Utility of Seated Lateral Radiographs in the Diagnosis and Classification of Lumbar Degenerative Spondylolisthesis

Methods@#We assessed baseline neutral upright, standing flexion, seated lateral radiographs, and magnetic resonance imaging (MRI) for patients identified with spondylolisthesis from January 2021 to May 2022 by a single spine surgeon. DS was classified by Meyerding and Clinical and Radiographic Degenerative Spondylolisthesis classifications. A difference of >10° or >8% between views, respectively, was used to characterize angular and translational instability. Analysis of variance and paired chi-square tests were utilized to compare modalities. @*Results@#A total of 136 patients were included. Seated lateral and standing flexion radiographs showed the greatest slip percentage (16.0% and 16.7%), while MRI revealed the lowest (12.2%, p 0.05). Translational instability was shown to be more prevalent when associated with seated lateral or standing flexion than when combined with neutral upright (31.5% vs. 20.2%, p =0.041; and 28.1% vs. 14.6%, p =0.014, respectively). There were no differences between seated lateral or standing flexion in the detection of instability (all p >0.20). @*Conclusions@#Seated lateral radiographs are appropriate alternatives for standing flexion radiographs. Films taken when standing up straight do not offer any more information for DS detection. Rather than standing flexion-extension radiographs, instability can be detected using an MRI, which is often performed preoperatively, paired with a single seated lateral radiograph.

The independent effect of exercise on biopsy-proven non-alcoholic fatty liver disease: A systematic review

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Although previous studies have demonstrated that exercise independently reduces hepatic steatosis measured by imaging modalities in NAFLD, the effect of exercise on histological endpoints remains unclear. We aimed to conduct a systematic review of the independent effect of exercise on hepatic steatosis, steatohepatitis, and liver fibrosis as measured by histological assessment or non-invasive tests (NITs) in biopsy-proven NAFLD. A systematic literature search of PubMed, Embase, and Web of Science databases was performed using keywords related to exercise, NAFLD, and biopsy. Articles were selected based on the following inclusion criteria: (1) involved human subjects with biopsy-proven NAFLD, (2) analyzed the independent effect of exercise, (3) assessed changes in hepatic steatosis, steatohepatitis, or liver fibrosis via either histological evaluation or NITs, and (4) were original research studies. We identified a total of six studies that analyzed the independent effect of exercise on histological endpoints in biopsy-proven NAFLD. Two randomized controlled trials (RCTs) did not detect significant histological improvement following exercise interventions, while other non-randomized interventional studies showed that exercise reduces hepatocyte ballooning and liver fibrosis. In addition, five studies assessed NIT outcomes, collectively demonstrating that exercise improves hepatic steatosis measured by magnetic resonance imaging-based techniques but not serum biomarkers for steatohepatitis and liver fibrosis. Additional large RCTs and meta-analyses are warranted to investigate the independent effect of exercise on histological and clinical outcome endpoints in NAFLD.

Injecting drug use & HIV prevalence among female sex workers: Evidence from the National Integrated Biological & Behavioural Surveillance, India

Background & objectives: Female sex workers (FSWs) who inject drugs (FSW-IDs) have a higher risk of HIV infection and transmission. Understanding the socio-demographic characteristics and other risk behaviours among FSW-IDs will help in strengthening targeted interventions for HIV prevention and management. In the present study, the HIV prevalence, associated socio-demographic characteristics and risk behaviours among FSWs who injected drugs (FSW-IDs) and those who did not ID (FSW-NIDs) was determined in India. Methods: The national cross-sectional, community-based, integrated biological and behavioural surveillance was conducted in 2014-2015 at 73 randomly selected FSW domains across 28 States and Union Territories in India. The sample size was fixed at 400 for each domain, and a probability-based sampling method was followed. The data were analyzed by logistic regression methods. Results: Data from 27,007 FSWs were included in the analysis, of which 802 (3%) were FSW-IDs. HIV prevalence among FSW-IDs was significantly higher than that in FSW-NIDs (4.5 vs. 1.9%). Univariate analysis showed that factors significantly associated with higher HIV prevalence among FSW-IDs were older age, sex work as the only source of income, dissolved marriage, living with a sex worker, urban locality of sex work and consumption of alcohol or oral drugs. In multivariable analysis, factors such as older age of FSW-IDs (35 yr and above), having a dissolved marriage and sex work being the only source of income were observed to be independently and significantly associated with higher HIV prevalence. Interpretation & conclusions: Scaling up the HIV preventive interventions for FSW-IDs, such as facilitating awareness and improved access to needle and syringe exchange programme (NSEP) and opioid substitution therapy (OST), encouraging safe sex and injecting practices, educating on the harmful effects of alcohol and drugs and providing alternative vocation options to secure their financial needs are several strategies that may reduce HIV transmission among FSWs.

