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1. Rethinking integrated service delivery for malaria

Author

Ansah, Evelyn K, Moucheraud, Corrina, Arogundade, Linda, and Rangel, Gabriel W

Subjects
Medical Microbiology, Biomedical and Clinical Sciences, Clinical Sciences, Infectious Diseases, Vector-Borne Diseases, Clinical Research, Rare Diseases, Malaria, Health Services, 8.1 Organisation and delivery of services, Health and social care services research, Infection, Good Health and Well Being
Abstract

Despite worldwide efforts and much progress toward malaria control, declines in malaria morbidity and mortality have hit a plateau. While many nations achieved significant malaria suppression or even elimination, success has been uneven, and other nations have made little headway-or even lost ground in this battle. These alarming trends threaten to derail the attainment of global targets for malaria control. Among the challenges impeding success in malaria reduction, many strategies center malaria as a set of technical problems in commodity development and delivery. Yet, this narrow perspective overlooks the importance of strong health systems and robust healthcare delivery. This paper argues that strategies that move the needle on health services and behaviors offer a significant opportunity to achieve malaria control through a comprehensive approach that integrates malaria with broader health services efforts. Indeed, malaria may serve as the thread that weaves integrated service delivery into a path forward for universal health coverage. Using key themes identified by the "Rethinking Malaria in the Context of COVID-19" effort through engagement with key stakeholders, we provide recommendations for pursuing integrated service delivery that can advance malaria control via strengthening health systems, increasing visibility and use of high-quality data at all levels, centering issues of equity, promoting research and innovation for new tools, expanding knowledge on effective implementation strategies for interventions, making the case for investing in malaria among stakeholders, and engaging impacted communities and nations.

Published
2022

3. Factors influencing primary care access, utilisation and quality of management for patients living with hypertension in West Africa: a scoping review protocol

Author

Amarteyfio, Kezia Naa Amerley Akosua, primary, Bondzie, Eugene Paa Kofi, additional, Reichenberger, Veronika, additional, Agyepong, Irene Akua, additional, Ansah, Evelyn K, additional, Diarra, Aissa, additional, Mirzoev, Tolib, additional, Perel, Pablo, additional, Yaogo, Maurice, additional, and Antwi, Edward, additional

Published
2024
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7. Predictors of sexual and reproductive health knowledge and utilization of services among adolescents in Ghana’s Adaklu district.

Author

Westerman, Clare, Gyapong, Margaret, Ansah, Evelyn K., Klu, Desmond, Aberese-Ako, Matilda, and Dalaba, Maxwell A.

Subjects
REPRODUCTIVE health services, REPRODUCTIVE health, SEXUAL health, TEENAGERS, PHYSICAL fitness centers, TRANSACTIONAL sex
Abstract

Objective: To explore factors associated with adolescents’ sexual and reproductive health (SRH) knowledge and their engagement with educational and clinical services Design: Regression analysis of secondary data collected during a community survey Setting: Adaklu district, Volta Region, Ghana Participants: 221 adolescent caregiver pairs Main outcome measures: The study employed three main outcome measures: (1) adolescents’ level of SRH knowledge (assessed via questionnaire), (2) membership in district-sponsored adolescent health clubs (AHCs), and (3) ever-utilization of clinical SRH services. Results: Greater SRH knowledge was significantly associated with older age, AHC membership, and relying primarily on teachers or friends for SRH information. Increased odds of AHC membership were observed among females (AOR = 2.38, 95% CI 1.14-4.95); those who had communicated with one parent about sexual issues (OR 2.70, 95% CI 1.17-6.21); and those with a history of transactional sex (OR 5.53, 95% CI 1.04-29.37). Decreased odds were observed among adolescents whose caregivers were educated to the primary level (AOR = 0.24, 95% CI = 0.07-0.79). Overall, utilization of clinical SRH services was low, but higher odds were detected among individuals reporting a history of forced sex (AOR = 117.07, 95% CI 3.82-3588.52) and those who had discussed sexual issues with both of their parents (AOR = 13.11, 95% CI 1.85-92.93). Conclusions: Awareness of the predictors of knowledge, AHC involvement, and clinical service utilization can empower adolescent SRH initiatives—both present and future—to enhance their teaching, develop targeted outreach to underserved groups, and promote engagement with key clinical resources. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs

Author

Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Grobbee, Diederick E, Amoakoh-Coleman, Mary, Oduro-Mensah, Ebenezer, Sarpong, Charity, Frimpong, Edith, Kayode, Gbenga A, Agyepong, Irene Akua, and Ansah, Evelyn K

Subjects
Information technology, T58.5-58.64, Public aspects of medicine, RA1-1270
Abstract

BackgroundDeveloping and maintaining resilient health systems in low-resource settings like Ghana requires innovative approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth) clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana. ObjectiveThis study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities (HFs). MethodsFor clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported in HFs was assessed using Spearman correlation. ResultsIn total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329], and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]). The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82% [630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity (20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at 6-month interval (P

Published
2019
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10. Patients with positive malaria tests not given artemisinin-based combination therapies: a research synthesis describing under-prescription of antimalarial medicines in Africa

