Introduction: The occurrence of eye issues among quarry workers in southern Ghana is significant, with 58% reporting irritation and 9.4% experiencing quarry-related eye problems. This study assessed factors associated with work-related eye injuries among stone quarry workers in the Ashanti Region of Ghana. Methods: We conducted a cross-sectional study among stone quarry workers in the Ashanti Region of Ghana. A pretested semi-structured questionnaire was administered to collect data on workers’ socio-demographic factors, occupational factors, lifestyle factors and history of work-related accidental eye injuries. Data was summarized into frequencies, means and odds ratio calculated at 95% CI using STATA. Results: Three hundred and seventy-five stone quarry workers took part in the study with 73 (19.5%) reporting at least one incidence of work-related eye injury. The mean age of the participants was 36.4 ± 11.3 years. Majority of participants 359 (95.7%) were males. Working for more than 8 hours (aOR=4.98, 95%CI: 1.25-19.76), being a smoker (aOR=4.59, 95%CI: 1.39–15.17) and alcohol consumption (aOR=2.15, 95%CI: 1.01-4.55) were associated with increased odds of eye injuries. Using Personal Protective Eye Devices (PPEDs) (aOR=0.07, 95%CI: 0.02-0.27) and education on PPEDs (aOR=0.05, 95%CI: 0.01-0.23) were associated with decreased odds of eye injuries among the workers. Conclusion: This study identifies extended working hours, smoking during course of work, and alcohol consumption as significant risk factors for work-related eye injuries among stone quarry workers. It also emphasizes the importance of implementing and promoting PPEDs use and providing education on their proper usage to mitigate the risk of such injuries.

Background The global prevalence of hepatitis B virus infection is estimated to affect over 2 billion individuals, with a notable proportion ranging from 6% to 25% residing in the Sub-Saharan African region. The prevalence of hepatitis B virus (HBV) in Liberia, Guinea, and Sierra Leone has been estimated to be approximately 2%. However, current understanding of the actual risk factors associated with HBV in the Greater Monrovia remains unclear. Consequently, this study aimed to identify the factors associated with hepatitis B Viral infection among pregnant women residing in Greater Monrovia, Liberia. Methods An unmatched case control study of 141 cases of HBV infected pregnant women and 141 controls was conducted. Data on socio-demographic characteristics, lifestyle activities and medical related risk factors were collected for both groups with a structured questionnaire. Bivariate and multivariate analyses established associations between the HBV infection and risk factors studied. Results In all, 141 cases of HBV infected pregnant women and 141 controls participated in this study. The mean age of cases was 35.6 years (SD ±9.5) and 36.1 years (SD ±8.4) for controls. Low-income level <100 dollars [aOR 13.0 (4.48-37.82, p<0.001)], employment [aOR 0.04 (0.09-0.18) p<0.001], STI history [aOR 5.19 (1.68-16.02, p=0.004)] and living with a HBV infected person [aOR 35.11 (4.24-58.90), p=0.001] were factors associated with HBV infection among pregnant women in Greater Monrovia. Conclusion The risk factors of HBV infection among pregnant women in Greater Monrovia were engagement in formal employment, low-income level, history of sexually transmitted infections (STIs), and residing with an individual infected with hepatitis B virus (HBV). Control efforts by designated state institutions should include advocacy and awareness creation on HBV status identification, safe sex, and vaccination of uninfected individuals.

