Long COVID manifests with T cell dysregulation, inflammation and an uncoordinated adaptive immune response to SARS-CoV-2.

Long COVID (LC) occurs after at least 10% of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, yet its etiology remains poorly understood. We used 'omic" assays and serology to deeply characterize the global and SARS-CoV-2-specific immunity in the blood of individuals with clear LC and non-LC clinical trajectories, 8 months postinfection. We found that LC individuals exhibited systemic inflammation and immune dysregulation. This was evidenced by global differences in T cell subset distribution implying ongoing immune responses, as well as by sex-specific perturbations in cytolytic subsets. LC individuals displayed increased frequencies of CD4+ T cells poised to migrate to inflamed tissues and exhausted SARS-CoV-2-specific CD8+ T cells, higher levels of SARS-CoV-2 antibodies and a mis-coordination between their SARS-CoV-2-specific T and B cell responses. Our analysis suggested an improper crosstalk between the cellular and humoral adaptive immunity in LC, which can lead to immune dysregulation, inflammation and clinical symptoms associated with this debilitating condition.

Acceptance of and Adherence to a Four-Dose RTS,S/AS01 Schedule: Findings from a Longitudinal Qualitative Evaluation Study for the Malaria Vaccine Implementation Programme.

BACKGROUND: The WHO recommended the use of the RTS,S/AS01 malaria vaccine (RTS,S) based on a pilot evaluation in routine use in Ghana, Kenya, and Malawi. A longitudinal qualitative study was conducted to examine facilitators and barriers to uptake of a 4-dose RTS,S schedule. METHODS: A cohort of 198 caregivers of RTS,S-eligible children from communities where RTS,S was provided through the pilot were interviewed three times over a ≈22-month, 4-dose schedule. The interviews examined caregiver perceptions and behaviors. Children's vaccination history was obtained to determine dose uptake. RESULTS: 162 caregivers remained at round 3 (R3); vaccination history was available for 152/162 children. Despite early rumors/fears, the uptake of initial doses was high, driven by vaccine trust. Fears dissipated by R2, replaced with an enthusiasm for RTS,S as caregivers perceived its safety and less frequent and severe malaria. By R3, 98/152 children had received four doses; 34 three doses; 9 one or two doses; and 11 zero doses. The health system and information barriers were important across all under-dose cases. Fears about AEFIs/safety were important in zero-, one-, and two-dose cases. Competing life/livelihood demands and complacency were found in three-dose cases. Regardless of the doses received, caregivers had positive attitudes towards RTS,S by R3. CONCLUSIONS: Findings from our study will help countries newly introducing the vaccine to anticipate and preempt reasons for delayed acceptance and missed RTS,S doses.

Multimodal Molecular Imaging Reveals Tissue-Based T Cell Activation and Viral RNA Persistence for Up to 2 Years Following COVID-19.

The etiologic mechanisms of post-acute medical morbidities and unexplained symptoms (Long COVID) following SARS-CoV-2 infection are incompletely understood. There is growing evidence that viral persistence and immune dysregulation may play a major role. We performed whole-body positron emission tomography (PET) imaging in a cohort of 24 participants at time points ranging from 27 to 910 days following acute SARS-CoV-2 infection using a novel radiopharmaceutical agent, [18F]F-AraG, a highly selective tracer that allows for anatomical quantitation of activated T lymphocytes. Tracer uptake in the post-acute COVID group, which included those with and without Long COVID symptoms, was significantly higher compared to pre-pandemic controls in many anatomical regions, including the brain stem, spinal cord, bone marrow, nasopharyngeal and hilar lymphoid tissue, cardiopulmonary tissues, and gut wall. Although T cell activation tended to be higher in participants imaged closer to the time of the acute illness, tracer uptake was increased in participants imaged up to 2.5 years following SARS-CoV-2 infection. We observed that T cell activation in spinal cord and gut wall was associated with the presence of Long COVID symptoms. In addition, tracer uptake in lung tissue was higher in those with persistent pulmonary symptoms. Notably, increased T cell activation in these tissues was also observed in many individuals without Long COVID. Given the high [18F]F-AraG uptake detected in the gut, we obtained colorectal tissue for in situ hybridization SARS-CoV-2 RNA and immunohistochemical studies in a subset of participants with Long COVID symptoms. We identified cellular SARS-CoV-2 RNA in rectosigmoid lamina propria tissue in all these participants, ranging from 158 to 676 days following initial COVID-19 illness, suggesting that tissue viral persistence could be associated with long-term immunological perturbations.

