Hyper-reactive Malarial Splenomegaly (HMS) in a patient with β thalassaemia syndrome

This report describes a case of hyper-reactive malarial splenomegaly in a patient with a thalassaemia syndrome. Increased haemoglobin A2 is valuable for the diagnosis of common forms of β-thalassemia, while haemoglobin F (HbF) helps in diagnosis of the rarer δβ- forms. Thalassemia is characterised by splenomegaly and is common in malaria endemic areas. Hyper-reactive malarial splenomegaly is also a common cause of massive splenomegaly in malaria endemic areas. Splenic enlargement regresses with prolonged antimalarial therapy

Contract Package as an Antecedent of Value for Money: The Mediating Role of Competitive Procurement.

Given the limited resources available to the government institutions, value for money in procurement is crucial to ensuring the optimal use of finite budgetary resources. This study delves into contract package as an antecedent of value for money; competitive procurement as a mediating role. Fifty-three (53) pre-university educational institutions in the Eastern region of Ghana were selected for the study. Two research objectives were examined whilst two research hypotheses were tested. This study is a quantitative one, which employed purposive and simple random sampling techniques. Using the Confirmatory Factor Analysis (CFA) and Structural Equation Model (SEM) for data analysis, the study found no relationship between contract package and value for money. Again, the study revealed that competitive procurement failed to exert significant effect or influence on contract package and value for money linkages. The study recommended that appropriate procurement process at the public sector is highly required to generate wealth, enhance transparency and accountability, encourage consistent procurement procedures and lessen corruption. Through this, value for money can be achieved

Microbial Quality of Household Drinking Water in the Sunyani Municipality of Ghana

The health risk associated with the microbial contamination of drinking water has been a major challenge in most households in the developing world. This challenge stems from the fact that water management systems are either inadequate or non-existent. In this study, the microbial quality of household drinking water in the Sunyani Municipality of Ghana was assessed. Thirty water samples were collected from the various households from eight communities for bacteriological analysis using the multiple tube method. The results were recorded as Most Probable Number (MPN) of coliform per 100 ml of water and compared with World Health Organization Guidelines for Drinking water quality. From the study, the mean total coliform of water ranged from 1.75 x 103 to 8.5 x106 cfu/100 ml. Out of the 30 water samples, twenty-two (73.3%) were positive with coliforms. The commonest source of drinking water standpipe had fifty percent of samples contaminated with coliforms. All four samples collected from the borehole were contaminated with coliforms. Out of the 22 coliform-positive samples, 59.1% of them showed positive for faecal coliform, out of which 50% of samples tested positive for the presence of Escherichia coli (E. coli). The study recommends intensive community education on proper water management systems as well as encouraging proper household hygiene practices. Keywords: Total coliforms, E. coli, Most Probable Number, water qualit

Assessing Landcover Changes from Coastal Tourism Development in Ghana: Evidence from the Kokrobite-Bortianor Coastline, Accra

As a major driver of landcover change, tourism-based developments are growing rapidly along different part of Ghana’s 560 km coastline. Kokrobite and Bortianor, with their serene environment, relatively clean, and pristine sandy beaches, have become popular coastal tourism destinations for tourists, recreationist, and holiday seekers in the Greater Accra region of Ghana. This study assesses how landcover changes emanating from coastal tourism establishments such as hotels, resorts, restaurants, and recreational facilities are affecting the socio-ecological landscape of the area. In this study, we utilize the maximum likelihood supervised classification along with post classification change detection techniques to analyze Landsat images for the years 1990, 2000 and 2010. Landcover maps of the different years were created and used to analyze changes occurring along the coastline of Kokrobite and Bortianor. Assembled results showed that built-up areas associated largely with tourism-based establishments have increased substantially from 1.02 km2 (16%) to 2.20 km2 (34.6%) between 1990 and 2010. Approximately 60% of the Kokrobite and Bortianor coastline’s natural ecosystem has been converted into different forms of tourism-based facilities such as hotels, resorts and settlements. Conversely, all forms of vegetative cover–riverine, dense active, and shrub/herbaceous cover are declining significantly. Increased tourist and recreationist demands along with the rapid urban growth in Accra is a preeminent cause of the current trends of developments. Regrettably, majority of the tourism-based establishments are unplanned, lacking authorization from development institutions and agencies, a reflection of the lack of a coherent integrated coastal zone management plan and functional urban landuse policy in Ghana. The result is a significant encroachment and degradation of the coastal ecosystems. Considering the already vulnerable state of most coastal areas in Ghana including Kokrobite and Bortianor, such developments could aggravate social and ecological vulnerability if left unchecked. In line with this, this study recommends the urgent need for a functional integrated coastal zone management plan and resourced institutions and agencies to enable effective management and regulation of developments in coastal zones in Ghana. Ultimately, coastal tourism, with all its recognized and potential socio-economic benefits to local and national economies can only be sustained with an ecologically productive coastal zone. Keywords: Tourism, Coastal tourism, Landcover, Kokrobite and Bortianor, Erosio

In utero exposure to cigarette smoking, environmental tobacco smoke and reproductive hormones in US girls approaching puberty

BACKGROUND/AIMS: Evidence is unclear whether prenatal smoking affects age at menarche and pubertal development, and its impact upon hormones has not been well studied. We aim to identify potential pathways through which prenatal smoking and environmental tobacco smoke (ETS) affect reproductive hormones in girls approaching puberty. METHODS: We examined the association between prenatal smoking, current ETS and luteinizing hormone (LH) and inhibin B (InB) in 6- to 11-year-old girls in the 3rd National Health and Nutrition Examination Survey, 1988-1994. Parents/guardians completed interviewer-assisted questionnaires on health and demographics at the time of physical examination. Residual blood samples were analyzed for reproductive hormones in 2008. RESULTS: Of 660 girls, 19 and 39% were exposed to prenatal smoke and current ETS, respectively. Accounting for multiple pathways in structural equation models, prenatally exposed girls had significantly lower LH (β = -0.205 log-mIU/ml, p < 0.0001) and InB (β = -0.162, log-pg/ml, p < 0.0001). Prenatal smoking also influenced LH positively and InB negatively indirectly through BMI-for-age. ETS was positively associated with LH, but not with InB. CONCLUSION: Exposure to maternal smoking may disrupt reproductive development manifesting in altered hormone levels near puberty

Predictors of anemia in preschool children: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project.

Background: A lack of information on the etiology of anemia has hampered the design and monitoring of anemia-control efforts.Objective: We aimed to evaluate predictors of anemia in preschool children (PSC) (age range: 6-59 mo) by country and infection-burden category.Design: Cross-sectional data from 16 surveys (n = 29,293) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed separately and pooled by category of infection burden. We assessed relations between anemia (hemoglobin concentration &lt;110 g/L) and severe anemia (hemoglobin concentration &lt;70 g/L) and individual-level (age, anthropometric measures, micronutrient deficiencies, malaria, and inflammation) and household-level predictors; we also examined the proportion of anemia with concomitant iron deficiency (defined as an inflammation-adjusted ferritin concentration &lt;12 μg/L). Countries were grouped into 4 categories on the basis of risk and burden of infectious disease, and a pooled multivariable logistic regression analysis was conducted for each group.Results: Iron deficiency, malaria, breastfeeding, stunting, underweight, inflammation, low socioeconomic status, and poor sanitation were each associated with anemia in &gt;50% of surveys. Associations between breastfeeding and anemia were attenuated by controlling for child age, which was negatively associated with anemia. The most consistent predictors of severe anemia were malaria, poor sanitation, and underweight. In multivariable pooled models, child age, iron deficiency, and stunting independently predicted anemia and severe anemia. Inflammation was generally associated with anemia in the high- and very high-infection groups but not in the low- and medium-infection groups. In PSC with anemia, 50%, 30%, 55%, and 58% of children had concomitant iron deficiency in low-, medium-, high-, and very high-infection categories, respectively.Conclusions: Although causal inference is limited by cross-sectional survey data, results suggest anemia-control programs should address both iron deficiency and infections. The relative importance of factors that are associated with anemia varies by setting, and thus, country-specific data are needed to guide programs

Intraindividual double burden of overweight and micronutrient deficiencies or anemia among preschool children

Background: Child overweight prevalence is increasing globally, but micronutrient deficiencies persist. Objectives: We aimed to 1) describe the prevalence and distribution of intraindividual double burden of malnutrition (DBM), defined as coexistence of overweight or obesity (OWOB) and either micronutrient deficiencies or anemia, among preschool children; 2) assess the independence of DBM components, e.g., whether the prevalence of DBM is greater than what would be expected by chance; and 3) identify predictors of intraindividual DBM, to guide intervention targeting. Methods: We analyzed data from 24 population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (separately by survey; n = 226 to n = 7166). We defined intraindividual DBM as coexisting OWOB and ≥1 micronutrient deficiency [e.g., Micronutrient Deficiency Index (MDI) \u3e 0; DBM-MDI] or anemia (DBM-Anemia). We assessed independence of DBM components with the Rao–Scott chi-square test and examined predictors of DBM and its components with logistic regression. Results: DBM prevalence ranged from 0% to 9.7% (median: 2.5%, DBM-MDI; 1.4%, DBM-Anemia), reflecting a lower prevalence of OWOB (range: 0%–19.5%) than of micronutrient deficiencies and anemia, which exceeded 20% in most surveys. OWOB was generally not significantly associated with micronutrient deficiencies or anemia. In more than half of surveys, children 6–23 mo of age, compared with ≥24 mo, had greater adjusted odds of DBM-Anemia, anemia, and micronutrient deficiencies. Child sex and household socioeconomic status, urban location, and caregiver education did not consistently predict DBM or its components. Conclusions: Intraindividual DBM among preschool children was low but might increase as child OWOB increases. The analysis does not support the hypothesis that DBM components cluster within individuals, suggesting that population-level DBM may be addressed by programs to reduce DBM components without targeting individuals with DBM

Predictors of fetal anemia and cord blood malaria parasitemia among newborns of HIV-positive mothers

Background: Malaria and HIV infections during pregnancy can individually or jointly unleash or confound pregnancy outcomes. Two of the probable outcomes are fetal anemia and cord blood malaria parasitemia. We determined clinical and demographic factors associated with fetal anemia and cord blood malaria parasitemia in newborns of HIV-positive women from two districts in Ghana. Results: We enrolled 1,154 antenatal attendees (443 HIV-positive and 711 HIV-negative) of which 66% were prospectively followed up at delivery. Maternal malaria parasitemia, and anemia rates among HIV+ participants at enrolment were 20.3% and 78.7% respectively, and 12.8% and 51.6% among HIV- participants. Multivariate linear and logistic regression models were used to study associations. Prevalence of fetal anemia (cord hemoglobin level < 12.5 g/dL) and cord parasitemia (presence of P. falciparum in cord blood at delivery) were 57.3% and 24.4% respectively. Factors found to be associated with fetal anemia were maternal malaria parasitemia and maternal anemia. Infant cord hemoglobin status at delivery was positively and significantly associated with maternal hemoglobin and gestational age whilst female gender of infant was negatively associated with cord hemoglobin status. Maternal malaria parasitemia status at recruitment and female gender of infant were positively associated with infant cord malaria parasitemia status. Conclusions: Our data show that newborns of women infected with HIV and/or malaria are at increased risk of anemia and also cord blood malaria parasitemia. Prevention of malaria infection during pregnancy may reduce the incidence of both adverse perinatal outcomes. © 2013 Laar et al.; licensee BioMed Central Ltd

Evaluating Health Research Capacity Building: An Evidence-Based Tool

Bates and colleagues describe the development of a tool to assess capacity-building programs in health research, which they used in Kumasi, Ghana

Combined infant and young child feeding with small-quantity lipid-based nutrient supplementation is associated with a reduction in anemia but no changes in anthropometric status of young children from Katanga Province of the Democratic Republic of Congo: a quasi-experimental effectiveness study.

BACKGROUND: Small-quantity lipid-based nutrient supplements (SQ-LNS) are efficacious in controlled settings; data are scarce on the effectiveness utilizing health care delivery platforms. OBJECTIVE: We evaluated the impact of an infant young child feeding (IYCF)-SQ-LNS intervention on anemia and growth in children aged 6-18 mo in the Democratic Republic of Congo following a quasi-experimental effectiveness design. METHODS: An intervention health zone (HZ) received enhanced IYCF including improved counseling on IYCF during pregnancy until 12 mo after birth and daily use of SQ-LNS for infants 6-12 mo; the control HZ received the standard IYCF package. We analyzed data from 2995 children, collected in repeated cross-sectional surveys. We used adjusted difference-in-difference analyses to calculate changes in anemia, iron and vitamin A deficiencies, stunting, wasting, and underweight. RESULTS: Of mothers, 70.5% received SQ-LNS at least once in the intervention HZ, with 99.6% of their children consuming SQ-LNS at least once. The mean number of batches of SQ-LNS (28 sachets per batch, 6 batches total) received was 2.3 ± 0.8 (i.e., 64.4 ± 22.4 d of SQ-LNS). The enhanced program was associated with an 11.0% point (95% CI: -18.1, -3.8; P < 0.01) adjusted relative reduction in anemia prevalence and a mean +0.26-g/dL (95% CI: 0.04, 0.48; P = 0.02) increase in hemoglobin but no effect on anthropometry or iron or vitamin A deficiencies. At endline in the intervention HZ, children aged 8-13 mo who received ≥3 monthly SQ-LNS batch distributions had higher anthropometry z scores [length-for-age z score (LAZ): +0.40, P = 0.04; weight-for-age z score (WAZ): +0.37, P = 0.04] and hemoglobin (+0.65 g/dL, P = 0.007) and a lower adjusted prevalence difference of stunting (-16.7%, P = 0.03) compared with those who received none. CONCLUSIONS: The enhanced IYCF-SQ-LNS intervention using the existing health care delivery platform was associated with a reduction in prevalence of anemia and improvement in mean hemoglobin. At endline among the subpopulation receiving ≥3 mo of SQ-LNS, their LAZ, WAZ, and hemoglobin improved. Future research could explore contextual tools to maximize coverage and intake adherence in programs using SQ-LNS