‘The medicine is not for sale’: Practices of traditional healers in snakebite envenoming in Ghana

Background Snakebite envenoming is a medical emergency which is common in many tropical lower-and middle-income countries. Traditional healers are frequently consulted as primary care-givers for snakebite victims in distress. Traditional healers therefore present a valuable source of information about how snakebite is perceived and handled at the community level, an understanding of which is critical to improve and extend snakebite-related healthcare. Method The study was approached from the interpretive paradigm with phenomenology as a meth-odology. Semi-structured interviews were conducted with 19 traditional healers who treat snakebite patients in two rural settings in Ghana. From the Ashanti and Upper West regions respectively, 11 and 8 healers were purposively sampled. Interview data was coded, col-lated and analysed thematically using ATLAS.ti 8 software. Demographic statistics were analysed using IBM SPSS Statistics version 26. Findings Snakebite was reportedly a frequent occurrence, perceived as dangerous and often deadly by healers. Healers felt optimistic in establishing a diagnosis of snakebite using a multitude of methods, ranging from herbal applications to spiritual consultations. They were equally confident about their therapies; encompassing the administration of plant and animal-based concoctions and manipulations of bite wounds. Traditional healers were consulted for both physical and spiritual manifestations of snakebite or after insufficient pain control and lack of antivenom at hospitals; referrals by healers to hospitals were primarily done to receive anti-venom and care for wound complications. Most healers welcomed opportunities to engage more productively with hospitals and clinical staff. Conclusions The fact that traditional healers did sometimes refer victims to hospitals indicates that improvement of antivenom stocks, pain management and wound care can potentially improve health seeking at hospitals. Our results emphasize the need to explore future ave-nues for communication and collaboration with traditional healers to improve health seeking behaviour and the delivery of much-needed healthcare to snakebite victims

Traditional healers' perception on scabies causation and management in Ghana

Introduction: Scabies is an underdiagnosed skin infestation caused by the Sarcoptes scabiei mite. The infection causes severe itching and a skin rash but can be effectively treated using topical or systemic drugs. Scabies outbreaks are commonly reported in resource‐poor countries, including Ghana. Traditional healers play an important role in primary care in rural areas. The role of these traditional healers in the management of scabies has so far not been explored. The aim of this study was therefore to investigate the perceptions of traditional healers regarding the causation and management of scabies. Methods: A phenomenological qualitative approach was employed. Traditional healers in the Asante Akim North and Central districts in Ghana were approached with an interview request. Using a semi‐structured interview protocol, 15 traditional healers were interviewed. The results were coded and analysed, after which seven themes were extrapolated. Results: Scabies infections were frequently reported by traditional healers. Itching and skin rash were unanimously regarded as the major symptoms of scabies. The majority acknowledged the infectious nature of scabies, but no participant reported the causative organism. A dichotomous disease classification was noted, consisting of ‘natural’ and ‘spiritual’ variants each with a unique disease profile and management requirements, as reported by the traditional healers. All but two traditional healers reported to treat scabies using almost exclusively herbs and spiritual rituals. Conclusion: The majority of traditional healers were open to collaboration with allopathic healthcare providers. Collaboration could broaden the primary care network in rural areas, but mistrust and lack of transparency form potential barriers to collaboration. We, therefore, emphasise the need for additional efforts to investigate strategies for future collaboration

Short Report: Buruli Ulcer Control in a Highly Endemic District in Ghana: Role of Community-Based Surveillance Volunteers

Buruli ulcer (BU) is an infectious skin disease that occurs mainly in West and Central Africa. It can lead to severe disability and stigma because of scarring and contractures. Effective treatment with antibiotics is available, but patients often report to the hospital too late to prevent surgery and the disabling consequences of the disease. In a highly endemic district in Ghana, intensified public health efforts, mainly revolving around training and motivating community-based surveillance volunteers (CBSVs), were implemented. As a result, 70% of cases were reported in the earliest-World Health Organization category I-stage of the disease, potentially minimizing the need for surgery. CBSVs referred more cases in total and more cases in the early stages of the disease than any other source. CBSVs are an important resource in the early detection of BU

An Assessment of Heavy Metal Pollution in Sediments of a Tropical Lagoon: A Case Study of the Benya Lagoon, Komenda Edina Eguafo Abrem Municipality (KEEA) — Ghana

Background. Elevated concentrations of heavy metals in soil have detrimental consequences on the environment, which translates into damaging effects on humans. Objective. An evaluation was carried out to determine the concentrations of seven heavy metals (As, Cd, Cr, Cu, Hg, Pb, Zn) in soil sediments collected from 12 different stations within the Benya Lagoon in Komenda Edina Eguafo Abrem Municipality (KEEA) in Ghana. Methods. The calibration and concentration measurements of the elements were carried out using a fast sequential hydride generation atomic absorption spectrophotometer. Results. An assessment according to metal concentration in terms of abundance found that Pb registered the highest, while a comparison with standard sediment criteria by USEPA and CBSQG indicated heavy pollution levels of As, Cd, Hg, and Pb. Using Pearson's coefficient matrix, As-Cd had a correlation of 1.000, while Zn-Pb registered 0.858, indicating the same or similar source input for each pair. Both the geo-accumulation index (Igeo) and the contamination factor (CF) gave the extent of contamination in the order Cd > Pb > As > Hg > Cu > Cr > Zn, while the degree of contamination Cd at the stations was in the order 1 > 3 > 4 > 5 > 6 > 2 > 7 > 8 > 9 > 10 > 12 > 11, indicating Station 1 as the most polluted. The Hakanson index established the order of decreasing threat of a potential ecological risk as Cd > Hg > As > Pb > Cu > Cr > Zn. Discussion. The high sums of the individual potential risks values obtained at the sampling stations point to a possible detrimental effect on the health of inhabitants that use resources directly from the lagoon without treatment, and therefore the need for education to curtail any unanticipated disasters. Competing Interests. The authors declare no competing financial interests

Absence of malaria-associated coagulopathy in asymptomatic plasmodium falciparum infection: results from a cross-sectional study in the Ashanti Region, Ghana

Background: Coagulopathy is common in acute symptomatic Plasmodium falciparum malaria, and the degree of coagulation abnormality correlates with parasitemia and disease severity. Chronic asymptomatic malaria has been associated with increased morbidity. However, the role of coagulation activation in asymptomatic, semi-immune individuals remains unclear. This study investigates the potential effect of asymptomatic P falciparum infection on coagulation activation in semi-immune Ghanaian adults. Methods: Blood from asymptomatic Ghanaian adults with P falciparum blood stage infection detectable by polymerase chain reaction (PCR) or by both PCR and rapid diagnostic test and from noninfected individuals, was investigated. Markers of coagulation activation including global coagulation tests, D-dimer, antithrombin III, fibrinogen, and von Willebrand factor antigen were tested. Furthermore, blood count, inflammation markers, and liver and kidney function tests were assessed. Results: Acquired coagulopathy was not found in asymptomatic P falciparum infection. Asymptomatic malaria was associated with significantly lower platelet counts. Systemic inflammation markers and liver and kidney function tests were not altered compared to noninfected controls. Conclusions: There is no laboratory evidence for acquired coagulopathy in adults with asymptomatic P falciparum malaria in highly endemic regions. Lack of laboratory evidence for systemic inflammation and liver and kidney dysfunction indicates that asymptomatic malaria may not be associated with significant morbidity.</p