Browsing by Author "Nakua, Emmanuel"

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    Community-Based Management of Acute Malnutrition Programme: Rural and Urban Maternal Socio-Demographic and Implementation Differentials in Ghana
    (Journal of Food Science and Nutrition Research, 2022-05-19) Apenkwa, Joana; Amponsah, Samuel Kofi; Edusei, Anthony; Nakua, Emmanuel; Newton, Sam; Otupiri, Easmon; Adaobi, Chukwuma Chinaza; 0000-0001-8986-1648
    Malnutrition is a public health problem in Ghana, and is estimated to contribute indirectly to more than half of under-five deaths. This study was designed to describe how implementation of the Community based Management of Malnutrition (CMAM) programme in Ghana differs in the rural and urban parts of the country. A mixed methods approach was used in a community-based survey that studied 497 mothers/caregivers and under-five pairs quantitatively, 25 health service providers qualitatively, and 25 mothers caregivers qualitatively. Quantitative data were analysed descriptively with Stata 14.0 (Stata Corp, Texas, USA) while the qualitative data were analysed thematically with Atlas.ti, version 7.5 (Scientific Software Development GmbH, Berlin). Programme implementation was assessed using the following variables: availability of CMAM tools, availability of CMAM supplies, organization of out-patient therapeutic and supplementary feeding programmes, personnel availability, availability of community-based components of CMAM and maternal experience with CMAM services. While the number of children alive, provision of nutrition education and counselling, and demonstration of food preparation significantly influenced program effectiveness (p<0.05) in the urban site, no variables were found to do similar in the rural district. The rural facilities were more likely than the urban ones to be without tools. Less than 10% of mothers/caregivers in both study sites acknowledged the availability of the community-based components of CMAM. Programme implementation in the two study districts is poor; in order to ensure that the CMAM intervention translates into a reduced malnutrition burden among children under-five in Ghana, the programme implementation should be revised to address the identified shortcomings.
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    Comparison of childhood household injuries and risk factors between urban and rural communities in Ghana: A cluster-randomized, population-based, survey to inform injury prevention research and programming
    (Injury, 2021) Stewart, Barclay; Gyedu, Adam; Otupiri, Easmon; Nakua, Emmanuel; Boakye, Godfred; Mehta, Kajal; Donkor, Peter; Mock, Charles; 0000-0001-8986-1648
    Background: Childhood household injuries incur a major proportion of the global disease burden, particularly in low- and middle-income countries (LMICs). However, household injury hazards are differentially distributed across developed environments. Therefore, we aimed to compare incidence of childhood household injuries and prevalence of risk factors between communities in urban and rural Ghana to inform prevention initiatives.Methods: Data from urban and a rural cluster-randomized, population-based surveys of caregivers of children <5 years in Ghana were combined. In both studies, caregivers were interviewed about childhood injuries that occurred within the past 6 months and 200 meters of the home that resulted in missed school/work, hospitalization, and/or death. Sampling weights were applied, injuries and incidence rate ratios (IRRs) were described, and multi-level regression was used to identify and compare risk factors. Results: We sampled 200 urban and 357 rural households that represented 20,575 children in Asawase and 14,032 children in Amakom, Ghana, respectively. There were 143 and 351 injuries in our urban and rural samples, which equated to 594 and 542 injuries per 1,000 child-years, respectively (IRR 1.09, 95%CI 1.05-1.14). Toddler-aged children had the highest odds of injury both urban and rural communities (OR 3.77 vs 3.17, 95%CI 1.34-10.55 vs 1.86-5.42 compared to infants, respectively). Urban children were more commonly injured by falling (IRR 1.50, 95%CI 1.41-1.60), but less commonly injured by flame/hot sub stances (IRR 0.51, 95%CI 0.44-0.59), violence (IRR 0.41, 95%CI 0.36-0.48), or motor vehicle (IRR 0.50, 95%CI 0.39-0.63). Rural households that cooked outside of the home (OR 0.36, 95%CI 0.22-0.60) and that also supervised older children (OR 0.33, 95%CI 0.17-0.62) had lower odds of childhood injuries than those that did not. Conclusions: Childhood injuries were similarly common in both urban and rural Ghana, but with different patterns of mechanisms and risk factors that must be taken into account when planning prevention strategies. However, the data suggest that several interventions could be effective, including: community-based, multi-strategy initiatives (e.g., home hazard reduction, provision of safety equipment, establishing community creches); traffic calming interventions in rural community clusters; and passive injury surveillance systems that collect data to inform violence and broader prevention strategies.