Background The RTS,S/AS01 E malaria vaccine (RTS,S) was introduced by national immunisation programmes in Ghana, Kenya, and Malawi in 2019 in large-scale pilot schemes. We aimed to address questions about feasibility and impact, and to assess safety signals that had been observed in the phase 3 trial that included an excess of meningitis and cerebral malaria cases in RTS,S recipients, and the possibility of an excess of deaths among girls who received RTS,S than in controls, to inform decisions about wider use. Methods In this prospective evaluation, 158 geographical clusters (66 districts in Ghana; 46 sub-counties in Kenya; and 46 groups of immunisation clinic catchment areas in Malawi) were randomly assigned to early or delayed introduction of RTS,S, with three doses to be administered between the ages of 5 months and 9 months and a fourth dose at the age of approximately 2 years. Primary outcomes of the evaluation, planned over 4 years, were mortality from all causes except injury (impact), hospital admission with severe malaria (impact), hospital admission with meningitis or cerebral malaria (safety), deaths in girls compared with boys (safety), and vaccination coverage (feasibility). Mortality was monitored in children aged 1-59 months throughout the pilot areas. Surveillance for meningitis and severe malaria was established in eight sentinel hospitals in Ghana, six in Kenya, and four in Malawi. Vaccine uptake was measured in surveys of children aged 12-23 months about 18 months after vaccine introduction. We estimated that sufficient data would have accrued after 24 months to evaluate each of the safety signals and the impact on severe malaria in a pooled analysis of the data from the three countries. We estimated incidence rate ratios (IRRs) by comparing the ratio of the number of events in children age-eligible to have received at least one dose of the vaccine (for safety outcomes), or age-eligible to have received three doses (for impact outcomes), to that in noneligible age groups in implementation areas with the equivalent ratio in comparison areas. To establish whether there was evidence of a difference between girls and boys in the vaccine's impact on mortality, the female-to-male mortality ratio in age groups eligible to receive the vaccine (relative to the ratio in non-eligible children) was compared between implementation and comparison areas. Preliminary findings contributed to WHO's recommendation in 2021 for widespread use of RTS,S in areas of moderate-to-high malaria transmission. Findings By April 30, 2021, 652 673 children had received at least one dose of RTS,S and 494 745 children had received three doses. Coverage of the first dose was 76% in Ghana, 79% in Kenya, and 73% in Malawi, and coverage of the third dose was 66% in Ghana, 62% in Kenya, and 62% in Malawi. 26 285 children aged 1-59 months were admitted to sentinel hospitals and 13 198 deaths were reported through mortality surveillance. Among children eligible to have received at least one dose of RTS,S, there was no evidence of an excess of meningitis or cerebral malaria cases in implementation areas compared with comparison areas (hospital admission with meningitis: IRR 063 [95% CI 022-179]; hospital admission with cerebral malaria: IRR 103 [95% CI 061-174]). The impact of RTS,S introduction on mortality was similar for girls and boys (relative mortality ratio 103 [95% CI 088-121]). Among children eligible for three vaccine doses, RTS,S introduction was associated with a 32% reduction (95% CI 5-51%) in hospital admission with severe malaria, and a 9% reduction (95% CI 0-18%) in all-cause mortality (excluding injury). Interpretation In the first 2 years of implementation of RTS,S, the three primary doses were effectively deployed through national immunisation programmes. There was no evidence of the safety signals that had been observed in the phase 3 trial, and introduction of the vaccine was associated with substantial reductions in hospital admission with severe malaria. Evaluation continues to assess the impact of four doses of RTS,S.

Introduction Good Water, Sanitation and Hygiene (WASH) practices, introduction of Rotavirus vaccination, zinc supplementation and improved nutrition have contributed significantly to the reduction of diarrhoea morbidity and mortality globally by 50%. In spite of these gains, diarrhoea still remains a leading cause of morbidity and mortality in children under-five. Causes of diarrhoea are multifaceted with many factors such as seasonality, behaviour, pathogenicity, epidemiology, etc. However, assessments on the causes of diarrhoea have generally been tackled in silos over the years focusing only on particular causes. In this study, we describe an integrated approach (evaluating WASH interventions implantation processes, assessing epidemiolocal risk factors, and identifying pathogens causing diarrhoea) for assessing determinants of diarrhoea. Methods The study has ethical approval from the Ghana Health Service Ethical Review Committee (GHSERC:020/07/22). It will employ three approaches; a process evaluation and a case-control study and laboratory analysis of diarrhoea samples. The process evaluation will assess the detailed procedures taken by the Anloga district to implement WASH interventions. A desk review and qualitative interviews with WASH stakeholders purposively sampled will be done. The evaluation will provide insight into bottlenecks in the implementation processes. Transcribed interviews will be analysed thematically and data triangulated with reviews. A 1:1 unmatched case-control study with 206 cases and 206 controls to determine risk factors associated with diarrhoea in children under-five will also be done. Odds ratios at 5.0% significance level would be calculated. Stool samples of cases will be taken and tested for diarrhoea pathogens using Standard ELISA and TAQMAN Array Card laboratory procedures. Expected outcome It is expected that this framework proposed would become one of the robust approaches for assessing public health community interventions for diseases. Through the process evaluation, epidemiological case-control study and pathogen identification, we would be able to identify the gaps in the current diarrhoea assessments, come up with tailored recommendations considering the existing risk and assumptions and involve the relevant stakeholders in reducing the diarrhoea burden in a coastal setting in Ghana.

