Actions, attitudes and beliefs of occupants in managing dampness in buildings

Dampness in buildings affects the health of occupants, structural stability and energy efficiency of buildings. Solutions to managing dampness focus on promoting the use of damp-proof construction materials, enhancing methods to avoid the introduction of moisture during construction and creating the awareness on the health effect of dampness. These solutions are incomplete without the identification of behaviours that occupants require to manage dampness. Given that dampness is characterised by the availability of a source, a route for the moisture to travel and driving force for moisture movement, the occupants can be said to play a significant role in contributing to dampness. As a result, this study seeks to examine the behaviours of occupants manifested to manage dampness in residential buildings. To achieve the aim, a qualitative research method was employed, under which interviews were carried out. Occupants in households in the northern and southern parts of England were interviewed to identify the actions, attitudes and beliefs in managing dampness. The findings revealed actions such as aeration and the use of anti-damp sprays. From the findings, dampness instilled attitudes such as anger, moodiness and unhappiness. In addition, dampness instilled cleaning habits in occupants due to the lack of comfort moulds create and the awareness of its health impact. The identification of these behaviours creates the awareness for occupants on their roles in managing dampness and how dampness affects their behaviours in addition to the health impact. This research also contributes to existing debates on dampness reduction specifically in residential buildings

Mechanisms for preventing rising damp in new building infrastructure

Purpose: Capillary rise of water in buildings has been an issue of concern among past and present researchers. Despite the research efforts devoted to the proper elimination of the problem in masonry construction, it still remains a challenge that needs to be addressed. This study explores treatment mechanisms that can be used to prevent rising damp in new building infrastructure. Methodology: Fourteen test walls are constructed, conditioned, subjected to various treatments, and monitored for four years. The treatments applied to the walls include the use of polyethylene damp proof courses, damp proof coatings, and dense concrete bases. The walls are then monitored with reference to the two climate seasons in Ghana. Findings: The results highlights that rising damp is present, as suggested by the constant increase and decrease in the height of the water levels in the walls during the rainy and dry seasons respectively. The findings further reveal that within the four-year period, the walls treated with the damp proof coatings, together with those with the dense concrete bases performed better than those treated with the polyethylene damp proof courses. Limitations: The economic and commercial impact of these preventive mechanisms were not considered in this study. A future research can be directed at these issues. Practical implication: The proposed treatment mechanisms highlights the effectiveness of some treatments applied to walls to prevent the capillary rise of water from the ground into the superstructure. Social implications: Building regulations, especially in Ghana and other tropical settings should be amended to include ways to prevent rising damp phenomena by including effective methods against rising damp during the building design or construction. Originality/Value: Series of studies worldwide have been conducted in laboratories to simulate the capillary rise of water in walls of buildings. This is among the few studies that look at how water rises from actual ground conditions into the walls of buildings

2016 Presidential Election - The Winners and Losers in the Health Care Industry

The 2016 presidential election had important implications for the country’s health care policies. In this study, we examine the health care industry stock returns associated with the 2016 presidential campaign. We use both market model and seemingly unrelated regression (SUR) methodologies to estimate abnormal stock returns of each health care sector associated with each event. Our results are robust and mostly consistent with our arguments. The regression analysis further augments our event study results. We find that, during the pre-election period, the Biological Products, Health Insurance, and Major Pharmaceuticals all suffer significantly negative cumulative average abnormal returns (CAARs). The Hospital/Nursing Management and Medical/Dental Instruments fare reasonably well. Our interpretation is that the market takes a dim view on the Biological Products, Health Insurance, and Major Pharmaceuticals sectors when the consensus is that Clinton would win the election. When the election is over, the fortune reverses for the Biological Products and Major Pharmaceuticals. It continues when President Trump meets with the health care industry CEOs. The regression results further confirm our event study results. Our study shows that the 2016 election has a significant impact on the affected industry and the firms in the industry. However, even in the same broad industry, sectors/firms fare differently. Our study shows that it is important to identify the winning and losing sectors and examine the impact of an election on various sectors in a detailed and refined way

Typhoid fever among children, Ghana.

