Understanding the effects of the Global Fund TB grants on tuberculosis control within the health system of Ghana

There is an ongoing debate about if and how vertical disease-specific programme funding undermines performance of health systems in recipient countries. Ghana, a low middle-income country, benefited from the Global Fund against Tuberculosis, HIV infection and Malaria (GF) grants intended to strengthen national tuberculosis control programme between 2003 and 2017. In 2015, one component of the GF provision (enablers’ fund) which aimed to support frontline health workers, treatment supporters and TB patients, was withdrawn. To date, a full understanding of the effects of the grants and the enablers’ fund withdrawal on TB services delivery in Ghana is largely unknown. This thesis aims to examine the effects of the full GF TB grants on TB service delivery and how the enablers’ fund withdrawal in-fluenced work practices of health systems actors including managers, frontline health work-ers, and TB treatment supporters. Van Olmen’s health systems conceptual framework was used to provide analysis of the im-pact of the GF TB grants, in particular the enablers’ fund, on functioning of TB service de-livery. A case study approach was applied to examine the TB control programme. Health systems actors included purposively selected managers, frontline community health workers, and treatment supporters who participated in TB patients’ supervision and care. Data collec-tion included key informant interviews (n=7) with national managers and health systems ex-perts, in-depth interviews with district level managers (n=18) and focus group discussions with frontline community health workers and treatment supporters (n=10). A retrospective record review of 3,019 TB cases was conducted in 30 randomly selected TB facilities to compare the patterns in TB treatment outcomes (treatment success and adverse outcomes) during the implementation period of the full GF TB grants (2012-2014) and after withdrawal of the GF enablers’ fund (2015-2017). The GF TB grants enhanced institutional capacity with systems ‘hardware’ (provision of vehicles, office space, microscopes, GeneXpert machines for TB diagnosis, regular supply of TB medication and increased human resources density) for the delivery of TB services. The GF TB grants also strengthened working collaborations systems ‘software’ among actors due to regular supervision, monthly meetings, and payment of incentives for communication. Interviews with frontline health workers and treatment supporters indicated motivation to provide TB patient’s supervision during the enabler’s fund period was due to material incen-tives. Treatment success was 78% during the enablers’ fund period and 88% after withdrawal. Chi-square test of independence showed that there was no significant association between TB patient treatment period (enablers’ fund or withdrawal period) and treatment outcome (treatment success and adverse outcome), X2 (3, N=3019) =6.1, p= .104. To sustain TB pa-tients’ treatment supervision during the period following withdrawal of the enablers’ fund, managers integrated community outreach with TB patient’s supervision and care. Interviews with frontline health workers and treatment supporters showed lack of incentives resulted in work apathy as frontline health workers and treatment supporters felt under-appreciated. The study contributes to the on-going debate on the impact of funding for disease-specific programme on the health system in Ghana and TB control in similar contexts. Using Van Olmen’s framework enabled analysis of the effects of GF funding on TB healthcare within the general health system. This study suggests that through the GF TB grants TB healthcare infrastructure (hardware) was strengthened due to additional resources (financial, human resources, medication, and supplies). However, policymakers need to recognise the changing motivation of frontline workers and the demotivating effect of unsustainable incentives provision in low-income countries

Molecular marker screening of tomato, (solanum lycopersicum L.) Germplasm for root-knot nematodes (Meloidogyne species) resistance

Tomato is one of the crops in which genetic resistance has specially been effective against root-knot nematodes. In this study, molecular screening was done on some tomato germplasm to detect markers for the gene that confers resistance (Mi) with specific primer (Mi23/F//Mi23/R). The cultivars; VFNT, FLA 505-BL 1172, 2641A, “Adwoa Deede” and Terminator FI showed the marker for the homozygous resistant genotypes (Mi/Mi). The cultivars, Tima and 2644A showed both markers, corresponding to heterozygous resistant genotypes (Mi/mi). Twenty one (21) of the cultivars did not show any of the markers presumably due to non-specificity at the primer-binding sites. Five (5) heterozygous individuals were determined out of 6 resistant cultivars following the Hardy-Weinberg principle in population genetics.Keywords: Germplasm, Meloidogyne incognita, molecular marker, resistance, Solanum lycopersicum

Municipal Solid Waste Characterisation and Quantification as a measure towards Effective Waste Management in the Takoradi Sub-Metro, Ghana

