Background Anaemia is a major public health problem globally. District and community estimates of anaemia burden are crucial for appropriate targeted interventions. We described the prevalence and risk factors of low haemoglobin (Hb) levels and anaemia in a cross-sectional survey in the Navrongo Health and Demographic Surveillance. Methods We recruited participants aged < 1 to > 40 years from the Kassena-Nankana districts in Northern Ghana. We estimated distributions of Hb concentrations by age, sex, district and Hb variant status. We defined anaemia based on the WHO threshold of Hb < 11.0 g/dL for children under 5 years, < 11.5 g/dL for children between 5 and 12 years, < 13 g/dL for men and < 12 g/dL for women. We then performed covariate-adjusted logistic and linear regression models to investigate predictors of anaemia and Hb concentrations. Results The prevalence of anaemia was 53.2% (95% CI: 50.7-55.7) and was significantly higher in participants below 18 years. The lowest mean Hb levels (11.0 g/dL +/- 1.32) were observed in children less than 5 years who contributed 84.1% of the anaemia. Participants with sickle cell condition had the highest prevalence of anaemia (68.2%). Male gender, positive malaria status and living in the Kassena-Nankana West (KNW) were significantly associated with increased odds of anaemia. Conclusions Malaria, sickle cell conditions and male gender are some of the risk factors for anaemia in the study area. Health education should be continuous in the districts. Interventions to reduce anaemia should also target males, since it has clearly shown that male gender increases the risk of anaemia.

Background Sickle cell disease contributes substantially to childhood morbidity and mortality in sub-Saharan Africa. However, access to health care remains limited among underserved populations, largely due to financial and structural barriers. Point-of-care testing is affordable and effective for identifying sickle cell disease, yet its implementation within routine health systems in resource-constrained settings remains limited. We aimed to assess the feasibility of integrating point-of-care sickle cell disease screening into routine immunisation services in northern Ghana. Methods We conducted a prospective feasibility study of point-of-care sickle cell disease screening integrated into routine immunisation services at ten primary health care clinics in northern Ghana. Children aged 0–59 months without a previous documented haemoglobin genotype were screened using Gazelle (Hemex Health, Portland, OR, USA) following caregiver consent. Children were excluded if they had a previous diagnosis of sickle cell disease or lived outside the catchment area. Children with presumptive sickle cell disease underwent confirmatory testing with SickleSCAN (BioMedomics, Morrisville, NC, USA) and were linked to specialised care. Outcomes were screening yield, prevalence of confirmed sickle cell disease, rate of confirmation of sickle cell disease, linkage to care, and retention in care at 24 months. Proportions were estimated with corresponding exact binomial 95% CIs. Findings Between Aug 15, 2022, and Sept 30, 2023, 6024 eligible children with consenting caregivers were screened; 2992 (49·7%) were female, 3032 (50·3%) were male, and the median age was 15 months (IQR 5–32). Refusals were not systematically recorded. 3971 (65·9%) of 6024 children had the HbAA genotype, 1146 (19·0%) had HbAC, 720 (12·0%) had HbAS, 106 (1·8%) had HbCC, 58 (1·0%) had HbSC, and 23 (0·4%) had HbSS. 273 (4·5% [95% CI 4·0–55·1]) of 6024 children were identified as having presumptive sickle cell disease, of whom 81 (29·7% [95% CI 24·3–35·5]) were confirmed to have sickle cell disease. Prevalence of confirmed sickle cell disease was 81 (1·3% [1·1–1·7]) of 6024. Of these 81, 79 (97·5% [91·4–99·7]) were enrolled into care. 75 (94·9% [87·5–98·6]) of the 79 enrolled children remained in care at 24 months. The median time from Gazelle screening to SickleSCAN confirmation was 10 days (IQR 3–92; range 0–414). No possible β-thalassaemia traits, inconclusive screening results, adverse events, or serious adverse events were observed. Interpretation Point-of-care sickle cell disease screening was effectively integrated into routine immunisation services for children younger than 5 years using existing primary health-care infrastructure and workforce in northern Ghana, facilitating early diagnosis, linkage to care, and sustained follow-up. These findings highlight the potential of routine child health platforms to expand access to sickle cell disease services in resource-limited settings, although broader implementation will require sustained policy and health system support. Funding Novartis.

Background: Streptococcus pneumoniae is a major cause of mortality from pneumonia and meningitis among children under five in West Africa. A systematic review in 2018 showed that 81% of pneumonia deaths in Africa were caused by pneumococcus. The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced into Ghana’s routine immunisation programme (EPI) in 2012, using the 3+0 schedule. However, few studies have assessed the impact of PCV13 on pneumonia and meningitis outcomes in Ghana and Africa. This study assessed the effectiveness of PCV13 in lowering mortality from clinical pneumonia and meningitis among children under five in the Kassena Nankana districts of Ghana. Methods: This was a retrospective observational study using longitudinal mortality and vaccination data of children younger than 5 years from the Navrongo Health and Demographic Surveillance System (NHDSS) database. The NHDSS monitors the health and demographics of 160,000 individuals across two districts. Secondary data on mortality and vaccinations from 1 January 2007 to 31 December 2017 were extracted. Mortality (non-traumatic) from pneumonia and all-cause mortality in children under five years in the study were assessed through verbal autopsies using the WHO tool. Mortality rates (MR) were calculated as the number of deaths per 1,000 live births. Results: Mortality from pneumonia fell by 50% in both males and females after the introduction of PCV13 vaccination. All-cause mortality for both sexes was reduced by 60%. PCV13 vaccine coverage increased from 85.9% in 2014 to 95.7% by 2017. Furthermore, mortality rates from pneumonia and meningitis combined showed a marked reduction from approximately 15% to 8% in children under five years old. Conclusion: PCV13 has been effective in lowering mortality from clinical pneumonia and meningitis in this study population.

Background: We set out to estimate the community-level exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Ghana. Methods: Phased seroprevalence studies of 2729 participants at selected locations across Ghana were conducted. Phase I (August 2020) sampled 1305 individuals at major markets/lorry stations, shopping malls, hospitals and research institutions involved in coronavirus disease 2019 (COVID-19) work. The study utilized a lateral flow rapid diagnostic test (RDT) which detected IgM and IgG antibodies against SARS-CoV-2 nucleocapsid protein. Results: During Phase I, 252/1305 (19%) tested positive for IgM or IgG or both. Exposure was significantly higher at markets/lorry stations (26.9%) compared to malls (9.4%), with 41–60-year group demonstrating highest seropositivity (27.2%). Exposure was higher in participants with no formal education (26.2%) than those with tertiary education (13.1%); and higher in informally employed workers (24.0%) than those in the formal sector (15.0%). Results from phases II and III, in October and December 2020 respectively, implied either reduced transmissions or loss of antibody expression in some participants. The Upper East region showed the lowest seropositivity (2%). Phase IV, in February 2021, showed doubled seropositivity in the upper income bracket (26.2%) since August 2020, reflective of Ghana’s second wave of symptomatic COVID-19 cases. This suggested that high transmission rates had overcome the initial socioeconomic stratification of exposure risk. Reflective of second wave hospitalisation trends, the 21-40 age group demonstrated modal seropositivity (24.9) in Phase IV whilst 40-60 years and 60+ previously demonstrated highest prevalence. Conclusions: Overall, the data indicates higher COVID-19 seroprevalence than officially acknowledged, likely implying a considerably lower-case fatality rate than the current national figure of 0.84%. The data also suggests that COVID-19 is predominantly asymptomatic COVID-19 in Ghana. The observed trends mimic clinical trends of infection and imply that the methodology used was appropriate.

INTRODUCTION:The contribution of obesity phenotypes to dyslipidaemia in middle-aged adults from four sub-Saharan African (SSA) countries at different stages of the epidemiological transition has not been reported. We characterized lipid levels and investigated their relation with the growing burden of obesity in SSA countries. METHODS:A cross-sectional study was conducted in Burkina Faso, Ghana, Kenya and South Africa. Participants were middle aged adults, 40-60 years old residing in the study sites for the past 10 years. Age-standardized prevalence and adjusted mean cholesterol, LDL-C, HDL-C, triglycerides and non-HDL-C were estimated using Poisson regression analyses and association of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WTHR) with abnormal lipid fractions modeled using a random effects meta-analysis. Obesity phenotypes are defined as BMI ≥ 30 kg/m2, increased WC and increased waist-to-hip ratio. RESULTS:A sample of 10,700 participants, with 54.7% being women was studied. Southern and Eastern African sites recorded higher age-standardized prevalence of five lipid fractions then West African sites. Men had higher LDL-C (19% vs 8%) and lower HDL-C (35% vs 24%) while women had higher total cholesterol (15% vs 19%), triglycerides (9% vs 10%) and non-HDL-cholesterol (20% vs 26%). All lipid fractions were significantly associated with three obesity phenotypes. Approximately 72% of participants in the sample needed screening for dyslipidaemia with more men than women requiring screening. CONCLUSION:Obesity in all forms may drive a dyslipidaemia epidemic in SSA with men and transitioned societies at a higher risk. Targeted interventions to control the epidemic should focus on health promoting and improved access to screening services.

