Vaccination Utilization and Subnational Inequities during the COVID-19 Pandemic: An Interrupted Time-Series Analysis of Administrative Data across 12 Low- and Middle-Income Countries.

BACKGROUND: During and after the SARS-CoV-2 (COVID-19) pandemic, many countries experienced declines in immunization that have not fully recovered to pre-pandemic levels. This study uses routine health facility immunization data to estimate variability between and within countries in post-pandemic immunization service recovery for BCG, DPT1, and DPT3. METHODS: After adjusting for data reporting completeness and outliers, interrupted time series regression was used to estimate the expected immunization service volume for each subnational unit, using an interruption point of March 2020. We assessed and compared the percent deviation of observed immunizations from the expected service volume for March 2020 between and within countries. RESULTS: Six countries experienced significant service volume declines for at least one vaccine as of October 2022. The shortfall in BCG service volume was ~6% (95% CI -1.2%, -9.8%) in Guinea and ~19% (95% CI -16%, 22%) in Liberia. Significant cumulative shortfalls in DPT1 service volume are observed in Afghanistan (-4%, 95% CI -1%, -7%), Ghana (-3%, 95% CI -1%, -5%), Haiti (-7%, 95% CI -1%, -12%), and Kenya (-3%, 95% CI -1%, -4%). Afghanistan has the highest percentage of subnational units reporting a shortfall of 5% or higher in DPT1 service volume (85% in 2021 Q1 and 79% in 2020 Q4), followed by Bangladesh (2020 Q1, 83%), Haiti (80% in 2020 Q2), and Ghana (2022 Q2, 75%). All subnational units in Bangladesh experienced a 5% or higher shortfall in DPT3 service volume in the second quarter of 2020. In Haiti, 80% of the subnational units experienced a 5% or higher reduction in DPT3 service volume in the second quarter of 2020 and the third quarter of 2022. CONCLUSIONS: At least one region in every country has a significantly lower-than-expected post-pandemic cumulative volume for at least one of the three vaccines. Subnational monitoring of immunization service volumes using disaggregated routine health facility information data should be conducted routinely to target the limited vaccination resources to subnational units with the highest inequities.

Exploring the Joint Association of Road Traffic Noise and Air Quality with Hypertension Using QGIS.

There is growing evidence linking exposure to air pollution and traffic noise with hypertension. The aim of this study was to examine the associations of registered hypertension cases and hypertension rate with exposure to air pollution and road noise. In this cross-sectional study, we linked the information from the NHS Scotland database of 776,579 hypertension patients' registrations and rates per 13.80 people at the Scottish NHS Board, HSCP, Cluster, and GP practice levels. Based on the geospatial attributes, the data on residential areas were added by modelling annual average air pollutant concentrations, including particulate matter (PM10 and PM2.5), nitrogen dioxide (NO2), and road-traffic noise at different frequency components (Lden). The relationships between exposure to road noise, air pollution, and hypertension were examined using multiple regression and multivariate analysis. Traffic noise and air pollution at various frequency components positively and negatively predicted registered hypertension cases and hypertension rate. Based on the canonical loading technique, the variance explained by the canonical independent variable at a canonical correlation of 0.342 is 89%. There is a significant correlation between joint air pollution and noise at different frequency components and combined registered hypertension cases and hypertension rate. Exploring the combined effects of the two environmental exposures and the joint modelling of noise and air pollutants with hypertension in geospatial views provides an opportunity to integrate environmental and health data to support spatial assessment strategies in public and environmental health.

Exploring the Combined Association between Road Traffic Noise and Air Quality Using QGIS.

There is mounting evidence that exposure to air pollution and noise from transportation are linked to the risk of hypertension. Most studies have only looked at relationships between single exposures. To examine links between combined exposure to road traffic, air pollution, and road noise. A Casella CEL-63x instrument was used to monitor traffic noise on a number of locations in residential streets in Glasgow, UK during peak traffic hours. The spatial numerical modelling capability of Quantum GIS (abbreviated QGIS) was used to analyse the combined association of noise and air pollution. Based on geospatial mapping, data on residential environmental exposure was added using annual average air pollutant concentrations from local air quality monitoring network, including particulate matter (PM10 and PM2.5), nitrogen dioxide (NO2), and road-traffic noise measurements at different component frequencies (Lden). The combined relationships between air pollution and traffic noise at different component frequencies were examined. Based on Moran I autocorrelation, geographically close values of a variable on a map typically have comparable values when there is a positive spatial autocorrelation. This means clustering on the map was influenced significantly by NO2, PM10 and PM2.5, and Lden at the majority of monitoring locations. Studies that only consider one of these two related exposures may exaggerate the impact of the individual exposure while underestimating the combined impact of the two environmental exposures.

The efficacy of pharmacological interventions to improve cognitive and behavior symptoms in people with dementia: A systematic review and meta-analysis.

Background and Aims: Dementia is becoming a major global public health menace in the aging population affecting 47 million people globally. Dementia has no cure and effective interventions. Treatment of dementia is a big problem. The most common symptomatic medications for cognition, behavior, and global functioning among patients with dementia currently are cholinesterase inhibitors and memantine. However, Information on the effectiveness of cholinesterase inhibitors for dementia is conflicting and controversial. Thus, this makes it difficult for decision-makers, healthcare providers, patients, and caregivers to decide on the most effective intervention. The current meta-analysis sought to investigate the efficacy of pharmacologic interventions to improve cognitive and behavioral symptoms in people with living dementia. Methods: This current systematic review and meta-analysis used the preferred reporting items for systematic reviews and meta-analyses to ensure accuracy and comprehensiveness. The Cochrane MEDLINE, Database of Systematic Reviews, and other databases were thoroughly searched for relevant studies. We selected Studies such as randomized controlled trials published in English with a sample size of at least 20 subjects. We selected and applied the random-effects meta-analysis as the most preferred model because of the heterogeneity across studies. The computation of the weighted effect size was based on the result from the test of heterogeneity. Results: Twenty-two studies were finally used in the meta-analysis. The study subjects who received donepezil 5 mg/day, donepezil 10 mg/day, and galantamine 24 mg/day had improved cognition symptoms (ADAS-cog) score of -1.46 (95% CI = -2.24, -0.68, z = 3.67, p < 0.001), -2.31 (95% CI = -3.30, -1.31, z = 5.45, p < 0.001) and -3.04 (95% CI = -4.16, -1.92, z = 5.31, p < 0.001) respectively. Conclusion: The current meta-analysis suggests significant benefits of cholinesterase inhibitors such as donepezil (5 and 10 mg/day) and galantamine on cognitive symptoms.

Teleost Nonapeptides, Isotocin and Vasotocin Administration Released the Milt by Abdominal Massage in Male Catfish, Clarias magur.

In the present work the nonapeptides i.e., isotocin and vasotocin alone or in a combination were tested in C. magur to evaluate their effect on stripping by abdominal massage. Also, we used chitosan-carbon nanotube nanocomposites to conjugate the nonapetides isotocin (abbreviated as COOH-SWCNTCSPeP) and isotocin and vasotocin (COOH-SWCNTCSPePs) with the aim of sustaining the effect for a longer duration. The conjugation of nonapeptides with nanocomposites was confirmed by Fourier-transform infrared spectroscopy (FTIR), Scanning electron microscopy (SEM), Transmission electron microscopy (TEM), Thermogravimetric analysis (TGA) and X-ray photoelectron spectroscopy (XPS). Two experiments were conducted to study the effect of naked (without nanoparticles) and conjugated nonapeptides on the milt release by stripping. Both the experiments consisted of eight treatments which included four naked groups two nanoconjugated groups and two controls. Both naked and nonconjugated formulations were successful in stripping the male catfish. The mRNA expression of selected reproductive genes was analysed to decipher the effect of nanopeptides at the molecular level. Nonapeptide treatment either naked or nanoconjugated, resulted in the upregulation of the transcript level of genes. Histological analysis revealed the concentration of spermatozoa was more in peptide injected groups than in the controls. The synergistic effects of nonapeptides and Ovatide had a positive impact on GSI. Thus, the present formulations were successful in stripping the male catfish to obtain the milt with significant reproductive success. Even though the naked groups perform better but the number of males required to fertilize the eggs in nanoconjuagted groups was smaller making it worth using for the delivery of nonapeptides.