Waste management is a major challenge for many metropolitan and municipal assemblies in Ghana. The quantity of waste generated from the cities keeps increasing at a faster rate without increasing facilities to match its management. In the Takoradi sub-metro for instance, all the waste generated ends up at the final disposal sites without any recovery of the valuables. Proper management of the generated waste requires reliable and informative data which could assist in the collection as well as value addition process. Waste separation efficiency; willingness to separate waste at source; physical composition and per capita waste generated by households within the Takoradi sub-metropolis were studied over a five-week period. Questionnaire, interviews and survey were employed in the collection of the required data. The data were analysed using SPSS. The results showed solid waste composition of 60.0% organics, 11.5% plastics, 8.0% inert materials, 7.1% papers and cardboard, 5.0% miscellaneous materials, 2.9% textiles, 2.4% metals, 1.5% glasses and 1.2% leather and rubber. Over 80% of the waste fraction has the potential for recovery into other products; with this, 22.7% could be recycled and 63.6% suitable for biological conversions such as composting and anaerobic digestion since they have a moisture content as high as 55%. The average per capita waste generated within the sub-metro was 0.70 kg/cap/day. Households were able to separate the organic fractions from the rest of the waste fractions reaching effectiveness of 92% for organic separation and 83% for all other wastes. The data generated on the quantity and composition of the waste stream in the Metropolis would play a positive role in solid waste management and help solid waste managers make informed decisions on waste management options.     Keywords: Waste Sorting and Separation, Biodegradables, Household Waste, Separation Efficienc

Microbiological quality and metal levels in wells and boreholes water in some peri-urban communities in Kumasi, Ghana

Many communities in Kumasi, Ghana, are increasingly dependent on boreholes and hand dug wells. The aim of this study was to examine the drinking water suitability of 6 wells and 3 boreholes in periurban communities in Kumasi, between December 2003 and January 2005. Total coliforms, faecal coliforms and enterococci were enumerated using the standard most probable number method and membrane filtration methods. The heavy metals in the water samples were determined using the atomic absorption spectrometry method. Overall, significantly higher bacterial counts were recorded during the wet (rainy) season compared to the dry (harmattan) season. Faecal coliforms counts (FCC) in 3 borehole samples ranged between 3 x 101 and 3.5 x 107 per 100 ml (geometric means 1.82, 1.75 and 2.8 x 104) while mean numbers of enterococci were 103-105 times lower. The range and geometric means of FCC was similar in samples from wells but levels of enterococci were 8 times higher than in boreholes. Manganese and iron levels were well within the WHO standards for all 9 sites but lead levels except for one site (Boadi) were all higher than the WHO standard. A brief sanitation survey at each site suggested that wells and boreholes were frequently cited near latrines, refuse tips and other social amenities, and in the vicinity of domestic or grazing animals. In Kumasi, the water from shallow wells and boreholes, upon which the local communities depend is of poor quality. The data are being used to advise the local government. An integrated approach is required to minimise faecal pollution of wells and boreholes within peri-urban communities.Key words: Boreholes, enterococci, faecal coliforms, peri-urban communities, total coliforms, wells

Physico-chemical Assessment of Mosquito Breeding Sites from Selected Mining Communities at the Obuasi Municipality in Ghana.

A survey was conducted in the Obuasi Municipality in Ghana to assess the impact of some physic-chemicals in waters of mosquito breeding sites from 15 randomly selected communities. The water samples, collected fortnightly for eight months, were analyzed using spectrophotometry and other standard laboratory protocols at the AngloGold Ashanti Environmental Quality Assurance Laboratory for temperature, total suspended solids, total dissolved solids, dissolved oxygen, electrical conductivity and pH. The physico-chemical parameters which ranged from 17.03 ± 0.18?C - 24.06 ± 0.18?C (temperature), 17.03 ± 4.04mg/L - 96.67 ± 4.04mg/L (TSS), 1.09±3.23mg/L - 35.67±3.23mg/L (TDS), 3.97 ± 0.13mg/L - 7.43 ± 0.13mg/L (DO), 17.00 ± 1.30µScm-3 - 83.00 ± 1.30 µScm-3 (EC) and 7.77 ± 0.0 - 10.70 ± 0.01 (pH) were much lower relative to the EPA Maximum Permissible Limits. It is apparent that under rising temperature conditions of climate change, the mosquito’s habitat may be highly favoured for adaptation and prolific breeding in the tropics and this further creates the opportunity for research partners to get actively involved in finding integrated control measures to counteract the life cycle of the pest. Keywords: Anglogold Ashanti, Obuasi Municipality, Physio-chemical Analysis, Mosquito Breeding Water

Effects of Group Size on Students Mathematics Achievement in Small Group Settings

An ideal group size is hard to obtain in small group settings; hence there are groups with more members than others. The purpose of the study was to find out whether group size has any effects on students’ mathematics achievement in small group settings. Two third year classes of the 2011 / 2012 academic year were selected from two schools in the Central Region of Ghana for the study.  The two classes constituted the control and experimental groups respectively and consisted of 50 students in the control group and 47 in the experimental group. The experimental group was subdivided into 12 groups made up of groups of 3members, groups of 4 members and groups of 5 members using stratified and simple random sampling. The students’ pre- and post-test scores served as the data for the study. The results of the study showed no significant difference in the mean scores of the three subgroups of the experimental group. Keywords: Group size, Cooperative learning, Achievemen

