ghanaopendata/ghanaian-research-english huggingface dataset:
Cost-effectiveness of rotavirus vaccination in Ghana: Examining impacts from 2012 to 2031

Background: Diarrhea causes about 10% of all deaths in children under five years globally, with rotavirus causing about 40% of all diarrhea deaths. Ghana introduced rotavirus vaccination as part of routine immunization in 2012 and it has been shown to be effective in reducing disease burden in children under five years. Ghana's transition from low to lower-middle income status in 2010 implies fewer resources from Gavi as well as other major global financing mechanisms. Ghana will soon bear the full cost of vaccines. The aim of this study was to estimate the health impact, costs and cost-effectiveness of rotavirus vaccination in Ghana from introduction and beyond the Gavi transition. Methods: The TRIVAC model is used to estimate costs and effects of rotavirus vaccination from 2012 through 2031. Model inputs include demographics, disease burden, health system structure, health care utilization and costs as well as vaccine cost, coverage, and efficacy. Model inputs came from local data, the international literature and expert consultation. Costs were examined from the health system and societal perspectives. Results: The results show that continued rotavirus vaccination could avert more than 2.2 million cases and 8900 deaths while saving US$6 to US$9 million in costs over a 20-year period. The net cost of vaccination program is approximately US$60 million over the same period. The societal cost per DALY averted is US$238 to US$332 with cost per case averted ranging from US$27 to US$38. The cost per death averted is approximately US$7000. Conclusion: The analysis shows that continued rotavirus vaccination will be highly cost-effective, even for the period during which Ghana will assume responsibility for purchasing vaccines after transition from Gavi support. © 2017 The Authors

Source: UG
Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana

Background: In Ghana, malaria is endemic and perennial (with significant seasonal variations in the three Northern Regions), accounting for 33 % of all deaths among children under 5 years old, with prevalence rates in children under-five ranging from 11 % in Greater Accra to 40 % in Northern Region. Ghana adopted the WHO-recommended Seasonal Malaria Chemoprevention (SMC) strategy with a trial in the Upper West Region in 2015. The objective of this study was to estimate the cost-effectiveness of seasonal malaria chemoprevention. Methods: Costs were analysed from provider and societal perspectives and are reported in 2015 US$. Data on resource use (direct and indirect costs) of the SMC intervention were collected from intervention records and a survey in all districts and at regional level. Additional numbers of malaria cases and deaths averted by the intervention were estimated based on prevalence data obtained from an SMC effectiveness study in the region. Incremental cost-effectiveness ratios (ICERs) were estimated for the districts and region. Sensitivity analyses were conducted to test the robustness of the ICERs. Results: The total financial cost of the intervention was US$1,142,040.80. The total economic cost was estimated to be US$7.96 million and US$2.66 million from the societal and provider perspectives, respectively. The additional numbers of cases estimated to be averted by the intervention were 24,881 and 808, respectively. The economic cost per child dosed was US$67.35 from societal perspective and US$22.53 from the provider perspective. The economic cost per additional case averted was US$107.06 from the provider perspective and US$319.96 from the societal perspective. The economic cost per additional child death averted by the intervention was US$3298.36 from the provider perspective and US$9858.02 from the societal perspective. The financial cost per the SMC intervention delivered to a child under-five was US$9.66. The ICERs were sensitive to mortality rate used. Conclusions: The SMC intervention is economically beneficial in reducing morbidity in children under-5 years and presents a viable approach to improving under-five health in Ghana.

Source: UG
Costs and Extra Length of Stay because of Neonatal Bloodstream Infection at a Teaching Hospital in Ghana.