Insulin resistance (IR) is linked to several metabolic diseases including type 2 diabetes mellitus (T2DM), metabolic syndrome, and metabolic dysfunction-associated fatty liver disease (MAFD). The factors that contribute to IR in rural African populations remain largely unknown. Understanding the determinants of IR will contribute to the management of several non-communicable diseases (NCDs). A cross-sectional study was conducted in two rural districts in northern Ghana involving male and female participants, aged 40 to 60 years, who were recruited into the study between the years 2015 and 2016. Sociodemographic, lifestyle, anthropometric, ultrasound, blood lipid profile, blood glucose and insulin, urine creatinine and urine protein data were collected. Insulin resistance was determined using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) formula. Multivariable linear regression analyses were performed between log-transformed IR and several variables. All association analyses were considered significant at p < 0.05. The median (log-transformed) IR among women (0.54) was significantly higher than that among men (0.43) (p < 0.001). The prevalence of IR was 7.6

Background: Maternal and newborn health outcomes remain a critical public health challenge, particularly in sub-Saharan Africa, where maternal and neonatal mortality rates are disproportionately high. Differential care, where care quality varies based on socioeconomic status or other attributes, exacerbates health inequities. This study explores maternal healthcare providers' perceptions of factors contributing to differential care during childbirth. Methods: We conducted in-depth interviews with 20 healthcare providers working in maternity units across 13 health facilities in the Upper East Region of Ghana from January to March 2021. Providers were selected based on their experience and involvement in childbirth care. We used a semi-structured guide to explore providers' views on factors contributing to poor and differential care, particularly regarding person-centered maternity care (PCMC)—respectful and responsive care during childbirth. Data were analyzed using thematic analysis. Results: Eight themes emerged from the qualitative analysis on factors contributing to differential care during childbirth. These included provider stress, client’s attitude and behavior, client’s appearance, client’s perceived knowledge and understanding, communication gaps, relationship with clients, birth preparedness, and severity or type of medical condition. The findings reveal a complex interplay of environment, provider, and client-related factors that contribute to differential care during childbirth. Conclusions: The study highlights the importance of addressing environmental, provider, and client-related factors to improve quality and equity in maternal health care. By addressing these issues, healthcare systems can work towards reducing disparities in maternal health care and improving outcomes for all women, particularly the most vulnerable women.

BACKGROUND:Cardiovascular disease (CVD) remains a global health challenge and contributes substantially to mortality burden in sub-Saharan Africa (SSA) in particular. Several factors, including particular blood group types in the ABO system, have been associated with CVD risk. However, the direction of the association of ABO blood groups with CVD remains controversial. This review looked at the studies that investigated the association of ABO blood groups and CVD and its risk in SSA and people of African ancestry. METHODS:The review included all observational studies that investigated ABO blood groups and their association with CVD and CVD risk in Africans and people of African descent and were published in English between 1960 and 2023. The data were extracted from Pubmed, Google Scholar, ScienceDirect, Web of Science, Scopus, African Wide and Medline. A total of 24 publications were reviewed following the inclusion criteria. The protocol for this systematic review was registered with PROSPERO (ID#: CRD42023495721). RESULTS:A total of 24 studies were included in the review with most of them being cross-sectional in design. The mean age of participants was 44 years with an age range of 1-89 years. The most common blood group in SSA was blood group O. The review showed that 11 out of the 24 studies indicated non-O groups association with CVD and CVD risk and 4 studies indicated blood group O association with CVD risk. The most common CVD risk markers studied were body mass index (BMI) and blood pressure (BP). The CVDs investigated were ischaemic disease, intracranial aneurysm, peripheral artery disease and coronary artery disease. CONCLUSION:There is no conclusive evidence showing a particular blood group, in the ABO system, being cardioprotective or more susceptible to CVD risk. The varying ABO associations with CVD risk among Africans and African ancestry underscore the importance of targeted and localised interventions aimed at curbing CVD against the backdrop of ABO profiling.