Barriers to utilization of sexual and reproductive health services among young deaf persons in Ghana.

Despite significant progress made to improve access to sexual and reproductive health (SRH) services to the general populace in Ghana, information on the accessibility of such services to deaf persons is limited. This study investigated access to and utilization of SRH services among young female deaf persons in Ghana. Sixty deaf persons were interviewed from six metropolis/municipalities/districts in three regions of Ghana. The data were collected using focus group discussion and one-on-one interviews. The data were subjected to content analysis, leading to the identification of two broad themes. The study identified barriers at two levels: point of service delivery and barriers at the individual level. For instance, at the point of service delivery, they were claims that deaf women were victims of negative attitudes from health workers. The study concludes on the need for health policymakers to consider collaborating with the Ghana National Association of the Deaf in an effort towards designing inclusive SRH programmes.

Barriers to utilization of sexual and reproductive health services among young deaf persons in Ghana

Despite significant progress made to improve access to sexual and reproductive health (SRH) services to the general populace in Ghana, information on the accessibility of such services to deaf persons is limited. This study investigated access to and utilization of SRH services among young female deaf persons in Ghana. Sixty deaf persons were interviewed from six metropolis/municipalities/districts in three regions of Ghana. The data were collected using focus group discussion and one-on-one interviews. The data were subjected to content analysis, leading to the identification of two broad themes. The study identified barriers at two levels: point of service delivery and barriers at the individual level. For instance, at the point of service delivery, they were claims that deaf women were victims of negative attitudes from health workers. The study concludes on the need for health policymakers to consider collaborating with the Ghana National Association of the Deaf in an effort towards designing inclusive SRH programmes.

Gonadotropin inhibitory hormone receptors (GnIHRs): Molecular characterization and synergistic effect of different drugs in Indian major carp, Labeo catla.

After the discovery of Gonadotropin-inhibitory hormone (GnIH) in birds in 2000, it showed different roles in different vertebrate classes and even in different species of same classes. In birds and mammals, GnIH inhibits the expression of gonadotropins during reproduction, while in fishes it exerts both inhibitory and stimulatory effect on reproduction. The current study evaluates the role of GnIH during reproduction in Labeo catla. The partial cDNA sequence of GnIHR1 and GnIHR3 receptor genes was identified by degenerate PCR. The mRNA expression analysis of GnIHRs during different reproductive phases showed that the expression of all three GnIH receptor genes is highest during spawning phase. The expression of GnIH receptors is detected in both brain and gonads except for GnIHR3 which only expressed in gonads. The in vivo experiments with GnIH antagonist, RF313 drastically reduced the expression level of reproduction related genes like LH, FSH, and GnRH at 1 h post-injection. In another experiment the surge induced by cGnIH-III peptide on gonadotropins gene expression is further increased when co-injected with LHRHa. However, co-injection of melatonin along with cGnIH-III peptide had opposite effects. These results showed that the GnIH/GnIHRs system has positive effect on reproduction in L. catla.

Characterization, Docking and Molecular Dynamics Simulation of Gonadotropin-Inhibitory Hormone Receptor (GnIHR2) in Labeo Catla.