Aims: This study sought to determine the risk factors of Influenza by investigating the characteristics of patients with Acute Respiratory Infections (ARIs). Study Design: An unmatched case-control study. Place and Duration of Study: This was conducted among residents of Shai-Osudoku (SO) and Ningo-Prampram (NP) Districts from April to November 2016. Methods: Prospective cases of ARIs from a facility-based sentinel surveillance on respiratory illnesses were screened for Influenza-Like-Illnesses (ILIs). Respiratory samples were obtained from those meeting the case definition for ILI and investigated. A total of 147 samples were influenza virus-positive and selected as case-patients. Another 294 patients were selected as control-patients from the pool of influenza negative tests. These two groups were used to assess the risk factors of influenza. Crude and adjusted odds ratios were calculated. A purposive selection logistic regression was used for the adjusted modelling. Results: The study identified Influenza A(H3N2) and Influenza B as the predominant circulating influenza viruses. Study participants had poor knowledge on the causes and prevention of acute respiratory illness. After the multivariate analysis, ILI patients presenting with Chills had 4 times odds (aOR:4.57; 95%CI: 1.51 – 13.76) of having influenza as compared with the controls. In addition, ILI patients with recent travel history in past 2 weeks had 3 times odds (aOR:3.05; 95%CI: 1.07 – 8.73) of being infected with the influenza virus compared with controls with no history of travel. Conclusion: The study provided clues for increasing the index of suspicion of clinicians in identifying patients with respiratory signs who could be at risk of influenza infection. Communication of the significant risk factors identified in the study to all health workers should be prioritized as an action. This important knowledge about factors associated with influenza among ILIs will inform early detection and appropriate health interventions to reduce the burden influenza disease.

Introduction: Over 140,000 people globally died from measles in 2018; most of which occurred in developing countries. In Ghana, measles is one of the diseases earmarked for elimination in the Integrated Disease Surveillance and Response (IDSR) strategy. The measles surveillance system seeks to monitor trends, detect outbreaks and report in a timely manner. In order to improve upon the performance of the Ga West Municipal Measles surveillance system, it was evaluated with the aim of determining its effectiveness. Methods: We used CDC updated guidelines for surveillance system evaluation to assess system attributes. Measles surveillance data from 2012 – 2016 were abstracted from the DHIMS. Case investigation forms, weekly and monthly IDSR reporting forms were reviewed to validate abstracted data. Key surveillance officers were interviewed on system operations. Data was analyzed descriptively to generate frequencies and relative frequencies. Results: The system operated with a reasonable number of disease variables and case definition was simple to apply. The system was found to be integrated with the national IDSR. Government facilities across all seven sub-districts, owned and contributed data to the system. Of the 48 suspected case-patients, 39 (81.0%) were investigated; none of which was positive giving a Predictive value positive (PVP) of 0%. Majority of facilities (though privately owned) did not contribute data to the system. All tested samples were received at the laboratory within the stipulated three (3) days. The system was stable with available case base forms. Over 56% (22/39) of the samples tested had no vaccination records. Data is used to guide routine and supplementary immunization activities. Conclusion: Ga west Municipal measles surveillance system is simple, flexible and generally acceptable. It is sensitive, timely, stable but with low representativeness. It is therefore effective. Municipal health officials have been sensitized on private sector participation and need for quality and timely data.

Introduction: Trachoma is leading cause of preventable blindness globally with the highest prevalence in Africa (85% of global cases). In Ghana, Upper West and Northern Regions are endemic for trachoma. Ghana has made significant strides toward the global elimination of trachoma (GET) 2020 target and reported to have reached the initial elimination thresholds of 5.0% for trachomatous inflammation-follicular (TF) among children 1 to 9-years old. We evaluated the Trachoma surveillance system in the Wa East district in Upper West region to determine its performance, usefulness and assess the system attributes. Methods: We used Center for Disease Control and Prevention (CDC) Updated Guidelines for surveillance system evaluation. We identified and interviewed key stakeholders using semi-structured questionnaire. We abstracted, analyzed 2010-2014 trachoma surveillance data and presented the results in tables and graph. Results: A total of 2,911 cases were recorded in Ghana with 232(8.1%) from Upper West region. Wa East district also recorded 3 cases in 2011 and 1 case in 2013 in the IDSR. Surveillance forms were easy to fill and the case definitions were well understood by participants. The system was sensitive to the detection of cases and was found to be useful as it was still detecting cases at all levels. All 18 health facilities reported to the surveillance system. Some discrepancies in data between the different datasets (OPD, IDSR and community screening) were identified. Conclusion: The trachoma surveillance system is simple, useful, sensitive, and partially meeting its objectives. However, data quality needs improvement.

Introduction Globally, postnatal care (PNC) is fraught with challenges. Despite high PNC coverages in Ghana’s Greater Accra Region (GAR), maternal and newborn health outcomes are of great concern. In 2017, neonatal and post-neonatal mortality rates in GAR were 19 and 13 per 1000 live births respectively despite PNC coverages of 93% for at least one PNC and 87.5% for PNC within 48 hours post-delivery. Telephone follow-up has been used to improve health outcomes in some settings, however, its usefulness in improving maternal and infant health during the postnatal period is not well known in Ghana. We assessed effectiveness of telephone-based PNC on infant and maternal illness in selected hospitals in GAR. Methods An open-label, assessor-blinded, parallel-group, two-arm superiority randomized controlled trial with 1:1 allocation ratio was conducted from September 2020 to March 2021. Mother-baby pairs in intervention arm, in addition to usual PNC, received midwife-led telephone counselling within 48 hours post-discharge plus telephone access to midwife during postnatal period. In control arm, only usual PNC was provided. Descriptive and inferential data analyses were conducted to generate frequencies, relative frequencies, risk ratios and 95% confidence intervals. Primary analysis was by intention-to-treat (ITT), complemented by per-protocol (PP) analysis. Results Of 608 mother-baby pairs assessed for eligibility, 400 (65.8%) were enrolled. During 3 months follow-up, proportion of infants who fell ill was 62.5% in intervention arm and 77.5% in control arm ( p = 0.001). Maternal illness occurred in 27.5% of intervention and 38.5% of control participants ( p = 0.02). Risk of infant illness was 20% less in intervention than control arm in both ITT analysis [RR = 0.8 (95%CI = 0.71–0.92] and PP analysis [RR = 0.8 (95%CI = 0.67–0.89)]. Compared to controls, risk of maternal illness in intervention arm was 30% lower in both ITT [RR = 0.7 (95%CI = 0.54–95.00)] and PP analysis [RR = 0.7 (95%CI = 0.51–0.94)]. Conclusion Telephone-based PNC significantly reduced risk of maternal and infant illness within first 3 months after delivery. This intervention merits consideration as a tool for adoption and scale up to improve infant and maternal health. Trial registration This trial was retrospectively registered with the International Standard Randomized Controlled Trial Number (ISRCTN) Registry with number ISRCTN46905855 on 09/04/2021.

