Access to Maternal Healthcare Services under the National Health Insurance Policy in the Upper West Region, Ghana

Health insurance coverage provides the spring board for pregnant women to access and utilise maternal healthcare services. Yet, studies on health insurance coverage, access and utilisation of maternal healthcare are a handful. Consequently, this study examines women’s access and utilisation of maternal healthcare services under the free maternal health policy in two districts in northern Ghana. The study adopted the mixed research approach with the aid of the cross-sectional design involving 212 respondents. An interview schedule was utilised in the collection of data. Percentages, Chi-square test for independence and Mann-Whitney U test as well as thematic analysis were used to analyse the data. The study revealed that 93.9% of the respondents had enrolled unto the national health insurance scheme and 98.6% of them went for antennal care. Majority (66.5%) of them had facility-based delivery. However, 79.7% of them incur cost in seeking delivery care. In brief, health insurance coverage appears to contribute to improved access and utilisation of maternal healthcare services in the two districts. Nonetheless, the government should provide the basic items that are needed for delivery to lessen the cost burden associated with facility-based delivery

Sorting the facts from the lots: Contribution of artisanal and small-scale mining (galamsey) to rural livelihood configurations in sub-Saharan Africa

In recent times, what is common in the scientific literature is findings showcasing the environmental and social menaces associated with artisanal and small-scale mining (ASM)–low-tech, low capital investment, and labor-intensive mineral extraction and processing. However, a better understanding of how ASM shapes livelihood and rural economies may present nuances as to how its negative ramifications can be addressed. As a result, this paper examines how galamsey engenders livelihoods and the transformation of rural economies in Ghana. We produced a nuanced counter-debate to the widely held view that galamsey is evil and a menace to national development by sourcing data from 236 operators using a questionnaire and key informant interviews with 11 relevant stakeholders in north-western Ghana. Findings show that galamsey is a source of employment, income, and accumulation of assets such as houses, motorbikes, cars, and filling stations, which together make the local economy thrive, thereby fostering a local economic boom. However, there is limited collaboration between regulatory agencies and local stakeholders in implementing sustainable mining policies in Ghana. To address this problem, the government should engage local community actors such as the chiefs and landlords, assembly members, and the lead miners on possible steps to streamline and effectively monitor galamsey operations as opposed to military clamp downs

Asymptomatic Malaria Infection and the Immune Response to the 2-Dose Ad26.ZEBOV, MVA-BN-Filo Ebola Vaccine Regimen in Adults and Children

Background Malaria infection affects the immune response to some vaccines. As Ebola virus (EBOV) outbreaks have occurred mainly in malaria-endemic countries, we have assessed whether asymptomatic malaria affects immune responses to the 2-dose Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen. Methods In this sub-study of the EBOVAC-Salone Ebola vaccine trial in Sierra Leone, malaria microscopy was performed at the time of Ebola vaccination. Participants with symptomatic malaria were treated before vaccination. Ebola vaccine responses were assessed post-dose 1 (day 57) and post-dose 2 (day 78) by the EBOV glycoprotein FANG enzyme-linked immunosorbent assay (ELISA), and responses expressed as geometric mean concentrations (GMCs). Geometric mean ratios (GMRs) of the GMCs in malaria-positive versus malaria-negative participants were derived with 95% confidence intervals (CIs). Results A total of 587 participants were studied, comprising 188 adults (≥18 years) and 399 children (in age groups of 12–17, 4–11, and 1–3 years). Asymptomatic malaria was observed in 47.5% of adults and 51.5% of children on day 1. Post-dose 1, GMCs were lower in 1–3-year-old malaria-positive compared with malaria-negative children (age group–specific GMR, .56; 95% CI, .39–.81) but not in older age groups. Post-dose 2, there was no consistent effect of malaria infection across the different age groups but there was a trend toward a lower response (GMR, .82; 95% CI, .67–1.02). Conclusions The Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen is immunogenic in participants with asymptomatic malaria. Therefore, it is not necessary to screen for asymptomatic malaria infection prior to vaccination with this regimen

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Effects of microfinance and small loans centre on poverty reduction in Wa West District, Ghana

Poverty, a pervasive and consequential global issue, has garnered significant attention due to its wide-reaching prevalence and profound implications. Various strategies, including microfinance, have been implemented to tackle this pressing concern. One such strategy is the Microfinance and Small Loans Centre (MASLOC) in Ghana, which aims to reduce poverty. However, despite its potential, MASLOC's role in poverty reduction has yet to be thoroughly examined, leading to inconclusive findings, and necessitating this study. A single case study design addressed this research gap and provided valuable insights. A comprehensive dataset was compiled through interviews and observations involving 40 MASLOC beneficiaries and officials. Thematic analysis was utilized to dissect the collected data, revealing noteworthy patterns and trends. The study's outcomes shed light on MASLOC's effectiveness in mitigating poverty. Specifically, it was found that MASLOC played a pivotal role in poverty reduction by bolstering income levels, amplifying consumption patterns, facilitating access to fundamental necessities, and enabling the accumulation of valuable assets. Nevertheless, the analysis also highlighted specific challenges. Issues related to loan repayment and staffing emerged as constraints within the MASLOC framework. In essence, the study established that MASLOC contributes to the overarching goal of poverty reduction. The findings are helpful because fostering a positive attitude towards loan repayment is crucial, and this endeavour should be complemented by the strategic recruitment of competent staff members who can effectively navigate the intricacies of the scheme to ensure the sustainability of MASLOC. What sets this study apart is its innovative exploration of the impact of MASLOC on poverty—a primarily overlooked facet. By delving into this uncharted territory, the study enriches the ongoing discourse surrounding government microfinance schemes' influence on its beneficiaries. This research contributes not only to the academic realm but also to the practical realm, as it offers actionable insights for policymakers in poverty reduction

Livelihood Diversification Among Indigenous Peri-Urban Women in the Wa Municipality, Ghana

Studies on peri-urban development have not paid enough attention to the strategies and dynamics of diversifying livelihoods among  indigenous women in the Global South. This paper explores the dynamics of livelihood diversification strategies among indigenous women in response to peri-urban development in Wa, Ghana. The mixed-methods design guided the study, while the sample consisted 399 respondents selected from a sample frame of 1494 women. Data analyses involved descriptive statistics, non-parametric and thematic analyses. The study found that peri-urban development had led to the loss of access to farmland among indigenous women. In response, women have resorted to switching from farm-based to non-farm-based livelihoods amidst multiple production challenges.There is, therefore, the need to support the sustainability of women’s livelihoods through the Municipal Assembly and, in particular, through policy interventions such as support for skills training and financial support to enable indigenous people to make a sustainable living. Keywords: Diversification, Ghana, Livelihoods, Peri-Urbanization, Wome

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality