Audit of documentation accompanying referred maternity cases to a referral hospital in northern Ghana: a mixed-methods study.

BACKGROUND: Effective referral of maternity cases, which cannot be managed at the primary healthcare level, with detailed referral forms is important for reducing possible delays in the provision of higher-level healthcare. This is the first study to audit documentation or referral forms that accompany referred maternity cases to a referral hospital in the northern region of Ghana. MATERIALS AND METHODS: This study employed an explanatory sequential mixed-method design, starting with a quantitative review of referral forms that accompanied all patients referred to four units (antenatal, antenatal emergency, labour and neonatal intensive care) of a referral hospital in northern Ghana. In-depth interviews were held with the heads of the four units afterwards. Descriptive statistics were computed for the quantitative data. The qualitative data was subjected to content analysis. Integration of the data occurred at the data interpretation/discussion level. RESULTS: A total of 217 referral forms were analysed. Nearly half of the cases were referred from the Tamale Metropolis (46.5%) and 83.9% were referred for advanced care, whilst 8.3% were referred due to a lack of medical logistics and equipment such as oxygen and skilled personnel (6%). Completion rates of the referral forms were as follows: < 50% completion (n = 81; 37.3%), 50-75% completion (n = 112; 51.6%) above 75% completion (n = 24; 11.1%). Some of the handwriting were not legible and were quite difficult to read. The key informants stated that incomplete forms sometimes delay treatment. The head of the antenatal care unit at the referral hospital suggested professional development sessions as a strategy for supporting clinicians to fill the forms as expected. CONCLUSION: The Ghana Health Service should conduct regular audits, develop job aides and provide incentives for health professionals who accurately complete referral forms. Completing forms and digitizing health records can help ensure further efficiencies in the health information system and sustain good maternity referral documentation practices

Dietary intakes and iron status of vegetarian and non-vegetarian children in selected communities in Accra and cape coast, Ghana

There is a scarcity of information on dietary intake and iron status of Ghanaian children raised on vegetarian diets. A cross-sectional study design was used to compare the diets and iron status of vegetarian children between the ages of 9 months and 11 years (n= 26) with matched controls, non-vegetarian children (n=26) of similar ages and same sex and living within the same communities in Accra and Cape Coast, Ghana. Dietary information was collected using 24-hr food recall and 12-hr home observation. Haemoglobin, plasma ferritin, C-reactive protein, and Transferrin Receptor (TfR) concentrations were determined on finger prick (haemoglobin) and venous blood samples collected during the study. Based on the 24-hr food recall, vegetarian children&rsquo;s diets were devoid of vitamin B12whereas non-vegetarian children&rsquo;s diets were not (0.0 &plusmn; 0.0 mg vs. 1.5 &plusmn; 1.8 mg, p&lt;0.001). The dietary intake based on 12-hr home observation showed similar results. However, vegetarians had significantly higher intake of dietary fibre (17.1 &plusmn; 11.9 g vs. 8.4 &plusmn; 6.2 g, p= 0.002), thiamine (1.1 &plusmn; 0.8 mg vs. 0.5 &plusmn; 0.3 mg, p= 0.001) and vitamin A (1702 &plusmn; 1887 Retinol Equivalent (RE)vs. 671 &plusmn; 691 RE, p= 0.010) than non-vegetarian children. Dietary diversity based on nine food groups was similar between groups (5.8 &plusmn;1.0score). Plasma ferritin was higher for non-vegetarian children compared to the vegetarians (59.2&plusmn; 48.2 ng/mL vs. 34.1&plusmn; 25.8ng/ml, p= 0.012) but there was no group difference in plasma TfR. The prevalence of anaemia was about 25% in both groups. Typical diets of Ghanaian children lack variety and both vegetarian and nonvegetarian diets are insufficient to support adequate iron status. Iron-rich foods such as meat or supplements are needed. There is urgent need for immediate vitamin B12 supplementation for all vegetarian children and a general need for nutrition education to diversify all children&rsquo;s diets

Enhancing backyard poultry enterprise performance in the techiman area: A value chain analysis