Author

O’Boyle, Shennae, Bruxvoort, Katia J., Ansah, Evelyn K., Burchett, Helen E. D., Chandler, Clare I. R., Clarke, Siân E., Goodman, Catherine, Mbacham, Wilfred, Mbonye, Anthony K., Onwujekwe, Obinna E., Staedke, Sarah G., Wiseman, Virginia L., Whitty, Christopher J. M., and Hopkins, Heidi

Published
2020
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11. Provision and experience of care among women with hypertension in pregnancy: a multi-center qualitative study in Ghana

Author

Global Health team 1, Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Verloskunde, Brain, Child Health, Adu-Bonsaffoh, Kwame, Tamma, Evelyn, Nwameme, Adanna, Dako-Gyeke, Phyllis, Srofenyoh, Emmanuel, Ansah, Evelyn K, Grobbee, Diederick E, Franx, Arie, Browne, Joyce L, Global Health team 1, Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Verloskunde, Brain, Child Health, Adu-Bonsaffoh, Kwame, Tamma, Evelyn, Nwameme, Adanna, Dako-Gyeke, Phyllis, Srofenyoh, Emmanuel, Ansah, Evelyn K, Grobbee, Diederick E, Franx, Arie, and Browne, Joyce L

Published
2023

17. Obstetric referral processes and the role of inter-facility communication: the district-level experience in the Greater Accra region of Ghana

Author

Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Amoakoh-Coleman, Mary, Klipstein-Grobusch, Kerstin, Vidzro, Edem S., Arhinful, Daniel K., Ansah, Evelyn K., Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Amoakoh-Coleman, Mary, Klipstein-Grobusch, Kerstin, Vidzro, Edem S., Arhinful, Daniel K., and Ansah, Evelyn K.

Published
2022

18. Obstetric referral processes and the role of inter-facility communication: the district-level experience in the Greater Accra region of Ghana.

Author

Amoakoh-Coleman, Mary, Klipstein-Grobusch, Kerstin, Vidzro, Edem S., Arhinful, Daniel K., and Ansah, Evelyn K.

Subjects
HEALTH facilities, PREGNANCY complications, MAGNESIUM sulfate, PRIMARY health care, TELECOMMUNICATION systems
Abstract

Objective: To describe the capacity of primary health care facilities to manage obstetric referrals, the reasons, and processes for managing obstetric referrals, and how an enhanced inter-facility communication system may have influenced these Design: Mixed methods comparing data before and during the intervention period. Setting: Three districts in the Greater Accra region, Ghana from May 2017 to February 2018 Participants: Referred pregnant women and their relatives, health workers at referring and referral facilities, facility and district health managers. Intervention: An enhanced inter-facility communication system for obstetric referrals Results: Twenty-two facilities and 673 referrals were assessed over the period. The major reason for referrals was pregnancy complications (85.5%). Emergency obstetric medicines - oxytocin and magnesium sulfate (MgSO4) were available in 81.8% and 54.5% facilities, respectively, and a health worker accompanied 110(16.3%) women to the referral centre. Inter-facility communication about the referral occurred for 240 (35.7%) patients. During the intervention period, referrals joining queues at the referral facility decreased (7.8% to 0.0%; p=0.01), referrals coming in with referral notes improved (78.4% to 91.2%) and referrals with inter-facility communication improved (43.1% to 52.9%). Health workers and managers reported improvement in feedback to lower-level facilities and better filling of referral forms. Conclusion: Facilities had varying levels of availability of infrastructure, protocols, guidelines, services, equipment, and logistics for managing obstetric referrals. Enhanced inter-facility communication for obstetric referrals which engages health workers and provides requisite tools, can facilitate an efficient referral process for desired outcomes. [ABSTRACT FROM AUTHOR]

Published
2022
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20. Can an mhealth clinical decision-making support system improve adherence to neonatal healthcare protocols in a low-resource setting?

Author

Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovascular Health, Global Health team 1, Epi Methoden Team 4, JC onderzoeksprogramma Methodology, Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Agyepong, Irene Akua, Amoakoh-Coleman, Mary, Kayode, Gbenga A, Reitsma, J B, Grobbee, Diederick E, Ansah, Evelyn K, Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovascular Health, Global Health team 1, Epi Methoden Team 4, JC onderzoeksprogramma Methodology, Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Agyepong, Irene Akua, Amoakoh-Coleman, Mary, Kayode, Gbenga A, Reitsma, J B, Grobbee, Diederick E, and Ansah, Evelyn K

Published
2020

21. Coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) influences delivery outcomes among women with obstetric referrals at the district level in Ghana

Author

Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovascular Health, Amoakoh-Coleman, Mary, Arhinful, Daniel K, Klipstein-Grobusch, Kerstin, Ansah, Evelyn K, Koram, Kwadwo A, Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovascular Health, Amoakoh-Coleman, Mary, Arhinful, Daniel K, Klipstein-Grobusch, Kerstin, Ansah, Evelyn K, and Koram, Kwadwo A

Published
2020

22. The effect of an mHealth clinical decision-making support system on neonatal mortality in a low resource setting: A cluster-randomized controlled trial

Author

Amoakoh, Hannah Brown, primary, Klipstein-Grobusch, Kerstin, additional, Agyepong, Irene Akua, additional, Zuithoff, Nicolaas P.A., additional, Amoakoh-Coleman, Mary, additional, Kayode, Gbenga A., additional, Sarpong, Charity, additional, Reitsma, Johannes B., additional, Grobbee, Diederick E., additional, and Ansah, Evelyn K., additional

Published
2019
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23. How can malaria rapid diagnostic tests achieve their potential? A qualitative study of a trial at health facilities in Ghana

Author

Ansah Evelyn K, Whitty Christopher JM, and Chandler Clare IR

Subjects
Arctic medicine. Tropical medicine, RC955-962, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Rapid diagnostic tests (RDTs) for malaria are at the early stages of introduction across malaria endemic countries. This is central to efforts to decrease malaria overdiagnosis and the consequent overuse of valuable anti-malarials and underdiagnosis of alternative causes of fever. Evidence of the effect of introducing RDTs on the overprescription of anti-malarials is mixed. A recent trial in rural health facilities in Ghana reduced overprescription of anti-malarials, but found that 45.5% patients who tested negative with RDTs were still prescribed an anti-malarial. Methods A qualitative study of this trial was conducted, using in-depth interviews with a purposive sample of health workers involved in the trial, ranging from those who continued to prescribe anti-malarials to most patients with negative RDT results to those who largely restricted anti-malarials to patients with positive RDT results. Interviews explored the experiences of using RDTs and their results amongst trial participants. Results Meanings of RDTs were constructed by health workers through participation with the tests themselves as well as through interactions with colleagues, patients and the research team. These different modes of participation with the tests and their results led to a change in practice for some health workers, and reinforced existing practice for others. Many of the characteristics of RDTs were found to be inherently conducive to change, but the limited support from purveyors, lack of system antecedents for change and limited system readiness for change were apparent in the analysis. Conclusions When introduced with a limited supporting package, RDTs were variously interpreted and used, reflecting how health workers had learnt how to use RDT results through participation. To build confidence of health workers in the face of negative RDT results, a supporting package should include local preparation for the innovation; unambiguous guidelines; training in alternative causes of disease; regular support for health workers to meet as communities of practice; interventions that address negotiation of health worker-patient relationships and encourage self-reflection of practice; feedback systems for results of quality control of RDTs; feedback systems of the results of their practice with RDTs; and RDT augmentation such as a technical and/or clinical troubleshooting resource.

Published
2010
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24. The effect of an mHealth clinical decision-making support system on neonatal mortality in a low resource setting : A cluster-randomized controlled trial

Author

Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Agyepong, Irene Akua, Zuithoff, Nicolaas P.A., Amoakoh-Coleman, Mary, Kayode, Gbenga A., Sarpong, Charity, Reitsma, Johannes B., Grobbee, Diederick E., Ansah, Evelyn K., Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Agyepong, Irene Akua, Zuithoff, Nicolaas P.A., Amoakoh-Coleman, Mary, Kayode, Gbenga A., Sarpong, Charity, Reitsma, Johannes B., Grobbee, Diederick E., and Ansah, Evelyn K.

Published
2019

26. The effect of an mHealth clinical decision-making support system on neonatal mortality in a low resource setting: A cluster-randomized controlled trial

Author

Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 10, UMC Utrecht, Biostatistiek Onderzoek, Other research (not in main researchprogram), Global Health team 1, Epi Methoden Team 4, JC onderzoeksprogramma Methodologie, Cardiovasculaire Epi Team 9, Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Agyepong, Irene Akua, Zuithoff, Nicolaas P.A., Amoakoh-Coleman, Mary, Kayode, Gbenga A., Sarpong, Charity, Reitsma, Johannes B., Grobbee, Diederick E., Ansah, Evelyn K., Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 10, UMC Utrecht, Biostatistiek Onderzoek, Other research (not in main researchprogram), Global Health team 1, Epi Methoden Team 4, JC onderzoeksprogramma Methodologie, Cardiovasculaire Epi Team 9, Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Agyepong, Irene Akua, Zuithoff, Nicolaas P.A., Amoakoh-Coleman, Mary, Kayode, Gbenga A., Sarpong, Charity, Reitsma, Johannes B., Grobbee, Diederick E., and Ansah, Evelyn K.

Published
2019

27. Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs

Author

Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 9, Global Health team 1, Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Grobbee, Diederick E, Amoakoh-Coleman, Mary, Oduro-Mensah, Ebenezer, Sarpong, Charity, Frimpong, Edith, Kayode, Gbenga A, Agyepong, Irene Akua, Ansah, Evelyn K, Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 9, Global Health team 1, Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Grobbee, Diederick E, Amoakoh-Coleman, Mary, Oduro-Mensah, Ebenezer, Sarpong, Charity, Frimpong, Edith, Kayode, Gbenga A, Agyepong, Irene Akua, and Ansah, Evelyn K

Published
2019

29. Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs (Preprint)

Author

Amoakoh, Hannah Brown, primary, Klipstein-Grobusch, Kerstin, additional, Grobbee, Diederick E, additional, Amoakoh-Coleman, Mary, additional, Oduro-Mensah, Ebenezer, additional, Sarpong, Charity, additional, Frimpong, Edith, additional, Kayode, Gbenga A, additional, Agyepong, Irene Akua, additional, and Ansah, Evelyn K, additional

