Pre-Hospital and Trauma Care to Road Traffic Accident Victims: Experiences of Residents Living along Accident-Prone Highways in Ghana

Road traffic accidents (RTAs) and associated injuries are a major public health problem in developing countries. The timely emergency pre-hospital care and subsequent transportation of accident victims to the health facility may help reduce the accident and injury outcomes. Available evidence suggests that RTA victims stand a greater chance of survival if attended to and cared for in a timely manner. This exploratory qualitative study set out to explore the experiences of residents of 12 communities along the Kasoa-Mankessim highway in Ghana (an accident-prone highway) in administering emergency pre-hospital care to RTA victims. We utilised data from a purposive sample of 80 respondents (i.e., people who have ever attended to RTA victims) from the communities through structured interview schedules. We found that the majority of the respondents had little knowledge and/or professional training in first-aid and emergency pre-hospital care to RTA victims. The skills and knowledge exhibited were gained through years of rescue services to RTA victims. The “scoop and run” method of first-aid care was predominant among the respondents. We recommend regular community member (layperson first responder) sensitisation and training on emergency pre-hospital care for RTA victims

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

Predictors of distractive activities to walking in Accra, Ghana

ABSTRACTWalking is a fundamental mode of transport for many people globally, with immense health and environmental benefits. However, increased walking is associated with an increased risk of road traffic crashes and injuries, especially where traffic enforcement is poor, and pedestrians could easily be distracted. Despite this, a plethora of evidence exists on driver distraction; however, there is a dread of evidence of pedestrian distraction (i.e. distracted walking), particularly in Africa. This paper uses a quantitative methodology to examine the predictors of distractive activities to walking in Accra, Ghana. The study surveyed 400 pedestrians within Accra’s Central Business District (CBD). A questionnaire was deployed via Kobo Toolkit and Jamovi was used in analysing the data. The study observed that three of the top four distractive activities to walking were digital devices-related (e.g. the use of mobile phones). We found that listening to music, making, receiving phone calls, and conversing with other people while walking are the main distractive activities. The binary logistic regression model found sex, age, level of education, occupation, reasons for walking, weekly time for walking and time for common trips as significant predictors of distractive activities to walking

Public bus passenger safety evaluations in Ghana: A phenomenological constructivist exploration

Notwithstanding the growing body of literature that recognises the importance of personal safety to public transport (PT) users, it remains unclear what PT users consider regarding their safety. In this study, we explore the criteria PT users in Ghana use to assess bus safety. This knowledge will afford a better understanding of PT users’ risk perceptions and assessments which may contribute to theoretical models of PT risk perceptions. We utilised phenomenological research methodology, with data drawn from 61 purposively sampled participants. Data collection (through focus group discussions and in-depth interviews) and analyses were done concurrently to the point of saturation. Our inductive data coding and analyses through the constant comparison and content analytic techniques resulted in 4 code categories (conceptual dimensions), 27 codes (safety items/criteria), and 100 quotations (data segments). The vehicle condition, driver’s marital status and transport operator’s safety records were the most important criteria participants use in assessing bus safety. These findings imply that investment in, and maintenance of safer vehicles, and responsible and safety-conscious drivers, and prioritisation of passengers’ safety are key-targets for public bus/minibus operators in Ghana

Testing the convergent- and predictive validity of a multi-dimensional belief-based scale for attitude towards personal safety on public bus/minibus for long-distance trips in Ghana: A SEM analysis

We examined the predictive validity of the public bus passenger safety attitude scale (PBPSAS), a measure of personal safety attitude (PSA), to predict future intention to use public bus/minibus for long-distance trips. Using 510 adults, we tested among other things the hypothesis that PSA has a positive significant effect on future intentions to use public bus/minibus for long-distance trips. Data analyses involved: (1) descriptive analyses of measure reliabilities and the strength and evaluation of people\u27s safety-related beliefs, (2) fitting measurement and structural models to determine the factorial structure of PSA and (3) path analysis to examine the relationships between two different measures for personal safety-related attitude (indirect (belief-based) measure for PSA and a direct measure) and future intentions to use public bus/minibus for long-distance trips. Data analyses were conducted using IBM SPSS Statistics 25 and AMOS 24. We found that: (1) a second-order factor model provides a more parsimonious framework for explaining PSA than a three-factor model, (2) the indirect measure for attitude towards personal safety has convergent validity, (3) PSA has a positive significant effect on both a direct measure for attitude towards personal safety on public bus/minibus, and future intention to use public bus/minibus for long-distance trips and (4) that the direct measure for attitude towards personal safety also has a positive significant effect on the future intention to use public bus/minibus. We thus conclude that PBPSAS is a useful instrument for measuring PSA and is valid in predicting future intentions to use public bus/minibus for long-distance trips

