The Impact of the National Health Insurance Scheme on Maternal Health Care in Ghana.

Despite significant gains in reducing maternal and infant mortalities across the world, Low and Middle-Income Countries continue to struggle in ensuring proper health care for mothers and children. To achieve the Sustainable Development Goals 3 of enhancing quality health care for women and children, the World Health Organization (WHO) admonishes countries to guarantee universal health coverage for their citizenry. Universal health coverage among other things, helps in alleviating the financial burden of women in accessing better health care during pregnancy and after childbirth. It is in light of this that countries including Ghana introduced the free maternal health policy under National Health Insurance Scheme (NHIS) to provide free maternal services for expectant and lactating mothers. Using interrupted time series analysis (itsa), this study examined any improvement at the national and regional levels, in delivery assistance by skilled birth attendants and postnatal care before and after the implementation of the free maternal health care within the NHIS. Findings from the study indicate that the NHIS had improved supervised deliveries by skilled birth attendants in all the 10 Ghanaian regions except for postnatal care. A greater number of NHIS-insured women utilized the services of skilled birth attendants during delivery after the commencement of the NHIS, unlike women with no insurance with the NHIS. On the contrary, the NHIS had no statistical association, nationally and in the 3 out of 10 regions, with postnatal care, despite an uptick post-NHIS, which suggests that a higher number of NHIS non-insured women received postnatal care compared to NHIS-insured women. With national and regional variations in maternal health care, the study brings to the fore, the need to increase enrollment in the NHIS and also identify and address other challenges affecting health care utilization such as long distances to health care centers, long waiting times at health facilities, unmotorable roads networks, which tend to undermine access to affordable health care for mothers and children

Antibiotics Availability and Usage in Health Facilities: A Case of the Offinso-South Municipality of Ghana

The use of antibiotics has received increased public health attention in recent times because their irrational use could pose a global health problem. Since the introduction of antimicrobial agents, there has been an association between antibiotic use and the development of antimicrobial resistance. The emergence of antibiotic resistance is primarily due to excessive and often unnecessary use of antibiotics in humans. This study therefore sought to assess antibiotics availability and usage in a municipal area of Ghana. The study was retrospective and descriptive in nature. Folders of 300 patients were sampled from a municipal hospital and three health centres. Simple random sampling technique was used in the recruitment of patients’ folders. The study revealed a high antibiotics usage in the municipality. Overall, respiratory tract infections rated the highest so far as conditions for which antibiotics were prescribed were concerned. The penicillins which were the frequently prescribed antibiotics formed 50% of prescriptions for the treatment of gastroenteritis, which was in violation of the existing standard treatment guidelines to be adhered to by prescribers. Regular training and refresher courses could be organized for prescribers towards ensuring the adherence to the existing treatment guidelines. Key words: antibiotics, availability, usage, health facilitie

The Prevalence and Risk Factors of Hepatitis B Virus Infection Among Dwellers in A Peri-Urban District of Ghana: A Cross-Sectional Study

Hepatitis B virus (HBV) infection is a significant health issue affecting about 296 million people worldwide. The disease is of great public health concern in Ghana as the country is within the endemic region of HBV infection. This study sought to determine the prevalence of HBV infection and associated risk factors among dwellers in a peri-urban district of Ghana. This cross-sectional descriptive study was conducted in the Sunyani West District of the Bono Region of Ghana. Respondents aged ≥18 years were purposively recruited from the four major towns in the District with health centres. A questionnaire was used to collect data from participants, and a rapid diagnostic test for the sero-presence or otherwise of hepatitis B infection was conducted. A total of 992 respondents took part in the study, with the prevalence of HBV infection using HBsAg as a marker among all the study participants being 2.9% (male 4.0% (12/298), female 2.5% (17/694)). Females aged between 20-29 years had a comparatively higher prevalence of hepatitis B infection than their corresponding males. The intake of alcohol (RR=4.23; 95% CI:2.05-8.74, p <0.000), previously diagnosed of having a sexually transmitted disease (RR= 2.43; 95% CI: 1.03-5.71, p = .04) and having multiple sexual partners (RR= 2.27; 95% CI: 1.11-4.65, p = .02) were the significant risk factors for HBV infection among the study participants. The study showed a low prevalence of HBV infection in the Sunyani West District of Ghana using HBsAg as a serum marker to diagnose the infection. Keywords: Hepatitis, prevalence, risk factors, Sunyani Wes

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Effects of feeding graded levels of Ackee leaf meal on nutrients digestibility, growth performance and carcass characteristics of weaner rabbits

A study was carried out to determine nutrients digestibility, growth performance and carcass characteristics of weaner rabbits fed graded levels of Ackee Leaf Meal (ALM). Twenty weaner rabbits were randomly assigned to four treatments (T0 – 0 % ALM, which served as the control, T1 – 7.5 % ALM, T2 – 15 % ALM and T3 – 22.5 % ALM) in a Completely Randomized Design (CRD) and fed the assigned diets for ten weeks after one week adjustment period. Parameters measured included average daily feed intake, average daily body weight gain, feed conversion ratio and mortality. The digestibility study was carried out during the 8th week of the feeding trial. At the end of the feeding trial, two rabbits per treatment were randomly selected, starved of feed for 24 hours and slaughtered. Carcass measurements and weights of internal organs were taken. The results revealed significant differences in final body weight, total weight gain and average daily weight gain with T1 recording the highest values. Feed conversion ratio (FCR) increased when ALM was increased to 22.5 %. Digestibility values for DM and EE were significantly (p&lt;0.05) higher for T2. Dressed weight and dressing percentage declined significantly (p&lt;0.05) when ALM was increased to 22.5 % of the diet. It was concluded that ALM could be used to improve average daily weight gain and FCR up to 15 % inclusion level without increasing the unit cost of feed. The inclusion of ALM up to 15 % of the diet could also improve digestibility of DM and EE. Keywords: Digestibility, Growth, Carcass, Ackee leaf meal, Weaner rabbit