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Introduction The Coronavirus disease 2019 (COVID-19) burden, coupled with unprecedented control measures including physical distancing, travel bans, and lockdowns of cities, implemented to stop the spread of the virus, have undoubtedly far-reaching aftereffects on other diseases. In low and middle-income countries (LMICs), a particular worry is the potential impact on Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), as a consequence of possible disruption to health services and limiting access to needed life-saving health care. In Ghana, there is a paucity of information regarding the impact of COVID-19 on disease control, particularly TB and HIV control. This study sought to contribute to bridging this knowledge gap. Method The study involved the analysis of secondary data obtained from the District Health Information Management System-2 (DHIMS-2) database of Ghana Health Service, from 2016 to 2020. Data were analysed using an interrupted time-series regression approach to estimate the impact of COVID-19 on TB case notification, HIV testing, and Antiretroviral Therapy (ART) initiations, using March 2020 as the event period. Results The study showed that during the COVID-19 pandemic period, there was an abrupt decline of 20.5% (955CI: 16.0%, 24.5%) in TB case notifications in April and 32.7% (95%CI: 28.8%, 39.1%) in May 2020, with a median monthly decline of 21.4% from April-December 2020. A cumulative loss of 2,128 (20%; 95%CI: 13.3%, 26.7%) TB cases was observed nationwide as of December 2020. There was also a 40.3% decrease in people presenting for HIV tests in the first month of COVID-19 (April 2020) and a cumulative loss of 262620 (26.5%) HIV tests as of December 2020 attributable to the COVID-19 pandemic. ART initiations increased by 39.2% in the first month and thereafter decreased by an average of 10% per month from May to September 2020. Cumulatively, 443 (1.9%) more of the people living with HIV initiated ART during the pandemic period, however, this was not statistically significant. Conclusion This study demonstrated that the COVID-19 pandemic negatively impacted TB case notifications and HIV testing and counselling services, However, ART initiation was generally not impacted during the first year of the pandemic. Proactive approaches aimed at actively finding the thousands of individuals with TB who were missed in 2020 and increasing HIV testing and counselling and subsequent treatment initiations should be prioritised.

Rotavirus gastroenteritis causes many deaths in infants in sub-Saharan Africa. Because rotavirus vaccines have proven effective in developed countries but had not been tested in developing countries, we assessed efficacy of a pentavalent rotavirus vaccine against severe disease in Ghana, Kenya, and Mali between April, 2007, and March, 2009. In our multicentre, double-blind, placebo-controlled trial, undertaken in rural areas of Ghana and Kenya and an urban area of Mali, we randomly assigned infants aged 4–12 weeks without symptoms of gastrointestinal disorders in a 1:1 ratio to receive three oral doses of pentavalent rotavirus vaccine 2 mL or placebo at around 6 weeks, 10 weeks, and 14 weeks of age. Infants with HIV infection were not excluded. Randomisation was done by computer-generated randomisation sequence in blocks of six. We obtained data for gastrointestinal symptoms from parents on presentation to health-care facilities and clinical data were obtained prospectively by clinicians. The primary endpoint was severe rotavirus gastroenteritis (Vesikari score ≥11), detected by enzyme immunoassay, arising 14 days or more after the third dose of placebo or vaccine to end of study (March 31, 2009; around 21 months of age). Analysis was per protocol; infants who received scheduled doses of vaccine or placebo without intervening laboratory-confirmed naturally occurring rotavirus disease earlier than 14 days after the third dose and had complete clinical and laboratory results were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT00362648. 5468 infants were randomly assigned to receive pentavalent rotavirus vaccine (n=2733) or placebo (n=2735). 2357 infants assigned to vaccine and 2348 assigned to placebo were included in the per-protocol analysis. 79 cases of severe rotavirus gastroenteritis were reported in 2610·6 person-years in the vaccine group, compared with 129 cases in 2585·9 person-years in the placebo group, resulting in a vaccine efficacy against severe rotavirus gastroenteritis of 39·3% (95% CI 19·1–54·7, p=0·0003 for efficacy >0%). Median follow-up in both groups was 527 days starting 14 days after the third dose of vaccine or placebo was given. 42 (1·5%) of 2723 infants assigned to receive vaccine and 45 (1·7%) of 2724 infants assigned to receive placebo had a serious adverse event within 14 days of any dose. The most frequent serious adverse event was gastroenteritis (vaccine 17 [0·6%]; placebo 17 [0·6%]). Pentavalent rotavirus vaccine is effective against severe rotavirus gastroenteritis in the first 2 years of life in African countries with high mortality in infants younger than 5 years. We support WHO's recommendation for adoption of rotavirus vaccine into national expanded programmes on immunisation in Africa. PATH (GAVI Alliance grant) and Merck.

Background In 2019, the RTS,S/AS01 E malaria vaccine (RTS,S) was introduced into Ghana’s routine health system as part of the Malaria Vaccine Implementation Programme (MVIP). Household surveys were conducted prior to vaccine introduction and approximately 18 and 30 months post-introduction. We present a description of the area in Ghana based on the baseline household survey including malaria prevalence, malnutrition, wealth, insecticide-treated net (ITN) coverage, other health interventions (deworming, Vitamin A supplementation (VAS)), coverage of Expanded Programme on Immunization (EPI) vaccines, and health-seeking behaviour for febrile children. Methods The baseline household survey was conducted between 25 February and 18 March 2019 in a representative sample of 6778 households across 66 districts (33 in each of the implementing and comparator areas) in Ghana. Caregivers of children aged 5–48 months were interviewed. For each child, vaccination details were transcribed from the maternal and child health record book, and we measured the mid-upper arm circumference and obtained a malaria Rapid Diagnostic Test (RDT). Survey-weighted coverage estimates were obtained using standard survey methods. Survey Poisson regression was used to estimate prevalence ratios. Results Overall, 7768 children were included in the study, and 21% (95% CI 18–23) tested positive for malaria parasitemia by RDT. About 87%, 95%CI (85–89) of all households owned at least one ITN, and 62%, 95%CI (59–64) of children aged 5–48 months slept under an insecticide-treated net (ITN) the night before the survey. Additionally, 22%, 95%CI (21–24) of children reported having fever in the two weeks preceding the survey; among those with reported fever, 72%, 95%CI (69–74) sought advice or treatment, 40%, 95%CI (37–44) were tested for malaria, and 42%, 95%CI (39–46) of those with fever took an antimalarial drug. Additionally, 17%, 95%CI (16–19) had a mid-upper arm circumference (MUAC) ≤ 13.5 cm, and 1%, 95%CI (0–1) had a (MUAC) ≤ 11.5 cm. The uptake of vitamin A VAS in the 6 months prior to the survey was 36%, based on routine delivery through EPI, and deworming coverage was 29%. Coverage of EPI vaccines was > 90%. Indicators in comparison and implementation areas were comparable. Conclusions The pilot implementation and evaluation of the RTS,S malaria vaccine in Ghana was conducted in an area with substantial malaria transmission and illness, modest health-seeking behaviour and ITN use, and good EPI vaccine coverage. This study has established the baseline comparability between implementation and comparator areas, which serves as the foundation for future feasibility assessments.

Background The routine surveillance of asymptomatic malaria using nucleic acid-based amplification tests is essential in obtaining reliable data that would inform malaria policy formulation and the implementation of appropriate control measures. Methods In this study, the prevalence rate and the dynamics of Plasmodium species among asymptomatic children (n = 1697) under 5 years from 30 communities within the Hohoe municipality in Ghana were determined. Results and discussion The observed prevalence of Plasmodium parasite infection by polymerase chain reaction (PCR) was 33.6% (571/1697), which was significantly higher compared to that obtained by microscopy [26.6% (451/1697)] ( P  < 0.0001). Based on species-specific analysis by nested PCR, Plasmodium falciparum infection [33.6% (570/1697)] was dominant, with Plasmodium malariae , Plasmodium ovale and Plasmodium vivax infections accounting for 0.1% (1/1697), 0.0% (0/1697), and 0.0% (0/1697), respectively. The prevalence of P. falciparum infection among the 30 communities ranged from 0.0 to 82.5%. Following artesunate-amodiaquine (AS + AQ, 25 mg/kg) treatment of a sub-population of the participants (n = 184), there was a substantial reduction in Plasmodium parasite prevalence by 100% and 79.2% on day 7 based on microscopy and nested PCR analysis, respectively. However, there was an increase in parasite prevalence from day 14 to day 42, with a subsequent decline on day 70 by both microscopy and nested PCR. For parasite clearance rate analysis, we found a significant proportion of the participants harbouring residual Plasmodium parasites or parasite genomic DNA on day 1 [65.0% (13/20)], day 2 [65.0% (13/20)] and day 3 [60.0% (12/20)] after initiating treatment. Of note, gametocyte carriage among participants was low before and after treatment. Conclusion Taken together, the results indicate that a significant number of individuals could harbour residual Plasmodium parasites or parasite genomic DNA after treatment. The study demonstrates the importance of routine surveillance of asymptomatic malaria using sensitive nucleic acid-based amplification techniques.

Background Menstrual health and hygiene (MHH) are a global public health priority, particularly for adolescent girls. Improper menstrual hygiene practices are linked to negative health outcomes. This study explored menstrual hygiene practices among adolescent girls in senior high schools in the Volta Region of Ghana, focusing on practices and beliefs surrounding menstrual blood disposal. Aim To investigate menstrual hygiene practices, including disposal methods and the influence of ritualistic beliefs on adolescent girls in selected high schools. Methods This qualitative study employed an exploratory design, using purposive and convenience sampling to select participants from five senior high schools in the Volta Region. Data were collected from 60 adolescent girls through focus group discussions. MAXQDA 2022 software was used for thematic analysis. Results Participants reported varied menstrual product disposal practices shaped by safety concerns and cultural beliefs. Common methods included burning, burying, or discarding in latrines. Fear of ritual use of menstrual blood led many to avoid public disposal, with parental advice reinforcing these fears. Observations, however, revealed inconsistent practices, including disposal in open pits and washroom floors. Additionally, water and hygiene facilities were mostly inadequate, with many girls relying on poorly maintained pit latrines and non-functional flushing toilets. Conclusion The study found a mismatch between what girls say they do with menstrual waste and what actually happens in schools. While they report discreet methods like burning or burying due to fear of ritual misuse, observations showed that waste were often left in open or unsanitary areas. This gap points to poor school sanitation and deep-rooted cultural beliefs. Improving menstrual hygiene in schools requires more than infrastructure – secure, private disposal options and culturally sensitive education are essential.

Malaria infections remain a serious global health problem in the world, particularly among children and pregnant women in Sub-Saharan Africa. Moreover, malaria control and elimination is hampered by rapid development of resistance by the parasite and the vector to commonly used antimalarial drugs and insecticides, respectively. Therefore, vaccine-based strategies are sorely needed, including those designed to interrupt disease transmission. However, a prerequisite for such a vaccine strategy is the understanding of both the human and vector immune responses to parasite developmental stages involved in parasite transmission in both man and mosquito. Here, we review the naturally acquired humoral and cellular responses to sexual stages of the parasite while in the human host and the vector. In addition, updates on current anti-gametocyte, anti-gamete, and anti-mosquito transmission blocking vaccines are given. We conclude with our views on some important future directions of research into sexual stage immunity relevant to the search for the most appropriate transmission-blocking vaccine.

