Determinants of Chronic Illness Among Aged Population in Ghana: A Multinomial Logit Approach

Generally, the constant change in demographic trends among the aged depict gradual increase in the size of the aged population globally. The aged population is often capitalised with degenerative conditions such as chronic illness which affect their ability to function effectively and often require special support. Despite the increase in the size of the aged population and their associated degenerative conditions, very few descriptive studies on the determinants of chronic illness among the aged has been researched especially in developing countries such as Ghana and there is no compelling evidence on the association of chronic illness and its determinants. Thus, this study seeks to analyse and predict the impact of age, gender, education, marital status, Quality of Life (QoL), social cohesion, settlement and depression on chronic illness among the aged population in Ghana. From the studies a Multinomial Logit Regression (MLR) was employed to analyse the data obtained from the Ghana Statistical Service (GSS) under, Ageing and Adult Health (SAGE), 2012. It was revealed that out of the 1384 sampled, 71% had no chronic illness whilst 22% and 7% had one and two or more chronic illness respectively. Again, it was observed that, Depression State, Gender, Marital Status and Settlement Type (rural or urban) play significant roles in determining the likelihood of the aged getting chronic illness while Physical Function, Social Cohesion, QoL, Age and Education Level were not statistically significant determinants of chronic illness. Our findings demonstrate that chronic illness among the aged is constantly increasing in Ghana especially in the urban communities and need to be addressed urgently through governmental policies and programs in the quest to help salvage the deteriorating conditions of the aged.   Keywords: Aged Population, Multinomial Logit Model, Chronic Illnes

Physicochemical influence on the spatial distribution of faecal bacteria and polychaetes in the Densu Estuary, Ghana

Coastal ecosystems are increasingly impacted by man-made disturbances including pollution from agriculture, aquaculture and municipal waste. This study employed multiple ecological indicators to assess environmental quality of the Densu Estuary and understanding of environmental controls on the spatial distribution of organisms. Physicochemical parameters were measured in situ. Water and sediment samples were collected from ten stations and analysed for nutrients, total suspended solids and organisms using standard methods. The water quality index for the Densu Estuary ranged from 359.5 to 484.4, suggesting an unhealthy ecosystem. The abundance of indicator species, e.g. faecal bacteria (Escherichia coli, Enterococcus species) and polychaetes (Capitella and Nereis species) varied significantly (p<0.05) among stations. Contaminated sites are located landwards with high human impacts. Faecal bacteria and polychaete abundance correlated significantly (p<0.05) with the respective physicochemical parameters. Canonical analysis (74.11%) showed the physicochemical influence on the spatial distribution of species. The pH significantly (p<0.05) controlled the spatial distribution of faecal bacteria and polychaetes in the Densu Estuary. The results suggest environmental pollution in the Densu Estuary, useful baseline information for effective legislation towards its sustainable management

