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Background: Vaccination has contributed to the reduction in vaccine preventable diseases. Despite, improved global coverage, vaccination among nomadic populations is still low especially in Africa. This study explored factors influencing vaccination uptake among pastoralist nomads in Ghana. Methods: We conducted key informant interviews (KII) in 11 districts across four regions of Ghana, using grounded theory qualitative research approach. One hundred and eighty-two KII were conducted among pastoralist nomads, community opinion leaders, community health volunteers, security services personnel, local government personnel and health workers. Guided by the WHO health systems building blocks, data was coded using Nvivo 12 and analysed thematically. Results were presented as narratives with excerpts to support the findings. Results: Community leaders support vaccination among pastoralist nomads as part of their leadership and governance responsibilities. Language barrier between health workers and pastoralist nomads affects service delivery. Also, healthcare providers fear being attacked by pastoralist nomads hence are hesitant to visit their settlements for vaccination. With regards to health workforce, healthcare providers' perceived use of derogatory words and discrimination against pastoralist nomads influence their vaccination uptake. On medical product, the lack of knowledge about diseases, severity and perceived negative effects about vaccines influence vaccination uptake. Inadequate funds and logistics at the district health directorates affects outreach to nomads during vaccinations. Leveraging existing partnership between the health services and community leaders, information centers, volunteers and butchers to send health information to pastoralist nomads influence vaccination uptake. Conclusion: Community leaders support vaccination among pastoralist nomads. Nomadic pastoralist miss vaccination dues to language barrier, feel discriminated against, and lack information about diseases and vaccinations. Strengthening Ghana Health Service collaboration with leaders of pastoralist nomads could build trust, create awareness and overcome language barrier between healthcare providers and pastoralist nomads. [ABSTRACT FROM AUTHOR]

Background In low- and middle-income countries (LMICs), the continuum of care (CoC) for maternal, newborn, and child health (MNCH) is not always complete. This study aimed to evaluate the effectiveness of an integrated package of CoC interventions on the CoC completion, morbidity, and mortality outcomes of woman-child pairs in Ghana. Methods and findings This cluster-randomized controlled trial (ISRCTN: 90618993) was conducted at 3 Health and Demographic Surveillance System (HDSS) sites in Ghana. The primary outcome was CoC completion by a woman-child pair, defined as receiving antenatal care (ANC) 4 times or more, delivery assistance from a skilled birth attendant (SBA), and postnatal care (PNC) 3 times or more. Other outcomes were the morbidity and mortality of women and children. Women received a package of interventions and routine services at health facilities (October 2014 to December 2015). The package comprised providing a CoC card for women, CoC orientation for health workers, and offering women with 24-hour stay at a health facility or a home visit within 48 hours after delivery. In the control arm, women received routine services only. Eligibility criteria were as follows: women who gave birth or had a stillbirth from September 1, 2012 to September 30, 2014 (before the trial period), from October 1, 2014 to December 31, 2015 (during the trial period), or from January 1, 2016 to December 31, 2016 (after the trial period). Health service and morbidity outcomes were assessed before and during the trial periods through face-to-face interviews. Mortality was assessed using demographic surveillance data for the 3 periods above. Mixed-effects logistic regression models were used to evaluate the effectiveness as difference in differences (DiD). For health service and morbidity outcomes, 2,970 woman-child pairs were assessed: 1,480 from the baseline survey and 1,490 from the follow-up survey. Additionally, 33,819 cases were assessed for perinatal mortality, 33,322 for neonatal mortality, and 39,205 for maternal mortality. The intervention arm had higher proportions of completed CoC (410/870 [47.1%]) than the control arm (246/620 [39.7%]; adjusted odds ratio [AOR] for DiD = 1.77; 95% confidence interval [CI]: 1.08 to 2.92; p = 0.024). Maternal complications that required hospitalization during pregnancy were lower in the intervention (95/870 [10.9%]) than in the control arm (83/620 [13.4%]) (AOR for DiD = 0.49; 95% CI: 0.29 to 0.83; p = 0.008). Maternal mortality was 8/6,163 live births (intervention arm) and 4/4,068 live births during the trial period (AOR for DiD = 1.60; 95% CI: 0.40 to 6.34; p = 0.507) and 1/4,626 (intervention arm) and 9/3,937 (control arm) after the trial period (AOR for DiD = 0.11; 95% CI: 0.11 to 1.00; p = 0.050). Perinatal and neonatal mortality was not significantly reduced. As this study was conducted in a real-world setting, possible limitations included differences in the type and scale of health facilities and the size of subdistricts, contamination for intervention effectiveness due to the geographic proximity of the arms, and insufficient number of cases for the mortality assessment. Conclusions This study found that an integrated package of CoC interventions increased CoC completion and decreased maternal complications requiring hospitalization during pregnancy and maternal mortality after the trial period. It did not find evidence of reduced perinatal and neonatal mortality. Trial registration The study protocol was registered in the International Standard Randomised Controlled Trial Number Registry (90618993)., Author(s): Akira Shibanuma 1, Evelyn Korkor Ansah 2,3, Kimiyo Kikuchi 1,4, Francis Yeji 5, Sumiyo Okawa 1,6, Charlotte Tawiah 7, Keiko Nanishi 1, Sheila Addei 8, John Williams 8, Kwaku [...]