Published
2018
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30. Changes in the availability and affordability of subsidised artemisinin combination therapy in the private drug retail sector in rural Ghana: before and after the introduction of the AMFm subsidy

Author

Ansah, Evelyn K, Whitty, Christopher Jm, Bart-Plange, Constance, and Gyapong, Margaret

Subjects
health care economics and organizations
Abstract

BACKGROUND: Most people with febrile illness are treated in the private drug retail sector. Ghana was among nine countries piloting the Global Fund Affordable Medicines Facility - malaria (AMFm). AMFm aimed to: increase artemisinin combination therapy (ACT) affordability; increase ACT availability; increase ACT use; and 'crowd out' artemisinin monotherapies. METHODS: Three censuses were carried out 2 months before (2010), 2 months after and 2.5 years after (2013) the first co-paid ACTs to assess changes in antimalarial (AM) availability and price in private retail shops in a Ghanaian rural district to assess the sustainability of the initial gains. Supply, stock-out and cost were explored. RESULTS: Of 62 shops in the district, 56 participated with 398, 388 and 442 brands of AMs in the shops during the 3 censuses. The proportion of ACTs increased over the period while monotherapies reduced. Herbal-based AM preparations comprised 40-45% of AMs in stock with minimal variation over the period. ACTs were the most sold AM type for all ages but overall buying and selling prices of Quality Assured-ACTs increased by 40-100%. CONCLUSIONS: Initial gains in ACT availability were sustained, but not improved on 2.5 years after AMFm. Widespread availability of unproven herbal medicines is a concern; AMFm had little impact on this.

Published
2016

31. The Impact of Introducing Malaria Rapid Diagnostic Tests on Fever Case Management: A Synthesis of Ten Studies from the ACT Consortium

Author

Bruxvoort, Katia J., primary, Leurent, Baptiste, additional, Chandler, Clare I. R., additional, Ansah, Evelyn K., additional, Baiden, Frank, additional, Björkman, Anders, additional, Burchett, Helen E. D., additional, Clarke, Siân E., additional, Cundill, Bonnie, additional, DiLiberto, Debora D., additional, Elfving, Kristina, additional, Goodman, Catherine, additional, Hansen, Kristian S., additional, Kachur, S. Patrick, additional, Lal, Sham, additional, Lalloo, David G., additional, Leslie, Toby, additional, Magnussen, Pascal, additional, Mangham-Jefferies, Lindsay, additional, Mårtensson, Andreas, additional, Mayan, Ismail, additional, Mbonye, Anthony K., additional, Msellem, Mwinyi I., additional, Onwujekwe, Obinna E., additional, Owusu-Agyei, Seth, additional, Rowland, Mark W., additional, Shakely, Delér, additional, Staedke, Sarah G., additional, Vestergaard, Lasse S., additional, Webster, Jayne, additional, Whitty, Christopher J. M., additional, Wiseman, Virginia L., additional, Yeung, Shunmay, additional, Schellenberg, David, additional, and Hopkins, Heidi, additional

Published
2017
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32. The effect of a clinical decision-making mHealth support system on maternal and neonatal mortality and morbidity in Ghana: study protocol for a cluster randomized controlled trial

Author

Amoakoh, Hannah Brown, primary, Klipstein-Grobusch, Kerstin, additional, Amoakoh-Coleman, Mary, additional, Agyepong, Irene Akua, additional, Kayode, Gbenga A., additional, Sarpong, Charity, additional, Grobbee, Diederick E., additional, and Ansah, Evelyn K., additional

Published
2017
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33. Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings

Author

Hopkins, Heidi, primary, Bruxvoort, Katia J, additional, Cairns, Matthew E, additional, Chandler, Clare I R, additional, Leurent, Baptiste, additional, Ansah, Evelyn K, additional, Baiden, Frank, additional, Baltzell, Kimberly A, additional, Björkman, Anders, additional, Burchett, Helen E D, additional, Clarke, Siân E, additional, DiLiberto, Deborah D, additional, Elfving, Kristina, additional, Goodman, Catherine, additional, Hansen, Kristian S, additional, Kachur, S Patrick, additional, Lal, Sham, additional, Lalloo, David G, additional, Leslie, Toby, additional, Magnussen, Pascal, additional, Jefferies, Lindsay Mangham, additional, Mårtensson, Andreas, additional, Mayan, Ismail, additional, Mbonye, Anthony K, additional, Msellem, Mwinyi I, additional, Onwujekwe, Obinna E, additional, Owusu-Agyei, Seth, additional, Reyburn, Hugh, additional, Rowland, Mark W, additional, Shakely, Delér, additional, Vestergaard, Lasse S, additional, Webster, Jayne, additional, Wiseman, Virginia L, additional, Yeung, Shunmay, additional, Schellenberg, David, additional, Staedke, Sarah G, additional, and Whitty, Christopher J M, additional

Published
2017
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34. Introducing malaria rapid diagnostic tests in private medicine retail outlets: A systematic literature review

Author

Visser, Theodoor, primary, Bruxvoort, Katia, additional, Maloney, Kathleen, additional, Leslie, Toby, additional, Barat, Lawrence M., additional, Allan, Richard, additional, Ansah, Evelyn K., additional, Anyanti, Jennifer, additional, Boulton, Ian, additional, Clarke, Siân E., additional, Cohen, Jessica L., additional, Cohen, Justin M., additional, Cutherell, Andrea, additional, Dolkart, Caitlin, additional, Eves, Katie, additional, Fink, Günther, additional, Goodman, Catherine, additional, Hutchinson, Eleanor, additional, Lal, Sham, additional, Mbonye, Anthony, additional, Onwujekwe, Obinna, additional, Petty, Nora, additional, Pontarollo, Julie, additional, Poyer, Stephen, additional, Schellenberg, David, additional, Streat, Elizabeth, additional, Ward, Abigail, additional, Wiseman, Virginia, additional, Whitty, Christopher J. M., additional, Yeung, Shunmay, additional, Cunningham, Jane, additional, and Chandler, Clare I. R., additional

Published
2017
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35. Patients with positive malaria tests not given artemisinin-based combination therapies: a research synthesis describing under-prescription of antimalarial medicines in Africa.

Author

O'Boyle, Shennae, Bruxvoort, Katia J., Ansah, Evelyn K., Burchett, Helen E. D., Chandler, Clare I. R., Clarke, Siân E., Goodman, Catherine, Mbacham, Wilfred, Mbonye, Anthony K., Onwujekwe, Obinna E., Staedke, Sarah G., Wiseman, Virginia L., Whitty, Christopher J. M., and Hopkins, Heidi

Subjects
MALARIA, DRUG counterfeiting, ENDEMIC diseases, MEDICAL care, CRIME & the press, DIAGNOSIS methods
Abstract

Background: There has been a successful push towards parasitological diagnosis of malaria in Africa, mainly with rapid diagnostic tests (mRDTs), which has reduced over-prescribing of artemisinin-based combination therapies (ACT) to malaria test-negative patients. The effect on prescribing for test-positive patients has received much less attention. Malaria infection in endemic Africa is often most dangerous for young children and those in low-transmission settings. This study examined non-prescription of antimalarials for patients with malaria infection demonstrated by positive mRDT results, and in particular these groups who are most vulnerable to poor outcomes if antimalarials are not given.Methods: Analysis of data from 562,762 patients in 8 studies co-designed as part of the ACT Consortium, conducted 2007-2013 in children and adults, in Cameroon, Ghana, Nigeria, Tanzania, and Uganda, in a variety of public and private health care sector settings, and across a range of malaria endemic zones.Results: Of 106,039 patients with positive mRDT results (median age 6 years), 7426 (7.0%) were not prescribed an ACT antimalarial. The proportion of mRDT-positive patients not prescribed ACT ranged across sites from 1.3 to 37.1%. For patients under age 5 years, 3473/44,539 (7.8%) were not prescribed an ACT, compared with 3833/60,043 (6.4%) of those aged ≥ 5 years. The proportion of < 5-year-olds not prescribed ACT ranged up to 41.8% across sites. The odds of not being prescribed an ACT were 2-32 times higher for patients in settings with lower-transmission intensity (using test positivity as a proxy) compared to areas of higher transmission. mRDT-positive children in low-transmission settings were especially likely not to be prescribed ACT, with proportions untreated up to 70%. Of the 7426 mRDT-positive patients not prescribed an ACT, 4121 (55.5%) were prescribed other, non-recommended non-ACT antimalarial medications, and the remainder (44.5%) were prescribed no antimalarial.Conclusions: In eight studies of mRDT implementation in five African countries, substantial proportions of patients testing mRDT-positive were not prescribed an ACT antimalarial, and many were not prescribed an antimalarial at all. Patients most vulnerable to serious outcomes, children < 5 years and those in low-transmission settings, were most likely to not be prescribed antimalarials, and young children in low-transmission settings were least likely to be treated for malaria. This major public health risk must be addressed in training and practice.Trial Registration: Reported in individual primary studies. [ABSTRACT FROM AUTHOR]

Published
2020
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36. The Impact of Introducing Malaria Rapid Diagnostic Tests on Fever Case Management : A Synthesis of Ten Studies from the ACT Consortium

Author

Bruxvoort, Katia J., Leurent, Baptiste, Chandler, Clare I. R., Ansah, Evelyn K., Baiden, Frank, Björkman, Anders, Burchett, Helen E. D., Clarke, Sian E., Cundill, Bonnie, DiLiberto, Debora D., Elfving, Kristina, Goodman, Catherine, Hansen, Kristian S., Kachur, Patrick, Lal, Sham, Lalloo, David G., Leslie, Toby, Magnussen, Pascal, Mangham-Jefferies, Lindsay, Mårtensson, Andreas, Mayan, Ismail, Mbonye, Anthony K., Msellem, Mwinyi I., Onwujekwe, Obinna E., Owusu-Agyei, Seth, Rowland, Mark W., Shakely, Deler, Staedke, Sarah G., Vestergaard, Lasse S., Webster, Jayne, Whitty, Christopher J. M., Wiseman, Virginia L., Yeung, Shunmay, Schellenberg, David, Hopkins, Heidi, Bruxvoort, Katia J., Leurent, Baptiste, Chandler, Clare I. R., Ansah, Evelyn K., Baiden, Frank, Björkman, Anders, Burchett, Helen E. D., Clarke, Sian E., Cundill, Bonnie, DiLiberto, Debora D., Elfving, Kristina, Goodman, Catherine, Hansen, Kristian S., Kachur, Patrick, Lal, Sham, Lalloo, David G., Leslie, Toby, Magnussen, Pascal, Mangham-Jefferies, Lindsay, Mårtensson, Andreas, Mayan, Ismail, Mbonye, Anthony K., Msellem, Mwinyi I., Onwujekwe, Obinna E., Owusu-Agyei, Seth, Rowland, Mark W., Shakely, Deler, Staedke, Sarah G., Vestergaard, Lasse S., Webster, Jayne, Whitty, Christopher J. M., Wiseman, Virginia L., Yeung, Shunmay, Schellenberg, David, and Hopkins, Heidi