Backyard Poultry (BP) production is widespread among rural households in Ghana and provides an opportunity for small scale enterprise development to contribute to poverty alleviation. Traditionally, efforts to improve poultry production activities have emphasized the technical aspects of production while neglecting the social and organizational processes that underlie BP enterprises. A value chain framework was used to qualitatively assess BP enterprises in two communities in the Techiman Municipality of the Brong Ahafo Region in Ghana. The main purpose of the study was to understand how the activities and relationships among actors along the BP value chain influence BP enterprise performance and its implications for development of the industry. Community key informants defined a BP enterprise as ownership of at least ten post vulnerability age chickens (defined as ability to roost on trees to escape predators and disease). All identified BP farmers in the communities were classified as &lsquo;high&rsquo; and &lsquo;low&rsquo; enterprise performers based on flock size of &lsquo;post- vulnerability age chickens&rsquo;. The study participants included a purposive sample of &lsquo;low&rsquo; (n=10) and &lsquo;high&rsquo; (n=10) performing BP farmers from each community as well as service providers and support institutions in the BP value chain identified through snowball sampling. Qualitative data were collected using focus group discussions and key informant interviews. Content analysis was used to summarize themes and patterns from the interview transcripts and to compare high and low performing BP enterprises based on the identified activities and relationships. Higher BP enterprise performance was associated with stronger inter- and intra-actor integration of activities in the various functions of the value chain and higher investment of resources in the activities of the value chain. Additionally, opportunities for import substitution to meet the high national demand for chicken meat were identified. Sustainable improvements in the BP sector must involve social, relational, organizational, as well as technical innovation

Assessment might dictate the curriculum, but what dictates assessment?

Almost all tertiary educators make assessment choices, for example, when they create an assessment task, design a rubric, or write multiple-choice items. Educators potentially have access to a variety of evidence and materials regarding good assessment practice but may not choose to consult them or be successful in translating these into practice. In this article, we propose a new challenge for the Scholarship of Teaching and Learning: the need to study the disjunction between proposals for assessment &ldquo;best practice&rdquo; and assessment in practice by examining the assessment decision-making of teachers. We suggest that assessment decision-making involves almost all university teachers, occurs at multiple levels, and is influenced by expertise, trust, culture, and policy. Assessment may dictate the curriculum from the student&rsquo;s perspective, and we argue that assessment decision-making dictates assessment

Relationship between caregivers’ income generation activities and their children’s animal source food intake

Enhancing Child Nutrition through Animal Source Food Management (ENAM) project provided financial and technical support for caregivers&rsquo; Income Generation Activities (IGA) with the aim of increasing their access to Animal Source Foods (ASF) for improved child nutrition. Using baseline data from the ENAM project, this study assessed the relationship between the type of caregivers&rsquo; IGA -whether it is related to ASF [ASF-R] or unrelated [ASF-U] - and the quantity and diversity of ASF consumed by their children. Structured questionnaire was used to obtain data on household socioeconomic and demographic characteristics and children&rsquo;s ASF consumption in the past week from 530 caregivers of children 2-to5 years old in 12 communities in three agro-ecological zones of Ghana. A weighed food record of children&rsquo;s dietary intakes was also completed during two 12-hour home observations on a randomly selected sample of 117 children. Approximately 6% (n=32) of caregivers were not engaged in any IGA. Of the caregivers who were involved in an IGA (n=498), approximately one-third of them were engaged in an ASF-R IGA, such as selling smoked fish, selling eggs and the selling cooked food that included ASF. Caregivers (67%) were engaged in ASF-U IGA, such as crop farming, petty trading in non ASF items and artisanal work. The quantity and diversity of ASF consumed by the children did not differ (p=0.988 and p=0.593, respectively) by the type of caregiver IGA. However, after accounting for agro-ecological zone, being involved in an ASF-R IGA positively predicted children&rsquo;s ASF diversity (p&lt;0.001). The number of children in the household negatively predicted children&rsquo;s ASF diversity (p=0.011) whereas high/medium household wealth status tended to be positively associated with ASF diversity (p=0.064).The study suggested that there is need to promote ASF-R IGA among caregivers to increase the ability to purchase more varied and nutritious food items for improving children&rsquo;s growth

Quality and women’s satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: A systematic review

Backgrounds: ub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highest burden of maternal and perinatal morbidity and mortality in the world. Timely and appropriate maternal referral to a suitable health facility is an indicator of effective health systems. In this systematic review we aimed to identify which referral practices are delivered according to accepted standards for pregnant women and newborns in sSA LLMICs by competent healthcare providers in line with the needs of pregnant women. Methods: : Six electronic databases were systematically searched for primary data studies (2009-2018) in English reporting on maternal referral practices and their effectiveness. We conducted a content analysis guided by a framework for assessing the quality of maternal referral. Quality referral was defined as: timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers in the receiving facility. Results: : Seventeen articles were included in the study. Most studies were quantitative (n=11). Two studies reported that women were dissatisfied due to delays in referral processes that affected their health. Most articles (10) reported that women were not accompanied to higher levels of care, delays in referral processes, transport challenges and poor referral documentation. Some healthcare providers administered essential drugs such as misoprostol prior to referral. Conclusions: : Efforts to improve maternal health in LLMICs should aim to enhance maternity care providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate barriers of referral. To ensure quality maternal referral, district level health managers should be trained and equipped with the skills needed to monitor and evaluate referral documentation, including quality and efficiency of maternal referrals. Systematic review registration: PROSPERO registration CRD4201811426

