The paper employs partial and biwavelet coherence techniques to examine the time-frequency dependence structure of international remittance inflow on economic growth by moderating the effect of ...exchange rates. We investigate the comovements of remittance and economic growth from 1980 to 2020. We observed heterogeneous patterns in the comovements structure of international remittance inflow and economic growth at various timescales. By examining the biwavelet coherence, the comovements are noticeable at elevated occurrences, implying that exchange rates, when acting as moderator in the nexus between remittance and economic growth, can hamper economic growth. Findings from the partial wavelet coherence reveal that exchange rates influence remittance and economic growth connectedness in emerging and frontier economies in Africa. Consequently, in situations where radical changes occur in exchange rates, the implemented policies of emerging African countries seem to have largely influenced the comovements between remittance inflow and economic growth. The risk posed by exchange rates on remittance inflow requires sustainable policies to prevent widespread spillovers, mostly during severe economic downturns. We posit that implementation of exchange rate mechanisms are central to parity which is essential to mitigating potential risk.
We describe the use of integrated geospatial applications for the provision of access to timely and accurate data on samples, visualisation of Spatio-temporal patterns of cases and effective ...communication between field sample collectors, testing laboratories, Regional Health directors and Government Decision Makers.
This study describes how an integrated geospatial platform based on case location and intelligence was developed and used for effective COVID-19 response during the initial stages of COVID-19 in Ghana.
Collector for ArcGIS, ArcGIS Survey123.
successful development and deployment of integrated geospatial applications and analytics.
The Collector for ArcGIS app was customised to collect COVID-19 positive cases location information. Survey 123 was introduced as a COVID-19 contact tracing application to digitise the case-based forms and provide real-time results from the laboratories to GHS and other stakeholders. The laboratory backend allowed the testing laboratories access to specific information about each patient (sample) collected by the fieldworkers. The regional supervisors' backend web application provided accessing test results for confidentiality and timely communication of results.
Geospatial platforms were successfully established in Ghana to provide timely results to Regional Health Directors and Government decision-makers. This helped to improve the timeliness of response and contact tracing at the district level.
The development and deployment of the application, COVID-19 pandemic response and writing workshop by the Ghana Field Epidemiology and Laboratory Training Programme (GFELTP) was supported with funding from President Malaria Initiative - CDC, and Korea International Cooperation Agency (on CDC CoAg 6NU2GGH001876) through AFENET and the United States Agency for International Development (USAID) through Results for Development (R4D).
The test, treat, and track (T3) strategy is directed at ensuring diagnosis and prompt treatment of uncomplicated malaria cases. Adherence to T3 strategy reduces wrong treatment and prevents delays in ...treating the actual cause of fever that may otherwise lead to complications or death. Data on adherence to all three aspects of the T3 strategy is sparse with previous studies focusing on the testing and treatment aspects. We determined adherence to the T3 strategy and associated factors in the Mfantseman Municipality of Ghana.
We conducted a health facility based cross-sectional survey in Saltpond Municipal Hospital and Mercy Women's Catholic Hospitals in Mfantseman Municipality of the Central Region, Ghana in 2020. We retrieved electronic records of febrile outpatients and extracted the testing, treatment and tracking variables. Prescribers were interviewed on factors associated with adherence using a semi-structured questionnaire. Data analyses was done using descriptive statistics, bivariate, and multiple logistic regression.
Of 414 febrile outpatient records analyzed, 47 (11.3%) were under five years old. About 180 (43.5%) were tested with 138 (76.7%) testing positive. All positive cases received antimalarials and 127 (92.0%) were reviewed after treatment. Of 414 febrile patients, 127 (30.7%) were treated according to the T3 strategy. Higher odds of adherence to T3 were observed for patients aged 5-25 years compared to older patients (AOR: 2.5, 95% CI: 1.27-4.87, p = 0.008). Adherence was low among physician assistants compared to medical officers (AOR 0.004, 95% CI 0.004-0.02, p<0.001). Prescribers trained on T3 had higher adherence (AOR: 99.33 95% CI: 19.53-505.13, p<0.000).
Adherence to T3 strategy is low in Mfantseman Municipality of the Central Region of Ghana. Health facilities should perform RDTs for febrile patients at the OPD with priority on low cadre prescribers during the planning and implementation of interventions to improve T3 adherence at the facility level.
With over 80% of children worldwide vaccinated, concerns about vaccine safety continues to be a public health issue. Ghana's Adverse Events Following Immunization surveillance started in 1978 with ...the objective to promptly detect and manage AEFI cases either real or perceived. Periodic evaluation of the surveillance system is critical for optimal performance; hence we evaluated the system to assess its attributes, usefulness and system's performance in meeting its objectives.
