Implementing household water treatment interventions: actors and factors for success

Despite the years of effort of organizations to scale up household water treatment and safe storage (HWTS) practices, HWTS practices are yet to achieve scale. PATH, UNICEF, and the Water Institute at UNC Chapel Hill collaborated to carry out a study aimed at determining the factors relevant to scaling up and sustaining HWTS practices. The main objective of the study was to produce useful and practical tools that could be used by organizations to effectively plan and implement HWTS interventions. This goal was achieved by interviewing HWTS practitioners with experience in dozens of countries and a variety of settings. The study identified six dimensions of a program essential to scale-up and sustainability: (1) Capacity building; (2) Resource availability; (3) Standards, regulations & legislation; (4) Integration and collaboration; (5) User preferences; and (6) Market strategies. Assessment tools were also developed to guide organizations in planning and implementing HWTS interventions

Factors associated with mortality in extrapulmonary tuberculosis patients at a teaching hospital in Ghana

Objectives: To investigate the clinical manifestations and factors associated with mortality in patients with extrapulmonary tuberculosis (EPTB) at the Korle-Bu Teaching Hospital Chest Clinic in Accra, Ghana.Design: We conducted a retrospective chart review of patients treated for EPTB at the Chest Clinic between January 1, 2009 and December 31, 2011. Patients with a new diagnosis of EPTB without concomitant pulmonary disease, aged 18 years or older, and who were treated at the Chest Clinic were eligible for participation in the study. Relevant data were abstracted from medical records and entered into a database. The factors associated with mortality were examined using bivariate and multivariate analysis.Results: Of the 157 patients in the study, the most affected age group was 25-34 years old (33.1%), 57.3% were male, and 71 (55.5%) of the 128 patients tested for HIV were sero-positive. Overall, 62 (39.5%) died during EPTB treatment. Mortality was associated with disseminated TB (AOR 149.85; P < 0.001), TB meningitis (AOR 79.14; P < 0.001), abdominal TB (AOR 23.59; P = 0.011), pleural effusion (AOR 12.6; P = 0.021) and age (AOR 1.05; P = 0.021). Among HIV co-infected patients, early initiation of ART reduced mortality rate.Conclusions: The site of EPTB was a key determinant of mortality. Given that death occurs soon after diagnosis, patients with suspected TB meningitis, disseminated, abdominal and pleural TB should be targeted for early diagnosis and treatment to reduce the high EPTB mortality in our setting.Key words: Extrapulmonary TB, HIV coinfection, Treatment outcomes, Mortality, Adults, Ghan

An economic evaluation of a long-term experiment on phosphorus and manure amendments to sandy Sahelian soils: Using a stochastic dominance model

Poor fertility status of sandy Sahelian soils represents a major constraint to cereal and legume production. Soil amendment options were evaluated, using a stochastic efficiency framework. Dominance analyses showed that in the presence of annual applications of 30 kg N ha−1 and 30 kg K ha−1, efficient soil amendment options comprise of either the annual application of 8.7 kg P ha−1 in the form of single superphosphates in combination with 5 tonnes manure ha−1 applied every three years or the annual application of 17.5 kg P ha−1 in the form of single superphosphates. Choice between these two efficient options depends on the availability of manure, deficiencies in sandy soils and farmer resource endowments

Artificial Sweeteners Disrupt Tight Junctions and Barrier Function in the Intestinal Epithelium through Activation of the Sweet Taste Receptor, T1R3

The breakdown of the intestinal epithelial barrier and subsequent increase in intestinal permeability can lead to systemic inflammatory diseases and multiple-organ failure. Nutrition impacts the intestinal barrier, with dietary components such as gluten increasing permeability. Artificial sweeteners are increasingly consumed by the general public in a range of foods and drinks. The sweet taste receptor (T1R3) is activated by artificial sweeteners and has been identified in the intestine to play a role in incretin release and glucose transport; however, T1R3 has not been previously linked to intestinal permeability. Here, the intestinal epithelial cell line, Caco-2, was used to study the effect of commonly-consumed artificial sweeteners, sucralose, aspartame and saccharin, on permeability. At high concentrations, aspartame and saccharin were found to induce apoptosis and cell death in intestinal epithelial cells, while at low concentrations, sucralose and aspartame increased epithelial barrier permeability and down-regulated claudin 3 at the cell surface. T1R3 knockdown was found to attenuate these effects of artificial sweeteners. Aspartame induced reactive oxygen species (ROS) production to cause permeability and claudin 3 internalization, while sweetener-induced permeability and oxidative stress was rescued by the overexpression of claudin 3. Taken together, our findings demonstrate that the artificial sweeteners sucralose, aspartame, and saccharin exert a range of negative effects on the intestinal epithelium through the sweet taste receptor T1R3