Early diagnosis of prostate cancer in the Western Cape

Background. Early stage prostate cancer does not cause symptoms, and even metastatic disease may exist for years without causing symptoms or signs. Whereas early stage prostate cancer can be cured with radical prostatectomy or radiotherapy, the prognosis of patients with locally advanced or metastatic cancer is significantly poorer.Objectives. ln view of the high incidence of advanced and therefore incurable prostate cancer seen at the oncology clinic of the Department of Urology, Tygerberg Hospital, we started a prostate clinic with the aim of detecting early stage prostate cancer which is potentially curable. A secondary objective was to investigate the question whether there is a higher incidence of prostate cancer among black African men.Patients and methods. Men aged 50 - 70 years were invited by means of media communications (newspaper and radio) to attend our prostate clinic for a free physical examination, including a digital rectal examination (DRE) and serum prostate specific antigen (PSA) assay. If the DRE was clinically suspicious of malignancy and/ or the serum PSA was &gt; 4 ng/ ml, the patient was appropriately counselled and referred for transrectal ultrasound (TRUS)-guided sextant prostate biopsy.Results. In the period June 1997- September 1999 a total of 1056 men attended the prostate clinic. Biopsies were indicated in 160 cases, and were obtained in 114 (71.3%, i.e. 10.8% of the entire cohort). Prostate cancer was detected on first biopsy in 3.5% of the entire group of men (in 35.9% of those with a clinically abnormal DRE, in 41.3% of those with a serum PSA &gt; 4 ng/ ml and in 88.6% of those with an abnormal DRE and serum PSA &gt; 4 ng/ ml. In the 37 men with prostate cancer, the clinical tumour stage was T1 - 2 in 83.8% and T3- 4 in 16.2%. ln the group of patients with clinical stage T1 - 2 tumours, the treatment was watchful waiting in 62.5% of cases, radiotherapy in 20.8% and radical prostatectomy in 16.7%. Analysis of the data according to race showed that in the group of 47 black men there was a higher percentage of clinically abnormal DRE, PSA &gt; 4 .0 ng/ ml and biopsies showing malignancy, and a higher overall prostate cancer detection rate (8.5%).Conclusions. Our prostate cancer detection rate of 3.5% is slightly lower than that reported in larger studies (4.7%), which may be due to the fact that prostate biopsy was performed in only 71% of those who had an indication for biopsy. ln the men diagnosed with clinically localised prostate cancer, potentially curative treatment was given in only 37.5% of cases. This compares unfavourably with the historical cohort of men seen at our oncology clinic, where 53% received potentially curative treatment, and a large European study where potentially curative treatment was given in 89% of cases. Our finding that black men had a higher percentage of clinically abnormal DRE, PSA &gt; 4.0 ng/ ml and biopsies showing malignancy and a higher overall detection rate of prostate cancer should be interpreted with caution, since black men comprised only 4.5% of our overall study cohort.

A Machine Learning Approach for Micro-Credit Scoring

© 2021 by the authors. In micro-lending markets, lack of recorded credit history is a significant impediment to assessing individual borrowers’ creditworthiness and therefore deciding fair interest rates. This research compares various machine learning algorithms on real micro-lending data to test their efficacy at classifying borrowers into various credit categories. We demonstrate that off-the-shelf multi-class classifiers such as random forest algorithms can perform this task very well, using readily available data about customers (such as age, occupation, and location). This presents inexpensive and reliable means to micro-lending institutions around the developing world with which to assess creditworthiness in the absence of credit history or central credit databases

Challenges and perceptions of implementing mass testing, treatment and tracking in malaria control: a qualitative study in Pakro sub-district of Ghana.

BACKGROUND: Malaria remains endemic in Ghana despite several interventions. Studies have demonstrated very high levels of asymptomatic malaria parasitaemia in both under-five and school-age children. Mass testing, treatment and tracking (MTTT) of malaria in communities is being proposed for implementation with the argument that it can reduce parasite load, amplify gains from the other control interventions and consequently lead to elimination. However, challenges associated with implementing MTTT such as feasibility, levels of coverage to be achieved for effectiveness, community perceptions and cost implications need to be clearly understood. This qualitative study was therefore conducted in an area with on-going MTTT to assess community and health workers' perceptions about feasibility of scale-up and effectiveness to guide scale-up decisions. METHODS: This qualitative study employed purposive sampling to select the study participants. Ten focus group discussions (FGDs) were conducted in seven communities; eight with community members (n = 80) and two with health workers (n = 14). In addition, two in-depth interviews (IDI) were conducted, one with a Physician Assistant and another with a Laboratory Technician at the health facility. All interviews were recorded, transcribed, translated and analyzed using QSR NVivo 12. RESULTS: Both health workers and community members expressed positive perceptions about the feasibility of implementation and effectiveness of MTTT as an intervention that could reduce the burden of malaria in the community. MTTT implementation was perceived to have increased sensitisation about malaria, reduced the incidence of malaria, reduced household expenditure on malaria and alleviated the need to travel long distances for healthcare. Key challenges to implementation were doubts about the expertise of trained Community-Based Health Volunteers (CBHVs) to diagnose and treat malaria appropriately, side effects of Artemisinin-based Combination Therapies (ACTs) and misconceptions that CBHVs could infect children with epilepsy. CONCLUSION: The study demonstrated that MTTT was perceived to be effective in reducing malaria incidence and related hospital visits in participating communities. MTTT was deemed useful in breaking financial and geographical barriers to accessing healthcare. The interventions were feasible and acceptable to community members, despite observed challenges to implementation such as concerns about CBHVs' knowledge and skills and reduced revenue from internally generated funds (IGF) of the health facility

Continuous positive airway pressure for children with undifferentiated respiratory distress in Ghana: an open-label,cluster, crossover trial

Background In low-income and middle-income countries, invasive mechanical ventilation is often not available for children at risk of death from respiratory failure. We aimed to determine if continuous positive airway pressure (CPAP), a form of non-invasive ventilation, decreases all-cause mortality in children with undifferentiated respiratory distress in Ghana. Methods This open-label, cluster, crossover trial was done in two Ghanaian non-tertiary hospitals where invasive mechanical ventilation is not routinely available. Eligible participants were children aged from 1 month to 5 years with a respiratory rate of more than 50 breaths per min in children 1–12 months old, or more than 40 breaths per min in children older than 12 months, and use of accessory muscles or nasal flaring. CPAP machines were allocated to one hospital during each study block, while the other hospital served as the control site. The initial intervention site was randomly chosen using a coin toss. 5 cm of water pressure was delivered via CPAP nasal prongs. The primary outcome measure was all-cause mortality rate at 2 weeks after enrolment in patients for whom data were available after 2 weeks. We also did post-hoc regression analysis and subgroup analysis of children by malaria status, oxygen saturation, and age. This study is registered with ClinicalTrials.gov, number NCT01839474. Findings Between Jan 20, 2014, and Dec 5, 2015, 2200 children were enrolled: 1025 at the intervention site and 1175 at the control site. Final analysis included 1021 patients in the CPAP group and 1160 patients in the control group. 2 weeks after enrolment, 26 (3%) of 1021 patients in the CPAP group, and 44 (4%) of 1160 patients in the control group, had died (relative risk [RR] of mortality 0·67, 95% CI 0·42–1·08; p=0·11). In children younger than 1 year, all-cause mortality was ten (3%) of 374 patients in the CPAP group, and 24 (7%) of 359 patients in the control group (RR 0·40, 0·19–0·82; p=0·01). After adjustment for study site, time, and clinically important variables, the odds ratio for 2-week mortality in the CPAP group versus the control group was 0·4 in children aged up to 6 months, 0·5 for children aged 12 months, 0·7 for children aged 24 months, and 1·0 for those aged 36 months. 28 patients (3%) in the CPAP group and 24 patients (2%) in the control group had CPAP-related adverse events, such as vomiting, aspiration, and nasal, skin, or eye trauma. No serious adverse events were observed. Interpretation In the unadjusted analysis the use of CPAP did not decrease all-cause 2-week mortality in children 1 month to 5 years of age with undifferentiated respiratory distress. After adjustment for study site, time, and clinically important variables, 2-week mortality in the CPAP group versus the control group was significantly decreased in children 1 year of age and younger. CPAP is safe and improves respiratory rate in a non-tertiary setting in a lowermiddle- income country

Carriage Dynamics of Pneumococcal Serotypes in Naturally Colonized Infants in a Rural African Setting During the First Year of Life

Streptococcus pneumoniae (the pneumococcus) carriage precedes invasive disease and influences population-wide strain dynamics, but limited data exist on temporal carriage patterns of serotypes due to the prohibitive costs of longitudinal studies. Here, we report carriage prevalence, clearance and acquisition rates of pneumococcal serotypes sampled from newborn infants bi-weekly from weeks 1 to 27, and then bi-monthly from weeks 35 to 52 in the Gambia. We used sweep latex agglutination and whole genome sequencing to serotype the isolates. We show rapid pneumococcal acquisition with nearly 31% of the infants colonized by the end of first week after birth and quickly exceeding 95% after 2 months. Co-colonization with multiple serotypes was consistently observed in over 40% of the infants at each sampling point during the first year of life. Overall, the mean acquisition time and carriage duration regardless of serotype was 38 and 24 days, respectively, but varied considerably between serotypes comparable to observations from other regions. Our data will inform disease prevention and control measures including providing baseline data for parameterising infectious disease mathematical models including those assessing the impact of clinical interventions such as pneumococcal conjugate vaccines

Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana.