Perceived Physical and Mental Health and Healthy Eating Habits During the COVID-19 Pandemic in Korea

Background@#The coronavirus disease 2019 (COVID-19) pandemic has disrupted the lives of people around the world since 2020. This study aims to reveal perceived impact of the coronavirus pandemic on physical and mental health and eating behaviors among people with disabilities and without disabilities in South Korea, as compared to other countries. @*Methods@#A secondary analysis of a prospective cross-sectional study which was conducted with a web-based global survey. @*Results@#Among the 3,550 responses from 65 countries, 2,621 responses with nation information were set as full data, 189 for South Korea and 2,432 for other countries. In Korea, there was no significant difference in healthy lifestyle behaviors between people with and without disabilities before the COVID-19 pandemic. Perceived physical and mental health and changes in eating habits during the COVID-19 pandemic showed no significant difference between people with and without disabilities in Korea. There were significant differences in physical health and dietary habits, but no differences in its effect on mental health between people living in Korea and other countries in both people with and without disabilities groups. In other words, more than 60% of people in all groups (disability vs. non-disability, Korea vs. non-Korea) reported worse mental health than before the COVID-19 pandemic. @*Conclusion@#In Korea and other countries, mental health showed a tendency to deteriorate regardless of the presence or absence of disability during the COVID-19 pandemic. In terms of healthy eating habits, Koreans were relatively less affected than people from other countries.

Data management during COVID-19 outbreak response in Ghana: a reference laboratory perspective on key issues and measures

The COVID-19 pandemic caused by SARS-CoV-2 is an important subject for global health. Ghana experienced lowmoderate transmission of the disease when the first case was detected in March 12, 2020 until the middle of July when the number of cases begun to drop. By August 24, 2020, the country's total number of confirmed cases stood at 43,622, with 263 deaths. By the same time, the Noguchi Memorial Institute for Medical Research (NMIMR) of the University of Ghana, the primary testing centre for COVID-19, had tested 285,501 with 28,878 confirmed cases. Due to database gaps, there were initial challenges with timely reporting and feedback to stakeholders during the peak surveillance period. The gaps resulted from mismatches between samples and their accompanying case investigation forms, samples without case investigation forms and vice versa, huge data entry requirements, and delayed test results. However, a revamp in data management procedures, and systems helped to improve the turnaround time for reporting results to all interested parties and partners. Additionally, inconsistencies such as multiple entries and discrepant patient-sample information were resolved by introducing a barcoding electronic capture system. Here, we describe the main challenges with COVID-19 data management and analysis in the laboratory and recommend measures for improvement

SARS-CoV-2 detection among international air travellers to Ghana during mandatory quarantine

Objectives: To determine the prevalence of SARS-CoV-2 detection among international travellers to Ghana during mandatory quarantine. Design: A retrospective cross-sectional study. Setting: Air travellers to Ghana on 21st and 22nd March 2020. Participants: On 21st and 22nd March 2020, a total of 1,030 returning international travellers were mandatorily quarantined in 15 different hotels in Accra and tested for SARS-CoV-2. All of these persons were included in the study. Main outcome measure: Positivity for SARS-CoV-2 by polymerase chain reaction. Results: The initial testing at the beginning of quarantine found 79 (7.7%) individuals to be positive for SARS-CoV2. In the exit screening after 12 to 13 days of quarantine, it was discovered that 26 of those who tested negative for SARS-CoV-2 in the initial screening subsequently tested positive. Conclusions: Ghana likely averted an early community spread of COVID-19 through the proactive approach to quarantine international travellers during the early phase of the pandemic

Development of self-help groups for caregivers of children with disabilities in Kilifi, Kenya: process evaluation

Background: Caring for a child with disabilities in a resource-poor setting brings many challenges to the caregiver. We examined the development of self-help groups for caregivers in a rural part of Kenya. Objectives: To conduct a process evaluation on the development of self-help groups during a 10-month set-up period, focusing on implementation and mechanisms associated with their functional status. Methods: Using a realist evaluation design, we set up 20 self-help groups for 254 caregivers. An evaluation was conducted to investigate implementation and mechanisms of impact. Implementation focused on caregiver registration, community group support and monitoring visit compliance. Data were collected from group registers, records of meetings and field notes. Mechanisms of impact employed a framework of strengths­weaknesses­opportunities­threats to review the groups at the end of the 10-month set-up period. Results: Recruitment resulted in registration of 254 participants to 18 groups ­ two groups disbanded early. Post-evaluation included 11 active and 7 inactive groups. Compliance with the monitoring visits was consistent across the active groups. All groups engaged in 'merry-go-round' activities. The active groups were characterised by strong leadership and at least one successful income generation project; the inactive had inconsistent leadership and had dishonest behaviour both within the group and/or externally in the community. Mediators associated with functional status included the following: available literacy and numeracy skills, regular meetings with consistent attendance by the members, viable income generating projects, geographical proximity of membership and strong leadership for managing threats. Conclusion: Self-help groups have the potential to progress in resource-poor settings. However, critical to group progression are literacy and numeracy skills amongst the members, their geographical proximity, regular meetings of the group, viable income generating projects and strong leadership

Pattern of limb amputations in Liberia

Background: Amputation is one of the oldest known surgical procedures. It has been one of the modalities of applying judgment and treatment. Its method and indications has evolved over time. Modern amputation is regarded as a part of treatment rather than failure of treatment. Amputation is the removal of a limb or part of a limb through on or more bone. When through a joint is referred to as disarticulation. Data on the profile and pattern of amputation in Liberia will add to the body of knowledge. Aim and Objectives: Is to describe the pattern of limb of amputations in Liberia. Also to describe the anatomical variations of limb amputations in Liberia. Patients and Method: A retrospective study of all patients that underwent limb amputation surgeries in the John F Kennedy Memorial (JFK M), Hospital , Monrovia Liberia between January 2010 to December 2015. Results: 100 patients had limb amputations between 2010 and 2015. Males(73) to female(27) ratio were 2.4:1. The age range was 9 - 91 years. Mean age was 42.9 years. The indications for amputations were Trauma 24%, Diabetes 29%, Gangrene (6%), Chronic ulcer (25%), Tumour (5%). Below knee(47%), Above Knee(45%), Below elbow(2%), Above Elbow(2%), Knee Disarticulation(2%), and Big Toe Disarticulation(2%). Conclusion: The profile of Limb amputation in Liberia is not very different from what is obtaining in the region. However the limitations of histology and other investigative procedure have affected the accurate diagnosis of certain conditions like tumours

Poliovirus neutralizing antibody levels among individuals in three regions of Ghana

Introduction: Ghana was declared polio-free in 2015 after the last polio case in 2008. We determined the poliovirus neutralizing antibody levels among individuals to identify possible immunity gaps. Methods: A cross-sectional, hospital-based study was undertaken in Northern, Ashanti and Greater Accra regions of Ghana. Individuals referred for haematology at the teaching hospitals' laboratories were invited to participate in our study. Neutralizing-antibody titers to poliovirus serotypes 1,2 & 3 were assayed by WHO-standards. Antibody titers of ≥8 were considered protective. Bivariate and multivariate analyses were conducted on subject characteristics to assess potential factors for failure to seroconvert. P-values < 0.05 were considered statistically significant. Results: Poliovirus (PV) neutralizing-antibody serotypes 1, 2 and 3 were detected in 86.0% (264/307), 84% (258/307) and 75% (230/307) of samples respectively. 60.1% (185/307) were seropositive for the three poliovirus serotypes. Neutralizing poliovirus antibodies for PV1 and PV2 were higher than for PV3. Seroprevalence of poliovirus-neutralizing antibodies among males (PV1=51.9%, PV2= 51.6% and PV3= 52.6%) were higher than in females. Seroprevalence rates of poliovirus-neutralizing antibodies (PV1, PV2, and PV3) were highest in the Northern region (90%, 81%, and 77%). Poliovirus neutralizing-antibodies (PV1and PV2) decreased with age [p< 0.001]. Low seroprevalence of poliovirus-neutralizing antibodies was significantly associated with low school attendance of mothers (p<0.001). Conclusion: Our study population has some protection from polio. However, immunity appears to be lower with a higher age or low Mother's education. This may suggest the need for young-adult booster-dose to minimize the risk of wild poliovirus infection

