Predictors of neonatal mortality in the Eastern Regional Hospital in Ghana: A retrospective cohort study.

Neonatal mortality accounts for nearly half of under-5 mortality in Ghana. The aim of this study was to identify the predictors of neonatal mortality in the Eastern Regional Hospital, Ghana. This was a retrospective cohort study conducted using secondary data from electronic medical records from the Eastern Regional Hospital between 1st January 2022 and 31st December 2022. The Kaplan-Meier estimator and adjusted Cox regression model were used to estimate survival probability and to assess the predictors of neonatal mortality. Data on 1684 neonates were analyzed and we found that 11.82% deaths occurred with a neonatal mortality rate (NMR) of 13.98 (95% CI: 12.05, 15.91) per 1000 person-days. Most neonatal deaths occurred within the first 24hrs of life (9.9%). The predictors of neonatal mortality were found to be low birthweight [Adjusted hazard rate (aHR): 1.63, 95% CI: 1.04, 2.54], hypothermia (aHR: 1.82, 95% CI: 1.16, 2.85), hyperthermia (aHR: 1.85, 95% CI: 1.01, 3.39), birth asphyxia (aHR: 3.69, 95% CI: 1.68, 8.11), and multiparty (aHR: 1.66, 95% CI: 1.02, 2.70). However, neonates aged 8-28 days (aHR: 0.41, 95% CI: 0.21, 0.81), born in the Eastern Regional Hospital (aHR: 0.39, 95% CI: 0.28, 0.55), walk-in neonates (aHR: 0.54, 95% CI: 0.32, 0.90), and neonates whose mothers had 8 or more antenatal contacts (aHR: 0.54, 95% CI: 0.32, 0.92) had lower neonatal mortality. There was high NMR in the Eastern Regional Hospital in Ghana. Averting complications such as low birthweight, hypothermia, hyperthermia, birth asphyxia, including the provision of obstetric and early neonatal care within the first 24 hours of life is critical to reducing neonatal mortality. Adherence to the World Health Organization's recommendation of 8 or more antenatal contacts among pregnant women is also essential in reducing neonatal mortality.

Phytochemistry, data mining, pharmacology, toxicology and the analytical methods of Cyperus rotundus L. (Cyperaceae): a comprehensive review.

Cyperus rotundus L. has been widely used in the treatment and prevention of numerous diseases in traditional systems of medicine around the world, such as nervous, gastrointestinal systems diseases and inflammation. In traditional Chinese medicine (TCM), its rhizomes are frequently used to treat liver disease, stomach pain, breast tenderness, dysmenorrheal and menstrual irregularities. The review is conducted to summarize comprehensively the plant's vernacular names, distribution, phytochemistry, pharmacology, toxicology and analytical methods, along with the data mining for TCM prescriptions containing C. rotundus. Herein, 552 compounds isolated or identified from C. rotundus were systematically collated and classified, concerning monoterpenoids, sesquiterpenoids, flavonoids, phenylpropanoids, phenolics and phenolic glycosides, triterpenoids and steroids, diterpenoids, quinonoids, alkaloids, saccharides and others. Their pharmacological effects on the digestive system, nervous system, gynecological diseases, and other bioactivities like antioxidant, anti-inflammatory, anti-cancer, insect repellent, anti-microbial activity, etc. were summarized accordingly. Moreover, except for the data mining on the compatibility of C. rotundus in TCM, the separation, identification and analytical methods of C. rotundus compositions were also systematically summarized, and constituents of the essential oils from different regions were re-analyzed using multivariate statistical analysis. In addition, the toxicological study progresses on C. rotundus revealed the safety property of this herb. This review is designed to serve as a scientific basis and theoretical reference for further exploration into the clinical use and scientific research of C. rotundus. Supplementary Information: The online version contains supplementary materials available at 10.1007/s11101-023-09870-3.

Metabolite profiling, antifungal, biofilm formation prevention and disruption of mature biofilm activities of Erythrina senegalensis stem bark extract against Candida albicans and Candida glabrata.

