Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness.

BACKGROUND: In high-resource settings, structured diabetes self-management education is associated with improved outcomes but the evidence from low-resource settings is limited and inconclusive. AIM: To compare, structured diabetes self-management education to usual care, in adults with type 2 diabetes, in low-resource settings. DESIGN: Single-blind randomised parallel comparator controlled multi-centre trial. Adults (> 18 years) with type 2 diabetes from two hospitals in urban Ghana were randomised 1:1 to usual care only, or usual care plus a structured diabetes self-management education program. Randomisation codes were computer-generated, and allotment concealed in opaque numbered envelopes. The intervention effect was assessed with linear mixed models. MAIN OUTCOME: Change in HbA1c after 3-month follow-up. Primary analysis involved all participants. CLINICALTRIAL: gov identifier:NCT04780425, retrospectively registered on 03/03/2021. RESULTS: Recruitment: 22nd until 29th January 2021. We randomised 206 participants (69% female, median age 58 years [IQR: 49-64], baseline HbA1c median 64 mmol/mol [IQR: 45-88 mmol/mol],7.9%[IQR: 6.4-10.2]). Primary outcome data was available for 79 and 80 participants in the intervention and control groups, respectively. Reasons for loss to follow-up were death (n = 1), stroke(n = 1) and unreachable or unavailable (n = 47). A reduction in HbA1c was found in both groups; -9 mmol/mol [95% CI: -13 to -5 mmol/mol], -0·9% [95% CI: -1·2% to -0·51%] in the intervention group and -3 mmol/mol [95% CI -6 to 1 mmol/mol], -0·3% [95% CI: -0·6% to 0.0%] in the control group. The intervention effect was 1 mmol/mol [95%CI:-5 TO 8 p = 0.726]; 0.1% [95% CI: -0.5, 0.7], p = 0·724], adjusted for site, age, and duration of diabetes. No significant harms were observed. CONCLUSION: In low-resource settings, diabetes self-management education might not be associated with glycaemic control. Clinician's expectations from diabetes self-management education must therefore be guarded.

The short-term effect of the government of Ghana's decision to open borders at the early-onset of the COVID-19 pandemic.

Non-Pharmaceutical Interventions (NPI) are used in public health to mitigate the risk and impact of epidemics or pandemics in the absence of medical or pharmaceutical solutions. Prior to the release of vaccines, COVID-19 control solely depended on NPIs. The Government of Ghana after assessing early NPIs introduced at the early stage of the pandemic began to ease some restrictions by the opening of international borders with isolation and quarantine measures enforced. It was argued by some experts that this was a hasty decision. In this study, we assessed the impact of the opening of borders to ascertain if this action caused a surge or otherwise in cases in the country. Using data from the database on Africa's records of COVID-19 from the John Hopkins University, the Generalized Linear Model (GLM) time-series regression model for count data was applied to study effects in Ghana during a 4-month and 8-month period post-opening of borders. The study showed that after the decision of the government to open international borders, Ghana's expected case count declined by 72.01 % in the 4-month period and 54.44 % in the 8-month period. This gives an indication of the gradual reversal of the gains made due to the early implementation of NPIs. Notably, this may not only be attributed to the opening of borders but the relaxation of the strict enforcement measures that were put in place at the onset of the pandemic in Ghana. There is therefore the need for continuous enforcement of intervention measures to reduce case counts, particularly with the emergence of new COVID-19 virus strains. The study provides some recommendations for policy and improvements in model building such as developing better data collection system in Ghana, investigating more control variables, estimating the decaying effect of interventions, and ensuring better preparations prior to easing of public health restrictions.

Characterization of Healthy Housing in Africa: Method, Profiles, and Determinants.

Housing is a key social determinant of health with implications for both physical and mental health. The measurement of healthy housing and studies characterizing the same in sub-Saharan Africa (SSA) are uncommon. This study described a methodological approach employed in the assessment and characterization of healthy housing in SSA using the Demographic and Health Survey (DHS) data for 15 countries and explored healthy housing determinants using a multiple survey-weighted logistic regression analysis. For all countries, we demonstrated that the healthy housing index developed using factor analysis reasonably satisfies both reliability and validity tests and can therefore be used to describe the distribution of healthy housing across different groups and in understanding the linkage with individual health outcomes. We infer from the results that unhealthy housing remains quite high in most SSA countries. Having a male head of the household was associated with decreased odds of healthy housing in Burkina Faso (OR = 0.80, CI = 0.68-0.95), Cameroon (OR = 0.65, CI = 0.57, 0.76), Malawi (OR = 0.70, CI = 0.64-0.78), and Senegal (OR = 0.62, CI = 0.51-0.74). Further, increasing household size was associated with reducing odds of healthy housing in Kenya (OR = 0.53, CI = 0.44-0.65), Namibia (OR = 0.34, CI = 0.24-0.48), Nigeria (OR = 0.57, CI = 0.46-0.71), and Uganda (OR = 0.79, CI = 0.67-0.94). Across all countries, household wealth was a strong determinant of healthy housing, with middle and rich households having higher odds of residing in healthy homes compared to poor households. Odds ratios ranged from 3.63 (CI = 2.96-4.44) for households in the middle wealth group in the DRC to 2812.2 (CI = 1634.8-4837.7) in Namibia's wealthiest households. For other factors, the analysis also showed variation across countries. Our findings provide timely insights for the implementation of housing policies across SSA countries, drawing attention to aspects of housing that would promote occupant health and wellbeing. Beyond the contribution to the measurement of healthy housing in SSA, our paper highlights key policy and program issues that need further interrogation in the search for pathways to addressing the healthy housing deficit across most SSA countries. This has become critical amid the COVID-19 pandemic, where access to healthy housing is pivotal in its control.