Mining groups of factors influencing bus/minibus crash severities on poor pavement condition roads considering different lighting status

Objective This study employs a data mining approach to discover hidden groups of crash-risk factors leading to each bus/minibus crash severity level on pothole-ridden/poor roads categorized under different lighting conditions namely daylight, night with streetlights turned on, and night with streetlights turned off/no streetlights. Methods The bus/minibus data employed contained 2,832 crashes observed on poor roads between 2011 and 2015, with variables such as the weather, driver, vehicle, roadway, and temporal characteristics. The data was grouped into three based on lighting condition, and the association rule data mining approach was applied. Results Overall, most rules pointing to fatal crashes included the hit-pedestrian variable, and these crashes were more frequent on straight/flat roads at night. While median presence was highly associated with severe bus/minibus crashes on dark-and-unlighted roads, median absence was correlated with severe crashes on dark-but-lighted roads. On-street parking was identified as a leading contributor to property-damage-only crashes in daylight conditions. Conclusions The study proposed relevant countermeasures to provide practical guidance to safety engineers regarding the mitigation of bus/minibus crashes in Ghana

Construction and validation of a public bus passenger safety scale

Public transport (PT) passengers make safety evaluations, yet to the best of our knowledge, there exists no instrument that captures what is considered by public transport users when they make such personal safety evaluations. What exists is a generalised service quality scale (SERVQUAL). Unfortunately, this scale does not adequately capture the content domain of personal safety which is important to PT users, especially in developing countries where PT vehicle accidents are both frequent and severe. This study discusses the development and validation of a public bus passenger safety scale (PBPSS), for measuring public bus passengers’ safety. The results of two independent studies suggest that the PBPSS measures three facets of public bus passengers’ safety: driver-related, transport operator-related and vehicle-related. Through both exploratory Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA) (using IBM SPSS Statistics and AMOS respectively), we demonstrated that the new scale is reliable, psychometrically sound and can be utilised to assess public bus passengers’ safety. The 3-factor model observed through PCA was confirmed using CFA, indicating that the same factor structure existed in both datasets. The final 3-factor, 17-item model exhibited an acceptable model fit and evidenced both convergent and discriminant validity

Modelling public bus/minibus transport accident severity in Ghana

The current safety concerns with buses/minibuses (public transport) in both developed and developing countries have warranted a renewed interest in bus/minibus safety research. Prior to this, there was a paucity of research in this domain especially in developed countries where the safety associated with buses was deemed adequate. In this study, we examined the factors that influence bus/minibus accident severity in Ghana using bus/minibus accident data from 2011–2015. We estimated the severity of bus/minibus accidents by fitting generalised ordered logit models. Our findings revealed that weekends, the absence of road median, night-time conditions, bad road terrain (curved, wet and rough roads), hit-pedestrian collisions, and drunk driving are associated with more severe bus/minibus accident outcomes. Conversely, minibuses, the absence of road shoulder, accidents in intersections, the presence of traffic control and collision types (except hit-pedestrian) are associated with less severe bus/minibus accidents

State of public transport services to Ghana's disability population: Lessons from public transport operators in the Accra Metropolitan Assembly

Access to public transport services is crucial to the enjoyment of various life-enhancing opportunities by persons with disabilities (PWDs). However, the attainment of such services is confronted with varying levels of difficulties due to the non-conformity between transport service delivery and PWDs' needs. While many players like transport operators and vehicle manufacturers contribute to the delivery of transport services, this study examines the responsiveness of public transport operators to the travel needs of commuters with disabilities in Accra. Using a qualitative research approach, 24 public transport operators were conveniently sampled from 3 popular and busy transport terminals in Accra, the capital city of Ghana. Thematic content analysis was employed using key constructs that emanated from the transcripts. The findings reveal that none of the public transport providers/operators had any knowledge of Ghana's Disability Act of 2006 and its transport provision. By this, all activities tailored to the disability population were generally informed by common sense despite refuting calls to acquire disability-friendly vehicles or support systems. It is recommended that sensitization on the transport provision of Ghana's Disability Act should be heightened by the Ministry of Transport given its ability to improve transport services to the disability population