Ghana adopted the WHO-recommended Seasonal Malaria Chemoprevention (SMC) in 2016 following a pilot study as a vital strategy for malaria control. SMC is the intermittent administration of a preventive and curative dose of anti-malarial medicine (Sulfadoxine-Pyrimetamine + Amodiaquine) during four months of the malaria season. This study monitored the implementation of SMC to ensure the intervention is achieving its target. This was a longitudinal study in four administrative districts of the Upper East Region of Ghana. Children aged between 3 and 59 months were sampled and followed up one week after each cycle of SMC dosing to complete a questionnaire. SMC status was determined through the caregiver’s report and child welfare cards, if available. Caregivers were asked if the participant had been treated for malaria since the last cycle. Simple and multiple logistic regressions were employed to determine associations between SMC adherence and the independent variables, with all results interpreted at a 95

With the impacts of climate change on health becoming increasingly severe and far-reaching, effective communication to diverse audiences is more crucial than ever. This review analyzes 93 studies published between 2000 and 2023 on public understanding and responses to information about climate change and health. We synthesize research on public perceptions of climate change and health, responses to health-framed climate information, and information about climate and health risks and solutions, and the depolarizing potential of health messaging. Our findings suggest that conveying the health relevance of climate change holds significant potential for enhancing public engagement and building support for climate action. Additionally, we identify research gaps, particularly in understanding how different demographic audiences perceive health-related climate information and suggest directions for future studies. This synthesis of international research provides valuable insights into how different populations perceive and react to health-related climate information, highlighting the importance of targeted and effective communication strategies in addressing the climate crisis. The findings and summaries in this review can serve as valuable tools for evidence-based initiatives to address the critical issue of climate change and its profound implications for public health.

Background Immunisation is an essential and cost-effective way of preventing infectious diseases. The emergence of new diseases, including COVID-19, along with advancements in malaria vaccines, has potentially led to an increase in vaccinations, particularly among children under 5 years old in Africa. However, concerns about vaccine safety have led to a decline in trust and greater vaccine hesitancy, as evidenced by the low uptake of newly introduced vaccines like the pneumococcal vaccine-13 in Ghana.Adverse events following immunisation (AEFIs) may range from mild to severe and are of concern because vaccines are generally given to healthy people. To monitor vaccine safety, it is important that those who experience adverse events report to the nearest health facility, but compliance is low in Ghana. This study explored the knowledge and experiences of mothers in northern Ghana regarding vaccine safety and adverse event reporting procedures.Methods This cross-sectional exploratory study used a qualitative research design that involved 10 focus group discussions (FGDs) with mothers from 5 administrative regions in resource-limited Northern Ghana. Participants for the FGDs were selected through a purposive sampling method at childhood vaccination clinics. All the interviews were recorded, transcribed and coded into themes using QSR NVivo V.12 software to aid thematic content analysis.Results The results revealed that mothers understood the need for vaccinations, although some were unaware of the diseases that the vaccines protect against. Even though most mothers knew about the benefits of vaccinations, many expressed concerns about the pain and discomfort their children experienced during the process. Furthermore, they noted that the absence of responses from health workers following the reporting of AEFIs, the belief that adverse events are commonplace, and previous vaccination experiences all influenced AEFI reporting. The fear of serious adverse events such as paralysis, coupled with insufficient explanation of the benefits, may dissuade parents from allowing their children to receive vaccinations. The findings also revealed that mothers were not adequately informed about vaccines and the need for them to report adverse events.Conclusions Many individuals regard vaccines as an essential public health intervention for preventing diseases and their related complications. Public health agencies and healthcare providers ought to address concerns about vaccine adverse events by providing thorough education for mothers about vaccines and AEFI reporting.

Background/Objectives: Cardiovascular diseases are a global health issue with an increasing burden and are exacerbated by hypertension. High blood pressure is partly attributed to genetic variants that are generally not well understood or extensively studied in sub-Saharan African populations. Variants linked to blood pressure have been found through genome-wide association studies (GWASs), which were mostly conducted among European ancestry populations; however, limited research has been undertaken in Africa. The current study evaluated single-nucleotide polymorphisms (SNPs) of PCSK9, ABCA1, LPL, and PON1 in relation to blood pressure measurements of 1839 Ghanaian adults. Methods: Genotypes were extracted from data generated by the H3Africa SNP array. After adjusting for sex, age, smoking, and body mass index (BMI), inferential statistics were used to investigate the relationships between SNPs and blood pressure (BP) indices. Additionally, Bonferroni correction was used to adjust for multiple testing. Results: Diastolic blood pressure (DBP) and the minor allele T of the PCSK9 variant (rs17111557) were positively associated at p = 0.006 after covariate adjustments. Although this novel DBP-associated variant is located in the 3′ untranslated region (3′ UTR) of the PCSK9 gene, in silico functional prediction suggests it is an expression quantitative trait locus (eQTL) that may change the binding site of transcription factors, potentially altering the rate of transcription and impacting DBP in this Ghanaian population. Conclusions: Our findings highlight the role of genetics in hypertension risk and the potential of discovering new therapies targeting isolated diastolic blood pressure in this rural African population.

Despite the high healthcare needs in rural regions in Ghana, it is a challenge for health managers to attract and retain healthcare professionals in these regions including the Upper East Region, which negatively affects health service delivery. This study investigated factors contributing to attrition of health professionals in the Upper East Region of Northern Ghana. The study used a qualitative research approach where 92 in-depth interviews were conducted with participants between June and August, 2023. The interviews were recorded, transcribed and coded into themes using QSR Nvivo 12 software before thematic content analysis. Participants agreed that health worker attrition in the Upper East Region was a problem. Difficulty for health workers to obtain study leave for further studies, administrative lapses, linked with lack of respect and appreciation, family issues and poor working conditions were the main factors contributing to health worker attrition. However, health worker motivation, approval of study leave for qualified health staff, provision of medical equipment/ logistics and health managers showing respect and appreciation to frontline healthcare workers were strategies recommended by participants to address health worker attrition. Views shared by stakeholders in our study suggest that health worker attrition is a serious issue affecting service delivery in the Upper East Region. Thus, it is important for health managers to implement appropriate strategies including those recommended in this study towards addressing the issue, to improve healthcare.

Background The increasing incidence of novel vaccine-preventable diseases, such as COVID-19, has led to an increase in the development of vaccines globally. Vaccine hesitancy has risen due to fears of vaccines causing harm. African health systems have generally relied on spontaneous reporting of adverse events following immunisation (AEFIs) to monitor vaccine safety.Objectives This study explored the views of healthcare professionals and managers regarding barriers and strategies to improve AEFI reporting in northern Ghana.Methods This study used a qualitative research design where in-depth interviews were conducted with health professionals and managers in five administrative regions in northern Ghana between March and August 2021. The purposive sampling method was used to select districts and participants. The interviews were audio recorded, transcribed, and coded into themes using QSR NVivo V.12 software before thematic content analysis.Results The study found that lack of feedback is the main regulatory-level factor affecting reporting adverse events. Health system-level factors, such as limited knowledge of reporting AEFIs, a lack of training, difficulties in using electronic application software to complete AEFI forms, and fear of punishment, significantly affect AEFI reporting. At the patient/community level, the main factors affecting AEFI reporting are the distance to health facilities and transportation costs. However, participants suggested continuous AEFI education, sensitisation of health workers and patients, timely feedback, and effective stakeholder collaboration among front-line health workers, health managers, and the national pharmacovigilance authority could improve AEFI reporting in Ghana.Conclusions Reporting of AEFIs contributes to improving vaccine safety, surveillance systems and prompt case management. However, the study identified multiple key factors at the regulatory, health system, and patient levels affecting AEFI reporting. Thus, improvements in line with these suggestions, including effective stakeholder engagement, are necessary to increase AEFI reporting.

INTRODUCTION:In Ghana, about 15,000 newborn children are diagnosed to have sickle cell disease (SCD) annually. Previous studies have demonstrated that while neonatal screening coupled with early intervention reduces SCD-related morbidity and mortality, only 50-70% of screened-positive children have been successfully followed-up to receive healthcare. Gazelle point-of-care testing (POCT) device with high specificity and sensitivity may be more easily integrated into existing immunization programs in rural settings, to improve follow-up rates. This study explored views of community members and healthcare workers about the role of counselling to reduce parental fears and anxiety about newborn screening for SCD in rural Northern Ghana. METHODS:This study used qualitative research approach where 16 focus group discussions and 19 in-depth interviews were conducted with participants between April and June 2022. Purposive sampling technique was used to select participants for the interviews. The interviews were recorded with consent of participants, transcribed and coded into themes using QSR Nvivo 12 software before thematic analysis. RESULTS:Participants saw the need for counselling services to be provided to participants in the planned SCD screening program. They believed that effective counselling could help parents take appropriate strategies to manage children diagnosed with SCD and improve their health status. Furthermore, healthcare workers, mothers and opinion leaders held that counsellors could offer words of encouragement to parents to reduce their anxiety and fears during the screening especially, those whose children could be tested positive. They however suggested various strategies such as adequate training and positive behaviour of counsellors to ensure effective counselling process during the SCD screening program. CONCLUSION:Although counselling has been described as a key component in the planned SCD screening program, adequate training to improve knowledge, counselling skills as well as positive attitude of counsellors towards parents could enhance the effectiveness of counselling services offered.

