Contribution of Community Based Health Planning Service in Maternal Health Service Delivery in the Tamale Metropolitan Area, Ghana.

The fast approach of the end of the Millennium Development Goals (MDGs) by the end of 2015 has driven many countries to accelerate their efforts at achieving the goals. In line with the proposed means of measuring the success of the MDG 5 by World Health Organisation (WHO): to reduce country maternal mortality ratios and achieve universal reproductive health, Ghana has been implementing the Community based Health Planning Services (CHPS) strategy to address the MDG 4 and 5. This study sought to assess the contribution of the CHPS to the attainment of the MDG5 using the indicators of antenatal care, delivery services, postnatal care and community participation components of CHPS. Adopting qualitative and quantitative study approach and the cross sectional research design, the Tamale Metropolitan Area (TaMA) was brought into focus to have a snap shot view on the contribution of CHPS to maternal health. Three hundred and ninety five women of child bearing age (15-49 years), 31 Traditional Birth Attendants (TBAs) and six health professionals in the CHPS zones provided information for the study through questionnaire administration, focused group discussions and interviews respectively. The results revealed that, 80.8percent of the women attended antenatal clinic in their respective CHPS compound. All the CHPS in the study did not provide delivery services for the women due to lack of midwives. Further, 89 percent of the women were delivered by TBAs at home whilst the rest delivered in either a health centre or hospital because of complications in pregnancy. All respondents received the first 24 hours postnatal care from either TBAs, or nurses who worked in their respective CHPS compound and midwives in the health centres or hospitals. All respondents accessed general health services in their zonal CHPS. The study concludes that, for full implementation of the CHPS to effectively contribute to the achievement of the MDG5, the District Director of Health Services should post midwives to the CHPS compound to ensure that skilled delivery services are provided. Keywords: Community based Heath Planning Service, Antenatal care, Delivery care and Postnatal care

Development of a Stope Stability Prediction Model Using Ensemble Learning Techniques - A Case Study

The consequences of collapsed stopes can be dire in the mining industry. This can lead to the revocation of a mining license in most jurisdictions, especially when the harm costs lives. Therefore, as a mine planning and technical services engineer, it is imperative to estimate the stability status of stopes. This study has attempted to produce a stope stability prediction model adopted from stability graph using ensemble learning techniques. This study was conducted using 472 case histories from 120 stopes of AngloGold Ashanti Ghana, Obuasi Mine. Random Forest, Gradient Boosting, Bootstrap Aggregating and Adaptive Boosting classification algorithms were used to produce the models. A comparative analysis was done using six classification performance metrics namely Accuracy, Precision, Sensitivity, F1-score, Specificity and Mathews Correlation Coefficient (MCC) to determine which ensemble learning technique performed best in predicting the stability of a stope. The Bootstrap Aggregating model obtained the highest MCC score of 96.84% while the Adaptive Boosting model obtained the lowest score. The Specificity scores in decreasing order of performance were 98.95%, 97.89%, 96.32% and 95.26% for Bootstrap Aggregating, Gradient Boosting, Random Forest and Adaptive Boosting respectively. The results showed equal Accuracy, Precision, F1-score and Sensitivity score of 97.89% for the Bootstrap Aggregating model while the same observation was made for Adaptive Boosting, Gradient Boosting and Random Forest with 90.53%, 92.63% and 95.79% scores respectively. At a 95% confidence interval using Wilson Score Interval, the results showed that the Bootstrap Aggregating model produced the minimal error and hence was selected as the alternative stope design tool for predicting the stability status of stopes.   Keywords: Stope Stability, Ensemble Learning Techniques, Stability Graph, Machine Learnin

Exploring perceptions of community health policy in Kenya and identifying implications for policy change

Background Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change. Methods We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those who will influence or be influenced by CHS policy change in Kenya (policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members) in two purposively selected counties: Nairobi and Kitui. Qualitative data were digitally recorded, transcribed, translated and coded before framework analysis. Results There is widespread community appreciation for the existing strategy. High attrition, lack of accountability for voluntary CHWs and lack of funds to pay CHW salaries, combined with high CHEW workload were seen as main drivers for strategy change. Areas for change identified include: lack of clear supervisory structure including provision of adequate travel resources, current uneven coverage and equity of community health services, limited community knowledge about the strategy revision and demand for home-based HIV testing and counselling. Conclusion This in-depth analysis which captures multiple perspectives results in robust recommendations for strategy revision informed by the Five Wonders of Change Framework. These recommendations point towards a more people-centred health system for improved equity and effectiveness and indicate priority areas for action if success of policy change through the roll-out of the revised strategy is to be realized

What do community health workers have to say about their work, and how can this inform improved programme design? A case study with CHWs within Kenya.

Community health workers (CHWs) are used increasingly in the world to address shortages of health workers and the lack of a pervasive national health system. However, while their role is often described at a policy level, it is not clear how these ideals are instantiated in practice, how best to support this work, or how the work is interpreted by local actors. CHWs are often spoken about or spoken for, but there is little evidence of CHWs' own characterisation of their practice, which raises questions for global health advocates regarding power and participation in CHW programmes. This paper addresses this issue

Total recall in the SCAMP Cohort: validation of self-reported mobile phone use in the smartphone era

Mobile phone use, predominantly smartphones, is almost ubiquitous amongst both adults and children. However adults and children have different usage patterns. A major challenge with research on mobile phone use is the reliability of self-reported phone activity for accurate exposure assessment. We investigated the agreement between self-reported mobile phone use data and objective mobile operator traffic data in a subset of adolescents aged 11-12 years participating in the Study of Cognition, Adolescents and Mobile Phones (SCAMP) cohort. We examined self-reported mobile phone use, including call frequency, cumulative call time duration and text messages sent among adolescents from SCAMP and matched these data with records provided by mobile network operators (n = 350). The extent of agreement between self-reported mobile phone use and mobile operator traffic data use was evaluated using Cohen's weighted Kappa (ĸ) statistics. Sensitivity and specificity of self-reported low ( 30min of call/day or ≥ 11 text messages sent /day) use were estimated. Agreement between self-reported mobile phone use and mobile operator traffic data was highest for the duration spent talking on mobile phones per day on weekdays (38.9%) and weekends (29.4%) compared to frequency of calls and number of text messages sent. Adolescents overestimated their mobile phone use during weekends compared to weekdays. Analysis of agreement showed little difference overall between the sexes and socio-economic groups. Weighted kappa between self-reported and mobile operator traffic data for call frequency during weekdays was κ = 0.12, 95% CI 0.06-0.18. Of the three modes of mobile phone use measured in the questionnaire, call frequency was the most sensitive for low mobile phone users on weekdays and weekends (77.1, 95% CI: 69.3-83.7 and 72.0, 95% CI: 65.0-78.4, respectively). Specificity was moderate to high for high users with the highest for call frequency during weekdays (98.4, 95% CI: 96.4-99.5). Despite differential agreement between adolescents' self-reported mobile phone use and mobile operator traffic data, our findings demonstrate that self-reported usage adequately distinguishes between high and low use. The greater use of mobile smartphones over Wi-Fi networks by adolescents, as opposed to mobile phone networks, means operator data are not the gold standard for exposure assessment in this age group. This has important implications for epidemiologic research on the health effects of mobile phone use in adolescents

Night-time screen-based media device use and adolescents’ sleep and health-related quality of life.

Objective: The present study investigates the relationship between night-time screen-based media devices (SBMD) use, which refers to use within one hour before sleep, in both light and dark rooms, and sleep outcomes and health-related quality of life (HRQoL) among 11 to 12-year-olds. Methods: We analysed baselined data from a large cohort of 6,616 adolescents from schools in and around London, United Kingdom, participating in the Study of Cognition Adolescents and Mobile Phone (SCAMP). Adolescents self-reported their use of any SBMD (mobile phone, tablet, laptop, television etc.). Sleep variables were derived from self-reported weekday and/or weekend bedtime, sleep onset latency (SOL) and wake time. Sleep quality was assessed using four standardised dimensions from the Swiss Health Survey. HRQoL was estimated using the KIDSCREEN-10 questionnaire. Results Over two-thirds (71.5%) of adolescents reported using at least one SBMD at night-time, and about a third (32.2%) reported using mobile phones at night-time in darkness. Night-time mobile phone and television use was associated with higher odds of insufficient sleep duration on weekdays (Odds Ratio, OR= 1.82, 95% Confidence Interval, CI [1.59, 2.07] and OR=1.40, 95% CI [1.23, 1.60], respectively). Adolescents who used mobile phones in a room with light were more likely to have insufficient sleep (OR=1.32, 95% CI [1.10, 1.60]) and later sleep midpoint (OR=1.64, 95% CI [1.37, 1.95]) on weekends compared to non-users. The magnitude of these associations was even stronger for those who used mobile phones in darkness for insufficient sleep duration on weekdays (OR=2.13, 95% CI [1.79, 2.54]) and for later sleep midpoint on weekdays (OR=3.88, 95% CI [3.25, 4.62]) compared to non-users. Night-time use of mobile phones in light was not associated with HRQoL but use in darkness was associated with a lower KIDSCREEN-10 score (β= -1.19, 95% CI [-1.83, -0.56]) compared to no use. Conclusions: We found consistent associations between night-time SBMD use and poor sleep outcomes and worse HRQoL in adolescents. The magnitude of these associations was stronger when SBMD use occurred in a dark room versus a lit room

Secondary bacterial infections of buruli ulcer lesions before and after chemotherapy with streptomycin and rifampicin

Buruli ulcer (BU), caused by Mycobacterium ulcerans is a chronic necrotizing skin disease. It usually starts with a subcutaneous nodule or plaque containing large clusters of extracellular acid-fast bacilli. Surrounding tissue is destroyed by the cytotoxic macrolide toxin mycolactone produced by microcolonies of M. ulcerans. Skin covering the destroyed subcutaneous fat and soft tissue may eventually break down leading to the formation of large ulcers that progress, if untreated, over months and years. Here we have analyzed the bacterial flora of BU lesions of three different groups of patients before, during and after daily treatment with streptomycin and rifampicin for eight weeks (SR8) and determined drug resistance of the bacteria isolated from the lesions. Before SR8 treatment, more than 60% of the examined BU lesions were infected with other bacteria, with Staphylococcus aureus and Pseudomonas aeruginosa being the most prominent ones. During treatment, 65% of all lesions were still infected, mainly with P. aeruginosa. After completion of SR8 treatment, still more than 75% of lesions clinically suspected to be infected were microbiologically confirmed as infected, mainly with P. aeruginosa or Proteus miriabilis. Drug susceptibility tests revealed especially for S. aureus a high frequency of resistance to the first line drugs used in Ghana. Our results show that secondary infection of BU lesions is common. This could lead to delayed healing and should therefore be further investigated

Processed data on the night-time use of screen-based media devices and adolescents' sleep quality and health-related quality of life

The data presented in this article relate to the research article entitled “Night-time screen-based media device use and adolescents' sleep and health-related quality of life” [1]. The present data reports findings from the investigation of the relationship between night-time screen-based media devices (SBMD) use and both sleep quality and health-related quality of life (HRQoL) among 11 to 12-year-olds. Baseline data from a large cohort of 6,616 adolescents from 39 schools in and around London, UK, participating in the Study of Cognition Adolescents and Mobile Phone (SCAMP) were analysed. Self-report data on adolescents’ use of any SBMD (mobile phone, tablet, laptop, television etc.) were the main exposures of interest. Mobile phone and television were the most commonly used portable and non-portable device, respectively. Sleep variables were derived from self-reported weekday and/or weekend bedtime, sleep onset latency (SOL) and wake time. Sleep quality was assessed using four standardised dimensions from the Swiss Health Survey. HRQoL was estimated using the KIDSCREEN-10 questionnaire

Pharmacokinetics of extended-release clarithromycin in patients with Mycobacterium ulcerans infection

Clarithromycin extended-release (CLA-ER) was used as companion drug to rifampicin (RIF) for Mycobacterium ulcerans infection in the intervention arm of a WHO drug trial. RIF enhances CYP3A4 metabolism, thereby reducing CLA serum concentrations, and RIF concentrations might be increased by CLA co-administration. We studied the pharmacokinetics of CLA-ER at a daily dose of 15 mg/kg combined with RIF at a dose of 10 mg/kg in a subset of trial participants, and compared these to previously obtained pharmacokinetic data. Serial dried blood spot samples were obtained over a period of ten hours, and analyzed by LC–MS/MS in 30 study participants—20 in the RIF-CLA study arm, and 10 in the RIF-streptomycin study arm. Median CLA Cmax was 0.4 mg/L—and median AUC 3.9 mg*h/L, following 15 mg/kg CLA-ER. Compared to standard CLA dosed at 7.5 mg/kg previously, CLA-ER resulted in a non-significant 58% decrease in Cmax and a non-significant 30% increase in AUC. CLA co-administration did not alter RIF Cmax or AUC. Treatment was successful in all study participants. No effect of CLA co-administration on RIF pharmacokinetics was observed. Based on our serum concentration studies, the benefits CLA-ER over CLA immediate release are unclear

Social factors influencing child health in Ghana

Objectives Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals’ target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal. Methods ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review. Results Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices. Conclusions Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother’s health knowledge is emphasised