Richmond Owusu - Academia.edu (original) (raw)

Papers by Richmond Owusu

Background Malaria remains a common course of morbidity in many sub-Saharan African countries. Wh... more Background Malaria remains a common course of morbidity in many sub-Saharan African countries. While treatment options have improved in recent times, inappropriate prescription seems conventional among providers, increasing the burden on patients and society. This study examined the cost of inappropriate prescriptions for uncomplicated malaria treatment in Ghana. Methods This study used retrospective data collected from January to December 2016 in 27 selected facilities, under different ownership in three regions of the country, mainly Volta, Upper East and Brong Ahafo. Stratified random sampling technique was used to extract 1,625 outpatient folders of patients diagnosed and treated for malaria. Two physicians independently reviewed patient folders according to the stated diagnoses. Malaria prescriptions were described as inappropriate when they do not adhere to the standard treatment guidelines. The economic cost was mainly treatment cost which was sourced as medication cost. Tota...

Introduction: Abnormal gene methylation has been observed in several cancers. A prior study repor... more Introduction: Abnormal gene methylation has been observed in several cancers. A prior study reported methylation of TWIST1 and NID2 as a quantitative biomarker for urothelial carcinoma, but external validation has yet to be performed. We sought to externally validate a urine-based methylation assay combining TWIST1 and NID2 and assess its clinical utility. Methods: A prospective trial was conducted comparing the methylation assay to cystoscopy and biopsy in patients with hematuria or prior non-muscle invasive bladder cancer. Sensitivity, specificity, negative and positive predictive values, and likelihood ratios of the methylation assay were calculated. Area under the receiver operating characteristic curves for each gene and the combined assay were computed. Bayesian analyses were performed to assess utility of the assay for a variety of clinical scenarios. Results: Complete data were available for 111 patients. In validating the prior assay definition in the current cohort, sensitivity and specificity were 79% and 63%, respectively, and when optimized for the current cohort were 75% and 71%, respectively. The area under the curve for the assay was 0.73 compared with biopsy and 0.71 compared with cystoscopy. Conclusions: We failed to replicate the excellent performance of the methylation assay in this external validation; however, this assay may have utility for screening or surveillance for non-muscle invasive bladder cancer.

PLOS ONE, 2021

Introduction In 2003, the Government of Ghana launched the National Health Insurance Scheme (NHIS... more Introduction In 2003, the Government of Ghana launched the National Health Insurance Scheme (NHIS) to enable all Ghanaian residents to have access to health services at the point of care without financial difficulty. However, the system has faced a number of challenges relating to delays in submission and reimbursement of claims. This study assessed views of stakeholders on claims submission, processing and re-imbursement under the NHIS and how that affected health service delivery in Ghana. Methods The study employed qualitative methods where in-depth interviews were conducted with stakeholders in three administrative regions in Ghana. Purposive sampling method was used to select health facilities and study participants for the interviews. QSR Nvivo 12 software was used to code the data into themes for thematic analysis. Results The results point to key barriers such as lack of qualified staff to process claims, unclear vetting procedure and the failure of National Health Insurance...

This study problematizes the partial consideration of the issue of building collapse by academics... more This study problematizes the partial consideration of the issue of building collapse by academics and look beyond increase in building technology and new methods of building to find a more lasting solution to the problem of building collapse in Ghana. This research focuses on the roles of the stakeholders in averting the problem of collapse of buildings. The study adopted mixed research methodology and used both quantitative and qualitative approaches to gather data. In addition to 16 experts and professionals interviewed at Accra and Kumasi, the two major cities in Ghana, 104 stakeholders including building contractors, artisans, labours and building owners were accidentally sampled to participate in the studies. The study found that the problem of building collapse is not only real; it's an urban or city phenomenon, and it is attributable to poor attitude of clients, poor work by contractors, lack of monitoring & supervision by regulatory bodies, poor design, structural failur...

Vaccine, 2022

Background This study estimated cost of COVID-19 vaccine introduction and deployment in Ghana. Me... more Background This study estimated cost of COVID-19 vaccine introduction and deployment in Ghana. Methods Using the WHO-UNICEF COVID-19 Vaccine Introduction and deployment Costing (CVIC) tool Ghana’s Ministry of Health Technical Working Group for Health Technology Assessment (TWG-HTA) in collaboration with School of Public Health, University of Ghana, organized an initial two-day workshop that brought together partners to deliberate and agree on input parameters to populate the CVIC tool. A further 2-3 days validation with the Expanded Program of Immunization (EPI) and other partners to finalize the analysis was done. Three scenarios, with different combinations of vaccine products and delivery modalities, as well as time period were analyzed. The scenarios included AstraZeneca (40%), Johnson & Johnson (J&J) (30%), Moderna, Pfizer, and Sputnik V at 10% each; with full vaccination by second half of 2021 (Scenario 1); AstraZeneca (30%), J&J (40%), Moderna, Pfizer, and Sputnik V at 10% each with full vaccination by first half of 2022 (Scenario 2); and equal distribution (20%) among AstraZeneca, J&J, Moderna, Pfizer, and Sputnik V with full vaccination by second half of 2022 (Scenario 3). Results The estimated total cost of COVID-19 vaccination ranges between 348.7−348.7-348.7−436.1 million for the target population of 17.5 million. These translate into per fully vaccinated person cost of 20.9−20.9 - 20.9−26.2 and per dose (including vaccine cost) of 10.5−10.5 - 10.5−13.1. Again, per fully vaccinated person excluding vaccine cost was 4.5and4.5 and 4.5and4.6, thus per dose excluding vaccine also ranged from 2.2–2.2 – 2.2–2.3. The main cost driver was vaccine doses, including shipping, which accounts for between 78% - 83% of total cost. Further, an estimated 8,437 - 10,247 vaccinators (non-FTEs) would be required during 2021 - 2022 to vaccinate using a mix of delivery strategies, accounting for 8%-10% of total cost. Conclusion These findings provide the estimates to inform resource mobilization efforts by government and other partners.

Introduction: Social health insurance is a collective pooled risk-sharing mechanism for providin ... more Introduction: Social health insurance is a collective pooled risk-sharing mechanism for providin all citizenry with eaqual acess to health care in Ghana.The purpose of the study is to examine the effect of insurance on demand of healthcare in the context of the National Health Insurance Scheme in Ghana. Methods: This study used three methodological approaches; initially an internet search of 108 articles with defined criteria for selection, systematic reviews and content analysis of the selected publication was also used to discuss this study on its objective. Results: Empirical evidence for the findings indicated that outpatients and inpatients service utilization has consistently increased since the introduction of the National Health Insurance Scheme in Ghana. Conclusion: The findings of the study provide an important insight for policy makers to mark-up strategies to meet the ever-increasing demand for healthcare and also ensure sustainability of the scheme to achieve universal ...

Background Malaria remains a global public health challenge despite efforts that have significant... more Background Malaria remains a global public health challenge despite efforts that have significantly reduced its burden. In addition to prevention, effective treatment using the recommended medicines and approaches is essential to further minimize the burden., Yet, inappropriate prescription of anti-malarial medicines remains a challenge. Malaria prescriptions are described as inappropriate when they do not adhere to standard treatment. Inappropriate prescription presents financial and economic burden for an under-resourced health system. This study examined the cost of inappropriate prescriptions for malaria treatment in Ghana. Methods This study used retrospective data collected from January to December 2016 in a number of study facilities in three regions of Ghana. Using stratified random sampling technique, folders of 1625 outpatients who had been treated for malaria were selected from 27 sampled facilities including private, public, and mission hospitals in the Upper East, Volta...

Urology, 2019

OBJECTIVES To ensure procedure success, American Urological Association Guidelines recommend post... more OBJECTIVES To ensure procedure success, American Urological Association Guidelines recommend post-vasectomy semen analysis; however, current literature suggests poor compliance. We sought to measure post-vasectomy semen analysis compliance and assess barriers to completion. METHODS A retrospective review was performed of vasectomies at San Diego Veterans Administration Hospital and UC San Diego Health between 2006 and 2018. Patients received pre-procedural counseling regarding semen analysis necessity. Post-procedural management included follow-up visit within 2-4 weeks and semen analysis after 15-20 ejaculations. Demographics and periprocedural variables were collected. Telephone interviews assessed patient reported reasons for noncompliance. Multivariable analysis was performed for factors associated with semen analysis. RESULTS 503 men, mean age 38.8 years, underwent vasectomy at San Diego Veterans Administration Hospital (n=331) and UC San Diego (n=172). Overall, 80% completed clinical follow-up (n=401) and 53% completed semen analysis (n=268). The cohorts exhibited significantly different rates of semen analysis completion (46% vs 67%, p<0.001) and clinical follow-up (64% vs 85%, p=0.038). No difference was observed in age, fatherhood or marital status. On multivariable analysis, fatherhood was the only factor associated with noncompliance of semen analysis (OR 0.52, 95% CI 0.33 - 0.83). Among men interviewed, the primary barriers to semen analysis completion were distance (38%), time constraints (34%), and forgetfulness (23%). 92% reported increased likelihood of completion with home-based semen testing. CONCLUSIONS Patients demonstrated poor post-vasectomy semen analysis compliance despite pre-procedural counseling. Given that distance and time constraints limited compliance, incorporating home-based semen testing may improve the quality of care for men undergoing vasectomy.

Malaria Journal, 2018

Background: This study seeks to compare the performance of HRP2 (First Response) and pLDH/HRP2 (C... more Background: This study seeks to compare the performance of HRP2 (First Response) and pLDH/HRP2 (Combo) RDTs for falciparum malaria against microscopy and PCR in acutely ill febrile children at presentation and follow-up. Methods: This is an interventional study that recruited children < 5 years who reported to health facilities with a history of fever within the past 72 h or a documented axillary temperature of 37.5 °C. Using a longitudinal approach, recruitment and follow-up of participants was done between January and May 2012. Based on results of HRP2-RDT screening, the children were grouped into one of the following three categories: (1) tested positive for malaria using RDT and received anti-malarial treatment (group 1, n = 85); (2) tested negative for malaria using RDT and were given anti-malarial treatment by the admitting physician (group 2, n = 74); or, (3) tested negative for malaria using RDT and did not receive any anti-malarial treatment (group 3, n = 101). Independent microscopy, PCR and Combo-RDT tests were done for each sample on day 0 and all follow-up days. Results: Mean age of the study participants was 22 months and females accounted for nearly 50%. At the time of diagnosis, the mean body temperature was 37.9 °C (range 35-40.1 °C). Microscopic parasite density ranged between 300 and 99,500 parasites/µL. With microscopy as gold standard, the sensitivity of HRP2 and Combo-RDTs were 95.1 and 96.3%, respectively. The sensitivities, specificities and predictive values for RDTs were relatively higher in microscopy-defined malaria cases than in PCR positive-defined cases. On day 0, participants who initially tested negative for HRP2 were positive by microscopy (n = 2), Combo (n = 1) and PCR (n = 17). On days 1 and 2, five of the children in this group (initially HRP2-negative) tested positive by PCR alone. On day 28, four patients who were originally HRP2negative tested positive for microscopy (n = 2), Combo (n = 2) and PCR (n = 4). Conclusion: The HRP2/pLDH RDTs showed comparable diagnostic accuracy in children presenting with an acute febrile illness to health facilities in a hard-to-reach rural area in Ghana. Nevertheless, discordant results recorded on day 0 and follow-up visits using the recommended RDTs means improved malaria diagnostic capability in malariaendemic regions is necessary.

Journal of Urology, 2019

INTRODUCTION AND OBJECTIVES: AUA Guidelines recommend that men obtain a post-vasectomy semen anal... more INTRODUCTION AND OBJECTIVES: AUA Guidelines recommend that men obtain a post-vasectomy semen analysis (PVSA) to confirm sterility. Current literature suggests poor compliance. No studies specifically address barriers to completion. We sought to determine compliance rate for PVSA and assess barriers to compliance. METHODS: A retrospective review was performed on men undergoing vasectomy at San Diego Veterans Administration (SDVA) Hospital and UC San Diego Health (UCSD) between 2006 and 2018. Prior to vasectomy, patients received counseling regarding the need for confirmatory PVSA. Post-procedural management included follow up visit within 2-4 weeks and PVSA after 15-20 ejaculations. Demographics and periprocedural variables were collected. Phone interviews were conducted for men failing to complete PVSA to assess barriers to compliance and alternative semen testing. Multivariate analysis was performed to identify factors associated with PVSA completion. RESULTS: 503 men, mean age 38.8 years, underwent vasectomy at SDVA (n[331) and UCSD (n[172). Overall, 80% completed clinical follow up (n[401) and 53% completed PVSA (n[268). The SDVA and UCSD cohorts exhibited significantly different rates of PVSA completion (46% vs 67%, p<0.001) and clinical follow up (64% vs 85%, p[0.038) with no difference in time to PVSA or follow up (Table 1). Men completing PVSA were more likely to undergo an office-based procedure (87% vs. 80%, p[0.047) performed by an attending as primary surgeon (43% vs 28%, p[0.001). No difference was observed in age, fatherhood or marital status. On multivariate analysis, fatherhood was the only factor associated with noncompliance of PVSA (OR 0.52, 95% CI 0.33 e 0.83). Among men interviewed, 38% reported distance as the primary barrier to PVSA, 34% stating time constraints and 23% citing forgetfulness. 92% reported increased likelihood of completion with home-based semen testing. CONCLUSIONS: Patients undergoing vasectomy demonstrated poor PVSA compliance despite pre-procedural counseling. Given that distance and time constraints limited compliance with guidelines, incorporating home-based semen testing in routine care may improve the quality of care for men undergoing vasectomy.

Journal of Sustainable Mining, 2018

This study assessed the impact of Ghana's Environmental Protection Agency (EPA) Akoben programme,... more This study assessed the impact of Ghana's Environmental Protection Agency (EPA) Akoben programme, a rating and disclosure tool which seeks to promote better environmental performance in the mining and manufacturing industries in Ghana. Using a case study approach, the Akoben audit report card for a mining company was analyzed over a three-year period (2009-2011) based on 7-criteria-legal requirements, hazardous on-site waste management, toxic emissions management, environmental monitoring and reporting, best practice environmental management, complaint management, and corporate social responsibility. Key stakeholders' perceptions of the programme's suitability were solicited from the Ghana Chamber of Mines, EPA, and the mining company. Findings revealed that overall environmental performance over the three-year period under review was poor (2009-56.6%; 2010-65.6%; 2011-59.1%) with none of the years meeting the expected minimum limit, with the exception of legal requirements and corporate social responsibilities; the company failed in all other criteria. Specifically, both toxic and non-toxic waste emission discharges were major concerns as toxic parameters, such as for Arsenic, pH and Cyanide, were exceeded. Environmental monitoring and reporting was also a problem for the company. Stakeholders identified inadequate publicity, an absence of legal backing, and a lack of incentives for outstanding performances as the main weaknesses of the programme. Despite this, the stakeholders acknowledge the fact that the Akoben programme has improved the environmental performance of the mining companies because it puts their operations in check, although more can yet be achieved with regards environmental sustainability with this programmme, if adequate measures including legal backing are put in place to ensure its continuity.

The Journal of Urology, 2018

Post-vasectomy semen analysis (PVSA) is required to confirm the success of vasectomy per AUA guid... more Post-vasectomy semen analysis (PVSA) is required to confirm the success of vasectomy per AUA guidelines. However, patient compliance to PVSA is unknown. We sought to determine the PVSA compliance rate and to identify factors that predicted compliance to the PVSA testing. METHODS: We performed a retrospective review of men who underwent vasectomy at our Veterans Administration hospital between January 2006 and December 2016. All patients underwent one or more pre-procedure counseling. Counseling emphasized that PVSA was required for definitive confirmation of the procedure's success and that contraception must be used until negative PVSA. Vasectomies were performed with local anesthesia in the office setting or under monitored anesthesia in the operating room. Specimens were sent for pathologic confirmation of vas. Post-vasectomy management included follow-up in 2-4 weeks and PVSA in 2-3 months or after 15-20 ejaculations. The PVSA compliance rate was calculated. Univariate and multivariable logistic regression analyses were performed to elucidate factors that predicted PVSA compliance. RESULTS: 331 men with mean age of 38 years underwent vasectomy. 84% were married and 88% had children. 78% of the vasectomies were performed in the office. Only 153 men completed PVSA, representing 46% compliance rate which remained stably low over time (Fig. 1). On univariate analysis, the PVSA group were less likely to have kids (84% vs 92%, p¼0.033) and more likely to followup for post-procedure visit (86% vs 69%, p¼0.00019) compared to the No-PVSA group. There was no difference between groups in terms of age, race, marital status, procedure year or location, procedure-specific factors, pathologic findings or complication. On multivariate analysis, attending post-vasectomy visit was associated with increased odds (OR 2.84, 95% CI 1.46-5.49) whereas fatherhood was associated with decreased odds (OR 0.37, 95% CI 0.17-0.83) of PVSA compliance CONCLUSIONS: Despite peri-procedural counseling, only 46% of veterans complied with PVSA requirement. Men without kids and those who attended post-vasectomy visit were more likely to comply with PVSA. Future studies to better understand the barriers and to develop new testing technique are needed to improve compliance

Journal of Urology, 2017

number of IPP devices and procedures performed. The median time to development of infection after... more number of IPP devices and procedures performed. The median time to development of infection after most recent IPP surgery was 2 months (IQR 1-3.3 months). No clinical or demographic differences were identified between the infection and non-infection cohorts, including age, DM status, tobacco usage, Charleston Comorbidity Index score, prior prostatectomy, prior hernia repair, or Peyronie 0 s disease. CONCLUSIONS: Infection rates of revision/salvage IPP surgery increase with each subsequent IPP placement or following IPPrelated surgeries. The majority of patients experience at least one infection by their 4th device. This data could provide relevant information necessary for appropriate patient counseling.

The Journal of Urology, 2017

patients referred for surgery while fear of biopsy-associated complications was the primary reaso... more patients referred for surgery while fear of biopsy-associated complications was the primary reason (58%) to decline RMB among those undergoing surveillance. Having an academic degree was associated with acceptance of a lower accuracy threshold (p¼0.03). Of the 59 participating urologists, 39% were reluctant to recommend RMB, primarily because of its inexorable non-diagnostic rate. CONCLUSIONS: Most patients and urologists would favor a RMB to facilitate their definitive treatment decision. Diagnostic accuracy of 95% was acceptable by the majority of study participants. The utility of RMB as part of the diagnostic algorithm for renal tumors should be discussed with patients, emphasizing its potential benefits and limitations.

Global Health Research and Policy, 2017

Background: Malaria is one of the most challenging public health concerns in the developing world... more Background: Malaria is one of the most challenging public health concerns in the developing world. To address its impact in endemic regions, several interventions are implemented by stakeholders. The Affordable Medicine Facility-malaria (AMFm) is an example of such interventions. Its activities include communication interventions to enhance the knowledge of caregivers of children under five years, licensed chemical sellers (LCS) and prescribers on malaria management with artemisinin-based combination therapy (ACT). This study was conducted to evaluate the effectiveness of the AMFm activities on malaria among targeted groups in two rural communities in Ghana. Methods: A communication intervention study was conducted in the Asante-Akim North and South Districts of Ghana. Repeated cross-sectional pre and post surveys were deployed. Relevant malaria messages were designed and used to develop the information, education and communication (IEC) tools for the intervention. With the aid of posters and flipcharts developed by our study, community health workers (CHWs), prescribers, and licenced chemical sellers provided proper counselling to clients on malaria management. Trained CHWs and community based volunteers educated caregivers of children under five years on malaria management at their homes and at public gatherings such as churches, mosques, schools. Chi-square tests and logistic regression were run to determine associations and control for demographic differences respectively. Results: There was significantly high exposure to malaria/ACT interventions in the intervention district than in the comparison district (OR = 16.02; 95% CI = 7.88-32.55) and same for malaria/ACT-related knowledge (OR = 3.63; 95% CI = 2.52-5.23). The participants in the intervention district were also more knowledgeable about correct administration of dispersible drug for children <5 years than their counterparts in the unexposed district. Conclusion: Our data show that targeted interventions improve malaria based competences in rural community settings. The availability of subsidized ACTs and the intensity of the communication campaigns contributed to the AMFm-related awareness, improved knowledge on malaria/ACTs and management practices.