BACKGROUND/AIMS: GnIH receptors (GnIHRs) belong to the family of G-protein coupled receptors (GPCRs) and play a key role in the regulation of reproduction from fishes to mammals, either by inhibiting or stimulating the expression of gonadotropins. The aim of this study was to characterize GnIH receptor (GnIHR2) from Indian Major Carp, Labeo catla and its docking and simulation with GnIH antagonist RF313. METHODS: The full length sequence of GnIHR2 was obtained with RACE PCR. The docking analysis of RF313 with GnIHR2 receptor was performed with AutoDock v. 4.2.6 and molecular dynamics (MD) simulation with GROMACS 5.0. RESULTS: In the present study, we cloned full-length cDNA (1733 bp) of GnIHR2 from the brain of L. catla. The phylogenetic analysis showed clustering of catla GnIHR2 with goldfish and zebrafish in the GPR147 group. L. catla GnIHR2 receptor comprised seven transmembrane domains and the 3D-structure was predicted by I-TASSER tool. The docking analysis revealed high binding affinity (-11.6 kcal/mol) of GnIH antagonist, RF313 towards GnIHR2 receptor. The primary bonds involved were alkyl and hydrogen bonds while the amino acids participated were proline 43, 210, 339, cysteine 214, leucine 211, serine 213 and phenylalanine 338. The MD simulation analysis of docked complex for 100 nano-seconds (ns) in the lipid membrane environment showed the stability of the complex with time. CONCLUSION: Our study showed that GnIH antagonist, RF313 interact tightly with the GnIH receptor, GnIHR2 of L. catla. To the best of our knowledge, this is the first report on computational modelling and MD simulation of GnIH receptor in fishes. This will help in functional characterization studies of GnIH/GnIHR system in vertebrates.

Chitosan grafting onto single-walled carbon nanotubes increased their stability and reduced the toxicity in vivo (catfish) model.

The present work was aimed to develop the tissue benign, modified acid-functionalized single-walled carbon nanotube (COOH-SWCNT) chitosan (CS) hybrid (COOH-SWCNT-CS). Chitosan-nanotube hybrids were characterized by Fourier-transform infrared spectroscopy (FTIR), Thermogravimetry Analysis (TGA), Raman spectroscopy, Emission Gun-Scanning Electron Microscopes (FEG-SEM), Transmission Electron Microscopy (TEM) and Energy-dispersive X-ray spectroscopy (EDS). Micronuclei test of blood cells, comet assay of liver tissue and histological analysis of liver and kidney tissues were conducted after different treatments to evaluate the toxicity. Fish receiving COOH-SWCNT developed more numbers of micronuclei than COOH-SWCNT-CS treatments. Similarly, more DNA damage was observed in fish injected with nanotubes alone than chitosan hybrid groups. Histological observations revealed severe liver cell damage at higher concentrations of COOH-SWCNT whereas, in COOH-SWCNT-CS, no such damage was observed. However, kidney tissue remained unaffected in all groups. The study suggests that the nanohybrid developed will be safe and useful for delivery of micro or macro biomolecules in fish and higher animals.

Ontogenetic and tissue-specific expression of gonadotropin-inhibitory hormone (GnIH) and its receptors in Catla catla.

Gonadotropin-inhibitory hormone (GnIH) is an RFamide peptide, and its role in reproduction is well studied from fish to mammals, but very few reports are available about the function of GnIH during larval development. In this study, we examined the GnIH and GnIH receptors (GnIHRs) expression from embryogenesis to adult stage and tissue-specific expression in adult Catla catla using quantitative real-time (qRT) PCR. The qRT PCR analysis of GnIH mRNA during ontogenetic development showed the increasing trend from early developmental stages to the adult stage with the highest expression in 24 months fish. However, the expression of two GnIH receptors, GnIHR1 and GnIHR2 also increased from larval stages to the adults with a peak at 17 days post-hatching, while GnIHR3 showed the higher mRNA expression during embryogenesis and then decreasing gradually. Tissue distribution analysis of GnIH showed the highest mRNA expression of GnIH in the brain, followed by gonads of both the sexes. GnIHR1 and GnIHR2 were also highly expressed in the brain and gonads of both the sexes, while GnIHR3 showed the highest expression in gonads of both the sexes without any expression in the brain. These results suggest that the brain is the primary site of action for GnIH, GnIHR1 and GnIHR2, while gonads for GnIHR3.

Knowledge of obstetric fistula among prenatal clinic attendees and midwives in Mfantsiman municipality, Ghana.

OBJECTIVE: To determine obstetric fistula knowledge among prenatal attendees and midwives in Mfantsiman municipality, Ghana. METHODS: An analytical cross-sectional study was conducted among prenatal clinic attendees and midwives in Mfantsiman municipality from March to April, 2016. Women were selected by systematic sampling and consenting midwives were recruited. Respondents were interviewed using a pretested structured questionnaire. Data were analyzed using the χ2 test and Poisson regression with a robust error variance to generate relative risks (RRs) with 95% confidence intervals (CIs). P<0.05 was considered statistically significant. RESULTS: Altogether, 393 prenatal attendees and 45 midwives were studied. Mean age of attendees was 28.1 ± 7.1 years. About 29% of prenatal attendees knew of, 37.2% had poor knowledge of, and 56.6% had some misconceptions about obstetric fistula. Women who had attained some level of education (P trend=0.001), were employed (adjusted RR 4.92; 95% CI, 1.98-12.21), or had given birth before (P trend=0.01) were more likely to have heard of obstetric fistula. All midwives knew of obstetric fistula and its preventive measures; however, up to 73.3% had some misconceptions about it. CONCLUSION: Educating prenatal attendees and organizing regular refresher courses on obstetric fistula for midwives should be a priority in the municipality.

Molecular characterization of gonadotropin-inhibitory hormone (GnIH) gene and effect of intramuscular injection of GnIH peptide on the reproductive axis in Catla catla.

Gonadotropin-inhibitory hormone (GnIH) plays an important role in reproduction by inhibiting the expression of gonadotropins in birds and mammals, but in fishes, it is ambiguous. In this study, we cloned 606 bp long cDNA of GnIH from Catla catla brain (cGnIH). The encoded preproGnIH peptide generated three putative peptides (cGnIH-I, -II, -III) of different size. Phylogenetic analysis of GnIH showed clustering of different peptide sequence with its orthologs in separate clades. The real-time PCR analysis showed the expression of cGnIH in brain, gonads, intestine, stomach, heart, gill and liver with the highest expression in the brain and gonads of both sexes. The basal GnIH mRNA expression was higher in spawning and spent phase of the male brain and spawning phase of the female brain. In testis, the expression was highest in spent phase, while in ovary the expression did not change significantly during reproductive phases. The in vivo experiment of cGnIH-III peptide exhibited the higher expression of HPG axis genes, lhb, fshb, cgnrh, kiss2 and kiss1r and serum hormone level of LH and FSH as soon as 3 h after the intramuscular delivery. These results suggest that the GnIH is positively involved in regulation of reproduction in HPG axis of C. catla.

Caregiving experiences and expectations of parents with in-school children with intellectual disability in Ghana.

BACKGROUND: The literature suggests that there are challenges faced by parents of children with intellectual disabilities (ID), which have resulted in calls for support services to be made available to parents and their children with ID. Although regular schools in Ghana are unable to admit students with ID, it is believed that special schools have the necessary facilities to support parents and their children with ID. However, little has been documented on the experiences and expectations of parents whose children with ID are enrolled in a special school. METHOD: In this qualitative study, one-on-one semi-structured interviews were conducted with purposively recruited parents (n = 20) from the second most populous city in Ghana to explore their caregiving experiences and expectations regarding the education of their school-going children with ID. RESULTS: Although the parents acknowledged that access to education has some benefits, such as the protection of their children with ID from negative societal attitudes and a reduction of their caregiving burden, they had low expectations for their children's education. Furthermore, the parents encountered considerable challenges in catering for their children with ID, such as financial problems and limited access to caregiving skills. CONCLUSION: There is a need to intensify efforts at public education in relation to disability acceptance as well as to develop formidable social support systems.

Implementation of Fee-Free Maternal Health-Care Policy in Ghana: Perspectives of Users of Antenatal and Delivery Care Services From Public Health-Care Facilities in Accra.

In 2008, the government of Ghana implemented a national user fee maternal care exemption policy through the National Health Insurance Scheme to improve financial access to maternal health services and reduce maternal as well as perinatal deaths. Although evidence shows that there has been some success with this initiative, there are still issues relating to cost of care to beneficiaries of the initiative. A qualitative study, comprising 12 focus group discussions and 6 interviews, was conducted with 90 women in six selected urban neighborhoods in Accra, Ghana, to examine users' perspectives regarding the implementation of this policy initiative. Findings showed that direct cost of delivery care services was entirely free, but costs related to antenatal care services and indirect costs related to delivery care still limit the use of hospital-based midwifery and obstetric care. There was also misunderstanding about the initiative due to misinformation created by the government through the media.We recommend that issues related to both direct and indirect costs of antenatal and delivery care provided in public health-care facilities must be addressed to eliminate some of the lingering barriers relating to cost hindering the smooth operation and sustainability of the maternal care fee exemption policy.

Effects of Water pH on Life History Parameters of a New Bosminid Cladocera: Bosmina (Bosmina) Tripurae (Korinek, Saha and Bhattachaya, 1999) in Laboratory Condition.

The effects of water pH on life history parameters of Bosmina tripurae have been studied to determine the most suitable water pH desired for the maximum growth and development of this newly discovered cladoceran species. The study was carried out under the laboratory condition at 20 ± 2°C. Five pH ranges 5.0 ± 0.2, 6.0 ± 0.2, 7.0 ± 0.2, 8.0 ± 0.2 and 9.0 ± 0.2 with six replicates for each pH consisting of one animal in each Petri dish (80 × 15 mm) were used for the study. 20 mL of respective test medium was maintained with Chlorella sp. (2 × 104 ± 0.03 cells mL-1) in each Petri dish throughout the experiment. Thirty (30) animals were observed daily to investigate different life history parameters like total life span, age at maturity, number of eggs, neonates and egg batches etc. at different condition. From the study it was found that acidic water (pH 5 ± 0.2) is more suitable for the culture of Bosmina tripurae in laboratory condition.

Knowledge and use of contraceptive methods amongst deaf people in Ghana.

BACKGROUND: Persons with disabilities in general face serious barriers to sexual and reproductive health (SRH) information and services due to institutional and attitudinal barriers. However, because deaf people have unique communication and linguistic needs, which are often misunderstood or ignored, they face greater barriers than other persons with disabilities. Whilst available data indicated that there is a wide gap between knowledge and usage of contraceptive amongst Ghanaians, little is known about the level of contraceptive knowledge and usage amongst deaf people. OBJECTIVES: The objective of the study was to investigate the level of knowledge and use of contraceptive methods amongst deaf people in Ghana with the aim of understanding their contraceptive behaviour and to improve access. METHOD: The study was a participatory SRH needs assessment utilising a two-phase, sequential, mixed methods design. The study included 179 participants, consisting of focus groups with seven executives of Ghana National Association of the Deaf (GNAD), 10 male deaf adults, and 9 deaf female adults. A total of 152 deaf people, made up of students, women, and men participated in a survey, whilst one hearing person served as a key informant. RESULTS: The findings of the study indicated that of the 13 methods shown in the survey, only three were known to about 70% of the adults and 60% of the students. Level of knowledge of the remaining nine methods was low. CONCLUSION: Clear and effective policies are needed to guide the provision of SRH information and services for deaf people in Ghana.

Sexual and reproductive health needs assessment with deaf people in Ghana: Methodological challenges and ethical concerns.

BACKGROUND: Deafness is a complex and multifaceted phenomenon. The different ways of perceiving and understanding deafness have practical implications for research with deaf people. Whilst the deaf community is not homogenous, it is generally distinct from the hearing population. Consequently, the appropriateness of applying research methods and informed concern processes designed for the hearing population in research with deaf people has been questioned. OBJECTIVES: This article reflected on some methodological challenges and ethical concerns arising from conducting a sexual and reproductive health needs assessment with deaf people in Ghana. The aim was to provide some perspectives on some of the challenges associated with doing research with deaf people. METHOD: The study was a two phase, sequential, mixed methods design, consisting of three focus groups to assist in the development of a survey and then the implementation of the survey for needs assessment data collection. The number of participants in the study was 179, consisting of 26 focus group participants: 7 executives of the Ghana National Association of the Deaf (GNAD), 10 male adults, and 9 female adults. There were 152 survey respondents (students, women and men) and one key informant. All participants, except the key informant, were deaf people. RESULTS: The application of traditional research methods to studies involving deaf participants presents numerous methodological and ethical dilemmas associated mainly with deaf people's unique cultural and linguistic characteristics. CONCLUSION: Research methods should not be taken as universal guidelines for conducting research in all settings because of differences in settings.