This study assessed knowledge, perceptions and cultural beliefs surrounding menstruation among adolescent high school boys in the Volta region of Ghana. A cross-sectional study was conducted among 434 adolescent boys from five senior high schools. Logistic regression was used to test factors associated with adequate knowledge and Spearman’s correlation was used to examine the relationships between knowledge, perceptions and cultural beliefs. Most (63.4%) participants demonstrated adequate knowledge. Being in Form 2 (AOR: 2.09, 95% CI: 1.30–3.38) or Form 3 (AOR: 3.13, 95% CI: 1.08–9.04) was associated with higher odds of having adequate knowledge, while being aged 18–19 years (AOR: 0.62, 95% CI: 0.01–0.96) was associated with lower odds of having adequate knowledge. While 73.5% of participants rejected menstrual discourse as taboo, 64.9% acknowledged culturally prescribed norms for menstruating women. Positive but small correlations were observed between knowledge scores and both family/cultural belief scores (ρ = 0.19, p = 0.0001) and perception scores (ρ = 0.26, p < 0.0001). The study shows the need for comprehensive menstrual health education for adolescent boys, addressing both factual knowledge and cultural misconceptions. By improving understanding and challenging negative perceptions, we can foster a more supportive environment for menstrual health and hygiene.

Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans. Its exact mode of transmission is not known. Previous studies have identified demographic, socio-economic, health and hygiene as well as environment related risk factors. We investigated whether the same factors pertain in Suhum-Kraboa-Coaltar (SKC) and Akuapem South (AS) Districts in Ghana which previously were not endemic for BU. We conducted a case control study. A case of BU was defined as any person aged 2 years or more who resided in study area (SKC or AS District) diagnosed according to the WHO clinical case definition for BU and matched with age- (+/-5 years), gender-, and community controls. A structured questionnaire on host, demographic, environmental, and behavioural factors was administered to participants. A total of 113 cases and 113 community controls were interviewed. Multivariate conditional logistic regression analysis identified presence of wetland in the neighborhood (OR=3.9, 95% CI=1.9-8.2), insect bites in water/mud (OR=5.7, 95% CI=2.5-13.1), use of adhesive when injured (OR=2.7, 95% CI=1.1-6.8), and washing in the Densu river (OR=2.3, 95% CI=1.1-4.96) as risk factors associated with BU. Rubbing an injured area with alcohol (OR=0.21, 95% CI=0.008-0.57) and wearing long sleeves for farming (OR=0.29, 95% CI=0.14-0.62) showed protection against BU. This study identified the presence of wetland, insect bites in water, use of adhesive when injured, and washing in the river as risk factors for BU; and covering limbs during farming as well as use of alcohol after insect bites as protective factors against BU in Ghana. Until paths of transmission are unraveled, control strategies in BU endemic areas should focus on these known risk factors.

To determine the demographic and health impact of deploying health service nurses and volunteers to village locations with a view to scaling up results. A four-celled plausibility trial was used for testing the impact of aligning community health services with the traditional social institutions that organize village life. Data from the Navrongo Demographic Surveillance System that tracks fertility and mortality events over time were used to estimate impact on fertility and mortality. Assigning nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated the time taken for attainment of the child survival Millennium Development Goal (MDG) in the study areas to 8 years. Fertility was also reduced by 15%, representing a decline of one birth in the total fertility rate. Programme costs added 1.92 US Dollar per capita to the 6.80 US Dollar per capita primary health care budget. Assigning nurses to community locations where they provide basic curative and preventive care substantially reduces childhood mortality and accelerates progress towards attainment of the child survival MDG. Approaches using community volunteers, however, have no impact on mortality. The results also demonstrate that increasing access to contraceptive supplies alone fails to address the social costs of fertility regulation. Effective deployment of volunteers and community mobilization strategies offsets the social constraints on the adoption of contraception. The research in Navrongo thus demonstrates that affordable and sustainable means of combining nurse services with volunteer action can accelerate attainment of both the International Conference on Population and Development agenda and the MDGs.

Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies. To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions. From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992-2012, but two-thirds of the observations related to 2006-2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality. Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level. The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology.