Automatic Classification of Antimalarial Herbal Drugs Exposed to Ultraviolet Radiation from Unexposed Ones Using Laser-Induced Autofluorescence with Chemometric Techniques.

Exposure of antimalarial herbal drugs (AMHDs) to ultraviolet radiation (UVR) affects the potency and integrity of the AMHDs. Instant classification of the AMHDs exposed to UVR (UVR-AMHDs) from unexposed ones (Non-UVR-AMHDs) would be beneficial for public health safety, especially in warm regions. For the first time, this work combined laser-induced autofluorescence (LIAF) with chemometric techniques to classify UVR-AMHDs from Non-UVR-AMHDs. LIAF spectra data were recorded from 200 ml of each of the UVR-AMHDs and Non-UVR-AMHDs. To extract useful data from the spectra fingerprint, principal components (PCs) analysis was used. The performance of five chemometric algorithms: random forest (RF), neural network (NN), support vector machine (SVM), linear discriminant analysis (LDA), and k-nearest neighbour (KNN), were compared after optimization by validation. The chemometric algorithms showed that KNN, SVM, NN, and RF were superior with a classification accuracy of 100% for UVR-AMHDs while LDA had a classification accuracy of 98.8% after standardization of the spectra data and was used as an input variable for the model. Meanwhile, a classification accuracy of 100% was obtained for KNN, LDA, SVM, and NN when the raw spectra data was used as input except for RF for which a classification accuracy of 99.9% was obtained. Classification accuracy above 99.74 ± 0.26% at 3 PCs in both the training and testing sets were obtained from the chemometric models. The results showed that the LIAF, combined with the chemometric techniques, can be used to classify UVR-AMHDs from Non-UVR-AMHDs for consumer confidence in malaria-prone regions. The technique offers a non-destructive, rapid, and viable tool for identifying UVR-AMHDs in resource-poor countries.

Classification of Organic and Conventional Cocoa Beans Using Laser-Induced Fluorescence Spectroscopy Combined with Chemometric Techniques.

The craving for organic cocoa beans has resulted in fraudulent practices such as mislabeling, adulteration, all known as food fraud, prompting the international cocoa market to call for the authenticity of organic cocoa beans before export. In this study, we proposed robust models using laser-induced fluorescence (LIF) and chemometric techniques for rapid classification of cocoa beans as either organic or conventional. The LIF measurements were conducted on cocoa beans harvested from organic and conventional farms. From the results, conventional cocoa beans exhibited a higher fluorescence intensity compared to organic ones. In addition, a general peak wavelength shift was observed when the cocoa beans were excited using a 445 nm laser source. These results highlight distinct characteristics that can be used to differentiate between organic and conventional cocoa beans. Identical compounds were found in the fluorescence spectra of both the organic and conventional ones. With preprocessed fluorescence spectra data and utilizing principal component analysis, classification models such as Linear Discriminant Analysis (LDA), Support Vector Machine (SVM), Neural Network (NN) and Random Forest (RF) models were employed. LDA and NN models yielded 100.0% classification accuracy for both training and validation sets, while 99.0% classification accuracy was achieved in the training and validation sets using SVM and RF models. The results demonstrate that employing a combination of LIF and either LDA or NN can be a reliable and efficient technique to classify authentic cocoa beans as either organic or conventional. This technique can play a vital role in maintaining integrity and preventing fraudulent practices in the cocoa bean supply chain.

Effect of different helmet types in head injuries: a case-control study in northern Ghana.

BACKGROUND: Motorcycle helmet use is low in Ghana and many helmets are non-standard. There are limited data on the effectiveness of the different helmet types in use in the real-world circumstances of low-income and middle-income countries. This study assessed the effect of different helmet types on risk of head injury among motorcycle crash victims in northern Ghana. METHODS: A prospective unmatched case-control study was conducted at the Tamale Teaching Hospital (TTH). All persons who had injuries from a motorcycle crash within 2 weeks of presentation to TTH were consecutively sampled. A total of 349 cases, persons who sustained minor to severe head injury, and 363 controls, persons without head injury, were enrolled. A semistructured questionnaire was used to interview patients and review their medical records. Multivariable logistic regression was used to estimate odds for head injury. RESULTS: After adjusting for confounders, the odds of head injuries were 93% less in motorcyclists with full-face helmet (FFH) (adjusted OR, AOR 0.07, 95% CI 0.04 to 0.15) or open-face helmet (OFH) (AOR 0.07, 95% CI 0.04, 0.13), compared with unhelmeted motorcyclists. Half-coverage helmets (HCH) were less effective (AOR 0.41, 95% CI 0.18 to 0.92). With exception of HCH, the AORs of head injury for the different types of helmets were lower in riders (FFH=0.06, OFH=0.05 and HCH=0.47) than in pillion riders (FFH=0.11, OFH=0.12 and HCH=0.35). CONCLUSION: Even in this environment where there is a high proportion of non-standard helmets, the available helmets provided significant protection against head injury, but with considerably less protection provided by HCHs.

Prevalence and determinants of home delivery among reproductive age women, Margibi County, Liberia.

BACKGROUND: The use of institutional delivery services is essential for improving maternal and child health. However, studies in Liberia reveal over 20% of women still deliver at home. We assessed the prevalence and associated factors of home delivery among women of reproductive age in Margibi County, Liberia. METHODS: We conducted a cross-sectional study among 438 women of reproductive age in Margibi County. Data were obtained using a semi-structured questionnaire. A simple random sampling approach was used to select the participants for the study. We performed binary logistic regression to identify factors influencing home delivery. Findings were summarized into tables displaying the frequencies, percentages, crude, and adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Prevalence of home delivery in the County was 90.6% (95% CI = 87.5 - 93.0). Women who were ≥ 31 years (aOR = 6.74, 95%CI = 2.86-15.90), women who had two or more children (aOR = 9.68, 95%CI = 4.07-22.99) and those who had rapid onset of labor (aOR = 6.35, 95%CI = 1.59 - 25.27) were associated with increased odds of home delivery. Good attitude of health workers (aOR = 0.01, 95%CI = 0.001 - 0.08) and the availability of transport to the nearest health facility (aOR = 0.01, 95%CI = 0.003 - 0.03) were factors associated with a decreased odds of home delivery among the study participants. CONCLUSION: The high prevalence of home delivery in the county is a call for urgent interventions by the government of Liberia and various non-governmental organizations. The government may need to supply the county with ambulances and ensure in-service training of health workers on good attitudes.

Poor mental health of livestock farmers in Africa: a mixed methods case study from Ghana.

BACKGROUND: Agriculture represents the mainstay of African economies and livestock products are essential to the human population's nutritional needs. However, in many developing countries, including Ghana, livestock production fails to meet demand due to population growth and negative effects of climate change. One of the challenges to production is livestock loss affecting farmers. However, despite stressful events experienced, livestock farmers' mental health is poorly documented. This study aims to identify the root causes of livestock losses and their influence on pastoralists' mental health. METHODS: We conducted a mixed methods study in two districts in the Northern and Southern Belts of Ghana. Using the Depression Anxiety and Stress Scale-21 and guided interviews, we collected quantitative and qualitative data from 287 livestock farmers and 24 key-informants respectively. Mental health scores were categorized using standard guidelines. We evaluated the factors that explained variations in mental wellbeing using general linear models (α = 0.05). RESULTS: About 85% (240/287) of the livestock farmers lost cattle within 1 year. Of these, 91% lost cattle to animal diseases, 50% to theft and 27% to pasture shortages. Qualitative findings reveal that due to poor access to veterinary services, farmers treat livestock diseases themselves with drugs from unregulated sources and often sell diseased cows for meat to recover losses. Findings showed that 60% of livestock farmers had poor mental health. Of those, 72% were depressed, 66% anxious and 59% stressed. Mental wellbeing was negatively associated with the number of adverse events experienced, proportion of livestock lost to most of the major loss factors, emotional attachment to livestock and self-reported physical illnesses in farmers, but positively associated with increasing herd size [F (8,278) = 14.18, p < 0.001, R2 = 0.29]. CONCLUSIONS: Livestock diseases are the leading cause of losses to livestock farmers, whose mental wellbeing is negatively affected by these losses. Although an adaptive strategy by farmers to compensate for poor veterinary services, the arbitrary use of veterinary drugs and sale of diseased cattle pose health risks to the public. Further research to evaluate the performance of veterinary services in Ghana, mental health problems and risk to human health due to potential high-risk meat entering the food chain, is needed.

Obstetric determinants of preterm delivery in a regional hospital, Accra, Ghana 2016.

BACKGROUND: Globally, prematurity is a major determinant of morbidity and mortality contributing 30-40% of neonatal mortality. The consequences of preterm deliveries are enormous with developmental and childhood complications as well as high economic and psycho-social burden on the parents (family) and society. Some risk factors include ever having preterm delivery, multiple births and some medical conditions like sexually transmitted infection and urinary tract infections but these have not been ascertained in our study area. Much research into these risk factors is needed in Ghana. We assessed the obstetric determinants of preterm delivery. METHODS: We conducted a 1:2 unmatched case-control study in Greater Accra Regional Hospital (GARH) -Ridge, a secondary referral facility in Accra, Ghana (from October, 2015 -May, 2016). A case was a mother who delivered between 28 and 36 weeks of gestation (preterm) and a control was a mother who delivered after 37 to 42 completed weeks (term). We used structured questionnaire to collect data, reviewed maternal and foetal records using a checklist. Categorical variables were analysed and expressed as frequencies and proportions. We determined the association between obstetric factors and preterm delivery with multiple logistic regression. Significance level of the strength of association was determined at 95% CI and p-value < 0.05. RESULTS: We recruited 390 mothers, 130 had preterm deliveries (cases) and 260 had term deliveries (controls). Experiencing premature rupture of membrane (aOR: 2.3; 95% CI:1.0-5.5), pre-eclampsia/eclampsia (aOR: 3.4; 95% CI: 1.0-11.9) were found to be associated with preterm delivery. However, four or more ANC visit was protective factor for preterm delivery (aOR: 0.2; 95% CI: 0.1-0.4). CONCLUSION: Premature rupture of membrane, hypertensive complications and antepartum haemorrhage were found to be risk factors associated with preterm delivery in Ridge Hospital. Health workforce providing ANC services need to identify risk factors and refer these mothers to the doctor for early management and improved outcome decreasing preterm delivery.

Outbreak of scabies among preschool children, Accra, Ghana, 2017.

BACKGROUND: Scabies occurs worldwide with a prevalence between 0.3 and 46.0%. In Ghana, even though a 5.1% proportion of scabies was reported in a retrospective review of skin diseases at the Korle Bu Teaching Hospital, the nationwide prevalence of scabies is unknown. Overall, its burden is higher in tropical regions. Scabies outbreaks mostly occur among children, the elderly in nursing homes, and prison inmates. Even though primary scabies hardly results in mortalities, the pain, itch, and systemic complications from secondary bacterial infections account for about 1.5 million years lived with disabilities. We investigated a scabies outbreak among school children in Ghana to determine its magnitude, stop the outbreak, and institute preventive measures to minimize risks of future outbreaks. METHODS: The investigation was conducted between March 14 and May 17, 2017 among pupils of Presbyterian Secondary Staff Basic School in Accra. We defined a case as a school child who on clinical examination, had an intensely pruritic rash on at least one typical predilection site with or without a burrow, or positive skin scrapings on microscopy. We screened and line listed cases, performed laboratory investigations on skin scrapings and wound swaps, and conducted an environmental assessment. We performed descriptive statistics on data, and calculated attack rate ratios (ARR) at 95% confidence level. RESULTS: Of 823 preschool children screened, 92 were cases. Median age of cases was 4 years (range 2-7 years) and their modal age was 3 years. The overall attack rate was 11.2% (92/823). The sex specific attack rate was 11.5% for males, and 10.8% for females (ARR: 0.93; CI: 0.67-1.28). Compared with the least affected class (crèche), the nursery one class was worst affected (ARR: 5.14; CI: 3.44-7.50). On microscopy, all skin scrapings were negative for scabies. Staphylococcus aureus and Streptococcus spp. were isolated from secondarily infected scabies lesions. CONCLUSIONS: A scabies outbreak with a propagated source occurred among preschool children. The 3-year-old pupils were most affected. It was controlled by mass treatment with benzyl benzoate and health education. Classrooms and sleeping mats were disinfected. We recommended the decongestion of classrooms and discouraged sharing of sleeping mats.

Evaluation of the enhanced meningitis surveillance system, Yendi municipality, northern Ghana, 2010-2015.

