Search

Background: Female genital schistosomiasis (FGS) is a gynaecological complication of urinary schistosomiasis (US) with an estimated burden of 20–120 million cases in endemic areas. A neglected sexual and reproductive health disease in sub-Saharan Africa, FGS increases susceptibility to sexually transmitted infections including cervical cancer and infertility among other morbidities. However, there appears to be limited FGS knowledge among practicing and pre-service health providers with implications for control. We assessed FGS awareness among final-year midwifery students who would soon be delivering primary maternal and reproductive health care. Methods: A cross-sectional study was conducted among 193 randomly selected final-year students from all three midwifery training institutions in the Volta region of Ghana in August/September, 2022. Data on participants' demographics and knowledge of the transmission, signs and symptoms, complications, treatment and prevention of both FGS and US were collected using structured questionnaires. Summary statistics were presented as frequencies, proportions and percentages. Results: Only 23.3% (44/189) of participants had heard about FGS compared to 64% (123/192) for US. Of the former, 42 (95%), 40 (91%) and 36 (81.8%) respectively identified genital itching/burning sensation, bloody vaginal discharge and pelvic pain/pain during intercourse as part of the symptoms of FGS. Less than a third (13/44) and about half (25/44) of those who indicated hearing about FGS knew it can be a risk for ectopic pregnancies and infertility respectively. Majority of these participants, 40 (91%), wrongly selected antibiotics as treatment for FGS while 9 indicated it is prevented by sleeping in insecticide-treated nets. Conclusion: Awareness of FGS was limited among the study participants. The high prevalence of knowledge of some FGS symptoms related to the genitalia needs cautious interpretation. Health care training institutions must make deliberate efforts to highlight FGS in the training of midwives as the condition has diagnostic and management implications for some sexual and reproductive health conditions. [ABSTRACT FROM AUTHOR]

