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The exposure-response association between prenatal and postnatal household air pollution (HAP) and infant growth trajectories is unknown. To evaluate associations between prenatal and postnatal HAP exposure and stove interventions on growth trajectories over the first year of life. The Ghana Randomized Air Pollution and Health Study enrolled pregnant women at gestation from Kintampo, Ghana, and randomized them to liquefied petroleum gas (LPG), improved biomass, or open fire (control) stoves. We quantified HAP exposure by repeated, personal prenatal and postnatal carbon monoxide (CO) and, in a subset, fine particulate matter [PM with an aerodynamic diameter of ( )] assessments. Length, weight, mid-upper arm circumference (MUAC) and head circumference (HC) were measured at birth, 3, 6, 9, and 12 months; weight-for-age, length-for-age (LAZ), and weight-for-length (WLZ)-scores were calculated. For each anthropometric measure, we employed latent class growth analysis to generate growth trajectories over the first year of life and assigned each child to a trajectory group. We then employed ordinal logistic regression to determine associations between HAP exposures and growth trajectory assignments. Associations with stove intervention arm were also considered. Of the 1,306 live births, 1,144 had valid CO data and anthropometric variables measured at least once. Prenatal HAP exposure increased risk for lower length [CO 1.17, 95% CI: 1.01, 1.35 per 1-ppm increase; 1.07, 95% CI: 1.02, 1.13 increase], lower LAZ -score (CO 1.15, 95% CI: 1.01, 1.32 per 1-ppm increase) and stunting (CO 1.25, 95% CI: 1.08, 1.45) trajectories. Postnatal HAP exposure increased risk for smaller HC (CO 1.09, 95% CI: 1.04, 1.13 per 1-ppm increase), smaller MUAC and lower WLZ-score ( 1.07, 95% CI: 1.00, 1.14 and 1.09, 95% CI: 1.01, 1.19 increase, respectively) trajectories. Infants in the LPG arm had decreased odds of having smaller HC and MUAC trajectories as compared with those in the open fire stove arm ( 0.58, 95% CI: 0.37, 0.92 and 0.45, 95% CI: 0.22, 0.90, respectively). Higher early life HAP exposure (during pregnancy and through the first year of life) was associated with poorer infant growth trajectories among children in rural Ghana. A cleaner-burning stove intervention may have improved some growth trajectories. https://doi.org/10.1289/EHP8109.

Globally, low and middle-income countries (LMICs) account for the majority of the adverse pregnancy outcomes. Risk prediction models (RPMs) can guide physicians in making clinical decisions to improve maternal and newborn health. However, there is scanty data on RPMs in determining adverse maternal and newborn outcomes in LMICs. Hence, this scoping review aims to describe the RPMs and the risk factors which have been used to determine both maternal and newborn adverse outcomes of pregnancy in LMICs. This scoping review will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR) and the JBI methodology for scoping reviews. The review would employ the Population, Concept, Context (PCC) framework to include studies that reported RPMs to determine either adverse maternal or newborn outcomes of pregnancy or both in LMICs. A literature search will be conducted in four databases for both published and unpublished articles on RPMs for adverse maternal or newborn outcomes from January 1, 2000, to June 26, 2024. We will use the JBI approach for study selection, data extraction, and presentation. The screening and data extraction will be conducted by two independent reviewers. This scoping review will provide a comprehensive assessment of RPMs for adverse maternal and newborn outcomes in LMICs. This study will help gain knowledge on the up-to-date literature on risk prediction models for adverse pregnancy outcomes which can be useful for researchers and clinicians in making clinical decisions. Review registration: Open Science Framework https://doi.org/10.17605/OSF.IO/B9CKJ.

