Prevalence and changes in boredom, anxiety and well-being among Ghanaians during the COVID-19 pandemic: a population-based study.

BACKGROUND: The outbreak of the COVID-19 pandemic has been associated with several adverse health outcomes. However, few studies in sub-Saharan Africa have examined its deleterious consequences on mental health. Therefore, we investigated the prevalence and changes in boredom, anxiety and psychological well-being before and during the COVID-19 pandemic in Ghana. METHODS: Data for this study were drawn from an online survey of 811 participants that collected retrospective information on mental health measures including symptoms of generalized anxiety disorder, boredom, and well-being. Additional data were collected on COVID-19 related measures, biosocial (e.g. age and sex) and sociocultural factors (e.g., education, occupation, marital status). Following descriptive and psychometric evaluation of measures used, multiple linear regression was used to assess the relationships between predictor variables and boredom, anxiety and psychological well-being scores during the pandemic. Second, we assessed the effect of anxiety on psychological well-being. Next, we assessed predictors of the changes in boredom, anxiety, and well-being. RESULTS: Before the COVID-19 pandemic, 63.5% reported better well-being, 11.6% symptoms of anxiety, and 29.6% symptoms of boredom. Comparing experiences before and during the pandemic, there was an increase in boredom and anxiety symptomatology, and a decrease in well-being mean scores. The adjusted model shows participants with existing medical conditions had higher scores on boredom (ß = 1.76, p < .001) and anxiety (ß = 1.83, p < .01). In a separate model, anxiety scores before the pandemic (ß = -0.25, p < .01) and having prior medical conditions (ß = -1.53, p < .001) were associated with decreased psychological well-being scores during the pandemic. In the change model, having a prior medical condition was associated with an increasing change in boredom, anxiety, and well-being. Older age was associated with decreasing changes in boredom and well-being scores. CONCLUSIONS: This study is the first in Ghana to provide evidence of the changes in boredom, anxiety and psychological well-being during the COVID-19 pandemic. The findings underscore the need for the inclusion of mental health interventions as part of the current pandemic control protocol and public health preparedness towards infectious disease outbreaks.

Disparate on-site access to water, sanitation, and food storage heighten the risk of COVID-19 spread in Sub-Saharan Africa.

COVID-19 is an active pandemic that likely poses an existential threat to humanity. Frequent handwashing, social distancing, and partial or total lockdowns are among the suite of measures prescribed by the World Health Organization (WHO) and being implemented across the world to contain the pandemic. However, existing inequalities in access to certain basic necessities of life (water, sanitation facility, and food storage) create layered vulnerabilities to COVID-19 and can render the preventive measures ineffective or simply counterproductive. We hypothesized that individuals in households without any of the named basic necessities of life are more likely to violate the preventive (especially lockdown) measures and thereby increase the risk of infection or aid the spread of COVID-19. Based on nationally-representative data for 25 sub-Saharan African (SSA) countries, multivariate statistical and geospatial analyses were used to investigate whether, and to what extent, household family structure is associated with in-house access to basic needs which, in turn, could reflect on a higher risk of COVID-19 infection. The results indicate that approximately 46% of the sampled households in these countries (except South Africa) did not have in-house access to any of the three basic needs and about 8% had access to all the three basic needs. Five countries had less than 2% of their households with in-house access to all three basic needs. Ten countries had over 50% of their households with no in-house access to all the three basic needs. There is a social gradient in in-house access between the rich and the poor, urban and rural richest, male- and female-headed households, among others. We conclude that SSA governments would need to infuse innovative gender- and age-sensitive support services (such as water supply, portable sanitation) to augment the preventive measures prescribed by the WHO. Short-, medium- and long-term interventions within and across countries should necessarily address the upstream, midstream and downstream determinants of in-house access and the full spectrum of layers of inequalities including individual, interpersonal, institutional, and population levels.

Respiratory and non-respiratory symptoms associated with pesticide management practices among farmers in Ghana's most important vegetable hub.

