The effect of milk type and fortification on the growth of low-birthweight infants: An umbrella review of systematic reviews and meta-analyses

Approximately 15% of infants worldwide are born with low birthweight (<2500 g). These children are at risk for growth failure. The aim of this umbrella review is to assess the relationship between infant milk type, fortification and growth in low-birthweight infants, with particular focus on low- and lower middle–income countries. We conducted a systematic review in PubMed, CINAHL, Embase and Web of Science comparing infant milk options and growth, grading the strength of evidence based on standard umbrella review criteria. Twenty-six systematic reviews qualified for inclusion. They predominantly focused on infants with very low birthweight (<1500 g) in high-income countries. We found the strongest evidence for (1) the addition of energy and protein fortification to human milk (donor or mother's milk) leading to increased weight gain (mean difference [MD] 1.81 g/kg/day; 95% confidence interval [CI] 1.23, 2.40), linear growth (MD 0.18 cm/week; 95% CI 0.10, 0.26) and head growth (MD 0.08 cm/week; 95% CI 0.04, 0.12) and (2) formula compared with donor human milk leading to increased weight gain (MD 2.51 g/kg/day; 95% CI 1.93, 3.08), linear growth (MD 1.21 mm/week; 95% CI 0.77, 1.65) and head growth (MD 0.85 mm/week; 95% CI 0.47, 1.23). We also found evidence of improved growth when protein is added to both human milk and formula. Fat supplementation did not seem to affect growth. More research is needed for infants with birthweight 1500–2500 g in low- and lower middle–income countries

Attitudes towards persons with mental health conditions and psychosocial disabilities as rights holders in Ghana: a World Health Organization study

Background: There are currently major efforts underway in Ghana to address stigma and discrimination, and promote the human rights of those with mental health conditions, within mental health services and the community, working with the World Health Organization’s QualityRights initiative. The present study aims to investigate attitudes towards people with lived experience of mental health conditions and psychosocial disabilities as rights holders. Methods: Stakeholders within the Ghanaian mental health system and community, including health professionals, policy makers, and persons with lived experience, completed the QualityRights pre-training questionnaire. The items examined attitudes towards coercion, legal capacity, service environment, and community inclusion. Additional analyses explored how far participant factors may link to attitudes. Results: Overall, attitudes towards the rights of persons with lived experience were not well aligned with a human rights approach to mental health. Most people supported the use of coercive practices and often thought that health practitioners and family members were in the best position to make treatment decisions. Health/mental health professionals were less likely to endorse coercive measures compared to other groups. Conclusion: This was the first in-depth study assessing attitudes towards persons with lived experience as rights holders in Ghana, and frequently attitudes did not comply with human rights standards, demonstrating a need for training initiatives to combat stigma and discrimination and promote human rights

Community-based Cluster Surveys on Treatment Preferences for Diarrhoea, Severe Diarrhoea, and Dysentery in Children Aged Less Than Five Years in Two Districts of Ghana

Hospital-based surveillance for severe diarrhoea has been recommended to assess the burden of disease due to rotavirus. However, information on healthcare-seeking patterns of residents in the hospital catchment area is needed first to obtain the burden of disease in the community using the hospital data. A community-based cluster survey was conducted in two districts of Ghana, each served by a single district hospital, to determine the prevalence of severe diarrhoea among and treatment preferences for children aged less than five years. Caretakers of 619 children in Tema, an urban district, and caretakers of 611 children in Akwapim South, a rural district, were interviewed. During the month preceding the survey, the prevalence of severe diarrhoea in children aged less than five years was similar in the two districts (13.6% urban and 12.9% rural), as was the proportion of mothers who sought care outside the home (69.0% urban and 70.9% rural). 48.8% of urban mothers of children with severe diarrhoea visited public/private clinics, 9.5% pharmacies, and 3.6% the district hospital. Whereas, 22.8% of rural mothers visited public/private clinics, 19.0% pharmacies, and 13.9% the district hospital. Results of the study suggest that rotavirus surveillance should be guided by community studies on healthcare-use patterns. Where hospital use is low for severe diarrhoea, rotavirus surveillance should include other health facilities

