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Ocan M, Bakubi R, Nakalembe L, Ekusai-Sebatta D, Sam N. Experience of healthcare personnel on Co-payment mechanism and the implications on its use in private drug outlets in Uganda. PLoS One 2024; 19:e0297416. [PMID: 38758832 PMCID: PMC11101086 DOI: 10.1371/journal.pone.0297416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Malaria treatment is faced with the challenge of access, affordability, availability, and quality of antimalarial medicines. Affordable medicines facility-malaria (AMFm) program and subsequently Co-payment mechanism were developed to help increase access to quality assured Artemisinin-based combination therapies (ACTs) in seven countries in sub-Saharan Africa. We explored through a qualitative study, experience of healthcare personnel on Co-payment mechanism and the implication on its use in private drug outlets in Uganda. METHOD Private drug outlets that reported stocking antimalarial agents in moderate-to-high and low malaria transmission settings were purposively selected for inclusion in the study. In each drug outlet, data was collected from a pharmacist/dispenser through key informant interview. The interview was done using a key informant interview guide which covered the following areas, (i) sociodemographic characteristics, ii) awareness of healthcare personnel on the co-payment mechanism, (iii) awareness of healthcare personnel on quality assured artemisinin combination therapies (QAACT), (iv) antimalarial stocking in private drug outlets, (v) antimalarial dispensing prices, (vi) considerations made while stocking, and pricing antimalarial agents, vii) challenges in antimalarial dispensing, and (viii) access to antimalarial agents in private drug outlets. Data was managed using Atlas.ti and analyzed using framework methodology. RESULTS Data was collected from 25 key informants (12 pharmacists and 13 dispensers). Five themes emerged following data analysis, (i) antimalarial stocking influenced by price and client demand, (ii) access and purchasing behavior of drug outlet clients, (iii) basis of dispensing antimalarial agents in private drug outlets, (iv) awareness of QAACT, and (v) awareness of Co-payment mechanism. None of the study participants was aware of the existence of Co-payment mechanism and QAACT in the private sector. Duocotecin brand of ACTs was the most mentioned and dispensed ACT among the study participants in private drug outlets. Nearly all the pharmacists/dispensers said that many clients who request to purchase ACTs don't come with a prescription and prefer buying cheaper antimalarial agents. Study participants reported stocking and selling both ACTs and non-ACT antimalarial agents in the drug outlets. Pharmacists/dispensers in the drug outlets reported that most clients could not afford buying a full dose of an ACT. None of the study participants considered using Co-payment mechanism while stocking ACTs in the drug outlets. CONCLUSION There is lack of awareness and utilization of Co-payment mechanism in stocking, pricing, and dispensing of ACTs among pharmacists/dispensers in private drug outlets in Uganda. The antimalarial dispensing in drug outlets was mostly based on prescriptions, clients' preferences, and medicine affordability. The Ministry of Health needs to create demand for Co-payment mechanism through public awareness campaigns, training of healthcare personnel and behavior change communication in the private sector.
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Affiliation(s)
- Moses Ocan
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Racheal Bakubi
- Department of Health Policy, Planning and Management, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Loyce Nakalembe
- Department of Pharmacology, Soroti University, Soroti, Uganda
| | | | - Nsobya Sam
- Infectious Disease Research Collaboration (IDRC), Kampala, Uganda
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Bedia-Tanoh VA, Angora ÉK, Miezan SAJ, Koné-Bravo EDM, Konaté-Touré A, Bosson-Vanga H, Kassi FK, Kiki-Barro PCM, Djohan V, Menan HEI, Yavo W. Knowledge and practices of private pharmacy auxiliaries on malaria in Abidjan, Côte d'Ivoire. Malar J 2023; 22:330. [PMID: 37919734 PMCID: PMC10623852 DOI: 10.1186/s12936-023-04751-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The emergence of resistance to artemisinin derivatives in Southeast Asia constitutes a serious threat for other malaria endemic areas, particularly in Côte d'Ivoire. To delay this resistance, the application of the control measures recommended by the National Malaria Control Programme (NMCP) for a correct management, in the private pharmacies, is a necessity. The purpose of this study was, therefore, to assess the level of knowledge and practices of private pharmacy auxiliary in Abidjan about the management of malaria. METHODS A descriptive cross-sectional study was conducted from April to November 2015. It included auxiliaries of private pharmacies in Abidjan. Data collection material was a structured an open pretested questionnaire. Data analysis was carried out using Package for Social Science (SPSS) software version 21.1. Chi square test was used to compare proportions for a significance threshold of 0.05 for the p value. RESULTS A total, 447 auxiliaries from 163 private pharmacies were interviewed. It was noted that the auxiliaries had a good knowledge of clinical signs of uncomplicated malaria (99.1%), biological examinations (54.6% for the thick film and 40.7% for rapid diagnostic tests (RDTs) and anti-malarial drugs (99.3% for artemether + lumefantrine, AL). The strategies of vector control (long-lasting insecticide-treated mosquito nets (LLITNs, Repellent ointments, cleaning gutters, elimination of larvae breeding site and intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) in pregnant women were also known by the auxiliaries, respectively 99.8% and 77.4%. However, the malaria pathogen (25.1%) and the NMCP recommendations (e.g. use of AL or AS + AQ as first-line treatment for uncomplicated malaria and IPTp-SP in pregnant women) were not well known by the auxiliaries (28.2% and 26.9% for uncomplicated and severe malaria). Concerning the practices of the auxiliaries, 91.1% offered anti-malarial drugs to patients without a prescription and 47.3% mentioned incorrect dosages. The combination artemether + lumefantrine was the most recommended (91.3%). The delivery of anti-malarial drugs was rarely accompanied by advice on malaria prevention, neither was it carried out on the result of an RDT. CONCLUSION The epidemiology and the NMCP recommendations for the diagnostic and therapeutic management of malaria, are not well known to auxiliaries, which may have implications for their practices. These results show the need to sensitize and train private pharmacy auxiliaries, and also to involve them in NMCP activities.
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Affiliation(s)
- Valérie A Bedia-Tanoh
- Pharmaceutical and Biological Sciences Training and Research Unit, Parasitology and Mycology Department, UFHB, PO Box V34, Abidjan, Côte d'Ivoire.
- Research and Control Malaria Centre, National Public Health Institute, PO Box V 47, Abidjan, Côte d'Ivoire.
| | - Étienne K Angora
- Pharmaceutical and Biological Sciences Training and Research Unit, Parasitology and Mycology Department, UFHB, PO Box V34, Abidjan, Côte d'Ivoire
| | - Sebastien A J Miezan
- Pharmaceutical and Biological Sciences Training and Research Unit, Parasitology and Mycology Department, UFHB, PO Box V34, Abidjan, Côte d'Ivoire
| | - Estelle D M Koné-Bravo
- Pharmaceutical and Biological Sciences Training and Research Unit, Parasitology and Mycology Department, UFHB, PO Box V34, Abidjan, Côte d'Ivoire
- Diagnostic and Research Centre on AIDS and other Infectious Diseases (CeDReS), CHU Treichville, PO Box V 13, Abidjan 01, Côte d'Ivoire
| | - Abibatou Konaté-Touré
- Pharmaceutical and Biological Sciences Training and Research Unit, Parasitology and Mycology Department, UFHB, PO Box V34, Abidjan, Côte d'Ivoire
- Research and Control Malaria Centre, National Public Health Institute, PO Box V 47, Abidjan, Côte d'Ivoire
| | - Henriette Bosson-Vanga
- Pharmaceutical and Biological Sciences Training and Research Unit, Parasitology and Mycology Department, UFHB, PO Box V34, Abidjan, Côte d'Ivoire
| | - Fulgence K Kassi
- Pharmaceutical and Biological Sciences Training and Research Unit, Parasitology and Mycology Department, UFHB, PO Box V34, Abidjan, Côte d'Ivoire
- Diagnostic and Research Centre on AIDS and other Infectious Diseases (CeDReS), CHU Treichville, PO Box V 13, Abidjan 01, Côte d'Ivoire
| | - Pulchérie C M Kiki-Barro
- Pharmaceutical and Biological Sciences Training and Research Unit, Parasitology and Mycology Department, UFHB, PO Box V34, Abidjan, Côte d'Ivoire
| | - Vincent Djohan
- Pharmaceutical and Biological Sciences Training and Research Unit, Parasitology and Mycology Department, UFHB, PO Box V34, Abidjan, Côte d'Ivoire
| | - Hervé E I Menan
- Pharmaceutical and Biological Sciences Training and Research Unit, Parasitology and Mycology Department, UFHB, PO Box V34, Abidjan, Côte d'Ivoire
- Diagnostic and Research Centre on AIDS and other Infectious Diseases (CeDReS), CHU Treichville, PO Box V 13, Abidjan 01, Côte d'Ivoire
| | - William Yavo
- Pharmaceutical and Biological Sciences Training and Research Unit, Parasitology and Mycology Department, UFHB, PO Box V34, Abidjan, Côte d'Ivoire
- Research and Control Malaria Centre, National Public Health Institute, PO Box V 47, Abidjan, Côte d'Ivoire
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Kabir Sulaiman S, Isma'il Tsiga-Ahmed F, Sale Musa M, Kabir Sulaiman A, Muhammad Dayyab F, Ab Khan M, Idris Ahmad S, Abasi-Okot Akpan U, Ibrahim Usman U, Tjjani Bako A. Prevalence, determinants, and reasons for malaria vaccine hesitancy among caregivers of under-five children in Nigeria: Results from a nationwide cross-sectional survey. Vaccine 2023; 41:1503-1512. [PMID: 36725434 DOI: 10.1016/j.vaccine.2023.01.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Malaria contributes to an enormous global burden of disease and mortality, especially in children. Approximately one in every four global cases and deaths from malaria occurs in Nigeria. This study aims to evaluate the prevalence and correlates of community hesitancy to the malaria vaccine, including the reasons for the hesitancy, following the approval of the RTS,S malaria vaccine by the World Health Organization (WHO). METHODS This was a nationwide cross-sectional online survey of Nigerian adults conducted from 20th October to 30th November 2021. Participants who replied 'no' or 'maybe' to a question assessing their willingness to accept the RTS,S malaria vaccine were considered "hesitant". We fit a multivariate logistic regression model to report the adjusted odds ratio (aOR) and 95 % confidence interval (CI) for the factors associated with vaccine hesitancy. FINDINGS Among 3377 total respondents (1961 [57.86 %] males; mean age [SD]: 30[9.1]), 1010 (29.91 %) were hesitant. Receiving information about the RTS,S malaria vaccine initially from healthcare workers (vs. the internet) (aOR:0.55; 95 % CI:0.35-0.87) was significantly associated with lower odds of hesitancy. Conversely, earning a high income of over NGN100, 000 (vs. < NGN 30,000) per month (aOR: 2.10, 95 % CI: 1.36-3.24), belonging to other religious groups (vs. Islam) (aOR:3.25, 95 % CI:1.18-8.98), and having a family size of more than ten (vs. < 5) (aOR:1.84; 95 % CI:1.08-3.13) were significantly associated with a higher odds of hesitancy. The main reasons for vaccine hesitancy included fear of vaccine adverse effects (34.95 %), availability of other malaria preventive measures (33.96 %) and not seeing the positive effect of the vaccine in others first (32.97 %). CONCLUSION The findings of this survey provide a valuable blueprint for the development of targeted interventions to facilitate caregiver acceptance of the RTS,S vaccine.
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Affiliation(s)
| | | | - Muhammad Sale Musa
- Department of Medicine, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | | | | | - Moien Ab Khan
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates; Primary Care, NHS North West London, London TW3 3EB, United Kingdom
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Laktabai J, Platt AC, Turner E, Saran I, Kipkoech J, Menya D, O’Meara WP. Community-Based Malaria Testing Reduces Polypharmacy in a Population-Based Survey of Febrile Illness in Western Kenya. Int J Public Health 2022; 67:1604826. [PMID: 36090831 PMCID: PMC9453644 DOI: 10.3389/ijph.2022.1604826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective was to describe the relationship between the location of care, the malaria test result, and the type of medicine consumed for the fever, and to determine whether community-based access to malaria testing reduced polypharmacy. Methods: This is a secondary analysis of a cluster-randomized trial of an intervention designed to increase diagnostic testing and targeting of Artemesinin Combined Therapies (ACTs). Data collected at baseline, 12, and 18 months were analyzed to determine the impact of diagnostic testing on drug consumption patterns among febrile individuals. Results: Of the 5,756 participants analyzed, 60.1% were female, 42% were aged 5–17 years, and 58.1% sought care for fever in a retail outlet. Consumption of both ACT and antibiotics was 22.1% (n = 443/2008) at baseline. At endline, dual consumption had declined to 16.6%. There was reduced antibiotic consumption among those testing positive for malaria (39.5%–26.5%) and those testing negative (63.4%–55.1%), accompanied by a substantial decline in ACT use among malaria-negative participants. Conclusion: Diagnostic testing for malaria reduces dual consumption of ACTs and antibiotics, especially among those testing outside the formal healthcare sector.
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Affiliation(s)
- Jeremiah Laktabai
- School of Medicine, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- *Correspondence: Jeremiah Laktabai,
| | - Alyssa C. Platt
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Elizabeth Turner
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, NC, United States
| | - Indrani Saran
- School of Social Work, Boston College, Chestnut Hill, MA, United States
| | - Joseph Kipkoech
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Diana Menya
- Moi University School of Public Health, Eldoret, Kenya
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Stakeholder perceptions on the deployment of multiple first-line therapies for uncomplicated malaria: a qualitative study in the health district of Kaya, Burkina Faso. Malar J 2022; 21:202. [PMID: 35761273 PMCID: PMC9235275 DOI: 10.1186/s12936-022-04225-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background In Burkina Faso, malaria remains the first cause of medical consultation and hospitalization in health centres. First-line case management of malaria in the country’s health facilities is based on the use of artemisinin-based combination therapy (ACT). To optimize the use of these anti-malarial drugs in the perspective of mitigating the emergence of artemisinin resistance, which is a serious threat to malaria control and elimination, a pilot programme using multiple first-line therapies (MFTs) [three artemisinin-based combinations—pyronaridine–artesunate, dihydroartemisinin–piperaquine and artemether-lumefantrine] has been designed for implementation. As the success of this MFT pilot programme depends on the perceptions of key stakeholders in the health system and community members, the study aimed to assess their perceptions on the implementation of this strategy. Methods Semi-structured interviews, including 27 individual in-depth interviews and 41 focus groups discussions, were conducted with key stakeholders including malaria control policymakers and implementers, health system managers, health workers and community members. Volunteers from targets stakeholder groups were randomly selected. All interviews were recorded, transcribed and translated. Content analysis was performed using the qualitative software programme QDA Miner. Results The interviews revealed a positive perception of stakeholders on the implementation of the planned MFT programme. They saw the strategy as an opportunity to strengthen the supply of anti-malarial drugs and improve the management of fever and malaria. However, due to lack of experience with the products, health workers and care givers expressed some reservations about the effectiveness and side-effect profiles of the two anti-malarial drugs included as first-line therapy in the MFT programme (pyronaridine–artesunate, dihydroartemisinin–piperaquine). Questions were raised about the appropriateness of segmenting the population into three groups and assigning a specific drug to each group. Conclusion The adherence of both populations and key stakeholders to the MFT implementation strategy will likely depend on the efficacy of the proposed drugs, the absence of, or low frequency of, side-effects, the cost of drugs and availability of the different combinations.
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Nwachukwu CA, Anorue LI, Ajaero ID. Rural-Urban Differentials in Access to Behaviour Change Communication and Use of Long-Lasting Insecticide-Treated Nets and Artemisinin-Based Combination Therapy in Southeast Nigeria. Ethiop J Health Sci 2022; 32:55-64. [PMID: 35250217 PMCID: PMC8864383 DOI: 10.4314/ejhs.v32i1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/18/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND As Malaria continues to take a heavy toll on the life and economy of Nigerians, The National Malaria Elimination Programme uses behaviour change communication (BCC) to promote the use of Long-Lasting Insecticide-treated Nets (LLIN) and Artemisinin-based Combination Therapy (ACT) to combat malaria. This study examined the impact of BCC on the use of LLIN and ACT in Southeast Nigeria. METHODS A structured questionnaire was used to gather data from 480 respondents in urban and rural communities across five states. Analysis of data was done using percentages, chi-square and logistic regression. RESULTS Findings showed weak effect of BCC on LLIN and ACT use despite achieving high (93.75%) exposure. Only 45.1% and 45.7% of the respondents used LLIN and ACT respectively. Urban residents were found to sleep under LLINs and use ACTs more than rural dwellers. Regression results showed that newspapers (OR=1.341) and the Internet (OR=3.216) increased the odds of LLIN use in the rural areas and magazines (OR=1.837) in the urban areas. Television (OR=2.375; P=0.002) and the Internet (OR=6.063; P=0.001) increased the odds of ACT use in the urban areas. Education was found to be a positive predictor of LLIN use in the rural (OR=4.645; P=0.011) and urban areas (OR=6.102) as well as ACT use in the rural (OR=7.268; p=0.002) and urban areas (0R=6.145; P=0.009). CONCLUSION Access to behaviour change communication though very high has not achieved the desired behaviour change. The National Malaria Elimination Programme should produce appropriate messages to address barriers to LLIN and ACT use.
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Affiliation(s)
| | - Luke I Anorue
- Department of Mass Communication, University of Nigeria, Nsukka Nigeria
| | - Ijeoma D Ajaero
- Department of Mass Communication, University of Nigeria, Nsukka Nigeria
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Osarfo J, Adjei RO, Magnussen P, Tagbor HK. Participation of Ghanaian pregnant women in an antimalarial drug trial: willingness, experiences and perceptions. Trans R Soc Trop Med Hyg 2021; 115:714-719. [PMID: 33137818 PMCID: PMC8169309 DOI: 10.1093/trstmh/traa120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/11/2020] [Accepted: 10/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With increasing orientation towards including pregnant women in clinical trials, investigators must conduct culturally acceptable research to aid recruitment and retention. There is limited information on experiences and meanings that pregnant women make of trial participation in Africa. This study reports experiences and perceptions of Ghanaian pregnant women regarding their participation in a clinical trial. METHODS From October to December 2012, 45 in-depth interviews were conducted among pregnant women and their male partners regarding their experiences and perceptions of clinical trial processes as part of an antimalarial drug safety and efficacy trial in pregnant women in the Ashanti region of Ghana. Analysis was by predetermined themes and inductive analysis. RESULTS Familiarity with the disease studied in the trial and trust in health workers favoured participation with the latter underlying acceptance of study drugs in the absence of symptoms. Adverse drug events were perceived as intrinsic sickness exhibited on the path to wellness. There were no cultural barriers to blood sampling during home visits but hospital-based sampling was preferred. Home visits were linked to participants having HIV infection. CONCLUSION This study contributes knowledge on sociocultural matters underpinning pregnant women's decisions regarding trial participation in an era of increasing drug trials involving pregnant women.
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Affiliation(s)
- Joseph Osarfo
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rose O Adjei
- Department of Health Education, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pascal Magnussen
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Harry K Tagbor
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Tetteh-Quarcoo PB, Dayie NTKD, Adutwum-Ofosu KK, Ahenkorah J, Afutu E, Amponsah SK, Abdul-Rahman M, Kretchy JP, Ocloo JY, Nii-Trebi NI, Yalley AK, Hagan OCK, Niriwa BP, Aghasili CC, Kotey FCN, Donkor ES, Ayeh-Kumi PF, Udofia EA. Unravelling the Perspectives of Day and Night Traders in Selected Markets within a Sub-Saharan African City with a Malaria Knowledge, Attitude and Practice Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3468. [PMID: 33810537 PMCID: PMC8037644 DOI: 10.3390/ijerph18073468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Malaria is still endemic in sub-Saharan Africa, with a high disease burden. Misconceptions about malaria contribute to poor attitudes and practices, further increasing the burden in endemic countries. Studies have examined the knowledge, attitudes, and practices (KAP) of malaria among different populations. However, there seems to be no available literature reporting on the perspectives of day and night market traders. To the best of our knowledge, this is the first report on malaria KAP with a focus on day and night market traders. METHODS A descriptive cross-sectional study involving day and night market traders in 10 selected markets within the Greater Accra Region of Ghana was carried out. Data were collected from consenting respondents using a structured questionnaire. RESULTS Of the 760 respondents (33.3% (n = 253) night and 66.7% (n = 507) day traders) interviewed, there was no significant difference between the day and night market traders in terms of malaria KAP. Although the market traders had an overall moderate knowledge (54.0% of the day traders and 56.5% of the night traders), misconceptions about malaria (especially that it could be caused by exposure to the sun) still existed among the traders. Moreover, the majority of the traders who demonstrated high knowledge (43.98%, n = 250) did not always take laboratory tests to confirm their suspicion, indicating poor attitude. Furthermore, the market traders' choice of drug for malaria treatment (p = 0.001) and preferred malaria treatment type (orthodox or herbal) (p = 0.005) were significantly associated with their knowledge level. CONCLUSIONS Despite the observation that no significant difference in KAP exists between day and night market traders, appropriate health education programs and interventions still need to be directed at misconceptions, poor attitudes, and poor practices revealed by this study. This will ultimately help in the prevention and control of malaria in Ghana, and globally.
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Affiliation(s)
- Patience B. Tetteh-Quarcoo
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (E.A.); (B.P.N.); (F.C.N.K.); (E.S.D.); (P.F.A.-K.)
| | - Nicholas T. K. D. Dayie
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (E.A.); (B.P.N.); (F.C.N.K.); (E.S.D.); (P.F.A.-K.)
| | - Kevin Kofi Adutwum-Ofosu
- Department of Anatomy, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (K.K.A.-O.); (J.A.)
| | - John Ahenkorah
- Department of Anatomy, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (K.K.A.-O.); (J.A.)
| | - Emmanuel Afutu
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (E.A.); (B.P.N.); (F.C.N.K.); (E.S.D.); (P.F.A.-K.)
| | - Seth K. Amponsah
- Department of Medical Pharmacology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana;
| | - Mubarak Abdul-Rahman
- Department of Pathology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana;
| | - James-Paul Kretchy
- Department of Physician Assitantship Studies/Public Health, School of Medicine and Health Sciences, Central University, Miotso P.O. Box DS 2305, Accra, Ghana;
| | - Janet Y. Ocloo
- Department of Pathology, Korle-Bu Teaching Hospital, Korle-Bu, Accra P.O. Box 77 233, Ghana;
| | - Nicholas I. Nii-Trebi
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Korle Bu, Accra P.O. Box KB 143, Ghana; (N.I.N.-T.); (A.K.Y.)
| | - Akua K. Yalley
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Korle Bu, Accra P.O. Box KB 143, Ghana; (N.I.N.-T.); (A.K.Y.)
| | - Oheneba C. K. Hagan
- Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana;
| | - Benjamin P. Niriwa
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (E.A.); (B.P.N.); (F.C.N.K.); (E.S.D.); (P.F.A.-K.)
- Holy Family Hospital, Techiman P.O. Box 36, Ghana
| | - Chukwuemeka C. Aghasili
- Department of Community Health, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (C.C.A.); (E.A.U.)
| | - Fleischer C. N. Kotey
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (E.A.); (B.P.N.); (F.C.N.K.); (E.S.D.); (P.F.A.-K.)
- FleRhoLife Research Consult, Teshie, Accra P.O. Box TS 853, Ghana
| | - Eric S. Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (E.A.); (B.P.N.); (F.C.N.K.); (E.S.D.); (P.F.A.-K.)
| | - Patrick F. Ayeh-Kumi
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (E.A.); (B.P.N.); (F.C.N.K.); (E.S.D.); (P.F.A.-K.)
| | - Emilia Asuquo Udofia
- Department of Community Health, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (C.C.A.); (E.A.U.)
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Tamiru D, Berhanu M, Dagne T, Kebede A, Getachew M, Tafese F, Kebede A, Etea HM, Amdissa D, Wakjira T, Tamiru A. Quality of integrated community case management services at public health posts, Southwest Ethiopia. J Pediatr Nurs 2021; 57:32-37. [PMID: 33212344 DOI: 10.1016/j.pedn.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study is to assess the quality of an integrated community case management service (ICCM) and associated factors at health posts in Ethiopia. DESIGN AND METHODS Institution-based cross-sectional study design was conducted in the health posts of Jimma zone. Data were collected using a structured questionnaire and in-depth interviews. Binary logistic regression was used to identify independent predictors of client satisfaction on services and the qualitative data were presented by triangulating with quantitative findings. RESULTS This study indicated that 80%, 65% and 55% of health extension workers (HEW) correctly assessed cases, classified cases and prescribed drugs of ICCM cases respectively. Some caregivers (40.2%) knew about danger signs which they heard from HEWs (81.9%). More than one-fourth (29.01%) of caregivers reported that their children were exposed to illness like diarrhea (39.1%) in the last two weeks. HEWs have demonstrated to a large number of caregivers (66%) how to give medications. Being a housewife [AOR = 0.17(0.05,0.56)], having a farmer husband[AOR = 3.77(1.09,12.98)] and having a government employed husband [AOR = 5.32(1.03,27.48)] were significantly associated with ICCM services. CONCLUSIONS More than half of health extension workers correctly assessed, classified and prescribed drugs for ICCM cases. Some caregivers knew about danger signs which the majority of them heard from health extension workers. Being a housewife and paternal occupation were significantly associated with clients' satisfaction in ICCM services. PRACTICE IMPLICATIONS Findings of this study can be used to guide the development of programs to improve integrated community case management service in Ethiopia by informing policymakers and other stakeholders about challenges of ICCM services.
