majority of shallow wells (80%), rivers (67%), and standpipes (61%), as well as 28% of dug wells. Boreholes were free of EC. Residents felt that the standpipes and boreholes produced safe drinking water. Intermittent service and poor water quality from the piped supply has led to limited access to drinking water. The perception of residents, that the water from standpipes is clean and does not need to be treated at home, is particularly troubling in light of the poor bacteriological quality of water from the standpipes.

Access to Artemisinin-Combination Therapy (ACT) and other Anti-Malarials: National Policy and Markets in Sierra Leone

Malaria remains the leading burden of disease in post-conflict Sierra Leone. To overcome the challenge of anti-malarial drug resistance and improve effective treatment, Sierra Leone adopted artemisinin-combination therapy artesunate-amodiaquine (AS+AQ) as first-line treatment for uncomplicated P. falciparum malaria. Other national policy anti-malarials include artemether-lumefantrine (AL) as an alternative to AS+AQ, quinine and artemether for treatment of complicated malaria; and sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment (IPTp). This study was conducted to evaluate access to national policy recommended anti-malarials. A cross-sectional survey of 127 medicine outlets (public, private and NGO) was conducted in urban and rural areas. The availability on the day of the survey, median prices, and affordability policy and available non-policy anti-malarials were calculated. Anti-malarials were stocked in 79% of all outlets surveyed. AS+AQ was widely available in public medicine outlets; AL was only available in the private and NGO sectors. Quinine was available in nearly two-thirds of public and NGO outlets and over one-third of private outlets. SP was widely available in all outlets. Non-policy anti-malarials were predominantly available in the private outlets. AS+AQ in the public sector was widely offered for free. Among the anti-malarials sold at a cost, the same median price of a course of AS+AQ (US

Role of Diagnostic Testing in Schistosomiasis Control Programs in Rural Ghana

1.56), quinine tablets (US

Design considerations for identifying breast cancer risk factors in a population-based study in Africa

0.63), were found in both the public and private sectors. Quinine injection had a median cost of US

Suboptimal vaccination rates in rural Ghana despite positive caregiver attitudes towards vaccination

0.31 in the public sector and US