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In 2019, the RTS,S/AS01Twenty-one in-depth interviews were conducted with regional and district health service managers and frontline health workers three months after the start of MVIP in May 2019. Data were coded using NVivo software version 12 and a coding framework was developed to support thematic analysis to identify the challenges and lessons learned during the RTS,S/AS01Participants reported challenges related to the characteristics of the intervention, such as issues with the vaccine schedule and eligibility criteria, and challenges related to how it was implemented as a pilot programme. Additionally, major challenges were faced due to the spread of rumours leading to vaccine refusals; thus, the outer setting of the CFIR was adapted to accommodate rumours within the community context. Health service managers and frontline health workers also experienced challenges with the process of implementing RTS,S/AS01This study identified 12 main challenges and lessons learned by health service managers and health workers during the planning and early implementation phases of the RTS,S/AS01

Whilst the health benefit of using clean cookstoves and fuels is widely known, there is limited information on the non-health benefit of these stoves, especially in low-middle-income countries. This paper reports the time use implications of using clean cookstoves and fuels by comparing liquified petroleum gas (LPG), an improved biomass cookstove (BioLite), and traditional biomass cookstoves (three-stone fires) in Ghana. Using survey-based time diaries, information on all the activities undertaken by study participants during a 24-h was collected and analyzed. The findings of the study show that LPG users spent significantly less time gathering firewood compared to the users of improved cookstoves and three-stone fires. LPG users spent slightly less time per cooking episode, generally, and there was no significant difference in cooking time across the three cookstoves mostly due to stove stacking. Time spent engaging in economic activities was highest for LPG users and improved biomass cookstove users, at least when compared to three-stone fire users. In this study, we provide evidence on the time use implications of clean cookstoves, highlighting their non-health benefits and supporting efforts towards the adoption and sustained used of clean cookstoves

Efforts to reduce the health and ecological burdens of household biomass combustion are underway in Ghana, principally by promoting clean cookstoves and fuels. Recent studies have focused on the sustained use of clean cookstoves, but sometimes household adopt a new cookstove and then end use of that stove. In this study, we introduce a novel framework for understanding and encouraging household transitions to cleaner cooking: clean fuel discontinuance. We leveraged data from the Ghana Randomized Air Pollution and Health Study (GRAPHS) (N = 1412) where pregnant women received either improved biomass (BioLite) or dual burner LPG stoves for free. LPG users were given free LPG refills during GRAPHS. Weekly questionnaires were administered. Stove use monitors tracked a sub-cohort (n = 220) 6 months before and after the fuel subsidy. We examined social and ecological determinants of stove use and discontinuance. Overall intervention stove use adherence was high throughout GRAPHS, with self-reported use at 69% and 86% of participant-weeks for BioLite and LPG arms respectively. Participants used intervention stoves less for meals requiring vigorous stirring. Burns from intervention stoves decreased use among BioLite (RR: 0.96, p = 0.009), but not LPG users. Device breakage was mentioned as an impediment in 18% of free-text responses for LPG users and 1% for BioLite. Tree canopy within a spatial buffer—a plausible proxy for biomass fuels access—was the only variable explaining LPG discontinued stove use in adjusted Cox time-to-event analyses (HR = −0.56, p

Despite its benefits and espousal in developed counties, the adoption of clean cookstoves is reportedly low in less developed countries, especially in Sub&ndash, Saharan Africa. This qualitative study aimed at exploring and documenting the enablers and barriers for adoption of clean cookstove in the middle belt of Ghana. The findings showed convenience of clean cookstove use, reduced firewood usage, less smoke emission and associated health problems resulting from indoor air pollution and time for firewood gathering and cooking, good smell and taste of food as enabling factors for clean cookstove adoption. Factors such as safety, financial constraint (cost), non-availability of spare parts on the open market to replace faulty stove accessories, stove size and household size were the potential barriers to clean cookstove adoption. These findings help us to understand the factors promoting and inhibiting the adoption of clean cook stoves, especially in rural settings.

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.

Household air pollution (HAP) is a leading cause of morbidity and mortality worldwide. To limit HAP exposure and environmental degradation from biomass fuel use, the Government of Ghana promotes liquefied petroleum gas (LPG) use in rural Ghana via the Rural LPG program (RLP). We assessed the experiences of the RLP in 2015, 2 years after its launch. A mixed methods approach was used involving Focus Group Discussions (19) and in-depth interviews (25). In addition, a survey questionnaire was administered to elicit socio-demographic characteristics, household cooking practices and stove use patterns of 200 randomly selected respondents. At about 9 months after LPG acquisition

Three billion individuals worldwide rely on biomass fuel [dung, wood, crops] for cooking and heating. Further, health conditions resulting from household air pollution (HAP) are responsible for approximately 3.9 million premature deaths each year. Though transition away from traditional biomass stoves is projected curb the health effects of HAP by mitigating exposure, the benefits of newer clean cookstove technologies can only be fully realized if use of these new stoves is exclusive and sustained. However, the conditions under which individuals adopt and sustain use of clean cookstoves is not well understood. The Enhancing LPG Adoption in Ghana (ELAG) study is a cluster-randomized controlled trial employing a factorial intervention design. The first component is a behavior change intervention based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model. This intervention seeks to align these five behavioral factors with clean cookstove adoption and sustained use. A second intervention is access-related and will improve LPG availability by offering a direct-delivery refueling service. These two interventions will be integrated via a factorial design whereby 27 communities are assigned to one of the following: the control arm, the educational intervention, the delivery, or a combined intervention. Intervention allocation is determined by a covariate-constrained randomization approach. After intervention, approximately 900 households’ individual fuel use is tracked for 12 months via iButton stove use monitors. Analysis will include hierarchical linear models used to compare intervention households’ fuel use to control households. Literature to-date demonstrates that recipients of improved cookstoves rarely completely adopt the new technology. Instead, they often practice partial adoption (fuel stacking). Consequently, interventions are needed to influence adoption patterns and simultaneously to understand drivers of fuel adoption. Ensuring uptake, adoption, and sustained use of improved cookstove technologies can then lead to HAP-reductions and consequent improvements in public health. NCT03352830 (November 24, 2017).

This study describes community members’ knowledge of Ebola Virus Disease (EVD), their attitudes and preventive practices. A mixed methods approach was used. A random sample of 1028 community members aged 15 - 65 years was interviewed in a quantitative survey. This was complemented with a qualitative study involving 24 opinion leaders who were carefully selected. The study was conducted in Kintampo North and South districts of Ghana from August 2014 to October 2014. 83% of respondents had heard of EVD, but 62.5% did not know the duration between the time of infection and onset of clinical symptoms. The most popular symptom mentioned spontaneously was bleeding through body orifices (48.6%). Majority of respondents mentioned handshake or skin contact as a mode of transmission (57.3%) and reduced contact with bats as a means to prevent the spread of EVD (58.1%). Knowledge of transmission of body fluids such as faeces, blood or urine was low (

Background: Breast cancer is one of the most common cancers in women worldwide. With an estimated incidence of 1,676,633 with 521,817 deaths in the year 2012, the figure is expected to hit the 82.5 millionth mark by 2015. Breast cancer screening is reported to be extremely low in most low-middle income countries like Ghana. This study was to determine the knowledge and practices of self-breast examination among market women at Makola Shopping Mall in Accra, Ghana. Methods: The study was conducted at the Makola Shopping Mall in Accra among women above the age of 20 years who owned a store and sell at the mall. Data were collected using mixed method involving in-depth interviews and questionnaire survey. Random samples of 170 participants were selected from a population of 400 for the quantitative survey. A total of eight in-depth interviews were conducted to generate qualitative data to complement the survey data. Results: Majority (60%) of the respondents were between the ages of 20 - 40 years. There’s a high literacy rate among the participants. Though awareness of self-breast examination was very high (93%), only 27% practiced self-breast examination in line with the recommended one week period after menses due to lack of knowledge of the basic skills to do self-breast examination. Conclusion: In view of the lack of knowledge resulting in non-performance of self-breast examination, continuous education on breast cancer screening should be given to the women to enable them acquire the skills of performing self-breast examination to promote early detection of the disease.

Background Mental disorders, also called psychiatric disorders, refer to unconventional or anomalous behavioral patterns, feelings, thoughts, perceptions and beliefs that cause distress or disability, and which are not developmentally or socially acceptable. Plasmodium falciparum (P. falciparum) malaria is the most common parasitic infection of the central nervous system and sub-Saharan Africa has the highest burden of this disease. Children living in this region of the world bear the brunt of P. falciparum malaria and neurological complications commonly associated with it. Objectives The objective of this review was to synthesize the best available evidence on the association of P. falciparum malaria and the short-term and long-term mental disorders of children. Inclusion criteria Types of participants Study participants aged five to 19 years who were residing in sub-Saharan Africa. Types of intervention(s)/phenomena of interest This review considered studies that examined the association between P. falciparum malaria (cerebral malaria, repetitive uncomplicated malaria or asymptomatic malaria) as exposure and a range of mental disorders as an outcome. Types of studies This review considered epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental trials, prospective and retrospective cohort studies, case control studies and analytical cross-sectional studies. Types of outcomes This review considered studies that included (but were not limited to) the following mental disorder outcome measures: cognitive deficits and impairments, acquired language disorder, school performance and psychomotor skills. There are many tests to measure these outcomes. Cognitive deficits and impairments are commonly measured with the Mini-Cog Test, language disorders with the Language Delays Assessment Test and psychomotor skills are measured with the Two-point Threshold Test (distance perception) and the Color Timing Test that measures mental speed. School performance is not commonly measured with norm-referenced standardized tests due to the large disparities in achievement between schools. This outcome measure is often picked from class assessment and examination records of the students, relative to their classmates. Search strategy A three-step search strategy was utilized in this review. Relevant studies published in the English language from 1980 to 2012, when the association between malaria and mental disorders was highlighted, were considered for inclusion in this review. Unpublished data was also searched for within the same period. The databases searched included PubMed, CINAHL, PsycARTICLES, PsycBITES, PsycINFO, Social Science Citation Index, ProQuest Dissertations and Theses (PQDT)/Digital dissertations, ProQuest Social Services abstracts, ProQuest Sociological abstracts, World Bank, British Library for Development Studies, SCOPUS and Mednar. Methodological quality Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute (i.e. JBI-MAStARI). Any disagreements that arose between the reviewers were resolved through discussion. Data collection Data were extracted from quantitative papers included in the review using the standardized data extraction tool from JBI-MAStARI. The data extracted included specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Data synthesis Meta-analysis was not done because the nature of the results from included studies did not make it statistically prudent to pool the results. Results A total of eight studies which met the inclusion criteria for this review were identified. Four (50%) studies were conducted in Kenya, three (37.5%) from Uganda and one (12.5%) from Senegal. The results of the review suggested that P. falciparum malaria was associated with mental disorders. Conclusions The review suggested that P. falciparum malaria is associated with mental disorders. However, there should be collaboration between investigators in this area so that multi-center trials can be conducted to ascertain the effects of P. falciparum malaria on more focused mental disorder outcomes.

Introduction: Nearly 3.7 billion people worldwide rely on the use of biomass fuels and open traditional cookstoves for their heating and cooking needs. Encouraging the uptake of health-relevant int...

Introduction Clean cook stoves help reduce firewood consumption, reduce exposure to household air pollution, and save households time from firewood gathering and cooking. The aim of the study is to...

Review objectives The objective of this review is to identify and synthesise the best available evidence on the association of Plasmodium falciparum malaria and the short-term and long-term mental health deficiencies of children aged between 5 years and 19 years in sub-Saharan Africa. More specifically, the objectives are to identify the effects of malaria episodes on children’s memory, attention, general school performance, schizophrenic and manic syndromes, typical and atypical depression, anxiety attacks, mental confusion, amnesia, irritability, violence and acute personality changes. In addition, this review will also consider studies that look at other negative sequelae such as visual hallucinations, motor agitation and those that report negative effects on the executive functions of the victims in sub-Saharan Africa. Inclusion criteria Type of participants This review will consider studies that include children aged between 5 years and 19 years, who reside in sub-Saharan Africa. Children below 5 years of age are prone to active bouts of falciparum malaria as compared to older children, 18 hence the lower age limit of 5 years to capture persons less prone to active malaria disease. The review focuses on children; the upper age limit of that group is 19 years. Phenomenon of interest/exposure This review will consider studies that examine the association between severe malaria, cerebral malaria, repetitive uncomplicated malaria or asymptomatic malaria and mental disorders. Type of outcomes The main outcome of interest is the association between malaria and mental health outcomes. This review will consider studies that include the following mental health outcome measures: cognitive deficits and impairments, acquired language disorder, school performance and psychomotor skills

Introduction: Epilepsy is common in sub-Saharan Africa, but there is little data in West Africa, to develop public health measures for epilepsy in this region. Methods: We conducted a three-stage cross-sectional survey to determine the prevalence and risk factors for active convulsive epilepsy (ACE), and estimated the treatment gap in Kintampo situated in the middle of Ghana. Results: 249 people with ACE were identified in a study population of 113,796 individuals. After adjusting for attrition and the sensitivity of the screening method, the prevalence of ACE was 10.1/1000 (95% Confidence Interval (95%CI) 9.5-10.7). In children aged