Deterrent libraries: Denying persons with disability

The 2030 Agenda for Sustainable Development which aims at the eradication of poverty by 2030 has as its fourth goal the need to ensure inclusive and equitable education for all. Nonetheless, less than two per cent of Persons with Disabilities (PWDs) in Ghana are able to attain higher education. The purpose of this study was to ascertain whether libraries, which are major components of Higher Education Institutions, are physically accessible to even the limited number of PWDs in such Institutions. This study was undertaken in 2015 using the Kwame Nkrumah University of Science and Technology, Kumasi (KNUST) in Ghana as a case study. A mixed method approach was used that involved a desk study, interviews and a physical audit of the KNUST Library System using a checklist developed from international  accessibility standards. In all, 16 libraries were assessed. The study concluded that the libraries at KNUST were generally not physically accessible and this served as a deterrent to PWDs in their academic pursuits. Recommendations which include the need for retrofitting the libraries were made to help make the libraries accessible and in consequence help toward the attainment of the 2030 Agenda for Sustainable Development with respect to Ghana.Keywords: Accessibility; Higher Education Institutions; Libraries; Persons with disabilities (PWDs); Universal design principle

From the Singular to the Plural: Exploring Diversities in Contemporary Childhoods in sub-Saharan Africa

The challenges that sub-Saharan Africa has faced in the post-colonial period have come to characterise the way the region is perceived. These narratives are especially evident in the various ways children’s lives are discussed, leading to a particular focus on childhoods in difficult circumstances or at the margins. This has eclipsed the mundanities of everyday life for many children whose lives are not characterised by ‘lacks’. This article seeks to move beyond an overwhelming focus on childhoods defined by what they lack by illustrating the multitude of childhoods which exist in the continent

Auswirkungen von Biokohle, Abwasserbewässerung und Düngung auf Bodeneigenschaften unter urbaner Landwirtschaft in Westafrika

Die zunehmende nachfrageorientierte Intensivierung der Agrarproduktion im semiariden Westafrika wird aus bodenkundlicher Sicht durch geringe Bodenfruchtbarkeit und hohen Bodendegradationsraten limitiert. Als vielversprechende Möglichkeit zur Bodenverbesserung wird seit einiger Zeit Biokohle vorgeschlagen. Zudem wird im städtischen Umfeld ungeklärtes Abwasser zur Bewässerung eingesetzt. Denn Abwasser wird nicht nur als ganzjährige Wasserquelle, sondern auch als Nährstoffquelle für Böden und Pflanzen betrachtet, trotz des hohen Kontaminationsrisikos durch Pathogene und Schwermetalle. Wissenslücken bestehen vor allem bezüglich der Wechselwirkungen zwischen Biokohle, Düngung und Abwasserbewässerung und Bodeneigenschaften. Das Ziel dieser Studie war daher die Untersuchung der Auswirkungen von Biokohle (hergestellt aus Ernterückständen des Mais- und Reisanbaus), organischer und anorganischer Düngung, Bewässerungsqualität und Bewässerungsquantität auf die Bodeneigenschaften von zwei sandigen, humus- und nährstoffarmen Böden unter Gemüseanbau im urbanen Raum von Tamale (Nordghana) und Ouagadougou (Burkina Faso) über einen Zeitraum von zwei Jahren. Die Applikation von Biokohle bewirkte eine Verdoppelung der C-Vorräte auf beiden Standorten, allerdings wurden anschließend C-Verluste in Höhe von 35 % in Ouagadougou und 46 % in Tamale beobachtet. Korrigiert durch die Auswirkungen der Landnutzungsänderungen verringern sich die C-Verluste in Tamale auf ebenfalls 35 %. Beide Biokohlen hatten keine Auswirkungen auf den pH-Wert, die KAK und das verfügbare P. Die Applikation von Reishülsenbiokohle führte zur N-Retention (18 % höhere N-Vorräte im Vergleich zur Kontrolle), wohingegen die Maisspindelkohle keine Auswirkung auf den N-Haushalt hatte. In Tamale führte die NPK Düngung zur Erhöhung des verfügbaren P sowie zur Versauerung (0.65 pH-Einheiten) und zur Verringerung der effektiven Basensättigung (von nahezu 100% auf 93%) aufgrund der geringen Pufferkapazität des Bodens. In Ouagadougou führte die regelmäßige organische Düngung mit Rindermist zur Erhöhung der C- und N-Vorräte und der KAK. Die einzigen Auswirkungen der Abwasserbewässerung waren ein Anstieg des austauschbaren Natriums und des pH Wertes. Die Ergebnisse der Untersuchungen an beiden Standorten zeigen, dass die Auswirkungen von Biokohle, die aus Ernterückständen hergestellt wurde, und Abwasserbewässerung auf die Bodeneigenschaften geringer sind als in früheren Studien beschrieben wurde

Analysis of drug resistance among difficult-to-treat tuberculosis patients in Ghana identifies several pre-XDR TB cases

BACKGROUND: Resistance to tuberculosis (TB) drugs has become a major threat to global control efforts. Early case detection and drug susceptibility profiling of the infecting bacteria are essential for appropriate case management. The objective of this study was to determine the drug susceptibility profiles of difficult-to-treat (DTT) TB patients in Ghana. METHODS: Sputum samples obtained from DTT-TB cases from health facilities across Ghana were processed for rapid diagnosis and detection of drug resistance using the Genotype MTBDRplus and Genotype MTBDRsl.v2 from Hain Life science. RESULTS: A total of 298 (90%) out of 331 sputum samples processed gave interpretable bands out of which 175 (58.7%) were resistant to at least one drug (ANY(r)); 16.8% (50/298) were isoniazid-mono-resistant (INH(r)), 16.8% (50/298) were rifampicin-mono-resistant (RIF(r)), and 25.2% (75/298) were MDR. 24 (13.7%) of the ANY(r) were additionally resistant to at least one second line drug: 7.4% (2 RIF(r), 1 INH(r), and 10 MDR samples) resistant to only FQs and 2.3% (2 RIF(r), 1 INH(r), and 1 MDR samples) resistant to AMG drugs kanamycin (KAN), amikacin (AMK), capreomycin (CAP), and viomycin (VIO). Additionally, there were 4.0% (5 RIF(r) and 2 MDR samples) resistant to both FQs and AMGs. 81 (65.6%) out of 125 INH-resistant samples including INH(r) and MDR had katG-mutations (MT) whereas 15 (12%) had inhApro-MT. The remaining 28 (22.4%) had both katG and inhA MT. All the 19 FQ-resistant samples were gyrA mutants whereas the 10 AMGs were rrs (3), eis (3) as well as rrs, and eis co-mutants (4). Except for the seven pre-XDR samples, no sample had eis MT. CONCLUSION: The detection of several pre-XDR TB cases in Ghana calls for intensified drug resistance surveillance and monitoring of TB patients to, respectively, ensure early diagnosis and treatment compliance

Systematic review of studies generating individual participant data on the efficacy of drugs for treating soil-transmitted helminthiases and the case for data-sharing

Preventive chemotherapy and transmission control (PCT) by mass drug administration is the cornerstone of the World Health Organization (WHO)’s policy to control soil-transmitted helminthiases (STHs) caused by Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm) and hookworm species (Necator americanus and Ancylostama duodenale) which affect over 1 billion people globally. Despite consensus that drug efficacies should be monitored for signs of decline that could jeopardise the effectiveness of PCT, systematic monitoring and evaluation is seldom implemented. Drug trials mostly report aggregate efficacies in groups of participants, but heterogeneities in design complicate classical meta-analyses of these data. Individual participant data (IPD) permit more detailed analysis of drug efficacies, offering increased sensitivity to identify atypical responses potentially caused by emerging drug resistance