Background Globally, the increasing rate of caesarean section (CS) delivery has become a major public health concern due to its cost, maternal, neonatal, and perinatal risks. In Ghana, the Family Health Division of the Ghana Health Service in 2016 opted to initiate a program to prevent the abuse of CS and identify the factors contributing to its increase in the country. This study aimed to determine the prevalence and factors influencing CS deliveries in the Kintampo Districts of Ghana. Methods The current study used secondary data from the Every Newborn–International Network for the Demographic Evaluation of Populations and their Health (EN-INDEPTH) project in Kintampo, Ghana. The outcome variable for this study is CS delivery. The predictor variables were socio-demographic and obstetric factors. Results The prevalence of CS delivery in the study area was 14.6%. Women with secondary education were 2.6 times more likely to give birth by CS than those with primary education. Unmarried women were about 2.5 times more likely to deliver by CS compared to those who were married. There was an increasing order of CS delivery among women in the wealthy quintiles from poorer to richest. The likelihood of women with gestational ages from 37 to 40 weeks to give birth by CS was about 58% less compared to those with less than 37 gestational weeks. Women who had 4–7 and 8 or more antenatal care (ANC) visits were 1.95 and 3.5 times more likely to deliver by CS compared to those who had less than 4 ANC visits. The odds of women who have had pregnancy loss before to deliver by CS was 68% higher compared to women who have not lost pregnancy before. Conclusions Caesarean section delivery prevalence in the study population was within the Ghana Health Service and World Health Organization ranges. In addition to known socio-demographic and obstetric factors, this study observed that a history of pregnancy loss increased the chances of a woman undergoing a CS. Policies should aim at addressing identified modifiable factors to stem the rise in CS deliveries.

Background There is growing interest in the use of reliable evidence for health decision-making among low-and middle-income countries. Ghana has deployed DHIMS2 to replace the previously existing manual data harmonization processes. Methods This cross-sectional study was conducted in 12 districts comprising 12 district directorates, 10 district hospitals, 29 sub-district health centers, and 38 community health facilities in the Brong-Ahafo Region. Data collection tools were developed based on the Measure Evaluate assessment tools designed for evaluating the performance of routine information systems management tools. Utilization was assessed based on documented evidence and data was analyzed using STATA version 14. Results Although 93% of the health facilities studied submitted data unto the DHIMS2 platform, evidence suggested low use of this data in decision-making, particularly at the community level facilities where only 26% of the facilities used data from DHIMS2 to inform annual action plans and even less than 20% examined findings and issued directives for action. At the district level, 58% issued directives based on DHIMS2 information, 50% used DHIMS2 information for Advocacy purposes and 58% gave feedback reports based on DHIMS2 data for action. Functional computers were lacking across all facilities. Conclusions Activities relating to the use of DHIMS2 information skew towards data quality checking with less focus on examining findings, making comparisons, and taking action-based decisions from findings and comparisons. Improving factors like internet access, availability of functional ICTs, frequency of supervisory visits, staff training and the provision of training manuals may facilitate the use of DHIMS2 in decision-making at all levels of the district health system.

High rates of childhood vaccination defaulting remain a significant barrier to achieving full vaccination coverage in sub-Saharan Africa, contributing to preventable morbidity and mortality. This study evaluated the utility of machine learning algorithms for predicting childhood vaccination defaulters in Ghana, addressing the limitations of traditional statistical methods when handling complex, high-dimensional health data. Using a merged dataset from two malaria vaccine pilot surveys, we engineered novel temporal features, including vaccination timing windows and birth seasonality. Six algorithms, namely logistic regression, support vector machine, random forest, gradient boosting machine, extreme gradient boosting, and artificial neural networks, were compared. Models were trained and validated on both original and synthetically balanced and augmented data. The results showed higher performance across the ensemble tree classifiers. The random forest and extreme gradient boosting models reported the highest F1 scores (0.92) and AUCs (0.95) on augmented unseen data. The key predictors identified include timely receipt of birth and week six vaccines, the child’s age, household wealth index, and maternal education. The findings demonstrate that robust machine learning frameworks, combined with temporal and contextual feature engineering, can improve defaulter risk prediction accuracy. Integrating such models into routine immunization programs could enable data-driven targeting of high-risk groups, supporting policymakers in strategies to close vaccination coverage gaps.