A case of AEFI was defined as any untoward medical event occurring within 28 days after vaccination and may not necessarily have causal relationship with the vaccine use. We reviewed surveillance data and procedures for the period 2014 to 2018 and interviewed key stakeholders. Adapting the CDC's Updated Guidelines for Evaluating Public Health Surveillance Systems, we assessed the system's attributes and usefulness. We performed summary descriptive statistics on quantitative data and directed content analysis on information gathered from interviews.
In all, 2,282 AEFI cases including 476 (21%) serious cases (life threatening events) were reported for the period. The highest case detection rates of 61.45 AEFIs per 100,000 surviving infants was recorded in 2018. Reporting forms were modified to accommodate new indicators without any disruption in the function of the system. At the national level, completeness of 100 randomly sampled reporting forms (100%) and was higher than the region (27%) but timeliness (50%) was lower than the region (83%). All (16/16) Community Health Nurses interviewed indicated "fear of being victimized" as the reason for underreporting, nonetheless, the system was useful as it made them cautious when vaccinating children to prevent reactions. Data on AEFI surveillance was also useful in guiding training needs and provision of vaccination logistics.
The AEFI surveillance system is useful at all levels but partially meeting its objective due to underreporting. We recommend training and supportive supervision to improve timeliness of reporting, data completeness and acceptability.
Although anaemia is a common life-threatening condition among pregnant women, particularly those in low-income countries, literature remains very limited in Ghana in general and particularly in the ...Madina La-Nkwantanang Municipality of the Greater Accra Region, where no studies have been done. This study, therefore, assessed anaemia in pregnant women attending the Pentecost Hospital in the La-Nkwantanang Municipality, Ghana. This cross-sectional study conveniently recruited 300 Ghanaian pregnant women attending the Madina Pentecost Hospital for antenatal care. A structured questionnaire was administered to obtain data on sociodemographics (age, marital status, level of education, occupation and religion) and knowledge level of anaemia. Blood samples were taken for an automated complete blood count (CBC). SPSS software version 26 and GraphPad Prism were used for the statistical analysis. The prevalence rate of anaemia was 211/300 (70.3%). 159 (75.4%) of the anaemic subjects presented with a mild anaemia form, 51(24.2%) presented with a moderate form, and 1(0.47%) presented with severe form. Normocytic normochromic anaemia was the dominant anaemia type (33.6%), followed by microcytic normochromic anaemia (27.0%), and then normocytic hypochromic (24.64%). Pregnant women within their third trimester recorded the highest incidence rates of both normocytic normochromic 34 (47.89%) and mild types 71 (44.65%) of anaemia. The prevalence of anaemia among pregnant women is overwhelmingly high with a preponderance towards those in their third trimester. As such, high-risk pregnant women should be well-monitored to prevent exacerbating the condition.
Ghana Health Service (GHS) has strengthened community-based surveillance (CBS) to facilitate early detection and rapid reporting of health events of all origins. Since June 2017, GHS has employed an ...event-based surveillance approach at the community level in a phased manner. CBS coverage has broadened from 2 to 30 districts across Ghana. Through this effort, capacity was built across all administrative levels in these districts to detect, report, triage, and verify signals, and to perform risk assessment and investigate events. Data were collected and analyzed during an evaluation of initial 2-district implementation in March 2018 and during expanded 30-district implementation in March 2019. Between September 2018 and March 2019, 317 health events were detected through CBS. These events included vaccine-preventable disease cases, acute hemorrhagic conjunctivitis outbreaks, clusters of unexpected animal deaths, and foodborne illness clusters. Eighty-nine percent of the 317 events were reported to district-level public health staff within 24 hours of detection at the community level, and 87% of all detected events were responded to within 48 hours of detection. CBS detected 26% of all suspected vaccine-preventable disease cases that were reported from implementing districts through routine disease surveillance. GHS strengthened CBS in Ghana to function as an early warning system for health events of all origins, advancing the Global Health Security Agenda.
Background and Aim
Frailty is a condition marked by accumulation of biological deficits and dysfunctions that come with aging and it is correlated with high morbidity and mortality in patients with ...cardiovascular diseases, particularly hypertension. Hypertension continues to be a leading cause of cardiovascular diseases and premature death globally. However, there is dearth of literature in sub‐Saharan Africa on frailty syndrome among hypertensives on medication. This study evaluated frailty syndrome and its associated factors among Ghanaian hypertensives.