Background and aim: The International Health Regulations (IHR, 2005) require that each country is prepared and able to detect, respond and undertake surveillance for public health risks, irrespective of origin or source. Gaps in relevant capacity can be identified via Joint External Evaluation. Field Epidemiology Training Programmes (FETP) are established in many countries and provide capacity to respond to infectious disease outbreaks and establish appropriate surveillance. Field epidemiology skills are required to assess, respond to, and mitigate the health impact of environmental and chemical hazards. Our training aimed to support capacity building in field environmental epidemiology in Ghana and Zambia. Methods: At the request of public health agencies in Ghana and Zambia, an environmental epidemiology module was developed as part of FETP programmes. The design of this module was based on the experience of providing a similar module to FETP trainees in the UK, and adapted to address local objectives and context for each country. The main educational theory underlying the design of the module was problem-based learning. Learning needs assessment identified topics to be prioritised for inclusion in the module. Results: Between 2018 and 2022, a week-long module in environmental epidemiology was delivered to cohorts of FETP fellows and environmental health practitioners in Ghana and Zambia. Topics addressed included preparedness in relation to chemical hazards, strategies for exposure assessment, risk assessment and communication, choice of design, and surveillance. The evaluation showed that participants consider case-studies in environmental epidemiology as a key element for training in this area, and field visit very valuable. Conclusions: An environmental epidemiology module was developed for inclusion in FETP curriculum. Workforce competencies in field environmental epidemiology for surveillance and response to chemical and environmental hazards were built, and their contribution to global health security and IHR capacity discussed. Key words: Field epidemiology, training

Background Recent studies from different malaria-endemic regions including western Africa have now shown that Plasmodium vivax can infect red blood cells (RBCs) and cause clinical disease in Duffy-negative people, though the Duffy-negative phenotype was thought to confer complete refractoriness against blood invasion with P. vivax . The actual prevalence of P. vivax in local populations in Ghana is unknown and little information is available about the distribution of Duffy genotypes. The aim of this study was to assess the prevalence of P. vivax in both asymptomatic and symptomatic outpatients and the distribution of Duffy genotypes in Ghana. Methods DNA was extracted from dried blood spots (DBS) collected from 952 subjects (845 malaria patients and 107 asymptomatic persons) from nine locations in Ghana. Plasmodium species identification was carried out by nested polymerase chain reaction (PCR) amplification of the small-subunit (SSU) rRNA genes. For P. vivax detection, a second PCR of the central region of the Pvcsp gene was carried out. Duffy blood group genotyping was performed by allele-specific PCR to detect the presence of the FY ES allele. Results No cases of P. vivax were detected in any of the samples by both PCR methods used. Majority of infections (542, 94.8%) in the malaria patient samples were due to P. falciparum with only 1 infection (0.0017%) due to Plasmodium malariae, and 2 infections (0.0034%) due to Plasmodium ovale . No case of mixed infection was identified. Of the samples tested for the FY ES allele from all the sites, 90.5% (862/952) had the FY ES allele. All positive samples were genotyped as FY*B-33 / FY*B-33 (Duffy-negative homozygous) and therefore classified as Fy(a−b−). Conclusions No cases of P. vivax were detected by both PCRs and majority of the subjects tested carried the FY ES allele. The lack of P. vivax infections observed can be attributed to the high frequency of the FY ES allele that silences erythroid expression of the Duffy. These results provide insights on the host susceptibility for P. vivax infections that had not been investigated in Ghana before.

Background Placental malaria (PM) poses life-threatening complications to pregnant women as they are at increased risk of maternal and perinatal morbidity and mortality associated with malaria. This study examined the factors associated with placental malaria in the Upper West Regional Hospital (UWR). Methods A cross-sectional hospital-based study was carried out among pregnant women delivering at Upper West Regional Hospital. A cross-sectional screening survey was conducted from January 2019 to April 2019. Three hundred eligible mothers were consecutively recruited. A record review of their maternal and child history was assessed using a checklist. Placental blood samples were taken for microscopy to determine placental malaria parasitemia. Logistic regression analysis was done to determine the factors associated with placental malaria at 95 % confidence level. Results The proportion of mothers with placental malaria was 7 % (21/300), (95 % CI, 4.3–10.5 %). Plasmodium falciparum was the only species identified in those with PM. Majority of the women 66.7 % (14/21) with placental malaria had parasite density in the range 501 to 5,000 parasites/µL. Obstetric and health service factors that were significantly associated with placental malaria were gravidity and antenatal care (ANC) attendance. Primigravida (aOR = 3.48, 95 %CI = 1.01–12.01) and having less than 4 ANC attendance (aOR = 9.78, 95 %CI = 2.89–33.11) were found to be significantly associated with placental malaria. Conclusions The proportion of women with PM was relatively low. Primigravid mothers reporting less than 4 ANC visits had the highest risk of placental malaria. Expectant mothers should be encouraged to attend at least 4 ANC visits prior to delivery.

