Faculty of Public Health

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    SPATIOTEMPORAL RELATIONSHIPS BETWEEN DOG BITES, DOG VACCINATION COVERAGES, DOG AND HUMAN RABIES IN GHANA: IMPLICATIONS FOR ONE HEALTH COLLABORATION
    (ODEI ERIC, 2024-10-17) ODEI, ERIC
    Introduction Rabies is preventable, yet globally, about 59,000 people die from the disease annually. About forty percent (40%) of these deaths occur in Sub-Saharan Africa (SSA). Rabies remains an important public health concern to human and veterinary health professionals in SSA. In line with the global strategic framework to eliminate dog-mediated human rabies by 2030, Ghana has committed to eliminating human rabies by improving dog vaccination coverages, creating awareness and providing prompt post-exposure treatment using the One Health approach. The study aimed to investigate the spatiotemporal relationships between dog bites, dog vaccination coverages, dog and human rabies cases in Ghana for the period 2015-2021 and to identify existing mechanisms, barriers and enablers of One Health collaboration for elimination of dog-mediated human rabies. Methods A mixed-methods approach was employed. Rabies surveillance data from the Disease Surveillance Department (DSD) of Ghana Health Service (GHS) and Veterinary Services Directorate (VSD) were abstracted for all 260 districts in Ghana and modelled using Besag-Yorke-Mollie model in R-INLA and SaTScan for spatial, temporal and spatiotemporal mapping and cluster analysis. Key informant interviews (KIIs) were conducted with 35 purposively selected officers in GHS and VSD at the national, regional and district levels to determine extent of data-sharing and collaboration between the two sectors. Concurrently, a cross-sectional survey was conducted among 468 frontline staff of the animal health and human health sectors in the same 12 purposively selected districts where KIIs were being conducted to assess their knowledge, perception and practices with respect to One Health collaboration for rabies elimination. A desk review of national policy documents on dog and human rabies elimination in Ghana was conducted to understand the policy environment. Results In the period 2015-2021, average annual reported dog bites, human rabies cases, dog rabies cases, and dogs vaccinated were 16,675, 19, 86, and 60,952 respectively translating into average annual dog bite incidence of 58.9 per 100,000 population, average annual human rabies incidence of 0.07 per 100,000 population, average annual dog rabies incidence of 8 per 100,000 dogs and vaccination coverage of 5.7%. Dog bites were spatiotemporally associated with dog vaccination coverage (RR:1.77; 95% Credible Interval (CI):1.26-2.46) but much less significantly so with dog rabies (RR:1.03; 95% CI:1.01-1.06) and human rabies cases (RR: 1.03; 95% CI: 1.00-1.06). Key Informant Interviews revealed that the approach to dog vaccinations were more reactionary than proactive with vaccinations being carried out in response to suspected rabies cases or dog bites. There was poor collaboration for routine data-sharing between the human health and veterinary services due to lack of a clear policy. Unwillingness and inability of pet owners to bear cost of vaccination and inadequate law enforcement regarding responsible pet ownership contributed to the low dog vaccination coverage. Conclusion and Recommendations Lack of One Health policy accounts for the poor collaboration for routine data sharing between the two sectors. Weak legislation and inadequate law enforcement are major drivers of the low dog vaccination coverages. Finalizing and implementing the One Health policy alongside stronger legislation with law enforcement on dog vaccinations are urgently required to ensure the achievement of ‘zero by 30’ target.
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    FACTORS INFLUENCING ADOLESCENTS’ USE OF SERVICES AT ADOLESCENT HEALTH CORNERS IN THE BRONG AHAFO REGION
    (AFREH KUFFOUR OSEI, 2021-03-12) AFREH, KUFFOUR OSEI
    Introduction: Adolescents are generally a healthy population. Nonetheless, they face significant health challenges. Low contraceptive use, unplanned pregnancies and Sexually Transmitted Infections (STIs) including HIV/AIDS among adolescents in sub-Saharan Africa are unacceptably high and of public health concern. Complications from pregnancy and childbirth have been identified as the leading cause of death in girls aged 15-19 yrs in low and middle income countries, where almost all the estimated 3 million unsafe abortions occur. Adolescent Health Corners (AHCs) were established at selected public health facilities in the early 2000s to create conducive environments for service delivery and utilisation by adolescents. Consequently, scale up of the AHCs was embarked upon by Ghana Health Service and her partners where UKAID through the Palladium Group’s Ghana Adolescent Reproductive Health (GHARH) Project, refurbished and equipped 54 Adolescent Health Corners in the Brong Ahafo Region. This study sought to examine factors that influence adolescents in using the services provided at the AHCs. Methods A cross-sectional study was used by adopting a mixed method of data collection. Quantitative data was collected randomly from 509 study participants selected from 11 districts sampled randomly from the 27 administrative districts across the Brong Ahafo Region. Two focus group discussions were also conducted for adolescents within two of the selected districts. Eleven in-depth interviews were conducted for health care providers at the AHCs in the selected Districts. Results Majority (73.1%) of the adolescents were aware of the presence of AHCs in their catchment area. Majority (82.5%) of the respondents who were aware of AHCs had used services at the AHCs. Females had a significantly higher odds of awareness of the existence of AHCs compared to males (AOR=2.34, CI=1051-3.62, p=0.003). Adolescents whose mothers and fathers attained a primary education had higher odds [4.25 (1.93, 9.35), 3.94 (1.21, 12.79) respectively] of being aware of AHCs in their area of residence (p<0.05). Only 48.5% of schools had School Health Clubs (SHC). Adolescents who were members of SHC were 5.86 times more likely to use the services at the AHC (p<0.002). 35.2% of respondent said that providing recreational activities in the corners would attract more adolescents and 33.8% stated that services should be provided in a friendly manner. They also called for intensification of awareness creation campaign about the existence of AHCs and services provided (18.6%), provision of regular health screening (10.1%) and abortion services at the corner (2.3%). Conclusion: AHCs are crucial in reaching out to adolescents through the provision of adequate information and services during the period of adolescence. Majority of adolescents interviewed were aware of AHCs and had used the services provided. However, efforts should be made to create more demand for the services. Establishment of SHC in schools with school children being members of the clubs was found to create additional opportunity to reach out to adolescents and improve use of services at AHCs. Services provided at AHCs should be appealing to adolescents with assured privacy and confidentiality. Trained staff should create a friendly environment to address the concerns of adolescents.