Introduction: Communicating complex clinical trial information to potential participants with varying literacy levels and health conditions can be challenging. Ensuring health equity and promoting clinical trial diversity requires building trust with patients from diverse sociocultural backgrounds, particularly those with low literacy levels. Exploring new communication strategies such as interactive audio-visual formats in their native language can improve participants' understanding of, and participation in, clinical trials, particularly when it is tailored to their literacy levels. The “Speaking Book (SB)” is a customizable, audio-visual tool that explains in a simplified language what it means to be part of a clinical trial to improve participants' understanding of clinical trials. It offers an interactive and engaging way to educate patients with low literacy levels, providing essential clinical trial information. This tool can be beneficial particularly in underserved communities, making learning about clinical research accessible and equitable for all. To determine the impact of the SB on participants' understanding of clinical trials, a non-interventional study is being conducted in Ghana, Kenya, and India. This study aims to determine whether SBs can significantly enhance the understanding of clinical trials among clinical trial-naive participants or those with limited knowledge on clinical research, especially among those with low literacy levels. Methods: This prospective, multicenter, qualitative research study included clinical trial-naive adult patients with benign hematological disorders with low literacy levels. Participants who are unable to understand or unwilling to sign an informed consent form and those with conditions that could hinder study completion such as psychiatric illnesses, visual or cognitive impairments, memory issues, or active substance addiction, were excluded. The primary objective is to evaluate the improvement in clinical trial knowledge among participants when using the SB. The secondary objectives are to assess the willingness to participate in a clinical trial and evaluate the ease of use and meaningfulness of the SB. The study plans to enroll 205 participants randomized (1:1) to either the control group (participants will receive standard education about clinical trials from their clinic team) or the review group (participants will receive both standard education and SBs). There are 2 study visits: visit 1 at baseline and visit 2 after 1 month (± 2 weeks). At both visits, all participants will complete the Clinical Trial Knowledge Questionnaire (CTKQ) to measure their knowledge of clinical trials. At visit 2, all participants will also complete the Knowledge Impact Questionnaire (KIQ) to measure their willingness to participate in clinical trials. The review group will additionally complete the Speaking Book Ease of use Questionnaire (SBEQ) to measure their satisfaction with the SB. The visit 2 questionnaires will be virtually administered by an independent interpreter or through telephone at the center. The primary endpoint will be the difference in clinical trial knowledge scores between the control and review groups at visit 2. The secondary endpoints are the difference in willingness to participate score, the descriptive assessment of the ease of use of the SB, and the descriptive assessment of patient demographics and/or center type impact on the utility of the SB. Results: The study follow-up is completed in Ghana, with enrollment and follow-up ongoing in Kenya and India. To date, 190 participants out of 205 planned have been enrolled. Data analysis and clinical study report will be finalized subsequently for presentation and/or publication. Conclusions: The study rationale and objectives are based on the hypothesis that the Speaking Books can significantly increase knowledge of clinical trials among research-naive patients with no or little clinical research knowledge, particularly those with low literacy levels in underserved communities. We anticipate that such practical and immersive approach will help build trust and embrace the inclusion of more diverse patients in clinical trials.

Hypertension and type 2 diabetes mellitus (T2DM) are important contributors to noncommunicable disease related morbidity and mortality. Health systems could benefit from exploring the use of Faith-Based Centres (FBC) to screen and link suspected cases for further care in order to help achieve Sustainable Development Goal (SDG) 3. The study investigated the role of faith-based screening for T2DM and hypertension and the linkage of cases to the healthcare system and examined the care cascade in the Kassena Nankana Districts of Northern Ghana. We screened individuals from 6 FBCs for elevated blood pressure and hyperglycaemia. Suspected hypertension and T2DM cases were referred to health facilities for confirmation and subsequently followed them up for 3 months. We assessed the prevalence of behavioural and metabolic risk factors, including hypertension and T2DM, and the retention of referred cases in the healthcare system over follow up period. We further assessed levels of awareness, treatment and adequate control of hypertension and T2DM. A total of 631 participants were screened, (mean age 49 ± 16years, 73