Youth Unemployment Challenges in Mining Areas of Ghana

Ghana, like the rest of West Africa is experiencing tremendous human migration both internally and across international boundaries. Rural-urban migration has assumed uncontrollable dimensions in the sub-region and the social consequences have become major development challenge. In Ghana the mining communities have been at the receiving end for some time now. This study on the Obuasi Municipal Assembly (OMA) in the Ashanti region of Ghana explores the tremendous socioeconomic changes, especially demographic patterns as a result of the inflows of migrants into the Obuasi Township and its catchment area in search of non existing jobs especially in mining. A major outcome is the serious unemployment problem in the township with all the attendant social vices. A three-month socio-economic study of the municipality was carried out to determine the scope of unemployment. The study showed that there is acute unemployment situation in the municipality which is due to the fact that AngloGold Ashanti, a mining giant in Ghana, the major employer, has limited job openings especially for menial workers who flock to the company. Other income generating opportunities are few. Agriculture which has the capacity to employ majority of the unemployed youth does not appeal to them because it is considered not lucrative. The acute unemployment situation has contributed significantly to the high crime rate, prostitution and widespread illegal mining activities with their attendant problems. The study explores options that are feasible for a typical mining setting especially for the youth who are very vulnerable and susceptible to crime and other social vices. Job creation, through the development and implementation of sustainable programmes aimed at training the youth to acquire the necessary employable skills is one of the options considered by the municipal managers and their partners. The study also looks at broader policy implications for the Economic Community of West African States (ECOWAS).Illegal Mining, Unemployment, AngloGold Ashanti, Social Vices, Agriculture, Mining Communities, Migration

Determinants of sputum ordering for tuberculosis diagnosis in people living with HIV in the Greater Accra Region, Ghana

Background: This study assessed factors associated with sputum ordering for tuberculosis (TB) diagnosis in people living with HIV (PLHIV) who were screened positive for TB in three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana.Objective: This study assessed the factors associated with sputum ordering in PLHIV with a positive TB symptom screen test.Methods: A mixed-method cross-sectional study was undertaken at three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana. The study involved a review of 400 patients' charts and in-depth interviews with health workers involved in the care and treatment of PLHIV. Bivariate analysis using a Chi-square test and Logistic regression for multivariate analysis were used to establish factors associated with sputum ordering. Factors having a p ≤ 0.05 were considered significantly associated with sputum ordering. Inductive thematic analysis was used to explain the associated factors.Results: Of the 400 charts reviewed, 67.7% were female patients with a median age of 39 (IQR 31 ̶ 49). TB screening was recorded in 78% (n = 312/400, 95% CI: 73.6 ̶ 82.0) of the patients, of whom ninety-two (92) patients had a positive TB screen test. Only 57.6% (n = 53) who had a positive screen test had sputum ordered for further TB testing. In the multivariate analysis, the patient's general appearance was described as abnormal (OR = 3.05, p = 0.036), having more than one TB symptom (OR = 3.42, p = 0.028) and presence of an alternative presumptive diagnosis (OR = 0.34, p = 0.023) were associated with having a sputum test ordered. High patient numbers, the inability to produce sputum, the unwillingness of moderately sick patients to provide sputum and the cost associated with chest X-rays were perceived as the challenges to further testing for TB.Conclusion: Almost half of PLHIV with a positive TB screen test did not have a sputum test documented. This calls for instituting measures to address the barriers to TB screening among people living with HIV/AIDS for effective TB and HIV comorbidity management

Marketability and sustainability of food security programmes: products and productivity of agricultural projects

This paper addresses the marketability and sustainability of food security programmes in Limpopo Province. Food security features prominently because poverty and inequality remains a huge challenge in South Africa’s rural sector. Thus the Government has initiated the establishment of agricultural community projects as part of interventions for creating jobs and improving income levels. However, lack of monitoring mechanisms in established projects create a challenge of nonsustainability of these projects. The study has used formative evaluation approach to determine the effectiveness of the established food security programme. A mixed model approach was used to collect data from key informants and project members. Descriptive statistics were computed using SPSS. Most projects were on vegetable, poultry and piggery production. The study has found that 64.1% of the respondents reported that access to inputs was not a challenge. Project products are sold to community members who accounted to 79%, and few (1%) to individuals owning business, clinics and outside the community. Project members advertised their produce mainly verbally (47.2%). Marketing strategies for project products were lacking and this creates a negative impact on income generated and sustainability of projects. The paper concludes by suggesting that project members should be advised on appropriate marketing strategies.S.Afr. Tydskr. Landbouvoorl./S. Afr. J. Agric. Ext., Vol. 40 2012: 1 – 1