Abstract

Since 2010, the World Health Organization has been recommending that all suspected cases of malaria be confirmed with parasite-based diagnosis before treatment. These guidelines represent a paradigm shift away from presumptive antimalarial treatment of fever. Malaria rapid diagnostic tests (mRDTs) are central to implementing this policy, intended to target artemisinin-based combination therapies (ACT) to patients with confirmed malaria and to improve management of patients with nonmalarial fevers. The ACT Consortium conducted ten linked studies, eight in sub-Saharan Africa and two in Afghanistan, to evaluate the impact of mRDT introduction on case management across settings that vary in malaria endemicity and healthcare provider type. This synthesis includes 562,368 outpatient encounters (study size range 2,400-432,513). mRDTs were associated with significantly lower ACT prescription (range 8-69% versus 20-100%). Prescribing did not always adhere to malaria test results; in several settings, ACTs were prescribed to more than 30% of test-negative patients or to fewer than 80% of test-positive patients. Either an antimalarial or an antibiotic was prescribed for more than 75% of patients across most settings; lower antimalarial prescription for malaria test-negative patients was partly offset by higher antibiotic prescription. Symptomatic management with antipyretics alone was prescribed for fewer than 25% of patients across all scenarios. In community health worker and private retailer settings, mRDTs increased referral of patients to other providers. This synthesis provides an overview of shifts in casemanagement thatmay be expected with mRDT introduction and highlights areas of focus to improve design and implementation of future case management programs.

Published
2017
Full Text
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37. Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing : analysis of observational and randomised studies in public and private healthcare settings

Author

Hopkins, Heidi, Bruxvoort, Katia J., Cairns, Matthew E., Chandler, Clare I. R., Leurent, Baptiste, Ansah, Evelyn K., Baiden, Frank, Baltzell, Kimberly A., Bjorkman, Anders, Burchett, Helen E. D., Clarke, Sian E., DiLiberto, Deborah D., Elfving, Kristina, Goodman, Catherine, Hansen, Kristian S., Kachur, S. Patrick, Lal, Sham, Lalloo, David G., Leslie, Toby, Magnussen, Pascal, Jefferies, Lindsay Mangham, Mårtensson, Andreas, Mayan, Ismail, Mbonye, Anthony K., Msellem, Mwinyi I., Onwujekwe, Obinna E., Owusu-Agyei, Seth, Reyburn, Hugh, Rowland, Mark W., Shakely, Deler, Vestergaard, Lasse S., Webster, Jayne, Wiseman, Virginia L., Yeung, Shunmay, Schellenberg, David, Staedke, Sarah G., Whitty, Christopher J. M., Hopkins, Heidi, Bruxvoort, Katia J., Cairns, Matthew E., Chandler, Clare I. R., Leurent, Baptiste, Ansah, Evelyn K., Baiden, Frank, Baltzell, Kimberly A., Bjorkman, Anders, Burchett, Helen E. D., Clarke, Sian E., DiLiberto, Deborah D., Elfving, Kristina, Goodman, Catherine, Hansen, Kristian S., Kachur, S. Patrick, Lal, Sham, Lalloo, David G., Leslie, Toby, Magnussen, Pascal, Jefferies, Lindsay Mangham, Mårtensson, Andreas, Mayan, Ismail, Mbonye, Anthony K., Msellem, Mwinyi I., Onwujekwe, Obinna E., Owusu-Agyei, Seth, Reyburn, Hugh, Rowland, Mark W., Shakely, Deler, Vestergaard, Lasse S., Webster, Jayne, Wiseman, Virginia L., Yeung, Shunmay, Schellenberg, David, Staedke, Sarah G., and Whitty, Christopher J. M.

Abstract

OBJECTIVES To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia. DESIGN Analysis of nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study). SETTING Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda. PARTICIPANTS 522 480 children and adults with acute febrile illness. INTERVENTIONS Rapid diagnostic tests for malaria. MAIN OUTCOME MEASURES Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings. RESULTS Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole. CONCLUSIONS Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials-a beneficial public health outcome-could drive up untargeted use of antibiotics.