Long COVID manifests with T cell dysregulation, inflammation, and an uncoordinated adaptive immune response to SARS-CoV-2.

Long COVID (LC), a type of post-acute sequelae of SARS-CoV-2 infection (PASC), occurs after at least 10% of SARS-CoV-2 infections, yet its etiology remains poorly understood. Here, we used multiple "omics" assays (CyTOF, RNAseq/scRNAseq, Olink) and serology to deeply characterize both global and SARS-CoV-2-specific immunity from blood of individuals with clear LC and non-LC clinical trajectories, 8 months following infection and prior to receipt of any SARS-CoV-2 vaccine. Our analysis focused on deep phenotyping of T cells, which play important roles in immunity against SARS-CoV-2 yet may also contribute to COVID-19 pathogenesis. Our findings demonstrate that individuals with LC exhibit systemic inflammation and immune dysregulation. This is evidenced by global differences in T cell subset distribution in ways that imply ongoing immune responses, as well as by sex-specific perturbations in cytolytic subsets. Individuals with LC harbored increased frequencies of CD4+ T cells poised to migrate to inflamed tissues, and exhausted SARS-CoV-2-specific CD8+ T cells. They also harbored significantly higher levels of SARS-CoV-2 antibodies, and in contrast to non-LC individuals, exhibited a mis-coordination between their SARS-CoV-2-specific T and B cell responses. RNAseq/scRNAseq and Olink analyses similarly revealed immune dysregulatory mechanisms, along with non-immune associated perturbations, in individuals with LC. Collectively, our data suggest that proper crosstalk between the humoral and cellular arms of adaptive immunity has broken down in LC, and that this, perhaps in the context of persistent virus, leads to the immune dysregulation, inflammation, and clinical symptoms associated with this debilitating condition.

Mapping Evapotranspiration of Agricultural Areas in Ghana.

Climate change is having an adverse effect on the environment especially in sub-Sahara Africa, where capacity for natural resource management such as water is very low. The scope of the effect on land use types have to be estimated to inform proper remedy. A combined estimation of transpiration and evaporation from plants and soil is critical to determine annual water requirement for different land use. Evapotranspiration (ET) is a major component in the world hydrological cycle, and understanding its spatial dimensions is critical in evaluating the effects it has on regional land use. A measure of this component is challenging due to variation in rainfall and environmental changes. The mapping evapotranspiration with high resolution and internalized calibration (METRIC) method is employed to create evapotranspiration map for land use, using remotely sensed data by satellite, processed, and analyzed in ArcGIS. Normalized difference vegetation index (NDVI) was related to the availability of water for vegetation on different land use, and the results indicate a high evapotranspiration for vegetated land use with high NDVI than land use with low NDVI.

The large footprint of small-scale artisanal gold mining in Ghana.

Gold mining has played a significant role in Ghana's economy for centuries. Regulation of this industry has varied over time and while industrial mining is prevalent in the country, the expansion of artisanal mining, or Galamsey has escalated in recent years. Many of these artisanal mines are not only harmful to human health due to the use of Mercury (Hg) in the amalgamation process, but also leave a significant footprint on terrestrial ecosystems, degrading and destroying forested ecosystems in the region. In this study, the Landsat image archive available through Google Earth Engine was used to quantify the total footprint of vegetation loss due to artisanal gold mines in Ghana from 2005 to 2019 and understand how conversion of forested regions to mining has changed over a decadal period from 2007 to 2017. A combination of machine learning and change detection algorithms were used to calculate different land cover conversions and the timing of conversion annually. Within the study area of southwestern Ghana, our results indicate that approximately 47,000 ha (⨦2218 ha) of vegetation were converted to mining at an average rate of ~2600 ha yr-1. The results indicate that a high percentage (~50%) of this mining occurred between 2014 and 2017. Around 700 ha of this mining occurred within protected areas as mapped by the World Database of Protected Areas. In addition to deforestation, increased artisanal mining activity in recent years has the potential to affect human health, access to drinking water resources and food security. This work expands upon limited research into the spatial footprint of Galamsey in Ghana, complements mapping efforts by local geographers, and will support efforts by the government of Ghana to monitor deforestation caused by artisanal mining.

Barriers to the Uptake of Cervical Cancer Screening and Treatment among Rural Women in Ghana.

BACKGROUND: This study sought to explore the barriers to the uptake of cervical cancer screening and treatment in the North Tongu district of Ghana. METHODS: Twenty-five in-depth interviews were conducted, while three focus group discussions were held among respondents. The data were analysed with the R package for qualitative data analysis using a thematic analytical approach. RESULTS: Low level of knowledge about the disease and screening services, personal or psychological convictions, and cost of screening and treatment coupled with a low level of income were the barriers at the individual level. Perceived health personnel attitude, perceived lack of privacy, and misdiagnosis were the barriers at the institutional level while the sociocultural belief system of the communities about the etiology of the disease was the barrier at the community level. Inadequate education about the disease, lack of funding and access to screening facilities also constrained screening and treatment at the policy level. CONCLUSIONS: Cervical cancer screening and treatment are constrained at multiple levels in rural Ghana. This study underscores the need to address the low uptake of cervical cancer screening and treatment at the individual, community, institutional, and policy levels simultaneously.

Male support for cervical cancer screening and treatment in rural Ghana.

Men have a critical role to play in reducing cervical cancer burden. Yet, there is little information on male involvement in the cervical cancer screening and treatment process in Ghana. In this study, we explore male knowledge and support during cervical cancer screening and treatment in a rural setting in Ghana. In-depth interviews and focus group discussions were conducted among a total of 41 respondents to collect qualitative data from cervical cancer patients, their male partners and other married men in the North Tongu District, Ghana. A thematic approach was used for data analysis and presentation of the results. The results show that male partners have little or no knowledge about cervical cancer. Some men provide various forms of support-financial, social, material and emotional-to their partners during the screening and treatment stages of the disease. Some men, however, abandoned their partners during the screening and treatment process of the disease. Men whose partners did not have cervical cancer said they were willing to provide financial, social, emotional and material support to their partners if they should contract the disease. Some men said they were willing to support their female partners but lacked education on the disease. This study underscores the need for cervical cancer education programmes to target Ghanaian men. The education should focus on the causes of the disease, screening and treatment methods of the disease, and, ultimately, promote spousal support during the screening and treatment processes.

Sex composition of living children in a matrilineal inheritance system and its association with pregnancy intendedness and postpartum family planning intentions in rural Ghana.