Evidence-based practice in local public health service in Ghana

While the role of evidence-based public health in improving health outcomes is frequently touted, there remains a dearth of research examining the use of evidence in public health service particularly in low- and middle-income countries. Therefore, the aim of this research was to examine the use of evidence in local public health service in Ghana, a lower middle-income country. Semi-structured in-depth interviews were conducted with local health managers from 11 District Directorates of Health in Ashanti Region. Three organising themes emerged from the interview transcripts: understanding of evidence-based public health; the process of using evidence; and the value of evidence in public health practice. The study suggests that though evidence-based practice was not new to the local health managers, its application was very low. The process of using evidence commenced with making a decision about the direction of a programme which had been already prioritised and planned by other high-level actors and then various sources of information, including available research evidence, were used to justify the decision. The study has revealed that there is an urgent need for pre-service and in-service training programmes that build and maintain common skill sets and language among local public health practitioners in Ghana to accomplish evidence-based public health goals. Similarly, giving local health managers flexibility to prioritise and make decisions would result in increased uptake of evidence in local public health service

Livelihood trends in Response to Climate Change in Forest Fringe Communities of the Offin Basin in Ghana

The livelihoods of forest fringe communities in Ghana depend, largely, on the renewable natural resources that they can find in the forests and any activities that impacts on the integrity of the forest disrupt the livelihood of the dependent communities. Forest fragmentation continues to take place in Ghana, mainly in response to a growing demand to feed an ever increasing population and for timber exploitation for export. One of the forest fringe communities in Ghana where the rural livelihoods of the people have been compromised due to deforestation and climate change is the Offin basin. The removal of forests impacts on local climate, water availability, and livelihoods due to influence of forests on precipitation and water balance. Fluxes in the quantity and frequency of rainfall contribute to decreasing food production and water availability. This study examines forest loss, precipitation and ambient temperature patterns in the forest fringe communities in the Offin river basin over the past four and a half decades and assesses current impacts and trends on rural livelihoods and coping strategies by the communities. The forests provide the communities with fuel-wood, fish and game, medicinal plants, food sources, and recreation. Between 2000 and 2005 deforestation rate in the basin was 2%. Mean annual precipitation decreased by 22.2% between 1960 and 2000 in response to a 1.3\ub0C rise in ambient temperature over the same period. Considerable changes in the frequency of rainfall and its unpredictability impacted negatively on the livelihood of the fringe communities who are predominantly cocoa and subsistence crop farmers. The livelihood resources of the community are severely constrained leading to reduction in food security and economic losses. In response to deforestation and associated climatic changes, several coping strategies for sustenance of livelihoods have been adopted by the forest fringe communities. @ JASE

Genetic Diversity of PCR-Positive, Culture-Negative and Culture-Positive Mycobacterium ulcerans Isolated from Buruli Ulcer Patients in Ghana.

Culture of Mycobacterium ulcerans from Buruli ulcer patients has very low sensitivity. Thus confirmation of M. ulcerans infection is primarily based on PCR directed against IS2404. In this study we compare the genotypes obtained by variable number of tandem repeat analysis of DNA from IS2404-PCR positive cultures with that obtained from IS2404 positive, culture-negative tissue. A significantly greater genetic heterogeneity was found among culture-negative samples compared with that found in cultured strains but a single genotype is over-represented in both sample sets. This study provides evidence that both the focal location of bacteria in a lesion as well as differences in the ability to culture a particular genotype may underlie the low sensitivity of culture. Though preliminary, data from this work also suggests that mycobacteria previously associated with fish disease (M. pseudoshottsii) may be pathogenic for humans

Rifampicin and clarithromycin (extended release) versus rifampicin and streptomycin for limited Buruli ulcer lesions: a randomised, open-label, non-inferiority phase 3 trial.