The quality and diagnostic value of open narratives in verbal autopsy: a mixed-methods analysis of partnered interviews from Malawi

Background Verbal autopsy (VA), the process of interviewing a deceased’s family or caregiver about signs and symptoms leading up to death, employs tools that ask a series of closed questions and can include an open narrative where respondents give an unprompted account of events preceding death. The extent to which an individual interviewer, who generally does not interpret the data, affects the quality of this data, and therefore the assigned cause of death, is poorly documented. We aimed to examine inter-interviewer reliability of open narrative and closed question data gathered during VA interviews. Methods During the introduction of VA data collection, as part of a larger study in Mchinji district, Malawi, we conducted partner interviews whereby two interviewers independently recorded open narrative and closed questions during the same interview. Closed questions were collected using a smartphone application (mobile-InterVA) and open narratives using pen and paper. We used mixed methods of analysis to evaluate the differences between recorded responses to open narratives and closed questions, causes of death assigned, and additional information gathered by open narrative. Results Eighteen partner interviews were conducted, with complete data for 11 pairs. Comparing closed questions between interviewers, the median number of differences was 1 (IQR: 0.5–3.5) of an average 65 answered; mean inter-interviewer concordance was 92 % (IQR: 92–99 %). Discrepancies in open narratives were summarized in five categories: demographics, history and care-seeking, diagnoses and symptoms, treatment and cultural. Most discrepancies were seen in the reporting of diagnoses and symptoms (e.g., malaria diagnosis); only one pair demonstrated no clear differences. The average number of clinical symptoms reported was 9 in open narratives and 20 in the closed questions. Open narratives contained additional information on health seeking and social issues surrounding deaths, which closed questions did not gather. Conclusions The information gleaned during open narratives was subject to inter-interviewer variability and contained a limited number of symptom indicators, suggesting that their use for assigning cause of death is questionable. However, they contained rich information on care-seeking, healthcare provision and social factors in the lead-up to death, which may be a valuable source of information for promoting accountable health services

Antiemetics: American Society of Clinical Oncology clinical practice guideline update

Purpose: To update the ASCO guideline for antiemetics in oncology. Methods: ASCO convened an Expert Panel and conducted a systematic review of the medical literature for the period of November 2009 to June 2016. Results: Forty-one publications were included in this systematic review. A phase III randomized controlled trial demonstrated that adding olanzapine to antiemetic prophylaxis reduces the likelihood of nausea among adult patients who are treated with high emetic risk antineoplastic agents. Randomized controlled trials also support an expanded role for neurokinin 1 receptor antagonists in patients who are treated with chemotherapy. Recommendation: Key updates include the addition of olanzapine to antiemetic regimens for adults who receive high-emetic-risk antineoplastic agents or who experience breakthrough nausea and vomiting; a recommendation to administer dexamethasone on day 1 only for adults who receive anthracycline and cyclophosphamide chemotherapy; and the addition of a neurokinin 1 receptor antagonist for adults who receive carboplatin area under the curve ≥ 4 mg/mL per minute or high-dose chemotherapy, and for pediatric patients who receive high-emetic-risk antineoplastic agents. For radiation-induced nausea and vomiting, adjustments were made to anatomic regions, risk levels, and antiemetic administration schedules. Rescue therapy alone is now recommended for low-emetic-risk radiation therapy. The Expert Panel reiterated the importance of using the most effective antiemetic regimens that are appropriate for antineoplastic agents or radiotherapy being administered. Such regimens should be used with initial treatment, rather than first assessing the patient’s emetic response with less-effective treatment. Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki

Fine root dynamics across pantropical rainforest ecosystems

Fine roots constitute a significant component of the net primary productivity (NPP) of forest ecosystems but are much less studied than above-ground NPP. Comparisons across sites and regions are also hampered by inconsistent methodologies, especially in tropical areas. Here, we present a novel dataset of fine root biomass, productivity, residence time, and allocation in tropical old-growth rainforest sites worldwide, measured using consistent methods, and examine how these variables are related to consistently determined soil and climatic characteristics. Our pantropical dataset spans intensive monitoring plots in lowland (wet, semi-deciduous, deciduous) and montane tropical forests in South America, Africa, and Southeast Asia (n=47). Large spatial variation in fine root dynamics was observed across montane and lowland forest types. In lowland forests, we found a strong positive linear relationship between fine root productivity and sand content, this relationship was even stronger when we considered the fractional allocation of total NPP to fine roots, demonstrating that understanding allocation adds explanatory power to understanding fine root productivity and total NPP. Fine root residence time was a function of multiple factors: soil sand content, soil pH, and maximum water deficit, with longest residence times in acidic, sandy, and water-stressed soils. In tropical montane forests, on the other hand, a different set of relationships prevailed, highlighting the very different nature of montane and lowland forest biomes. Root productivity was a strong positive linear function of mean annual temperature, root residence time was a strong positive function of soil nitrogen content in montane forests, and lastly decreasing soil P content increased allocation of productivity to fine roots. In contrast to the lowlands, environmental conditions were a better predictor for fine root productivity than for fractional allocation of total NPP to fine roots, suggesting that root productivity is a particularly strong driver of NPP allocation in tropical mountain regions.Output Status: Forthcoming/Available Online Additional co-authors: Christopher E. Doughty, Imma Oliveras, Darcy F. Galiano Cabrera, Liliana Durand Baca, Filio Farfán Amézquita, Javier E. Silva Espejo, Antonio C.L. da Costa, Erick Oblitas Mendoza, Carlos Alberto Quesada, Fidele Evouna Ondo, Josué Edzang Ndong, Vianet Mihindou, Natacha N’ssi Bengone, Forzia Ibrahim, Shalom D. Addo-Danso, Akwasi Duah-Gyamfi, Gloria Djaney Djagbletey, Kennedy Owusu-Afriyie, Lucy Amissah, Armel T. Mbou, Toby R. Marthews, Daniel B. Metcalfe, Luiz E.O. Aragão, Ben H. Marimon-Junior, Beatriz S. Marimon, Noreen Majalap, Stephen Adu-Bredu, Miles Silman, Robert M. Ewers, Patrick Meir, Yadvinder Malh

Urban Movement and Alcohol Intake Strongly Predict Defaulting from Tuberculosis Treatment: An Operational Study

BACKGROUND: High levels of defaulting from treatment challenge tuberculosis control in many African cities. We assessed defaulting from tuberculosis treatment in an African urban setting. METHODS: An observational study among adult patients with smear-positive pulmonary tuberculosis receiving treatment at urban primary care clinics in Kampala, Uganda. Defaulting was defined as having missed two consecutive monthly clinic visits while not being reported to have died or continued treatment elsewhere. Defaulting patients were actively followed-up and interviewed. We assessed proportions of patients abandoning treatment with and without the information obtained through active follow-up and we examined associated factors through multivariable logistic regression. RESULTS: Between April 2007 and April 2008, 270 adults aged ≥15 years were included; 54 patients (20%) were recorded as treatment defaulters. On active follow-up vital status was established of 28/54 (52%) patients. Of these, 19 (68%) had completely stopped treatment, one (4%) had died and eight (29%) had continued treatment elsewhere. Extrapolating this to all defaulters meant that 14% rather than 20% of all patients had truly abandoned treatment. Daily consumption of alcohol, recorded at the start of treatment, predicted defaulting (adjusted odds ratio [OR(adj)] 4.4, 95%CI 1.8-13.5), as did change of residence during treatment (OR(adj) 8.7, 95%CI 1.8-41.5); 32% of patients abandoning treatment had changed residence. CONCLUSIONS: A high proportion of tuberculosis patients in primary care clinics in Kampala abandon treatment. Assessing change of residence during scheduled clinic appointments may serve as an early warning signal that the patient may default and needs adherence counseling