Joseph R. Oppong

Ghana's national health insurance scheme in the context of the health MDGs: an empirical evaluation using propensity score matching

In 2003 the Government of Ghana established a National Health Insurance Scheme (NHIS) to improve health-care access for Ghanaians and eventually replace the cash-and-carry system. This study evaluates an important aspect of its promise in the context of the Millennium Development Goals #4 and #5 which deal with the health of women and children. We use Propensity Score Matching techniques to balance the relevant background characteristics in our survey data and compare health indicators of recent mothers who are enrolled in the NHIS with those who are not. Our findings suggest that NHIS women are more likely to receive prenatal care, deliver at a hospital, have their deliveries attended by trained health professionals, and experience less birth complications. We conclude that NHIS is an effective tool for improving health outcomes among those who are covered, which should encourage the Ghanaian government to promote further enrollment, in particular among the poor.

The refugee crisis in Africa and implications for health and disease: a political ecology approach

Political violence in civil war and ethnic conflicts has generated millions of refugees across the African continent with unbelievable pictures of suffering and unnecessary death. Using a political ecology framework, this paper examines the geographies of exile and refugee movements and the associated implications for re-emerging and newly emerging infectious diseases in great detail. It examines how the political ecologic circumstances underlying the refugee crisis influences health services delivery and the problems of disease and health in refugee camps. It has four main themes, namely, an examination of the geography of the refugee crisis: the disruption of health services due to political ecologic forces that produce refugees; the breeding of disease in refugee camps due to the prevailing desperation and destitution; and the creation of an optimal environment for emergence and spread of disease due to the chaotic nature of war and violence that produces refugees. We argue in this paper that there is great potential of something more virulent than cholera and Ebola emerging and taking a big toll before being identified and controlled. We conclude by noting that once such a disease is out in the public rapid diffusion despite political boundaries is likely, a fact that has a direct bearing on global health. The extensive evidence presented in this paper of the overriding role of political factors in the refugee health problem calls for political reform and peace accords, engagement and empowerment of Pan-African organizations, foreign policy changes by Western governments and greater vigilance of non-governmental organizations (NGOs) in the allocation and distribution of relief aid.

A Vulnerability Interpretation of the Geography of HIV/AIDS in Ghana, 1986-1995

Ten years after the human immuno-deficiency virus (HIV) was first reported in Ghana, it continues to spread throughout the country following patterns that are rare in other African countries. HIV is seen in twice as many females as males, more frequently in rural than urban regions, and regions with high rates of polygamy have significantly lower rates. The evidence presented in this paper shows that HIV diffusion patterns probably reflect the spatial distribution and social networks of vulnerable social groups. While information-based campaigns are still necessary in the fight against HIV/AIDS, they fail to enable or empower vulnerable people to protect themselves against infection.

Using GIS technology to identify areas of tuberculosis transmission and incidence

BackgroundCurrently in the U.S. it is recommended that tuberculosis screening and treatment programs be targeted at high-risk populations. While a strategy of targeted testing and treatment of persons most likely to develop tuberculosis is attractive, it is uncertain how best to accomplish this goal. In this study we seek to identify geographical areas where on-going tuberculosis transmission is occurring by linking Geographic Information Systems (GIS) technology with molecular surveillance.MethodsThis cross-sectional analysis was performed on data collected on persons newly diagnosed with culture positive tuberculosis at the Tarrant County Health Department (TCHD) between January 1, 1993 and December 31, 2000. Clinical isolates were molecularly characterized using IS6110-based RFLP analysis and spoligotyping methods to identify patients infected with the same strain. Residential addresses at the time of diagnosis of tuberculosis were geocoded and mapped according to strain characterization. Generalized estimating equations (GEE) analysis models were used to identify risk factors involved in clustering.ResultsEvaluation of the spatial distribution of cases within zip-code boundaries identified distinct areas of geographical distribution of same strain disease. We identified these geographical areas as having increased likelihood of on-going transmission. Based on this evidence we plan to perform geographically based screening and treatment programs.ConclusionUsing GIS analysis combined with molecular epidemiological surveillance may be an effective method for identifying instances of local transmission. These methods can be used to enhance targeted screening and control efforts, with the goal of interruption of disease transmission and ultimately incidence reduction.

Buruli Ulcer Disease and Its Association with Land Cover in Southwestern Ghana

Background Buruli ulcer (BU), one of 17 neglected tropical diseases, is a debilitating skin and soft tissue infection caused by Mycobacterium ulcerans. In tropical Africa, changes in land use and proximity to water have been associated with the disease. This study presents the first analysis of BU at the village level in southwestern Ghana, where prevalence rates are among the highest globally, and explores fine and medium-scale associations with land cover by comparing patterns both within BU clusters and surrounding landscapes. Methodology/Principal Findings We obtained 339 hospital-confirmed BU cases in southwestern Ghana between 2007 and 2010. The clusters of BU were identified using spatial scan statistics and the percentages of six land cover classes were calculated based on Landsat and Rapid Eye imagery for each of 154 villages/towns. The association between BU prevalence and each land cover class was calculated using negative binomial regression models. We found that older people had a significantly higher risk for BU after considering population age structure. BU cases were positively associated with the higher percentage of water and grassland surrounding each village, but negatively associated with the percent of urban. The results also showed that BU was clustered in areas with high percentage of mining activity, suggesting that water and mining play an important and potentially interactive role in BU occurrence. Conclusions/Significance Our study highlights the importance of multiple land use changes along the Offin River, particularly mining and agriculture, which might be associated with BU disease in southwestern Ghana. Our study is the first to use both medium- and high-resolution imagery to assess these changes. We also show that older populations (≥ 60 y) appear to be at higher risk of BU disease than children, once BU data were weighted by population age structures.

