Effect of Vitamin A Supplementation on Cause-Specific Mortality in Women of Reproductive Age in Ghana: a Secondary Analysis from the ObaapaVitA trial

Objective:To determine the effect of weekly low-dose vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana. Methods: A cluster-randomized; triple-blind; placebo-controlled trial was conducted in seven districts of the Brong Ahafo region of Ghana. Women aged 15-45 years who were capable of giving informed consent and intended to live in the trial area for at least 3 months were enrolled and randomly assigned; according to their cluster of residence; to receive oral vitamin A (7500 ?g) or placebo once a week. Randomization was blocked; with two clusters in each fieldwork area allocated to vitamin A and two to placebo. Every 4 weeks; fieldworkers distributed capsules and collected data during home visits. Verbal autopsies were conducted by field supervisors and reviewed by physicians; who assigned a cause of death. Cause-specific mortality rates in both arms were compared by means of random-effects Poisson regression models to allow for the cluster randomization. Analysis was by intention-to-treat; based on cluster of residence; with women eligible for inclusion once they had consistently received the supplement or placebo capsules for 6 months. Findings The analysis was based on 581 870 woman-years and 2624 deaths. Cause-specific mortality rates were found to be similar in the two study arms.Conclusion: Low-dose vitamin A supplements administered weekly are of no benefit in programmes to reduce mortality in women of childbearing age

Adherence to Behavioral Symptoms Therapy for Uncomplicated Malaria in Rural Ghana: A Randomised Trial of Supervised Versus Unsupervised Drug Administration

Introduction.To enhance effective treatment; african nations including Ghana changed its malaria treatment policy from monotherapy to combination treatment with artesunate-amodiaquine (AS+AQ). The major challenge to its use in loose form is adherence. Objective. The objectives of this study were to investigate adherence and treatment outcome among patients treated with AS+AQ combination therapy for acute uncomplicated malaria. Methodology. The study was conducted in two rural districts located in the middle belt of Ghana using quantitative methods. Patients diagnosed with acute uncomplicated malaria as per the Ghana Ministry of Health malaria case definitions were randomly allocated to one of two groups. All patients in both groups were educated about the dose regimen of AS+AQ therapy and the need for adherence. Treatment with AS+AQ was supervised in one group while the other group was not supervised. Adherence was assessed by direct observation of the blister package of AS+AQ left on day 2. Results. 401 participants were randomized into the supervised (211) and unsupervised (190) groups. Compliance in both supervised (95.7) and unsupervised (92.6) groups were similar (P=.18). The commonest side-effects reported on day 2 among both groups were headaches; and body weakness. Parasite clearance by day 28 was 95in both groups. Discussion/Conclusions. Administration of AS-AQ in both groups resulted in high levels of adherence to treatment regimen among adolescent and adult population in central Ghana. It appears that high level of adherence to AS-AQ is achievable through a rigorous education programme during routine clinic visits