Globally, functional traits are weak predictors of juvenile tree growth, and we do not know why

1. Plant functional traits, in particular specific leaf area (SLA), wood density and seed mass, are often good predictors of individual tree growth rates within communities. Individuals and species with high SLA, low wood density and small seeds tend to have faster growth rates. 2. If community-level relationships between traits and growth have general predictive value, then similar relationships should also be observed in analyses that integrate across taxa, biogeographic regions and environments. Such global consistency would imply that traits could serve as valuable proxies for the complex suite of factors that determine growth rate, and, therefore, could underpin a new generation of robust dynamic vegetation models. Alternatively, growth rates may depend more strongly on the local environment or growth-trait relationships may vary along environmental gradients. 3. We tested these alternative hypotheses using data on 27352 juvenile trees, representing 278 species from 27 sites on all forested continents, and extensive functional trait data, 38% of which were obtained at the same sites at which growth was assessed. Data on potential evapotranspiration (PET), which summarizes the joint ecological effects of temperature and precipitation, were obtained from a global data base. 4. We estimated size-standardized relative height growth rates (SGR) for all species, then related them to functional traits and PET using mixed-effect models for the fastest growing species and for all species together. 5. Both the mean and 95th percentile SGR were more strongly associated with functional traits than with PET. PET was unrelated to SGR at the global scale. SGR increased with increasing SLA and decreased with increasing wood density and seed mass, but these traits explained only 3.1% of the variation in SGR. SGR-trait relationships were consistently weak across families and biogeographic zones, and over a range of tree statures. Thus, the most widely studied functional traits in plant ecology were poor predictors of tree growth over large scales. 6. Synthesis. We conclude that these functional traits alone may be unsuitable for predicting growth of trees over broad scales. Determining the functional traits that predict vital rates under specific environmental conditions may generate more insight than a monolithic global relationship can offer.Additional co-authors: Hervé Jactel, Xuefei Li, Kaoru Kitajima, Julia Koricheva, Cristina Martínez-Garza, Christian Messier, Alain Paquette, Christopher Philipson, Daniel Piotto, Lourens Poorter, Juan M. Posada, Catherine Potvin, Kalle Rainio, Sabrina E. Russo, Mariacarmen Ruiz-Jaen, Michael Scherer-Lorenzen, Campbell O. Webb, S. Joseph Wright, Rakan A. Zahawi, and Andy Hecto

Community-based Cluster Surveys on Treatment Preferences for Diarrhoea, Severe Diarrhoea, and Dysentery in Children Aged Less Than Five Years in Two Districts of Ghana

ABSTRACT Hospital-based surveillance for severe diarrhoea has been recommended to assess the burden of disease due to rotavirus. However, information on healthcare-seeking patterns of residents in the hospital catchment area is needed first to obtain the burden of disease in the community using the hospital data. A community-based cluster survey was conducted in two districts of Ghana, each served by a single district hospital, to determine the prevalence of severe diarrhoea among and treatment preferences for children aged less than five years. Caretakers of 619 children in Tema, an urban district, and caretakers of 611 children in Akwapim South, a rural district, were interviewed. During the month preceding the survey, the prevalence of severe diarrhoea in children aged less than five years was similar in the two districts (13.6% urban and 12.9% rural), as was the proportion of mothers who sought care outside the home (69.0% urban and 70.9% rural). 48.8% of urban mothers of children with severe diarrhoea visited public/private clinics, 9.5% pharmacies, and 3.6% the district hospital. Whereas, 22.8% of rural mothers visited public/private clinics, 19.0% pharmacies, and 13.9% the district hospital. Results of the study suggest that rotavirus surveillance should be guided by community studies on healthcare-use patterns. Where hospital use is low for severe diarrhoea, rotavirus surveillance should include other health facilities

A nationwide evaluation study of the quality of care and respect of human rights in mental health facilities in Ghana: results from the World Health Organization QualityRights initiative