Evaluation of Antiplasmodial Activity and Safety of Flower Extracts of Chrysanthemum cinerariaefolium, Singly and in Combination with Chloroquine, Lumefantrine and Piperaquine

Objective: To evaluate the antiplasmodial activity and safety of organic and aqueous flower extracts of Chrysanthemum cinerariaefolium from Kenya, singly and in combination with chloroquine, lumefantrine and piperaquine. Methodology: Antiplasmodial activity of organic and aqueous flower extracts of C. cinerariaefolium was assessed in vitro by serial micro-dilution assay technique against Plasmodium falciparum, and in vivo using the 4-day suppressive test as well as the established infection test against P. berghei ANKA in mice. To determine the safety of the extracts, cytotoxicity evaluation of extracts against Vero E6 cells and acute toxicity studies in mice were also done. Results: In vitro antiplasmodial assays showed that methanolic extract of C. cinerariaefolium flowers was active, petroleum ether extract was moderately active, while the aqueous extract was inactive. Methanolic extract combined with chloroquine (CQ) against CQ-sensitive (3D7) and CQ-resistant (W2) P. falciparum showed marked synergy. Both methanol and aqueous extracts (1000mg/kg) showed chemosuppression of >45% (P<0.05) in both 4-day suppression test and established infection test against P. berghei ANKA in mice. Lumefantrine (LU) or piperaquine (PQ) combined with either methanol or aqueous extracts showed chemosuppression of >63% (P<0.05) against LU-resistant and PQ-resistant P. berghei ANKA strains, indicating synergistic interactions. Methanolic and aqueous flower extracts of C. cinerariaefolium had no cytotoxic effect on Vero E6 cells and no overt signs of toxicity in mice. Conclusion: The findings showed that C. cinerariaefolium flower extracts are safe in mammalian systems, have antiplasmodial activity and have potentiation effect of conventional antimalarials. There is need therefore to further explore the plant’s bioactive molecules which may serve as template for development of novel, effective and affordable antimalarial agents for management of malaria.

Diabetic retinopathy and its risk factors in patients with type 2 diabetes attending rural primary healthcare facilities in Tamil Nadu.

Background. India has a high burden of diabetic retinopathy ranging from 12.2% to 20.4% among patients with type 2 diabetes mellitus (T2DM). A T2DM management programme was initiated in the public sector in Tamil Nadu. We estimated the prevalence of diabetic retinopathy and its associated risk factors. Methods. We did a cross-sectional survey among patients with T2DM attending two primary health centres for treatment and follow-up in Kancheepuram, Tamil Nadu in January– March 2013. We did a questionnaire-based survey, and measured blood pressure and biochemical parameters (serum creatinine, plasma glucose, etc.) of the patients. We examined their eyes by direct and indirect ophthalmoscopy and defined diabetic retinopathy using a modified classification by Klein et al. We calculated the proportion and 95% CI for the prevalence and adjusted odds ratio (AOR) for risk factors associated with diabetic retinopathy. Results. Among the 270 patients, the mean (SD) age was 54.5 (10) years. The median duration of T2DM was 48 months. The prevalence of diabetic retinopathy was 29.6%. Overall, 65.9% of patients had hypertension, 14.4% had nephropathy (eGFR <60 mg/dl) and 67.4% had neuropathy. Among patients with comorbid conditions, 60%, 48%, 32%, and 3% were already diagnosed to have hypertension, neuropathy, retinopathy, and nephropathy, respectively. The risk factors for diabetic retinopathy were hypertension (AOR 3.2, 95% CI 1.7–6.3), duration of T2DM >5 years (AOR 6.5, 95% CI 3.6–11.7), poor glycaemic control (AOR 2.4,

Building inclusive health innovation systems: lessons from India / Creación de sistemas inclusivos de innovación en salud: lecciones desde la India / A criação de sistemas inclusivos de inovação em saúde: lições da Índia

Abstract: This article presents an overview of the changes that are taking place within the public and private health innovation systems in India including delivery of medical care, pharmaceutical products, medical devices, and Indian traditional medicine. The nature of the flaws that exist in the health innovation system is pinpointed. The response by the government, the health, technology and medical institutions, and the evolving industry is addressed on a national level. The article also discusses how the alignment of policies and institutions was developed within the scope of national health innovation systems, and how the government and the industry are dealing with the challenges to integrate health system, industry, and social policy development processes.