The antifungal activity of the 70% ethanol stem bark extract of Erythrina senegalensis (ESB) against different strains and drug resistant clinical isolates of Candida albicans and Candida glabrata were evaluated in the study. The effect of ESB on biofilms as well as its activity in combination with fluconazole, nystatin or caspofungin against the Candida strains were also evaluated. We then evaluated the antifungal activity of a microemulsion formulation of ESB against planktonic and biofilms of the Candida species. UPLC-QTOF-MS2 analysis was then undertaken to identify the phytoconstituents of the extract and UPLC fingerprints developed for the routine authentication as part of quality control measures. ESB exerted strong antifungal activities against C. albicans ATCC 10231 and SC5314 strains, and C. glabrata ATCC 2001 strain with minimum inhibitory concentration (MIC) values from 3.91 to 31.25 µg/mL and minimum fungicidal concentrations (MFCs) that ranged from 62.5 to 250 µg/mL. It also exhibited potent antifungal activities (MIC = 4-64 µg/mL) against a collection of C. albicans and C. glabrata clinical isolates that were resistant to either nystatin or azole antifungals. The formulated ESB demonstrated higher antifungal potency against the C. albicans and C. glabrata strains with MIC values of 3.91-31.25 µg/mL which was the same as the MFC values. The extract and its microemulsion formulation were active against biofilms of the strains of the Candida species inhibiting their biofilm formations (SMIC50 = 16-64 µg/mL) and their preformed biofilms (SMIC50 = 128 ->512 µg/mL). ESB also exhibited synergistic antifungal action with fluconazole and nystatin against C. albicans ATCC 10231 and C. glabrata ATCC 2001 strains in the checkerboard assay. Chemical characterization of the extract revealed the presence of phenolic compounds such as flavonoids and their prenylated derivatives, anthracene glycosides and alkaloids. UPLC Fingerprints of the extract was also developed and validated for routine identification and authentication of the stem bark of E. senegalensis. The study findings have demonstrated that the stem bark of E. senegalensis is as a potential source of bioactive compounds that could be developed as novel antifungal agents.

Antifungal Activities of Phytochemically Characterized Hydroethanolic Extracts of Sclerocarya birrea Leaves and Stem Bark against Fluconazole-Resistant Candida albicans Strains.

The study evaluated the antifungal activities of the 70% ethanol extracts of Sclerocarya birrea leaves (SBL) and stem bark (SBB) against C. albicans strains and fluconazole-resistant isolates, their antifungal effects in combination with conventional antifungals as well as their effects on the biofilms of the C. albicans strains and isolates. UPLC-QTOF-MS/MS analysis was then carried out to investigate the metabolite profile of the extracts and UPLC fingerprints developed for their routine identification as part of quality control measures. The extracts exhibited considerable antifungal activity with MIC ranging from 12.21 to 97.66 µg/mL and MFC from 12.21 to 390.63 µg/mL against the C. albicans strains and isolates. The antifungal activity of the stem bark extract was higher than the leaf extract. SBL and SBB also significantly inhibited biofilm formation (IC50 = 12.49 to 164.42 µg/mL) and the mature biofilms (IC50 = 91.50 to 685.20 µg/mL) of the strains and isolates of the C. albicans and demonstrated potential for their use in combination therapies with currently used antifungals especially the stem bark extract with nystatin. Metabolite profiling identified the presence of polyphenolic compounds in both leaves and stem bark mostly flavonoids, their derivatives, and proanthocyanidins, which contribute in part to the bioactivity of the plant. Whereas flavonoids like quercetin, myricetin, and their derivatives were abundant in the leaves, epicatechin monomers with their condensed tannins, including procyanidin B2 and procyanidin C, were abundant in the stem bark. Fingerprints of SBL and SBB were developed and validated and could be used as qualitative tools to authenticate the plant. The outcomes of the study show the promise of the leaf and stem bark extracts of S. birrea to be studied further and developed as antifungal agents.

Hypoglycaemic activity of Oleanonic acid, a 3-oxotriterpenoid isolated from Aidia Genipiflora (DC.) Dandy, involves inhibition of carbohydrate metabolic enzymes and promotion of glucose uptake.

The present study evaluated the antidiabetic activities of the 70% ethanol stem bark extract of Aidia genipiflora (AGB) and one of its constituents, oleanonic acid in streptozotocin (40 mg/kg)-induced diabetic rats. In vitro assays of glucose uptake and inhibition of carbohydrate metabolizing enzymes were then used to investigate their mechanism(s) of hypoglycaemic action. In silico evaluation of the pharmacokinetic and toxicity properties of the compound was also carried out. Administration of AGB (100-400 mg/kg) and oleanonic acid (15 - 60 mg/kg) resulted in significant reductions (p < 0.001) in the blood glucose and considerable decrease (p < 0.05) in the elevated lipid parameters of the diabetic animals. AGB activity at 200 and 400 mg/kg; and oleanonic acid at 60 mg/kg were comparable to glibenclamide (5 mg/kg). The extract and its isolate strongly inhibited α-glucosidase and α-amylase activity with IC50 values of (10.48 ± 1.39 µg/mL and 14.51 ± 1.26 µg/mL) and (36.52 ± 1.95 µM and 105.84 ± 1.08 µM) respectively. The glucose uptake assays showed that AGB and oleanonic acid exerted both insulin-dependent and independent promotional effect of glucose transport into the periphery by upregulating the expression of PI3K and PPARγ transcripts with a concomitant increase in GLUT-4 transcripts. Although oleanonic acid was predicted to be teratogenic, it was found to be generally non-lethal with favourable pharmacokinetics properties making it suitable for further studies. The study has shown that the stem bark of A. genipiflora is a source of new hypoglycaemic agents and that oleanonic acid possesses hypoglycaemic and anti-hyperlipidaemic activities.

Bioactive triterpenoids from Solanum torvum fruits with antifungal, resistance modulatory and anti-biofilm formation activities against fluconazole-resistant candida albicans strains.

Vulvovaginal candidiasis (VVC) is the second most common vaginal infection that affects women of reproductive age. Its increased occurrence and associated treatment cost coupled to the rise in resistance of the causative pathogen to current antifungal therapies has necessitated the need for the discovery and development of novel effective antifungal agents for the treatment of the disease. We report in this study the anti-Candida albicans activity of Solanum torvum 70% ethanol fruit extract (STF), fractions and some isolated compounds against four (4) fluconazole-resistant strains of C. albicans. We further report on the effect of the isolated compounds on the antifungal activity of fluconazole and voriconazole in the resistant isolates as well as their inhibitory effect on C. albicans biofilm formation. STF was fractionated using n-hexane, chloroform (CHCl3) and ethyl acetate (EtOAc) to obtain four respective major fractions, which were then evaluated for anti-C. albicans activity using the microbroth dilution method. The whole extract and fractions recorded MICs that ranged from 0.25 to 16.00 mg/mL. From the most active fraction, STF- CHCl3 (MIC = 0.25-1.00 mg/mL), four (4) known compounds were isolated as Betulinic acid, 3-oxo-friedelan-20α-oic acid, Sitosterol-3-ß-D-glucopyranoside and Oleanolic acid. The compounds demonstrated considerably higher antifungal activity (0.016 to 0.512 mg/mL) than the extract and fractions and caused a concentration-dependent anti-biofilm formation activity. They also increased the sensitivity of the C. albicans isolates to fluconazole. This is the first report of 3-oxo-friedelan-20α-oic acid in the plant as well as the first report of betulinic acid, sitosterol-3-ß-D-glucopyranoside and oleanolic acid from the fruits of S. torvum. The present study has demonstrated the anti-C. albicans activity of the constituents of S. torvum ethanol fruit extract and also shown that the constituents possess anti-biofilm formation and resistance modulatory activities against fluconazole-resistant clinical C. albicans isolates.

The role of the public and private health sectors on factors associated with early essential newborn care practices among institutional deliveries in Ghana.

