Sanitation investments in Ghana: An ethnographic investigation of the role of tenure security, land ownership and livelihoods.

BACKGROUND: Ghana's low investment in household sanitation is evident from the low rates of improved sanitation. This study analysed how land ownership, tenancy security and livelihood patterns are related to sanitation investments in three adjacent rural and peri-urban communities in a district close to Accra, Ghana's capital. METHODS: Qualitative data was gathered for this comparative ethnographic study over seven months, (June, 2011-January, 2012) using an average of 43 (bi-weekly) participant observation per community and 56 in-depth interviews. Detailed observational data from study communities were triangulated with multiple interview material and contextual knowledge on social structures, history of settlement, land use, livelihoods, and access to and perceptions about sanitation. RESULTS: This study shows that the history of settlement and land ownership issues are highly correlated with people's willingness and ability to invest in household sanitation across all communities. The status of being a stranger i.e. migrant in the area left some populations without rights over the land they occupied and with low incentives to invest in sanitation, while indigenous communities were challenged by the increasing appropriation of their land for commercial enterprises and for governmental development projects. Interview responses suggest that increasing migrant population and the high demand for housing in the face of limited available space has resulted in general unwillingness and inability to establish private sanitation facilities in the communities. The increasing population has also created high demand for cheap accommodation, pushing tenants to accept informal tenancy agreements that provided for poor sanitation facilities. In addition, poor knowledge of tenancy rights leaves tenants in no position to demand sanitation improvements and therefore landlords feel no obligation or motivation to provide and maintain domestic sanitation facilities. CONCLUSIONS: The study states that poor land rights, the history of settlements, in-migration and insecure tenancy are key components that are associated with local livelihoods and investments in private sanitation in rapidly changing rural and peri-urban communities of Ghana. Sanitation policy makers and programme managers must acknowledge that these profound local, ethnic and economic forces are shaping people's abilities and motivations for sanitation investments.

From abandoned warehouse to life-saving facility, Pakro, Ghana. The Accra PMM Team.

PRELIMINARY STUDIES: Focus group discussions in Akwapim South District, Ghana, highlighted a lack of accessible health facilities as an important factor contributing to maternal deaths. INTERVENTIONS: In 1991, a health center was established by rennovating an abandoned warehouse. The center was equipped with beds, a refrigerator, a safe water supply, drugs and supplies. With the posting of a community health nurse from the Ministry of Health (MOH), it began functioning as a maternal and child health/family planning clinic. A senior nurse-midwife was posted in 1992 and obstetric services were offered. Starting in 1994, community interventions focused on reducing the delay in seeking care. RESULTS: An average of nine women with major obstetric complications were seen each 12-month period between 1992 and 1995. Many minor complications and non-obstetric ailments were also treated. COSTS: The material costs of establishing the health center amounted to US $12,550: 47% came from the community, 43% came from non-governmental organizations (NGOs), 7% from PMM and 3% from MOH. The costs of staff salaries were paid by MOH. CONCLUSIONS: It is possible to mobilize communities, government and NGOs to help provide emergency obstetric services. If emergency obstetric services are available, women will use them, even before the launching of community information and education campaigns.

The maternity waiting home concept: the Nsawam, Ghana experience. The Accra PMM Team.

PRELIMINARY STUDIES: Focus group discussions with community members in Nsawam District, Ghana, identified poor roads, scarce transport and exorbitant fees for emergency transport as barriers to reaching the district hospital for treatment of an obstetric complication. INTERVENTIONS: To minimize delay in the event of a complication, a maternity waiting home (MWH) was established in Nsawam in 1994. One ward of an abandoned hospital was renovated and furnished for this purpose. The objective was to encourage women at high risk of obstetric complications to move to the MWH so they could be transferred to the hospital when labor began. RESULTS: Of 25 women referred to the MWH by health personnel over 12 months, only one complied, for one night. Focus group discussions with community members and hospital staff later revealed that cost and hardship of staying away from home, absence of health personnel, distance from hospital, desolate surroundings and lack of perceived need were reasons for poor utilization. COSTS: The intervention cost approximately US $10,500, shared approximately equally between the project and government. The main government contribution was the building. CONCLUSIONS: It is important to consult potential users not only to identify problems, but also to identify appropriate solutions. Careful 'market research' should be done before launching interventions.

Sandifer's syndrome--a report of one case.

The authors report a case of postural abnormality of the head and neck (Torticollis) in a fourteen month old infant with severe gastroesophageal reflux (GER). Disappearance of this abnormality after surgical correction of the reflux leads the authors to confirm the diagnosis of Sandifer's syndrome of which the main features are underlined. In its initial descriptions, Sandifer's syndrome was characterized by the sudden occurrence, usually during meals, of torticollis, consecutive to hiatal hernia in children. This torticollis disappears within days or weeks following surgical treatment of the hiatal hernia. It was later proved that the origin of the torticollis was not the hiatal hernia itself, but the consequent gastroesophageal reflux (GER).

Les plaies penetrantes de l'abdomen au CHU de Lome; a propos de 44 cas

Les auteurs rapportent les resultats d'une etude retrospective de 44 cas de plaies penetrantes de l'abdomen vue en 5 ans (Janvier 1990 a Decembre 1994) dans le service de chirurgie general du CHU Tokoin; dans le but d'en ressortir les problemes diagnostiques et therapeutiques. Les plaies penetrantes ont represente 0;73 pour cent des urgences abdominales chirurgicales durant la meme periode. La plupart des blesses etaient de sexe masculin (90;9 pour cent) et ages de 20 a 40 ans (70;5 pour cent). L'agent causal etait l'arme blanche dans 72;7 pour cent des cas. La lesion intra-abdominale etait cliniquement evidente dans 45;4 pour cent des cas; devant l'existence d'un choc hemorragique; d'un hemoperitoine ou d'une peritonite. Les plaies par armes a feu ont occasionne plus frequemment des lesions abdominales multiviscerales ainsi que des lesions extrathoraciques associees. Compte tenu de l'insuffisance de ressources humaines et materielles dans les services; l'attitude demeure la laparotomie systematique devant toutes les plaies penetrantes abdominales malgre un taux important de laparotomie blanche (40;9 pour cent). La lourde mortalite (15;9 pour cent) pourrait etre reduite par l'amelioration de mesures de reanimation

Volvulus du colon pelvien au CHU de Lome (Togo)

Une etude retrospective des cas de volvulus pelvien operes dans le service de Chirugie Generale du CHU de Lome-Tokoin a ete entreprise dans le but d'en degager les caracteristiques epidemiologiques; etio-pathologiques; cliniques et pronostiques. Au nombre de 26; les volvulus du colon pelvien 30;95 pour cent des volvulus intestinaux ont represente 50 pour cent des causes d'occlusion colique mecanique. Ils ont ete marques par une nette predominance masculine (96;15 pour cent) avec un age moyen de 47; 65 ans. Sur le plan pathogenique; des facteurs constitutionnels affectant la morphologie du colon et une meso-sigmoidite retractile ont ete trouves a l'origine des volvulus. La radio de l'abdomen sans preparation; pratiquee dans tous les cas; a montre chez 22 patients une image typique de volvulus pelvien du colon pelvien. Le traitement a consiste en une detorsion simple (8 fois); une detorsion avec geste associe (7 fois); colectomie ideale (10 fois); et une hemicolectomie gauche (1 fois). Les auteurs ont deplore 4;76 pour cent de deces et 11;54 pour cent de redicives

Stenose hypertrophique du pylore du nourrisson au CHU de Lome (Togo)

Une etude prospective a permis en 4 ans (de janvier 1988 a decembre 1991) de recruter 19 cas de stenose hypertrophique du pylore chez le nourrisson au CHU de Lome (Togo). Les patients etaient ages de 28 a 80 jours; avec une predominance masculine (15 garcons pour 4 filles). Le diagnostic a ete essentiellement clinique; le motif d'hospitalisation univoque: les vomissements. Le diagnostic a ete confirme par une radiographie dans 13 cas; et une echographie a ete realisee chez 8 patients. Tous les patients ont ete traites par pylorotomie extramuqueuse par courte incision horizontale dans l'hypochondre droit. Au rang des complications observees la persistance postoperatoire des vomissements dans 8 cas. Aucun cas de blessure de la muqueuse duodenale; ni d'infection. Deux deces ont ete deplores. L'amelioration de nos resultats exige une specialisation de nos reanimateurs en reanimation neonatale

Resultats preliminaires du traitement de luxations anterieures redicivantes de l'epaule par la methode de Boitchev II modifiee

Vingt deux cas de luxation anterieure redicivante de l'epaule ont ete traites dans le service de chirurgie generale du CHU de Lome par l'operation BOITCHEV II modifiee; de mars 1988 a novembre 1992. Aucun critere particulier n'a preside au choix des patients; en dehors du caractere redicivant de la luxation antero-interne. L'operation BOITCHEV II; qui consiste a derouter le coraco-biceps entre capsule articulaire et sous scapulaire; a ete completee par un platre thoraco-brachial permettant une mobilisation active precoce. Cette methode a donne; dans tous les cas; une recuperation fonctionnelle rapide et complete avec une parfaite stabilite de l'epaule 1 a 5 ans apres l'operation. Mais ces resultats preliminaires doivent etre verifies par une serie plus grande et avec un recul plus important

Le volvulus du caecum au CHU de Lome (Togo)

Une etude retrospective sur les cas de volvulus du caecum operes dans le service de chirurgie du C.H.U. de Lome du 1er janvier 1977 au 31 decembre 1986 est presentee. Le volvulus caecal s'est avere une affection tres rare : 3 cas en 10 ans et tous les 3 patients etaient de sexe masculain; ages respectivement de 20; 35 et 72 ans. Il y avait 2 cas de volvulus caeco-colique et 1 cas de volvulus ileo-caeco-colique. Les methodes therapeutiques utilisees etaient une detorsion; suivie de fixation; et une fois l'hemicolectomie droite. Un deces a ete deplore (patient de 72 ans)