Resumen: El artículo presenta el panorama de los cambios actualmente en curso dentro de los sistemas públicos y privados de innovación en salud en la India, incluyendo la prestación de servicios médicos, productos farmacéuticos, dispositivos médicos y medicina tradicional india. Se destaca la naturaleza de las carencias que existen en los sistemas de innovación en salud. Los autores abordan la respuesta existente, a nivel nacional, por parte del gobierno, instituciones médicas y de salud y tecnología, y por la industria en este proceso de evolución. El artículo también discute cómo se desarrolló la alineación de políticas e instituciones en el alcance de los sistemas nacionales de innovación en salud, y cómo el gobierno, así como la industria, están enfrentando los desafíos que se presentan, con el fin de integrar sistema de salud, industria y desarrollo de políticas sociales.

Resumo: O artigo apresenta um panorama das mudanças atualmente em curso dentro dos sistemas público e privado de inovação em saúde na Índia, incluindo a prestação de serviços médicos, produtos farmacêuticos, dispositivos médicos e medicina tradicional indiana. É destacada a natureza das falhas que existem nos sistemas de inovação em saúde. As respostas do governo, das instituições médicas, de saúde e tecnologia e indústrias envolvidas, são abordadas em nível nacional. O artigo também discute como foi desenvolvido o alinhamento de políticas e instituições no escopo dos sistemas nacionais de inovação em saúde, e como governo e indústria estão lidando com os desafios para integrar o sistema de saúde, a indústria e o desenvolvimento de políticas sociais.

Immunological Profiles of Mice Protected from Chlamydia-induced Infertility by Anti-caspase Treatment.

The study is to investigate the effect of anti-caspase treatment on anti-chlamydia immune response in mice. Both the humoral and aspects of cell-mediated immune response against Chlamydia trachomatis were studied. Antibody response was measured using the ELISA technique to identify all common isotypes, and cytokine response was measured using the PCR technique. The antibody levels (IgG, IgG1, IgG2a and IgA) in Z-VAD-FMK treated group were significantly higher than non-treated group. ELISA results [showed a significantly higher amount of antibodies (IgG, IgG1, Ig G2a and IgA)] were produced in the mice that were pre-treated with Z-VAD-FMK before infection with Chlamydia trachomatis compared to mice post treated with Z-VAD-FMK after Chlamydia trachomatis infection. Data of the study indicate that the caspase inhibitor, Z-VAD-FMK did not negatively affect humoral and T cell mediated immune responses against C. trachomatis in mice.

Cholera Outbreak Linked with Lack of Safe Water Supply Following a Tropical Cyclone in Pondicherry, India, 2012.

In the aftermath of a severe cyclonic storm on 7 January 2012, a cluster of acute diarrhoea cases was reported from two localities in Pondicherry, Southern India. We investigated the outbreak to identify causes and recommend control measures. We defined a case as occurrence of diarrhoea of more than three loose stools per day with or without vomiting in a resident of affected areas during 6-18 January 2012. We used active (door-to-door survey) and stimulated passive (healthy facility-based) surveillance to identify cases. We described the outbreak by time, place, and person. We compared the case-patients with up to three controls without any apparent signs and symptoms of diarrhoea and matched for age, gender, and neighbourhood. We calculated matched odds ratio (MOR), 95% confidence intervals (CI), and population attributable fractions (PAF). We collected rectal swabs and water samples for laboratory diagnosis and tested water samples for microbiological quality. We identified 921 cases and one death among 8,367 residents (attack rate: 11%, case-fatality: 0.1%). The attack rate was the highest among persons of 50 years and above (14%) and females (12%). The outbreak started on 6 January and peaked on the 9th and lasted till 14 January. Cases were clustered around two major leakages in water supply system. Nine of the 16 stool samples yielded V. cholerae O1 Ogawa. We identified that consumption of water from the public distribution system (MOR=37, 95% CI 4.9-285, PAF: 97%), drinking unboiled water (MOR=35, 95% CI 4.5-269, PAF: 97%), and a common latrine used by two or more households (MOR=2.7, 95% CI 1.3-5.6) were independently associated with cholera. Epidemiological evidence suggested that this outbreak was due to ingestion of water contaminated by drainage following rains during cyclone. We recommended repair of the water supply lines, cleaning-up of the drains, handwashing, and drinking of boiled water.

Bacterial Meningitis: A Review in the Upper East Region of Ghana 2010-2014.

Introduction: Meningitis is an acute inflammation of the protective membranes covering the brain and the spinal cord. It can cause severe brain damage and is fatal in 50% of cases if untreated. The Upper East Region (UER) of Ghana recorded 70 case-patients in 2014 with a case fatality of 10%. Furthermore, there have been series of out outbreaks of bacterial meningitis in the region. The study reviewed meningitis surveillance data to assess the progress towards interruption of meningitis transmission and identified opportunities for surveillance improvement in the UER. Methods: This involved records review and secondary data analysis of all reported meningitis cases in the Region from 2010 to 2014. Data quality was assessed: described by person, place, time, causative agents involved and identified opportunities for system improvement. Results: Of 1142 suspected cases of meningitis recorded at the health facilities and communities in the UER, 352(30.8%) were confirmed cases of various forms of Bacterial meningitis. Majority of the cases (50.7%) were males. The age group 0-9 years was mostly 491(43.0%) affected. There were 146 deaths, giving a case fatality rate of 13.0%. The identified etiological agents were Neisseria meningitides (Nm W135) 50.3%, Streptococcus pneumonia (41.7%), Neisseria meningitides (Nm A) 1.7%, Neisseria meningitides (Nm Y 5%), Haemophilus Influenzae Type B1.5%. Majority of the case-patients were observed in 2010 (34.7%) and 2012 (44.2%) between February and April (%). The Kassena Nankana Municipal recorded the highest number of cases 234(20.5%) and the Bulsa South District recorded no case of bacterial meningitis cases. 69 (6%) of case-patients had no lumber puncture done. Time spent before presentation of case-patients to the health facilities had no significant association with the outcome of the infection (p= 0.319). Conclusions: There has been a consistent outbreak of Bacterial meningitis in the Upper East Region that involved many cases-patients with some mortality. More bacterial meningitis cases were recorded in children compared to adults. Lumber puncture was not performed in all casepatients. Many case-patients were recorded in the first quarter of the year with the majority in the Kassena Nankana District. There is an urgent need to review the management of meningitis, coupled with enhanced strategies in prevention of occurrences of the disease in the Upper East Region of Ghana.

Effectiveness of the credit-line approach for support of CD4 equipment functionality in northern Uganda

Background: Improving laboratory service delivery requires a functioning logistics and supply system. Uganda's Ministry of Health uses the credit-line approach to provide laboratory supplies including commodities for CD4 test equipment.Objectives: We examined the effectiveness of the credit-line approach in improving laboratory service delivery by using the functionality of CD4 test equipment as a proxy indicator. Method: A cross-sectional survey was conducted at 7 level-three health centres (HC IIIs); 18 level-four health centres (HC IVs); and 10 hospitals in 15 districts of mid-northern Uganda; including the Lango (17 facilities) and Acholi sub-regions (18 facilities); between July 2013 and August 2013. Functionality; was determined through self- and interviewer-administered questionnaires. The chi-squared test was used to assess differences in functionality by subregion; facility type; and equipment type.Results: A total of 38 CD4 test analysers were assessed. Of these; 26 (68%) were functional. In hospitals; 85% of CD4 analysers were functional; in HC IVs; 67% were functional and in HCIIIs; 43% were functional. The differences did not reach statistical significance. In the Langosub-region; 72% of analysers were functional; in the Acholi sub-region; 65% were functional. Non-functionality was mainly due to lack of reagents and cartridges; as well as low staffing levels of laboratory technicians with the skills necessary to operate the equipment.Conclusion: The credit-line approach supported the functionality of CD4 equipment in the surveyed facilities. However; there is a need to address issues of staffing and availability of reagents to enhance the functionality of CD4 equipment and improve patient care; especiallyat HC IIIs

Prevalence of Hypertension and Associated Risk Factors in Adults from a Semi Urban District in Ghana: A Population Based Survey.