BACKGROUND: Sex composition of living children within the context of "sex preference" and its association with various reproductive health outcomes has been extensively studied in South and South East Asia. Although sex preference has been observed in sub-Saharan Africa, there is paucity of research on sex composition of living children and its association with reproductive health behaviours and outcomes, particularly in a matrilineal inheritance system. The purpose of the study was to explore the existence of sex preference in a matrilineal inheritance system. Specifically, the study sought to better understand the issues by examining the sex composition of living children and how it is associated with reproductive outcomes such as pregnancy intendedness and intention to use postpartum family planning among women in a matrilineal area of Ghana. METHODS: This was a cross sectional study conducted at four selected health facilities in the Mfantseman municipality of the Central Region of Ghana. Out of the 1914 pregnant women attending antenatal clinic selected using total enumeration, from 2nd January to 30th April 2012, 1091 with living children and complete socio-demographic data were recruited for this study. Descriptive, chi square and multivariate logistic regression analyses were conducted. RESULTS: The mean age of the 1091 respondents in this study was 28.2 ± 6.0 years with mean gestational age of 26.7 ± 6.6 weeks. Whilst 78% of the women had at least a son, 71% had at least a daughter, with those having only sons exceeding those with only daughters by 6.3%. Also, majority of the women with more sons than daughters did not intend their current pregnancies. These observations, coupled with a sex ratio of 109 males to 100 females, inferred the existence of son preference. The levels of unintended pregnancy and intention to use postpartum family planning were high (70% and 78% respectively). There was an association between sex composition of living children and unintended pregnancy but no association between sex composition of living children and intention to use postpartum family planning. Women with only sons were 50% less likely to have unintended pregnancies compared to those with equal number of sons and daughters [AOR 0.5, 95% CI (0.3-0.8)]. Similarly, women over 30 years were 80% less likely to have unintended pregnancies compared to those 15-19 years [AOR 0.2, 95% CI (0.1-0.6)]. The women with parity of 5 or more and resident in Anomabo were more likely to have unintended pregnancy compared to those with parity of up to two [AOR 3.8, 95% CI (1.7-8.59)] and those resident in Saltpond [AOR 1.8, 95%CI (1.1-2.8), respectively. In addition, the women resident in Anomabo were more likely to have intention to use postpartum family planning compared to those in Saltpond [AOR 1.8, 95% CI (1.0-3.3)]. CONCLUSION: There was persistence of more sons than daughters born in a predominantly matrilineal inheritance system and sex composition of living children had significant association with pregnancy intendedness but not with intention to use postpartum family planning.

Challenges to implementing national comprehensive sexuality education curricula in low- and middle-income countries: Case studies of Ghana, Kenya, Peru and Guatemala.

School-based comprehensive sexuality education (CSE) can help adolescents achieve their full potential and realize their sexual and reproductive health and rights. This is particularly pressing in low- and middle-income countries (LMICs), where high rates of unintended pregnancy and STIs among adolescents can limit countries' ability to capitalize on the demographic dividend. While many LMICs have developed CSE curricula, their full implementation is often hindered by challenges around program planning and roll-out at the national and local level. A better understanding of these barriers, and similarities and differences across countries, can help devise strategies to improve implementation; yet few studies have examined these barriers. This paper analyzes the challenges to the implementation of national CSE curricula in four LMICs: Ghana, Kenya, Peru and Guatemala. It presents qualitative findings from in-depth interviews with central and local government officials, civil society representatives, and community level stakeholders ranging from religious leaders to youth representatives. Qualitative findings are complemented by quantitative results from surveys of principals, teachers who teach CSE topics, and students aged 15-17 in a representative sample of 60-80 secondary schools distributed across three regions in each country, for a total of around 3000 students per country. Challenges encountered were strikingly similar across countries. Program planning-related challenges included insufficient and piecemeal funding for CSE; lack of coordination of the various efforts by central and local government, NGOs and development partners; and inadequate systems for monitoring and evaluating teachers and students on CSE. Curriculum implementation-related challenges included inadequate weight given to CSE when integrated into other subjects, insufficient adaptation of the curriculum to local contexts, and limited stakeholder participation in curriculum development. While challenges were similar across countries, the strategies used to overcome them were different, and offer useful lessons to improve implementation for these and other low- and middle-income countries facing similar challenges.

"I always tried to forget about the condition and pretend I was healed": coping with cervical cancer in rural Ghana.

BACKGROUND: Cervical cancer is a very common disease among women in Ghana and in the world as a whole. However, there is a dearth of information on the mechanisms cervical cancer patients adopt to cope with the condition in Ghana. This study sought to explore the strategies adopted by cervical cancer patients in rural Ghana to cope with the disease. METHODS: In-depth interviews were conducted to collect qualitative data from cervical cancer patients in a health facility in the Volta Region of Ghana. Data processing was done using the R software package for Qualitative Data Analysis (RQDA) and a thematic approach was used to analyse and present the results. RESULTS: The results show that cervical cancer patients adopted personal and psychological strategies such as sexual abstinence, personal hygiene, and disease denial to cope with the condition. Respondents also described social, financial and non-material support services they received from family members and the church as critical resources, which helped them to manage the conditions of the disease. Respondents also reported that faith healing, herbal and orthodox medicines helped them to manage the symptoms of the disease. CONCLUSIONS: Cervical cancer patients used a variety of coping strategies to manage the disease. Yet, it will be essential for interventions to focus on strengthening knowledge about the disease. This study underscores the need for financial, social and material support as well as an encouragement of the use of health services among cervical cancer patients.

