Bringing toilets back to Kumasi's compound houses: landlord and tenant behaviours and motivators

In the low-income urban communities of Kumasi, Ghana, a large part of the population live in compound housing, where they often share the same living space with more than 20 tenants. Partly resulting from the high prevalence of public toilets in the city, the vast majority of these tenants have no access to ‘inhouse’ sanitation. Led by the Kumasi Metropolitan Assembly, a five-year strategy is being prepared to promote increased adoption, access, usage and maintenance of compound toilets in Kumasi’s lowincome communities. This paper shares the results of a desk and field-based study commissioned to inform the strategy: among the key challenges to be confronted are the clarification of responsibilities between landlords and tenants with regards to financing sanitation improvements, and the need to motivate landlords - at the hub of compound level sanitation governance - to improve the situation for the betterment of their tenants

Development of an instrument to evaluate the knowledge that the patient with hepatic cirhosis has about his disease and treatment

Introduction: hepatic cirrhosis (HC) is a disease with high morbidity and mortality in Brazil. Its treatment is complex and requires from lifestyle changes to large surgeries such as liver transplantation. To reach the best treatment results, it is necessary to guarantee a good patient’s adherence to the treatment. Studies indicate that the patient’s self-knowledge about his or her clinical condition is a determining factor in its adherence.Objectives: to assist in the design of an instrument that evaluates knowledge about the disease and treatment of HC. To improve the student knowledge on liver cirrhosis. Development of skills related to physical examination of the patient with HC.Methodology: The development process of the instrument will be divided into 3 stages: construction of the instrument (1st stage), evaluation of content validity and clarity of the instrument (2nd stage) and assessment of the reliability of the instrument (3 rd stage).Results: an instrument to evaluate the cirrhotic patient knowledge about the disease was made, analyzed by specialists and approved in the criteria proposed.Conclusions:1) The development of the instrument followed the steps described in literature.2) The suggestion of the evaluators allowed to restructure the questions making them clearer and more relevant to the proposal of the instrument.3) it was possible to achieve satisfactorily the proposal of the construction of the instrument.Key words: Liver cirrhosis; Self concept; Surveys and questionnaires; Health education

Development of an instrument to evaluate the knowledge that the patient with hepatic cirrhosis has about his disease and treatment

Introdução: cirrose hepática (CH) é uma doença com alta morbidade e mortalidade no Brasil. Seu tratamento é complexo e requer desde mudanças no estilo de vida até se submeter a grandes cirurgias, como o transplante hepático. Para alcançar os melhores resultados é necessário que o paciente tenha uma boa aderência ao tratamento. Estudos indicam que o conhecimento do paciente sobre sua condição clínica é um fator determinante na aderência. Objetivos: criar um instrumento que meça o conhecimento que um paciente com CH tem sobre sua doença e seu tratamento. Methodologia: o processo de desenvolvimento do instrument foi dividido em 3 estágios: construção do instrument (1º estágio), avaliação do conteúdo e claridade do instrument (2º estágio) e avaliação da confiabilidade do instrument (3º estágio). Results: um instrument para avaliar o conhecimento do paciente cirrótico sobre sua doença foi feito, analisado por especialistas e aprovado pelos critérios propostos. Conclusions: 1) O desenvolvimento do instrumento seguiu os passos descritos na literatura. 2) As sugestões dos avaliadores foram seguidas na reestruturação das questões, tornando-as mais claras e relevantes para a proposta do instrumento. 3) Foi possível alcançar de forma satisfatória a proposta de construção do instrumento.Introduction: hepatic cirrhosis (HC) is a disease with high morbidity and mortality in Brazil. Its treatment is complex and requires from lifestyle changes to large surgeries such as liver transplantation. To reach the best treatment results, it is necessary to guarantee a good patient’s adherence to the treatment. Studies indicate that the patient’s self-knowledge about his or her clinical condition is a determining factor in its adherence. Objectives: to assist in the design of an instrument that evaluates knowledge about the disease and treatment of HC. Methodology: The development process of the instrument will be divided into 3 stages: construction of the instrument (1st stage), evaluation of content validity and clarity of the instrument (2nd stage) and assessment of the reliability of the instrument (3 rd stage). Results: an instrument to evaluate the cirrhotic patient knowledge about the disease was made, analyzed by specialists and approved in the criteria proposed. Conclusions: 1) The development of the instrument followed the steps described in literature. 2) The suggestion of the evaluators allowed to restructure the questions making them clearer and more relevant to the proposal of the instrument. 3) it was possible to achieve satisfactorily the proposal of the construction of the instrument

Within-Compound Versus Public Latrine Access and Child Feces Disposal Practices in Low-Income Neighborhoods of Accra, Ghana.