BACKGROUND: Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifampicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions. METHODS: We did an open-label, non-inferiority, randomised (1:1 with blocks of six), multicentre, phase 3 clinical trial comparing fully oral RC8 with RS8 in patients with early, limited Buruli ulcer lesions. There were four trial sites in hospitals in Ghana (Agogo, Tepa, Nkawie, Dunkwa) and one in Benin (Pobè). Participants were included if they were aged 5 years or older and had typical Buruli ulcer with no more than one lesion (caterories I and II) no larger than 10 cm in diameter. The trial was open label, and neither the investigators who took measurements of the lesions nor the attending doctors were masked to treatment assignment. The primary clinical endpoint was lesion healing (ie, full epithelialisation or stable scar) without recurrence at 52 weeks after start of antimicrobial therapy. The primary endpoint and safety were assessed in the intention-to-treat population. A sample size of 332 participants was calculated to detect inferiority of RC8 by a margin of 12%. This study was registered with ClinicalTrials.gov, NCT01659437. FINDINGS: Between Jan 1, 2013, and Dec 31, 2017, participants were recruited to the trial. We stopped recruitment after 310 participants. Median age of participants was 14 years (IQR 10-29) and 153 (52%) were female. 297 patients had PCR-confirmed Buruli ulcer; 151 (51%) were assigned to RS8 treatment, and 146 (49%) received oral RC8 treatment. In the RS8 group, lesions healed in 144 (95%, 95% CI 91 to 98) of 151 patients, whereas lesions healed in 140 (96%, 91 to 99) of 146 patients in the RC8 group. The difference in proportion, -0·5% (-5·2 to 4·2), was not significantly greater than zero (p=0·59), showing that RC8 treatment is non-inferior to RS8 treatment for lesion healing at 52 weeks. Treatment-related adverse events were recorded in 20 (13%) patients receiving RS8 and in nine (7%) patients receiving RC8. Most adverse events were grade 1-2, but one (1%) patient receiving RS8 developed serious ototoxicity and ended treatment after 6 weeks. No patients needed surgical resection. Four patients (two in each study group) had skin grafts. INTERPRETATION: Fully oral RC8 regimen was non-inferior to RS8 for treatment of early, limited Buruli ulcer and was associated with fewer adverse events. Therefore, we propose that fully oral RC8 should be the preferred therapy for early, limited lesions of Buruli ulcer. FUNDING: WHO with additional support from MAP International, American Leprosy Missions, Fondation Raoul Follereau France, Buruli ulcer Groningen Foundation, Sanofi-Pasteur, and BuruliVac

Mycobacterium ulcerans DNA Not Detected in Faecal Samples from Buruli Ulcer Patients: Results of a Pilot Study

It has recently been shown that in a Buruli ulcer (BU) endemic region of southeastern Australia, significant numbers of possums (native tree-dwelling marsupials) have clinical BU disease. Furthermore, based on quantitative PCR (qPCR) analysis, animals with BU lesions (and some without) shed M. ulcerans DNA in their faeces, indicative of bacterial loads of up to 108 organisms/gram. These findings led us to propose that humans might also harbour M. ulcerans in their gastrointestinal tract and shed the bacterium in their faeces. We conducted a pilot study and collected faecal swabs from 26 patients with confirmed BU and 31 healthy household controls. Faecal samples were also collected from 10 healthy controls from non-endemic regions in Ghana. All 67 specimens were negative when tested by IS2404 PCR. The detection sensitivity of this method was ≥104 bacteria per gram (wet-weight) of human faecal material. We conclude that the human gastrointestinal tract is unlikely to be a significant reservoir of M. ulcerans

Life's Simple 7 at Midlife and Risk of Recurrent Cardiovascular Disease and Mortality after Stroke: The ARIC study

Background: Stroke is a leading cause of morbidity and mortality among adults in the U.S. Ideal levels of the Life's Simple 7 (LS7) are associated with lower cardiovascular disease (CVD) and all-cause mortality. However, the association of LS7 with CVD, recurrent stroke, and all-cause mortality after incident stroke is unknown. Methods: We used data from the ARIC study, a cohort of 13,508 adults from four US communities, 45–64 years old at baseline (1987–1989). Cardiovascular hospitalizations and mortality were ascertained in follow-up through December 31st, 2017. We defined cardiovascular health (CVH) based on AHA definitions for LS7 (range 0-14) and categorized CVH into four levels: LS7 0-3, 4-6, 7-9, and ≥10 (ideal LS7), according to prior studies. Outcomes included incident stroke, CVD, recurrent stroke, all-cause mortality, and a composite outcome including all the above. Adjusted hazard ratios (95% CI) were estimated with Cox proportional hazards regression models. Results: Median (25%-75%) follow-up for incident stroke was 28 (18.6-29.2) years. Participants with incident stroke were 55.7 (SD 5.6) years-old at baseline, 53% were women and 35% Black. Individuals with LS7 score ≥10 had 65% lower risk (HR: 0.35; 95% CI: 0.29-0.41) of incident stroke than those with LS7 4-6 (reference group). Of 1,218 participants with incident stroke, 41.2% (n=502) had composite CVD and 68.3% (n=832) died during a median (25%-75%) follow-up of 4.0 (0.76-9.95) years. Adjusted HR (95% CI) for stroke survivors with LS7≥10 at baseline were 0.74 (0.58-0.94) for the composite outcome, 0.38(0.17-0.85) for myocardial infarction, 0.60 (0.40-0.90) for heart failure, 0.63 (0.48-0.84) for all-cause mortality, and 0.65 (0.39-1.08) for recurrent stroke. Conclusions: Good and excellent midlife cardiovascular health are associated with lower risks of incident stroke and CVD after stroke. Clinicians should stress the importance of a healthy lifestyle for primary and secondary CVD prevention