There are no published studies on the costs of hospital-acquired neonatal bloodstream infection (BSI) in Ghana. Therefore, this study aims to calculate the cost and extra length of stay (LOS) of neonatal BSI. A prospective case–control study was undertaken at the neonatal intensive care unit (NICU) of Korle Bu Teaching Hospital (KBTH) in Ghana. Methods The clinical data of 357 neonates were prospectively analysed. Overall, 100 neonates with BSI and 100 control neonates without BSI were matched by weight, sex and type of delivery. The direct and indirect costs to neonates and their caregivers was obtained on a daily basis. The cost of drugs was confrmed with the Pharmacy Department at KBTH. A count data model, specifcally negative binomial regression, was employed to estimate the extra LOS in the NICU due to neonatal BSI. The study analyzed the total, average and marginal costs of neonatal BSI for the case and control groups from the perspective of the patients/carers/providers. Fifty-four percent of the total sample were born with a low birth weight. Neonates with BSI recorded higher costs compared with neonates without BSI. The highest diference in direct costs was recorded among neonates with extremely low birth weight (US$732), which is 67% higher than similar neonates without BSI. The regression estimates show a signifcant correlation between neonatal BSI and LOS in the NICU (p<0.001). Neonates with BSI stayed an additional 10 days in the NICU compared with their matched cohort. The LOS varies signifcantly depending on the neonate’s weight at birth. The extra days range from 1 day for neonates defned as macrosomia to 15 extra days for extremely low birth weight neonates. Neonatal BSI was signifcantly associated with prolonged LOS. The continuous presence of experienced medical staf, as well as parents, to monitor newborns during their stay on the ward has enormous economic burden on both hospitals and caregivers

Source: UG
Costs and psychosocial burden of tuberculosis to the treatment supporters in Ghana

Objectives: Tuberculosis treatment supporters contribute crucially to tuberculosis control and prevention without financial compensation. The World Health Organization recommends direct observation of treatment, involving supporters who incurred costs for frequent health facility visits and waiting times, potentially impacting their socio-economic status. This study aims to inform tuberculosis control and prevention policy by determining the costs and psychosocial burden associated with treatment support. Methods: A cross-sectional cost-of-illness approach, data from 385 supporters were collected through validated questionnaires. Both direct and indirect costs were assessed, with psychosocial burden measured using the Zarit Burden Interview (ZBI) 12-item questionnaire. Results: Results reveal that, on average, supporters spent GHS 122.4 (US$21.1) monthly, constituting 19 % of their income. A significant 77.1 % experienced a high burden on the ZBI scale, with females facing a greater burden than males. Socio-demographic factors such as education, household size, income, and district of resi dence influenced both direct and indirect costs. Conclusion: In conclusion, the study underscores the substantial costs and psychosocial burden on tuberculosis treatment supporters and recommends extending the livelihood empowerment against poverty program in Ghana to cover treatment support costs.

Source: UG
Costs associated with implementation of computer-assisted clinical decision support system for antenatal and delivery care: Case study of Kassena-Nankana district of northern Ghana

Objective: This study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS) in selected health care centres in Ghana. Methods: A descriptive cross sectional study was conducted in the Kassena-Nankana district (KND). CDSS was deployed in selected health centres in KND as an intervention to manage patients attending antenatal clinics and the labour ward. The CDSS users were mainly nurses who were trained. Activities and associated costs involved in the implementation of CDSS (pre-intervention and intervention) were collected for the period between 2009-2013 from the provider perspective. The ingredients approach was used for the cost analysis. Costs were grouped into personnel, trainings, overheads (recurrent costs) and equipment costs (capital cost). We calculated cost without annualizing capital cost to represent financial cost and cost with annualizing capital costs to represent economic cost. Results: Twenty-two trained CDSS users (at least 2 users per health centre) participated in the study. Between April 2012 and March 2013, users managed 5,595 antenatal clients and 872 labour clients using the CDSS. We observed a decrease in the proportion of complications during delivery (pre-intervention 10.74% versus post-intervention 9.64%) and a reduction in the number of maternal deaths (pre-intervention 4 deaths versus post-intervention 1 death). The overall financial cost of CDSS implementation was US$ 23,316, approximately US$1,060 per CDSS user trained. Of the total cost of implementation, 48% (US$11,272) was pre-intervention cost and intervention cost was 52% (US$12,044). Equipment costs accounted for the largest proportion of financial cost: 34% (US$7,917). When economic cost was considered, total cost of implementation was US$17,128-lower than the financial cost by 26.5%. Conclusions: The study provides useful information in the implementation of CDSS at health facilities to enhance health workers' adherence to practice guidelines and taking accurate decisions to improve maternal health care.