Inferior vena cava injury: survival of a rare case

The inferior vena cava is the most commonly injured abdominal vessel and accounts for about 25% of abdominal vascular injuries. Despite improved preoperative care and operative techniques, the mortality rates for the inferior vena cava injuries are still high due to delayed presentation, inadequate or delayed fluid resuscitation, difficulty of diagnosis and technical problems in repair. A case of the inferior vena cava injury encountered after abdominal stabinjury with about 4cm vertical tear of infrarenal vena cava, survived due to immediate transportation, appropriate and successful perioperative fluid and blood resuscitation, prompt surgical management with a team approach and critical post-operative surgical management.Keywords: The inferior vena cava (IVC), stab wound, venorrhaphy, haemoperitoneu

Groundwater quality, sanitation and vulnerable groups: case study of Bawku East District

The effect of human hygienic behaviour on the quality of groundwater was investigated using standard methods for trace elements and bacteria pollution indicators in Bawku East District of Ghana in 2006. No iron was detected in water; manganese levels were higher in wells than boreholes and fluoride levels exceeded the WHO standard (1.5mg/l) by 0.5-1.0mg/l in one well and a borehole at Bawku. Typical bacteria numbers deviated from normal trends (i.e.1014, 1011, 108, and 104 for total coliforms, faecal coliforms, E. coli and enterococci in the well water compared to 106, 105, 103 and 102 in the boreholes respectively). The six UNICEF boreholes were within the WHO guideline of zero helminthes (100-1 ml) but the wells were not. Hence, quality of the boreholes was higher than the wells for drinking purposes

Preliminary Evaluation of Indoor Radon Exposure Levels in Students' Halls of Residence at the Northern Campus (New Site) of the University of Cape Coast, Ghana

Abstract: The study seeks to present Radon exposure levels in some rooms within halls of residence at the New Site of the University of Cape Coast, Ghana determined using LR-115 TypeII Solid State Nuclear Track Detector (SSNTD) and E-PERM detecting systems. Pieces of the plastic LR-115 detectors were covered with aluminium foil and fixed in plastic holder such that the active part (coated part) of the detector was exposed (bare), facing downwards and together with the E-PERM were placed at a location in each of the selected rooms in the halls of residence for 30 days. The voltages of the E-PERMs were taken using the SPER-1 Reader whilst the LR-115 was chemically etched to reveal the alpha tracks. The mean radon exposure level for LR-115 was 6.8 mSv (range: 3.1-9.1 mSv) whiles the mean exposure for the E-PERM was 3.6 mSv (range: 1.7-5.3 mSv). The results obtained also indicated that the exposure levels measured by both the E-PERM and the LR-115 detectors were generally below the Environmental Protection Agency (US-EPA) guideline limit of 8 mSv. However, some rooms had their exposure levels (measured with the LR-115 detector) above the remedial guideline limit of 8 mSv, but far below the immediate action limit of 20 mSv. Most of a student time is spent indoors. There is therefore the need to have a fair idea the radon concentration and exposure levels in rooms since radon has been identified as a carcinogenic gas

Pointed gaps in the provision, quality, patronage and management of toilet facilities in Bawku East District

The objective was to assess the level of sanitation and hygiene with baseline information on the impact of onsite sanitation facility development on public health in the Bawku East District using hundred and sixty eight (n=168) respondents from five randomly selected communities according to UNICEF water and sanitation support programs for a survey. Public latrine alone accounted for 43% patronage of toilet facilities in the district. Unfortunately, about 70% of the population who preferred household toilets rather patronized open defecation due to poverty and inadequate good toilet facilities at user ratio of 1: over 500 people with very low seat capacities. Among the subjects encountered, 42% were unskilled labourers whilst 27% students, who, could hardly afford the comfort of household toilet facilities

