Prevalence and determinants of sexual abuse among adolescent girls during the COVID-19 lockdown and school closures in Ghana: A mixed method study.

BACKGROUND: In the wake of the COVID-19 pandemic, concerns have been raised that the pandemic may derail global efforts against child sexual abuse (CSA). OBJECTIVES: This study examines the prevalence and associated factors of sexual abuse among adolescent girls in the context of the COVID-19 pandemic in Ghana. PARTICIPANTS AND SETTING: The sample comprised 853 adolescent girls aged 13-19 (16.03 ± 2.04 years) in Ghana. METHODS: The study employed a concurrent mixed-method design. RESULTS: Overall, the prevalence of CSA during the COVID-19 lockdown and school closures was 32.5 %. Protective factors for CSA were feeling safe in neighbourhood (AOR = 0.526, 95 % CI = [0.325, 0.850]) and parents often listen to opinions (AOR = 0.446, 95 % CI = [0.241, 0.826]). Risk factors for CSA were physical activity (AOR = 1.649, OR = 1.783, 95 % CIAOR = [1.093, 2.487, 95 % CIOR = [1.241, 2.561]), parents sometimes listen to opinions (AOR = 1.199, OR = 1.924, 95 % CIAOR = [0.504, 2.853], 95 % CIOR = [1.034, 3.582]), living with another relative (AOR = 2.352, OR = 2.484, 95 % CIAOR = [0.270, 20.523], 95 % CIOR = [0.317, 19.475]), Akan ethnicity (AOR = 1.576, OR = 1.437, 95 % CIAOR = [0.307, 8.091], 95 % CIOR = [0.316, 6.534]), having no disability (AOR = 1.099, OR = 1.138, 95 % CIAOR = [0.679, 1.581], 95 % CIOR = [0.786, 1.649]) and having a close relationship with parents (AOR = 1.334, OR = 1.752, 95 % CIAOR = [0.746, 2.385], 95 % CIOR = [1.096, 2.802]). CONCLUSION: Knowledge of the risk and protective factors identified in this study can guide and inform the development of CSA prevention programmes during disruptive occurrences like school closures and lockdown.

Trends in extrapulmonary TB cases at three teaching hospitals in Ghana, 2008-2017.

SETTING: Three teaching hospitals in Ghana. OBJECTIVE: To elucidate trends in demographics, clinical characteristics and treatment outcomes in extrapulmonary TB (EPTB) patients. DESIGN: This was a retrospective study involving the review and comparison of EPTB and pulmonary TB (PTB) data from 1 January 2008 to 31 December 2017 in TB registers and treatment cards. RESULTS: Of 15,392 TB cases, 4607 (30%) were EPTB, including 4477/4607 (97%) new cases. There were 2,679/4607 (58%) males and the age range was 0.3 to 96 years. Pleural TB (1021/4607, 22%) was the most common. Treatment success rates for EPTB and PTB were respectively 72% and 84%. HIV positivity was high among patients with disseminated/miliary TB (429/779, 55%) and TB meningitis (242/526, 46%). To note, disseminated/miliary TB (χ2 = 33.53, P < 0.0001) increased, whereas TB meningitis (χ2 = 19.43, P < 0.0001) decreased over the 10-year period. Mortality among EPTB patients was associated with increasing age (⩾25 years), disseminated/miliary TB, TB meningitis and HIV positivity. CONCLUSIONS: There is male preponderance for both EPTB and PTB in Ghana. Increasing age, disseminated/ miliary TB, TB meningitis and HIV are risk factors for mortality among EPTB patients. This emphasises the need for public education on the risk factors for EPTB and preventive strategies.