Typhoid fever (TF) remains a problem of concern in many low-income countries. Salmonella enterica serovar Typhi causes ≈22,000,000 symptomatic infections and 220,000 fatalities worldwide annually (1). However, the effect and incidence of TF in many parts of subSaharan Africa are largely unknown because diagnostic laboratories are lacking and fatal TF is frequently attributed to malaria (2,3). In Ghana, TF ranks among the leading 20 causes of outpatient illness, accounting for 0.92% of hospital admissions (4). We conducted our study at the rural Agogo Presbyterian Hospital in the Ashanti Region of Ghana. The percentage of residents of 99 villages and household clusters of buildings (population size 18–13,559 persons, median 277 persons) with access to the study hospital was assessed in a healthcare utilization survey. A proportional-to-size number of children were randomly selected in each village, and a standardized interview was conducted. TF incidences were calculated for September 2007–November 2008 (Table). A bacteriology laboratory with BACTEC 9050 automated blood culture system (Becton Dickinson, Sparks, MD, USA) was established in the study hospital and run to assess the number of admissions with TF, the incidence of TF in the adjoining community and S. enterica ser. Typhi resistance to a panel of antimicrobial drugs

Clinical indicators for bacterial co-infection in Ghanaian children with P. falciparum infection.

Differentiation of infectious causes in severely ill children is essential but challenging in sub- Saharan Africa. The aim of the study was to determine clinical indicators that are able to identify bacterial co-infections in P. falciparum infected children in rural Ghana. In total, 1,915 severely ill children below the age of 15 years were recruited at Agogo Presbyterian Hospital in Ghana between May 2007 and February 2011. In 771 (40%) of the children malaria parasites were detected. This group was analyzed for indicators of bacterial co-infections using bivariate and multivariate regression analyses with 24 socio-economic variables, 16 terms describing medical history and anthropometrical information and 68 variables describing clinical symptoms. The variables were tested for sensitivity, specificity, positive predictive value and negative predictive value. In 46 (6.0%) of the children with malaria infection, bacterial co-infection was detected. The most frequent pathogens were non-typhoid salmonellae (45.7%), followed by Streptococcus spp. (13.0%). Coughing, dehydration, splenomegaly, severe anemia and leukocytosis were positively associated with bacteremia. Domestic hygiene and exclusive breastfeeding is negatively associated with bacteremia. In cases of high parasitemia (>10,000/μl), a significant association with bacteremia was found for splenomegaly (OR 8.8; CI 1.6-48.9), dehydration (OR 18.2; CI 2.0-166.0) and coughing (OR 9.0; CI 0.7-118.6). In children with low parasitemia, associations with bacteremia were found for vomiting (OR 4.7; CI 1.4-15.8), severe anemia (OR 3.3; CI 1.0-11.1) and leukocytosis (OR 6.8 CI 1.9-24.2). Clinical signs of impaired microcirculation were negatively associated with bacteremia. Ceftriaxone achieved best coverage of isolated pathogens. The results demonstrate the limitation of clinical symptoms to determine bacterial co-infections in P. falciparum infected children. Best clinical indicators are dependent on the parasitemia level. Even with a moderate sensitivity of >60%, only low positive predictive values can be obtained due to low prevalence of bacteremia. Rapid testing for distinguishing parasitemia and bacteremia is essential

Incidence and characteristics of bacteremia among children in rural Ghana.

The objective of the study was to describe systemic bacterial infections occurring in acutely ill and hospitalized children in a rural region in Ghana, regarding frequency, incidence, antimicrobial susceptibility patterns and associations with anthropometrical data.Blood cultures were performed in all children below the age of five years, who were admitted to Agogo Presbyterian Hospital (APH), Asante Region, Ghana, between September 2007 and July 2009. Medical history and anthropometrical data were assessed using a standardized questionnaire at admission. Incidences were calculated after considering the coverage population adjusted for village-dependent health-seeking behavior.Among 1,196 hospitalized children, 19.9% (n = 238) were blood culture positive. The four most frequent isolated pathogens were nontyphoidal salmonellae (NTS) (53.3%; n = 129), Staphylococcus aureus (13.2%; n = 32), Streptococcus pneumoniae (9.1%; n = 22) and Salmonella ser. Typhi (7.0%; n = 17). Yearly cumulative incidence of bacteremia was 46.6 cases/1,000 (CI 40.9-52.2). Yearly cumulative incidences per 1,000 of the four most frequent isolates were 25.2 (CI 21.1-29.4) for NTS, 6.3 (CI 4.1-8.4) for S. aureus, 4.3 (CI 2.5-6.1) for S. pneumoniae and 3.3 (CI 1.8-4.9) for Salmonella ser. Typhi. Wasting was positively associated with bacteremia and systemic NTS bloodstream infection. Children older than three months had more often NTS bacteremia than younger children. Ninety-eight percent of NTS and 100% of Salmonella ser. Typhi isolates were susceptible to ciprofloxacin, whereas both tested 100% susceptible to ceftriaxone. Seventy-seven percent of NTS and 65% of Salmonella ser. Typhi isolates were multi-drug resistant (MDR). Systemic bacterial infections in nearly 20% of hospitalized children underline the need for microbiological diagnostics, to guide targeted antimicrobial treatment and prevention of bacteremia. If microbiological diagnostics are lacking, calculated antimicrobial treatment of severely ill children in malaria-endemic areas should be considered

Systemic bacteraemia in children presenting with clinical pneumonia and the impact of non-typhoid salmonella (NTS).

BACKGROUND: The diagnosis and antimicrobial treatment of pneumonia in African children in the absence of diagnostic means such as x-ray facilities or microbiological laboratories relies primarily on clinical symptoms presented by the patients. In order to assess the spectrum of bacterial pathogens, blood cultures were performed in children fulfilling the clinical criteria of pneumonia. METHODS: In total, 1032 blood cultures were taken from children between 2 months and 5 years of age who were admitted to a rural hospital in Ghana between September 2007 and July 2009. Pneumonia was diagnosed clinically and according to WHO criteria classified as "non-severe pneumonia" and "severe pneumonia" ("severe pneumonia" includes the WHO categories "severe pneumonia" and "very severe pneumonia"). RESULTS: The proportion of bacteriaemia with non-typhoid salmonella (NTS) was similar in children with pneumonia (16/173, 9.2%) compared to children hospitalized for other reasons (112/859, 13%). NTS were the predominant organisms isolated from children with clinical pneumonia and significantly more frequent than Streptococcus pneumoniae (8/173, 4.6%). Nine percent (9/101) of children presenting with severe pneumonia and 10% (7/72) of children with non-severe pneumonia were infected with NTS. Nineteen out of 123 NTS isolates (15%) were susceptible to aminopenicillins (amoxycillin/ampicillin), 23/127 (18%) to chlorampenicol, and 23/98 (23%) to co-trimoxazole. All NTS isolates were sensitive to ceftriaxone and ciprofloxacin. CONCLUSION: In Sub-saharan Africa, sepsis with NTS should be considered in children with symptoms of pneumonia and aminopenicillins might often not be the adequate drugs for treatment

Longitudinal estimation of Plasmodium falciparum prevalence in relation to malaria prevention measures in six sub-Saharan African countries.