Experiences of cervical cancer patients in rural Ghana: An exploratory study.

Even though cervical cancer is quite a prevalent disease in Ghana, there is hardly any study on this disease. This paper sought to explore the experiences of cervical cancer patients living with the disease with emphasis on their knowledge about the disease before and after the diagnosis. Qualitative data were collected through in-depth interviews with cervical cancer patients undergoing treatment in a specialised cancer treatment health facility in rural Ghana. Cervical cancer patients had inadequate knowledge about the disease, its symptoms, risk factors, treatment and prevention prior to being diagnosed of the disease. These patients were diagnosed late because they usually sought treatment elsewhere before reporting to health facilities. They experienced physical, psychological, economic and social disruptions in their daily lives, which affected their quality of life. It is evident that lack of knowledge about cervical cancer constitutes a threat to its prevention and treatment. Intensive health education through the mass media and community health promotion outreaches can be a sure way of creating adequate knowledge about cervical cancer in Ghana. Treatment and care for cervical cancer patients should incorporate counselling sessions, which should take into consideration the different levels of disruption the women experience and the implications for their wellbeing and management of the condition.

Perception of Risk of HIV among Adolescents' Living in an Urban Slum in Ghana.

Due to a number of biological, social, developmental, and behavioural factors young people are disproportionately affected by STIs including HIV and AIDS. Using the Health Belief Model, the study investigated factors influencing perception of risk of HIV among adolescents living in an urban slum in Ghana. Data were obtained from 902 adolescents, aged 10-19 years living in Kwesimintsim Zongo, an urban slum in the Western region of Ghana. A multi-staged sampling technique was used to select the respondents and both bivariate and multivariate analyses were carried out to examine the factors influencing perception of risk of HIV among adolescents. Adolescents' perception of risk of HIV was generally low and was predicted by age, ethnicity, membership of social groups and exposure to the print media. The low risk perception might cause adolescents to engage in behaviours, which are likely to endanger their health in general, and reproductive health in particular. Considering the effects of HIV and AIDS on young people, it is imperative to put in place campaigns that would help to increase their perceived risks of HIV. Factors that affect adolescents' perception of risks should be taken into consideration in designing HIV and AIDS campaigns to ensure positive behavioural change.

HOUSEHOLD NUCLEATION, DEPENDENCY AND CHILD HEALTH OUTCOMES IN GHANA.

This study uses three key anthropometric measures of nutritional status among children (stunting, wasting and underweight) to explore the dual effects of household composition and dependency on nutritional outcomes of under-five children in Ghana. The objective is to examine changes in household living arrangements of under-five children to explore the interaction of dependency and nucleation on child health outcomes. The concept of nucleation refers to the changing structure and composition of household living arrangements, from highly extended with its associated socioeconomic system of production and reproduction, social behaviour and values, towards single-family households - especially the nuclear family, containing a husband and wife and their children alone. A negative relationship between levels of dependency, as measured by the number of children in the household, and child health outcomes is premised on the grounds that high dependency depletes resources, both tangible and intangible, to the disadvantage of young children. Data were drawn from the last four rounds of the Ghana Demographic and Health Surveys (GDHSs), from 1993 to 2008, for the first objective - to explore changes in household composition. For the second objective, the study used data from the 2008 GDHS. The results show that, over time, households in Ghana have been changing towards nucleation. The main finding is that in households with the same number of dependent children, in nucleated households children under age 5 have better health outcomes compared with children under age 5 in non-nucleated households. The results also indicate that the effect of dependency on child health outcomes is mediated by household nucleation and wealth status and that, as such, high levels of dependency do not necessarily translate into negative health outcomes for children under age 5, based on anthropometric measures.

Attitudes of gatekeepers towards adolescent sexual and reproductive health in Ghana.

Adults constitute gatekeepers on adolescent sexual and reproductive health (ASRH). This qualitative paper discusses the views of adults on ASRH problems and challenges based on 60 in-depth interviews conducted among adults in Ghana in 2005. Adults were purposively selected based on their roles as parents, teachers, health care providers and community leaders. The major ASRH problems mentioned were teenage pregnancy and HIV/AIDS. The results indicated a number of challenges confronting ASRH promotion including resistance from parents, attitudes of adolescents, communication gap between adults and adolescents and attitudes of health care providers. Among health workers three broad categories were identified: those who were helpful, judgmental and dictators. Some adults supported services for young people while others did not. Some served as mediators and assisted to 'solve' ASRH problems, which occurred in their communities. It is argued that exploring the views of adults about their fears and concerns will contribute to the development of strategies and programmes which will help to improve ASRH.

Determinants of unintended pregnancies in rural Ghana.

BACKGROUND: Unintended pregnancies may carry serious consequences for women and their families, including the possibility of unsafe abortion, delayed prenatal care, poor maternal mental health and poor child health outcomes. Although between 1993 and 2008, unintended births decreased from 42% to 37% in Ghana, the rate of decline is low, whilst levels are still very high. This raises the need to understand factors associated with unintended pregnancies, especially among women in rural settings where the rates and risks are highest to help improve maternal health. METHOD: We collected data from 1,914 pregnant women attending antenatal clinic between January 2012 and April 2012 in four health facilities in the Mfantseman Municipal of the Central Region of Ghana. We used bivariate and multivariate logistic regression analyses to explore how socio-demographic characteristics, past reproductive health experiences, partner characteristics and relations, awareness and past experience with contraceptives, influenced the status of women's current pregnancy (whether intended or unintended). RESULTS: The mean age of the 1,914 respondents in this study was 25.6 ± 6.5 years. Seventy percent (70%) said the pregnancies they were carrying were unintended. The odds of carrying unintended pregnancy among women with five or more children were higher than those with one to two children [AOR 6.06, 95% CI (3.24-11.38) versus AOR 1.48, 95% CI (1.14-1.93)]. Women with other marital arrangements showed significantly higher odds of carrying unintended pregnancy compared to those married by ordinance (Muslim or Christian wedding). Women not living with their partners exhibited increased odds of having unintended pregnancies compared to women who lived with their partners (AOR 1.72, 95% CI: 1.28 - 2.30). Awareness of traditional methods of family planning (withdrawal and rhythm) was associated with lower odds of having unintended pregnancy compared to non-awareness (AOR 0.66, 95% CI (0.49-0.89). CONCLUSIONS: In this study, important risk factors associated with unintended pregnancies were: parity, living arrangements with partner, marriage by ordinance and awareness of traditional, non-pharmacological contraceptive methods. Family planning interventions targeting different groups of women, especially during the postpartum period, would be essential to reduce rates of unintended pregnancies and promote positive health outcomes.

The politics of tuberculosis and HIV service integration in Ghana.

The need to integrate TB/HIV control programmes has become critical due to the comorbidity regarding these diseases and the need to optimise the use of resources. In developing countries such as Ghana, where public health interventions depend on donor funds, the integration of the two programmes has become more urgent. This paper explores stakeholders' views on the integration of TB/HIV control programmes in Ghana within the remits of contingency theory. With 31 purposively selected informants from four regions, semi-structured interviews and observations were conducted between March and May 2012, and the data collected were analysed using the inductive approach. The results showed both support for and opposition to integration, as well as some of the avoidable challenges inherent in combining TB/HIV control. While those who supported integration based their arguments on clinical synergies and the need to promote the efficient use of resources, those who opposed integration cited the potential increase in workload, the clinical complications associated with joint management, the potential for a leadership crisis, and the "smaller the better" propositions to support their stance. Although a policy on TB/HIV integration exists, inadequate 'political will' from the top management of both programmes has trickled down to lower levels, which has stifled progress towards the comprehensive management of TB/HIV and particularly leading to weak data collection and management structures and unsatisfactory administration of co-trimoxazole for co-infected patients. It is our view that the leadership of both programmes show an increased commitment to protocols involving the integration of TB/HIV, followed by a commitment to addressing the 'fears' of frontline service providers to encourage confidence in the process of service integration.

Ocular health assessment of cocoa farmers in a rural community in Ghana.

Cocoa farming provides employment for over 800,000 households in rural Ghana, with the country currently touted as the second largest producer of cocoa worldwide. Agriculture is one of the riskiest occupations for the eyes due to the numerous ocular hazards on farms. The authors conducted an ocular health assessment among cocoa farmers at Mfuom, a rural community in the Central Region of Ghana, to examine the ocular health status and the ocular safety measures used by cocoa farmers. A structured questionnaire was used to evaluate demographic characteristics, ocular injuries, and utilization of eye care services and ocular protection, and a clinical examination was used to evaluate their ocular status. Cocoa farmers were at high risk for ocular injuries and farm-related vision disorders and utilized eye care services and ocular protection poorly. Ocular condition identified were mainly refractive error (28.6%), cataract (20.0%), glaucoma (11.7%), conjunctivitis (13%), pterygium (2.7%), and cornea opacity (2.2%). There is a need for the introduction of an interventional eye care program to help address the ocular health challenges identified among the farmers. This can be done through collaborative efforts by educational institutions, government, and other role players in the agricultural industry to improve the quality of life of the vulnerable cocoa farmers in rural Ghana.

Health Facility Cost of Buruli Ulcer Wound Treatment in Ghana: A Case Study.

OBJECTIVE: To estimate the wound treatment cost borne by the Buruli Ulcer Treatment Centre of the Amasaman Government Hospital, Ghana. METHODS: Three different types of data collection approaches were used, namely, 1) observation checklist, 2) in-depth interviews, and 3) expenditure data review. Wound dressing processes were observed. Retrospective health facility cost data of Buruli ulcer (BU) wound treatment for the year 2011 were used. Cost data gathered covered medical and nonmedical items. Cost analyses were carried out to determine the health facility's financial and economic costs. RESULTS: The total annual financial cost was US $121,189.16, of which 99% was recurrent cost. This constitutes about 13% of the expenditure by the Amasaman Government Hospital for the year 2011. The total annual economic cost was US $143,609.22, of which 93% was recurrent cost. The main cost driver for both financial and economic costs was personnel. The annual BU wound treatment costs per capita were US $1615.86 for financial cost and US $1914.79 for economic cost, respectively. The study did not cover household patient costs. CONCLUSIONS: The cost of BU wound treatment takes a considerable amount of the hospital's expenditure. This shows the importance of health facility cost as one of the decision-making tools for both resource allocation and mobilization. Hospital management must therefore constantly examine its staffing norms and the associated cost to improve the hospital's resource allocation.

Reflections on tuberculosis diagnosis and treatment outcomes in Ghana.

BACKGROUND: Available evidence in Ghana shows the implementation of tuberculosis (TB) control activities efforts since the beginning of the 1900s. In spite of that, TB continues to be one of the common diseases in the country. In 1994, local and international policy windows opened for renewed strategies for the control of TB. This paper explores some of the approaches which have been in place since 1994 and their implications for treatment outcomes. METHODS: The study combines quantitative and qualitative data. The quantitative data consist of treatment outcome from 1997-2010 and the qualitative data are derived from in-depth interviews with some staff of the TB control programme. Poisson regression and inductive coding were applied to the quantitative and qualitative data respectively. RESULTS: Reported cure rates increased from 43.6% to 87.7% between 1997 and 2010. The data from the in-depth interviews (IDIs) suggested that improvements in diagnosis, community TB care, stigma reduction among community and health workers towards TB patients, the public-private partnership, and the enablers' package contributed to the improved better treatment outcomes, particularly from 2008. CONCLUSIONS: Lessons learnt include the achievement of objectives with varying strategies and stakeholder interventions. Further studies would be needed to quantify the contributions of the various interventions to help determine those that are cost effective as well as efficient and effective for TB control.