Background In the phase III RTS,S /AS01 trial, significant heterogeneity in efficacy of the vaccine across study sites was seen. Question on whether variations in socio - economic status (SES) of participant contributed to the heterogeinity of the vaccine efficacy (VE) remains unknown. Methods Data from the Phase III RTS,S /AS01 trial in children aged 5–17 months in Kintampo were re-analysed. SES of each child was derived from the Kintampo Health and Demographic Surveillance System, using principal component analysis of household assets. Extended Cox regression was used to estimate the interaction between RTS,S/AS01 VE and household SES. Results Protective efficacy of the RTS,S/AS0 vaccine significantly varied by participant’s household SES, thus increase in household SES was associated with an increase in protective efficacy ( P -value = 0.0041). Effect modification persisted after adjusting for age at first vaccination, gender, distance from community to the health facility, child’s haemoglobin level, household size, place of residence and mothers’ educational level. Conclusion Household SES may be a proxy for malaria transmission intensity. The study showed a significant modification of the RTS,S/AS01 malaria vaccine efficacy by the different levels of child’s household socio - economic status. Trial registration Efficacy of GSK Biologicals’ candidate malaria vaccine (25049) against malaria disease in infants and children in Africa. NCT00866619 prospectively registered on 20 March 2009.

IntroductionAdditional investigation is needed to better understand the associations between prenatal and early child malaria and early childhood growth outcomes.MethodsWe leveraged the Ghana Randomized Air Pollution and Health Study which enrolled 1414 pregnant women from Kintampo, Ghana, and followed the mother-child dyads through the child’s first year of life. We defined prenatal malaria exposure by histopathological examination of placenta tissue. We defined early child malaria exposure by active health surveillance over the child’s first year of life and malaria rapid diagnostic testing when clinically indicated. We employed latent class growth analyses to construct growth trajectories for each anthropometric measure (weight and height and corresponding WHO z-scores, mid-upper arm circumference and head circumference (HC)), which we measured at birth, 3, 6, 9 and 12 months of age. We then used unadjusted and adjusted ordinal and multinomial regression to identify associations between prenatal and early child malaria growth trajectories, considered separately.ResultsOf the 1306 live births, 1144 children had prenatal and early child malaria exposure and growth data and were included in the analysis; 250 (21.9%) had prenatal malaria exposure, and 525 (45.9%) had early child malaria infection. Children with prenatal malaria as compared to those without had higher risk for poorer length growth (OR=1.46, 95% CI 1.08 to 1.98; multivariable OR=1.46, 95% CI 1.05 to 2.02), poorer length-for-age z-scores (OR=1.43, 95% CI 1.09 to 1.88; multivariable OR=1.53 95% CI 1.14 to 2.05) and smaller HC (OR=1.56, 95% CI 1.16 to 2.09; multivariable OR=1.43, 95% CI 1.04 to 1.98). Children with early childhood malaria as compared to those without had higher risk for poorer length-for-age z-score (OR=1.13, 95% CI 1.03 to 1.24; multivariable OR=1.12, 95% CI 1.01 to 1.24). Children with prenatal malaria as compared to without showed a trend for persistent stunting (multivariable OR=1.63, 95% CI 0.98 to 2.71).ConclusionMalaria beginning in pregnancy was associated with poorer growth outcomes. Public health preventative strategies beginning in pregnancy may reduce malaria incidence and improve early childhood growth.

Background Malaria remains a major public health problem, especially among children in sub-Saharan Africa. Knowledge of malaria parasite prevalence informs targeted interventions and helps to monitor the effectiveness of those interventions. This study aimed to determine prevalence and factors associated with malaria in children aged 6 months to 10 years in the Greater Accra Region of Ghana. Methods A community-based cross-sectional study was conducted among 8,741 children aged 6–59 months and 8,292 children aged 5–10 years in all 29 districts of the Greater Accra Region of Ghana in October 2020. Systematic random sampling was used to select communities, households and study participants. A structured questionnaire was used to collect data from caregivers. Rapid diagnostic test kits were used to determine the presence of malaria parasites in blood samples collected by fingerprick. Factors associated with malaria RDT-positivity were determined using multivariate logistic regression analysis. Results Of 8727 children aged 6–59 months and 8279 aged 5–10 years from whom blood samples were obtained, positive results were obtained for 289 (3.3%; 95% CI 3.0–3.7) and 406 (4.9%; 95% CI 4.5–5.4) respectively. Malaria parasite prevalence in the districts ranged from 0.9 to 10.7% and 1.4–15.0% in children aged 6–59 months and 5–10 years respectively. Factors associated with increased odds of malaria included higher age (AOR = 1.43; 95% CI 1.14–1.71), and living in households without nets on the windows (AOR 1.64; 95% CI 1.10–2.45). On the other hand, living in households located in urban communities was associated with a lower risk of malaria (AOR 0.56; 95% CI 0.40–0.78). Conclusion The average prevalence of malaria in the Greater Accra Region is low compared with other regions. However, there are potential hotspots that need to be targeted with appropriate interventions to accelerate the drive towards malaria elimination.