Accommodating the rainy season in Third World location-allocation applications

Abstract While data limitations do not preclude the application of location-allocation (LA) models in the Third World, the socio-spatial circumstances in such locations are sufficiently different to warrant additional caution in applications. For example, the rainy season disrupts transportation and travel for long periods in many countries; yet, typical LA applications fail to consider it. Using the simple p-median and coverage models, this study examines the effect of the rainy season on Third World LA applications. The results indicate that ignoring the rainy season can produce potentially disastrous results, while accommodating it, perhaps by simply editing the data, is likely to produce better results. Moreover, embedded values in these models influence locational outcomes. The results thus call for considerable caution in Third World LA applications.

Foreign-Born Status and Geographic Patterns of Tuberculosis Genotypes in Tarrant County, Texas

Abstract Regardless of destination, immigrants arrive with health profiles typical of people in their previous surroundings. Thus, immigrants change the epidemiological profile of destination communities, and immigrant neighborhoods may represent islands of infectious disease. Genotyping has emerged as a useful surveillance tool to track the spread of disease at the molecular level. Yet the spatial distribution of infectious disease at the molecular level associated with migration and immigrant neighborhoods has received little attention. Using molecular genotyping to characterize M. tuberculosis isolated from tuberculosis cases, this article analyzes spatial variations of unique molecular M. tuberculosis strains by zip code in Tarrant County, Texas. The results suggest that immigrant neighborhoods have higher rates of unique isolates of tuberculosis (suggestive of remote transmission) compared to neighborhoods occupied by the native-born. Neighborhoods dominated by the native-born have higher rates of clustered isolates (suggestive of recent transmission). Therefore, in addition to being culturally distinct, immigrant neighborhoods may also be pathogenically distinct from surrounding neighborhoods.

The global health threat of African urban slums: the example of urban tuberculosis

Urban slums in developing countries are experiencing the most rapid population growth of any settlement type globally. Such growth of densely settled slums exerts a profound influence on the epidemiology and geography of communicable disease, transmitted through multiple modes. Specifically, high density, poor sanitation, poorly built housing, and lack of both adequate sewage systems and water supply facilitate pathogen spread. Long-range transmission of infection, partly through migration or travel of infected individuals, makes communicable diseases of urban areas in developing countries health problems of the entire world rather than localized areas. Non-endemic areas are threatened with disease spread. Because a significant proportion of slum growth and disease burden is in sub-Saharan Africa, global well-being demands that we understand and control disease spread in African slums as a major international health priority. This paper outlines the potential threats and implications of African urban slum health using the example of tuberculosis (TB), which is highly prevalent in developing countries. Using the case of Nima, a slum in Accra, Ghana, we argue that successful disease control efforts in developed countries depend critically on effective disease surveillance and control efforts in developing countries, including African urban slums.

The Geography of Landmines and Implications for Health and Disease in Africa: A Political Ecology Approach

With more than 37 million landmines in at least nineteen countries, no region suffers more than Africa from the presence of landmines. Angola alone has an estimated 15 million landmines and an amputee population of 70,000, the highest rate in the world. Multiple conflicts throughout the continent produce new minefields every day, denying people access to critical resources and severely obstructing healthcare delivery. This paper examines the health and environmental implications of Africas landmine crisis. It analyzes how landmines undermine human livelihoods and overpower healthcare systems. Without a ban on the laying of landmines and proper compliance with existing landmine agreements, solutions to Africas development and health problems will prove elusive.

Mapping late testers for HIV in Texas

Understanding the spatial patterns of late testing for HIV infection is critically important for designing and evaluating intervention strategies to reduce the social and economic burdens of HIV/AIDS. Traditional mapping methods that rely on frequency counts or rates in predefined areal units are known to be problematic due to issues of small numbers and visual biases. Additionally, confidentiality requirements associated with health data further restrict the ability to produce cartographic representations at fine geographic scales. While kernel density estimation methods produce stable and geographically detailed patterns of the late testing burden, the resulting pattern depends critically on the definition of the at-risk population. Using three definitions of at risk groups, we examine the cartographic representation of HIV late testers in Texas and show that the resulting spatial patterns and the interpretation of disease burdens are different based on the choice of the at-risk population. Disease mappers should exercise considerable caution in selecting the denominator population for mapping.