The data presented here are from the Offinso North District Farm Health Study (ONFAHS), a population-based cross-sectional study among vegetable farmers in Ghana. The paper addresses knowledge, pesticide handling practices, and protective measures related to pesticide use by self-reported symptoms for 310 adult farmers who completed a comprehensive questionnaire on pesticide management practices and health. In addition, an inventory was prepared using information supplied by pesticide sellers/dealers in this district. We report that cough and wheezing (but not breathlessness) are positively associated with stirring pesticide preparations with bare hands/drinking water while mixing/applying pesticides, and stirring pesticide preparations with bare hands/drinking water/smoking cigarettes while mixing/applying pesticides. There is a significant exposure-response association between the number of precautionary measures practiced while handling pesticides and cough and wheezing but not with breathlessness. We also found unsafe practices to be associated with sexual dysfunction, nervousness, and lack of concentration. The results also suggest a negative association between practice of any precautionary measure when mixing/applying pesticides and sexual dysfunction, nervousness, and lack of concentration. We found that in spite of the fact that farmers have adequate knowledge about the environment and health effects of pesticides, several unhygienic practices are in widespread use, indicating that knowledge is not necessarily always translated in action. Further action is necessary to promote the safe use of pesticides and to replace existing poor management practices among these and other farmers in Ghana.

Modelling spatio-temporal heterogeneities in groundwater quality in Ghana: a multivariate chemometric approach.

Chemometric techniques were applied to evaluate the spatial and temporal heterogeneities in groundwater quality data for approximately 740 goldmining and agriculture-intensive locations in Ghana. The strongest linear and monotonic relationships occurred between Mn and Fe. Sixty-nine per cent of total variance in the dataset was explained by four variance factors: physicochemical properties, bacteriological quality, natural geologic attributes and anthropogenic factors (artisanal goldmining). There was evidence of significant differences in means of all trace metals and physicochemical parameters (p < 0.001) between goldmining and non-goldmining locations. Arsenic and turbidity produced very high value F's demonstrating that 'physical properties and chalcophilic elements' was the function that most discriminated between non-goldmining and goldmining locations. Variations in Escherichia coli and total coliforms were observed between the dry and wet seasons. The overall predictive accuracy of the discriminant function showed that non-goldmining locations were classified with slightly better accuracy (89%) than goldmining areas (69.6%). There were significant differences between the underlying distributions of Cd, Mn and Pb in the wet and dry seasons. This study emphasizes the practicality of chemometrics in the assessment and elucidation of complex water quality datasets to promote effective management of groundwater resources for sustaining human health.

Associations between pesticide use and respiratory symptoms: A cross-sectional study in Southern Ghana.

BACKGROUND: Indiscriminate use of pesticides is a common practice amongst farmers in Low and Middle Income Countries (LMIC) across the globe. However, there is little evidence defining whether pesticide use is associated with respiratory symptoms. OBJECTIVES: This cross-sectional study was conducted with 300 vegetable farmers in southern Ghana (Akumadan). Data on pesticide use was collected with an interviewed-administered questionnaire. The concentration of seven organochlorine pesticides and 3 pyrethroid pesticides was assayed in urine collected from a sub-population of 100 vegetable farmers by a gas chromatograph equipped with an electron capture detector (GC-ECD). RESULTS: A statistically significant exposure-response relationship of years per day spent mixing/applying fumigant with wheezing [30-60 days/year: prevalence ratio (PR)=1.80 (95% CI 1.30, 2.50); >60days/year: 3.25 (1.70-6.33), p for trend=0.003] and hours per day spent mixing/applying fumigant with wheezing [1-2h/day: 1.20 (1.02-1.41), 3-5h/day: 1.45 (1.05-1.99), >5h/day: 1.74 (1.07-2.81), p for trend=0.0225]; days per year spent mixing/applying fungicide with wheezing [30-60 days/year: 2.04 (1.31-3.17); >60days/year: 4.16 (1.72-10.08), p for trend=0.0017] and h per day spent mixing/applying fungicide with phlegm production [1-2h/day: 1.25 (1.05-1.47), 3-5h/day: 1.55 (1.11-2.17), >5h/day: 1.93 (1.17-3.19), p for trend=0.0028] and with wheezing [1-2h/day: 1.10 (1.00-1.50), 3-5h/day: 1.20 (1.11-1.72), >5h/day: 1.32 (1.09-2.53), p for trend=0.0088]; h per day spent mixing/applying insecticide with phlegm production [1-2h/day: 1.23 (1.09-1.62), 3-5h/day: 1.51 (1.20-2.58), >5h/day: 1.85 (1.31-4.15), p for trend=0.0387] and wheezing [1-2h/day: 1.22 (1.02-1.46), 3-5h/day: 1.49 (1.04-2.12), >5h/day: 1.81 (1.07-3.08), p for trend=0.0185] were observed. Statistically significant exposure-response association was also observed for a combination of activities that exposes farmers to pesticide with all 3 respiratory symptoms. Furthermore, significant exposure-response associations for 3 organochlorine insecticides: beta-HCH, heptachlor and endosulfan sulfate were noted. CONCLUSIONS: In conclusion, vegetable farmers in Ghana may be at increased risk for respiratory symptoms as a result of exposure to pesticides.

Characterization and quantification of endocrine disruptors in female menstrual blood samples.

Selected endocrine disrupting chemicals (EDCs) were measured in adult female menstrual blood for the first time in Ghana, Africa, taking into account the importance of non-invasive means of matrices sampling in vulnerable groups, such as pregnant women, the elderly or chronically ill people. The menstrual blood samples of twenty (20) female adults between the ages of 25-45 years were sampled. The Quick, Easy, Cheap, Effective, Rugged and Safe (QuEChERS) method was applied for the extraction and clean up, while gas chromatography-mass spectrometry (GC-MS) was used to measure the selected EDCs in adult female menstrual blood, taking into account the composition of menstrual discharge. Diethyl phthalate (DEP), Dibutyl phthalate (DBP) and Bis (2-ethylhexyl) phthalate (DEHP) were detected in all samples, whereas bisphenol A (BPA) was found in 13 participants. Dimethyl phthalate (DMP) was detected in 7 participants, Di-n-octyl phthalate (DNOP) was detected in 3 participants, Bis (2-ethylhexyl) adipate (DEHA) and pyrimidine were detected in 2 participants, while benzyl butyl phthalate (BBP) was detected in only 1 participant. The maximum concentration of DEP measured was 115.6 µg.L-1and the minimum was 439 µg.L-1. DEHP was the next most abundant phthalate with a maximum measured concentration of 982 µg.L-1 and minimum of 95 µg.L-1. The presence of parent phthalates (rather than metabolites) in menstrual blood of all participants studied suggests that bioaccumulation of selected phthalate compounds such as DEHP, DEP and DBP may be occurring with appreciable human toxicity though the carcinogenic exposure risks of DEHP via various routes were much lower than 1 × 10-6 considered to be very low.

Parenting practices and family relationships during the COVID-19 lockdown in Ghana.

The effects of the COVID-19 pandemic have been far reaching across almost every sphere of life. Families, which are the basic units of society, have not been spared the ravages of the pandemic. Changes in family daily routines as a result of COVID-19 can affect spousal relationships, parenting and childcare practices. However, the extent to which the pandemic has affected parenting practices and family relationships in Ghana is not known. The goal of this study was to assess how parenting practices and family relationships have been influenced during the COVID-19 pandemic in Ghana. Data for this paper was drawn from an online questionnaire response from 463 participants in Ghana as a subset analysis from a multi-country study on personal and family coping system with COVID-19 pandemic in the global south. The mean score for pre-COVID-19 relationship with partner (36.86) was higher (p<0.0001) than the mean score for during COVID-19 relationship with partner (35.32) indicating that COVID-19 has had negative influence on relationships. The mean score for pre-COVID-19 parenting (32.78) was higher (p<0.0001) compared to the mean score for during COVID-19 parenting (31.40) indicating negative influence on parenting. We have predicted that participants whose coping levels were "Well" on the average, are likely to be doing well in relationship with partners and parenting practices during the COVID-19 period The challenging public health containment measures of the COVID-19 pandemic have negatively influenced the relationship between partners and parenting practices in Ghana.

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.

Systematic review of the effects of agricultural interventions on food security in northern Ghana.

BACKGROUND: Food insecurity and poverty rates in Ghana are highest in the districts from latitude 8° N upwards. These have motivated several interventions aimed at addressing the food insecurity via promoting agricultural growth. An assessment of the overall impact of these interventions on food security is necessary to guide policy design and future interventions. METHODS AND FINDINGS: A systematic review was used to assess the cumulative evidence of the effect of development interventions, implemented from 2006 to 2016 on food security, especially in Northern Ghana. Information were retrieved from over 20 Government and non-Governmental organisations through online search and actual visits. The number of studies included in systematic review was 22. The study showed that a large number of interventions have been implemented in Northern Ghana over the study period. Access to quality extension services, training and capacity building was a major intervention strategy. About 82% of studies considered increasing production but only 14% of the studies reported on changes in yield. About 42% of the included studies used market access as a strategy but about 44% reported increase in incomes of beneficiaries (with only seven studies providing numerical evidence for this claim). The ranking of frequency of intervention strategies was in the order extension and capacity building > production > postharvest value addition > water and irrigation facilities > storage facilities > input supply. A substantial number of the studies had no counterfactuals, weakening confidence in attributing impacts on food security for even the beneficiaries. CONCLUSIONS: It is concluded that evidence for impacts of the interventions on food security was weak, or largely assumed. A logical recommendation is the need for development partners to synchronise their measurement and indicators of food security outcomes. It is also recommended that some food security indicators are explicitly incorporated into intervention design while bearing in mind the potential need for counterfactuals.

Access to improved water and sanitation in sub-Saharan Africa in a quarter century.

The realization of the scale, magnitude, and complexity of the water and sanitation problem at the global level has compelled international agencies and national governments to increase their resolve to face the challenge. There is extensive evidence on the independent effects of urbanicity (rural-urban environment) and wealth status on access to water and sanitation services in sub-Saharan Africa. However, our understanding of the joint effect of urbanicity and wealth on access to water and sanitation services across spatio-temporal scales is nascent. In this study, a pooled regression analysis of the compositional and contextual factors that systematically vary with access to water and sanitation services over a 25-year time period in fifteen countries across sub-Saharan Africa (SSA) was carried out. On the whole, substantial improvements have been made in providing access to improved water sources in SSA from 1990 to 2015 unlike access to sanitation facilities over the same period. Households were 28.2 percent and 125.2 percent more likely to have access to improved water sources in 2000-2005 and 2010-2015 respectively, than in 1990-1995. Urban rich households were 329 percent more likely to have access to improved water sources compared with the urban poor. Although access to improved sanitation facilities increased from 69 percent in 1990-1995 and 74 percent in 2000-2005 it declined significantly to 53 percent in 2010-2015. Urban rich households were 227 percent more likely to have access to improved sanitation facilities compared with urban poor households. These results were mediated and attenuated by biosocial, socio-cultural and contextual factors and underscore the fact that the challenge of access to water and sanitation in sub-Saharan Africa is not merely scientific and technical but interwoven with environment, culture, economics and human behaviour necessitating the need for interdisciplinary research and policy interventions.

Ghanaians Might Be at Risk of Excess Dietary Intake of Potassium Based on Food Supply Data.