BACKGROUND: Global efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Indoor Residual Spraying, Intermittent Preventive Treatment and Test, Treat and Track. Despite these, the drive for malaria elimination is far from being realistic in endemic communities in Africa. This is partly due to the fact that asymptomatic parasite carriage, not specifically targeted by most interventions, remains the bedrock that fuels transmission. This has led to mass testing, treatment and tracking (MTTT) as an alternative strategy to target asymptomatic individuals. We report the impact of MTTT on the prevalence of asymptomatic malaria parasitaemia over a one-year period in Ghana, hypothesizing that implementing MTTT could reduce the rate of asymptomatic parasitaemia. METHODS: A population of about 5000 individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers who conducted house-to-house testing using RDTs every 4 months and treated positive cases with Artemisinin-based Combination Therapy. Between interventions, community-based management of malaria was implemented for symptomatic cases. RESULTS: MTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 36.3% (1795/4941) in July 2017 to 32.9% (1303/3966) in July 2018 (p = 0.001). Prevalence of asymptomatic parasitaemia among children under 15 years declined from 52.6% (1043/1984) in July 2017 to 47.5% (820/1728) in July 2018 (p = 0.002). Implementing MTTT significantly reduced asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and axillary temperature (OR = 0.76, CI = 0.67, 0.85 p ≤ 0.001). CONCLUSION: This study has demonstrated that implementing MTTT is feasible and could reduce the prevalence of asymptomatic malaria parasitaemia in children under 15 years of age. Furthermore, the use of community-based health volunteers could ensure high coverage at lower cost of implementation

Permeable biosorbent barrier for wastewater remediation

Chromium is one of the heavy metals that significantly affect water quality in Mongolia. The present study is focused on the remediation of surface water contaminated with chromium (III) by a permeable barrier in order to prevent sediment pollution. The adsorption capacity of the selected materials (13X zeolite and vermiculite) was investigated at different sorbent dosages, pH and initial Cr(III) concentration. The equilibrium adsorption studies showed that vermiculite has a higher Cr(III) removal efficiency in comparison with 13X zeolite. A fungal isolate obtained from the sediment samples collected near Tuul River (Mongolia) was selected from enriched Luria-Bertani medium, showing a good performance for Cr(III) removal (78.2\% for an initial concentration of 50 mg/L). The fungal isolate was genetically typed by DNA sequencing and was identified as belonging to the Alternaria alternata species. 13X zeolite showed the best performance for Cr removal in the permeable barrier assays compared to vermiculite, achieving a total removal of 96\\% and a global uptake of 2.49 mg/g. After 13 days of operation none of the barriers reached saturation with chromium.A previous version of the paper has been presented in the 2nd EWaS International Conference: BEfficient & Sustainable Water Systems Management toward Worth Living Development^, Chania, Crete, Greece, 1-4 June 2016. This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2013 unit and COMPETE 2020 (POCI-01-0145-FEDER-006684) and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020 - Programa Operacional Regional do Norte. Bruna Silva is thankful to the FCT for the concession of a Post-Doc grant (SFRH/BPD/112354/2015). Sampling process was supported by the collaborative research grant of National Academy of Sciences of Taiwan and Science and Technology Foundation of Mongolia, project code NCS-NECS2013003 and co-funded by the Young Scientist Grant (SEAS-2015075) of National University of Mongolia. E. Tuuguu would like to acknowledge the Erasmus-Mundus AREAS+ program for the opportunity to conduct research at CEB-University of Minho.info:eu-repo/semantics/publishedVersio