Source: UG
Costs of HIV⁄AIDS outpatient services delivered through Zambian public health facilities

objective To present evidence on unit and total costs of outpatient HIV ⁄ AIDS services in ZPCT supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV ⁄ AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother-to child transmission (PMTCT) in Zambia. methods Cost data from 2008 were collected in 12 ZPCT-supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV ⁄ AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009. results Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First-year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT-supported facilities were estimated at US$14.7–$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0–114.2 million for ART and US$57.7 million for ANC including PMTCT. conclusions Consistent with the literature, total costs of services were dominated by drugs, labora tory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility-level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening.

Source: UG
The costs of living in the city: influence of urbanization on the trophic niche and body condition of the African rainbow lizard Agama picticauda

Trophic niche is a fundamental aspect of the ecology and natural history of animals, influencing their behavior, health, survival, and population dynamics. Although urbanization can strongly affect the trophic niche of wildlife by altering prey availability, abundance, and distribution, this effect remains understudied in tropical reptiles. Here, we assessed the influence of urbanization on the trophic niche and body condition of the West African rainbow lizard Agama picticauda in the Accra Plains of Ghana. Gastrointestinal content analysis of 98 lizards sampled from urban, suburban, and rural areas revealed 1088 prey items belonging to 14 orders and ~47 families of arthropods. Generally, the lizards consumed insects, with Hymenoptera (Formicidae) and Coleoptera (Carabidae) being the most frequently consumed prey orders. Multinomial regression modeling indicated that sex and site strongly affected the diet and body condition of the lizards, with suburban and rural lizards scoring the highest and lowest on both trophic niche breadth and body condition, respectively. We found a weak positive association between body condition and the diversity of ingested prey orders. Our data indicated that urbanization negatively influenced the trophic niche and body condition of A. picticauda. Although the differences in body condition among sites were not statistically significant, these could have important biological ramifications. The negative body condition of the urban female lizards suggests that the city could be an ecological trap, which can reduce the long-term fitness of lizards living in the urban area. Our findings can inform urban land use planning and effective conservation of urban habitats. We caution, however, that the findings of this study may not necessarily reflect the long-term trophic dynamics of rainbow lizards in the Accra Plains of Ghana and other cities.

Source: UG
Costs, effects and cost-effectiveness of breast cancer control in Ghana

OBJECTIVE: Breast cancer control in Ghana is characterised by low awareness, late-stage treatment and poor survival. In settings with severely constrained health resources, there is a need to spend money wisely. To achieve this and to guide policy makers in their selection of interventions, this study systematically compares costs and effects of breast cancer control interventions in Ghana. METHODS: We used a mathematical model to estimate costs and health effects of breast cancer interventions in Ghana from the healthcare perspective. Analyses were based on the WHO-CHOICE method, with health effects expressed in disability-adjusted life years (DALYs), costs in 2009 US dollars (US$) and cost-effectiveness ratios (CERs) in US$ per DALY averted. Analyses were based on local demographic, epidemiological and economic data, to the extent these data were available. RESULTS: Biennial screening by clinical breast examination (CBE) of women aged 40-69 years, in combination with treatment of all stages, seems the most cost-effective intervention (costing $1299 per DALY averted). The intervention is also economically attractive according to international standards on cost-effectiveness. Mass media awareness raising (MAR) is the second best option (costing $1364 per DALY averted). Mammography screening of women of aged 40-69 years (costing $12,908 per DALY averted) cannot be considered cost-effective. CONCLUSIONS: Both CBE screening and MAR seem economically attractive interventions. Given the uncertainty about the effectiveness of these interventions, only their phased introduction, carefully monitored and evaluated, is warranted. Moreover, their implementation is only meaningful if the capacity of basic cancer diagnostic, referral and treatment and possibly palliative services is simultaneously improved.

Source: UG
Could cost sharing sustain the Ghana National Health Insurance Scheme?

This paper estimates the effect of cost sharing on the sustainability of the Ghana National Health Insurance Scheme (NHIS) from the point of view of enrollment, utilization, and financing. We use data from a nationwide survey to estimate the retention of subscribers and propensity to utilize the scheme's benefit package under a cost sharing policy. The estimates from the survey are used together with data on the Ghana NHIS, to estimate the patronage, and financial status of the Ghana NHIS had cost sharing been introduced. The result indicates that a 5% cost sharing rate would have kept the scheme in surplus between 2007 and 2015. In addition, the 5% cost sharing rate would have led to virtually no change in enrollment and would have reduced utilization rate by about 15%. It is also found that women have higher enrollment and utilization of health insurance than men under cost sharing.

Source: UG
Could nuclear matrix protein 22 (NMP22) play a role with urine cytology in screening for bladder cancer? - Experience at Kuwait University

Objectives: This prospective study was undertaken to evaluate nuclear matrix protein (NMP22) compared to urine cytology in the detection of bladder cancer and also to determine whether indexing suspicious cytology to NMP22 could enhance the clinical utility of cytology. Methods: Cytological findings of voided urine collected prior to a cystoscopic biopsy were correlated with urine NMP22 assay in 46 patients attending the urology clinic in Mubarak Al-Kabeer Hospital. The patients were clinically categorized into newly diagnosed cases of transitional cell carcinoma (TCC), recurrent TCC, TCC in remission and controls. Results: Using histological diagnosis as the gold standard the sensitivity and specificity of NMP22 were 78% and 43% respectively and of cases with malignant urine cytology were 30% and 87% respectively. If suspicious and malignant cytology were combined as positive results the sensitivity increased significantly to 87% while the specificity decreased but not significantly to 74%. Suspicious or malignant cytology enhanced by positive NMP22 gave a sensitivity of 70% and specificity of 87% neither of which was significantly different from cytology alone. There were three false positive cases on cytology and 13 false positive cases on NMP22 assay. There were three false negative cytology and five false negative NMP22 cases but only one was false negative for both, resulting in a high sensitivity (96%) but low specificity (30%) if either positive NMP22 or malignant or suspicious cytology was taken as a positive result. Conclusion: Combining NMP22 with malignant or suspicious cytological result improved sensitivity for the detection of bladder cancer but with a major decrease in specificity, suggesting a potential role in screening rather than diagnosis.

Source: UG
Count every newborn; A measurement improvement roadmap for coverage data

Background: The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. Methods: In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. Results: ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. Conclusions: The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.

Source: UG
Counting adolescents in: the development of an adolescent health indicator framework for population-based settings

Changing realities in low- and middle-income countries (LMICs) in terms of inequalities, urbanization, globalization, migration, and economic adversity shape adolescent development and health, as well as successful transitions be tween adolescence and young adulthood. It is estimated that 90% of adolescents live in LMICs in 2019, but inade quate data exist to inform evidence-based and concerted policies and programs tailored to address the distinctive developmental and health needs of adolescents. Population-based data surveillance such as Health and Demographic Surveillance Systems (HDSS) and school-based surveys provide access to a well-defined population and provide cost-effective opportunities to fill in data gaps about adolescent health and well-being by collecting population representative longitudinal data. The Africa Research Implementation Science and Education (ARISE) Network, therefore, systematically developed adolescent health and well-being indicators and a questionnaire for measuring these indicators that can be used in population-based LMIC settings. We conducted a multistage collaborative and iterative process led by network members alongside consultation with health-domain and adolescent health experts globally. Seven key domains emerged from this process: socio-demographics, health awareness and behaviors; nutrition; mental health; sexual and reproductive health; substance use; and healthcare utilization. For each domain, we generated a clear definition; rationale for inclusion; sub-domain descriptions, and a set of questions for mea surement. The ARISE Network will implement the questionnaire longitudinally (i.e., at two time-points one year apart) at ten sites in seven countries in sub-Saharan Africa and two countries in Asia. Integrating the questionnaire within established population-based data collection platforms such as HDSS and school settings can provide measured experiences of young people to inform policy and program planning and evaluation in LMICs and improve adolescent health and well-being.

Source: UG