BACKGROUND: Plasmodium falciparum prevalence (PfPR) is a widely used metric for assessing malaria transmission intensity. This study was carried out concurrently with the RTS,S/AS01 candidate malaria vaccine Phase III trial and estimated PfPR over ≤ 4 standardized cross-sectional surveys. METHODS: This epidemiology study (NCT01190202) was conducted in 8 sites from 6 countries (Burkina Faso, Gabon, Ghana, Kenya, Malawi, and Tanzania), between March 2011 and December 2013. Participants were enrolled in a 2:1:1 ratio according to age category: 6 months-4 years, 5-19 years, and ≥ 20 years, respectively, per year and per centre. All sites carried out surveys 1-3 while survey 4 was conducted only in 3 sites. Surveys were usually performed during the peak malaria parasite transmission season, in one home visit, when medical history and malaria risk factors/prevention measures were collected, and a blood sample taken for rapid diagnostic test, microscopy, and haemoglobin measurement. PfPR was estimated by site and age category. RESULTS: Overall, 6401 (survey 1), 6411 (survey 2), 6400 (survey 3), and 2399 (survey 4) individuals were included in the analyses. In the 6 months-4 years age group, the lowest prevalence (assessed using microscopy) was observed in 2 Tanzanian centres (4.6% for Korogwe and 9.95% for Bagamoyo) and Lambaréné, Gabon (6.0%), while the highest PfPR was recorded for Nanoro, Burkina Faso (52.5%). PfPR significantly decreased over the 3 years in Agogo (Ghana), Kombewa (Kenya), Lilongwe (Malawi), and Bagamoyo (Tanzania), and a trend for increased PfPR was observed over the 4 surveys for Kintampo, Ghana. Over the 4 surveys, for all sites, PfPR was predominantly higher in the 5-19 years group than in the other age categories. Occurrence of fever and anaemia was associated with high P. falciparum parasitaemia. Univariate analyses showed a significant association of anti-malarial treatment in 4 surveys (odds ratios [ORs]: 0.52, 0.52, 0.68, 0.41) and bed net use in 2 surveys (ORs: 0.63, 0.68, 1.03, 1.78) with lower risk of malaria infection. CONCLUSION: Local PfPR differed substantially between sites and age groups. In children 6 months-4 years old, a significant decrease in prevalence over the 3 years was observed in 4 out of the 8 study sites. Trial registration Clinical Trials.gov identifier: NCT01190202:NCT. GSK Study ID numbers: 114001

Antibiotic resistance in Escherichia coli and Klebsiella pneumoniae: mobile resistance genes and outer membrane porins

β-lactam antibiotics are among the most frequently prescribed antimicrobial agents for the treatment of severe infections and the emergence of β-lactam resistance in E. coli and K. pneumoniae (recently described by WHO as critical antibiotic resistant priority pathogens) has become a serious problem world-wide. In this thesis, the β-lactamase genes conferring resistance to third generation cephalosporin in E. coli and K. pneumoniae at a teaching hospital in Ghana were explored (Chapter 2). blaCTX-M-15 was identified as the predominant ESBL gene (n=62/63) in E. coli and K. pneumoniae and this is consistent with global data. In these isolates, blaCTX-M-15 was associated with ISEcp1 and orf477Δ and majority of them also carried additional resistance genes (blaTEM, aac(3)-II, aacA4cr and/or blaOXA-30) conferring resistance to other unrelated antibiotics (Chapter 2). In Chapter 3 of this thesis, the minimal inhibitory concentration (MIC) distributions of selected third-generation cephalosporin and carbapenem antibiotics against E. coli and K. pneumoniae isolates carrying commonly acquired resistance genes including blaCTX-M-15 was explored, to explore variation of the normal distribution of the MIC. It was observed that β-lactam MICs associated with acquired resistance genes are normally distributed and any variation in this normal distribution in K. pneumoniae is predictably linked to changes in the major porin OmpK36. Most clinical isolates of K. pneumoniae lack OmpK35 and therefore cannot compensate for any OmpK36 deficiency, as they normally might. Fitness costs and antimicrobial resistance associated with different outer membrane porin mutations were explored (Chapter 4). The OmpK35 deficient mutant was competitive with the parental strain in high osmolarity nutritious media, where OmpK35 is not normally expressed, which may explain why most ESBL producing K. pneumoniae isolates lack this porin. Among the mutations in the OmpK36 (OmpK36 deletion versus OmpK36134_135dupGD [GD duplication]), the GD duplication had less impact on fitness although both had comparable resistance phenotypes. This suggests that the GD duplication commonly seen in clinical isolate of K. pneumoniae could allow a resistant population to stably co-exist with competing antibiotic-susceptible populations in the absence of antibiotic selection pressure