Maternal first antenatal care visit biometric indices as potential predictors of umbilical cord morphometric parameters.

BACKGROUND: One key factor proven to increase quality of pregnancy outcome has been antenatal care (ANC) service. The perinatal triad of mother, placenta and fetus becomes functionally complete with a functional umbilical cord. The objective of the study was to establish mathematical models to predict the outcome of umbilical cord morphometric parameters using maternal first antenatal care visit biometric indices. METHOD: This analytical descriptive cross-sectional study was conducted on 240 pregnant women who attended antenatal care for the first time in their first trimester at the Victory Maternity Home and Clinic in the Kumasi Metropolis, between April 2016 and October 2019. Umbilical cord length, diameter, area, volume and weight were measured after delivery. Maternal first antenatal care visit blood pressure was taken and their non-fasting blood samples were collected and lipid profile done. RESULTS: Mean values for umbilical cord measurements were; cord length, 38.10±7.86 cm; diameter, 1.04±0.17 cm; area, 66.10±24.49 cm2 and volume was 34.02±11.16 cm3 respectively while mean cord weight was 65.01±21.35 g. The study found that a unit increase in total cholesterol led to an increase of 2.33 units in umbilical cord length, high-density lipoprotein also resulted in 0.06 units increase in cord diameter while low-density lipoprotein decreases cord length by 3.31 units. Also, a unit increase in maternal booking total cholesterol resulted in 2.33 units increase in umbilical cord length. CONCLUSION: Maternal first antenatal care visit total cholesterol, high-density lipoprotein and low-density lipoprotein could influence the outcome of umbilical cord length, diameter and area.

Trends in under-five mortality rate disaggregated across five inequality dimensions in Ghana between 1993 and 2014.

OBJECTIVES: Globally, there has been a considerable decline in under-five mortality in the past years. However, it remains a critical issue among low- and middle-income countries, especially in sub-Saharan Africa. In Ghana, under-five mortality is a critical public health issue that requires national interventions. In the present study, we examined the trends of under-five mortality in Ghana from 1993 to 2014. METHODS: Using the World Health Organization's Health Equity Assessment Toolkit, we analyzed data from the 1993-2014 Ghana Demographic and Health surveys. We disaggregated the under-five mortality rate by five equity stratifiers: wealth index, education, sex, place, and region of residence. We measured the inequality through summary measures, namely difference, population attributable risk, ratio and population attributable fraction. RESULTS: In 1993, under-five mortality among children in poor households (172.90, uncertainty intervals [UIs = 153.21-194.53]) was more than twice the proportion of children from the richest households who died before their 5th birthday (74.96; UI = 60.31-92.81) and this trend continued until 2008. However, in 2014, the poorest had the lowest rate (30.91, UI = 78.70-104.80). Children of women with no formal education consistently recorded the highest burden of under-five mortality. Although in 2014 the gap appeared to have narrowed, children of mothers with no formal education record the highest under-five mortality rate (91.61; UI = 79.73-105.07) compared with those with secondary or higher education (54.34; UI = 46.24-63.77). Under-five mortality was higher among rural residents throughout the years. Men repeatedly had the greatest share of under-five mortality with the highest prevalence occurring in 1993 (137.52; UI = 123.51-152.85) and the lowest occurring in 2014 (77.40; UI = 69.15-86.54). The Northern region consistently accounted for the greatest proportion of under-five mortality. CONCLUSION: Ghana has experienced a decline in under-five mortality from 1993 to 2014. Context-specific appropriate interventions are necessary for various disadvantaged sub-populations with risks of health disparities.

High BMI: an important health risk factor among older adults in Ghana.

OBJECTIVE: We examined BMI as a health risk factor for self-reported diabetes mellitus, angina, strokes and arthritis among older Ghanaians aged 50 years and above. DESIGN: We analysed the individual-level data from the World Health Organization Study on global AGEing and adult health Ghana Wave 2 (2014/2015). The influence of BMI on self-reported chronic conditions including diabetes, angina, stroke and arthritis was examined. SETTING: Households from all the administrative regions of Ghana. PARTICIPANTS: Included 3350 adults aged 50 years and older. RESULTS: The prevalence of overweight and obesity among participants was 22·8 % (95 % CI 20·6, 25·2) and 13·2 %, respectively (95 % CI 11·5, 15·1). With respect to individual chronic conditions, arthritis emerged with the highest prevalence rate of 7·3 (95 % CI 5·3, 9·9), while the prevalence rate of diabetes, angina and stroke was 2·8 % (95 % CI 2·0, 3·9), 1·7 % (95 % CI 1·1, 2·6) and 1·3 % (95 % CI 1·0, 1·8), respectively. The risk of diabetes among overweight and obesity was over three and two times, respectively, higher compared with participants with normal weights. Overweight and obesity were significantly more than two and three times likely to experience angina, respectively, compared with participants with normal weight. Obesity significantly influences arthritis with approximately two times increased odds compared with normal weight participants. CONCLUSION: Prevalence of obesity and overweight in Ghana is high and increasing, which poses a health risk at the individual and population levels. Inter-sectorial and multidisciplinary measures in line with the national non-communicable disease policies aimed at curbing this trend are imperative.

A Combined Study of Headspace Volatiles using Human Sensory, Mass Spectrometry and Chemometrics.

Smokeless tobacco products (STPs) are widely used in certain parts of the world, yet there is limited understanding of how they are consumed, particularly the impact of chemosensory characteristics on their use. In order to develop an understanding of the drivers of STP use and product acceptability we conducted both human sensory panel testing and chemical analyses on a range of STPs. Free-sorting paired odour testing using sensory panellists identified similarities and clear differences between eleven different STPs. Headspace volatiles, analysed by headspace solid-phase microextraction gas chromatography mass spectrometry (HS-SPME-GC-MS), identified 20 to 70 components depending upon the STP. Key differences in headspace volatiles were found between STPs. For example, the headspace of Skoal Bandits Wintergreen was dominated by methyl salicylate, while Marlboro Spice consists of a more complex profile including pinene, nicotine, eugenol and cymene. Chemometric Target Factor Analysis (TFA) and Hierarchical Cluster Analysis (HCA) of chemistry and sensory data was used to deduce chemical drivers of sensory perceptions. The chemometric strategy used showed that headspace analysis is a complementary screening tool to sensory analysis in classification studies. This study is generic with applications across various product sectors that require routine human sensory panel evaluation.

The effects of esterified solvents on the diffusion of a model compound across human skin: an ATR-FTIR spectroscopic study.

Attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy has been used to investigate the effects of three fatty acid esters on skin permeation. Propylene glycol diperlargonate (DPPG), isopropyl myristate (IPM) and isostearyl isostearate (ISIS) were selected as pharmaceutically relevant solvents with a range of lipophilicities and cyanophenol (CNP) was used as a model drug. The resultant data were compared with that obtained when water was used as the solvent. The diffusion of CNP, DPPG and IPM across epidermis was successfully described by a Fickian model. When ISIS was used as a solvent Fickian behaviour was only obtained across isolated stratum corneum suggesting that the hydrophilic layers of the epidermis interfere with the permeation of the hydrophobic ISIS. The diffusion coefficients of CNP across epidermis in the different solvents were not significantly different. Using chemometric data analysis diffusion profiles for the solvents were deconvoluted from that of the skin and modelled. Each of these solvents was found to diffuse at a faster rate across the skin than CNP. DPPG considerably increased the concentration of CNP in the stratum corneum in comparison with the other solvents indicating strong penetration enhancer potential. In contrast IPM produced a similar CNP concentration in the stratum corneum to water with ISIS resulting in a lower CNP concentration suggesting negligible enhancement and penetration retardation effects for these two solvents respectively.

Preparation, optimisation and characterisation of novel wound healing film dressings loaded with streptomycin and diclofenac.

Streptomycin (STP) and diclofenac (DLF) loaded film dressings were prepared by blending Polyox(®) (POL) with four hydrophilic polymers [hydroxypropylmethylcellulose (HPMC), carrageenan (CAR), sodium alginate (SA) or chitosan (CS)] using glycerol (GLY) as plasticiser. The films were characterised by scanning electron microscopy (SEM), differential scanning calorimetry (DSC), X-ray diffraction (XRD) and Fourier transform infrared (FTIR) spectroscopy, texture analysis (tensile and swelling characteristics) and in vitro dissolution profiles using Franz diffusion cell. SEM showed homogeneous morphology for both blank (BLK) and drug loaded (DL) films. Films prepared by blending of POL with the other polymers showed a reduction in the crystallisation of POL in descending order of SA>CS>HPMC>CAR respectively. DSC and XRD showed no crystalline peaks of STP and DLF suggesting molecular dispersion of both drugs as well as possible drug interaction with negatively charged sulphate ions present in CAR. The DL films did not show any IR bands of both drugs, confirming the DSC and XRD results. POL-CAR-BLK films showed higher tensile strength (12.32±1.40 MPa) than the POL-CAR-DL films (9.52±1.12 MPa). DL films plasticised with 25%w/w GLY revealed soft and tough (tensile strength 1.02±0.28 MPa, % elongation 1031.33±16.23) formulations. The swelling capacities of POL-CAR-BLK and POL-CAR-DL films were (733.17±25.78%) and (646.39±40.39%), increasing to (1072.71±80.30%) and (1051±86.68%) for POL-CAR-BLK-25% GLY and POL-CAR-DL-25% GLY respectively. POL-CAR-DL films showed significantly (n=3, p<0.0318) lower cumulative release of STP and DLF (52.11±1.34, 55.26±2.25) compared to POL-CAR-DL-25% GLY films (60.07±1.56, 63.39±1.92) respectively.