In crowded urban settlements in low-income countries, many households rely on shared sanitation facilities. Shared facilities are not currently considered "improved sanitation" because of concerns about whether hygiene conditions sufficiently protect users from the feces of others. Prevention of fecal exposure at a latrine is only one aspect of sanitary safety. Ensuring consistent use of latrines for feces disposal, especially child feces, is required to reduce fecal contamination in households and communities. Household crowding and shared latrine access are correlated in these settings, rendering latrine use by neighbors sharing communal living areas as critically important for protecting one's own household. This study in Accra, Ghana, found that household access to a within-compound basic latrine was associated with higher latrine use by children of ages 5-12 years and for disposal of feces of children < 5 years, compared with households using public latrines. However, within-compound access was not associated with improved child feces disposal by other caregivers in the compound. Feces was rarely observed in household compounds but was observed more often in compounds with latrines versus compounds relying on public latrines. Escherichia coli and human adenovirus were detected frequently on household surfaces, but concentrations did not differ when compared by latrine access or usage practices. The differences in latrine use for households sharing within-compound versus public latrines in Accra suggest that disaggregated shared sanitation categories may be useful in monitoring global progress in sanitation coverage. However, compound access did not completely ensure that households were protected from feces and microbial contamination

Invasin-functionalized liposome nanocarriers improve the intracellular delivery of anti-infective drugs

Intracellular infections caused by invasive pathogens continue to prove difficult to combat, due in part to the commonly poor membrane permeability of anti-infective drugs. The aim of this study was to improve the intracellular delivery of one such poorly permeable (but broad-spectrum) anti-infective, gentamicin. Gentamicin was encapsulated into liposomal nanocarriers which were then surface functionalized with InvA497, a bacteria-derived invasion protein. Treatment of HEp-2 cells infected with the enteroinvasive bacteria Yersinia pseudotuberculosis or Salmonella enterica with gentamicincontaining, InvA497-functionalized liposomes resulted in a significantly greater reduction in infection load than treatment with non-functionalized liposomes, indicating that such a bacteriomimetic nanocarrier was not only able to promote successful cellular uptake of gentamicin but was also able to mediate anti-infective drug delivery to both cell cytoplasm and intracellular compartments. The developed InvA497-functionalized liposomal nanocarrier therefore holds great promise as a strategy for improving the therapy of intracellular infections

Cowries in the archaeology of West Africa: the present picture

Despite the perceived importance of cowrie shells as indicators of long-distance connections in the West African past, their distribution and consumption patterns in archaeological contexts remain surprisingly underexplored, a gap that is only partly explicable by the sparse distribution of archaeological sites within the sub-continent. General writings on the timeline of importation of cowries into West Africa often fail to take into account the latest archaeological evidence and rely instead on accounts drawn from historical or ethnographic documents. This paper is based on a first-hand assessment of over 4500 shells from 78 sites across West Africa, examining chronology, shell species and processes of modification to assess what distribution patterns can tell us about the history of importation and usage of cowries. These first-hand analyses are paralleled by a consideration of published materials. We re-examine the default assumption that two distinct routes of entry existed — one overland from North Africa before the fifteenth century, another coming into use from the time sea links were established with the East African coast and becoming predominant by the middle of the nineteenth century. We focus on the eastern part of West Africa, where the importance of imported cowries to local communities in relatively recent periods is well known and from where we have a good archaeological sample. The conclusion is that on suitably large assemblages shell size can be an indication of provenance and that, while the present archaeological picture seems largely to confirm historical sources, much of this may be due to the discrepancy in archaeological data available from the Sahara/Sahel zone compared to the more forested regions of the sub-continent. Future archaeological work will clarify this matter

Prevalence, Reasons, Predictors, Perceived Effects, and Regulation of Alcohol Use among Children in Ghana

Early initiation of alcohol consumption increases the risk of alcohol dependence and adverse health outcomes. Consequently, nations have enacted laws to make alcohol unlawful to be purchased by, sold to, or used in public by children. This study examined the lifetime prevalence of alcohol use among children and their reasons for consuming alcohol. In addition, the study investigated predictors of alcohol consumption and the effects of alcohol use on children. Finally, it examined the effectiveness of measures in place for regulating the sale and use of alcohol by children in the country. A total of 5024 children between the ages of 8 and 17 were sampled across the ten regions of Ghana using a cross-sectional convergent parallel mixed method. Children were interviewed with a semi-structured questionnaire, while focus group discussions were held with children, parents, and key informants. Lifetime prevalence of alcohol consumption was measured by “have you ever taken alcohol?”. The study revealed that lifetime alcohol consumption was less prevalent (6.6%) among children. Sex, age, and region of residence were significant predictors of lifetime alcohol use among children. More than half of the children who reported ever taking alcohol were first introduced to drinking by friends, and more than six in ten children claimed having been intoxicated after drinking alcohol. The findings further revealed that efforts to control the sale and consumption of alcohol by children have proven difficult despite the existence of laws, policies, and national regulatory structures. While regulations on alcohol sales and consumption have been difficult to implement in rural areas, they have been successful in urban areas because institutions there ensure rigorous adherence to the regulations. The study encourages national organizations with responsibility for child protection and development to step up their regulation, investigation, and information-sharing efforts to discourage and limit children from purchasing and consuming alcohol

Public toilets and their customers in low-income Accra, Ghana

Public pay-per-use toilets are the only alternative to open defecation for a significant number of people in many low-income, urban neighbourhoods where insecure tenure, space constraints, and/or cost make private sanitation facilities unfeasible. This study explores public toilet use, characteristics of public toilet customers and possible improvements to public toilet facilities in four neighbourhoods in Accra, Ghana, the country with the highest reliance on shared sanitation facilities globally. Reliance on public toilets ranged considerably depending on neighbourhood affluence, but even some people living in compounds with a private toilet used a public toilet. The vast majority of users were adults. Few public toilet customers could foresee owning a household toilet in the coming year, mostly because of lack of space, and they voiced desires for more and cleaner public toilets with better provision of handwashing facilities. Improved accessibility and management of public toilets, along with facilities more suitable for children, could reduce open defecation. </jats:p

The impact of properly diagnosed sarcopenia on postoperative outcomes after gastrointestinal surgery: A systematic review and meta-analysis.

BackgroundSarcopenia is defined as the loss of muscle mass combined with loss of muscle strength, with or without loss of muscle performance. The use of this parameter as a risk factor for complications after surgery is not currently used. This meta-analysis aims to assess the impact of sarcopenia defined by radiologically and clinically criteria and its relationship with complications after gastrointestinal surgeries.Materials and methodsA review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42019132221). Articles were selected from the PUBMED and EMBASE databases that adequately assessed sarcopenia and its impact on postoperative complications in gastrointestinal surgery patients. Pooled estimates of pre-operative outcome data were calculated using the odds ratio (OR) and 95% confidence interval (CI). Subgroup analysis were performed to assess each type of surgery.ResultsThe search strategy returned 1323, with 11 studies meeting the inclusion criteria. A total of 4265 patients were analysed. The prevalence of sarcopenia between studies ranged from 6.8% to 35.9%. The meta-analysis showed an OR for complications after surgery of 3.01 (95% CI 2.55-3.55) and an OR of 2.2 (95% CI 1.44-3.36) for hospital readmission (30 days).ConclusionSarcopenia, when properly diagnosed, is associated with an increase in late postoperative complications, as well as an increase in the number of postoperative hospital readmissions for various types of gastrointestinal surgery. We believe that any preoperative evaluation should include, in a patient at risk, tests for the diagnosis of sarcopenia and appropriate procedures to reduce its impact on the patient's health

Multipathway Quantitative Assessment of Exposure to Fecal Contamination for Young Children in Low-Income Urban Environments in Accra, Ghana: The SaniPath Analytical Approach.

Lack of adequate sanitation results in fecal contamination of the environment and poses a risk of disease transmission via multiple exposure pathways. To better understand how eight different sources contribute to overall exposure to fecal contamination, we quantified exposure through multiple pathways for children under 5 years old in four high-density, low-income, urban neighborhoods in Accra, Ghana. We collected more than 500 hours of structured observation of behaviors of 156 children, 800 household surveys, and 1,855 environmental samples. Data were analyzed using Bayesian models, estimating the environmental and behavioral factors associated with exposure to fecal contamination. These estimates were applied in exposure models simulating sequences of behaviors and transfers of fecal indicators. This approach allows us to identify the contribution of any sources of fecal contamination in the environment to child exposure and use dynamic fecal microbe transfer networks to track fecal indicators from the environment to oral ingestion. The contributions of different sources to exposure were categorized into four types (high/low by dose and frequency), as a basis for ranking pathways by the potential to reduce exposure. Although we observed variation in estimated exposure (108-1016 CFU/day for Escherichia coli) between different age groups and neighborhoods, the greatest contribution was consistently from food (contributing > 99.9% to total exposure). Hands played a pivotal role in fecal microbe transfer, linking environmental sources to oral ingestion. The fecal microbe transfer network constructed here provides a systematic approach to study the complex interaction between contaminated environment and human behavior on exposure to fecal contamination