Published
2017
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39. The effect of a clinical decision-making mHealth support system on maternal and neonatal mortality and morbidity in Ghana : study protocol for a cluster randomized controlled trial

Author

Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Amoakoh-Coleman, Mary, Agyepong, Irene Akua, Kayode, Gbenga A, Sarpong, Charity, Grobbee, Diederick E, Ansah, Evelyn K, Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Amoakoh-Coleman, Mary, Agyepong, Irene Akua, Kayode, Gbenga A, Sarpong, Charity, Grobbee, Diederick E, and Ansah, Evelyn K

Published
2017

40. Variation in neonatal mortality and its relation to country characteristics in sub-Saharan Africa: an ecological study

Author

Global Health, Cardiovasculaire Epi Team 9, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Global Health team 1, Kayode, Gbenga Ayodele, Grobbee, Diederick E, Amoakoh-Coleman, Mary, Ansah, Evelyn K., Uthman, Olalekan A, Klipstein-Grobusch, Kerstin, Global Health, Cardiovasculaire Epi Team 9, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Global Health team 1, Kayode, Gbenga Ayodele, Grobbee, Diederick E, Amoakoh-Coleman, Mary, Ansah, Evelyn K., Uthman, Olalekan A, and Klipstein-Grobusch, Kerstin

Published
2017

41. The effect of a clinical decision-making mHealth support system on maternal and neonatal mortality and morbidity in Ghana: study protocol for a cluster randomized controlled trial

Author

Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 9, Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Amoakoh-Coleman, Mary, Agyepong, Irene Akua, Kayode, Gbenga A, Sarpong, Charity, Grobbee, Diederick E, Ansah, Evelyn K, Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 9, Amoakoh, Hannah Brown, Klipstein-Grobusch, Kerstin, Amoakoh-Coleman, Mary, Agyepong, Irene Akua, Kayode, Gbenga A, Sarpong, Charity, Grobbee, Diederick E, and Ansah, Evelyn K

Published
2017

42. The impact of introducing malaria rapid diagnostic tests on fever case management:A synthesis of ten studies from the ACT Consortium

Author

Bruxvoort, Katia J, Leurent, Baptiste, Chandler, Clare I R, Ansah, Evelyn K, Baiden, Frank, Björkman, Anders, Burchett, Helen E D, Clarke, Siân E, Cundill, Bonnie, DiLiberto, Debora D, Elfving, Kristina, Goodman, Catherine, Hansen, Kristian S, Kachur, S Patrick, Lal, Sham, Lalloo, David G, Leslie, Toby, Magnussen, Pascal, Mangham-Jefferies, Lindsay, Mårtensson, Andreas, Mayan, Ismail, Mbonye, Anthony K, Msellem, Mwinyi I, Onwujekwe, Obinna E, Owusu-Agyei, Seth, Rowland, Mark W, Shakely, Delér, Staedke, Sarah G, Vestergaard, Lasse S, Webster, Jayne, Whitty, Christopher J M, Wiseman, Virginia L, Yeung, Shunmay, Schellenberg, David, Hopkins, Heidi, Bruxvoort, Katia J, Leurent, Baptiste, Chandler, Clare I R, Ansah, Evelyn K, Baiden, Frank, Björkman, Anders, Burchett, Helen E D, Clarke, Siân E, Cundill, Bonnie, DiLiberto, Debora D, Elfving, Kristina, Goodman, Catherine, Hansen, Kristian S, Kachur, S Patrick, Lal, Sham, Lalloo, David G, Leslie, Toby, Magnussen, Pascal, Mangham-Jefferies, Lindsay, Mårtensson, Andreas, Mayan, Ismail, Mbonye, Anthony K, Msellem, Mwinyi I, Onwujekwe, Obinna E, Owusu-Agyei, Seth, Rowland, Mark W, Shakely, Delér, Staedke, Sarah G, Vestergaard, Lasse S, Webster, Jayne, Whitty, Christopher J M, Wiseman, Virginia L, Yeung, Shunmay, Schellenberg, David, and Hopkins, Heidi

Abstract

Since 2010, the World Health Organization has been recommending that all suspected cases of malaria be confirmed with parasite-based diagnosis before treatment. These guidelines represent a paradigm shift away from presumptive antimalarial treatment of fever. Malaria rapid diagnostic tests (mRDTs) are central to implementing this policy, intended to target artemisinin-based combination therapies (ACT) to patients with confirmed malaria and to improve management of patients with nonmalarial fevers. The ACT Consortium conducted ten linked studies, eight in sub-Saharan Africa and two in Afghanistan, to evaluate the impact of mRDT introduction on case management across settings that vary in malaria endemicity and healthcare provider type. This synthesis includes 562,368 outpatient encounters (study size range 2,400-432,513). mRDTs were associated with significantly lower ACT prescription (range 8-69% versus 20-100%). Prescribing did not always adhere to malaria test results; in several settings, ACTs were prescribed to more than 30% of test-negative patients or to fewer than 80% of test-positive patients. Either an antimalarial or an antibiotic was prescribed for more than 75% of patients across most settings; lower antimalarial prescription for malaria test-negative patients was partly offset by higher antibiotic prescription. Symptomatic management with antipyretics alone was prescribed for fewer than 25% of patients across all scenarios. In community health worker and private retailer settings, mRDTs increased referral of patients to other providers. This synthesis provides an overview of shifts in case management that may be expected with mRDT introduction and highlights areas of focus to improve design and implementation of future case management programs.