Assessment of contamination of singed hides from cattle and goats by heavy metals in Ghana

Many local butchers in Ghana have been using scrap tyres as substitute for firewood to singe slaughtered ruminants. This study analysed such singed hides from seven goats and three cattle in unregulated local slaughtering operations near the Kumasi abattoir, for risk of heavy metal contamination (Mg, Mn, Cu, Ni, Cd, Pb and Zn) using atomic absorption spectrometry. Relative to unsinged control hides, singed treatments generally elevated heavy metal levels in both goats and cattle hides. Magnesium, Mn, Cu, Ni and Cd concentrations in un-singed goats hide increased by 23, 29, 54, 24 and 20% respectively to 108.63 ± 3.85, 0.83 ± 0.13, 1.63 ± 0.13, 2.15 ± 0.29 and 2.26 ± 0.20 mg/kg in the singed material. Similarly, singeing increased Mg, Mn, Cu, Ni, Cd and Zn concentrations in cattle hide by 94, 49, 130, 33, 174 and 1055% to 80.0 ± 5.25, 2.13 ± 0.26, 5.67 ± 1.24, 3.50 ± 0.17, 4.20 ± 0.17, and 204.49 ± 36.69 mg/kg respectively. Lead concentration in cattle hide on the other hand decreased by 34% upon singeing, from 4.61 ± 0.30 mg/kg in un-singed controls to 3.06 ± 0.26 mg/kg in singed material. High concentrations of the metals in singed hides could not be entirely attributed to the singed treatment alone, in view of considerable background levels of heavy metals recorded in the un-singed samples; a situation that probably reflected a larger problem of heavy metal pollution in the local environment. Concentrations of Cd and Pb in hides were above maximum permissible levels (MPLs) of 0.05 and 0.01 mg/kg respectively set by the European Commission Regulation, whilst Zn was also above MPL of 50.0 mg/kg, according to the Meat Food Products Order of India. It was concluded that the hides were potentially unsafe for human consumption.Key words: Heavy metal contamination, meat products, singed treatments, consumed animal hide

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

Plant-parasitic nematodes associated with sweet potato rhizosphere soil in the Semi- Deciduous Forest and Coastal Savannah Zones of Ghana

A survey was conducted in nine major sweet potato producing districts across the semi-deciduous forest and coastal savannah zones of Ghana to determine the prevalence of plant-parasitic nematodes parasitizing the crop. Soil samples were collected at 90-days after planting from the rhizosphere of sweet potato crop and analysed using Modified Baermann tray method from 100 farms across the study area. Seven plant-parasitic nematode genera were extracted from soil samples collected and morphologically identified under a microscope with four of them, namely Meloidogyne, Pratylenchus, Rotylenchulus, and Helicotylenchus being the most prevalent. Scutellonema sp. occurred in 89% while Tylenchus sp. occurred in 33% of the districts sampled. The ring nematode, Criconemella sp. was found in only two of the nine districts covered; Ketu North and Akatsi South which incidentally recorded 100% of the seven nematodes encountered in the survey. The abundant nematode was Meloidogyne sp. which represented 39% and Criconemella, the least (0.1%) of the total nematodes recovered in the survey. This study has shown that high diversity, incidence and density of economically important plant-parasitic nematodes are associated with sweet potato crop. Development of appropriate management strategies to mitigate the negative effects of plant-parasitic nematodes on sweet potato is recommended. &nbsp

Traced Metals and Nutrients in Mosquito Breeding Sites at the Obuasi Municipality of Ashanti Region in Ghana

A survey was conducted in the Obuasi Municipality to assess the impact of some trace metals and nutrients on mosquito breeding sites from 15 randomly selected communities. The water samples, collected fortnightly for eight months, were analyzed using spectrophotometry and other standard laboratory protocols at the AngloGold Ashanti Environmental Quality Assurance Laboratory. The results on trace metals, and nutrients did not reveal any significant pattern of attendant pollution that would influence the breeding patterns of mosquitoes. However, the trace metals ranged from 0.12±0.01mg/L - 13.42±0.01mg/L and 0.01±0.01mg/L - 0.30±0.01mg/L for Fe and Pb respectively in the waters whilst As and Zn were not detected. For the nutrients - nitrate values which were > 1 ranged from 2mg/L – > 40mg/L. Sulphate levels varied between < 20mg/L and > 200mg/L and were above the EPA Maximun Permissible Limit of 1.5 mg/L  for polluted  natural water bodies. There was no definite pattern in the concentrations of phosphates which varied between 0.1mg/L and 1.5mg/L in the waters. It is apparent that under rising temperature conditions of climate change, the mosquito’s habitat may be highly favoured for adaptation and prolific breeding in the tropics and this further creates the opportunity for research partners to get actively involved in finding integrated control measures to counteract the life cycle of the pest. Keywords: Anglogold Ashanti, Obuasi Municipality, Traced Metal Analysis, Mosquito Breeding Water