Effect of vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana: a secondary analysis from the Obaapa VitA trial/Effet de la supplementation en vitamine A sur la mortalite relative chez les femmes en age de procreer au Ghana: une analyse secondaire de l'etude Obaapa VitA/El efecto de los suplementos de vitamina A en la mortalidad por causas especificas de mujeres en edad reproductiva en Ghana: un analisis secundario del ensayo Obaapa VITA. Objective To determine the effect of weekly low-dose vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana. Methods A cluster-randomized, triple-blind, placebo-controlled trial was conducted in seven districts of the Brong Ahafo region of Ghana. Women aged 15-45 years who were capable of giving informed consent and intended to live in the trial area for at least 3 months were enrolled and randomly assigned, according to their cluster of residence, to receive oral vitamin A (7500 |jg) or placebo once a week. Randomization was blocked, with two clusters in each fieldwork area allocated to vitamin A and two to placebo. Every 4 weeks, fieldworkers distributed capsules and collected data during home visits. Verbal autopsies were conducted by field supervisors and reviewed by physicians, who assigned a cause of death. Cause-specific mortality rates in both arms were compared by means of random-effects Poisson regression models to allow for the cluster randomization. Analysis was by intention-to-treat, based on cluster of residence, with women eligible for inclusion once they had consistently received the supplement or placebo capsules for 6 months. Findings The analysis was based on 581 870 woman-years and 2624 deaths. Cause-specific mortality rates were found to be similar in the two study arms. Conclusion Low-dose vitamin A supplements administered weekly are of no benefit in programmes to reduce mortality in women of childbearing age. Objectif Determiner l'effet de la supplementation hebdomadaire en vitamine A a faible dose sur la mortalite specifique des femmes en age de procreer au Ghana. Methodes Une etude randomisee, en triple aveugle, controlee contre placebo, a ete menee dans sept districts de la region de Brong Ahafo au Ghana. Les femmes agees de 15 a 45 ans, capables de donner un consentement eclaire et amenees a vivre dans la region de l'etude pendant au moins 3 mois, ont ete incluses et il a ete determine qu'elles recevraient une fois par semaine, au hasard selon leur groupe de residence, de la vitamine A par voie orale (7 500 ug) ou un placebo. La randomisation a ete fixee par deux groupes dans chaque zone recevant la vitamine A et deux groupes recevant le placebo. Toutes les 4 semaines, les agents de terrain distribuaient les capsules et recueillaient les donnees lors de visites a domicile. Des autopsies orales ont ete effectuees par les superviseurs sur le terrain et analysees par des medecins, qui determinaient la cause du deces. Les taux de mortalite specifique dans les deux groupes ont ete compares a l'aide d'une regression de Poisson pour valider la randomisation des groupes. L'analyse, basee sur l'intention de traiter, etait basee sur le groupe de residence, pour des femmes eligibles a l'etude ayant recu les capsules de supplement ou de placebo de maniere constante pendant 6 mois. Resultats L'analyse s'est basee sur 581 870 annees-femmes et 2624 deces. Les taux de mortalite specifique ont ete juges similaires dans les deux groupes de l'etude. Conclusion Les supplements en vitamine A a faible dose administres hebdomadairement ne sont d'aucune utilite dans les programmes visant a reduire la mortalite chez les femmes en age de procreer. Objetivo Determinar el efecto de la administracion semanal de dosis bajas de vitamina A en la mortalidad por causas especificas de mujeres en edad reproductiva en Ghana. Metodos Se realizo un ensayo aleatorio de grupos, triple ciego y controlado por placebo en siete distritos de la region de Brong Ahafo, en Ghana. Se inscribieron mujeres de entre 15 y 45 anos de edad capaces de dar su consentimiento informado y que tuvieran previsto vivir en el area de ensayo durante al menos tres meses. De acuerdo con el grupo de residencia al que habian sido asignadas de forma aleatoria, recibieron semanalmente vitamina A por via oral (7500 ug) o placebo. La distribucion aleatoria se limito en cada area de trabajo a dos grupos a los que se les administro vitamina A y dos grupos que recibieron placebo. Cada cuatro semanas, los investigadores de campo distribuyeron capsulas y recogieron datos durante las visitas a los hogares. Las autopsias verbales realizadas por los supervisores de campo fueron revisadas por medicos, quienes determinaron la causa de la muerte. Se compararon las tasas de mortalidad por causas especificas de ambos brazos mediante los modelos de regresion de Poisson con efectos aleatorios para facilitar la distribucion aleatoria de los grupos. El analisis fue por intencion