The World Health Organization (WHO) has highlighted the beneficial role of adequate intake of potassium (K) in combating the global burden of noncommunicable diseases (NCDs), mainly hypertension and cardiovascular diseases. Diets are the main source of K supply to humans and can contribute to both K deficiency (hypokalemia) and excess (hyperkalemia). While global attention is currently devoted to K deficiency, K excess can be even more dangerous and deserves equal attention. The objectives of this paper were to (i) estimate the K intake of Ghanaian population using food supply and food composition data and (ii) compare this estimate with the WHO-recommended requirement for K in order to assess if there is a risk of inadequate or excess K intake. Food supply data (1961-2011) were obtained from the Food Balance Sheet (FBS) of the Food and Agriculture Organization of the United Nations to derive trends in food and K supply. The average food supply in the FBS for 2010 and 2011 was used in assessing the risk of inadequate or excess dietary intake of K. The K content of the food items was obtained from food composition databases. Based on 2010-2011 average data, the K supply per capita per day was approximately 9,086 mg, about 2.6-fold larger than the WHO-recommended level (3,510 mg). The assessment suggests a potentially large risk of excess dietary K supply at both individual and population levels. The results suggest the need for assessing options for managing K excess as part of food security and public health strategies. The results further underscore a need for assessment of the K status of staple food crops and mixed diets, as well as K management in food crop production systems in Ghana.

Effectiveness of interventions to reduce household air pollution and/or improve health in homes using solid fuel in low-and-middle income countries: A systematic review and meta-analysis.

BACKGROUND: Cookstove intervention programs have been increasing over the past two (2) decades in Low and Middle Income Countries (LMICs) across the globe. However, there remains uncertainty regarding the effects of these interventions on household air pollution concentrations, personal exposure concentrations and health outcomes. OBJECTIVES: The primary objective was to determine if household air pollution (HAP) interventions were associated with improved indoor air quality (IAQ) in households in LMICs. Given the potential impact of HAP interventions on health, a secondary objective was to evaluate the effectiveness of HAP interventions to improve health in populations receiving these interventions. DATA SOURCES: OVID Medline, Ovid Embase, SCOPUS and PubMED were searched from their inception until December 2015 with no restrictions on study design. The WHO Global database of household air pollution measurements and Members' archives were also reviewed together with the reference lists of identified reviews and relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTION: We considered randomized controlled trials, or non-randomized control trials, or before-and-after studies; original studies; studies conducted in a LMIC (based on the United Nations Human Development Report released in March 2013 (World Bank, 2013); interventions that were explicitly aimed at improving IAQ and/or health from solid fuel use; studies published in a peer-reviewed journal or student theses or reports; studies that reported on outcomes which was indicative of IAQ or/and health. There was no restriction on the type of comparator (e.g. household receiving plancha vs. household using traditional cookstove) used in the intervention study. STUDY APPRAISAL AND SYNTHESIS METHODS: Five review authors independently used pre-designed data collection forms to extract information from the original studies and assessed risk of bias using the Effective Public Health Practice Project (EPHPP). We computed standardized weighted mean difference (SMD) using random-effects models. Heterogeneity was computed using the Q and I2-statistics. We examined the influence of various characteristics on the study-specific effect estimates by stratifying the analysis by population type, study design, intervention type, and duration of exposure monitoring. The trim and fill method was used to assess the potential impact of missing studies. RESULTS: Fifty-five studies met our a priori inclusion criteria and were included in the systematic review. Fifteen studies provided 43 effect estimates for our meta-analysis. The largest improvement in HAP was observed for average particulate matter (PM) (SMD=1.57) concentrations in household kitchens (1.03), followed by daily personal average concentrations of PM (1.18), and carbon monoxide (CO) concentrations in kitchens. With respect to personal PM, significant improvement was observed in studies of children (1.26) and studies monitoring PM for ≥24h (1.32). This observation was also noted in terms of studies of kitchen concentrations of CO. A significant improvement was also observed for kitchen levels of PM in both adult populations (1.56) and in RCT/cohort designs (1.59) involving replacing cookstoves without chimneys. Our findings on health outcomes were inconclusive. LIMITATIONS, CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: We observed high statistical between study variability in the study-specific estimate. Thus, care should be taken in concluding that HAP interventions - as currently designed and implemented - support reductions in the average kitchen and personal levels of PM and CO. Further, there is limited evidence that current stand-alone HAP interventions yield any health benefits. Post-intervention levels of pollutants were generally still greatly in excess of the relevant WHO guideline and thus a need to promote cleaner fuels in LMICs to reduce HAP levels below the WHO guidelines. SYSTEMATIC REVIEW REGISTRATION NUMBER: The review has been registered with PROSPERO (registration number CRD42014009768).