Published
2017

43. Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing:analysis of observational and randomised studies in public and private healthcare settings

Author

Hopkins, Heidi, Bruxvoort, Katia J, Cairns, Matthew E, Chandler, Clare I R, Leurent, Baptiste, Ansah, Evelyn K, Baiden, Frank, Baltzell, Kimberly A, Björkman, Anders, Burchett, Helen E D, Clarke, Siân E, DiLiberto, Deborah D, Elfving, Kristina, Goodman, Catherine, Hansen, Kristian S, Kachur, S Patrick, Lal, Sham, Lalloo, David G, Leslie, Toby, Magnussen, Pascal, Jefferies, Lindsay Mangham, Mårtensson, Andreas, Mayan, Ismail, Mbonye, Anthony K, Msellem, Mwinyi I, Onwujekwe, Obinna E, Owusu-Agyei, Seth, Reyburn, Hugh, Rowland, Mark W, Shakely, Delér, Vestergaard, Lasse S, Webster, Jayne, Wiseman, Virginia L, Yeung, Shunmay, Schellenberg, David, Staedke, Sarah G, Whitty, Christopher J M, Hopkins, Heidi, Bruxvoort, Katia J, Cairns, Matthew E, Chandler, Clare I R, Leurent, Baptiste, Ansah, Evelyn K, Baiden, Frank, Baltzell, Kimberly A, Björkman, Anders, Burchett, Helen E D, Clarke, Siân E, DiLiberto, Deborah D, Elfving, Kristina, Goodman, Catherine, Hansen, Kristian S, Kachur, S Patrick, Lal, Sham, Lalloo, David G, Leslie, Toby, Magnussen, Pascal, Jefferies, Lindsay Mangham, Mårtensson, Andreas, Mayan, Ismail, Mbonye, Anthony K, Msellem, Mwinyi I, Onwujekwe, Obinna E, Owusu-Agyei, Seth, Reyburn, Hugh, Rowland, Mark W, Shakely, Delér, Vestergaard, Lasse S, Webster, Jayne, Wiseman, Virginia L, Yeung, Shunmay, Schellenberg, David, Staedke, Sarah G, and Whitty, Christopher J M

Abstract

Objectives To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia.Design Analysisof nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study).Setting Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda.Participants 522 480 children and adults with acute febrile illness.Interventions Rapid diagnostic tests for malaria.Main outcome measures Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings.Results Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole.Conclusions Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials-a beneficial public health outcome-could drive up untargeted use of antibiotics. That

Published
2017

44. Characteristics of Inpatient Hypertension Cases and Factors Associated with Admission Outcomes in Ashanti Region, Ghana: An Analytic Cross-Sectional Study

Author

Nuamah, Kenneth, primary, Affran Bonful, Harriet, additional, Danso Yeboah, Joseph, additional, Antwi Amankwaah, Ebenezer, additional, Boakye, Daniel, additional, Kwame Owusu, Samuel, additional, Aduako Owusu, Adwoa, additional, Amponsah, Freddie, additional, Adomako-Boateng, Fred, additional, Nang-Beifubah, Alexis, additional, Gyapong, Margaret, additional, Ofosu, Anthony, additional, Garshong, Bertha, additional, and Ansah, Evelyn K., additional

Published
2017
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48. Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries : A Systematic Review

Author

Amoakoh-Coleman, Mary, Borgstein, Alexander Berend-Jan, Sondaal, Stephanie F V, Grobbee, Diederick E, Miltenburg, Andrea Solnes, Verwijs, Mirjam, Ansah, Evelyn K, Browne, Joyce L, Klipstein-Grobusch, Kerstin, Amoakoh-Coleman, Mary, Borgstein, Alexander Berend-Jan, Sondaal, Stephanie F V, Grobbee, Diederick E, Miltenburg, Andrea Solnes, Verwijs, Mirjam, Ansah, Evelyn K, Browne, Joyce L, and Klipstein-Grobusch, Kerstin

Published
2016

49. Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana

Author

Global Health, Cardiovasculaire Epi Team 9, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Amoakoh-Coleman, Mary, Agyepong, Irene Akua, Kayode, Gbenga A, Grobbee, Diederick E, Klipstein-Grobusch, Kerstin, Ansah, Evelyn K, Global Health, Cardiovasculaire Epi Team 9, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Amoakoh-Coleman, Mary, Agyepong, Irene Akua, Kayode, Gbenga A, Grobbee, Diederick E, Klipstein-Grobusch, Kerstin, and Ansah, Evelyn K

Published
2016

50. Client Factors Affect Provider Adherence to Clinical Guidelines during First Antenatal Care

Author

Global Health, Biostatistiek Onderzoek, Other research (not in main researchprogram), Cardiovasculaire Epi Team 9, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Amoakoh-Coleman, Mary, Agyepong, Irene Akua, Zuithoff, Nicolaas P A, Kayode, Gbenga A, Grobbee, Diederick E, Klipstein-Grobusch, Kerstin, Ansah, Evelyn K, Global Health, Biostatistiek Onderzoek, Other research (not in main researchprogram), Cardiovasculaire Epi Team 9, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Amoakoh-Coleman, Mary, Agyepong, Irene Akua, Zuithoff, Nicolaas P A, Kayode, Gbenga A, Grobbee, Diederick E, Klipstein-Grobusch, Kerstin, and Ansah, Evelyn K

Published
2016

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