Progress with the implementation of kangaroo mother care in four regions in Ghana

AIM : To measure progress with the implementation of kangaroo mother care (KMC) for low birth-weight (LBW) infants at a health systems level. DESIGN : Action research design, with district and regional hospitals as the unit of analysis. SETTING : Four regions in Ghana, identified by the Ghana Health Service and UNICEF. PARTICIPANTS : Health workers and officials, health care facilities and districts in the four regions. INTERVENTION : A one-year implementation programme with three phases: (1) introduction to KMC, skills development in KMC practice and the management of implementation; (2) advanced skills development for regional steering committee members; and (3) an assessment of progress at the end of the intervention. MAIN OUTCOME MEASURES : Description of practices, services and facilities for KMC and the identification of strengths and challenges. RESULTS : Twenty-six of 38 hospitals (68%) demonstrated sufficient progress with KMC implementation. Half of the hospitals had designated a special ward for KMC. 66% of hospitals used a special record for infants receiving KMC. Two of the main challenges were lack of support for mothers who had to remain with their LBW infants in hospital and no follow-up review services for LBW infants in 39% of hospitals. CONCLUSIONS : It was possible to roll out KMC in Ghana, but further support for the regions is needed to maintain the momentum. Lessons learned from this project could inform further scale-up of KMC and other projects in Ghana.The United Nations Children’s Fundhttp://www.ghanamedj.orgam2017Paediatrics and Child Healt

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Progress with the Implement of Kangaroo Mother Care in Four Regions in Ghana

Aim: To measure progress with the implementation of kangaroo mother care (KMC) for low birth-weight (LBW) infants at a health systems level.Design: Action research design, with district and regional hospitals as the unit of analysis.Setting: Four regions in Ghana, identified by the Ghana Health Service and UNICEF.Participants: Health workers and officials, health care facilities and districts in the four regions.Intervention: A one-year implementation programme with three phases: (1) introduction to KMC, skills development in KMC practice and the management of implementation; (2) advanced skills development for regional steering committee members; and (3) an assessment of progress at the end of the intervention.Main outcome measures: Description of practices, services and facilities for KMC and the identification of strengths and challenges.Results: Twenty-six of 38 hospitals (68%) demonstrated sufficient progress with KMC implementation. Half of the hospitals had designated a special ward for KMC. 66% of hospitals used a special record for infants receiving KMC. Two of the main challenges were lack of support for mothers who had to remain with their LBW infants in hospital and no follow-up review services for LBW infants in 39% of hospitals.Conclusions: It was possible to roll out KMC in Ghana, but further support for the regions is needed to maintain the momentum. Lessons learned from this project could inform further scale-up of KMC and other projects in Ghana.Keywords: kangaroo mother care, premature infant, implementation, evaluation, Ghan

Projections and impact assessment of the local climate change conditions of the Black Volta Basin of Ghana based on the Statistical DownScaling Model

The uncertainties and biases associated with Global Climate Models (GCMs) ascend from global to regional and local scales which delimits the applicability and suitability of GCMs in site-specific impact assessment research. The study downscaled two GCMs to evaluate effects of climate change (CC) in the Black Volta Basin (BVB) using Statistical DownScaling Model (SDSM) and 40-year ground station data. The study employed Taylor diagrams, dimensionless, dimensioned, and goodness of fit statistics to evaluate model performance. SDSM produced good performance in downscaling daily precipitation, maximum and minimum temperature in the basin. Future projections of precipitation by HadCM3 and CanESM2 indicated decreasing trend as revealed by the delta statistics and ITA plots. Both models projected near- to far-future increases in temperature and decreases in precipitation by 2.05-23.89, 5.41–46.35, and 5.84–35.33% in the near, mid, and far future respectively. Therefore, BVB is expected to become hotter and drier by 2100. As such, climate actions to combat detrimental effects on the BVB must be revamped since the basin hosts one of the largest hydropower dams in Ghana. The study is expected to support the integration of CC mitigation into local, national, and international policies, and support knowledge and capacity building to meet CC challenges