IntroductionMalaria is endemic in Ghana, accounting for about 40% of all OPD diagnosis. Data on malaria is routinely collected as part of the IDSR monthly reporting forms. Sunyani municipality recorded 56,540 malaria cases in 2016 with about 35% of the cases occurring in children under five years of age. We analyzed malaria surveillance data to identify the distribution of malaria cases by person, place and time and determine the timeliness and completeness of malaria report submission in the municipality.MethodsWe analyzed malaria surveillance data in Sunyani municipality reported between 2015 and 2019 from the District Health Management Information System II. We calculated morbidity and mortality rates of cases by person and estimated proportion of cases by sub-districts. We performed trend analysis and calculated disease threshold levels. We presented the findings using tables and figures.ResultsOf 639,361 malaria cases suspected, 93.5% (597,512/639,361) were tested, of which 49.4% (295,458/597,512) was positive. Females accounted for 55.7% (164,436/295,458) of the morbidity. Children < 5 years recorded the highest proportion, 29.9% (88,135/295,458) of cases in the municipality. The case fatality rate was 3.7% (18/484) and 1.4% (7/484) for persons under age five and over age five, respectively. Abesim (6,276.03 per 10,000) recorded the highest number of cases, and the least cases were in New Dormaa (1,890.97 per 10,000). The majority of malaria cases were in May and October of each year. Antwi-krom recorded the highest rates of completeness and timeliness of 41.9% and 40.0% respectively.ConclusionMore females were diagnosed with malaria and children < 5 years recorded the highest proportion of cases in the municipality. Abesim recorded the highest proportion of malaria cases during the period. High patterns of malaria transmissions occurred during months of high rainfalls. None of the sub-districts met the WHO target for timeliness and completeness of report submission. The NMCP should consider interventions such as SMC among children under five, in the Sunyani municipality.

The study was funded by the authors.

Background: Yellow fever is an acute viral hemorrhagic disease caused by the yellow fever virus. There is no specific treatment for yellow fever; only supportive treatment is available to manage symptoms. Without treatment, up to 50% of severely affected persons die. Yellow fever surveillance system in Adaklu District has never been an evaluated. We evaluated the yellow fever surveillance system in Adaklu District to determine whether the system meets its objectives and assess its attributes. Methods and materials: We used the Centers for Disease Control and Prevention updated guidelines 2001, to evaluate the system. Secondary data was obtained from district health information management system database from 2014–2018, reports and case based forms. We interviewed key stakeholders involved in yellow fever surveillance using semi-structured questionnaires. We performed summary descriptive analysis on quantitative data, and directed content analysis on qualitative data. We presented the results in tables and charts. Results: From 2014 through 2018, 22 suspected cases reported. The highest proportion of cases (36.3%) reported in 2018. Most of the suspected cases 63.6% were male. Completeness of data on case based forms after laboratory investigation was 76.9%. Suspected cases of yellow fever not recorded in consulting room registers in 2017 and 2018. The completeness of weekly reporting was 71.8% in 2014 and 100% in 2018. Timeliness of weekly reporting was 8.2% in 2014 and 97.9% in 2018. Proportion of facilities that reported case in the district increased from 26% in 2017 to 40% in 2018. District met 80% target samples reaching laboratory in adequate condition. Feedback on specimen tested within seven days after the receipt was 45.4%. Conclusion: The yellow fever surveillance system partially met its objectives. The system is useful and sensitive. Data quality, timely feedback needs improvement. Clinicians sensitized on the importance of recording patient information on registers and monitor trend of yellow fever.

Background Implementation research is increasingly being recognised as an important discipline seeking to maximise the benefits of evidence-based interventions. Although capacity-building efforts are ongoing, there has been limited attention on the contextual and health system peculiarities in low- and middle-income countries. Moreover, given the challenges encountered during the implementation of health interventions, the field of implementation research requires a creative attempt to build expertise for health researchers and practitioners simultaneously. With support from the Special Programme for Research and Training in Tropical Diseases, we have developed an implementation research short course that targets both researchers and practitioners. This paper seeks to explain the course development processes and report on training evaluations, highlighting its relevance for inter-institutional and inter-regional capacity strengthening. Methods The development of the implementation research course curriculum was categorised into four phases, namely the formation of a core curriculum development team, course content development, internal reviews and pilot, and external reviews and evaluations. Five modules were developed covering Introduction to implementation research, Methods in implementation research, Ethics and quality management in implementation research, Community and stakeholder engagement, and Dissemination in implementation research. Course evaluations were conducted using developed tools measuring participants’ reactions and learning. Results From 2016 to 2018, the IR curriculum has been used to train a total of 165 researchers and practitioners predominantly from African countries, the majority of whom are males (57%) and researchers/academics (79.4%). Participants generally gave positive ratings (e.g. integration of concepts) for their reactions to the training. Under ‘learnings’, participants indicated improvement in their knowledge in areas such as identification of implementation research problems and questions. Conclusion The approach for training both researchers and practitioners offers a dynamic opportunity for the acquisition and sharing of knowledge for both categories of learners. This approach was crucial in demonstrating a key characteristic of implementation research (e.g. multidisciplinary) practically evident during the training sessions. Using such a model to effectively train participants from various low- and middle-income countries shows the opportunities this training curriculum offers as a capacity-building tool.

Background: Acute flaccid paralysis (AFP) surveillance was adopted by many countries to monitor the progress towards poliomyelitis eradication. Although the Sierra Leone surveillance system routinely collects AFP surveillance data, limited epidemiological analysis has been conducted. We described the trend, demographic and clinical features of AFP cases and assessed the performance of the system using the WHO-specified core AFP global surveillance indicators. Methods and materials: We conducted a descriptive analysis of AFP surveillance data for Sierra Leone, for the period January 2009 to December 2018. We collected data on demographic characteristics, vaccination history, clinical presentation and virological investigation on stool specimens collected. We calculated age and sex proportions, annualized non-polio AFP rate, stool adequacy rate and mapped confirmed polio cases. Results: Overall, Sierra Leone reported 1241 AFP cases. Of cases, 79.7% (989/1241) were aged less than five years and 20.3% were between five and fifteen years. Majority (51.3%, 636/1241) were males, and 11.1% (138/1238) had received less than three doses of oral polio vaccine(OPV). About 51% (626/1226) presented with asymmetric paralysis and 79.6% (988/1241) were notified within 24 h of onset of paralysis. Wild poliovirus type 1 was isolated from 12 AFP cases in five districts between 2009 and 2010. All the cases were imported from neighbouring countries. The national annualized non-polio AFP rate per 100,000 population <15 years was lowest (1.3) in 2015 and highest (7.1) in 2009. At district level, only two districts consistently exceeded this target throughout the ten-year period. The target of 80% for stool adequacy was exceeded over the period of the study, ranging from 80.3% to 95.8%, while that for timeliness of specimen transportation to regional laboratory in Abidjan was exceeded only in 2015 (100%) and 2016 (80.6%). A 60-day follow up was conducted for 57.9% (719/1241) of the cases, with none classified as compatible. Conclusion: The AFP surveillance in Sierra Leone met most WHO-specific epidemiological and laboratory performance standards. The national surveillance programme needs to address problems of delayed specimen transportation to regional laboratory, strengthen districts AFP surveillance performance and maintain surveillance for other priority diseases during an outbreak.