Background: In 2012, Ghana ratified the United Nations Convention on the Rights of Persons with Disabilities and enacted a Mental Health Act to improve the quality of mental health care and stop human rights violations against people with mental health conditions. In line with these objectives, Ghanaian stakeholders collected data on the quality of mental health services and respect for human rights in psychiatric facilities to identify challenges and gather useful information for the development of plans aimed to improve the quality of the services offered. This study aimed to assess psychiatric facilities from different Ghanaian regions and provide evidence on the quality of care and respect of human rights in mental health services. Methods: Assessments were conducted by independent visiting committees that collected data through observation, review of documentation, and interviews with service users, staff, and carers, and provided scores using the World Health Organization QualityRights Toolkit methodology. Results: This study revealed significant key challenges in the implementation of the United Nations Convention on the Rights of Persons with Disabilities principles in Ghanaian psychiatric services. The rights to an adequate standard of living and enjoyment of the highest attainable standard of health were not fully promoted. Only initial steps had been taken to guarantee the right to exercise legal capacity and the right to personal liberty and security. Significant gaps in the promotion of the right to live independently and be included in the community were identified. Conclusions: This study identifies shortcomings and critical areas that the Ghanaian government and facilities need to target for implementing a human rights-based approach in mental health and improve the quality of mental health care throughout the country

Police views of suicidal persons and the law criminalizing attempted suicide in Ghana: A qualitative study with policy implications

The penal code of Ghana condemns suicide attempt. The present study sought to explore the views of the police on persons who attempt suicide and the law criminalizing the act. Qualitative in-depth interviews were used to explore the views of 18 officers of the Ghana Police Service. Data were analyzed using thematic analysis technique. Findings showed that the police officers profiled suicide attempters as needy, enigmatic, ignorant, and blameworthy. Majority (n = 14) of them disagreed with the law and suggested a repeal, whereas only four of them agreed with the law. Regardless of their positions on criminalization, they showed an inclination to help, rather than arrest, when confronted with such persons in line of their duty. Educating the police on suicidal behavior may help to deepen their understanding and help improve the way they handle suicidal persons. This may also strengthen police suicide prevention gatekeeping obligations

Globally, functional traits are weak predictors of juvenile tree growth, and we do not know why

1. Plant functional traits, in particular specific leaf area (SLA), wood density and seed mass, are often good predictors of individual tree growth rates within communities. Individuals and species with high SLA, low wood density and small seeds tend to have faster growth rates. 2. If community-level relationships between traits and growth have general predictive value, then similar relationships should also be observed in analyses that integrate across taxa, biogeographic regions and environments. Such global consistency would imply that traits could serve as valuable proxies for the complex suite of factors that determine growth rate, and, therefore, could underpin a new generation of robust dynamic vegetation models. Alternatively, growth rates may depend more strongly on the local environment or growth–trait relationships may vary along environmental gradients. 3. We tested these alternative hypotheses using data on 27 352 juvenile trees, representing 278 species from 27 sites on all forested continents, and extensive functional trait data, 38% of which were obtained at the same sites at which growth was assessed. Data on potential evapotranspiration (PET), which summarizes the joint ecological effects of temperature and precipitation, were obtained from a global data base. 4. We estimated size-standardized relative height growth rates (SGR) for all species, then related them to functional traits and PET using mixed-effect models for the fastest growing species and for all species together. 5. Both the mean and 95th percentile SGR were more strongly associated with functional traits than with PET. PET was unrelated to SGR at the global scale. SGR increased with increasing SLA and decreased with increasing wood density and seed mass, but these traits explained only 3.1% of the variation in SGR. SGR–trait relationships were consistently weak across families and biogeographic zones, and over a range of tree statures. Thus, the most widely studied functional traits in plant ecology were poor predictors of tree growth over large scales. 6. Synthesis. We conclude that these functional traits alone may be unsuitable for predicting growth of trees over broad scales. Determining the functional traits that predict vital rates under specific environmental conditions may generate more insight than a monolithic global relationship can offer