Possible Health Risk due to the Environmental Exposure of High Levels of Lead in Exhaust Soot of Automobiles in Parts of Accra, Ghana

Internal combustion engines produce soot as a result of incomplete gasoline and diesel combustion.  Leaded exhaust soot emitted into the atmosphere has serious health and environmental concerns. Lead has been outlawed as an automotive gasoline additive in most countries including Ghana because of its cumulative toxicity in humans especially children and damaging effect on catalytic converters in automobiles. Nevertheless, leaded fuels are apparently being produced, imported and used illegally in some countries as octane rating booster because of its profitability. Refined gasoline and diesel are imported into Ghana through bulk oil distribution firms. This preliminary study assessed the level of lead in automotive exhaust soot from randomly selected automobiles in parts of Accra. Exhaust soot samples obtained from ten diesel and ten gasoline automobiles were collected for analysis of its lead concentration using atomic absorption spectrophotometry. The results showed the presence of lead in 4(40%) and 10(100%) of the randomly selected diesel and gasoline vehicular exhaust soot respectively. The concentration of lead in the exhaust soot of diesel-powered automobiles ranged from 0.060mg/kg to 0.435mg/kg and that of the gasoline-powered vehicles recorded values ranging from 0.195mg/kg to 2.055mg/kg. With this rather high level of lead in the vehicular soot, it could be concluded that the exhaust soot can be a significant source of lead in the atmosphere in parts of Accra. Lead exposure is known to cause debilitating developmental and neurological effects in children and cardiovascular effects in adults. The high levels of lead in the exhaust soot may be attributed to the possibility of lead additives in the gasoline and diesel used by those automobiles. Regulators of the petroleum downstream industry such as the National Petroleum Authority must routinely test for lead in imported refined petroleum products and enforce the ban on the importation, sale and usage of the outlawed leaded fuel in Ghana. Further studies should be conducted on the levels of lead in air and blood lead levels in fuel dispensers, fuel tanker drivers and fuel loading workers of bulk oil distribution firms. Keywords: Lead, Exhaust, Soot, Gasoline, Automobil

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Fertilizer and residue quality effects on organic matter stabilization in soil aggregates

This study examined the influence of organic residue quality and N fertilizer on aggregate-associated SOM in maize cropping systems of southern Ghana. Six residue treatments of differing quality (Crotalaria juncea, Leucaena leucocephala, maize stover, sawdust, cattle manure and a control with no residues added) were applied at 4 Mg C ha-1 yr-1 both with and without fertilizer N additions (120 kg N ha-1 season-1). Soils (0-15cm) were sampled three years after study implementation and wet sieved into four aggregate size classes (8000–2000, 2000– 250, 250–53, and 250 ?m), microaggregates within macroaggregates (53-250 ?m), and macroaggregate occluded silt and clay (<53 ?m). N fertilizer additions reduced aggregate stability as was evident from a 40% increase in the weight of the silt and clay fraction (P= 0.014) as well as a decrease in microaggregates across all residue types (P = 0.019). Fertilizer similarly affected C and N storage within these aggregate fractions, while effects of residue quality were largely insignificant. Our results suggest that fertilizer effects on soil aggregation may have important implications for long-term SOM dynamics

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally