Characterisation of Seasonal Rainfall for Cropping Schedules

El Nino-South Oscillation (ENSO) phenomenon occurs in the Equatorial Eastern Pacific Ocean and has been noted to account significantly for rainfall variability in many parts of the world, particularly tropical regions.This variability is very important in rainfed crop production and needs to be well understood. Thirty years of daily rainfall data (1976–2006 excluding 1991) from the Akatsi District in the Volta Region of Ghana were analysed to observe the variation of rainfall characteristics such as onset and cessation dates, seasonal rainfall amount and their temporal distribution with ENSO phase, namely El Nino, La Nina and Neutral. Using  rainfallreference evapotranspiration relationships, the onset of rainfall during La Nina and Neutral seasons occurred within the same period, March 11–20, but about a month late (April 11–20) during El Nino. Without regards to ENSO phase, the long-term mean onset date of the rainy season occurred from March 11–20. Annual and major season (March–July) rainfall amounts decreased in the order of these ENSO phases; La Nina, Neutral and El Nino but showed an opposite decreasing order of El Nino, Neutral and La Nina during the minor seasons (September-November). The trend of variability of rainfall distribution during the major season was observed to be highest during El Nino years and least during Neutral years. The study also showed that the optimum planting periods on 10-day time scales during La Nina, Neutral and El Nino years were found to be March 13–22; March, 17–26 and April 20–29, with March 16–25 for the long-term situation. These observations seem to reveal that long-term or climatological observations alone are no longer sufficient for seasonal rainfall prediction to aid cropping schedules

Influence of Method of Residue Application and Moisture Content on Water Soluble Nitrogen in a RhodicKandiustalf Amended with Different Fallow Plant Materials

Use of plant residues as nutrient sources presents a viable option to resource poor farmers who sparsely use mineral fertilizer in crop production. A study was conducted to gain an insight into how different application methods of residues from different fallow management systems under two moisture regimes would affect soluble N release in a Rhodic Kandiustalf. Three residue types viz, elephant grass from a natural fallow (T1) and another as a fallow following a previously fertilized maize (T2) and a fallow legume (T3) were surface applied and incorporated in a Rhodic Kandiustalf at both field capacity (FC) and 60% field capacity over a sixteen-week period. Incorporation of mucuna residues and elephant grass from previously fertilized maize fallow released similar soluble N levels which were higher than levels from the natural elephant grass amendments. At 60% FC, both mucuna and elephant grass from the fertilized maize fields that were surface applied had slower N releases than the grass from the natural fallow, suggesting the elephant grass from the natural fallow field could be used as an N source amidst light watering to avoid leaching in the dry season

The Impact of Insecticide-treated Bednet Use on Malarai and Anaemia in Kassena-Nankana District, Ghana

A study was conducted in Kassena-Nankana district, Ghana from April 1994 to April 1995 to assess the impact of insecticide-treated bednets on malaria and anaemia in pregnancy. A secondary objective was to assess the impact of insecticide-treated bednets on pregnancy outcome, although it was recognised that the sample size would be relatively small for this purpose. The study took place within a large-scale controlled trial designed to assess the impact of insecticide-treated bednets on child mortality. The study area was divided into 96 clusters of compounds and of these 48 clusters were randomly selected to receive the intervention (treated nets). The endpoints of the study were haemoglobin levels, parasitaemia and parasite density and weight of newborns which were recorded within 7 days of delivery. All pregnant women were included in the study but the target group of main interest was primigravidae and secundigravidae. A total of 2812 pregnant women, of all parities, were enrolled into the study; 1961 (70 percent) women were seen at least once at a study clinic of whom 641 were seen for a second time between 28-40 weeks gestation. At both clinic visits, blood was taken for haemoglobin determination and malaria parasitology. Chloroquine ELISA assays, using dried blood spots on filter paper, were performed for 64 percent of pregnant women at their first clinic visits. Data were obtained on 821 delivery outcomes, including 799 newborn weights recorded within 7 days of delivery. A cross-sectional survey was done to determine the distribution of haemoglobin levels and malaria parasitaemia in non-pregnant adult females. Focus group discussions were conducted to assess study women's attitudes to antenatal care and use of bednets. Bednet use provided no protection against anaemia defined as (HbclOO g/l), severe anaemia (Hb2000 parasitcs/pl or low : >0 parasite/pl) or low birth weight. The characteristics of women in the treated and the no net groups were comparable. Net usage was lower than expected, especially in primigravidae. Effective net use was as follows: primigravidae 42 percent (net coverage: 60 percent, use: 70 percent), secundigravidae 58 percent (net coverage: 80 percent, use: 72 percent), multigravidae 63 percent (net coverage: 86 percent, use: 73 percent). Below 10 percent of chloroquine ELISA assays were positive with no differences by treatment arms, parity or season. Odds ratios (ORs) for the different endpoints for those with nets in comparison to those without nets, based on an intention-to-treat (ITT) analysis did not show a statistically significant protective effect; First clinic visit: Anaemia Severe anaemia Low Parasitaemia High Parasitaemia -0.97 (0.86, 1.10) -0.91 (0.57, 1.43) - 1.13(0.54,2.38) -0.98 (0.85, 1.12) The following results were obtained when data for first and second clinic visits were combined (combined data) and restricted to one record per woman with at least 26 weeks gestation and including all second clinic visit records. Combined data: Anaemia - 0.88 (0.70, 1.09) Severe anaemia - 0.80 (0.55, 1.16) Low Parasitaemia - 0.89 (0.73, 1.08) High Parasitaemia - 1.11 (0.93, 1.33) Low birth weight: Adjusted (<2500g)- 0.87 (0.63, 1.19) Unadjusted - 0.88 (0.61, 1.24) Analysis of protection at individual level showed similar results. Based on the findings of this study, insecticide-treated bednets are not recommended as a primary tool for malaria control in pregnancy in northern Ghana. Further operational research is required to assess the impact of insecticide-treated bednets combined with chemoprophylaxis and behavioural interventions on malaria in pregnancy

Smoke-Free Policy in Vermont Public Housing Authorities

Introduction. Millions of adults and children living in public housing face exposure to second hand smoke from adjacent apartments. These tenants are less able to escape smoke exposure by moving, and Housing Authorities are beginning to implement smoke-free policies. We assessed the status of smoke-free policy in Vermont public housing, and explored the experience of tenants and managers in Burlington who recently implemented such a policy.https://scholarworks.uvm.edu/comphp_gallery/1080/thumbnail.jp

Basic newborn care and neonatal resuscitation: a multi-country analysis of health system bottlenecks and potential solutions.

BACKGROUND: An estimated two-thirds of the world's 2.7 million newborn deaths could be prevented with quality care at birth and during the postnatal period. Basic Newborn Care (BNC) is part of the solution and includes hygienic birth and newborn care practices including cord care, thermal care, and early and exclusive breastfeeding. Timely provision of resuscitation if needed is also critical to newborn survival. This paper describes health system barriers to BNC and neonatal resuscitation and proposes solutions to scale up evidence-based strategies. METHODS: The maternal and newborn bottleneck analysis tool was applied by 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" that hinder the scale up of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for BNC and neonatal resuscitation. RESULTS: Eleven of the 12 countries provided grading data. Overall, bottlenecks were graded more severely for resuscitation. The most severely graded bottlenecks for BNC were health workforce (8 of 11 countries), health financing (9 out of 11) and service delivery (7 out of 9); and for neonatal resuscitation, workforce (9 out of 10), essential commodities (9 out of 10) and service delivery (8 out of 10). Country teams from Africa graded bottlenecks overall more severely. Improving workforce performance, availability of essential commodities, and well-integrated health service delivery were the key solutions proposed. CONCLUSIONS: BNC was perceived to have the least health system challenges among the seven maternal and newborn intervention packages assessed. Although neonatal resuscitation bottlenecks were graded more severe than for BNC, similarities particularly in the workforce and service delivery building blocks highlight the inextricable link between the two interventions and the need to equip birth attendants with requisite skills and commodities to assess and care for every newborn. Solutions highlighted by country teams include ensuring more investment to improve workforce performance and distribution, especially numbers of skilled birth attendants, incentives for placement in challenging settings, and skills-based training particularly for neonatal resuscitation

Global Prevalence of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

1. Abstract 1.1. Background: Evidence suggests that diabetes in all forms are on the rise especially gesta-tional diabetes mellitus which increases the risk of maternal and neonatal morbidities; however global prevalence rates and geographical distribution of GDM remain uncertain. The aim of this study is to examine the global burden of gestational diabetes mellitus. 1.2. Methods: A systematic review and meta-analysis of studies reporting Randomised Clinical Trials (RCTs) in pregnant women who have GDM was conducted. Cochrane (Central), PubMed, Scopus, JBI, Medline, EMBASE and reference lists of retrieved studies were searched from inception to March 2019. Publications on prevalence of GDM irrespective of the baseline criteria used to diagnose GDM were included in the study. Studies were limited to English language, randomised control trials and women aged between 19-44 years inclusive. 1.3. Results: Eleven RCTs met the inclusion criteria for this review. The included studies collectively reported GDM rates of 13,450 pregnant women from 7 countries. The diagnostic criteria used in the studies were World Health Organisation (WHO) 1985 and 1999, International Association of Diabetes, Pregnancy Study Group (IADPSG), National Diabetes Data Group (NDDG), Carpenter-Coustan (C&C) and O'Sullivan's criteria. Seven RCTs screened for GDM in comparison with different diagnostic criteria in the same population while three studies used the same criteria for different groups. One study compared 100g, 3h OGTT to 75g, 2h OGTT for diagnosing GDM using Carpenter and Coustan criteria. All seven RCTs that compared different diagnostic criteria in the same population detected different prevalence rates of GDM. Three RCTs measured prevalence of GDM in the same population using WHO 1999 and IADPSG 2013 criteria. Using random effect model, data from three studies that compared IADPSG criteria to WHO 1999 showed an Odds Ratio (OR) of 0.52(0.15, 1.84), 95% Confidence Interval (CI) and high heterogeneity of 99%. In all three studies, prevalence of GDM measured by IADPSG criteria was higher than WHO 1999 criteria, although not significant (p= 0.31). Combining all the studies gave a global estimated prevalence of GDM to be 10.13% (95% CI, 7.33-12.94) with moderate heterogeneity of 27%. The highest prevalence of GDM wit

The Performance of a Rapid Diagnostic Test in Detecting Malaria Infection in Pregnant Women and the Impact of Missed Infections.

BACKGROUND: Intermittent screening and treatment in pregnancy (ISTp) is a potential strategy for the control of malaria during pregnancy. However, the frequency and consequences of malaria infections missed by a rapid diagnostic test (RDT) for malaria are a concern. METHODS: Primigravidae and secundigravidae who participated in the ISTp arm of a noninferiority trial in 4 West African countries were screened with an HRP2/pLDH RDT on enrollment and, in Ghana, at subsequent antenatal clinic (ANC) visits. Blood samples were examined subsequently by microscopy and by a polymerase chain reaction (PCR) assay. RESULTS: The sensitivity of the RDT to detect peripheral blood infections confirmed by microscopy and/or PCR at enrollment ranged from 91% (95% confidence interval [CI], 88%, 94%) in Burkina Faso to 59% (95% CI, 48%, 70% in The Gambia. In Ghana, RDT sensitivity was 89% (95% CI, 85%, 92%), 83% (95% CI, 76%, 90%) and 77% (95% CI, 67%, 86%) at enrollment, second and third ANC visits respectively but only 49% (95% CI, 31%, 66%) at delivery. Screening at enrollment detected 56% of all infections detected throughout pregnancy. Seventy-five RDT negative PCR or microscopy positive infections were detected in 540 women; these were not associated with maternal anemia, placental malaria, or low birth weight. CONCLUSIONS: The sensitivity of an RDT to detect malaria in primigravidae and secundigravidae was high at enrollment in 3 of 4 countries and, in Ghana, at subsequent ANC visits. In Ghana, RDT negative malaria infections were not associated with adverse birth outcomes but missed infections were uncommon

Multi-centre point-prevalence survey of hospital-acquired infections in Ghana

Background: There is a paucity of data describing hospital-acquired infections (HAIs) in Africa. Objective: To describe the prevalence and distribution of HAIs in acute care hospitals in Ghana. Methods: Between September and December 2016, point-prevalence surveys were conducted in participating hospitals using protocols of the European Centre for Disease Prevention and Control. Medical records of eligible inpatients at or before 8am on the survey date were reviewed to identify HAIs present at the time of the survey. Findings: Ten hospitals were surveyed, representing 32.9% of all acute care beds in government hospitals. Of 2107 inpatients surveyed, 184 HAIs were identified among 172 patients, corresponding to an overall prevalence of 8.2%. The prevalence values in hospitals ranged from 3.5% to 14.4%, with higher proportions of infections in secondary and tertiary care facilities. The most common HAIs were surgical site infections (32.6%), bloodstream infections (19.5%), urinary tract infections (18.5%) and respiratory tract infections (16.3%). Device-associated infections accounted for 7.1% of HAIs. For 12.5% of HAIs, a micro-organism was reported; the most commonly isolated micro-organism was Escherichia coli. Approximately 61% of all patients surveyed were on antibiotics; 89.5% of patients with an HAI received at least one antimicrobial agent on the survey date. The strongest independent predictors for HAI were the presence of an invasive device before onset of infection and duration of hospital stay. Conclusion: A low HAI burden was found compared with findings from other low- and middle-income countries