Papers by isaiah agorinya
medRxiv (Cold Spring Harbor Laboratory), Aug 20, 2023
Background: Out-of-pocket health payments (OOPs) are a key indicator of health financing systems'... more Background: Out-of-pocket health payments (OOPs) are a key indicator of health financing systems' performance. Measuring OOPs through household surveys is challenging and yet it is the primary source of information in the absence of comprehensive data on user charges in the public sector and market data from the private sector. The choice of the recall period has been identified as a source of bias in previous studies. This study investigates the effect of two different types of recall periods on the agreement between OOPs reported by households and providers. Methods: Households were sampled for the community survey from the Navrongo Health and Demographic Surveillance System, Ghana. Two versions of a health expenditure module were developed differing only in the recall periods, "shorter recall periods"2weeks for medicines and outpatient care, 3monthsfor preventive care and 6months for inpatient care and medical products. The longer recall periods were 4 weeks, 6months and 12months.Households from both community and provider sampling were randomly assigned to the two questionnaires. The providers included the hospital, one clinic and health facilities and drug shops in the area. We estimated the ratio between the overall mean household OOPs and overall mean provider OOPs. We assessed agreement between the individual matched household-provider OOPs using the Bland-Altman analysis. Findings: The short and long recall period versions of the questionnaires were administered to746 and 480 households with matching success to provider records of 72% and 84%, respectively. The most common spending categories were inpatient care and medicines in this sample. The overall mean OOPs reported by the households were higher than provider records for both recall periods. For matched household-provider data, there was no evidence of a difference in the agreement between the household and provider OOPs for inpatient care, the ratio of household to provider for the 12 months recall was estimated to be 0.74 (95% CI 0.45, 1.19; p=0.22) that of the ratio of household to provider for the 6-month period, where less than 1 indicates better agreement. For medicines, the ratio of 4 weeks to 2 weeks was 1.26 (0.93, 1.39; p=0.39). Conclusion: There were considerable challenges in using provider data to assess the accuracy of reported OOPs in this setting. There was no evidence from this study that the agreement between household and provider data differed by recall period, however the confidence intervals of the effect were wide, and an effect cannot be ruled out.
Journal of Global Health Science
Background: Little is known about the economic burden of snakebites to households in Ghana. This ... more Background: Little is known about the economic burden of snakebites to households in Ghana. This study examined the economic burden of snakebites to victims of households in 2 snakebite endemic districts in the Oti Region of Ghana. Methods: STATA version 14 was used for the data analysis and the cost of treating snakebite was estimated from the patient perspective. In the study, we first present descriptive statistics of the variables used and then use the Kruskal-Wallis test to assess significant difference in the mean cost of snakebite across groups. We also used the Generalized Linear Model to establish the relationship between cost of treating snakebite versus potential risk factors associated with the cost. Results: A total of 373 respondents were involved in the study and the majority were males (68.36%). The mean non-medical cost incurred during treatment was USD 26.57 with feeding accounting for the largest non-medical cost (USD 17.97). The mean medical cost incurred was USD 70.60 with largest expenditures on medications (USD 49.70). The average indirect cost relating to productivity loss due to snakebite was USD 60.57 and the average number of days unable to work due to the snakebite was 39 days. The overall direct and indirect mean cost incurred by victims was USD 155.56. Of the total cost, direct medical cost accounted for 44.90%, indirect cost accounted for 38.52%, and non-medical cost accounted for 16.58%. The average cost incurred by the insured under the national insurance scheme (USD 154.07) was statistically lower (P-value = 0.017) than those uninsured under the scheme (USD 158.78). Conclusion: To assist reduce the economic burden of treating snakebites, antivenom should be included in the National Health Insurance Scheme benefit package and should be made readily available at health facilities.