BACKGROUND: Early essential newborn care is one of the important interventions developed by the World Health Organization to reduce morbidities and mortalities in neonates. This study investigated the role of the public and private sector health facilities on factors associated with early essential newborn care practices following institutional delivery in Ghana. METHODS: We used data from the 2017/2018 multiple indicator cluster survey for our analysis. A total of 2749 mothers aged 15-49 years were included in the study. Logistic regression analysis was used to assess the factors associated with early essential newborn care in both public and private health sectors. RESULTS: The prevalence of good early essential newborn care in the public sector health facilities was 26.4 % (95 % CI: 23.55, 29.30) whiles that of the private sector health facilities was 19.9 % (95 % CI: 13.55, 26.30). Mothers who had a Caesarean section in the public sector health facilities had 67 % lower odds of early essential newborn care compared to mothers who had a vaginal delivery [adjusted prevalence odds ratios (aPOR) = 0.33, 95 % CI: 0.20, 0.53]. Mothers without a health insurance in the public sector health facilities had 26 % lower odds of early essential newborn care compared to mothers with a health insurance (aPOR = 0.74, 95 % CI: 0.56, 0.97). However, these associations were not observed in the private sector health facilities. CONCLUSIONS: The findings suggest that the prevalence of good early essential newborn care in the public sector health facilities was higher than that reported in the private sector health facilities. Child health programs on early essential newborn care needs to be prioritized in the private healthcare sector. The Government of Ghana may also need to increase the coverage of the national health insurance scheme for women in reproductive age.

Myrianthus libericus: Possible mechanisms of hypoglycaemic action and in silico prediction of pharmacokinetics and toxicity profile of its bioactive metabolite, friedelan-3-one.

The hypoglycaemic and anti-hyperlipidaemic effects of the 70% ethanol stem bark extract of Myrianthus libericus (MLB), used traditionally in the management of diabetes in Ghana, was evaluated in this study using streptozotocin (45 mg/kg)-induced diabetic rats. In vitro hypoglycaemic activities of the extract and one of its principal compounds, friedelan-3-one were then investigated using α-amylase inhibitory and glucose uptake assay in C2C12 myotubes. In silico analysis of the pharmacokinetic and toxicity properties of the compound was also performed. MLB significantly (p < 0.001) reduced the elevated blood glucose levels and corrected considerably (p < 0.01) the altered serum lipid profiles of the diabetic rats which was comparable to glibenclamide (5 mg/kg). Together with friedelan-3-one, the extract markedly inhibited the activity of α-amylase and promoted glucose uptake in C2C12 cells. Whereas MLB significantly (p < 0.001) up-regulated PI3K and PPARγ transcripts with a corresponding increase in GLUT-4 transcripts within the muscle cells, friedelan-3-one only up-regulated PI3K and GLUT-4 transcripts to promote glucose transport. Friedelan-3-one was shown to be non-carcinogenic, non-hepatotoxic, has decent oral bioavailability and a good compound for optimisation into a drug candidate. The study has demonstrated that MLB possess hypoglycaemic and anti-hyperlipidaemic activities and could be used as a therapeutic agent in the management of diabetes mellitus.

Cyclical cholera outbreaks in Ghana: filth, not myth.

BACKGROUND: Ranked among the world's dirtiest countries, Ghana has poor environmental sanitation and hygiene, and a lack of potable water, all of which combined have been largely blamed as the underscoring reasons for cholera outbreaks. The country has concomitantly suffered seasonal cholera outbreaks that have impacted negatively on the population's health, as well as on the nation's economy. To prevent cyclical cholera outbreaks in Ghana, this commentary discusses the associated problems and makes recommendations to solve them. MAIN BODY: This commentary aims to throw light on the menace of cholera in Ghana and the need to curb the recurrence of outbreaks and bouts of this epidemic. Response measures, challenges, and lessons learnt from the most recent cholera outbreak are critically assessed to determine how best this public health issue could be resolved. General and specific policy recommendations are identified in this regard. CONCLUSION: To resolve this problem, there is a need for an oral cholera vaccine to be introduced. There is also a need to develop strategies and interventions relating to water, sanitation, and hygiene, to be initiated by the Ministry of Health, with component activities that are culturally tailored to Ghanaian communities. Policy change towards the prevention of outbreaks in Ghana is identified as another requisite.