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Affiliation(s)
- Dessalegn Tamiru
- Jimma University, Nutrition and Dietetics Department, Jimma, Ethiopia.
| | | | - Tesfaye Dagne
- Jimma University, Health Economics, Management and Policy, Jimma, Ethiopia
| | - Alemi Kebede
- Jimma University Population and Family Health Department, Jimma, Ethiopia
| | - Muluneh Getachew
- Jimma University, Health Economics, Management and Policy, Jimma, Ethiopia
| | - Fikru Tafese
- Jimma University, Health Economics, Management and Policy, Jimma, Ethiopia
| | - Ayantu Kebede
- Jimma University, Department of Epidemiology, Jimma, Ethiopia
| | | | - Demuma Amdissa
- Jimma University, Department of Behavioural Science and Society, Jimma, Ethiopia
| | - Tekle Wakjira
- Jimma University, Department of Gynaecology and obstetrics, Jimma, Ethiopia
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Blanco M, Suárez-Sanchez P, García B, Nzang J, Ncogo P, Riloha M, Berzosa P, Benito A, Romay-Barja M. Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea. Malar J 2021; 20:21. [PMID: 33413402 PMCID: PMC7789308 DOI: 10.1186/s12936-020-03528-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background In 2018, an estimated 228 million cases of malaria occurred worldwide. Countries are far from having achieved reasonable levels of national protocol compliance among health workers. Lack of awareness of treatment protocols and treatment resistance by prescribers threatens to undermine progress when it comes to reducing the prevalence of this disease. This study sought to evaluate the degree of knowledge and practices regarding malaria diagnosis and treatment amongst prescribers working at the public health facilities of Bata, Equatorial Guinea. Methods A cross-sectional survey was conducted in October-December 2017 amongst all public health professionals who attended patients under the age of 15 years, with suspected malaria in the Bata District of Equatorial Guinea. Practitioners were asked about their practices and knowledge of malaria and the National Malaria Treatment Guidelines. A bivariate analysis and a logistic regression model were used to determine factors associated with their knowledge. Results Among the 44 practitioners interviewed, 59.1% worked at a Health Centre and 40.9% at the District Hospital of Bata. Important differences in knowledge and practices between hospital and health centre workers were found. Clinical diagnosis was more frequently by practitioners at the health centres (p = 0.059), while microscopy confirmation was more frequent at regional hospital (100%). Intramuscular artemether was the anti-malarial most administrated at the health centres (50.0%), while artemether-lumefantrine was the treatment most used at the regional hospital (66.7%). Most practitioners working at public health facilities (63.6%) have a low level of knowledge regarding the National Malaria Treatment Guidelines. While knowledge regarding malaria, the National Malaria Treatment Guidelines and treatment resistances is low, it was higher amongst hospital workers than amongst practitioners at health centres. Conclusions It is essential to reinforce practitioners’ knowledge, treatment and diagnosis practices and use of the National Malaria Treatment Guidelines in order to improve malaria case management and disease control in the region. A specific malaria training programme ensuring ongoing updates training is necessary in order to ensure that greater experience does not entail obsolete knowledge and, consequently, inadequate diagnosis and treatment practices.
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Affiliation(s)
- Marta Blanco
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Medicina Preventiva, Hospital Virgen de la Salud, Toledo, Spain
| | - Pablo Suárez-Sanchez
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain
| | - Belén García
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.,Fundación Estatal, Salud, Infancia y Bienestar Social (FCSAI), Madrid, Spain
| | - Jesús Nzang
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.,Fundación Estatal, Salud, Infancia y Bienestar Social (FCSAI), Madrid, Spain
| | - Policarpo Ncogo
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.,Fundación Estatal, Salud, Infancia y Bienestar Social (FCSAI), Madrid, Spain
| | - Matilde Riloha
- Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea
| | - Pedro Berzosa
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.,Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Agustín Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.,Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - María Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain. .,Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain.
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11
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Failures in the case management of children with uncomplicated malaria in Bata district of Equatorial Guinea and associated factors. PLoS One 2019; 14:e0220789. [PMID: 31374107 PMCID: PMC6677319 DOI: 10.1371/journal.pone.0220789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/23/2019] [Indexed: 11/22/2022] Open
Abstract
Background In Equatorial Guinea, malaria continues to be one of the main causes of morbidity and mortality among children. The National Therapeutic Guide established artesunate-amodiaquine (ASAQ) as first-line treatment for uncomplicated malaria, but compliance with this treatment is low. The aim of this study was to assess, for the first time, the performance of public healthcare workers in the diagnosis and treatment of uncomplicated malaria, their compliance with first-line Malaria National Therapeutic Guide and the associated factors. Methods A cross-sectional survey was conducted at the nine public health facilities in the Bata District of Equatorial Guinea to assess the management of uncomplicated malaria in children < 15 years of age. Bivariate and multivariate statistical analyses were used to determine the recommended treatment compliance and related factors. Results A total of 227 children with uncomplicated malaria were recorded from 9 public health facilities. Most of the treatments prescribed (83.3%) did not follow the first-line treatment recommended for uncomplicated malaria. The diagnosis was established with parasite confirmation in 182 cases (80.2%). After adjustment for other variables, children under 2 months of age, the use of parasite confirmation to the diagnosis of malaria and being familiar with the national therapeutic guide were significantly associated with the prescription of the first-line recommended treatment. Cases attended at the hospital or in a health facility with ASAQ in the pharmacy at the time of the study were also more likely to be prescribed with the recommended treatment, but with non-significant association after adjustment for other variables. Conclusions This study identified the factors associated with the low compliance with the first-line treatment by the public healthcare facilities of Bata District of Equatorial Guinea. It seems necessary to improve case management of children with uncomplicated malaria; to reinforce the use of Malaria National Therapeutic Guide and to inform about the danger of using artemisinin monotherapy. Furthermore, it is crucial to provide recommended first-line treatment to the pharmacies of all public health facilities to ensure access to this treatment.
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12
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Kwarteng A, Malm KL, Febir LG, Tawiah T, Adjei G, Nyame S, Agbokey F, Twumasi M, Amenga-Etego S, Danquah DA, Bart-Plange C, Owusu-Agyei S, Asante KP. The Accuracy and Perception of Test-Based Management of Malaria at Private Licensed Chemical Shops in the Middle Belt of Ghana. Am J Trop Med Hyg 2019; 100:264-274. [PMID: 30652659 DOI: 10.4269/ajtmh.17-0970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The sale of artemisinin-based combination therapy (ACT) by private licensed chemical shops (LCS) without testing is contrary to current policy recommendations. This study assessed the accuracy and perception of test-based management of malaria using malaria rapid diagnostic test (mRDT) kits at private LCS in two predominantly rural areas in the middle part of Ghana. Clients presenting at LCS with fever or other signs and symptoms suspected to be malaria in the absence of signs of severe malaria were tested with mRDT by trained attendants and treated based on the national malaria treatment guidelines. Using structured questionnaires, exit interviews were conducted within 48 hours and a follow-up interview on day 7 (±3 days). Focus group discussions and in-depth interviews were also conducted to assess stakeholders' perception on the use of mRDT at LCS. About 79.0% (N = 1,797) of clients reported with a fever. Sixty-six percent (947/1,426) of febrile clients had a positive mRDT result. Eighty-six percent (815/947) of clients with uncomplicated malaria were treated with the recommended ACT. About 97.8% (790/808) of clients with uncomplicated malaria treated with ACT were reported to be well by day 7. However, referral for those with negative mRDT results was very low (4.1%, 27/662). A high proportion of clients with a positive mRDT result received the recommended malaria treatment. Test-based management of malaria by LCS attendants was found to be feasible and acceptable by the community members and other stakeholders. Successful implementation will however require effective referral, supervision and quality control systems.
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Affiliation(s)
- Anthony Kwarteng
- Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana
| | - Keziah L Malm
- The National Malaria Control Program, Ghana Health Service, Accra, Ghana
| | | | - Theresa Tawiah
- Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana
| | - George Adjei
- Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana
| | - Solomon Nyame
- Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana
| | - Francis Agbokey
- Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana
| | - Mieks Twumasi
- Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana
| | | | | | | | - Seth Owusu-Agyei
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana
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13
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The Challenges and Knowledge Gaps in Malaria Therapy: A Stakeholder Approach to Improving Oral Quinine Use in the Treatment of Childhood Malaria in Ghana. JOURNAL OF PHARMACEUTICS 2018; 2018:1784645. [PMID: 30538884 PMCID: PMC6261397 DOI: 10.1155/2018/1784645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022]
Abstract
Background The study was undertaken to elicit the knowledge, views, and perceptions of key stakeholders on malaria, its bioburden, and treatment options, in order to ascertain the knowledge gabs and challenges, especially in the use of oral quinine in childhood malaria. Methods A cross-sectional survey was conducted using a well-structured Likert Scale and self-administered questionnaire. The principal site of the study was a government-run children's hospital located in the Ashiedu Keteke Sub-Metro of Accra. The study population included health workers, parents, and guardians or care givers. The participants were 300, purposively selected, and consisted of both men (41%) and women (59%) who were twenty years and above, whether employed (42%), self-employed (37%), or unemployed (21%). Results Majority of the participants (78%) demonstrated above average knowledge of malaria. However, their awareness of the causes, modes of transmission, signs, and symptoms as well as preventive mechanisms of malaria did not result in low incidence of malaria. About 77% of the respondents agreed they would seek treatment within 24 hours once signs and symptoms are detected. Though close to 50% undertook home treatment of malaria, majority eventually sought treatment at hospital or clinic. Above 92% of respondents knew that quinine is used to treat malaria and agreed its bitter taste greatly affects compliance, especially in children. Consequently, 95% of the respondents would be glad if its bitter taste is masked. Conclusion The study demonstrated the availability of substantial knowledge of the devastating effects of malaria, especially in children. Therefore, there is the need to ensure the availability and utilization of effective paediatric formulations in the fight against malaria. From this study, fast dissolving oral thin film with a good mouth feel, would be the formulation of choice for quinine.
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Uzochukwu BSC, Ossai EN, Okeke CC, Ndu AC, Onwujekwe OE. Malaria Knowledge and Treatment Practices in Enugu State, Nigeria: A Qualitative Study. Int J Health Policy Manag 2018; 7:859-866. [PMID: 30316234 PMCID: PMC6186483 DOI: 10.15171/ijhpm.2018.41] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/18/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Malaria accounts for 60% of outpatient visits in Nigeria. The aim of the study was to assess the knowledge of malaria and its treatment practices in Enugu state, Nigeria.
Methods: Qualitative data was collected through the use of focus group discussions (FGDs), from six villages three each from urban and rural areas of Enugu state, Nigeria. A total of 18 FGDs involving 189 participants were conducted and data on place of treatment for malaria and drug of choice for malaria treatment were collected.
Results: Most discussants had a good knowledge of the signs and symptoms of malaria. They reported late for treatment when they had symptoms suggestive of malaria. Treatment timing was affected by financial capability and perceived severity of disease. There was preference for patent medicine dealers (PMDs) and pharmacies for malaria treatment. The reasons included drug affordability, obtaining preferred drug, short waiting time and polite treatment from the providers. Treatment in most cases was without proper malaria diagnosis. Cost was an important factor in determining the drug of choice for malaria treatment. This could explain why people were not aware of the use of artemisininbased combination therapy while preferring mono-therapies and herbal drugs. Public hospitals were considered as good sources of treatment for malaria although they remain the last resort when treatment from these drug outlets failed.
Conclusion: The community members preferred PMDs and pharmacies for malaria treatment. Unfortunately, these drug outlets do not encourage the use of artemisinin combination therapy (ACT). This makes it necessary that pharmacists and PMDs are trained on management of malaria. Also, improving the knowledge of the public on the need for malaria diagnosis before treatment and use of artemisinin-based combination therapy will improve the control of malaria. The populace should be instructed to seek treatment early while also discouraging the use of herbal drugs for malaria treatment. There is also the need to improve service delivery at public health facilities.
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Affiliation(s)
- Benjamin Sunday C Uzochukwu
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria.,Health Policy and Research Group Enugu, Enugu State, Nigeria
| | - Edmund Ndudi Ossai
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Chinyere Cecilia Okeke
- Department of Community Medicine, University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State, Nigeria
| | - Anne Chigedu Ndu
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria
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15
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Awuah RB, Asante PY, Sakyi L, Biney AAE, Kushitor MK, Agyei F, de-Graft Aikins A. Factors associated with treatment-seeking for malaria in urban poor communities in Accra, Ghana. Malar J 2018; 17:168. [PMID: 29661191 PMCID: PMC5902882 DOI: 10.1186/s12936-018-2311-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/05/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In Ghana, about 3.5 million cases of malaria are recorded each year. Urban poor residents particularly have a higher risk of malaria mainly due to poor housing, low socio-economic status and poor sanitation. Alternative treatment for malaria (mainly African traditional/herbal and/or self-medication) is further compounding efforts to control the incidence of malaria in urban poor communities. This study assesses factors associated with seeking alternative treatment as the first response to malaria, relative to orthodox treatment in three urban poor communities in Accra, Ghana. METHODS This cross-sectional study was conducted in three urban poor localities in Accra, Ghana among individuals in their reproductive ages (15-59 years for men and 15-49 years for women). The analytic sample for the study was 707. A multinomial regression model was used to assess individual, interpersonal and structural level factors associated with treatment-seeking for malaria. RESULTS Overall, 31% of the respondents sought orthodox treatment, 8% sought traditional/herbal treatment and 61% self-medicated as the first response to malaria. At the bivariate level, more males than females used traditional/herbal treatment and self-medicated for malaria. The results of the regression analysis showed that current health insurance status, perceived relative economic standing, level of social support, and locality of residence were associated with seeking alternative treatment for malaria relative to orthodox treatment. CONCLUSIONS The findings show that many urban poor residents in Accra self-medicate as the first response to malaria. Additionally, individuals who were not enrolled in a health insurance scheme, those who perceived they had a low economic standing, those with a high level of social support, and locality of residence were significantly associated with the use of alternative treatment for malaria. Multi-level strategies should be employed to address the use of alternative forms of treatment for malaria within the context of urban poverty.
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Affiliation(s)
| | | | - Lionel Sakyi
- Centre for Migration Studies, University of Ghana, Accra, Ghana
| | - Adriana A E Biney
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | | | - Francis Agyei
- Department of Psychology, University of Ghana, Accra, Ghana
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana.
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Romay-Barja M, Ncogo P, Nseng G, Santana-Morales MA, Berzosa P, Herrador Z, Valladares B, Riloha M, Benito A. The use and preference of artemether as a first-choice treatment for malaria: results from a cross-sectional survey in the Bata district, Equatorial Guinea. Malar J 2018. [PMID: 29523144 PMCID: PMC5845225 DOI: 10.1186/s12936-018-2254-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is endemic in Equatorial Guinea with stable transmission, and it remains a major cause of morbidity and mortality in children under 5 years of age. Adherence to artemisinin-based combination therapy (ACT) as a first-line treatment for uncomplicated malaria is critical to malaria control. Six years after the introduction of artesunate-amodiaquine (AS/AQ) therapy in Equatorial Guinea, adherence to the first-line treatment seems to be low in the Bata district. The factors associated with the choice of malaria treatment have not been studied previously in this area; therefore, this study aimed to analyse the preference and use of artemether as malaria treatment and its related factors in the Bata district of Equatorial Guinea. METHODS In 2013, a cross-sectional study was conducted in the Bata district, which involved 428 households. Bivariate and multivariate statistical analyses were conducted to determine the relevance of socio-economic, geographical, and behavioural factors that played a role in the preference and use of artemether as malaria treatment. RESULTS Artemether was considered the best treatment for malaria by 110 caregivers (26%), and was the antimalarial most administrated in the Bata district. It was prescribed to 117 children (27.34%); while, only 6.78% were administered AS/AQ. Caregivers living ≤ 3 km from the nearest health facility were almost two times more likely to consider artemether as the best treatment than those living farther away (95% CI 0.31-0.86). Caregivers with at least a secondary school education were 2.7 times more likely to consider artemether as the best treatment than those less educated. Children whose caregivers considered artemether the best treatment against malaria were five times more likely to be treated with artemether than children with caregivers who did not consider it the best (OR 5.07, 95% CI 2.93-8.78). In contrast, children that reported weakness as a symptom were less likely to be treated with artemether than those with other symptoms (OR 0.47, 95% CI 0.28-0.78). CONCLUSION Caregivers, public and private health staff, and drug sellers need to understand the importance of using ACT to treat uncomplicated malaria and the dangers of using artemisinin monotherapy.
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Affiliation(s)
- Maria Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain. .,Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain.
| | - Policarpo Ncogo
- Centro de Referencia de Control de Endemias, Malabo, Equatorial Guinea
| | - Gloria Nseng
- Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea
| | - Maria A Santana-Morales
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain.,Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Pedro Berzosa
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.,Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Zaida Herrador
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.,Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Basilio Valladares
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain.,Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Matilde Riloha
- Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea
| | - Agustin Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.,Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
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Tawiah T, Malam K, Kwarteng A, Bart-Plange C, Febir L, Aubyn V, Obermann K, Owusu-Agyei S, Asante KP. Improving the first-line treatment of febrile illnesses in Ghana: willingness to pay for malaria rapid diagnostic tests at licensed chemical shops in the Kintampo area. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:4. [PMID: 29434526 PMCID: PMC5793370 DOI: 10.1186/s12962-018-0090-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Use of malaria rapid diagnostic test (mRDT) enhances patient management and reduces costs associated with the inappropriate use of antimalarials. Despite its proven clinical effectiveness, mRDT is not readily available at licensed chemical shops in Ghana. Therefore, in order to improve the use of mRDT, there is the need to understand the willingness to pay for and sell mRDT. This study assessed patients’ willingness to pay and licensed chemical operators’ (LCS) willingness to sell mRDTs. Methods The study was a cross-sectional survey conducted in Kintampo North Municipality and Kintampo South District of Ghana. Contingent valuation method using the dichotomous approach was applied to explore patient’s willingness to pay. In-depth interviews (IDIs) were used to obtain information from licensed chemical operators’ willingness to sell. Results Majority 161 (97%) of the customers were willing to pay for mRDT while 100% of licensed chemical operators were also willing to sell mRDT. The average lowest amount respondents were willing to pay was Ghana cedis (GH¢) 1.1 (US$ 0.26) and an average highest amount of GH¢ 2.1 (US$ 0.49). LCS operators were willing to sell the test kit at an average lowest price of GH¢1 (US$ 0.23) and average highest price of GH¢2 (US$ 0.47). Conclusion Community members were willing to pay for mRDT and LCS operators are willing to sell mRDTs. However, the high cost of the mRDT is likely to prevent the widespread use of mRDT. There is a clear need to find system-compatible ways to subsidize the use of mRDT via National Health Insurance scheme.
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Affiliation(s)
- Theresa Tawiah
- Kintampo Health Research Center, P. O Box 200, Kintampo, Ghana
| | - Keziah Malam
- 2National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | | | | | - Lawrence Febir
- Kintampo Health Research Center, P. O Box 200, Kintampo, Ghana
| | - Vivian Aubyn
- 2National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | - Konrad Obermann
- 3Mannheimer Institut of Public Health, Heidelberg University, Heidelberg, Germany
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Ganfon H, Ekanmian G, Amoussou L, Daniel-Garcia E, Allabi AC. Evaluation of the knowledge and attitude of pharmacists about the national malaria control policy in southern Benin. Malar J 2017; 16:231. [PMID: 28569154 PMCID: PMC5452350 DOI: 10.1186/s12936-017-1880-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/26/2017] [Indexed: 11/17/2022] Open
Abstract
Background The national strategy against malaria in an endemic country should involve all the health stakeholders. In Benin, the private sector is rarely present in the activities of the National Malaria Control Programme (NMCP), and its surveillance system does not cover private sector outlets that are a non-negligible part of the healthcare system. Objective The aim of this study was to describe the drug delivery practices within private pharmacies of Cotonou and Porto-Novo and the awareness of medicine providers concerning the national policy of malaria treatment. Methods A survey was performed among pharmacy staff members responsible for dispensing medicines and providing advice to patients within pharmacies of Cotonou and Porto-Novo. Dispensing/pharmacy assistants (‘dispensators’) from 82 pharmacies in Cotonou and 19 in Porto-Novo were surveyed. Data entry was performed using Epidata 3.1 software and data analysis was carried out using SPSS software version 21.1. Chi square test was used to compare proportions. A significance threshold of 0.05 was defined for the p value. Results 46% of providers did not know the artemisinin-based combination therapy recommended by the NMCP for treating uncomplicated malaria. 58.7% were not able to recognize the gravity signs of malaria. 89.8% of dispensators were used to deliver an anti-malarial upon patient request, without prior biological confirmation as requested by the NMCP policy. Conclusions Dispensing practices within the studied pharmacies from Cotonou and Porto-Novo were not in adequacy with the NMCP guidelines for uncomplicated malaria, which is a striking weakness in the training of drug providers on key elements of the guidelines for managing malaria. The NMCP needs to help dispensator from private pharmacies sector to standardize drug delivery practices according to its guidelines.
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Affiliation(s)
- Habib Ganfon
- Unité de formation et de recherche en Pharmacie, Faculté des Sciences de la Santé (FSS), Université d'Abomey-Calavi, 01 BP 188, Cotonou, Benin.,Centre d'Information Pharmaco-thérapeutique du Bénin, 06 BP 2610, Cotonou, Benin.,Réseau Médicament et Développement (ReMeD), 35 Rue Daviel, 75013, Paris, France
| | - Giraud Ekanmian
- Centre d'Information Pharmaco-thérapeutique du Bénin, 06 BP 2610, Cotonou, Benin.
| | - Louis Amoussou
- Unité de formation et de recherche en Pharmacie, Faculté des Sciences de la Santé (FSS), Université d'Abomey-Calavi, 01 BP 188, Cotonou, Benin
| | | | - Aurel Constant Allabi
- Unité de formation et de recherche en Pharmacie, Faculté des Sciences de la Santé (FSS), Université d'Abomey-Calavi, 01 BP 188, Cotonou, Benin
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Freeman A, Kwarteng A, Febir LG, Amenga-Etego S, Owusu-Agyei S, Asante KP. Two years post affordable medicines facility for malaria program: availability and prices of anti-malarial drugs in central Ghana. J Pharm Policy Pract 2017; 10:15. [PMID: 28465829 PMCID: PMC5410094 DOI: 10.1186/s40545-017-0103-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Affordable Medicines Facility for malaria (AMFm) Program was a subsidy aimed at artemisinin-based combination therapies (ACTs) in order to increase availability, affordability, and market share of ACTs in 8 malaria endemic countries in Africa. The WHO supervised the manufacture of the subsidized products, named them Quality Assured ACTs (QAACT) and printed a Green Leaf Logo on all QAACT packages. Ghana began to receive the subsidized QAACTs in 2010. METHODS A cross-sectional stock survey was conducted at 63 licensed chemical shops (LCS) and private pharmacies in two districts of the Brong-Ahafo region of Ghana to determine the availability and price of all anti-malarial treatments. Drug outlets were visited over a 3-weeks period in October and November of 2014, about 2 years after the end of AMFm program. RESULTS At least one QAACT was available in 88.9% (95% CI 80.9% - 96.8%) of all drug outlets with no difference between urban and rural locations. Non-Assured ACTs (NAACT) were significantly more available in urban drug outlets [75.0% availability (95% CI 59.1% - 90.9%)] than in rural drug outlets [16.1% availability (95% CI 2.4% - 29.9%)]. The top selling product was Artemether Lumefantrine with the Green Leaf Logo, a QAACT. There was a significant difference in the mean price of a QAACT [$1.04 USD (95% CI $0.98 - $1.11)], and the mean price of a NAACT in both the urban and rural areas [$2.46 USD (95% CI $2.11 - $2.81)]. There was no significant difference in the price of any product that was available in urban and rural settings. CONCLUSION About 2 years after the AMFm program, subsidized QAACTs in Ghana were widely available and more affordable than NAACTs in the Kintampo North District and Kintampo South Municipality of Ghana. The AMFm program appeared to have mostly succeeded in making QAACTs available and affordable.
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Affiliation(s)
- Alexander Freeman
- Georgetown University, 3700 O St NW, Washington, DC 20057 USA.,Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo North Municipality, Brong Ahafo Region Ghana
| | - Anthony Kwarteng
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo North Municipality, Brong Ahafo Region Ghana
| | - Lawrence Gyabaa Febir
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo North Municipality, Brong Ahafo Region Ghana
| | - Seeba Amenga-Etego
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo North Municipality, Brong Ahafo Region Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo North Municipality, Brong Ahafo Region Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo North Municipality, Brong Ahafo Region Ghana
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Tivura M, Asante I, van Wyk A, Gyaase S, Malik N, Mahama E, Hostetler DM, Fernandez FM, Asante KP, Kaur H, Owusu-Agyei S. Quality of Artemisinin-based Combination Therapy for malaria found in Ghanaian markets and public health implications of their use. BMC Pharmacol Toxicol 2016; 17:48. [PMID: 27788677 PMCID: PMC5084396 DOI: 10.1186/s40360-016-0089-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 09/28/2016] [Indexed: 12/03/2022] Open
Abstract
Background Ghana changed their antimalarial drug policy from monotherapies to Artemisinin-based Combination Therapies in 2004 in order to provide more efficacious medicines for treatment of malaria. The policy change can be eroded if poor quality Artemisinin-based Combination Therapies are allowed to remain on the Ghanaian market unchecked by regulatory bodies and law enforcement agencies. The presence and prevalence of substandard and counterfeit Artemisinin-based Combination Therapies need to be determined on open markets in Ghana; a review of the current policy; identifying any gaps and making recommendations on actions to be taken in addressing gaps identified are essential as the data provided and recommendations made will help in ensuring effective control of malaria in Ghana. Methods A field survey of antimalarial drugs was conducted in the central part of Ghana. The amount of active pharmaceutical ingredient in each Artemisinin-based Combination Therapy sample identified in the survey was measured using high performance liquid chromatographic analyses. Active pharmaceutical ingredient within the range of 85–115 % was considered as standard and active pharmaceutical ingredient results out of the range were considered as substandard. All samples were screened to confirm stated active pharmaceutical ingredient presence using mass spectrometry. Results A total of 256 Artemisinin-based Combination Therapies were purchased from known medicine outlets, including market stalls, hospitals/clinics, pharmacies, drug stores. Artemether lumefantrine (52.5 %) and artesunate amodiaquine (43.2 %) were the predominant Artemisinin-based Combination Therapies purchased. Of the 256 Artemisinin-based Combination Therapies purchased, 254 were tested, excluding two samples of Artesunate-SP. About 35 % of Artemisinin-based Combination Therapies were found to be substandard. Nine percent of Artemisinin-based Combination Therapies purchased were past their expiry date; no counterfeit (falsified) medicine samples were detected by either high performance liquid chromatographic or mass spectrometry. Conclusion A high proportion of Artemisinin-based Combination Therapies sold in central Ghana were found to be substandard. Manufacturing of medicines that do not adhere to good manufacturing practices may have contributed to the poor quality of the Artemisinin-based Combination Therapies procured. A strict law enforcement and quality monitoring systems is recommended to ensure effective malaria case management as part of malaria control.
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Affiliation(s)
- Mathilda Tivura
- Kintampo Health Research Centre, Ghana Health Service/Ministry of Health, P O Box 200, Kintampo, Ghana
| | - Isaac Asante
- Kintampo Health Research Centre, Ghana Health Service/Ministry of Health, P O Box 200, Kintampo, Ghana
| | - Albert van Wyk
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Stephaney Gyaase
- Kintampo Health Research Centre, Ghana Health Service/Ministry of Health, P O Box 200, Kintampo, Ghana
| | - Naiela Malik
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Emmanuel Mahama
- Kintampo Health Research Centre, Ghana Health Service/Ministry of Health, P O Box 200, Kintampo, Ghana
| | - Dana M Hostetler
- Georgia Institute of Technology, School of Chemistry and Biochemistry, Atlanta, GA, USA
| | - Facundo M Fernandez
- Georgia Institute of Technology, School of Chemistry and Biochemistry, Atlanta, GA, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service/Ministry of Health, P O Box 200, Kintampo, Ghana
| | - Harparkash Kaur
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service/Ministry of Health, P O Box 200, Kintampo, Ghana. .,London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
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Abbey M, Chinbuah MA, Gyapong M, Bartholomew LK, van den Borne B. Community perceptions and practices of treatment seeking for childhood pneumonia: a mixed methods study in a rural district, Ghana. BMC Public Health 2016; 16:848. [PMID: 27549163 PMCID: PMC4994405 DOI: 10.1186/s12889-016-3513-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 08/13/2016] [Indexed: 11/23/2022] Open
Abstract
Background The World Health Organization recommends community case management of malaria and pneumonia for reduction of under-five mortality in developing countries. Caregivers’ perception and understanding of the illness influences the care a sick child receives. Studies in Ghana and elsewhere have routinely shown adequate recognition of malaria by caregivers. Similarly, evidence from Asia and some African countries have shown adequate knowledge on pneumonia. However, in Ghana, little has been documented about community awareness, knowledge, perceptions and management of childhood pneumonia particularly in the Dangme West district. Therefore this formative study was conducted to determine community perceptions of pneumonia for the purpose of informing the design and implementation of context specific health communication strategies to promote early and appropriate care seeking behaviour for childhood pneumonia. Methods A mixed method approach was adopted. Data were obtained from structured interviews (N = 501) and eight focus group discussions made up of 56 caregivers of under-fives and eight community Key Informants. Descriptive and inference statistics were used for the quantitative data and grounded theory to guide the analysis of the qualitative data. Results Two-thirds of the respondents had never heard the name pneumonia. Most respondents did not know about the signs and symptoms of pneumonia. For the few who have heard about pneumonia, causes were largely attributed to coming into contact with cold temperature in various forms. Management practices mostly were self-treatment with home remedies and allopathic care. Conclusion The low awareness and inadequate recognition of pneumonia implies that affected children may not receive prompt and appropriate treatment as their caregivers may misdiagnose the illness. Adequate measures need to be taken to create the needed awareness to improve care seeking behaviour. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3513-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mercy Abbey
- Research and Development Division, Ghana Health Service, PM Bag 190, Accra, Ghana.
| | - Margaret A Chinbuah
- Research and Development Division, Ghana Health Service, PM Bag 190, Accra, Ghana
| | - Margaret Gyapong
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dangme-West District, Ghana
| | - L Kay Bartholomew
- School of Public Health, University of Texas Health Science Centre, 1200 Herman Pressler, Suite W238, Houston, TX, 77030, USA
| | - Bart van den Borne
- Department of Health Promotion, University of Maastricht, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
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Factors influencing choice of care-seeking for acute fever comparing private chemical shops with health centres and hospitals in Ghana: a study using case-control methodology. Malar J 2016; 15:290. [PMID: 27225480 PMCID: PMC4880965 DOI: 10.1186/s12936-016-1351-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background Several public health interventions to improve management of patients with fever are largely focused on the public sector yet a high proportion of patients seek care outside the formal healthcare sector. Few studies have provided information on the determinants of utilization of the private sector as against formal public sector. Understanding the differences between those who attend public and private health institutions, and their pathway to care, has significant practical implications. The chemical shop is an important source of care for acute fever in Ghana. Methods Case–control methodology was used to identify factors associated with seeking care for fever in the Dangme West District, Ghana. People presenting to health centres, or hospital outpatients, with a history or current fever were compared to counterparts from the same community with fever visiting a chemical shop. Results Of 600 patients, 150 each, were recruited from the district hospital and two health centres, respectively, and 300 controls from 51 chemical shops. Overall, 103 (17.2 %) patients tested slide positive for malaria. Specifically, 13.7 % (41/300) of chemical shop patients, 30.7 % (46/150) health centre and 10.7 % (16/150) hospital patients were slide positive. While it was the first option for care for 92.7 % (278/300) chemical shop patients, 42.7 % (64/150) of health centre patients first sought care from a chemical shop. More health centre patients (61.3 %; 92/150) presented with fever after more than 3 days than chemical shop patients (27.7 %; 83/300) [AOR = 0.19; p < 0.001 CI 0.11–0.30]. Although the hospital was the first option for 83.3 % (125/150) of hospital patients, most (63.3 %; 95/150) patients arrived there over 3 days after their symptoms begun. Proximity was significantly associated with utilization of each source of care. Education, but not other socioeconomic or demographic factors were significantly associated with chemical shop use. Conclusions The private drug retail sector is the first option for the majority of patients, including poorer patients, with fever in this setting. Most patients with fever arrive at chemical shops with less delay and fewer signs of severity than at public health facilities. Improving chemical shop skills is a good opportunity to diagnose, treat or refer people with fever early.
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Asante KP, Kinney P, Zandoh C, Vliet EV, Nettey E, Abokyi L, Owusu-Agyei S, Jack D. CHILDHOOD RESPIRATORY MORBIDITY AND COOKING PRACTICES AMONG HOUSEHOLDS IN A PREDOMINANTLY RURAL AREA OF GHANA. Afr J Infect Dis 2016; 10:102-110. [PMID: 28480444 PMCID: PMC5411984 DOI: 10.21010/ajid.v10i2.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Household air pollution is a leading risk factor for respiratory morbidity and mortality in developing countries where biomass fuel is mainly used for cooking. Materials and Method: A household cross-sectional survey was conducted in a predominantly rural area of Ghana in 2007 to determine the prevalence of respiratory symptoms and their associated risk factors. Household cooking practices were also assessed as part of the survey. Results: Household heads of twelve thousand, three hundred and thirty-three households were interviewed. Fifty-seven percent (7006/12333) of these households had at least one child less than five years of age. The prevalence of symptoms of acute lower respiratory infections (ALRI) was 13.7% (n= 957, 95% CI 12.8 – 15.5%). A majority (77.8%, 95% CI, 77.7 - 78.5%) of households used wood as their primary fuel. Majority of respondents who used wood as their primary fuel obtained them by gathering wood from their neighborhood (95.6%, 9177/9595) and used a 3-stone local stove for cooking (94.9%, 9101/9595). In a randomly selected subset of respondents, females were the persons who mostly gathered firewood from the fields (90.8%, 296/326) and did the cooking (94.8%, 384/406) for the household. Conclusion: Symptoms of ALRI reported by caregivers is high in the Kintampo area of Ghana where biomass fuel use is also high. There is the need to initiate interventions that use improved cook stoves and to test the health benefits of such interventions.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Patrick Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, 722 West 168th Street, Room 1104ENew York, NY 10032
| | - Charles Zandoh
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Eleanne Van Vliet
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Ernest Nettey
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Livesy Abokyi
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Research Centre, P. O. Box 200, Kintampo, Ghana
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, 722 West 168th Street, Room 1104ENew York, NY 10032
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Mtenga S, Kimweri A, Romore I, Ali A, Exavery A, Sicuri E, Tanner M, Abdulla S, Lusingu J, Kafuruki S. Stakeholders' opinions and questions regarding the anticipated malaria vaccine in Tanzania. Malar J 2016; 15:189. [PMID: 27048260 PMCID: PMC4822277 DOI: 10.1186/s12936-016-1209-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 03/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within the context of combined interventions, malaria vaccine may provide additional value in malaria prevention. Stakeholders' perspectives are thus critical for informed recommendation of the vaccine in Tanzania. This paper presents the views of stakeholders with regards to malaria vaccine in 12 Tanzanian districts. METHODS Quantitative and qualitative methods were employed. A structured questionnaire was administered to 2123 mothers of under five children. Forty-six in-depth interviews and 12 focus group discussions were conducted with teachers, religious leaders, community health workers, health care professionals, and scientists. Quantitative data analysis involved frequency distributions and cross tabulations using Chi square test to determine the association between malaria vaccine acceptability and independent variables. Qualitative data were analysed thematically. RESULTS Overall, 84.2% of the mothers had perfect acceptance of malaria vaccine. Acceptance varied significantly according to religion, occupation, tribe and region (p < 0.001). Ninety two percent reported that they will accept the malaria vaccine despite the need to continue using insecticide-treated nets (ITNs), while 88.4% reported that they will accept malaria vaccine even if their children get malaria less often than non-vaccinated children. Qualitative results revealed that the positive opinions towards malaria vaccine were due to a need for additional malaria prevention strategies and expectations that the vaccine will reduce visits to the health facility, deaths, malaria episodes and treatment-related expenses. Vaccine related questions included its side effects, efficacy, protective duration, composition, interaction with other medications, provision schedule, availability to the pregnant women, mode of administration (oral or injection?) and whether a child born of HIV virus or with a chronic illness will be eligible for the vaccine? CONCLUSION Stakeholders had high acceptance and positive opinions towards the combined use of the anticipated malaria vaccine and ITNs, and that their acceptance remains high even when the vaccine may not provide full protection, this is a crucial finding for malaria vaccine policy decisions in Tanzania. An inclusive communication strategy should be designed to address the stakeholders' questions through a process that should engage and be implemented by communities and health care professionals. Social cultural aspects associated with vaccine acceptance should be integrated in the communication strategy.
