Bacteriological Quality Assessment of swimming pools in the Osu-Labadi Area, Accra

Bacterial contamination of swimming pool water poses public health risks to swimmers and others who come into direct contact with such pools. There has been an increase in the patronage of swimming pools in Ghana for sports and recreation and therefore the need to investigate the pools compliance with sanitary standards. This study examined the bacteriological and physicochemical (pH, temperature and residual chlorine) levels of swimming pool water in Osu-Labadi, Accra, Ghana to determine the levels of bacterial pollution. Six outdoor swimming pools were randomly selected for this cross-sectional study. Microbiological examination was conducted on a total of 18 samples collected monthly in the evening after the pools had been used. This took place over a 3 month period, from March to May 2014, using standard microbiological and analytical methods. The results of the study indicated that the total viable bacteria count of all the pool water exceeded the acceptable limits. All 6 pools were contaminated by E. coli, Enterobacter faecalis and Klebsiella pneumonia, as well, 5 out of the 6 pools were contaminated by Enterobacter cloacae, Staphylococcus aureus, and Streptococcus agalactiae. The residual chlorine level in all the pools was below the recommended level of 1.0 mg/liter. Statistical analysis showed significant association between water contamination with microbial indicators and physicochemical aspects such as pH, temperature and residual chlorine (p<0.05). The high microbial load count and the isolation of pathogenic bacteria from the pools is an indication of the need to improve monitoring by pool health authorities, improve pool disinfection standards and educate swimmers on hygiene before entering pools. Key words: swimming pool, microbial load, residual chlorine, bacterial contaminant

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