ATR-FTIR spectroscopy and spectroscopic imaging of solvent and permeant diffusion across model membranes.

The uptake and diffusion of solvents across polymer membranes is important in controlled drug delivery, effects on drug uptake into, for example, infusion bags and containers, as well as transport across protective clothing. Attenuated Total Reflectance Fourier Transform Infrared (ATR-FTIR) spectroscopy has been used to monitor the effects of different solvents on the diffusion of a model compound, 4-cyanophenol (CNP) across silicone membrane and on the equilibrium concentration of CNP obtained in the membrane following diffusion. ATR-FTIR spectroscopic imaging of membrane diffusion was used to gain an understanding of when the boundary conditions applied to Fick's second law, used to model the diffusion of permeants across the silicone membrane do not hold. The imaging experiments indicated that when the solvent was not taken up appreciably into the membrane, the presence of discrete solvent pools between the ATR crystal and the silicone membrane can affect the diffusion profile of the permeant. This effect is more significant if the permeant has a high solubility in the solvent. In contrast, solvents that are taken up into the membrane to a greater extent, or those where the solubility of the permeant in the vehicle is relatively low, were found to show a good fit to the diffusion model. As such these systems allow the ATR-FTIR spectroscopic approach to give mechanistic insight into how the particular solvents enhance permeation. The solubility of CNP in the solvent and the uptake of the solvent into the membrane were found to be important influences on the equilibrium concentration of the permeant obtained in the membrane following diffusion. In general, solvents which were taken up to a significant extent into the membrane and which caused the membrane to swell increased the diffusion coefficient of the permeant in the membrane though other factors such as solvent viscosity may also be important.

Local examination of skin diffusion using FTIR spectroscopic imaging and multivariate target factor analysis.

In the context of trans-dermal drug delivery it is very important to have mechanistic insight into the barrier function of the skin's stratum corneum and the diffusion mechanisms of topically applied drugs. Currently spectroscopic imaging techniques are evolving which enable a spatial examination of various types of samples in a dynamic way. ATR-FTIR imaging opens up the possibility to monitor spatial diffusion profiles across the stratum corneum of a skin sample. Multivariate data analyses methods based on factor analysis are able to provide insight into the large amount of spectroscopically complex and highly overlapping signals generated. Multivariate target factor analysis was used for spectral resolution and local diffusion profiles with time through stratum corneum. A model drug, 4-cyanophenol in polyethylene glycol 600 and water was studied. Results indicate that the average diffusion profiles between spatially different locations show similar profiles despite the heterogeneous nature of the biological sample and the challenging experimental set-up.

The effect of solvent on permeant diffusion through membranes studied using ATR-FTIR and chemometric data analysis.

One method of improving the bioavailability of a topical formulation is to add an appropriate solvent that will act as a solubilizer for the permeant and, at the same time, modify the barrier properties of the stratum corneum. It has proved very difficult to determine the precise mechanisms of action involved; this is complicated by the concurrent diffusion of the solvent and the permeant into the skin. Under these circumstances the barrier function may well be changing as a function of time as the solvent disrupts it. We have observed this phenomenon in a model silicone membrane system that we have chosen to study initially to avoid the complexity of the heterogeneous nature of skin and its inherent biological variability. Diffusion experiments were conducted using an established ATR-FTIR approach but the data interpreted using sophisticated chemometric approaches that allowed us to deconvolve the IR signals from the permeant, the solvent, and the membrane. Data are presented that show the concurrent diffusion of benzoic acid (permeant), octanol (solvent), and how the octanol modifies the characteristics of the silicone membrane. Initial data are then presented using human skin to show the power of the diffusion approach coupled to the data deconvolution technique.

Vaccine-modified measles in previously immunized children in Accra, Ghana: clinical, virological and serological parameters.