Journal of Global Health Science
Background: Little is known about the economic burden of snakebites to households in Ghana. This ... more Background: Little is known about the economic burden of snakebites to households in Ghana. This study examined the economic burden of snakebites to victims of households in 2 snakebite endemic districts in the Oti Region of Ghana. Methods: STATA version 14 was used for the data analysis and the cost of treating snakebite was estimated from the patient perspective. In the study, we first present descriptive statistics of the variables used and then use the Kruskal-Wallis test to assess significant difference in the mean cost of snakebite across groups. We also used the Generalized Linear Model to establish the relationship between cost of treating snakebite versus potential risk factors associated with the cost. Results: A total of 373 respondents were involved in the study and the majority were males (68.36%). The mean non-medical cost incurred during treatment was USD 26.57 with feeding accounting for the largest non-medical cost (USD 17.97). The mean medical cost incurred was USD 70.60 with largest expenditures on medications (USD 49.70). The average indirect cost relating to productivity loss due to snakebite was USD 60.57 and the average number of days unable to work due to the snakebite was 39 days. The overall direct and indirect mean cost incurred by victims was USD 155.56. Of the total cost, direct medical cost accounted for 44.90%, indirect cost accounted for 38.52%, and non-medical cost accounted for 16.58%. The average cost incurred by the insured under the national insurance scheme (USD 154.07) was statistically lower (P-value = 0.017) than those uninsured under the scheme (USD 158.78). Conclusion: To assist reduce the economic burden of treating snakebites, antivenom should be included in the National Health Insurance Scheme benefit package and should be made readily available at health facilities.
<p>Descriptive statistics of maternal and neonatal characteristics.</p
European Journal Of Public Health
Background Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and result... more Background Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and results in adverse pregnancy outcomes among affected women. This paper assessed the prevalence and effects of FGM on pregnancy outcomes in a rural Ghanaian setting. Methods We analyzed 9306 delivery records between 2003 and 2013 from the Navrongo War Memorial Hospital. Multivariable logistic regression analyses were used to determine the effects of FGM on pregnancy outcomes such as stillbirth, birth weight, postpartum haemorrhage, caesarean and instrumental delivery. We also assessed differences in the duration of stay in the hospital by FGM status. Results A greater proportion of mothers with FGM (24.7%) were older than 35 years compared with those without FGM (7.6%). FGM declined progressively from 28.4% in 2003 to 0.6% in 2013. Mothers with FGM were nearly twice as likely to have caesarean delivery (adjusted odds ratios = 1.85 with 95%CI [1.72, 1.99]) and stillbirths (1.60 [1.21, 2.11]) com...
<p>Maternal, demographic and socio-economic factors associated with LBW in the Kassena-Nank... more <p>Maternal, demographic and socio-economic factors associated with LBW in the Kassena-Nankana districts.</p
BMC International Health and Human Rights, Jun 28, 2017
Background: In spite of global decline in under-five mortality, the goal of achieving MDG 4 still... more Background: In spite of global decline in under-five mortality, the goal of achieving MDG 4 still remains largely unattained in low and middle income countries as the year 2015 closes-in. To accelerate the pace of mortality decline, proven interventions with high impact need to be implemented to help achieve the goal of drastically reducing childhood mortality. This paper explores the association between socio-economic and demographic factors and under-five mortality in an impoverished region in rural northern Ghana. Methods: We used survey data on 3975 women aged 15–49 who have ever given birth. First, chi-square test was used to test the association of social, economic and demographic characteristics of mothers with the experience of under-five death. Subsequently, we ran a logistic regression model to estimate the relative association of factors that influence childhood mortality after excluding variables that were not significant at the bivariate level. Results: Factors that sig...
JAMA Pediatrics, 2020
estational age at birth (GAB) is an important determinant of child health and development. Worldw... more estational age at birth (GAB) is an important determinant of child health and development. Worldwide, approximately 13 million newborns are born preterm (GAB<37 weeks) annually. 1 Prematurity is associated with morbidity and mortality, 2,3 including neurodevelopmental problems, such as cerebral palsy, intellectual disability, learning disability, and poor motor development. 4-6 Preterm birth is reportedly associated with increased risks of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, 7-9 and psychiatric disorders in adulthood. 10 In some countries, postterm birth (GAB≥42 weeks) accounts for up to 10% of births 11 and is associated with adverse birth outcomes, increased neonatal mortality, cognitive impairment, and increased risk of ADHD. 12 Few studies 13,14 have investigated the associations of GAB with brain structures despite the dynamic neurodevelopment that occurs during early life. During the third trimester of gestation, there is a 4-fold increase in brain size accompanied by marked growth of brain surface area, resulting in the emergence of sulci and gyri. 15,16 Thus, birth before the presumed optimal gestational duration (approximately 40 weeks) may be associated with disruption of neurodevelopmental processes in late pregnancy that persist during postnatal life. Prior studies 17-22 often focused on children born extremely preterm (<28 weeks of gestation) or very preterm (<34 weeks of gestation) and found less gray and white matter volume in premature children and adolescents. These studies 17-22 IMPORTANCE Preterm and postterm births are associated with adverse neuropsychiatric outcomes. However, it remains unclear whether variation of gestational age within the 37-to 42-week range of term deliveries is associated with neurodevelopment. OBJECTIVE To investigate the association of gestational age at birth (GAB) with structural brain morphometry in children aged 10 years. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included pregnant women living in Rotterdam, the Netherlands, with an expected delivery date between April 1, 2002, and January 31, 2006. The study evaluated 3079 singleton children with GAB ranging from 26.3 to 43.3 weeks and structural neuroimaging at 10 years of age from the Generation R Study, a longitudinal, population-based prospective birth cohort from early pregnancy onward in Rotterdam. Data analysis was performed from March 1, 2019, to February 28, 2020, and at the time of the revision based on reviewer suggestions. EXPOSURES The GAB was calculated based on ultrasonographic assessment of crown-rump length (<12 weeks 5 days) or biparietal diameter (Ն12 weeks 5 days) in dedicated research centers. MAIN OUTCOMES AND MEASURES Brain structure, including global and regional brain volumes and surface-based cortical measures (thickness, surface area, and gyrification), was quantified by magnetic resonance imaging. RESULTS In the 3079 children (1546 [50.2%] female) evaluated at 10 years of age, GAB was linearly associated with global and regional brain volumes. Longer gestational duration was associated with larger brain volumes; for example, every 1-week-longer gestational duration corresponded to an additional 4.5 cm 3 /wk (95% CI, 2.7-6.3 cm 3 /wk) larger total brain volume. These associations persisted when the sample was restricted to children born at term (GAB of 37-42 weeks: 4.8 cm 3 /wk; 95% CI, 1.8-7.7 cm 3 /wk). No evidence of nonlinear associations between GA and brain morphometry was observed. CONCLUSIONS AND RELEVANCE In this cohort study, gestational duration was linearly associated with brain morphometry during childhood, including within the window of term delivery. These findings may have marked clinical importance, particularly given the prevalence of elective cesarean deliveries.
PLOS ONE, 2020
Background Maternal and Child health remains at the core of global health priorities transcending... more Background Maternal and Child health remains at the core of global health priorities transcending the Millennium Development Goals into the current era of Sustainable Development Goals. Most low and middle-income countries including Ghana are yet to achieve the required levels of reduction in child and maternal mortality. This paper analysed the trends and the associated risk factors of stillbirths in a district hospital located in an impoverished and remote region of Ghana. Methods Retrospective hospital maternal records on all deliveries conducted in the Navrongo War Memorial hospital from 2003-2013 were retrieved and analysed. Descriptive and inferential statistics were used to summarise trends in stillbirths while the generalized linear estimation logistic regression is used to determine socio-demographic, maternal and neonatal factors associated with stillbirths. Results A total of 16,670 deliveries were analysed over the study period. Stillbirth rate was 3.4% of all births. There was an overall decline in stillbirth rate over the study period as stillbirths declined from 4.2% in 2003 to 2.1% in 2013. Female neonates were less likely to be stillborn (Adjusted Odds ratio = 0.62 and 95%CI [0.46, 0.84]; p = 0.002) compared to male neonates;
European Journal of Public Health, 2019
Background Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and result... more Background Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and results in adverse pregnancy outcomes among affected women. This paper assessed the prevalence and effects of FGM on pregnancy outcomes in a rural Ghanaian setting. Methods We analyzed 9306 delivery records between 2003 and 2013 from the Navrongo War Memorial Hospital. Multivariable logistic regression analyses were used to determine the effects of FGM on pregnancy outcomes such as stillbirth, birth weight, postpartum haemorrhage, caesarean and instrumental delivery. We also assessed differences in the duration of stay in the hospital by FGM status. Results A greater proportion of mothers with FGM (24.7%) were older than 35 years compared with those without FGM (7.6%). FGM declined progressively from 28.4% in 2003 to 0.6% in 2013. Mothers with FGM were nearly twice as likely to have caesarean delivery (adjusted odds ratios = 1.85 with 95%CI [1.72, 1.99]) and stillbirths (1.60 [1.21, 2.11]) com...