Female genital schistosomiasis as a result of chronic infection with Schistosoma haematobium (commonly known as bilharzia) continues to be largely ignored by national and global health policy-makers. International attention for large-scale action against the disease focuses on whether it is a risk factor for the transmission of human immunodeficiency virus (HIV). Yet female genital schistosomiasis itself is linked to pain, bleeding and sub- or infertility, leading to social stigma, and is a common issue for women in schistosomiasis-endemic areas in sub-Saharan Africa. The disease should therefore be recognized as another component of a comprehensive health and human rights agenda for women and girls in Africa, alongside HIV and cervical cancer. Each of these three diseases has a targeted and proven preventive intervention: antiretroviral therapy and pre-exposure prophylaxis for HIV; human papilloma virus vaccine for cervical cancer; and praziquantel treatment for female genital schistosomiasis. We discuss how female genital schistosomiasis control can be integrated with HIV and cervical cancer care. Such a programme will be part of a broader framework of sexual and reproductive health and rights, women's empowerment and social justice in Africa. Integrated approaches that join up multiple public health programmes have the potential to expand or create opportunities to reach more girls and women throughout their life course. We outline a pragmatic operational research agenda that has the potential to optimize joint implementation of a package of measures responding to the specific needs of girls and women. [phrase omitted] [phrase omitted] La schistosomiase genitale feminine, resultant d'une infection chronique a Schistosoma haematobium (egalement connue sous le nom de bilharziose), continue d'etre largement ignoree par les responsables des politiques de sante nationales et internationales. Si le monde lui accorde son attention en vue de mener une action a grande echelle contre la maladie, c'est surtout pour determiner s'il s'agit d'un facteur de risque pour la transmission du virus de l'immunodeficience humaine (VIH). Pourtant, la schistosomiase genitale feminine est associee a des douleurs, des saignements et peut engendrer l'hypofertilite, voire la sterilite. Par consequent, celles qui en souffrent sont souvent stigmatisees, et le probleme est courant dans les regions endemiques d'Afrique subsaharienne. Cette maladie doit donc etre consideree comme composante a part entiere d'une approche globale de la sante et des droits humains pour les femmes et filles africaines, a l'instar du VIH et du cancer du col de l'uterus. Chacune de ces trois maladies fait l'objet d'une intervention preventive ciblee qui a deja fait ses preuves: le traitement antiretroviral et la prophylaxie pre-exposition pour le VIH; le vaccin contre le papillomavirus humain pour le cancer du col de l'uterus; et l'administration de praziquantel pour la schistosomiase genitale feminine. Le present document se penche sur la maniere d'integrer la schistosomiase genitale feminine dans la prise en charge du VIH et du cancer du col de l'uterus. Un tel programme fera partie d'un cadre plus vaste consacre aux droits et a la sante sexuelle et reproductive, a l'emancipation des femmes et a la justice sociale en Afrique. Les approches integrees qui regroupent plusieurs programmes de sante publique permettent d'elargir des perspectives ou de creer des opportunites visant a atteindre un plus grand nombre de filles et de femmes tout au long de leur vie. Nous exposons les grandes lignes d'un programme de recherches pragmatiques et operationnelles capable d'optimiser la mise en reuvre conjointe d'une serie de mesures qui repondent aux besoins specifiques des filles et des femmes. [phrase omitted] Los responsables de formular las politicas sanitarias nacionales y globales siguen ignorando en gran medida la esquistosomiasis genital femenina como consecuencia de la infeccion cronica por Schistosoma haematobium (conocida comunmente como bilharziasis). La atencion internacional para adoptar medidas de gran alcance contra la enfermedad se centra en determinar si es un factor de riesgo para la transmision del virus de la inmunodeficiencia humana (VIH). Sin embargo, la propia esquistosomiasis genital femenina esta vinculada al dolor, las hemorragias y la infertilidad o subfertilidad, lo que conduce al estigma social, ademas de ser un problema comun para las mujeres de las areas en donde la esqulstosomlasls es endemica en el Africa subsaharlana. Por consiguiente, la enfermedad debe ser reconocida como otro componente de un programa integral de salud y de derechos humanos para las mujeres y las ninas de Africa, junto con el VIH y el cancer de cuello uterino. Cada una de estas tres enfermedades tiene una intervencion preventiva especifica y comprobada: la terapia antirretroviral y la profilaxis previa a la exposicion para el VIH; la vacuna contra el virus del papiloma humano para el cancer de cuello uterino; y el tratamiento con praziquantel para la esquistosomiasis genital femenina. Se analiza como el control de la esquistosomiasis genital femenina se puede integrar con la atencion del VIH y el cancer de cuello uterino. Ese programa formara parte de un marco mas amplio de salud y de derechos sexuales y reproductivos, de empoderamiento de la mujer y de justicia social en Africa. Los enfoques integrados que unen multiples programas de salud publica tienen el potencial de ampliar o crear oportunidades para llegar a mas ninas y mujeres a lo largo de sus vidas. Se describe a grandes rasgos un programa de investigacion operacional pragmatico que tiene el potencial de optimizar la implementacion conjunta de una serie de medidas que respondan a las necesidades especificas de las ninas y de las mujeres., Introduction Gynaecological schistosomiasis as a result of chronic infection with Schistosoma haematobium (commonly known as bilharzia) has been described in the medical literature since the 1940s. (1,2) In the early [...]

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]

Background: The WHO recommended the use of the RTS,S/AS01 malaria vaccine (RTS,S) based on a pilot evaluation in routine use in Ghana, Kenya, and Malawi. A longitudinal qualitative study was conducted to examine facilitators and barriers to uptake of a 4-dose RTS,S schedule. Methods: A cohort of 198 caregivers of RTS,S-eligible children from communities where RTS,S was provided through the pilot were interviewed three times over a ≈22-month, 4-dose schedule. The interviews examined caregiver perceptions and behaviors. Children's vaccination history was obtained to determine dose uptake. Results: 162 caregivers remained at round 3 (R3); vaccination history was available for 152/162 children. Despite early rumors/fears, the uptake of initial doses was high, driven by vaccine trust. Fears dissipated by R2, replaced with an enthusiasm for RTS,S as caregivers perceived its safety and less frequent and severe malaria. By R3, 98/152 children had received four doses; 34 three doses; 9 one or two doses; and 11 zero doses. The health system and information barriers were important across all under-dose cases. Fears about AEFIs/safety were important in zero-, one-, and two-dose cases. Competing life/livelihood demands and complacency were found in three-dose cases. Regardless of the doses received, caregivers had positive attitudes towards RTS,S by R3. Conclusions: Findings from our study will help countries newly introducing the vaccine to anticipate and preempt reasons for delayed acceptance and missed RTS,S doses. [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 [...]

Background. The COVID-19 pandemic and government-led interventions to tackle it have had life-changing effects on vulnerable populations, especially rural and urban slum dwellers in developing countries. This ethnographic study explored how the Ghanaian government's management of COVID-19, socio-cultural factors, infrastructural challenges, and poverty influenced community perceptions, attitudes, and observance of COVID-19 prevention measures in Ghana. Methods. The study employed focused ethnography using in-depth interviews (IDIs), focus group discussions (FGDs), and nonparticipant observations to collect data from an urban slum and a rural community as well as from government officials, from October 2020 to January 2021. The data were triangulated and analyzed thematically with the support of qualitative software NVivo 12. All ethical procedures were followed. Results. The Ghanaian government's strategy of communicating COVID-19-related information to the public, health-related factors such as health facilities failing to follow standard procedures in testing and tracing persons who came into contact with COVID-19-positive cases, poverty, and lack of social amenities contributed to the poor observance of COVID-19 preventive measures. In addition, the government's relaxation of COVID-19 restrictions, community and family values, beliefs, and misconceptions contributed to the poor observance of COVID-19 preventive measures. Nevertheless, some aspects of the government's intervention measures and support to communities with COVID-19 prevention items, support from nongovernmental organizations (NGOs), and high knowledge of COVID-19 and its devastating effects contributed to positive attitudes and observance of COVID-19 preventive measures. Conclusion. There is a need for the government to use the existing community structures to engage vulnerable communities so that their concerns are factored into interventions to ensure that appropriate interventions are designed to suit the context. Moreover, the government needs to invest in social amenities in deprived communities. Finally, the government has to be consistent with the information it shares with the public to enhance trust relations. [ABSTRACT FROM AUTHOR]

The right to health was enshrined in the constitution of the World Health Organization in 1946 and in the Universal Declaration of Human Rights in 1948, which also guaranteed women's fundamental freedoms and dignity. The Declaration of Human Rights was signed by almost every country in the world. Nonetheless, gender inequalities in health and health systems continue to persist, especially in lower and middle income countries that are disproportionately affected by a litany of neglected diseases. In this paper, we focus on one of the most neglected human rights, development, and reproductive health issues globally, female genital schistosomiasis (FGS), which imposes enormous unacknowledged suffering on an estimated 56 million women and girls in Sub-Saharan Africa. Despite increasing calls for attention to FGS, no country has fully incorporated it into its health system. An appropriate response will require a comprehensive approach, guided by human rights mandates and the redress of FGS-related gender inequalities. In this paper, we propose the application of existing human rights and its clients, women, and girls affected by FGS as rights holders. Within the different components or building blocks of the health system, we propose elements of an appropriate health system response using the four components identified within the FGS Accelerated Scale Together (FAST) Package—awareness raising, prevention of infection, training of health personnel, and diagnosis and treatment. The framework is aspirational, its recommended elements and actions are not exhaustive, and countries will need to adapt it to their own situations and resource availability. However, it can be a useful guide to help health systems define how to begin to incorporate FGS into their programming in a way that responds to their human rights obligations in a gender- and culturally sensitive manner. [ABSTRACT FROM AUTHOR]

Background: Good menstrual hygiene practice is critical to the health of adolescent girls and women. In Ghanaian public schools, the School Health Education Program which includes menstrual health education has been instituted to equip adolescents with knowledge on menstruation and its related good hygiene practices. However, in most communities, menstruation is scarcely discussed openly due to mostly negative social and religious beliefs about menstruation. In this study, we examined socio-cultural factors associated with knowledge, attitudes and menstrual hygiene practices among Junior High School adolescent girls in the Kpando Municipality of Ghana. Materials and methods: A mixed method approach was employed with 480 respondents. A survey was conducted among 390 adolescent girls using interviewer-administered questionnaires to collect data on knowledge of menstruation and menstrual hygiene practices. Focus Group Discussions (FGDs) using a discussion guide were conducted among 90 respondents in groups of 9 members. The FGD was used to collect data on socio-cultural beliefs and practices regarding menstruation. Descriptive and inferential statistics and content analysis were used to analyze the quantitative and qualitative data respectively. Results: Most (80%) of the study participants had good knowledge of menstruation. Also, most (82%) of the participants practiced good menstrual hygiene. Attending a public (AOR = 0.24, 95% CI = 0.12–0.48, p<0.001) and rural (AOR = 0.40, 95% CI = 0.21–0.75, p<0.01) school was significantly associated with reduced odds of practicing good menstrual hygiene. Good knowledge of menstruation was associated with increased odds of good hygiene practices (AOR = 4.31, 95% CI = 2.39–7.90, p<0.001). Qualitative results showed that teachers provided adolescents with more detailed biological information on menstruation than key informants (family members) did at menarche. However, both teachers and family members spoke positively of menstruation to adolescent girls. Social and religious beliefs indicate that menstruation is evil and unclean. Such beliefs influenced community members' attitudes towards adolescent girls and led to practices such as isolating menstruating girls and limiting their ability to interact and participate in certain community and religious activities. Conclusion: Despite the prominence of negative social and religious beliefs about menstruation, good menstrual hygiene practice was high among study participants. Knowledge of menstruation; place of residents; and type of school were the major factors associated with good menstrual hygiene practice. It is therefore, necessary to intensify the School Health Education Program in both rural and urban public and intensively involve private schools as well to ensure equal access to accurate information on menstruation and good menstrual hygiene practices among adolescent girls. [ABSTRACT FROM AUTHOR]

Acknowledgements We thank the national NTD programmes, regional and district health staff and community health workers for their tireless determination and efforts towards the control and elimination of neglected tropical diseases. Neglected tropical disease elimination is a relay race - let's not drop the baton How has the Ascend programme contributed to strengthening health systems for sustainable country-driven neglected tropical disease programming? Keywords: behaviour change; COVID response; elimination; health systems; neglected tropical diseases; supply chains; West and Central Africa EN behaviour change COVID response elimination health systems neglected tropical diseases supply chains West and Central Africa ii1 ii6 6 10/14/22 20220902 NES 220902 Background The timelines for eliminating neglected tropical diseases (NTDs) are relatively short in comparison to the millennia that these diseases have plagued communities, yet within our lifetime, several countries have successfully eliminated diseases through focused and concerted public health campaigns. [Extracted from the article]

Background: Vulnerable populations such as rural and urban-slum dwellers are more likely to suffer greatly from the deleterious effects of the novel Coronavirus disease 2019 (COVID-19). However, in Ghana, most COVID-19 mitigating packages are not focused on vulnerable populations. Methods: Concurrent mixed methods design was used to examine the socio-economic and health effects of COVID-19 among rural and urban-slum dwellers in Ghana. Four hundred respondents were sampled for the quantitative arm of the study, while 46 In-depth Interviews (IDIs) were conducted with community members and government officials. Sixty-four community members participated in Focus Group Discussions (FGDs) and non-participant observation was carried out for three months. Quantitative data were analysed using frequencies, percentages, Pearson Chi2 and ordered logistic regression. Interviews were recorded using digital recorders and later transcribed. Transcribed data (IDIs, FGDs) and observation notes were uploaded onto a computer and transferred to qualitative software NVivo 12 to support thematic coding and analysis. Results: Majority of the respondents confirmed the deleterious socio-economic and health effects of COVID-19 on jobs and prices of food. Other effects were fear of visiting a health facility even when unwell, depression and anxiety. Young people (18–32 years), males, urban-slum dwellers, married individuals, the employed and low-income earners (those who earn GHC10/$1.7 to GHC100/ $17), were more likely to suffer from the socio-economic and health effects of COVID-19. Urban-slum dwellers coped by relying on family and social networks for food and other basic necessities, while rural dwellers created locally appropriate washing aids to facilitate hand washing in the rural communities. Conclusion: COVID-19 and the government's mitigation measures had negative socio-economic and health effects on vulnerable communities. While vulnerable populations should be targeted for the government's COVID-19 mitigating packages, special attention should be given to young people (18–32 years), males, urban-slum dwellers, married individuals and low-income earners. Communities should be encouraged to maintain coping strategies adopted even after COVID-19. [ABSTRACT FROM AUTHOR]

Lymphatic filariasis (LF) is endemic in approximately 80 tropical and subtropical countries. About 120 million people are infected with the parasite and a billion are estimated to be at risk of infection. The main focus of the LF elimination programme to date has been to interrupt transmission by means of annual community-wide treatment campaigns with diethylcarbamazine and albendazole, or albendazole and ivermectin, for a period of four to six years. Although substantial progress has been recorded wherever the strategy has been successfully implemented, initial gains have been accompanied by a realization that this strategy alone will not ensure a permanent solution in all settings. The fairly extensive LF literature is dominated by laboratory research and quantitative field measurement of the impact of LF, particularly local prevalence studies of parasite-infected humans and vectors. As the global elimination programme expands, the absence of sociocultural understanding is being recognized as a critical flaw in ensuring that programmes are appropriate and responsive to local needs and understanding. This paper assesses the current state of sociocultural understanding pertaining to LE It concludes that, at present, there is insufficient understanding of the sociocultural factors associated with the presence and treatment of the disease, and that appropriate social science methods should be used to address this deficiency and ensure community partnership in delivering and sustaining the success of LF elimination programmes. La filariose lymphatique (FL) est endemique dans environ 80 pays tropicaux et subtropicaux. Quelque 120 millions de personnes sont infestees par le parasite responsable de cette maladie et on estime a pres d&apos;un milliard le nombre de celles exposees au risque d&apos;infestation. A ce jour, l&apos;axe d&apos;intervention principal du programme d&apos;elimination de la FL consistait a interrompre la transmission de la maladie par des series sur quatre a six ans de campagnes annuelles de traitement des communautes par l&apos;association diethylcarbamazinelalbendazole ou l&apos;association albendazolel ivermectine. Tout en enregistrant des succes substantiels partout ou ils avaient reussi a appliquer cette strategie, les responsables du programme ont neanmoins compris que celle-ci n&apos;apporterait pas seule une solution durable dans tous les contextes. La litterature relativement abondante sur la FL comprend principalement des travaux de recherche sur cette maladie et des evaluations quantitatives sur le terrain de son impact (notamment des etudes sur la prevalence locale des infestations humaine et vectorielle). A mesure que le programme d&apos;elimination mondiale de la filariose lymphatique se developpe, les responsables reconnaissent de plus en plus l&apos;absence de comprehension des aspects socioculturels de la maladie comme une lacune redhibitoire pour la mise au point de programmes adaptes et repondant aux perceptions et aux besoins locaux. Le present article evalue l&apos;etat actuel des connaissances sur les elements socioculturels associes a la LF. Sa conclusion est que la comprehension actuelle des facteurs socioculturels lies a la presence et au traitement de cette maladie est insuffisante et qu&apos;il faut recourir a des methodes appropriees, du domaine des sciences sociales, pour combler cette lacune et pour s&apos;assurer de la participation des communautes a la delivrance des programmes d&apos;elimination de la LF et au maintien de leur succes. La filariasis linfatica es endemica en aproximadamente 80 paises tropicales y subtropicales. Alrededor de 120 millones de personas estan infectadas por el parasito que la causa, y se estima que unos mil millones estan expuestas al riesgo de infeccion. EI principal objetivo del programa de eliminacion de la filariasis linfatica hasta la fecha ha sido la interrupcion de la transmision mediante campanas de tratamiento anuales a escala comunitaria con dietilcarbamazina y albendazol, o bien albendazol e ivermectina, durante un periodo de cuatro a sels anos. Aunque se han registrado grandes progresos en todos los lugares donde se ha conseguido aplicar eficazmente esa estrategia, paralelamente a las mejoras iniciales ha habido que reconocer que por si sola la estrategia no garantizara la continuidad de los resultados en todos los entornos. La bibliografia sobre la filariasis linfatica, bastante extensa, esta dominada por las investigaciones de laboratorio y la medicion cuantitativa sobre el terreno del impacto de la enfermedad, en particular por estudios sobre la prevalencia local en poblaciones humanas y de vectores infectadas por el parasito. Conforme se amplia el programa mundial de eliminacion, la ausencia de datos sobre el contexto sociocultural se esta revelando como un obstaculo fundamental para articular unos programas apropiados y con capacidad de respuesta a las necesidades y las ideas locales. En este articulo se evalua el estado actual de los conocimientos sobre el entorno sociocultural de la filariasis linfatica. Se llega a la conclusion de que por el momento no se conocen suficientemente los factores socioculturales asociados a la presencia y el tratamiento de la enfermedad, y de que deberian utilizarse los metodos sociologicos oportunos para corregir esa deficiencia y asegurar la colaboracion de la comunidad en la ejecucion de los programas de eliminacion de la filariasis linfatica y el mantenimiento del exito con ellos logrado. [TEXT NOT REPRODUCIBLE IN ASCII], Introduction Lymphatic filariasis (LF), the second most common vector-borne parasitic disease after malaria, is found in over 80 tropical and subtropical countries. WHO estimates that 120 million people are infected [...]

Background: Intermittent preventive treatment of malaria among pregnant women with sulfadoxine-pyrimethamine (IPTp-SP), is one of the three recommended interventions for the prevention of malaria in pregnancy (MiP) in sub-Sahara Africa. The World Health Organisation recommended in 2012 that SP be given at each scheduled ANC visit except during the first trimester and can be given a dose every month until the time of delivery, to ensure that a high proportion of women receive at least three doses of SP during pregnancy. Despite implementation of this policy, Ghana did not attain the target of 100% access to IPTp-SP by 2015. Additionally, negative outcomes of malaria infection in pregnancy are still recurring. This ethnographic study explored how health system, individual and socio-cultural factors influence IPTp-SP uptake in two Ghanaian regions. Methods: The study design was ethnographic, employing non-participant observation, case studies and in depth interviews in 8 health facilities and 8 communities, from April 2018 to March 2019, in two Ghanaian regions. Recommended ethical procedures were observed. Results: Health system factors such as organization of antenatal care (ANC) services and strategies employed by health workers to administer SP contributed to initial uptake. Women's trust in the health care system contributed to continued uptake. Inadequate information provided to women accessing ANC, stock-outs and fees charged for ANC services reduced access to IPTp-SP. Socio-cultural factor such as encouragement from social networks influenced utilization of ANC services and IPTp-SP uptake. Individual factors such as refusing to take SP, skipping ANC appointments and initiating ANC attendance late affected uptake. Conclusion: Health system, socio-cultural and individual factors influence uptake of optimum doses of IPTp-SP. Consequently, interventions that aim at addressing IPTp-SP uptake should focus on regular and sufficient supply of SP to health facilities, effective implementation of free ANC, provision of appropriate and adequate information to women and community outreach programmes to encourage early and regular ANC visits. [ABSTRACT FROM AUTHOR]

Abstract Background Ghana is a Buruli ulcer (BU) endemic country yet there is paucity of socio-cultural research on BU. Examining distinctive experiences and meanings for pre-ulcers and ulcers of BU may clarify the disease burden, illness experience and local perceptions of causes and spread, and environmental features of BU, which are useful to guide public health programmes and future research. This study aimed to explain local meanings and experiences of BU for persons with pre-ulcers and ulcers in the Ga-West and Ga-South municipalities in Accra. Methods Semi-structured interviews based on the Explanatory Model Interview Catalogue framework were administered to 181 respondents comprising 15 respondents with pre-ulcers and 166 respondents with ulcers. The Wilcoxon rank-sum test was used to compare categories of illness experiences (PD) and perceived causes (PC) among respondents with pre-ulcer and ulcer conditions. The Fisher’s exact test was used to compare the most troubling PD and the most important PC variables. Qualitative phenomenological analysis of respondents’ narratives clarified illness experiences and meanings with reference to PC and PD variables. Results Families of respondents with pre-ulcers and the respondents themselves were often anxious about disease progression, while families of respondents with ulcers, who had to give care, worried about income loss and disruption of school attendance. Respondents with pre-ulcers frequently reported swimming in ponds and rivers as a perceived cause and considered it as the most important PC (53.3%). Respondents with ulcers frequently attributed their BU illness to witchcraft (64.5%) and respondents who claimed they had no water contact, questioned the credibility of health messages Conclusions Affected persons with pre-ulcers are likely to delay treatment because of social and financial constraints and the absence of pain. Scepticism on the role of water in disease contagion and prolonged healing is perceived to make ideas of witchcraft as a PC more credible, among respondents with ulcers. Health messages should address issues of locally perceived risk and vulnerability. Guided by study findings, further research on the role of environmental, socio-cultural and genetic factors in BU contagion, is also needed to clarify and formulate health messages and strengthen public health initiatives.

Abstract Background Effective implementation of child survival interventions depends on improved understanding of cultural, social, and health system factors affecting utilization of health care. Never the less, no standardized instrument exists for collecting and interpreting information on how to avert death and improve the implementation of child survival interventions. Objective To describe the methodology, development, and first results of a standard social autopsy tool for the collection of information to understand common barriers to health care, risky behaviors, and missed opportunities for health intervention in deceased children under 5 years old. Methods Under the INDEPTH Network, a social autopsy working group was formed to reach consensus around a standard social autopsy tool for neonatal and child death. The details around 434 child deaths in Iganga/Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda and 40 child deaths in Dodowa HDSS in Ghana were investigated over 12 to 18 months. Interviews with the caretakers of these children elicited information on what happened before death, including signs and symptoms, contact with health services, details on treatments, and details of doctors. These social autopsies were used to assess the contributions of delays in care seeking and case management to the childhood deaths. Results At least one severe symptom had been recognized prior to death in 96% of the children in Iganga/Mayuge HDSS and in 70% in Dodowa HDSS, yet 32% and 80% of children were first treated at home, respectively. Twenty percent of children in Iganga/Mayuge HDSS and 13% of children in Dodowa HDSS were never taken for care outside the home. In both countries most went to private providers. In Iganga/Mayuge HDSS the main delays were caused by inadequate case management by the health provider, while in Dodowa HDSS the main delays were in the home. Conclusion While delay at home was a main obstacle to prompt and appropriate treatment in Dodowa HDSS, there were severe challenges to prompt and adequate case management in the health system in both study sites in Ghana and Uganda. Meanwhile, caretaker awareness of danger signs needs to improve in both countries to promote early care seeking and to reduce the number of children needing referral. Social autopsy methods can improve this understanding, which can assist health planners to prioritize scarce resources appropriately.

Abstract Background Health care demand studies help to examine the behaviour of individuals and households during illnesses. Few of existing health care demand studies examine the choice of treatment services for childhood illnesses. Besides, in their analyses, many of the existing studies compare alternative treatment options to a single option, usually self-medication. This study aims at examining the factors that influence the choices that caregivers of children under-five years make regarding treatment of fevers due to malaria and pneumonia in a rural setting. The study also examines how the choice of alternative treatment options compare with each other. Methods The study uses data from a 2006 household socio-economic survey and health and demographic surveillance covering caregivers of 529 children under-five years of age in the Dangme West District and applies a multinomial probit technique to model the choice of treatment services for fevers in under-fives in rural Ghana. Four health care options are considered: self-medication, over-the-counter providers, public providers and private providers. Results The findings indicate that longer travel, waiting and treatment times encourage people to use self-medication and over-the-counter providers compared to public and private providers. Caregivers with health insurance coverage also use care from public providers compared to over-the-counter or private providers. Caregivers with higher incomes use public and private providers over self-medication while higher treatment charges and longer times at public facilities encourage caregivers to resort to private providers. Besides, caregivers of female under-fives use self-care while caregivers of male under-fives use public providers instead of self-care, implying gender disparity in the choice of treatment. Conclusions The results of this study imply that efforts at curbing under-five mortality due to malaria and pneumonia need to take into account care-seeking behaviour of caregivers of under-fives as well as implementation of strategies.