Background: Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide with an estimated 10 million new (incident) TB cases in 2017. In Ghana, prevalence was estimated at 356 per 100,000 population and incidence of 160 per 100,000 population, mortality rate of 7.5 per 1000 infected people. The TB surveillance system exists to monitor TB burden in Ho and to improve the clinical outcomes of TB case patients. We evaluated the surveillance system at the Ho Municipality, Volta Region from 2014–2018 to determine its performance, usefulness and assess it system's attributes. Methods and materials: We extracted and reviewed data from reporting form and DHIMS 2 covering the period 2014–2018. We interviewed stakeholders at Ho Municipality using a semi structured questionnaire for information on case detection and clinical outcomes. We assessed the system attributes using the CDC updated guidelines for evaluating public health systems (2006). Summary descriptive statistics was performed on quantitative data and results were presented in tables and graphs. Results: Overall, 428 case of pulmonary TB were recorded in Ho Municipality for the evaluation period. The annual incidence of tuberculosis ranged from 1.6/100,000 in 2012 to 62.6/100,000 in 2014. The average case fatality rate was 8.3%. The predictive value positive was 1.2% (63/5876) in 2014 and 3.5% (958/1635) in 2018. Data inconsistency in reporting ledgers 100% (60/60) and DHIMS 40% (24/60). Conclusion: The TB surveillance system was found to be useful and partially meeting its objectives. The system was complex and acceptable with good data quality. However, there is a need to improve data validation in the DHIMS 2 and laboratory capacity for timely results.

BACKGROUND:We reviewed malaria morbidity data to assess compliance to malaria T3 strategy in Bosomtwi District, Ashanti Region, Ghana.DESIGN:The study was descriptive secondary data analysis.SETTING:Bosomtwi District.DATA SOURCE:District Health Information Management Systems (DHIMS2).MAIN OUTCOME:Proportion of recorded cases tested, proportion of tested cases treated and proportion of cases tracked.RESULTS:Data for suspected and tested malaria cases was complete for only 3 years (2014-2016). Malaria testing reduced from 84.4% in 2015 to 76.8% in 2016 (national average 77.3%; regional average 70%). The proportion of untested but treated malaria cases declined from 46.3% in 2015 to 4.9% in 2016. Proportion of confirmed malaria cases put on antimalarial drugs was highest in 2016 at 63.9%. Pramso sub-district although home to largest facility in the district, under prescribed antimalarial drugs. Reports generated on malaria showed information on only confirmed suspected cases, under five, and above five malaria mortalities. The district did not determine their malaria thresholds.CONCLUSION:The malaria-testing rate in the Bosomtwi District is higher than the regional average and close to the national average. About a third of confirmed malaria cases missed getting appropriate antimalarial drugs. Limited analysis on malaria data reduced the information required to inform policy.FUNDING:Author GO was fully sponsored by President's Malaria Initiative (PMI)-CDC CoAg 6NU2GGH001876.

Background Population-specific epidemiologic data on human Papillomavirus infection, which are limited in most of the SubSaharan African countries, are necessary for effective cervical cancer prevention. This study aimed to generate population-specific data on human Papillomavirus infections, and determine which of these, self-collected and provider-collected specimens, gives a higher estimate of the prevalence of human Papillomaviruses, including vaccine and non-vaccine-type human Papillomavirus. Methods In this cross-sectional study, following a questionnaire-based collection of epidemiological data, self-, and provider-collected specimens, obtained from women 15−65 years of age, were analysed for human Papillomavirus types by a nested-multiplex polymerase chain reaction, and for cervical lesions by Pap testing. HPV data were categorised according to risk type and vaccine types for further analysis. Results The difference between the overall human Papillomavirus infection prevalences obtained with the self-collected specimens, 43.1% (95% CI of 38.0–51.0%) and that with the provider-collected samples, 23.3% (95% CI of 19.0–31.0%) were significant (p ≤ 0.001). The prevalence of quadrivalent vaccine-type human Papillomaviruses was 12.3% with self-collected specimens, but 6.0% with provider-collected specimens. For the nonavalent vaccine-types, the prevalences were 26.6% and 16.7% respectively. There were multiple infections involving both vaccine-preventable and nonvaccine preventable high-risk human Papillomavirus genotypes. Conclusion The Akuse subdistrict can, therefore, be said to have a high burden of human Papillomavirus infections, which included nonvaccine types, as detected with both self-collected and provider-collected specimens. These imply that self-collection is to be given a higher consideration as a means for a population-based high-risk human Papillomavirus infections burdens assessment/screening. Additionally, even with a successful implementation of the HPV vaccination, if introduced in Ghana, there is still the need to continue with the screening of women.