BMC International Health and Human Rights, 2018
Background: Over the past two decades, employment in the informal sector has grown rapidly in all... more Background: Over the past two decades, employment in the informal sector has grown rapidly in all regions including low and middle-income countries. In the developing countries, between 50 and 75% of workers are employed in the informal sector. In Ghana, more than 80% of the total working population is working in the informal sector. They are largely self-employed persons such as farmers, traders, food processors, artisans, craftworkers among others. The persistent problem in advancing efforts to address health vulnerabilities of informal workers is lack of systematic data. Therefore, this study explored factors affecting informal workers access to health care services in Northern Ghana. Method: The study used qualitative methodology where focus group discussions and in-depth interviews were conducted. Purposive sampling technique was used to select participants for the interviews. The interviews were transcribed and coded into emergent themes using Nvivo 10 software before thematic content analysis. Results: Study participants held the view that factors such as poverty, time spent at the health facility seeking for health care, unpleasant attitude of health providers towards clients affected their access to health care services. They perceived that poor organization and operations of the current health system and poor health care services provided under the national health insurance scheme affected access to health care services according to study participants. However, sale of assets, family support, borrowed money from friends and occasional employer support were the copying strategies used by informal workers to finance their health care needs. Conclusion: Most of the population in Ghana are engaged in informal employment hence their contribution to the economy is very important. Therefore, efforts needed to be made by all stakeholders to address these challenges in order to help improve on access to health care services to all patients particularly the most vulnerable groups in society.
African Journal of Primary Health Care & Family Medicine, 2019
Background: Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected ear... more Background: Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana.Aim: The aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits.Setting: The study was conducted in the Navrongo War Memorial Hospital, a secondary referral facility in the Kassena-Nankana district in rural northern Ghana.Methods: A retrospective analysis of antenatal clinic records of pregnant women collected from January to December 2014. All pregnant women initiating antenatal clinic, who had initial haemoglobin (Hb) levels measured, were included in the study. Logistic regression analyses were carried out to determine factors associated with anaemia at the initiation of ANC.Results: We analysed data from 506 women with median Hb of 11.1 g/dL (IQR 7.31–13.8). The median gest...
International Journal of Gynecology & Obstetrics, 2019
To explore basic and comprehensive emergency obstetric service provision across four districts in... more To explore basic and comprehensive emergency obstetric service provision across four districts in rural northern Ghana, and whether women were more likely to deliver at facilities with more skilled care. Methods: Field workers geo-coded all health facilities in East Mamprusi, Sissala East, Kassena Nankana Municipal, and Kassena Nankana West districts, and administered surveys to assess providers and emergency obstetric care available. Data were also prospectively collected on delivery locations of women and neonates who died, or nearly died (near misses), between September 1, 2015 and April 30, 2017. Results: There were 14 physicians for a population of nearly 360,000 women. Six (6%) facilities could provide basic emergency care, and 3 (3%) could provide comprehensive care. Services were distributed unequally, with 6 (67%) of the emergency facilities located in the least populated district. Among the sample of women and neonates who died or nearly died, 175 (39%) delivered at locations unable to provide basic emergency services.
Global Health, Epidemiology and Genomics, 2016
Africa is experiencing a rapid increase in adult obesity and associated cardiometabolic diseases ... more Africa is experiencing a rapid increase in adult obesity and associated cardiometabolic diseases (CMDs). The H3Africa AWI-Gen Collaborative Centre was established to examine genomic and environmental factors that influence body composition, body fat distribution and CMD risk, with the aim to provide insights towards effective treatment and intervention strategies. It provides a research platform of over 10 500 participants, 40–60 years old, from Burkina Faso, Ghana, Kenya and South Africa. Following a process that involved community engagement, training of project staff and participant informed consent, participants were administered detailed questionnaires, anthropometric measurements were taken and biospecimens collected. This generated a wealth of demographic, health history, environmental, behavioural and biomarker data. The H3Africa SNP array will be used for genome-wide association studies. AWI-Gen is building capacity to perform large epidemiological, genomic and epigenomic s...
Paediatric and Perinatal Epidemiology, 1999
To examine the social, economic and demographic factors that determine low birth weight in the tw... more To examine the social, economic and demographic factors that determine low birth weight in the two Kassena Nankana districts of the Upper East region of Ghana. Methods Cross-sectional data was collected from January 2009 to December 2011 using the Navrongo Health and Demographic Surveillance System which monitors routine health and demographic outcomes in the study area. Data on foetal characteristics such as birth weight, and sex and maternal age, parity, maternal education, marital status, ethnicity, religious affiliation and socioeconomic characteristics were collected and described. Tests of means, proportions and Chi-squares are employed in bivariate analysis, and adjusted logistic regression models fitted to control for potential confounding variables. All tests were twosided and test of significance was set at p-value of < 0.05. Results There were 8,263 live births (44.9% females) with an overall average birth weight of 2.85 kg (2.9 kg for males and 2.8 kg for females). The average maternal age was 28 years, median parity 2, maternal literacy rate was about 70% and 83% of mothers were married. The prevalence of low birth weight was 13.8% 95%CI [13.10, 14.6] and more in female babies than in males (15.5% vs 12.2%; p<0.0001). Determinants of low birth-weight after controlling for confounding factors were sex of neonate (OR = 1.32, 95%CI [1.14,1.52]; p<0.0001), maternal age (p = 0.004), and mothers who are not married (OR = 1.44 [1.19, 1.74]; p<0.0001). Conclusion Female neonates in this population were likely to present with low birth weight and maternal factors such as younger age, lower socioeconomic status and single parenthood were
European Journal of Law and Economics, 2010
ABSTRACT The raising trend both in violent and property crime are of major concern in Iran. Using... more ABSTRACT The raising trend both in violent and property crime are of major concern in Iran. Using a panel data modeling (province wide), the paper provides an econometrics assessment of the relationship between crime against properties and violent crimes as functions of deterrent, social, economic and demographic factors in Iran, in the framework of Becker-Ehrlich crime supply theory. The findings indicate that, although deterrence hypothesis is not confirmed for burglary and assault, it explains the variations of murders and threats. Economic factors play key role in burglary and threat explanation, but they do not affect willful murders, however, Literacy explains both murders and threats. Average of families’ income is explored as a deterrent factor for crime against properties. KeywordsEconomics of crime–Deterrence hypothesis–Social determinant of crime
PLoS ONE, 2020
Out-of-pocket payments (OOPs), direct payments by households or individuals for healthcare are pa... more Out-of-pocket payments (OOPs), direct payments by households or individuals for healthcare are part of the health financing landscape. Data on OOPs is needed to monitor progress in financial risk protection, and the evaluation of health financing policies. In low-and-middle-income countries, estimates of OOPs rely heavily on self-reported data from household surveys. These surveys require respondents to recall events in the past and can suffer from recall biases. This study investigates the effect of recall period on the agreement of the amount and timing of inpatient OOPs between household reports and provider records in Bavi, Vietnam. We recruited 1397 households for interview using records from the district hospital. The households were interviewed with identical questionnaires except that the recall period was either 12 or 6 months. We linked household with provider data and excluded medicine costs from both household and provider OOPs since they could be purchased outside the h...
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Papers by isaiah agorinya