Marketing and performance: a thematic study of firms in the UK and Ghana.

The issue being investigated in this thesis concerns the extent to which marketing practices impact upon business performance and how the competitive environment influences the market orientation-performance relationships in an industrialised nation and a developing economy. This thesis takes as its underlying theoretical framework, the marketing-performance paradigm of marketing strategy theory and practice and involves a thematic study of marketing practices, their relevance in different environmental scenarios and effects on a variety of performance measures. In order to determine the universal importance of marketing principles, the effects of various facets of marketing such as marketing culture, marketing effectiveness and market orientation on both customer-based and financial performance indicators, are investigated in the United Kingdom (UK) and Ghana. The contribution to knowledge stems from the systematic application of marketing principles to describe the behaviour of firms in a range of businesses and, on the basis of primary data, determine whether firms that engage in sound marketing practices, are characterised by relatively higher performance levels irrespective of the environment. This thesis contains eight empirical papers, one case study and one conceptual article on the U K and Ghana and the findings have been published/scheduled for publication in key internationally refereed journals in the management/ marketing fields. Within the U K context, issues relating to marketing culture, marketing effectiveness and their effects on various performance dimensions are explored. Moreover, the concept of market orientation, its impact upon measures of business effectiveness, efficiency and adaptability, and the extent to which environmental factors influence these relationships are examined. Sectors to which specific marketing constructs could be appropriately applied are selected for survey. These include marketing effectiveness in large organisations (over 500 employees), marketing culture in service firms, and market orientation in the small business (10 to 50 employees) and high technology (biotechnology) sectors. This approach facilitates a comprehensive testing of these different but related constructs in diverse contexts and provides useful conclusions on the efficacy of marketing principles in business practices. In the context of Ghana, the role of marketing is examined against the background of the International Monetary Fund's (IMF) structural adjustment policies (SAP). This is followed by a study of the effects of corporate culture on market orientation and a case study on performance of firms which have adapted successfully to the changes taking place in Ghana's liberalised economy through effective implementation of SAP-tailored marketing strategies. In addition, a comparison of the marketing activity-performance association among foreign and domestic firms is undertaken together with an investigation of the market orientation performance link and potential moderators of the relationship. Studying the role and effectiveness of marketing in these different scenarios provides invaluable insights into the relevance of marketing principles in a developing economy. Overall, this thematic approach facilitates a thorough exploration o f the significance of marketing practice in industrialised and developing economies and, more importantly, tackles the research question posed at the outset. Generally, the results indicate that in the UK, sound marketing practices exert a positive impact on performance while in Ghana, foreign firms' marketing practices are found to exert a greater effect on performance than those of domestic firms. Moreover, in the UK, a significant link between market orientation and performance emerges over a shorter period compared with a similar analysis in Ghana. Managerial implications o f the findings are subsequently highlighted and future research directions are identified and discussed

Association of MYH9-rs3752462 polymorphisms with chronic kidney disease among clinically diagnosed hypertensive patients: a case-control study in a Ghanaian population

Background: Chronic kidney disease (CKD) is a significant comorbidity among hypertensive patients. Polymorphisms in the non-muscle myosin heavy chain 9 gene (MYH9) have been demonstrated to be significantly associated with CKD, among African- and European-derived populations. We investigated the spectrum of MYH9-associated CKD among Ghanaian hypertensive patients. Methods: The study constituted a total of 264 hypertensive patients. Hypertensive patients with glomerular filtration rate (eGFR) \u3c 60 ml/min/1.73m (CKD-EPI formula) or clinically diagnosed were defined as case subjects ( = 132) while those with eGFR ≥60 ml/min/1.73m were classified as control subjects ( = 132). Demographic data were obtained with a questionnaire and anthropometric measurements were taken. Five (5) millilitres (ml) of venous blood was drawn from study subjects into gel and EDTA vacutainer tubes. Two (2) mL of EDTA anticoagulated blood was used for genomic DNA extraction while three (3) mL of blood was processed to obtain serum for biochemical measurements. Genotyping of MYH9 polymorphisms (rs3752462) was done employing Tetra primer Amplification Refractory Mutation System (T-ARMS) polymerase chain reaction (PCR). Spot urine samples were also collected for urinalysis. Hardy-Weinberg population was assessed. Logistic regression models were used to assess the associations between single nucleotide polymorphisms and CKD. Results: The cases and control participants differed in terms of age, sex, family history, and duration of CKD (-value \u3c 0.001). The minor allele frequencies of rs3752462 SNP were 0.820 and 0.567 respectively among the control and case subjects. Patients with the heterozygote genotype of rs3752462 (CT) were more likely to develop CKD [aOR = 7.82 (3.81-16.04)] whereas those with homozygote recessive variant (TT) were protective [aOR = 0.12 (0.06-0.25)]. Single nucleotide polymorphism of rs3752462 (CT genotype) was associated with increased proteinuria, albuminuria, and reduced eGFR. Conclusions: We have demonstrated that MYH9 polymorphisms exist among Ghanaian hypertensive patients and rs3752462 polymorphism of MYH9 is associated with CKD. This baseline indicates that further longitudinal and multi-institutional studies in larger cohorts in Ghana are warranted to evaluate MYH9 SNP as an independent predictor of CKD among hypertensive patients in Ghana

Enhancing productivity of farmer-saved seed yam in Ghana: Positive selection and neem leaf powder factors

Recycling of diseased and pests infested seed yam ( Dioscorea spp.) has resulted in drastic yield reductions in yam production. The objective of this study was to determine the effect of positive selection on the quality of farmer-saved seed yam and also evaluate the effect of neem leaf powder in managing plant parasitic nematodes damage to yam. Two farming systems namely; Positive selection (PS) and Farmer practice (FP) and two soil amendment regimes; neem leaf powder at 20 g stand-1 (NA20) and no neem amendment (NA0) were tested on one variety of yam (Dente). A 2 x 2 x 1 factorial study, mounted on a randomised complete block design in a split plot arrangement was conducted in four replications. Positive selection occupied main plots; while Farmer practice occupied sub-plots. The study was conducted in eight communities located in two municipalities of Ghana, during 2015-2017. Parameters evaluated included Yam Mosaic Virus incidence and severity, incidence and severity of nematode cracks and galling on yam tubers, plant establishment and yield of yam. It was observed that Yam Mosaic Virus (YMV) disease incidence decreased from 38% in 2016 to 31% in 2017 in PS plots as a result of using virus-free planting materials. However, in FP plots, it increased from 67% in 2016 to 72% in 2017. Neem leaf powder amendment resulted in significantly (P< 0.05) low tuber galling (7%) compared with 40% in unamended plots. Similarly, PS plots yielded 7.7 t ha-1 compared to 5.9 t ha-1 in FP fields. In conclusion, Positive selection out-yielded FP by 30.5%; while PS-neem leaf powder interaction resulted in 38.5% over and above FP without neem amendment.Le recyclage des semences d\u2019igname ( Dioscorea spp.) contamin\ue9es par des maladies et des parasites a entra\ueen\ue9 une r\ue9duction drastique du rendement de la production d\u2019igname. L\u2019objectif de cette \ue9tude \ue9tait de d\ue9terminer l\u2019effet de la s\ue9lection positive sur la qualit\ue9 des semences d\u2019igname conserv\ue9es par les agriculteurs et \ue9galement d\u2019\ue9valuer l\u2019effet de la poudre de feuilles de neem dans la gestion des dommages caus\ue9s par les n\ue9matodes parasites des plantes. Deux syst\ue8mes agricoles \ue0 savoir; S\ue9lection positive (PS) et pratique paysanne (PF) et deux r\ue9gimes d\u2019amendement du sol; De la poudre de feuille de neem \ue0 20 g du stand-1 (NA20) et aucun amendement de neem (NA0) ont \ue9t\ue9 test\ue9s sur une vari\ue9t\ue9 d\u2019igname (Dente). Une \ue9tude factorielle de 2 x 2 x 1, mont\ue9e sur une dispositif en\ua0blocs al\ue9atoires complets dans un arrangement en parcelles divis\ue9es, a \ue9t\ue9 men\ue9e en quatre r\ue9p\ue9titions. S\ue9lection positive occup\ue9e parcelles principales; tandis que la pratique paysanne occupait des sous-parcelles. L\u2019\ue9tude a \ue9t\ue9 men\ue9e dans huit communaut\ue9s situ\ue9es dans deux municipalit\ue9s du Ghana en 2015-2017. Les param\ue8tres \ue9valu\ue9s comprenaient l\u2019incidence et la gravit\ue9 du virus de la mosa\uefque de l\u2019igname, l\u2019incidence et la gravit\ue9 des fissures de n\ue9matode et le grippage des tubercules de l\u2019igname, l\u2019\ue9tablissement de la plante et le rendement de l\u2019igname. Il a \ue9t\ue9 observ\ue9 que l\u2019incidence de la maladie caus\ue9e par le virus de la mosa\uefque \ue0 l\u2019igname (YMV) avait diminu\ue9 de 38% en 2016 \ue0 31% en 2017 dans les parcelles PS gr\ue2ce \ue0 l\u2019utilisation de mat\ue9riel de plantation d\ue9pourvu de virus. Cependant, dans les parcelles de PF, il est pass\ue9 de 67% en 2016 \ue0 72% en 2017. L\u2019amendement de poudre de feuille de Neem a entra\ueen\ue9 une r\ue9duction significative du galles des tubercules (P <0,05) (7%) par rapport \ue0 40% dans les parcelles non modifi\ue9es. De m\ueame, les parcelles de PS ont produit 7,7 t ha-1, contre 5,9 t ha-1 dans les champs de PF. En conclusion, la s\ue9lection positive a eu un rendement sup\ue9rieur de 30,5% \ue0 celui de la PF; tandis que l\u2019interaction de la poudre de feuille PS-neem a eu pour r\ue9sultat 38,5% de plus que FP sans amendement de nee

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Coercive Pressures and Anti-corruption Reporting: The Case of ASEAN Countries

This paper aims to investigate the extent of anti-corruption reporting by ASEAN companies and examine whether coercive factors influence the level of disclosure. The authors adopt indicators from the Global Reporting Initiative version 4.0 to measure the extent of anti-corruption disclosures in 117 companies’ reports. Informed by a coercive isomorphism tenet drawn from the institutional theory, the authors propose that several institutional factors influence the extent of their voluntary disclosures. The findings reveal that a large degree of variability difference between the average levels of anti-corruption disclosure in Thailand (434 words) and the Philippines (149 words). The dependence on government tenders and foreign ownership are associated with the level of disclosure. Surprisingly, the United Nation Global Compact membership is not a significant determinant of anti-corruption reporting. This signifies that the membership in the international initiative does not correspond to individual company’s commitment to disclose anti-corruption information. In spite of significant efforts undertaken by global organizations to combat corruption, the level of anti-corruption disclosure is significantly different among the four countries under study. The disclosure of sensitive information such as the confirmed incidences of corruption cases requires careful consideration by the top management as it is subjected to legal implications and reputational risks. Thus, impression management can complement the coercive pressure in explaining the level of anti-corruption reporting. This study is among the first studies which explores the association between coercive factors and the level of anti-corruption disclosure in ASEAN region

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone