Factors affecting birth weight in Cape Coast, Ghana

Background: This study aimed at determining the incidence of low birth weight among live births and maternal anaemia and to investigate the association between some maternal factors and birth weight.Methods: This was a retrospective cross sectional study that involved mothers who regularly attended antenatal clinics and had delivered singleton live births between January 2014 to December 2014 in the University of Cape Coast Hospital, Cape Coast, Ghana.Results: Out of the 405 newborns included in the study, 194 (47.90%) were females and 211 (52.10%) males with a mean birth weight of 3.25±0.52kg. There was a low birth weight prevalence of 7.7% and a maternal anaemia prevalence of 38.8%. The period of gestation (p=0.00001), maternal anaemia (p=0.0217) and maternal age (p=0.0030) were found to be significantly associated with birth weight. Sex of baby (p=0.6668), parity of mother (p=0.6959) and maternal sickling status (p=0.7915) were not significantly associated with birth weight.Conclusions: As far as low birth weight is concerned, frequency is not high among live babies born to mothers who regularly attended antenatal clinics. This agrees with studies that suggest that antenatal clinic attendance positively affects birth weight. Thus in order to reduce the high prevalence of low birth weight and maternal anaemia in developing countries all pregnant women must be encouraged to attend antenatal clinics regularly

Antidepressant-like properties of Antiaris toxicaria aqueous extract

Background: Depression is a global burden whose therapy is plagued with inconsistent efficacy. Hence, the need for the discovery of newer therapies.Methods: In this study, Antiaris toxicaria extract (200, 400 and 800 mg/kg, p.o.), was evaluated for antidepressant activity using behavioral tests battery particularly the forced swim test (FST) and tail suspension test (TST). In order to investigate its mechanism of action, animals groups were pretreated with α-methyldopa (α-MD), para-chlorophenylalanine (PCPA), reserpine, D-serine and 5-hydroxytryptophan.Results: It increased the mobility periods and decreased immobility periods significantly in both the FST and the TST when compared to the control group. But the TST showed more promising effect than the FST. Pre-treatment with α-MD reversed the antidepressant property of A. toxicaria aqueous extract as did PCPA, reserpine and reserpine combined with α-MD. The extract increased the number of head twitches produced by 5-hydroxytryptophan confirming the involvement of serotonin in the antidepressant property and inhibited carbachol-induced contractions on the isolated rat uterus, which was non-competitively antagonized by propranolol.Treatment with D-serine produced no significant increase in the immobility time produced by the extract at the doses studied. This excludes the involvement of N-methyl-d-aspartate in the possible mechanisms of action.Conclusion: A. toxicaria possesses antidepressant-like action in rodents

Spectrum of anxiety and depression reported in reproductive-aged women diagnosed with gynaecological disorders at a tertiary healthcare facility in Ghana

Background: Patients with gynaecological disorders often suffer from psychological disorders including anxiety and depression. Although depression and anxiety have been studied in Ghana, data regarding the prevalence of these disorders in patients with gynaecological disorders is non-existent. The aim of the study was to investigate the prevalence of anxiety and depression in reproductive-aged women diagnosed with gynaecological disorders.Methods: Cross-sectional observational study was conducted at the Gynaecology Clinic of Korle-Bu Teaching Hospital, a tertiary health facility in Accra, Ghana. Patients of reproductive age seeking gynaecological care at the facility from December 2018 to January 2019 were assessed for anxiety and depression using the Generalized anxiety disorder (GAD) questionnaire and the Beck depression inventory (BDI) respectively. Sociodemographic and clinical information was gathered as well.Results: Of the 120 patients interviewed (mean age 34.33±0.66), 36.7% were depressed while 51.6% were reported anxiety disorders. Patients aged 35-45 years had the highest prevalence of anxiety (24.58%) and depression (29.18%). Again, prevalence rates were highest among respondents with senior high school as the highest educational qualification, (anxiety (22.15%); depression (24.20%). Patients suffering from pelvic floor disorder recorded the highest prevalence of anxiety (11.40%) and depression (13.77%). There was a significant association between depression and gynaecological disorders [χ2(25) =53.915, p=0.001, CI=95%], but there was not enough evidence of an association between anxiety and gynaecological disorders [χ2(15) =22.791, p=0.089, CI=95%].Conclusions: Anxiety and depression are prevalent amongst women in their reproductive age diagnosed presenting with gynaecological disorders and there is a significant association between gynaecological disorders and the prevalence of depression

A review of pharmacological effects of xylopic acid

Xylopic acid (15β-acetyloxy-kaur-16-en-19-oic acid) is a kaurene diterpene that can be obtained from various Xylopia spp. Xylopic acid has demonstrated several pharmacological activities in vitro and in vivo. The compound has shown promising effect as a potent analgesic, anti-inflammatory and anti-allergic agent. Xylopic acid is a CNS depressant and was able to ameliorate anxiety-like symptoms in mice in addition to its neuroprotective effects. Deleterious effects of xylopic acid on the reproductive system of mice have been well documented but extensive toxicity study detailing effect of the acid upon chronic exposure needs to be determined. Due to the heavy consumption of X. aethiopica fruits, it is recommended that the pharmacokinetics of xylopic acid be determined to ascertain the possible food-drug interaction that may occur when conventional drugs are taken together with foods containing xylopic acid

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Factors affecting birth weight in Cape Coast, Ghana

Background: This study aimed at determining the incidence of low birth weight among live births and maternal anaemia and to investigate the association between some maternal factors and birth weight.Methods: This was a retrospective cross sectional study that involved mothers who regularly attended antenatal clinics and had delivered singleton live births between January 2014 to December 2014 in the University of Cape Coast Hospital, Cape Coast, Ghana.Results: Out of the 405 newborns included in the study, 194 (47.90%) were females and 211 (52.10%) males with a mean birth weight of 3.25±0.52kg. There was a low birth weight prevalence of 7.7% and a maternal anaemia prevalence of 38.8%. The period of gestation (p=0.00001), maternal anaemia (p=0.0217) and maternal age (p=0.0030) were found to be significantly associated with birth weight. Sex of baby (p=0.6668), parity of mother (p=0.6959) and maternal sickling status (p=0.7915) were not significantly associated with birth weight.Conclusions: As far as low birth weight is concerned, frequency is not high among live babies born to mothers who regularly attended antenatal clinics. This agrees with studies that suggest that antenatal clinic attendance positively affects birth weight. Thus in order to reduce the high prevalence of low birth weight and maternal anaemia in developing countries all pregnant women must be encouraged to attend antenatal clinics regularly

Global Response to the Initial Outbreak of COVID-19 and its Implications on the Current Happenings

Hagan Jr. JE, Ahinkorah BO, Seidu AA, Ameyaw EK, Schack T. Global Response to the Initial Outbreak of COVID-19 and its Implications on the Current Happenings. Journal of Physical Medicine and Rehabilitation. 2020;2(2):1-5

Africa’s COVID-19 situation in focus and recent happenings: A mini review.

Hagan Jr. JE, Ahinkorah BO, Seidu AA, Ameyaw EK, Schack T. Africa’s COVID-19 situation in focus and recent happenings: A mini review. Frontiers in Public Health. 2020;8:1-8

Isobolographic analysis of co-administration of two plant-derived antiplasmodial drug candidates, cryptolepine and xylopic acid, in Plasmodium berghei

Abstract Background Increasing resistance to current anti-malarial therapies requires a renewed effort in searching for alternative therapies to combat this challenge, and combination therapy is the preferred approach to address this. The present study confirms the anti-plasmodial effects of two compounds, cryptolepine and xylopic acid and the relationship that exists in their combined administration determined. Methods Anti-plasmodial effect of cryptolepine (CYP) (3, 10, 30 mg kg−1) and xylopic acid (XA) (3, 10, 30 mg kg−1) was evaluated in Plasmodium berghei-infected male mice after a 6-day drug treatment. The respective doses which produced 50% chemosuppression (ED50) was determined by iterative fitting of the log-dose responses of both drugs. CYP and XA were then co-administered in a fixed dose combination of their ED50s (1:1) as well as different fractions of these combinations (1/2, 1/4, 1/8, 1/16 and 1/32) to find the experimental ED50 (Zexp). The nature of interaction between cryptolepine and xylopic acid was determined by constructing an isobologram to compare the Zexp with the theoretical ED50 (Zadd). Additionally, the effect of cryptolepine/xylopic acid co-administration on vital organs associated with malarial parasiticidal action was assessed. Results The Zadd and Zexp were determined to be 12.75 ± 0.33 and 2.60 ± 0.41, respectively, with an interaction index of 0.2041. The Zexp was significantly (P < 0.001) below the additive isobole indicating that co-administration of cryptolepine and xylopic acid yielded a synergistic anti-plasmodial effect. This observed synergistic antiplasmodial effect did not have any significant deleterious effect on the kidney, liver and spleen. However, the testis were affected at high doses. Conclusion The co-administration of cryptolepine and xylopic acid produces synergistic anti-malarial effect with minimal toxicity