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    Coverage Assessment for Community-Based Management of Acute Malnutrition In Rural and Urban Ghana: A Comparative Cross-Sectional Study
    (Journal of Food Science and Nutrition Research, 2022) Apenkwa, Joana; Amponsah, Samuel K.; Newton, K. Sam; Osei-Antwi, Reuben; Nakua, Emmanuel; Edusei, Anthony K.; Otupiri, Easmon; 0000-0001-8986-1648
    Background: Ghana for years has implemented the Community-based Management of Acute Malnutrition (CMAM) to reduce malnutrition in children. However, the prevalence of malnutrition remains high. This study aimed to determine CMAM coverage levels in the Ahafo Ano South (AAS), a rural district and Kumasi Subin sub-metropolis (KSSM), an urban district. Methods: The study was a cross-sectional comparative study with a mixed-methods approach. In all, 497 mothers/caregivers and children under-five were surveyed using a quantitative approach while qualitative methods were used to study 25 service providers and 40 mothers/ caregivers who did not participate in the quantitative survey. Four types of coverage indicators were assessed: point coverage (defined as the number of Severe Acute Malnutrition cases [SAM] in treatment divided by total number of Severe Acute Malnutrition cases in the study district), geographical coverage (defined as total number of health facilities delivering treatment for SAM divided by total number of healthcare facilities in the study district), treatment coverage (defined as children with SAM receiving therapeutic care divided by total number of SAM children in the study district) and programme coverage (defined as number of SAM cases in the CMAM programme ÷ Number of SAM cases that should be in the programme). The qualitative approach was used to support the assessment of the coverage indicators. Data were analyzed using STATA version 14, and Atlas.ti, version 7.5 for the quantitative and qualitative data respectively. Results: Geographically, only 6% of the facilities in the urban communities were participating in the CMAM programme as against 29% of rural district facilities. The districts had point coverage of 41% and 10% for the urban and rural districts respectively. The urban setting recorded a SAM prevalence of 52% as against 36% in the rural setting. The proportion of SAM children enrolled in CMAM was higher in KSSM as compared to AAS; 41% and 33% respectively. In both districts, the most likely factors to attract mothers/caregivers to utilize the CMAM services were: ‘free services’ and ‘a cured child.’ The qualitative approach showed that coverage improvement in both districts is hampered by distance, transportation cost, lack of trained personnel in the communities for community mobilization home visits and insufficient feeds. Conclusion: To improve CMAM coverage, there is the need to train health workers to embark on aggressive health education strategies to encourage mothers/caregivers of malnourished children to utilize CMAM while ensuring that services reach those who need them.
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    Does the data tell the true story? A modelling assessment of early COVID-19 pandemic suppression and mitigation strategies in Ghana
    (Plose One, 2021) Frempong, Nana Kena; Acheampong, Theophilus; Apenteng, Ofosuhene O.; Nakua, Emmanuel; Amuasi,; 0000-0002-7138-3526
    This paper uses publicly available data and various statistical models to estimate the basic reproduction number (R0) and other disease parameters for Ghana’s early COVID-19 pan demic outbreak. We also test the effectiveness of government imposition of public health measures to reduce the risk of transmission and impact of the pandemic, especially in the early phase. R0 is estimated from the statistical model as 3.21 using a 0.147 estimated growth rate [95% C.I.: 0.137–0.157] and a 15-day time to recovery after COVID-19 infection. This estimate of the initial R0 is consistent with others reported in the literature from other parts of Africa, China and Europe. Our results also indicate that COVID-19 transmission reduced consistently in Ghana after the imposition of public health interventions—such as border restrictions, intra-city movement, quarantine and isolation—during the first phase of the pandemic from March to May 2020. However, the time-dependent reproduction number (Rt) beyond mid-May 2020 does not represent the true situation, given that there was not a consistent testing regime in place. This is also confirmed by our Jack-knife bootstrap esti mates which show that the positivity rate over-estimates the true incidence rate from mid May 2020. Given concerns about virus mutations, delays in vaccination and a possible new wave of the pandemic, there is a need for systematic testing of a representative sample of the population to monitor the reproduction number. There is also an urgent need to increase the availability of testing for the general population to enable early detection, isolation and treatment of infected individuals to reduce progression to severe disease and mortality