An assessment of hospital maternal health services in northern Ghana: a cross-sectional survey

Abstract Background Access to and delivery of comprehensive emergency obstetric and neonatal care (CEmONC) services are often weak in low and middle-income countries affecting maternal and infant health outcomes. There are no studies on resources for maternal healthcare in the Northern region of Ghana. This knowledge is vital for health service planning and mobilising funding to address identified gaps. We investigated the available resources for managing CEmONC and referral services in the region. Methods This study involved a cross-sectional survey of maternity facilities in ten hospitals in the Northern region of Ghana, serving a population of 2,479,461, including 582,897 women aged 15–49. Public and faith-based hospitals were included in the study. We used the Service Provision Assessment tool to gather data for this study between October and December 2019. Given the small sample size, we used descriptive statistics to summarise the data using SPSS version 25 and Excel 2016. Results A total of 22,271 ANC visits from women to these hospitals occurred in the past 3 months preceding the study; however, 6072 birth events (cases) occurred within the same period. All the hospitals had less than one general medical doctor per 10,000 population (range 0.02–0.30). The number of midwives per 10,000 population ranged from 0.00 (facility H and J) to 1.87 (facility E), and none of the hospitals had a university-trained nurse designated for maternity care. Only one hospital had complete equipment for emergency obstetric and newborn care, while four others had adequate emergency obstetric care equipment. The number of maternity and delivery beds per 10,000 population was low, ranging from 0.40 to 2.13. Conclusions The management of emergency obstetric care and referrals are likely to be affected by the limited human resources and equipment in hospitals in Northern Ghana. Financial and non-financial incentives to entice midwives, obstetricians and medical officers to the Northern region should be implemented. Resources should be mobilised to improve the availability of essential equipment such as vacuum extractors and reliable ambulances to enhance referral services. Considerable health system strengthening efforts are required to achieve the required standards. </jats:sec

Boosting Wnt activity during colorectal cancer progression through selective hypermethylation of Wnt signaling antagonists.

BACKGROUND: There is emerging evidence that Wnt pathway activity may increase during the progression from colorectal adenoma to carcinoma and that this increase is potentially an important step towards the invasive stage. Here, we investigated whether epigenetic silencing of Wnt antagonists is the biological driver for this increased Wnt activity in human tissues and how these methylation changes correlate with MSI (Microsatelite Instability) and CIMP (CpG Island Methylator Phenotype) statuses as well as known mutations in genes driving colorectal neoplasia. METHODS: We conducted a systematic analysis by pyrosequencing, to determine the promoter methylation of CpG islands associated with 17 Wnt signaling component genes. Methylation levels were correlated with MSI and CIMP statuses and known mutations within the APC, BRAF and KRAS genes in 264 matched samples representing the progression from normal to pre-invasive adenoma to colorectal carcinoma. RESULTS: We discovered widespread hypermethylation of the Wnt antagonists SFRP1, SFRP2, SFRP5, DKK2, WIF1 and SOX17 in the transition from normal to adenoma with only the Wnt antagonists SFRP1, SFRP2, DKK2 and WIF1 showing further significant increase in methylation from adenoma to carcinoma. We show this to be accompanied by loss of expression of these Wnt antagonists, and by an increase in nuclear Wnt pathway activity. Mixed effects models revealed that mutations in APC, BRAF and KRAS occur at the transition from normal to adenoma stages whilst the hypermethylation of the Wnt antagonists continued to accumulate during the transitions from adenoma to carcinoma stages. CONCLUSION: Our study provides strong evidence for a correlation between progressive hypermethylation and silencing of several Wnt antagonists with stepping-up in Wnt pathway activity beyond the APC loss associated tumour-initiating Wnt signalling levels.A.L.S. was supported by the Fundacao para a Ciencia e Tecnologia (Portugal); A.I. by a Clinician Scientist Fellowship from Cancer Research UK (grant no C10112/A11388); M.B. by the Medical Research Council (U105192713) and by Cancer Research UK (grant no C7379/A8709).This is the final published version. It first appeared at http://www.biomedcentral.com/1471-2407/14/891

Identification of single-site gold catalysis in acetylene hydrochlorination

There remains considerable debate over the active form of gold under operating conditions of a recently validated gold catalyst for acetylene hydrochlorination. We have performed an in situ x-ray absorption fine structure study of gold/carbon (Au/C) catalysts under acetylene hydrochlorination reaction conditions and show that highly active catalysts comprise single-site cationic Au entities whose activity correlates with the ratio of Au(I):Au(III) present. We demonstrate that these Au/C catalysts are supported analogs of single-site homogeneous Au catalysts and propose a mechanism, supported by computational modeling, based on a redox couple of Au(I)-Au(III) species