BACKGROUND: Meningitis is the inflammation of the meninges of the brain and or spinal cord. Global mortality rates vary from 2% to 30%. Epidemic meningitis remains a public health concern along the meningitis belt of Africa. Despite the operation of an enhanced meningitis surveillance system in Ghana, institutional mortality rates are estimated to range from 36% to 50%. In 2014, Yendi recorded 83 confirmed cases; with focal epidemics in some sub-municipals. We evaluated the system over a five-year period to find out whether it was achieving its objectives of systematic collection and analyses of data for the prevention or early detection of meningitis epidemics. METHODS: We used cross-sectional design. Both qualitative and quantitative data from Yendi Municipality between January 2010 and December 2015 were collected and analyzed. The updated guidelines for evaluating surveillance systems from Centers for Disease Control and Prevention were used. Content analysis was performed on the responses of key informants. Surveillance data was analyzed using MS-Excel. RESULTS: Fifteen healthcare workers were interviewed. For the period under evaluation, the annual incidence of meningitis ranged from 1.6/100,000 in 2012 to 62.6/100,000 in 2014. The average case fatality rate for the period was 8.3%. The system was sensitive, representative, and acceptable. The predictive value positive was 100% from 2010 to 2014 and 63.3% in 2015. Data quality was good, but timeliness of reporting was poor. CONCLUSIONS: The enhanced meningitis surveillance system in Yendi Municipality is achieving most of its objectives. However, financial constraints and poor personnel motivation pose threats to the sustainability of the system.

Outbreak of foodborne gastroenteritis in a senior high school in South-eastern Ghana: a retrospective cohort study.

BACKGROUND: On 4th February 2015, a group of Senior High School students from Fanteakwa district presented to the emergency unit of the district hospital with complaints of abdominal pain, vomiting and diarrhoea. All the students had eaten from a specific food vendor and had neither eaten any other common meal that day nor the previous day. A foodborne disease outbreak was suspected. We investigated to verify the outbreak, determine its magnitude, identify the source and implement control measures. METHODS: A retrospective cohort study was conducted. We reviewed medical records and interviewed patrons of the food vendor. We collected data on age, sex, signs and symptoms, date of illness onset, date of admission, date of discharge, treatments given and outcome. A case of foodborne disease was any person in the school with abdominal pain, vomiting and or diarrhoea from 4th to 11th February 2015 and had eaten from the food vendor. We conducted active case search to identify more cases. We conducted environmental assessment and collected clinical and food samples for laboratory testing. Descriptive and inferential statistical analyses were performed using Stata 12.0. RESULTS: A total of 68 cases were recorded giving overall attack rate of 35.79 % (68/190) with no death. Of these, 51.47 % (35/68) were males. Mean age of case-patients was 17.8 (standard deviation +/-1.62). The index case, a 17-year-old female student ate from the food vendor on 4th February at 9:00 am and fell ill at 3:40 pm later that day. Compared to those who ate other food items, students who drank water from container at the canteen were more likely to develop foodborne disease at statistically significant levels [RR = 2.6, 95 % CI = (2.11-3.15)]. Clostridium perfringens (C. perfringens) and Salmonella species (Salmonella spp) were isolated from water and stew respectively. Clinical features of case-patients were compatible with both organisms. CONCLUSION: A foodborne gastroenteritis outbreak occurred in a Senior High School in Fanteakwa District from 4th to 7th February 2015. The most probable aetiologic agent was C. perfringens with contaminated water at canteen as the vehicle of transmission. Concurrent Salmonella spp infection could not be ruled out. Rapid outbreak response helped in controlling the outbreak.

Multimorbidity of chronic diseases among adult patients presenting to an inner-city clinic in Ghana.

BACKGROUND: Very little is known about multimorbidity and chronic diseases in low and middle income countries, particularly Sub-Saharan Africa, and more information is needed to guide the process of adapting the health systems in these countries to respond adequately to the increasing burden of chronic diseases. We conducted a hospital-based survey in an urban setting in Ghana to determine the prevalence of multimorbidity and its associated risk factors among adult patients presenting to an inner city clinic. METHODS: Between May and June 2012, we interviewed adult patients (aged 18 years and above) attending a routine outpatient clinic at an inner-city hospital in Accra using a structured questionnaire. We supplemented the information obtained from the interviews with information obtained from respondents' health records. We used logistic regression analyses to explore the risk factors for multimorbidity. RESULTS: We interviewed 1,527 patients and retrieved matching medical records for 1,399 (91.6%). The median age of participants was 52.1 years (37-64 years). While the prevalence of multimorbidity was 38.8%, around half (48.6%) of the patients with multimorbidity were aged between 18-59 years old. The most common combination of conditions was hypertension and diabetes mellitus (36.6%), hypertension and musculoskeletal conditions (19.9%), and hypertension and other cardiovascular conditions (11.4%). Compared with patients aged 18-39 years, those aged 40-49 years (OR 4.68, 95% CI: 2.98-7.34), 50-59 years (OR 12.48, 95% CI: 8.23-18.92) and 60 years or older (OR 15.80, 95% CI: 10.66-23.42) were increasingly likely to present with multimorbidity. While men were less likely to present with multimorbidity, (OR 0.71, 95% CI: 0.45-0.94, p = 0.015), having a family history of any chronic disease was predictive of multimorbidity (OR 1.43, 95% CI: 1.03-1.68, p = 0.027). CONCLUSIONS: Multimorbidity is a significant problem in this population. By identifying the risk factors for multimorbidity, the results of the present study provide further evidence for informing future policies aimed at improving clinical case management, health education and medical training in Ghana.

Evaluation of facilitative supervision visits in primary health care service delivery in Northern Ghana.

BACKGROUND: In Ghana's health delivery services, facilitative supervisory visit (FSV) as a system of management is new. This paper presents the standard evaluation results of FSV, which formed an integral part of the community-based health planning services (CHPS) initiative. METHODS: The study was conducted in the Upper West Region of Ghana. The Project developed guidelines and tools for FSV for four different health system levels--regional, district, sub-district and community levels. Electronic data from all four levels representing quarterly results were compiled into their annual equivalents, and summarized graphically for comparison. RESULTS: The data show that all the nine districts embraced the FSV concept even though they differed markedly with regard to the degree of adherence to some set benchmarks. Three DHMTs (Wa Municipal, Lawra and Jirapa) were graded as good while the remaining six DHMTs were adjudged as fair in relation to management of supplies, transport and equipment, information, meeting, and technical support. CONCLUSIONS: The data further suggest that there is much to gain both individually and institutionally from FSVs. Generally, FSVs are crucial to the delivery of primary health care services in especially rural areas.

Adherence to the test, treat and track strategy for malaria control among prescribers, Mfantseman Municipality, Central Region, Ghana.

BACKGROUND: The test, treat, and track (T3) strategy is directed at ensuring diagnosis and prompt treatment of uncomplicated malaria cases. Adherence to T3 strategy reduces wrong treatment and prevents delays in treating the actual cause of fever that may otherwise lead to complications or death. Data on adherence to all three aspects of the T3 strategy is sparse with previous studies focusing on the testing and treatment aspects. We determined adherence to the T3 strategy and associated factors in the Mfantseman Municipality of Ghana. METHODS: We conducted a health facility based cross-sectional survey in Saltpond Municipal Hospital and Mercy Women's Catholic Hospitals in Mfantseman Municipality of the Central Region, Ghana in 2020. We retrieved electronic records of febrile outpatients and extracted the testing, treatment and tracking variables. Prescribers were interviewed on factors associated with adherence using a semi-structured questionnaire. Data analyses was done using descriptive statistics, bivariate, and multiple logistic regression. RESULTS: Of 414 febrile outpatient records analyzed, 47 (11.3%) were under five years old. About 180 (43.5%) were tested with 138 (76.7%) testing positive. All positive cases received antimalarials and 127 (92.0%) were reviewed after treatment. Of 414 febrile patients, 127 (30.7%) were treated according to the T3 strategy. Higher odds of adherence to T3 were observed for patients aged 5-25 years compared to older patients (AOR: 2.5, 95% CI: 1.27-4.87, p = 0.008). Adherence was low among physician assistants compared to medical officers (AOR 0.004, 95% CI 0.004-0.02, p<0.001). Prescribers trained on T3 had higher adherence (AOR: 99.33 95% CI: 19.53-505.13, p<0.000). CONCLUSION: Adherence to T3 strategy is low in Mfantseman Municipality of the Central Region of Ghana. Health facilities should perform RDTs for febrile patients at the OPD with priority on low cadre prescribers during the planning and implementation of interventions to improve T3 adherence at the facility level.

Factors associated with head injury among survivors of motorcycle crashes: a case-control study in northern Ghana.

Introduction: the increasing use of motorcycles in northern Ghana is associated with a high incidence of motorcycle crashes and resultant head injuries. This study sought to determine factors associated with head injuries among survivors of motorcycle crashes in northern Ghana. Methods: a prospective unmatched case-control study was conducted at the Tamale Teaching Hospital (TTH). A total of 326 cases (victims who suffered a head injury with or without other injuries) and 294 controls (persons who suffered various injuries except for head injury) from motorcycle crashes were consecutively sampled at TTH from December 15, 2019, to May 15, 2020. A semi-structured questionnaire was used to interview patients in addition to medical records review. Factors associated with head injury were examined using multivariable logistic regression at p<0.05 and a 95% confidence interval. Results: the prevalence of head injury was 53.03% among of 660 survivors of motorcycle crashes. The majority of the patients were young males aged 15-44 years. The rate of helmet use was lower in cases (12.88%) than in controls (57.82%) (p<0.001). Factors associated with head injury were not wearing helmet (AOR= 9.80, 95% CI: 6.22, 15.43), male (AOR=1.75, 95% CI: 1.07, 2.85), student (AOR=0.38, 95% CI: 0.16, 0.91), and alcohol use within 24 hours (AOR=0.17, 95% CI: 0.04, 0.70). Conclusion: non-use of helmet and male gender significantly increased the risk of head injury risk in this study. Alcohol use and being a student were associated with lower odds of head injuries. Motorcycle safety efforts in the study area should emphasize helmet promotion.

Determinants of low birth weight deliveries at five referral hospitals in Western Area Urban district, Sierra Leone.

BACKGROUND: Low birth weight (LBW) contributes significantly to infant and child mortality. Each year, about 20 1million deliveries are LBW with 96.5% occurring in developing countries. Whiles the incidence of LBW is reducing in other districts of Sierra Leone, it has been reported to be increasing in the Western Area Urban district. Determining the risk factors in a specific geographic area is important for identifying mothers at risk and thereby for planning and taking appropriate action. The current study sought to identify factors associated with LBW deliveries in the Western Area Urban district of Sierra Leone. METHODS: A hospital-based unmatched 1:2 case-control study was conducted among mothers who delivered live singleton babies from November, 2019 to February, 2020 in five referral health facilities. Mothers were conveniently sampled and sequentially enrolled into the study after delivery. Their antenatal care cards were reviewed and a pre-tested questionnaire administered to the mothers. Data analysis was done using Stata 15.0 and association between maternal socio-demographic, socio-economic, obstetric and lifestyle factors and LBW assessed using bivariable and multivariable logistic regression analyses. RESULTS: A total of 438 mothers (146 cases and 292 controls), mean age: 24.2 (±5.8) and 26.1 (±5.5) years for cases and controls respectively participated in the study. Multivariable analysis revealed that being unemployed (AoR = 2.52, 95% CI 1.16-5.49, p = 0.020), having anaemia during pregnancy (AoR = 3.88, 95% CI 1.90-7.90, p <  0.001), having less than 2 years inter-pregnancy interval (AoR = 2.53, 95% CI 1.11-5.73, p = 0.026), and smoking cigarettes during pregnancy (AoR = 4.36, 95% CI 1.94-9.80, p <  0.001) were significantly associated with having LBW babies. CONCLUSION: Factors associated with LBW identified were unemployment, anaemia during pregnancy, < 2 years inter-pregnancy interval and cigarette smoking during pregnancy. Health care providers should screen and sensitize mothers on the risk factors of LBW during antenatal sessions.

Tuberculosis surveillance system evaluation: case of Ga West municipality, Ghana, 2011 to 2016.