CONTEXTE: Trois centres hospitalières universitaires au Ghana. OBJECTIF: Elucider les tendances démographiques, les caractéristiques cliniques et les résultats du traitement de patients atteints de TB extrapulmonaire (EPTB) au Ghana. SCHEMA: Ceci est une étude rétrospective de revue et de comparaison des données de EPTB et de TB pulmonaire (PTB) du 1e janvier 2008 au 31 décembre 2017 dans les registres de TB et les cartes de traitement. RESULTATS: Sur 15 392 cas de TB, 4607 (30%) étaient des EPTB dont 4477/4607 (97%) étaient de nouveaux cas. Les hommes représentaient 2679/4607 (58%) et leur âge allait de 0,3 à 96 ans. Une TB pleurale 1021/4607 (22%) était la plus fréquente. Le taux de réussite du traitement de la EPTB et de la PTB a été de 72% et 84%, respectivement. La positivité au VIH était élevée parmi les patients atteints de TB disséminée/miliaire (429/779 ; 55%) et de méningite tuberculeuse (242/526 ; 46%). Il est significatif que la TB disséminée/miliaire (χ2 = 33,53 ; P < 0,0001) a augmenté tandis que la méningite TB (χ2 = 19,43, P < 0,0001) a diminué au long de la période de 10 ans. La mortalité des patients EPTB a été associée à un âge croissant (≥25 ans), une forme disséminée/miliaire, à une méningite TB et à la positivité au VIH. CONCLUSIONS: Il y a une prépondérance masculine à la fois de la EPTB et de la PTB au Ghana. Un âge croissant, une forme disséminée/ miliaire, une méningite TB et le VIH sont des facteurs de risque de mortalité pour les patients EPTB. Ceci met l'accent sur le besoin d'éducation du public relative aux facteurs de risque et aux stratégies de prévention.

Haematological Changes among HIV-Positive Persons on Antiretroviral Therapy at a Tertiary Hospital in Ghana.

BACKGROUND: Haematological abnormalities such as anaemia, leucopenia, and thrombocytopenia are common complications of Human Immunodeficiency Virus (HIV) infection. Few researchers have studied the changes in HIV positive patients before and during antiretroviral therapy (ART) in Ghana. This study is aimed at determining the haematological profile of people living with HIV (PLHIV) at baseline and whilst on ART in a tertiary facility in Cape Coast, Ghana. METHODS: This was an analytical cross-sectional study with a retrospective component among PLHIV assessing ART services at the Cape Coast Teaching Hospital, Ghana. Full blood count (FBC) test was performed on blood samples and the results were analyzed and categorized based on WHO definitions. RESULTS: A total of 440 participants were included. The mean haemoglobin level (g/dL) for females at baseline, 6 months after ART and during this study were 9.6 (±1.8), 10.9 (±1.4) and 11.6 (±1.4); and 10.2 (±2.1), 11.6 (±1.7) and 11.8 (±1.6) for males. At baseline, the commonest type of anaemia for both females and males was microcytic hypochromic anaemia. The mean platelet count was 382 x 109/l at baseline but reduced to 298 x 109/L after 6 months on ART. Among male participants in this study, the main factor associated with being anaemic after 6 months on ART was the ART regimen with non-Zidovudine based regimen, having reduced odds of anaemia of OR 0.3 (95%CI 0.1 - 0.9), p-value of 0.04. Among females, having plasma viral load >1000 copies per ml was found to have increased odds of being anaemic (OR 1.4, 95%CI 0.7 - 2.6), though not statistically significant (P-value of 0.32). CONCLUSION: The prevalence of anaemia, though improved on ART, was high among PLHIV. It is essential to ensure that full blood count of PLHIV in Ghana are done regularly, at all levels of service provision, with appropriate referral systems in place. The change to the current TDF based preferred first line ART regimen must also be enforced to reduce the potential risks associated with AZT use. This will improve outcome for PLHIV.

Exploration of conservation and development strategies with a limited stakeholder approach for local cattle breeds.

Many local breeds have become endangered due to their substitution by high-yielding breeds. To conserve local breeds, effective development strategies need to be investigated. The aim of this study was to explore conservation and development strategies based on quantified strengths, weaknesses, opportunities and threats (SWOT) for two local cattle breeds from Northern Germany, namely the German Angler (GA) and Red Dual-Purpose cattle (RDP). The data comprised 158 questionnaires regarding both breeds' SWOT, which were answered by 78 farmers of GA and 80 farmers of RDP. First, data were analysed using the SWOT-Analytic Hierarchy Process (AHP) method, which combines the qualitative strategic decision tool of SWOT analysis and the quantitative tool of AHP. Second, prioritised SWOT factors were discussed with stakeholders in order to form final conservation and development strategies at breed level. For GA prioritised strengths were daily gain, meat quality, milk production and the usage of new biotechnologies, weaknesses were genetic gain in milk production and inbreeding, opportunities were organic farming and breed-specific characteristics and threats were milk prices and dependency regarding the dairy business. Consequently, three conservation and development strategies were formed: (1) changing relative weights and the relevant breeding goal to drift from milk to meat, (2) increasing genetic gain and control the rate of inbreeding by the implementation of specific selection programs and (3) selection of unique and breed characteristic components on product level, that is, milk-fat and fine muscle fibers. For RDP defined strengths were robustness, high adaptability for different housing systems and a balanced dual-purpose of milk and meat, weaknesses were inbreeding, breed extinction, genomic selection with young bulls and milk yield, opportunities were organic farming and dual-purpose aspects and threats were milk and decreasing beef cattle prices. Thus, three conservation and development strategies were identified: (1) adjust relative weights and the relevant breeding goal to balance milk and meat yield, (2) increasing genetic gain and avoid extinction by implementing targeted selection programs and (3) selection of unique and breed characteristic traits on breed level, that is, environmental robustness. Quantified SWOT establish a basis for the exploration of conservation and development strategies at breed level. Explored strategies are promising even if the stakeholder approach was limited for small populations regarding a small number of stakeholder groups. The used approach reflects farmers' individual convenience better than existing quantitative strategy decision tools on their own.

Towards elimination of mother-to-child transmission of HIV in Ghana: an analysis of national programme data.

BACKGROUND: Despite global scale up of interventions for Preventing Mother to child HIV Transmissions (PMTCT), there still remain high pediatric HIV infections, which result from unequal access in resource-constrained settings. Sub-Saharan Africa alone contributes more than 90 % of global Mother-to-Child Transmission (MTCT) burden. As part of efforts to address this, African countries (including Ghana) disproportionately contributing to MTCT burden were earmarked in 2009 for rapid PMTCT interventions scale-up within their primary care system for maternal and child health. In this study, we reviewed records in Ghana, on ANC registrants eligible for PMTCT services to describe regional disparities and national trends in key PMTCT indicators. We also assessed distribution of missed opportunities for testing pregnant women and treating those who are HIV positive across the country. Implications for scaling up HIV-related maternal and child health services to ensure equitable access and eliminate mother-to-child transmissions by 2015 are also discussed. METHODS: Data for this review is National AIDS/STI Control Programme (NACP) regional disaggregated records on registered antenatal clinic (ANC) attendees across the country, who are also eligible to receive PMTCT services. These records cover a period of 3 years (2011-2013). Number of ANC registrants, utilization of HIV Testing and Counseling among ANC registrants, number of HIV positive pregnant women, and number of HIV positive pregnant women initiated on ARVs were extracted. Trends were examined by comparing these indicators over time (2011-2013) and across the ten administrative regions. Descriptive statistics were conducted on the dataset and presented in simple frequencies, proportions and percentages. These are used to determine gaps in utilization of PMTCT services. All analyses were conducted using Microsoft Excel 2010 version. RESULTS: Although there was a decline in HIV prevalence among pregnant women, untested ANC registrants increased from 17 % in 2011 to 25 % in 2013. There were varying levels of missed opportunities for testing across the ten regions, which led to a total of 487,725 untested ANC clients during the period under review. In 2013, Greater Accra (31 %), Northern (27 %) and Volta (48 %) regions recorded high percentages of untested ANC clients. Overall, HIV positive pregnant women initiated onto ARVs remarkably increased from 57% (2011) to 82 % (2013), yet about a third (33 %) of them in the Volta and Northern regions did not receive ARVs in 2013. CONCLUSIONS: Missed opportunities to test pregnant women for HIV and also initiate those who are positive on ARVs across all the regions pose challenges to the quest to eliminate mother-to-child transmission of HIV in Ghana. For some regions these missed opportunities mimic previously observed gaps in continuous use of primary care for maternal and child health in those areas. Increased national and regional efforts aimed at improving maternal and child healthcare delivery, as well as HIV-related care, is paramount for ensuring equitable access across the country.

Estimation of heritability and breeding values for early egg production in laying hens from pooled data.

Under commercial conditions, data on egg production in laying hens are usually collected per cage rather than individually. In current breeding programs, genetic evaluations are, however, based on individually recorded egg production. Because commercial flocks are not maintained in single cages, this environmental difference between the breeding and commercial setting may result in a genotype x environment interaction. This study was aimed at estimating genetic parameters and predicting estimated breeding values for early egg production of laying hens by using pooled data (i.e., data from multiple bird cages) from pedigree birds housed in 4-bird cages. Using cage records, we compared 2 different methods of handling pooled data: cage sums and the assignment of cage means to individual birds, referred to as the approximate method. The 2 methods were compared by using cross-validation. Data from 3 purebred White Leghorn layer lines were used. Estimated heritability for early egg production was 0.36 when cage sums were used and 0.30 with the approximate method. The correlation of estimated breeding values between the cage sums method and the approximate method was 0.88. Cross-validation showed that the use of cage sums led to better predictions of missing phenotypes compared with the approximate method. The results of the research demonstrate that pooled data can be used in the genetic evaluation of laying hens and show that using directly pooled records (e.g., cage sums) gives better results than assigning group means to the birds of the group, thus simulating individual records.

A phase I trial to assess the pharmacology of the new oestrogen receptor antagonist fulvestrant on the endometrium in healthy postmenopausal volunteers.

While tamoxifen use is associated with clear benefits in the treatment of hormone-sensitive breast cancer, it also exhibits partial oestrogen agonist activity that is associated with adverse events, including endometrial cancer. Fulvestrant ("Faslodex") is a new oestrogen receptor antagonist that downregulates the oestrogen receptor and has no known agonist effect. This single-centre, double-blind, randomised, parallel-group trial was conducted to determine the direct effects of fulvestrant on the female endometrium when given alone and in combination with the oestrogen, ethinyloestradiol. Following a 14-day, pretrial screening period, 30 eligible postmenopausal volunteers were randomised to receive fulvestrant 250 mg, fulvestrant 125 mg or matched placebo administered as a single intramuscular injection. Two weeks postinjection, volunteers received 2-weeks concurrent exposure to ethinyloestradiol 20 microg day(-1). Endometrial thickness was measured before and after the 14-day screening period with further measurements predose (to confirm a return to baseline) and on days 14, 28 and 42 post-treatment with fulvestrant. Pharmacokinetic and safety assessments were performed throughout the trial. Fulvestrant at a dose of 250 mg significantly (P=0.0001) inhibited the oestrogen-stimulated thickening of the endometrium compared with placebo. Neither the 125 mg nor 250 mg doses of fulvestrant demonstrated oestrogenic effects on the endometrium over the initial 14-day assessment period. Fulvestrant was well tolerated and reduced the incidence of ethinyloestradiol-related side effects. At the same dose level that is being evaluated in clinical trials of postmenopausal women with advanced breast cancer, fulvestrant (250 mg) is an antioestrogen with no evidence of agonist activity in the endometrium of healthy postmenopausal women.

Serum of patients with prostatic cancer or benign prostatic hypertrophy contains nonpolar testosterone.

We have previously described a nonpolar form of radioimmunoassayable serum testosterone (NPT) not measured by available antitestosterone antibodies. It is detected by mild alkaline hydrolysis of the petroleum ether extract of serum and subsequent radioimmunoassay. The properties of NPT are consistent with that of a fatty acid ester of testosterone or dihydrotestosterone. The serum of young males contains 1 to 3 ng/ml NPT, but it is not detected in female serum. We measured serum testosterone and NPT levels in 36 men between 58 and 87 years of age. Seventeen subjects with advanced prostatic cancer (NPT 1.70 +/- 1.44 ng/ml) were compared with a control group consisting of six patients with benign prostatic hypertrophy (BPH) and 13 patients with no prostatic disease (NPT 0.72 +/- 0.46, P = 0.017). There was no significant difference between BPH patients and patients with no prostatic disease; the results were pooled. The concentration of NPT in prostatic cancer patients but not in controls was inversely correlated with that of testosterone. Immunoassayable testosterone was present in the serum of two orchiectomized patients and, therefore, cannot derive solely from the testes.

Non-polar extracts of serum from males contain covert radioimmunoassayable testosterone.

Non-polar extracts of sera from human males contain immunoreactive testosterone in a form that is released by mild alkaline hydrolysis. The non-polar derivative shows no immunoreactivity with testosterone antibody prior to hydrolysis. Hydrolyzed non-polar serum extracts from ten adult male volunteers contained 2.0 +/- 0.8 (SD) ng/mL of testosterone. Neither non-polar serum extracts of normal females nor a water blank substituted for non-polar extract of serum yields any immunoreactive testosterone after alkaline hydrolysis. Testosterone palmitate hydrolyzed alone or after addition to non-polar extract of serum yields the expected quantities of radioimmunoassayable testosterone. Previously described conjugates of testosterone are polar and are neither extractable by petroleum ether nor hydrolyzable by alkali. These observations suggest that fatty acid esters of testosterone may be present in serum of human males.