Mathematical modelling of earlier stages of COVID-19 transmission dynamics in Ghana.

In late 2019, a novel coronavirus, the SARS-CoV-2 outbreak was identified in Wuhan, China and later spread to every corner of the globe. Whilst the number of infection-induced deaths in Ghana, West Africa are minimal when compared with the rest of the world, the impact on the local health service is still significant. Compartmental models are a useful framework for investigating transmission of diseases in societies. To understand how the infection will spread and how to limit the outbreak. We have developed a modified SEIR compartmental model with nine compartments (CoVCom9) to describe the dynamics of SARS-CoV-2 transmission in Ghana. We have carried out a detailed mathematical analysis of the CoVCom9, including the derivation of the basic reproduction number, R 0 . In particular, we have shown that the disease-free equilibrium is globally asymptotically stable when R 0 < 1 via a candidate Lyapunov function. Using the SARS-CoV-2 reported data for confirmed-positive cases and deaths from March 13 to August 10, 2020, we have parametrised the CoVCom9 model. The results of this fit show good agreement with data. We used Latin hypercube sampling-rank correlation coefficient (LHS-PRCC) to investigate the uncertainty and sensitivity of R 0 since the results derived are significant in controlling the spread of SARS-CoV-2. We estimate that over this five month period, the basic reproduction number is given by R 0 = 3 . 110 , with the 95% confidence interval being 2 . 042 ≤ R 0 ≤ 3 . 240 , and the mean value being R 0 = 2 . 623 . Of the 32 parameters in the model, we find that just six have a significant influence on R 0 , these include the rate of testing, where an increasing testing rate contributes to the reduction of R 0 .

Coping strategies adapted by Ghanaians during the COVID-19 crisis and lockdown: A population-based study.

BACKGROUND: The COVID-19 pandemic and control measures adopted by countries globally can lead to stress and anxiety. Investigating the coping strategies to this unprecedented crisis is essential to guide mental health intervention and public health policy. This study examined how people are coping with the COVID-19 crisis in Ghana and identify factors influencing it. METHODS: This study was part of a multinational online cross-sectional survey on Personal and Family Coping with COVID-19 in the Global South. The study population included adults, ≥18 years and residents in Ghana. Respondents were recruited through different platforms, including social media and phone calls. The questionnaire was composed of different psychometrically validated instruments with coping as the outcome variable measured on the ordinal scale with 3 levels, namely, Not well or worse, Neutral, and Well or better. An ordinal logistic regression model using proportional odds assumption was then applied. RESULTS: A total of 811 responses were included in the analysis with 45.2% describing their coping level as well/better, 42.4% as neither worse nor better and 12.4% as worse/not well. Many respondents (46.9%) were between 25-34 years, 50.1% were males while 79.2% lived in urban Ghana. Having pre-existing conditions increased the chances of not coping well (aOR = 1.86, 95%CI: 1.15-3.01). Not being concerned about supporting the family financially (aOR = 1.67, 95%CI: 1.06-2.68) or having the feeling that life is better during the pandemic (aOR = 2.37, 95%CI: 1.26-4.62) increased chances of coping well. Praying (aOR: 0.62, 95%CI: 0.43-0.90) or sleeping (aOR: 0.55, 95%CI: 0.34-0.89) more during the pandemic than before reduces coping. CONCLUSION: In Ghana, during the COVID-19 pandemic, financial security and optimism about the disease increase one's chances of coping well while having pre-existing medical conditions, praying and sleeping more during the pandemic than before reduces one's chances of coping well. These findings should be considered in planning mental health and public health intervention/policy.

Mathematical modeling of COVID-19 infection dynamics in Ghana: Impact evaluation of integrated government and individual level interventions.

The raging COVID-19 pandemic is arguably the most important threat to global health presently. Although there Although there is currently a a a vaccine, preventive measures have been proposed to reduce the spread of infection but the efficacy of these interventions, and their likely impact on the number of COVID-19 infections is unknown. In this study, we proposed the SEIQHRS model (susceptible-exposed-infectious-quarantine-hospitalized-recovered-susceptible) model that predicts the trajectory of the epidemic to help plan an effective control strategy for COVID-19 in Ghana. We provided a short-term forecast of the early phase of the epidemic trajectory in Ghana using the generalized growth model. We estimated the effective basic Reproductive number Re in real-time using three different estimation procedures and simulated worse case epidemic scenarios and the impact of integrated individual and government interventions on the epidemic in the long term using compartmental models. The maximum likelihood estimates of Re and the corresponding 95% confidence interval was 2.04 [95% CI: 1.82-2.27; 12th March-7th April 2020]. The Re estimate using the exponential growth method was 2.11 [95% CI: 2.00-2.24] within the same period. The Re estimate using time-dependent (TD) method showed a gradual decline of the Effective Reproductive Number since March 12, 2020 when the first 2 index cases were recorded but the rate of transmission remains high (TD: Re = 2.52; 95% CI: [1.87-3.49]). The current estimate of Re based on the TD method is 1.74 [95% CI: 1.41-2.10; (13th May 2020)] but with comprehensive integrated government and individual level interventions, the Re could reduce to 0.5 which is an indication of the epidemic dying out in the general population. Our results showed that enhanced government and individual-level interventions and the intensity of media coverage could have a substantial effect on suppressing transmission of new COVID-19 cases and reduced death rates in Ghana until such a time that a potent vaccine or drug is discovered.