BACKGROUND: Evaluate the Tuberculosis (TB) surveillance system in the Ga West Municipality to determine if it is achieving its objectives, and to assess its attributes and usefulness. DESIGN: Descriptive analysis of primary and secondary data. DATA SOURCE: Stakeholder interviews and record reviews on the objectives and operation of the surveillance system at all levels of the system. INTERVENTION: We evaluated the system's operation from 2011-2015 using the Centers for Disease Control and Prevention (CDC) updated guidelines for evaluating public health surveillance systems and the World Health Organisation (WHO) TB surveillance checklist for assessing the performance of national surveillance systems. RESULTS: The TB surveillance system in the municipality was functional and operated at all levels for timely detection of cases, accurate diagnosis, and case management. The system improved management of TB/HIV co-infections. The average time taken to confirm a suspected TB case was one day. The registration of a confirmed case and subsequent treatment happen immediately after confirmation. The municipality detected 109 of 727 TB cases in 2015 (case detection rate=15%). The positive predictive value (PPV) was 6.4%. There was one diagnostic centre in the municipality. Private facilities involvement in TB surveillance activities was low (1/15). CONCLUSION: The Tuberculosis surveillance system in the Ga West Municipality is well structured but partially meeting its objectives. The system is timely, stable and acceptable by most stakeholders and useful at all levels. It has no major data quality issues. Private health facilities in the municipality should be well incorporated into TB surveillance. FUNDING: This work was supported by Ghana Field Epidemiology and Laboratory Training Program (GFELTP), University of Ghana through the support of the West Africa Health Organization (Ref.: Prog/A17IEpidemSurveillN° 57212014/mcrt) to B-YA.

Geospatial clustering of meningitis: an early warning system (hotspot) for potential meningitis outbreak in upper east region of Ghana.

OBJECTIVE: We mapped and generated hot spots for potential meningitis outbreak from existing data in Upper East region, Ghana. DESIGN: This was a cross-sectional study conducted in 2017. DATA SOURCE: Meningitis data in the Upper East Region from January 2007, to December 2016. MAIN OUTCOME MEASURE: We used spatial tools in Quantum Geographic Information System (QGIS) and Geoda to draw choropleth map of meningitis incidence, case fatality and hotspot for potential meningitis outbreak. RESULTS: A total of 2312 meningitis cases (suspected and confirmed) were recorded from 2016-2017 with median incidence of 15.0cases/100,000 population (min 6.3, max 47.8). Median age of cases was 15 years (IQR: 6-31 years). Most (44.2%) of those affected were 10 years and below. Females (51.2%) constituted the highest proportion. Median incidence from 2007-2011 was 20cases/100,000 population (Min 11.3, Max 39.9) whilst from 2012-2016 was 11.1cases/100,000 populations (Min 6.3, Max 47.8). A total of 28 significant hotspot sub-districts clusters (p=0.024) were identified with 7 High-high risk areas as potential meningitis outbreak spots. CONCLUSION: The occurrence of meningitis is not random, spatial cluster with high -high-risk exist in some sub-districts. Overall meningitis incidence and fatality rate have declined in the region with district variations. Districts with high meningitis incidence and fatality rates should be targeted for intervention. FUNDING: Author EA was supported by the West Africa Health Organization (Ref.: Prog/A17IEpidemSurveillN°57212014/mcrt).

Sleeping space matters: LLINs usage in Ghana.

Long Lasting Insecticidal Net (LLIN) is an effective malaria prevention mechanism. However, ownership of LLIN does not imply its use among households. The availability of enough sleeping space is a natural prerequisite to install and use LLINs. The objective of this study was to explore the effect of sleeping space and other socio-demographic factors of households' heads on LLINs usage among households. A cross-sectional household-based study was conducted using a quantitative approach. Data was collected exclusively from households that received LLINs at no direct financial cost to them in a mass malaria campaign conducted in the study area using a structured questionnaire. A total of 383 households sampled for the study received 1,181 LLINs with a range of 1 to 15 LLINs per household. Less than 16% of households that received more than 2 LLINs installed all the LLINs they received during the distribution. Among households that received LLINs, 45% of them did not use them at all and 36% of them used them every night including the night before data collection. The number of bedrooms, children and members per household, and the number of occupants per bedroom were also found statistically associated with the use of LLINs among households. The study used a quantitative approach to investigate sleeping space in relation to LLINs usage and malaria control, an area and topic that has not been adequately covered in the literature.

Evaluation of Buruli Ulcer Disease Surveillance System in the Ga West Municipality, Ghana, 2011-2015.

BACKGROUND: Buruli ulcer (BU) is one of the most neglected tropical diseases caused by Mycobacterium ulcerans. M. ulcerans infection may manifest initially as a pre-ulcerative nodule, a plaque, or oedema which breaks down to form characteristic ulcers with undermined edges. The Ga West Municipality is an endemic area for Buruli ulcer, and we evaluated the BU surveillance system to determine whether the system is meeting its objectives and to assess its attributes. MATERIALS AND METHODS: We used a checklist based on Centers for Disease Control and Prevention (CDC) updated surveillance evaluation guidelines, 2006. We reviewed records and dataset on Buruli ulcer for the period 2011-2015. The evaluation was carried out at the national, regional, district, and community levels using the Ga West Municipality of the Greater Accra Region as a study site. Interviews with key stakeholders at the various levels were done using an interview guide, and observations were done with a checklist. Data were entered and analyzed using Epi info 7. RESULTS: A total of 594 cases of Buruli ulcer were reported from 2011 to 2015 in Ga West. The number of confirmed cases decreased from 109 in 2011 to 17 in 2015. The system was useful, fairly simple, flexible, representative, and fairly acceptable. The system was sensitive with a PVP of 45.3%. Although the data quality was good with 85% of case report forms completed, there was under-reporting (3.6%), some discrepancies of data at the district, regional, and national levels. The system was moderately stable, and timeliness of reporting was 30.7%. CONCLUSION: The Buruli ulcer surveillance system is meeting its set objectives, and the data generated are used to reliably describe the epidemiologic situation and evaluate the results for actions and plan future interventions. There is a need for timely submission of data. We recommend that the National Buruli Ulcer Control Program (NBUCP) provides logistical support to treatment centres.

Psychological working conditions and predictors of occupational stress among nurses, Salaga Government Hospital, Ghana, 2016.

INTRODUCTION: Occupational stress is a recognized health problem among nurses. Globally, its prevalence varies between 9.2% and 68.0%. It detracts from nurses' quality of life and efficiency of job performance. In Ghana, we do not know the important contributory factors to this problem. Our study sought to identify the important predictors of occupational stress among nurses. METHODS: In January 2016, we conducted an institutional-based survey among nurses of Salaga Government Hospital. They completed a five-point Likert type questionnaire adopted from the British Psychological Working Conditions Survey, and the Nurse Stress Index. Across 30 predictor variables, a mean score of 4.00 to 5.00 represented high to extreme occupational stress. We performed bivariate and multivariate analyses to identify important predictors of occupational stress at 95% confidence level. RESULTS: Of 167 nurses, 58.1% (97) were females. Respondents who experienced high to extreme stress levels had a 2.3 times odds of reporting sickness absence (CI: 1.03-5.14). Sources of occupational stress included: manual lifting of patients and pieces of equipment (OR: 16.23; CI: 6.28 - 41.92), the risks of acquiring infections (OR: 14.67; CI 5.90 - 36.46), receiving feedback only upon unsatisfactory performance (OR: 28.00; CI: 9.72 - 80.64), and inadequate opportunities for continuous professional development (OR: 63.50; CI: 19.99 - 201.75). CONCLUSION: The working conditions of nurses were stressful. The most significant predictors of occupational stress were poor supportive supervision by superiors, lack of adequate skills to perform routine tasks, uncertainty about their job role, and the lack of adequate opportunities for career advancements.

Quantitative Pore Characterization of Polyurethane Foam with Cost-Effective Imaging Tools and Image Analysis: A Proof-Of-Principle Study.

This study investigated the pore characterization of polyurethane (PU) foam as a necessary step in water filtration membrane fabrication. Porous material characterization is essential for predicting membrane performance, strength, durability, surface feel, and to understand the transport mechanisms using modeling and simulations. Most existing pore characterization techniques are relatively costly, time-consuming, subjective, and have cumbersome sample preparations. This study focused on using three relatively inexpensive imaging systems: a black box, Canon camera (EOS760D), and LaserJet scanner (M1132 MFP). Two standard, state-of-the-art imaging systems were used for comparison: a stereomicroscope and a scanning electron microscope. Digital images produced by the imaging systems were used with a MATLAB algorithm to determine the surface porosity, pore area, and shape factor of the polyurethane foam in an efficient manner. The results obtained established the compatibility of the image analysis algorithm with the imaging systems. The black box results were found to be more comparable to both the stereomicroscope and SEM systems than those of the Canon camera and scanner imaging systems. Indeed, the current research effort demonstrates the possibility of substrate characterization with inexpensive imaging systems.