Methods
This cross‐sectional study recruited 303 patients with hypertension from the University Hospital, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. Data on sociodemographic, lifestyle and clinical factors were collected using a well‐structured questionnaire. Medication adherence was measured using Adherence in Chronic Disease Scale, and frailty was assessed by Tilburg Frailty Indicator. Statistical analyses were performed using SPSS Version 26.0 and GraphPad prism 8.0. p‐value of < 0.05 and 95% confidence interval (CI) were considered statistically significant.
Results
The prevalence of frailty was 59.7%. The proportion of high, medium and low medication adherence was 23.4%, 64.4% and 12.2%, respectively. Being ≥ 70years (adjusted odds ratio aOR: 8.33, 95% CI 3.72–18.67, p < 0.0001), unmarried (aOR: 2.59, 95% CI 1.37–4.89, p = 0.0030), having confirmed hypertension complications (aOR: 3.21, 95% CI 1.36–7.53, p = 0.0080), medium (aOR: 1.99, 95% CI 1.05–3.82, p = 0.0360) and low antihypertensive drug adherence (aOR: 27.69, 95% CI 7.05–108.69, p < 0.0001) were independent predictors of increased odds of developing frailty syndrome.
Conclusion
Approximately 6 out of 10 Ghanaian adult patients with hypertension experience frailty syndrome. Hypertension complications, older age, being unmarried, and low antihypertensive drug adherence increased the chances of developing frailty syndrome. These should be considered in intervention programmes to prevent frailty among patients with hypertension.
Preeclampsia (PE) is associated with endothelial injury and hemostatic abnormalities. However, the diagnostic role of coagulation parameters and natural anticoagulants in predicting PE has not been ...explored in Ghana. This study assessed plasma levels of these factors as surrogate markers of PE and its subtypes. This case–control study included 90 women with PE (cases) and 90 normotensive pregnant women (controls). Blood samples were drawn for the estimation of complete blood count and coagulation tests. The prothrombin time (PT), activated partial thromboplastin time (APTT), and the calculation of the international normalized ratio (INR) were determined by an ACL elite coagulometer while the levels of protein C (PC), protein S (PS), antithrombin III (ATIII), and D-dimers were also measured using the solid-phase sandwich enzyme-linked immunosorbent assay (ELISA) method. All statistical analyses were performed using the R Language for Statistical Computing. Results showed significantly (p < .05) shortened APTT (28.25 s) and higher D-dimer levels (1219.00 ng/mL) among PE women, as well as low levels of PC (1.02 µg/mL), PS (6.58 µg/mL), and ATIII (3.99 ng/mL). No significant difference was found in terms of PT and INR. From the receiver operating characteristic analysis, PC, PS, and ATIII could significantly predict PE and its subtypes at certain cutoffs with high accuracies (area under the curve AUC ≥0.70). Most women with PE are in a hypercoagulable state with lower natural anticoagulants. PC, PS, and ATIII are good predictive and diagnostic markers of PE and its subtypes (early-onset PE EO-PE and late-onset PE LO-PE) and should be explored in future studies.
Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by hyperglycemia, insulin resistance, and pancreatic islet cell dysfunction. T2DM is associated with non-alcoholic fatty liver ...disease (NAFLD) because of impaired glucose metabolism in both conditions. However, it is widely assumed that people with T2DM in sub-Saharan Africa (SSA) have a lower prevalence of NAFLD than in other parts of the world. With our recent access to transient elastography, we aimed to investigate the prevalence of, severity of, and contributing factors to NAFLD in persons with T2DM in Ghana. We performed a cross-sectional study recruiting 218 individuals with T2DM at the Kwadaso Seventh-Day Adventist and Mount Sinai Hospitals in the Ashanti region of Ghana using a simple randomized sampling technique. A structured questionnaire was used to obtain socio-demographic information, clinical history, exercise and other lifestyle factors, and anthropometric measurements. Transient elastography was performed using a FibroScan
machine to obtain the Controlled Attenuation Parameter (CAP) score and liver fibrosis score. The prevalence of NAFLD among Ghanaian T2DM participants was 51.4% (112/218), of whom 11.6% had significant liver fibrosis. An evaluation of the NAFLD group (
= 112) versus the non-NAFLD group (
= 106) revealed a higher BMI (28.7 vs. 25.2 kg/m
,
= 0.001), waist circumference (106.0 vs. 98.0 cm,
= 0.001), hip circumference (107.0 vs. 100.5 cm,
= 0.003), and waist-to-height ratio (0.66 vs. 0.62,
= 0.001) in T2DM patients with NAFLD compared to those without NAFLD. Being obese was an independent predictor of NAFLD in persons with T2DM than known history of hypertension and dyslipidaemia.
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