de tratar, segun el grupo de residencia y con mujeres que cumplieron las condiciones de inclusion una vez habian recibido de forma constante las capsulas de suplemento o placebo durante seis meses. Resultados El analisis se baso en 581 870 anos-mujer y 2624 muertes. Se descubrio que las tasas de mortalidad por causas especificas fueron similares en ambos brazos del estudio. Conclusion Los suplementos de dosis bajas de vitamina A administrados semanalmente no presentan ninguna ventaja en los programas para reducir la mortalidad de las mujeres en edad reproductiva., Introduction Vitamin A deficiency is an important problem in low- and middle-income countries. (1) Although in these countries all-cause mortality among young children (i.e. children aged from 6 months to [...]

Abstract Background The findings of the CAPRISA tenofovir studies have raised expectations that soon an approved microbicide would be available. However it is in only a limited number of countries in sub-Saharan Africa that the acceptability of microbicides has been evaluated. We conducted a study to assess the acceptability of vaginal microbicides among women in rural Ghana. Methods The study employs a mixed method design, using cross-sectional survey and focus group discussions to further understand issues related to awareness and attitudes towards microbicide development, acceptability and perceived partner attitudes among pregnant women attending antenatal clinic in two health facilities in the Kintampo North municipality of Ghana. We used logistic regression to identify possible predictors of microbicide acceptability among the women surveyed. Results Although only 2% of the 504 women were aware of the development of microbicides, 95% were willing to use one when it became available. The cost of a microbicide that will be considered affordable to 50% of women was US$0.75. Although there were concerns about possible wetting effect, gel or creams were the most preferred (68% of women) formulation. Although 71% thought their partners will find microbicide acceptable, apprehensions about the feasibility of and consequences of failed discreet use were evident. 49% of women were concerned about possible negative effect of microbicide on sexual pleasure. Perceived partner acceptability (O.R. =17.7; 95%C.I. 5.03-62.5) and possibility of discreet use (O.R. =8.9 95%C.I. 2.63-30.13) were the important predictors of microbicide acceptability. Conclusion Achieving microbicide acceptability among male partners should be made a part of the promotive interventions for ensuring effective use among women in rural Ghana.

Background: Electronic data collection is increasingly used for household surveys, but factors influencing design and implementation have not been widely studied. The Every Newborn-INDEPTH (EN-INDEPTH) study was a multi-site survey using electronic data collection in five INDEPTH health and demographic surveillance system sites. Methods: We described experiences and learning involved in the design and implementation of the EN-INDEPTH survey, and undertook six focus group discussions with field and research team to explore their experiences. Thematic analyses were conducted in NVivo12 using an iterative process guided by a priori themes. Results: Five steps of the process of selecting, adapting and implementing electronic data collection in the EN-INDEPTH study are described. Firstly, we reviewed possible electronic data collection platforms, and selected the World Bank's Survey Solutions® as the most suited for the EN-INDEPTH study. Secondly, the survey questionnaire was coded and translated into local languages, and further context-specific adaptations were made. Thirdly, data collectors were selected and trained using standardised manual. Training varied between 4.5 and 10 days. Fourthly, instruments were piloted in the field and the questionnaires finalised. During data collection, data collectors appreciated the built-in skip patterns and error messages. Internet connection unreliability was a challenge, especially for data synchronisation. For the fifth and final step, data management and analyses, it was considered that data quality was higher and less time was spent on data cleaning. The possibility to use paradata to analyse survey timing and corrections was valued. Synchronisation and data transfer should be given special consideration. Conclusion: We synthesised experiences using electronic data collection in a multi-site household survey, including perceived advantages and challenges. Our recommendations for others considering electronic data collection include ensuring adaptations of tools to local context, piloting/refining the questionnaire in one site first, buying power banks to mitigate against power interruption and paying attention to issues such as GPS tracking and synchronisation, particularly in settings with poor internet connectivity. [ABSTRACT FROM AUTHOR]