Background: Increasing exposure to climatic features is strongly linked to various adverse health outcomes and mortality. While the link between these features and cardiovascular outcomes is well established, most studies are from high-income countries. Objectives: This review synthesizes evidence as well as research gaps on the relationship between climate indicators, household/ambient air pollution, and all-cause cardiovascular disease (CVD) morbidity and mortality in low- and middle-income countries (LMICs). Methods: Seven electronic databases were searched up to June 15, 2024. Articles were included if they focused on LMICs, addressed all-cause CVD morbidity and/or mortality, and studied climate or environmental exposures. Studies were selected using ASReview LAB, extracted and analyzed with random effect meta-analysis performed if sufficient articles were identified. Results & Conclusion: Out of 7,306 articles, 58 met the inclusion criteria: 26 on morbidity, 29 on mortality, and 3 on both. Exposures included PM10, PM2.5, NO2, SO2, BC, O3, CO, solid fuel usage, and temperature variation. Short-term exposure to PM2.5 was significantly associated with CVD morbidity (RR per 10 µg/m3 increase:1.006, 95% CI 1.003–1.009) and mortality (RR:1.007, 95% CI 1.002–1.012). Short-term exposure to NO2 and O3 also increased CVD mortality risk. Long-term exposure to PM2.5 elevated CVD morbidity (RR per 10 µg/m3 increase:1.131, 95% CI 1.057–1.210) and mortality (RR:1.092, 95% CI 1.030–1.159). High and low temperatures and long-term solid fuel use were linked to CVD deaths. The bulk of studies were from mainland China (72%), which may not accurately reflect the situation in other LMICs. Sub-Saharan Africa was particularly lacking, representing a major research gap.

Background Malaria continues to be a major disease burden affecting all ages. The WHO in 2012 introduced the test, treat and track (T3) policy for malaria management in endemic settings. All malaria suspected conditions are to be confirmed by test and treatment initiated with recommended artemisinin-based combination therapy (ACT) and treatment outcomes monitored over the course of the illness. This study evaluated the adherence of health facilities and client’s perspective of T3 policy in Ghana. Methods This cross sectional study was conducted in November 2019 involving 30 health facilities conveniently selected from six districts in the 3 malaria epidemiological zones, and clients exit interviews were performed from each facility. Factors associated with the test , treat and track defined outcomes were assessed using chi square and multivariable logistic regression models at 5% level of significance and 95% confidence interval. Data were classified according to facility and clients’ perspectives. Results Overall, 590 patients and 30 health facility managers were interviewed from 30 facilities in 6 districts across the three zones. CHPS compounds formed 18 (60.0%) of facilities assessed. Twenty-nine out of 30 health facilities had Rapid Diagnostic Test (RDT) kits and antimalarials. Health facilities in the southern zone of Ghana had 2.87 increased odds of adhering to the T3 policy compared to the middle zone [aOR = 2.87 (1.7, 4.8): p < 0.001]. Males were more likely not to return to the health facility for review or more likely to miss home visit [aOR = 0.6 (0.3, 0.9): p = 0.018]. Conclusion Testing and treating for malaria were high among health facilities in the three zones. However, tracking of patients was very low across the zones. Adherence from clients’ perspective was low especially for males. The study recommended among others that the National Malaria Elimination Programme (NMEP) should ensure periodic trainings of health facility staff especially those within the Northern and Middle zones of Ghana and strengthen monitoring and supervision of health facilities to enhance adherence to the T3 policy.