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Affiliation(s)
- Sally Mtenga
- Ifakara Health Institute (IHI), P.O. Box 78373, Dar es Salaam, Tanzania.
| | - Angela Kimweri
- Ifakara Health Institute (IHI), P.O. Box 78373, Dar es Salaam, Tanzania
| | - Idda Romore
- Ifakara Health Institute (IHI), P.O. Box 78373, Dar es Salaam, Tanzania
| | - Ali Ali
- Ifakara Health Institute (IHI), P.O. Box 78373, Dar es Salaam, Tanzania
| | - Amon Exavery
- Ifakara Health Institute (IHI), P.O. Box 78373, Dar es Salaam, Tanzania
| | - Elisa Sicuri
- ISGlobal, Barcelona Centre International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Salim Abdulla
- Ifakara Health Institute (IHI), P.O. Box 78373, Dar es Salaam, Tanzania
| | - John Lusingu
- National Institute for Medical Research Institute (NIMR), Tanga, Tanzania
| | - Shubi Kafuruki
- Ifakara Health Institute (IHI), P.O. Box 78373, Dar es Salaam, Tanzania
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Febir LG, Asante KP, Afari-Asiedu S, Abokyi LN, Kwarteng A, Ogutu B, Gyapong M, Owusu-Agyei S. Seeking treatment for uncomplicated malaria: experiences from the Kintampo districts of Ghana. Malar J 2016; 15:108. [PMID: 26896962 PMCID: PMC4761197 DOI: 10.1186/s12936-016-1151-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 02/04/2016] [Indexed: 02/03/2023] Open
Abstract
Background Malaria accounts for many deaths and illnesses, mostly among young children and pregnant women in sub-Saharan Africa. An integrated approach is recommended to ensure effective malaria control. Socio-cultural factors continue to serve as determinants of malaria health-seeking behaviour. An INDEPTH effectiveness and safety study platform was established to unearth issues around the use of licensed and nationally recommended anti-malarials in real life settings. This study reports on treatment-seeking behaviour for uncomplicated malaria among community members. Methods A qualitative study was conducted in the dry and rainy seasons in purposively selected communities in Kintampo north and south districts. This was based on distances to a health facility, ethnicity and availability of medicines at the sale outlets. Twenty-four focus group discussions were conducted among adult men, women care-takers of children less than 5 years and pregnant women. Ten INDEPTH interviews were also conducted among operators of medicine sale outlets and managers of health facilities. Fifty-one illnesses narrative interviews were conducted among adult men, women, women caretakers of children less than 5 years and pregnant women. Transcripts were transferred into Nvivo 8 software for data management and analysis. Results The artemisinin-based combinations that were commonly known and used were artesunate–amodiaquine and artemether–lumefantrine. Use of herbal preparation to treat diseases including uncomplicated malaria is rife in the communities. Drug stores were not the main source of artemisinin-based combination sales at time of the study. Monotherapies, pain killers and other medicines were purchased from these shops for malaria treatment. Dizziness, general body weakness and sleepiness were noted among respondents who used artemisinin-based combination therapy (ACT) in the past. Conclusion There is no clear cut trajectory for management of uncomplicated malaria in the study area. Different approaches are adopted when treating malaria. There is need for community education to influence behaviour on the management of malaria to achieve real gains from ACT use.
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Affiliation(s)
- Lawrence G Febir
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Ghana.
| | | | | | - Livesy N Abokyi
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Ghana.
| | - Anthony Kwarteng
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Ghana.
| | | | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Ghana.
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Tawiah T, Asante KP, Dwommoh RA, Kwarteng A, Gyaase S, Mahama E, Abokyi L, Amenga-Etego S, Hansen K, Akweongo P, Owusu-Agyei S. Economic costs of fever to households in the middle belt of Ghana. Malar J 2016; 15:68. [PMID: 26851936 PMCID: PMC4744404 DOI: 10.1186/s12936-016-1116-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 01/21/2016] [Indexed: 11/12/2022] Open
Abstract
Background Malaria is one of the main health problems in the sub-Saharan Africa accounting for approximately 198 million morbidity and close to 600,000 mortality cases. Households incur out-of-pocket expenditure for treatment and lose income as a result of not being able to work or care for family members. The main objective of this survey was to assess the economic cost of treating malaria and/or fever with the new ACT to households in the Kintampo districts of Ghana where a health and demographic surveillance systems (KHDSS) are set up to document population dynamics. Methods The study was a cross-sectional survey conducted from October 2009 to July 2011 using community members’ accessed using KHDSS population in the Kintampo area. An estimated sample size of 4226 was randomly selected from the active members of the KHDSS. A structured questionnaire was administered to the selected populates who reported of fever within the last 2 weeks prior to the visit. Data was collected on treatment-seeking behaviour, direct and indirect costs of malaria from the patient perspective. Results Of the 4226 households selected, 947 households with 1222 household members had fever out of which 92 % sought treatment outside home; 55 % of these were females. 31.6 % of these patients sought care from chemical shops. A mean amount of GHS 4.2 (US$2.76) and GHS 18.0 (US$11.84) were incurred by households as direct and indirect cost respectively. On average a household incurred a total cost of GHS 22.2 (US$14.61) per patient per episode. Total economic cost was lowest for those in the highest quintile and highest for those in the middle quintile. Conclusion The total cost of treating fever/malaria episode is relatively high in the study area considering the poverty levels in Ghana. The NHIS has positively influenced health-seeking behaviours and reduced the financial burden of seeking care for those that are insured.
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Affiliation(s)
- Theresa Tawiah
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Ghana.
| | | | | | - Anthony Kwarteng
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Ghana.
| | - Stephaney Gyaase
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Ghana.
| | - Emmanuel Mahama
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Ghana.
| | - Livesy Abokyi
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Ghana.
| | | | - Kristian Hansen
- London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK.
| | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Ghana.
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Danquah DA, Buabeng KO, Asante KP, Mahama E, Bart-Plange C, Owusu-Dabo E. Malaria case detection using rapid diagnostic test at the community level in Ghana: consumer perception and practitioners' experiences. Malar J 2016; 15:34. [PMID: 26794614 PMCID: PMC4722632 DOI: 10.1186/s12936-016-1086-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 01/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Ghana has scaled-up malaria control strategies over the past decade. Much as malaria morbidity and mortality seem to have declined with these efforts, there appears to be increased consumption of artemisinin-based combination therapy (ACT). This study explored the perception and experiences of community members and medicines outlet practitioners on malaria case detection using rapid diagnostic test (RDTs) to guide malaria therapy. Methods This was a cross-sectional study using both quantitative and qualitative approaches for data. In-depth interviews with structured questionnaires were conducted among 197 practitioners randomly selected from community pharmacies and over-the-counter medicine sellers shops within two metropolis (Kumasi and Obuasi) in the Ashanti Region of Ghana. Two focus group discussions were also held in the two communities among female adult caregivers. Results Medicine outlet practitioners and community members often used raised body temperature of individuals as an index for malaria case detection. The raised body temperature was presumptively determined by touching the forehead with hands. Seventy percent of the practitioners’ perceived malaria RDTs are used in hospitals and clinics but not in retail medicines outlets. Many of the practitioners and community members agreed to the need for using RDT for malaria case detection at medicine outlets. However, about 30 % of the practitioners (n = 59) and some community members (n = 6) held the view that RDT negative results does not mean no malaria illness and would use ACT. Conclusions Though malaria RDT use in medicines outlets was largely uncommon, both community members and medicine outlet practitioners welcomed its use. Public education is however needed to improve malaria case detection using RDTs at the community level, to inform appropriate use of ACT.
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Affiliation(s)
- Daniel A Danquah
- Department of Clinical and Social Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,Education and Training Department, Pharmacy Council, Accra, Ghana.
| | - Kwame O Buabeng
- Department of Clinical and Social Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Kwaku P Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, B/A, Ghana.
| | - Emmanuel Mahama
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, B/A, Ghana.
| | | | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Abokyi LN, Asante KP, Mahama E, Gyaase S, Sulemana A, Kwarteng A, Ayaam J, Dosoo D, Adu-Gyasi D, Amenga Etego S, Ogutu B, Akweongo P, Owusu-Agyei S. Use of Antimalarial in the Management of Fever during a Community Survey in the Kintampo Districts of Ghana. PLoS One 2015; 10:e0142106. [PMID: 26580076 PMCID: PMC4651568 DOI: 10.1371/journal.pone.0142106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background Epidemiology of malaria and related fevers in most parts of Africa is changing due to scale up of interventions such as appropriate use of ACTs in the effort towards sustained control and eventual elimination of malaria. The use of ACTs in the management of malaria-associated fever was evaluated in the Kintampo districts of Ghana. Methods Household survey was conducted between October 2009 and February, 2011. A random selection of 370 households was generated from 25,000 households existing within the Health and Demographic Surveillance Systems in Kintampo, Ghana at the time. All household members present at the time of survey in the eligible households were interviewed based on a two weeks reported fever recall and the use of antimalarial for the management of fever. A finger-prick blood sample was also obtained from each member of the household present and later examined for malaria parasites using microscopy. Descriptive analysis was performed, with univariate and multivariate analysis used to identify predictors of fever and malaria parasitemia. Results A total of 1436 individuals were interviewed from 370 households. Overall, fever prevalence was 23.8% (341/1436) and was 38.8% (77/198) in children < 5 years, 21.3% (264/1238) in older children plus adults. Participants who sought treatment for fever were 84% (285/341) with 47.7% (136/285) using any anti-malarial. Artemisinin-based Combination Therapy use was in 69.1% (94/136) of cases while 30.9% used mono-therapies. Malaria parasitaemia rate was 28.2% (397/1407). Conclusion The study reports high community fever prevalence, frequent use of antimalarials for fever treatment and relatively high use of mono-therapies especially in children < 5 years in an area with high malaria parasite prevalence in Ghana.
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Affiliation(s)
- Livesy Naafoe Abokyi
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
- * E-mail:
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Emmanuel Mahama
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Stephaney Gyaase
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Abubakari Sulemana
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Anthony Kwarteng
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Jennifer Ayaam
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - David Dosoo
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Dennis Adu-Gyasi
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Seeba Amenga Etego
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
| | - Bernhards Ogutu
- INDEPTH Network, East Legon, P.O. Box KD 213 Kanda, Accra, Ghana
| | - Patricia Akweongo
- School of Public Health, College of Health Sciences, PO Box LG-13, Legon, Accra, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, P. O. Box 200, Kintampo, Brong Ahafo Region
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Kwarteng A, Asante KP, Abokyi L, Gyaase S, Febir LG, Mahama E, Konadu DG, Tawiah T, Adu-Gyasi D, Dosoo D, Amenga-Etego S, Ogutu B, Owusu-Agyei S. Provider compliance to artemisinin-based combination therapy at primary health care facilities in the middle belt of Ghana. Malar J 2015; 14:361. [PMID: 26391129 PMCID: PMC4578607 DOI: 10.1186/s12936-015-0902-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2004, Ghana implemented the artemisinin-based combination therapy (ACT) policy. Health worker (HW) adherence to the national malaria guidelines on case-management with ACT for children below 5 years of age and older patients presenting at health facilities (HF) for primary illness consultations was evaluated 5 years post-ACT policy change. METHODS Cross-sectional surveys were conducted from 2010 to 2011 at HFs that provide curative care as part of outpatient activities in two districts located in the middle belt of Ghana to coincide with the periods of low and high malaria transmission seasons. A review of patient medical records, HW interviews, HF inventories and finger-pricked blood obtained for independent malaria microscopy were used to assess HW practices on malaria case-management. RESULTS Data from 130 HW interviews, 769 patient medical records at 20 HFs over 75 survey days were individually linked and evaluated. The majority of consultations were performed at health centres/clinics (68.3 %) by medical assistants (28.6 %) and nurse aids (23.5 %). About 68.4 % of HWs had received ACT-specific training and 51.9 %, supervisory visits in the preceding 6 months. Despite the availability of malaria diagnostic test at most HFs (94 %), only 39.8 % (241) out of 605 (78.7 %) patients who reported fever were investigated for malaria. Treatment with ACT in line with the guidelines was 66.7 %; higher in <5 children compared to patients ≥5 years old. Judged against reference microscopy, only 44.8 % (107/239) of ACT prescriptions that conformed to the guidelines were "truly malaria". Multivariate logistic regression analysis showed that HW were significantly more likely to comply with the guidelines if treatment were by low cadre of health staff, were for children below 5 years of age, and malaria test was performed. CONCLUSION Although the majority of patients presenting with malaria received treatment according to the national malaria guidelines, there were widespread inappropriate treatment with ACT. Compliance with the guidelines on ACT use was low, 5 years post-ACT policy change. The Ghana NMCP needs to strengthen HW capacity on malaria case-management through regular training supported by effective laboratory quality control measures.
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Affiliation(s)
- Anthony Kwarteng
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
| | - Livesy Abokyi
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
| | - Stephaney Gyaase
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
| | - Lawrence G Febir
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
| | - Emmanuel Mahama
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
| | - Dennis G Konadu
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
| | - Theresa Tawiah
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
| | - Dennis Adu-Gyasi
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
| | - David Dosoo
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
| | - Seeba Amenga-Etego
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
| | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Ghana.
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Romay-Barja M, Jarrin I, Ncogo P, Nseng G, Sagrado MJ, Santana-Morales MA, Aparcio P, Valladares B, Riloha M, Benito A. Rural-Urban Differences in Household Treatment-Seeking Behaviour for Suspected Malaria in Children at Bata District, Equatorial Guinea. PLoS One 2015; 10:e0135887. [PMID: 26284683 PMCID: PMC4540319 DOI: 10.1371/journal.pone.0135887] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/27/2015] [Indexed: 11/25/2022] Open
Abstract
Background Malaria remains a major cause of morbidity and mortality among children under five years old in Equatorial Guinea. However, little is known about the community management of malaria and treatment-seeking patterns. We aimed to assess symptoms of children with reported malaria and treatment-seeking behaviour of their caretakers in rural and urban areas in the Bata District. Methodology A cross-sectional study was conducted in the district of Bata and 440 houses were selected from 18 rural villages and 26 urban neighbourhoods. Differences between rural and urban caregivers and children with reported malaria were assessed through the chi-squared test for independence of categorical variables and the t-Student or the non-parametric Mann-Whitney test for normally or not-normally distributed continuous variables, respectively. Results Differences between rural and urban households were observed in caregiver treatment-seeking patterns. Fever was the main symptom associated with malaria in both areas. Malaria was treated first at home, particularly in rural areas. The second step was to seek treatment outside the home, mainly at hospital and Health Centre for rural households and at hospital and private clinic for urban ones. Artemether monotherapy was the antimalarial treatment prescribed most often. Households waited for more than 24 hours before seeking treatment outside and delays were longest in rural areas. The total cost of treatment was higher in urban than in rural areas in Bata. Conclusions The delays in seeking treatment, the type of malaria therapy received and the cost of treatment are the principal problems found in Bata District. Important steps for reducing malaria morbidity and mortality in this area are to provide sufficient supplies of effective antimalarial drugs and to improve malaria treatment skills in households and in both public and private sectors.
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Affiliation(s)
- Maria Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
- * E-mail:
| | - Inma Jarrin
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Policarpo Ncogo
- Centro de Referencia de Control de Endemias, Malabo, Equatorial Guinea
| | - Gloria Nseng
- Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea
| | - Maria Jose Sagrado
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria A. Santana-Morales
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Tenerife, Spain
| | - Pilar Aparcio
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Basilio Valladares
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Tenerife, Spain
| | - Matilde Riloha
- Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea
| | - Agustin Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
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Ameh S, Welaga P, Kabiru CW, Ndifon W, Ikpeme B, Nsan E, Oyo-Ita A. Factors associated with appropriate home management of uncomplicated malaria in children in Kassena-Nankana district of Ghana and implications for community case management of childhood illness: a cross-sectional study. BMC Public Health 2015; 15:458. [PMID: 25934315 PMCID: PMC4429811 DOI: 10.1186/s12889-015-1777-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/22/2015] [Indexed: 11/20/2022] Open
Abstract
Background Home management of uncomplicated malaria (HMM) is now integrated into the community case management of childhood illness (CCM), an approach that requires parasitological diagnosis before treatment. The success of CCM in resource-constrained settings without access to parasitological testing significantly depends on the caregiver’s ability to recognise malaria in children under five years (U5), assess its severity, and initiate early treatment with the use of effective antimalarial drugs in the appropriate regimen at home. Little is known about factors that influence effective presumptive treatment of malaria in U5 by caregivers in resource-constrained malaria endemic areas. This study examined the factors associated with appropriate HMM in U5 by caregivers in rural Kassena-Nankana district, northern Ghana. Methods A cross-sectional household survey was conducted among 811 caregivers recruited through multistage sampling. A caregiver was reported to have practiced appropriate HMM if an antimalarial drug was administered to a febrile child in the recommended regimen (correct dose and duration for the child’s age). Binary logistic regression was used to determine factors associated with appropriate HMM. Results Of the 811 caregivers, 87% recognised the symptoms of uncomplicated malaria in U5, and 49% (n = 395) used antimalarial drugs for the HMM. Fifty percent (n = 197) of caregivers who administered antimalarial drugs used the appropriate regimen. In the multivariate logistic regression, caregivers with secondary (OR = 1.71, 95% CI: 1.03, 2.83) and tertiary (OR = 3.58, 95% CI: 1.08, 11.87) education had increased odds of practicing appropriate HMM compared with those with no formal education. Those who sought treatment in the hospital for previous febrile illness in U5 had increased odds of practicing appropriate HMM (OR = 2.24, 95% CI: 1.12, 4.60) compared with those who visited the health centres. Conclusions Half of caregivers who used antimalarial drugs practiced appropriate HMM. Educational status and utilisation of hospitals in previous illness were associated with appropriate HMM. Health education programmes that promote the use of the current first line antimalarial drugs in the appropriate regimen should be targeted at caregivers with no education in order to improve HMM in communities where parasitological diagnosis of malaria may not be feasible. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1777-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Soter Ameh
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria. .,Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Paul Welaga
- Navrongo Health Research Centre, Navrongo, Ghana.
| | | | - Wilfred Ndifon
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria.
| | - Bassey Ikpeme
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria.
| | - Emmanuel Nsan
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria.
| | - Angela Oyo-Ita
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria.
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Vialle-Valentin CE, LeCates RF, Zhang F, Ross-Degnan D. Treatment of Febrile illness with artemisinin combination therapy: prevalence and predictors in five African household surveys. J Pharm Policy Pract 2015; 8:1. [PMID: 25926989 PMCID: PMC4403946 DOI: 10.1186/s40545-014-0024-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/19/2014] [Indexed: 12/17/2022] Open
Abstract
Objectives To evaluate the determinants of compliance with national policies recommending Artemisinin Combination Therapy (ACT) for the treatment of uncomplicated malaria in the community. Methods We used data from Gambia, Ghana, Kenya, Nigeria, and Uganda national household surveys that were conducted with a standardized World Health Organization (WHO) methodology to measure access to and use of medicines. We analyzed all episodes of acute fever reported in the five surveys. We used logistic regression models accounting for the clustered design of the surveys to identify determinants of seeking care in public healthcare facilities, of being treated with antimalarials, and of receiving ACT. Results Overall, 92% of individuals with a febrile episode sought care outside the home, 96% received medicines, 67% were treated with antimalarials, and 16% received ACT. The choice of provider was influenced by perceptions about medicines availability and affordability. In addition, seeking care in a public healthcare facility was the single most important predictor of treatment with ACT [odds ratio (OR): 4.64, 95% confidence intervals (CI): 2.98–7.22, P < 0.001]. Children under 5 years old were more likely than adults to be treated with antimalarials [OR: 1.28, CI: 0.91–1.79, not significant (NS)] but less likely to receive ACT (OR: 0.80, CI: 0.57–1.13, NS). Conclusions Our results confirm the high prevalence of presumptive antimalarial treatment for acute fever, especially in public healthcare facilities where poor people seek care. They show that perceptions about access to medicines shape behaviors by directing patients and caregivers to sources of care where they believe medicines are accessible. The success of national policies recommending ACT for the treatment of uncomplicated malaria depends not only on restricting ACT to confirmed malaria cases, but also on ensuring that ACT is available and affordable for those who need it.
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Affiliation(s)
- Catherine E Vialle-Valentin
- Department of Population, Medical Harvard School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA
| | - Robert F LeCates
- Department of Population, Medical Harvard School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA
| | - Fang Zhang
- Department of Population, Medical Harvard School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA
| | - Dennis Ross-Degnan
- Department of Population, Medical Harvard School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA
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Evaluation of antimalarial resistance marker polymorphism in returned migrant workers in China. Antimicrob Agents Chemother 2014; 59:326-30. [PMID: 25348538 DOI: 10.1128/aac.04144-14] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Imported malaria has been a great challenge for public health in China due to decreased locally transmitted cases and frequent exchange worldwide. Plasmodium falciparum has been mainly responsible for the increasing impact. Currently, artesunate plus amodiaquine, one of the artemisinin combination therapies recommended by the World Health Organization, has been mainly used against uncomplicated P. falciparum malaria in China. However, drug resistance marker polymorphism in returning migrant workers has not been demonstrated. Here, we have evaluated the prevalence of pfmdr1 and pfcrt polymorphisms, as well as the K13 propeller gene, a molecular marker of artemisinin resistance, in migrant workers returned from Ghana to Shanglin County, Guangxi Province, China, in 2013. A total of 118 blood samples were randomly selected and used for the assay. Mutations of the pfmdr1 gene that covered codons 86, 184, 1034, and 1246 were found in 11 isolates. Mutations at codon N86Y (9.7%) were more frequent than at others, and Y(86)Y(184)S(1034)D(1246) was the most prevalent (63.6%) of the four haplotypes. Mutations of the pfcrt gene that covered codons 74, 75, and 76 were observed in 17 isolates, and M(74)N(75)T(76) was common (70.6%) in three haplotypes. Eight different genotypes of the K13 propeller were first observed in 10 samples in China, 2 synonymous mutations (V487V and A627A) and 6 nonsynonymous mutations. C580Y was the most prevalent (2.7%) in all the samples. The data presented might be helpful for enrichment of molecular surveillance of antimalarial resistance and will be useful for developing and updating antimalarial guidance in China.
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Asante KP, Agyemang CT, Zandoh C, Saah J, Febir LG, Donlebo CK, Owusu-Agyei S. Community engagement in biomedical research in an African setting: the Kintampo Health Research Centre experience. BMC Health Serv Res 2013; 13:383. [PMID: 24090148 PMCID: PMC4015992 DOI: 10.1186/1472-6963-13-383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 09/30/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Community engagement (CE) is becoming relevant in health research activities; however, models for CE in health research are limited in developing countries. The Kintampo Health Research Centre (KHRC) conducts research to influence health policy locally and also internationally. Since its establishment in 1994 with the mandate of conducting relevant public health studies in the middle part of Ghana, KHRC has embarked on a series of clinical and operational studies involving community members. In these studies, community members have been engaged through community durbars before, during and also after all study implementations. Lessons learnt from these activities suggested the need to embark on further CE processes that could serve as a model for emerging research institutions based in African communities. METHODS Interactive community durbars, workshops, in-depth discussions, focus group discussions and radio interactions were used as the main methods in the CE process. RESULTS Community members outlined areas of research that they perceived as being of interest to them. Though community members expressed continual interest in our traditional areas of research in communicable, maternal, neonatal and child health, they were interested in new areas such as non- communicable diseases such as diabetes and hypertension. Misconceptions about KHRC and its research activities were identified and clarified. This research provided KHRC the opportunity to improve communication guidelines with the community and these are being used in engaging the community at various stages of our research, thus improving on the design and implementation of research. CONCLUSION KHRC has developed a culturally appropriate CE model based on mutual understanding with community members. The experience obtained in the CE process has contributed to building CE capacity in KHRC. Other health research institutions in developing countries could consider the experiences gained.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Charlotte Tawiah Agyemang
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Charles Zandoh
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Jacob Saah
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Lawrence Gyabaa Febir
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Casimir Kabio Donlebo
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
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Febir LG, Asante KP, Dzorgbo DBS, Senah KA, Letsa TS, Owusu-Agyei S. Community perceptions of a malaria vaccine in the Kintampo districts of Ghana. Malar J 2013; 12:156. [PMID: 23651533 PMCID: PMC3656774 DOI: 10.1186/1475-2875-12-156] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/06/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Malaria remains the leading cause of morbidity and mortality in sub-Saharan Africa despite tools currently available for its control. Making malaria vaccine available for routine use will be a major hallmark, but its acceptance by community members and health professionals within the health system could pose considerable challenge as has been found with the introduction of polio vaccinations in parts of West Africa. Some of these challenges may not be expected since decisions people make are many a time driven by a complex myriad of perceptions. This paper reports knowledge and perceptions of community members in the Kintampo area of Ghana where malaria vaccine trials have been ongoing as part of the drive for the first-ever licensed malaria vaccine in the near future. METHODS Both qualitative and quantitative methods were used in the data collection processes. Women and men whose children were or were not involved in the malaria vaccine trial were invited to participate in focus group discussions (FGDs). Respondents, made up of heads of religious groupings in the study area, health care providers, traditional healers and traditional birth attendants, were also invited to participate in in-depth interviews (IDIs). A cross-sectional survey was conducted in communities where the malaria vaccine trial (Mal 047RTS,S) was carried out. In total, 12 FGDs, 15 IDIs and 466 household head interviews were conducted. RESULTS Knowledge about vaccines was widespread among participants. Respondents would like their children to be vaccinated against all childhood illnesses including malaria. Knowledge of the long existing routine vaccines was relatively high among respondents compared to hepatitis B and Haemophilus influenza type B vaccines that were introduced more recently in 2002. There was no clear religious belief or sociocultural practice that will serve as a possible barrier to the acceptance of a malaria vaccine. CONCLUSION With the assumption that a malaria vaccine will be as efficacious as other EPI vaccines, community members in Central Ghana will accept and prefer malaria vaccine to malaria drugs as a malaria control tool. Beliefs and cultural practices as barriers to the acceptance of malaria vaccine were virtually unknown in the communities surveyed.
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Osei-Kwakye K, Asante KP, Mahama E, Apanga S, Owusu R, Kwara E, Adjei G, Abokyi L, Yeetey E, Dosoo DK, Punguyire D, Owusu-Agyei S. The benefits or otherwise of managing malaria cases with or without laboratory diagnosis: the experience in a district hospital in Ghana. PLoS One 2013; 8:e58107. [PMID: 23505457 PMCID: PMC3591456 DOI: 10.1371/journal.pone.0058107] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 01/30/2013] [Indexed: 11/19/2022] Open
Abstract
Background This study was conducted at the Kintampo Municipal Hospital in Ghana to determine whether there was any benefit (or otherwise) in basing the management of cases of suspected malaria solely on laboratory confirmation (microscopy or by RDT) as compared with presumptive diagnosis. Method Children under five years who reported at the Out-Patient Department of the Hospital with axillary temperature ≥37.5°C or with a 48 hr history of fever were enrolled and had malaria microscopy and RDT performed. The attending clinician was blinded from laboratory results unless a request for these tests had been made earlier. Diagnosis of malaria was based on three main methods: presumptive or microscopy and/or RDT. Cost implication for adopting laboratory diagnosis or not was determined to inform malaria control programmes. Results In total, 936 children were enrolled in the study. Proportions of malaria diagnosed presumptively, by RDT and microscopy were 73.6% (689/936), 66.0% (618/936) and 43.2% (404/936) respectively. Over 50% (170/318) of the children who were RDT negative and 60% (321/532) who were microscopy negative were treated for malaria when presumptive diagnoses were used. Comparing the methods of diagnoses, the cost of malaria treatment could have been reduced by 24% and 46% in the RDT and microscopy groups respectively; the reduction was greater in the dry season (43% vs. 50%) compared with the wet season (20% vs. 45%) for the RDT and microscopy confirmed cases respectively. Discussion/Conclusion Over-diagnosis of malaria was prevalent in Kintampo during the period of the study. Though the use of RDT for diagnosis of malaria might have improved the quality of care for children, it appeared not to have a cost saving effect on the management of children with suspected malaria. Further research may be needed to confirm this.
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Affiliation(s)
- Kingsley Osei-Kwakye
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana
| | - Emmanuel Mahama
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana
| | - Stephen Apanga
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana
| | - Ruth Owusu
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana
| | - Evans Kwara
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana
| | - George Adjei
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana
| | - Livesy Abokyi
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana
| | - Enuameh Yeetey
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana
| | - David Kwame Dosoo
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana
| | - Damien Punguyire
- Kintampo Municipal Hospital, Ghana Health Service, Ministry of Health, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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37
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Boahen O, Owusu-Agyei S, Febir LG, Tawiah C, Tawiah T, Afari S, Newton S. Community perception and beliefs about blood draw for clinical research in Ghana. Trans R Soc Trop Med Hyg 2013; 107:261-5. [PMID: 23426114 DOI: 10.1093/trstmh/trt012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical research participants often express concerns about blood draw because of misconceptions about the uses to which the blood will be put. Their comments can generate rumours in their communities, thereby affecting rates of recruitment to research studies and increasing losses to follow-up. This study sought to identify community perceptions about blood draw for clinical research. METHODS Between September 2010 and March 2011, 12 focus group discussions and eight in-depth interviews were conducted among community members in the Kintampo district of Ghana, to determine what cultural beliefs and traditional practices might affect attitudes to blood draw. RESULTS Most of the study participants did not mention any cultural beliefs prohibiting blood draw but were of the opinion that collecting blood from children and pregnant women could lead to serious health consequences. They could not understand why blood would be taken from participants who were not sick. Some were of the opinion that blood samples could be used for rituals and others recounted unpleasant experiences following blood draws. CONCLUSION To facilitate clinical research that entails blood draw, it is important to address concerns and rumours through intensive community sensitisation.
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Affiliation(s)
- Owusu Boahen
- Kintampo Health Research Centre, PO Box 200, Kintampo, Ghana.
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Anthony MP, Burrows JN, Duparc S, JMoehrle J, Wells TNC. The global pipeline of new medicines for the control and elimination of malaria. Malar J 2012; 11:316. [PMID: 22958514 PMCID: PMC3472257 DOI: 10.1186/1475-2875-11-316] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 07/21/2012] [Indexed: 12/03/2022] Open
Abstract
Over the past decade, there has been a transformation in the portfolio of medicines to combat malaria. New fixed-dose artemisinin combination therapy is available, with four different types having received approval from Stringent Regulatory Authorities or the World Health Organization (WHO). However, there is still scope for improvement. The Malaria Eradication Research agenda identified several gaps in the current portfolio. Simpler regimens, such as a single-dose cure are needed, compared with the current three-day treatment. In addition, new medicines that prevent transmission and also relapse are needed, but with better safety profiles than current medicines. There is also a big opportunity for new medicines to prevent reinfection and to provide chemoprotection. This study reviews the global portfolio of new medicines in development against malaria, as of the summer of 2012. Cell-based phenotypic screening, and 'fast followers' of clinically validated classes, mean that there are now many new classes of molecules starting in clinical development, especially for the blood stages of malaria. There remain significant gaps for medicines blocking transmission, preventing relapse, and long-duration molecules for chemoprotection. The nascent pipeline of new medicines is significantly stronger than five years ago. However, there are still risks ahead in clinical development and sustainable funding of clinical studies is vital if this early promise is going to be delivered.
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Affiliation(s)
- Melinda P Anthony
- Medicines for Malaria Venture (MMV), 20 rte de Pré-Bois 1215, Geneva, Switzerland
| | - Jeremy N Burrows
- Medicines for Malaria Venture (MMV), 20 rte de Pré-Bois 1215, Geneva, Switzerland
| | - Stephan Duparc
- Medicines for Malaria Venture (MMV), 20 rte de Pré-Bois 1215, Geneva, Switzerland
| | - Joerg JMoehrle
- Medicines for Malaria Venture (MMV), 20 rte de Pré-Bois 1215, Geneva, Switzerland
| | - Timothy NC Wells
- Medicines for Malaria Venture (MMV), 20 rte de Pré-Bois 1215, Geneva, Switzerland
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Read U. "I want the one that will heal me completely so it won't come back again": the limits of antipsychotic medication in rural Ghana. Transcult Psychiatry 2012; 49:438-60. [PMID: 22722982 DOI: 10.1177/1363461512447070] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Campaigns to scale up mental health services in low-income countries emphasise the need to improve access to psychotropic medication as part of effective treatment yet there is little acknowledgement of the limitations of psychotropic drugs as perceived by those who use them. This paper considers responses to treatment with antipsychotics by people with mental illness and their families in rural Ghana, drawing on an anthropological study of family experiences and help seeking for mental illness. Despite a perception among health workers that there was little popular awareness of biomedical treatment for mental disorders, psychiatric services had been used by almost all informants. However, in many cases antipsychotic treatment had been discontinued, even where it had been recognised to have beneficial effects such as controlling aggression or inducing sleep. Unpleasant side effects such as feelings of weakness and prolonged drowsiness conflicted with notions of health as strength and were seen to reduce the ability to work. The reduction of perceptual experiences such as visions was less valued than a return to social functioning. The failure of antipsychotics to achieve a permanent cure also cast doubt on their efficacy and strengthened suspicions of a spiritual illness which would resist medical treatment. These findings suggest that efforts to improve the treatment of mental disorders in low-income countries should take into account the limitations of antipsychotic drugs for those who use them and consider how local resources and concepts of recovery can be used to maximise treatment and support families.
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Affiliation(s)
- Ursula Read
- Department of Anthropology, University College London, 14 Taviton Street, London, UK.
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Nonaka D, Jimba M, Mizoue T, Kobayashi J, Yasuoka J, Ayi I, Jayatilleke AC, Shrestha S, Kikuchi K, Haque SE, Yi S. Content analysis of primary and secondary school textbooks regarding malaria control: a multi-country study. PLoS One 2012; 7:e36629. [PMID: 22574203 PMCID: PMC3344925 DOI: 10.1371/journal.pone.0036629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 04/04/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In tropical settings, malaria education at school is potentially useful, but textbook content related to malaria education has so far received little attention. This study aimed to examine whether school textbooks contain sufficient knowledge and skills to help children in primary and lower secondary schools and their family members to cope with malaria. METHODOLOGY/PRINCIPAL FINDINGS This was a descriptive, cross-country study. We collected textbooks that were used by children in grades one to nine from nine countries endemic for malaria: Laos, Cambodia, Nepal, Bangladesh, Sri Lanka, Zambia, Niger, Benin, and Ghana. Two reviewers per country identified descriptions about malaria by seeking the term "malaria" or a local word that corresponds to malaria in languages other than English. The authors categorized the identified descriptions according to the content of the descriptions. Additionally, the authors examined whether the identified contents addressed life skill messages. Of a total of 474 textbooks collected, 35 contained descriptions about malaria. The most commonly included content was transmission mode/vector (77.1%), followed by preventive measures (60.0%), epidemiology (57.1%), cause/agent (54.3%), signs/symptoms (37.1%) and treatment (22.9%). Treatment-related content was not included in any textbooks from four countries and textbooks failed to recommend the use of insecticide-treated bed nets in five countries. Very few textbooks included content that facilitated prompt treatment, protection of risk groups, and use of recommended therapy. CONCLUSION/SIGNIFICANCE Textbooks rarely included knowledge and skills that are crucial to protect schoolchildren and their families from malaria. This study identified the need for improvement to textbook contents regarding malaria.
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Affiliation(s)
- Daisuke Nonaka
- Department of Parasitology and International Health, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
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Kwansa-Bentum B, Ayi I, Suzuki T, Otchere J, Kumagai T, Anyan WK, Asahi H, Akao N, Wilson MD, Boakye DA, Ohta N. Administrative practices of health professionals and use of artesunate-amodiaquine by community members for treating uncomplicated malaria in southern Ghana: implications for artemisinin-based combination therapy deployment. Trop Med Int Health 2011; 16:1215-24. [PMID: 21740487 DOI: 10.1111/j.1365-3156.2011.02833.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the use of artemisinin-based combination and monotherapy by community members and the administrative practices of health professionals in treating malaria in Ghana. METHOD This study is a community-based cross-sectional survey in 11 rural and urban areas in southern Ghana. Using the interviewer method, close-ended questionnaires were administered to community members. Similar questionnaires were also administered in health facilities, community pharmacies and licensed chemical shops. RESULTS A total of 1085 individuals comprising 959 non-health professionals and 126 health professionals were interviewed. Fifty-seven per cent of the community members visit pharmacies/drug stores as the first point of call when they suspect malaria. According to the participating drug sellers, artemether-lumefantrine (AL) is the most prescribed/sold anti-malarial drug (59.2%), followed by dihydroartemisinin (35%), sulfadoxine-pyrimethamine (33.0%) and artesunate-amodiaquine (AS-AQ) (27.2%). The majority of customers who visit pharmacies or drug stores without prescription have their anti-malarial drug selected by the shop attendant; in situations like that, dihydroartemisinin and artesunate monotherapies are sold just as AS-AQ and AL. Chloroquine is still sold by some drug vendors, 5 years after its proscription. CONCLUSION Whereas the use of AS-AQ and AL are acceptable, the frequent use of dihydroartemisinin and artesunate monotherapy threatens the future of ACTs.
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Affiliation(s)
- Bethel Kwansa-Bentum
- Section of Environmental Parasitology, Tokyo Medical and Dental University, Tokyo, Japan
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