Nutrients and bioactive compounds content of Baillonella toxisperma, Trichoscypha abut and Pentaclethra macrophylla from Cameroon

Baillonella toxisperma, Pentaclethra macrophylla and Trichoscypha abut are important foods for communities living around forests in Cameroon. Information on the nutritional value and bioactive content of these foods is required to establish their contribution to the nutrition and health of the communities. Samples of the three foods were obtained from four villages in east and three villages in south Cameroon. The foods were analyzed for proximate composition, minerals and bioactive content using standard chemical analysis methods. T. abut was found to be an excellent source of bioactive compounds; flavonoids (306 mg/100 g), polyphenols (947 mg/100 g), proanthocyanins (61.2 mg/100 g), vitamin C (80.05 mg/100 g), and total oxalates (0.6 mg/100 g). P. macrophylla was found to be a rich source of total fat (38.71%), protein (15.82%) and total fiber (17.10%) and some bioactive compounds; vitamin E (19.4 mg/100 g) and proanthocyanins (65.0 mg/100 g). B. toxisperma, was found to have high content of carbohydrates (89.6%), potassium (27.5 mg/100 g) and calcium (37.5 mg/100 g). Flavonoids, polyphenols, vitamins C and E are the main bioactive compounds in these forest foods. The daily consumption of some of these fruits may coffer protection against some ailments and oxidative stress. Approximately 200 g of either B. toxisperma or P. macrophylla, can supply 100% iron and zinc RDAs for children aged 1–3 years, while 300 g of the two forest foods can supply about 85% iron and zinc RDAs for non-pregnant non-lactating women. The three foods provide 100% daily vitamins C and E requirements for both adults and children. The results of this study show that Baillonella toxisperma, Pentaclethra macrophylla and Trichoscypha abut can considerably contribute towards the human nutrient requirements. These forest foods also contain substantial levels of health promoting phytochemicals notably flavonoids, polyphenols, vitamins C and E. These foods therefore have potential to promote nutrition and health, especially among forest dependent communities who consume them in substantial amounts

Molecular epidemiology of Mycobacterium africanum in Ghana

BACKGROUND: Mycobacterium africanum comprises two phylogenetic lineages within the M. tuberculosis complex (MTBC) and is an important cause of human tuberculosis (TB) in West Africa. The reasons for this geographic restriction of M. africanum remain unclear. Here, we performed a prospective study to explore associations between the characteristics of TB patients and the MTBC lineages circulating in Ghana. METHOD: We genotyped 1,211 MTBC isolates recovered from pulmonary TB patients recruited between 2012 and 2014 using single nucleotide polymorphism typing and spoligotyping. Associations between patient and pathogen variables were assessed using univariate and multivariate logistic regression. RESULTS: Of the 1,211 MTBC isolates analysed, 71.9 % (871) belonged to Lineage 4; 12.6 % (152) to Lineage 5 (also known as M. africanum West-Africa 1), 9.2 % (112) to Lineage 6 (also known as M. africanum West-Africa 2) and 0.6 % (7) to Mycobacterium bovis. Univariate analysis revealed that Lineage 6 strains were less likely to be isoniazid resistant compared to other strains (odds ratio = 0.25, 95 % confidence interval (CI): 0.05-0.77, P < 0.01). Multivariate analysis showed that Lineage 5 was significantly more common in patients from the Ewe ethnic group (adjusted odds ratio (adjOR): 2.79; 95 % CI: 1.47-5.29, P < 0.001) and Lineage 6 more likely to be found among HIV-co-infected TB patients (adjOR = 2.2; 95 % confidence interval (CI: 1.32-3.7, P < 0.001). CONCLUSION: Our findings confirm the importance of M. africanum in Ghana and highlight the need to differentiate between Lineage 5 and Lineage 6, as these lineages differ in associated patient variables