Objectives: Given the paucity of community based surveys on hypertension and other non-communicable diseases in the Akwapim North District (AKND) of Ghana’s Eastern-Region (ER), we conducted a population survey to determine the prevalence of hypertension and its associated determinants. Methods: We recruited 519 adults age ≥ 25years in a multi-stage sample of enumeration centres over a one-month period. We measured body weight, waist and hip circumference, height, blood pressure (BP) and obtained demographic and risk factor information. Univariate and bivariate-analysis determined the prevalence of hypertension, significant difference and predictors of known risk factors (p <0.05). Results: Among the 519 participants, 62.8% were women. The mean age and body mass index (BMI) were 48.6±16.8 years and 23.2±5.2 kg/m2 respectively. Prevalence of hypertension was 32.2% with a male-to-female distribution of 27.5% and 35.0% respectively. The prevalence of alcohol use was high at 65.6% (340/519). Age and waist circumference were predictors of diastolic BP. Conclusions: There is a high prevalence of hypertension in the AKND of Ghana. Stakeholders should structure interventions on hypertension to promote healthier-lifestyles.

Living with Obstetric Fistula: Perceived Causes, Challenges and Coping Strategies among Women Attending the Fistula Clinic at Mulago Hospital, Uganda.

Aims: To determine perceived causes, challenges and coping mechanisms of women living with obstetric fistula (OF) in Uganda. Study Design: Cross-sectional study. Place and Duration of the Study: Mulago National Referral Hospital Uganda – January to July 2009. Methodology: Thirty women with OF were interviewed on challenges, coping mechanisms and perceived causes of OF using semi-structured questionnaires. Two focus group discussions were held with 10 caretakers of the women with OF and key informant interviews with 10 health care providers. Results: Majority of the women (21; 70%) were young (<25 years) had primary education (20; 67%) and had lived with OF for 2-9 years (20; 67%). The main perceived causes of OF were injury by surgeon (8; 27%), delivery of a big baby (7; 23%) and prolonged labor (4; 13%). Nearly all women with OF (27; 90%) reported that OF had detrimentally affected their health and well being; 26 women (87%) lost their children at birth or within the neonatal period. Families were affected by high cost of treatment (13; 43%); provision of basic items (10; 32%), and suffered stress (17; 55%). Women coped with OF by hiding from the general public (27; 90%), maintaining strict hygiene (25; 83%), ignoring people’s comments (23; 75%) or resorting to prayer (18; 57%). Conclusion: Women with OF experienced physical, emotional and socio-economic challenges and coped with OF through non-effective social measures. There is need to strengthen strategies to prevent OF and enhance OF rehabilitation services for affected women and their families.

Community Knowledge and Perceptions on Malaria and Its Prevention and Control in the Akwapim North Municipality, Ghana.

Background: Malaria is an important cause of morbidity and mortality especially among children less than five years in the Akwapim North Municipality of the Eastern Region of Ghana. Knowledge of community members in malaria is a major factor that can influence malaria prevention and control. In 2012, the municipality was enrolled onto the home-based management of malaria programme in the region using the community based health volunteers. We assessed the knowledge and level of understanding of the people about the disease prior to the introduction. This is to enhance the control of malaria in the Municipality. Methods: A cross sectional study involving 616 adults, were selected from households using a simple random selection method. Information on age, marital status, levels of education, occupation, awareness, knowledge and perceptions on malaria were obtained using a questionnaire. Univariate analyses were expressed as frequencies, percentages and means. Bivariate analysis ascertained the relationship between gender, age, educational level and knowledge on prevention of malaria (p<0.05). Results: Among the 616 respondents, 58.6 % were females. The median age was 33.0 years old (range 14-81). Respondent’s awareness of malaria was 96.7% but rather a poor knowledge of malaria etiology (1.6%). 64.2% of the respondents knew that mosquitoes transmit malaria. Knowledge on the classical symptoms of uncomplicated malaria was moderate (7.6 – 48.7%). The respondent’s knowledge of danger signs of severe malaria was low (5.6-16.2%). Myths regarding causes of malaria such as filth, flies were mentioned by 20.9% and 4.2% of the respondents. 81% perceived malaria is preventable and the use of an insecticide treated bed net among respondents was 39.0%. Females were more likely (p-value 0.003) to have more knowledge on prevention of malaria. Conclusion: Although awareness of malaria in the Akwapim North Municipality is high, there is a serious knowledge gap in identifying the dangers signs associated with the disease. Many community members do agree that malaria is preventable but still harbour myths regarding its etiology. Health education should therefore be reviewed and intensified in the communities.