Despite rapidly increasing measles immunization coverage, epidemics of measles occurred from January to March 2000 in some parts of Accra, the capital of Ghana. 44 cases of acute measles were diagnosed at three health facilities during the outbreaks, which we examined clinically and serologically. The peak incidence occurred among 6-12-year-olds, clinical symptoms were milder than the typical symptoms of measles, and fever was significantly less common. None of the cases developed complications and all recovered completely. Thirty-eight (86.4%) were tested serologically; IgM antibodies were detected in 73.7% and IgG antibodies in 84.2% during the acute phase. Milder symptoms in a significant number of cases with measles IgG antibodies suggest that these are vaccine-modified measles, attributable to waning antibodies and low circulation of wild type virus in an area of high vaccine coverage. Serological confirmation will be required for accurate diagnosis, if measles is to be eradicated or kept under control. It also seems likely that multiple dose immunization schedules will be needed in the future to maintain protective antibody levels and to protect children against measles in Ghana. This will eliminate the frequent outbreaks of measles involving immunized children.

Provision of emergency contraceptive pills to spermicide users in ghana.

This study evaluated the effect of two approaches to provision of emergency contraceptive pills (ECPs) on ECP use and unprotected intercourse among women relying on spermicides for contraception. The study enrolled 211 women at 4 family planning clinics in Ghana. At two clinics, participants were advised to return to the clinic within 3 days after unprotected intercourse to obtain ECPs. At the other two clinics, participants were given ECPs to take home for use if unprotected intercourse occurred. All participants were asked to maintain daily diaries for 8 weeks to record information on sexual activity, spermicide use, and ECP use. Women at all clinics used ECPs after at least 78% of unprotected coital acts. ECPs were used more promptly by women who had the pills at home. At three of the clinics, at most 1.3% of the coital acts were unprotected; at the fourth, 6.7% were unprotected. Our data did not suggest that the availability of ECPs increased the frequency of unprotected intercourse.

Country watch: Ghana.

PIP: Many men in Ghanaian society have the final say in couples on whether or not to use contraception, the type of contraceptive to use, how many children to have, and when to have them. However, despite their important roles in families and family planning decision-making, men have long been overlooked by family planning programs. Not including and accommodating men in family planning programs impedes men's access to family planning services and limits women's ability to make full use of available reproductive health services. Planned Parenthood Association of Ghana (PPAG) field workers organized male workers of the Prestea Oil Palm Plantation in the western region of Ghana into a "daddies' club" and provided them with indoor recreational games as an entry point for discussions of family planning and other reproductive health issues. In 1980, PPAG created the Male Involvement in Family Planning project to increase male participation in family planning and other reproductive health issues. The project now covers 7 of the country's 10 regions and by the end of 1997, operated through 19 daddies' clubs, 24 industrial centers, 9 garage associations, 13 drivers' unions, 3 national vocational training institutes, 5 artisan's groups, 32 functional literacy facilitators, 4 young men's clubs, and an agricultural college. Members' recreational activities have generated discussions on reproductive health issues.^ieng

Avoidance of used endometrial sites by blastocysts of the bank vole, Clethrionomys glareolus.

In bank voles blastocysts arising from mating immediately after parturition do not implant in used zones of the preceding pregnancy but in the regions between them. However, if mating is postponed until 12 or more days after parturition blastocysts do implant in used zones of the previous pregnancy. Implantations also occur at zones used two pregnancies previously. It seems likely that the absence of implantations at recently used zones of the uterus is determined by the uterus rather than blastocysts.

Hormonal requirements and the influence of age on the decidual cell reaction in the bank vole (Clethrionomys glareolus).

Laboratory bred bank voles of different age and reproductive status were bilaterally ovariectomized, treated with exogenous oestrogen or progesterone or both, and given an artificial decidual stimulus (crushing with artery forceps). An hormonal regimen of oestrogen (100 ng) followed by progesterone (1 mg) and small amounts of oestrogen (10 ng) was necessary for maximal development of the decidual cell reaction (DCR). A DCR did not develop if the animals were treated with only oestrogen or progesterone. Middle-aged virgin females 5-7 months old had larger responses than did young virgin females 2-3 months old, and parous females, 15-19 months old and having had at least 10 litters, had a response similar to that of virgin females of about the same age. The size of the DCR in old parous females was inversely related to the time elapsing since the last litter. It is concluded that in its hormonal requirements for a successful DCR the bank vole is similar to the mouse. The results also suggest that the increase in fertility of bank voles up to the age of about 100 days may in part be explained by increased response of the endometrium to blastocysts. The reduction in size of the DCR in old animals is a consequence of ageing rather than of repeated pregnancies.