Singleton preterm births in Korle bu teaching hospital, Accra, Ghana – origins and outcomes

Objective: To determine the singleton preterm birth rate, the relative proportions of the clinical categories of preterm births and to compare the outcomes in these categories. Setting: Department of Obstetrics & Gynaecol-ogy, Korle Bu Teaching Hospital. Participants: Preterm births from 1st July to 31st December 2003. Results: Out of a total of 4731 singleton births 440 were preterm, giving a preterm birth rate of 9.3%. One hundred and eighty-five (42%, [95% Confidence Interval (CI) 37.4%, 46.8%]) preterm births followed spontaneous onset of preterm la-bour (group A), 82 (18.6%, [95% CI 15.2%, 22.7%]) followed preterm premature rupture of membranes, PPROM (group B) and 173 (39.3%, [95% CI 34.8%, 44.1%]) were medically indicated (group C). The commonest indication for delivery in group C was severe pre-eclampsia/eclampsia. Although there was no significant difference in the mean gestational ages at delivery between the groups, babies in group C had significantly lower birth weights. No differences in sex ratios, still-birth rates, or incidence of low Apgar scores were found. Babies in group C were significantly more likely to be admitted to the neonatal intensive care unit (NICU) and had a significantly higher perina-tal death rate. Survivors of NICU admission among group C babies spent significantly longer periods in hospital before discharge.Conclusion: Outcomes of preterm births in Korle Bu Teaching Hospital are less favourable among indicated preterm births than among spontaneous or PPROM-related preterm births. A detailed study of the causes of neonatal morbidity and mortality is suggested to determine any differences between the three groups

Smartphone colorimetry using ambient subtraction: Application to neonatal jaundice screening in Ghana

A smartphone app to screen for neonatal jaundice has a large potential impact in reducing neonatal death and disability. Our app, neoSCB, uses a colour measurement of the sclera to make a screening decision. Although there are numerous benefits of a smartphone-based approach, smartphone colour measurement that is accurate and repeatable is a challenge. Using data from a clinical setting in Ghana, we compare sclera colour measurement using an ambient subtraction method to sclera colour measurement using a standard colour card method, and find they are comparable provided the subtracted signal-to-noise ratio (SSNR) is sufficient. Calculating a screening decision metric via the colour card method gave 100% sensitivity and 69% specificity (n=87), while applying the ambient subtraction method gave 100% sensitivity and 78% specificity (SSNR>3.5; n=50)

Tillage systems and soils in the semi-arid tropics

Even though conservation tillage may be ideal for the semi-arid tropics (SAT) in view of results from studies and tillage practices in the U.S.A. and Australia, studies conducted in semi-arid regions of Africa appear to support the use of conventional tillage systems. Some of the reasons for this apparent discrepancy are because of the physical properties of the soils in semi-arid Africa, particularly the Sahelian zones where the soils are sandy, have high bulk densities and therefore low total porosities and form crusts upon wetting and drying. Consequently, no-till or reduced tillage systems that do not have the soil surface covered by residue in irder to prevent formation of crust as a result of raindrop impact, tend to lose water through runoff in a region where water economy is essential. Also, because these soils have inherently high bulk densities, conventional tillage systems appear to be suitable since they increase the macropores, reduce both bulk density and strength and thus ensure prolific root distribution and the resultant exploration of water and nutrients at greater soil depths. Notwithstanding, it seems that since most of the SAT soils are structurally unstable, further conventional tillage even though it has ephemeral advantages, may in the long term be exacerbating the problems of structural instability and their deleterious effect on water and soil conservation and therefore on crop production. We suggest that at this stage soil tillage research in the semi-arid regions of Africa and Asia should re-examine some of the concepts of conservation tillage in relation to soil physical properties and processes in order to obtain a tillage system that ensures high crop yields without destruction of the soil resource

Feasibility of smartphone colorimetry of the face as an anaemia screening tool for infants and young children in Ghana

Background Anaemia affects approximately a quarter of the global population. When anaemia occurs during childhood, it can increase susceptibility to infectious diseases and impair cognitive development. This research uses smartphone-based colorimetry to develop a non-invasive technique for screening for anaemia in a previously understudied population of infants and young children in Ghana. Methods We propose a colorimetric algorithm for screening for anaemia which uses a novel combination of three regions of interest: the lower eyelid (palpebral conjunctiva), the sclera, and the mucosal membrane adjacent to the lower lip. These regions are chosen to have minimal skin pigmentation occluding the blood chromaticity. As part of the algorithm development, different methods were compared for (1) accounting for varying ambient lighting, and (2) choosing a chromaticity metric for each region of interest. In comparison to some prior work, no specialist hardware (such as a colour reference card) is required for image acquisition. Results Sixty-two patients under 4 years of age were recruited as a convenience clinical sample in Korle Bu Teaching Hospital, Ghana. Forty-three of these had quality images for all regions of interest. Using a naïve Bayes classifier, this method was capable of screening for anaemia (<11.0g/dL haemoglobin concentration) vs healthy blood haemoglobin concentration (≥11.0g/dL) with a sensitivity of 92.9% (95% CI 66.1% to 99.8%), a specificity of 89.7% (72.7% to 97.8%) when acting on unseen data, using only an affordable smartphone and no additional hardware. Conclusion These results add to the body of evidence suggesting that smartphone colorimetry is likely to be a useful tool for making anaemia screening more widely available. However, there remains no consensus on the optimal method for image preprocessing or feature extraction, especially across diverse patient populations

Evaluating services for perinatal asphyxia and low birth weight at two hospitals in Ghana: a micro-costing analysis

Background: Neonatal mortality has been decreasing slowly in Ghana despite investments in maternal-newborn services. Although community-based interventions are effective in reducing newborn deaths, hospital-based services provide better health outcomes.Objective: To examine the process and cost of hospital-based services for perinatal asphyxia and low birth weight/preterm at a district and a regional level referral hospital in Ghana.Methods: A cross-sectional study was conducted at 2 hospitals in Greater Accra Region during May-July 2016. Term infants with perinatal asphyxia and low birth weight/preterm infants referred for special care within 24hours after birth were eligible. Time-driven activity-based costing (TDABC) approach was used to examine the process and cost of all activities in the full cycle of care from admission until discharge or death. Costs were analysed from health provider’s perspective.Results: Sixty-two newborns (perinatal asphyxia 27, low-birth-weight/preterm 35) were enrolled. Cost of care was proportionately related to length-of-stay. Personnel costs constituted over 95% of direct costs, and all resources including personnel, equipment and supplies were overstretched.Conclusion: TDABC analysis revealed gaps in the organization, process and financing of neonatal services that undermined the quality of care for hospitalized newborns. The study provides baseline cost data for future cost-effectiveness studies on neonatal services in Ghana.Keywords: perinatal asphyxia; low-birth-weight; time-driven activity-based costing; process of careFunding: Authors received no external funding for the stud

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

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

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