Ghanaians Might Be at Risk of Inadequate Dietary Intake of Potassium.

Adequate dietary intake of potassium (K) helps fight noncommunicable diseases (NCDs), mainly hypertension and cardiovascular diseases. This paper (i) estimated the K intake of Ghanaian population using food supply and food composition data and (ii) compared this estimate with the WHO recommended requirement for K in order to assess if there is a risk of inadequate K intake. Food supply data (1961-2011) was obtained from the FAO Food Balance Sheet (FBS) to derive trends in food and K supply. The average food supply in the FBS for 2010 and 2011 was used in assessing the risk of inadequate dietary intake of K. The K contents of the food items were obtained from food composition databases. The mean K supply per capita per day was approximately 856 mg. The assessment suggests a potentially large risk of inadequate dietary K supply at both individual and population levels. The results suggest the need for assessing options for managing K deficiency, including assessment of K supplying power of soils and K fertilizer management in food crop production systems, as well as empirical estimates of K content of food items (including those underreported in the FBS) and mixed diets in Ghana.

Historical Perspective and Risk of Multiple Neglected Tropical Diseases in Coastal Tanzania: Compositional and Contextual Determinants of Disease Risk.

BACKGROUND: In the past decade, research on neglected tropical diseases (NTDs) has intensified in response to the need to enhance community participation in health delivery, establish monitoring and surveillance systems, and integrate existing disease-specific treatment programs to control overlapping NTD burdens and detrimental effects. In this paper, we evaluated the geographical distribution of NTDs in coastal Tanzania. METHODS AND FINDINGS: We also assessed the collective (compositional and contextual) factors that currently determine risks to multiple NTDs using a cross sectional survey of 1253 individuals in coastal Tanzania. The results show that the effect size in decreasing order of magnitude for non-binary predictors of NTD risks is as follows: NTD comorbidities > poverty > educational attainment > self-reported household quality of life > ethnicity. The multivariate analysis explained 95% of the variance in the relationship between NTD risks and the theoretically-relevant covariates. Compositional (biosocial and sociocultural) factors explained more variance at the neighbourhood level than at the regional level, whereas contextual factors, such as access to health services and household quality, in districts explained a large proportion of variance at the regional level but individually had modest statistical significance, demonstrating the complex interactions between compositional and contextual factors in generating NTD risks. CONCLUSIONS: NTD risks were inequitably distributed over geographic space, which has several important policy implications. First, it suggests that localities of high burden of NTDs are likely to diminish within statistical averages at higher (regional or national) levels. Second, it indicates that curative or preventive interventions will become more efficient provided they can be focused on the localities, particularly as populations in these localities are likely to be burdened by several NTDs simultaneously, further increasing the imperative of multi-disease interventions.

Effectiveness of interventions to reduce indoor air pollution and/or improve health in homes using solid fuel in lower and middle income countries: protocol for a systematic review.

BACKGROUND: Indoor air pollution (IAP) interventions are widely promoted as a means of reducing indoor air pollution/health from solid fuel use; and research addressing impact of these interventions has increased substantially in the past two decades. It is timely and important to understand more about effectiveness of these interventions. We describe the protocol of a systematic review to (i) evaluate effectiveness of IAP interventions to improve indoor air quality and/or health in homes using solid fuel for cooking and/or heating in lower- and middle-income countries, (ii) identify the most effective intervention to improve indoor air quality and/or health, and (iii) identify future research needs. METHODS: This review will be conducted according to the National Institute for Health and Care Excellence (NICE) guidelines and will be reported following the PRISMA statement. Ovid MEDLINE, Ovid Embase, SCOPUS, and PubMed searches were conducted in September 2013 and updated in November 2014 (and include any further search updates in February 2015). Additional references will be located through searching the references cited by identified studies and through the World Health Organization Global database of household air pollution measurements. We will also search our own archives. Data extraction and risk of bias assessment of all included papers will be conducted independently by five reviewers. DISCUSSION: The study will provide insights into what interventions are most effective in reducing indoor air pollution and/or adverse health outcomes in homes using solid fuel for cooking or heating in lower- or middle-income countries. The findings from this review will be used to inform future IAP interventions and policy on poverty reduction and health improvement in poor communities who rely on biomass and solid fuels for cooking and heating. SYSTEMATIC REVIEW REGISTRATION: The review has been registered with PROSPERO (registration number CRD42014009768 ).

Association of arsenic with adverse pregnancy outcomes/infant mortality: a systematic review and meta-analysis.

BACKGROUND: Exposure to arsenic is one of the major global health problems, affecting > 300 million people worldwide, but arsenic's effects on human reproduction are uncertain. OBJECTIVES: We conducted a systematic review and meta-analysis to examine the association between arsenic and adverse pregnancy outcomes/infant mortality. METHODS: We searched PubMed and Ovid MEDLINE (from 1946 through July 2013) and EMBASE (from 1988 through July 2013) databases and the reference lists of reviews and relevant articles. Studies satisfying our a priori eligibility criteria were evaluated independently by two authors. RESULTS: Our systematic search yielded 888 articles; of these, 23 were included in the systematic review. Sixteen provided sufficient data for our quantitative analysis. Arsenic in groundwater (≥ 50 µg/L) was associated with increased risk of spontaneous abortion (6 studies: OR = 1.98; 95% CI: 1.27, 3.10), stillbirth (9 studies: OR = 1.77; 95% CI: 1.32, 2.36), moderate risk of neonatal mortality (5 studies: OR = 1.51; 95% CI: 1.28, 1.78), and infant mortality (7 studies: OR = 1.35; 95% CI: 1.12, 1.62). Exposure to environmental arsenic was associated with a significant reduction in birth weight (4 studies: ß = -53.2 g; 95% CI: -94.9, -11.4). There was paucity of evidence for low-to-moderate arsenic dose. CONCLUSIONS: Arsenic is associated with adverse pregnancy outcomes and infant mortality. The interpretation of the causal association is hampered by methodological challenges and limited number of studies on dose response. Exposure to arsenic continues to be a major global health issue, and we therefore advocate for high-quality prospective studies that include individual-level data to quantify the impact of arsenic on adverse pregnancy outcomes/infant mortality.

A Systematic Review of Heavy Metals of Anthropogenic Origin in Environmental Media and Biota in the Context of Gold Mining in Ghana.

Heavy metal accumulation in the food chain is an issue of global concern because it eventually leads to toxic effects on humans through the water we drink, contaminated soils, crops, and animals. Reports of toxicant levels in environmental media (air, water, and soil) and biota in Ghana were sought in SCOPUS, PubMed, MEDLINE, and EMBASE. Of 1004 bibliographic records identified, 54 studies were included in evidence synthesis. A disproportionately large number of papers (about 80%) focused exclusively on environmental media. Papers focusing on biomonitoring and human health were relatively few. Studies reported a high degree of spatial variability for the concentrations of 8 metals in groundwater. Generally, heavy metal concentrations in soil reported by the studies reviewed were higher than metal concentrations in riverine sediments. Urine and hair were the most common biological markers of heavy metal exposure used by the studies reviewed unlike nails, which were sparingly used. By and large, published results on the levels of heavy metals in goldmine and non-mine workers yielded contradictory results. Mostly, concentrations of heavy metals reported by the studies reviewed for nails were higher than for hair. A high degree of variability in the heavy metal concentrations in human subjects in the studies reviewed is likely due to heterogeneity in physiological states, excretion profiles, and body burdens of individuals. These, in turn, may be a product of genetic polymorphisms influencing detoxification efficiency.

Night-time decibel hell: mapping noise exposure zones and individual annoyance ratings in an urban environment in ghana.

Although accumulating evidence over the past thirty years indicates that noise is an environmental stressor in residential settings, much of the data emanated from studies in high-intensity, noise impact zones around airports or major roads. Little is known about religious noise, especially at night, which is increasingly a growing concern for both the general public and policy-makers in sub-Saharan Africa. Using geographical information systems (GIS), this study measured and mapped exposure to religious noise in a rapidly urbanising municipality in Ghana. Quantitative noise risk assessment was used to evaluate the risk of religious noise-induced hearing loss to residents in the exposed neighbourhoods. The results show that all neighbourhoods where churches were situated had at least one location with significant risk of noise-induced hearing loss. However, there was no statistically significant relationship between neighbourhoods where religious noise exposure was the highest and where noise annoyance was the highest. The magnitude of the noise values for night-time exposure is remarkable particularly given that excessive night-time noise exposure has the greatest detrimental effect on public health. There is the need to focus on vulnerable groups, sensitive hours of the night, and possible confounding with air pollution in order to wholly address this potential hazard.

Health Risks to Children and Adults Residing in Riverine Environments where Surficial Sediments Contain Metals Generated by Active Gold Mining in Ghana.

The purpose of this study was to investigate the current status of metal pollution in the sediment from rivers, lakes, and streams in active gold mining districts in Ghana. Two hundred and fifty surface sediment samples from 99 locations were collected and analyzed for concentrations of As, Hg, Cr, Co, Cu, Fe, Zn, Pb, Cd, Ni, and Mn using inductively coupled plasma-mass spectroscopy (ICP-MS). Metal concentrations were then used to assess the human health risks to resident children and adults in central tendency exposure (CTE) and reasonable maximum exposure (RME) scenarios. The concentrations of Pb, Cd, and As were almost twice the threshold values established by the Hong Kong Interim Sediment Quality Guidelines (ISQG). Hg, Cu, and Cr concentrations in sediment were 14, 20, and 26 times higher than the Canadian Freshwater Sediment Guidelines for these elements. Also, the concentrations of Pb, Cu, Cr, and Hg were 3, 11, 12, and 16 times more than the Australian and New Zealand Environment and Conservation Council (ANZECC) sediment guideline values. The results of the human health risk assessment indicate that for ingestion of sediment under the central tendency exposure (CTE) scenario, the cancer risks for child and adult residents from exposure to As were 4.18 × 10(-6) and 1.84 × 10(-7), respectively. This suggests that up to 4 children out of one million equally exposed children would contract cancer if exposed continuously to As over 70 years (the assumed lifetime). The hazard index for child residents following exposure to Cr(VI) in the RME scenario was 4.2. This is greater than the United States Environmental Protection Agency (USEPA) threshold of 1, indicating that adverse health effects to children from exposure to Cr(VI) are possible. This study demonstrates the urgent need to control industrial emissions and the severe heavy metal pollution in gold mining environments.

A Review of the Ethnobotany and Pharmacological Importance of Alstonia boonei De Wild (Apocynaceae).

Alstonia boonei De Wild is a herbal medicinal plant of West African origin, popularly known as God's tree or "Onyame dua". Within West Africa, it is considered as sacred in some forest communities; consequently the plant parts are not eaten. The plant parts have been traditionally used for its antimalarial, aphrodisiac, antidiabetic, antimicrobial, and antipyretic activities, which have also been proved scientifically. The plant parts are rich in various bioactive compounds such as echitamidine, Nα-formylechitamidine, boonein, loganin, lupeol, ursolic acid, and ß-amyrin among which the alkaloids and triterpenoids form a major portion. The present paper aims at investigating the main research undertaken on the plant in order to provide sufficient baseline information for future work and for commercial exploitation.