COVID-19 pandemic response in Ghana: more to be done

COVID-19, which emerged in December 2019 and was declared a pandemic in March 2020, has come at a heavy health, economic and social cost to many nations. There have been global efforts to find solutions to both the pandemic and its problems. As a result of unprecedented intense research and development during the pandemic, a better understanding has emerged of the SARS-CoV-2 virus, the disease it causes – COVID-19, its epidemiology, pathophysiology, and clinical management, as well as prevention solutions. However, many questions are yet to be answered, including the role of new variants of the virus in the fight against COVID-19

Dose Variation To Critical Points In Low Dose Rate Intracavitary Brachytherapy Of Cervical Cancer As Justification For Incident Learning

Background: Low Dose Rate (LDR) brachytherapy necessitates a more extended treatment duration. This technique maintains the patient on the treatment machine for a longer length of time, which may cause changes in the applicators' position due to vaginal packing soaking and patient movement for incident learning justification. Objective: The purpose of this study is to evaluate pre- and post-dosage variation to points 'A' and 'B,' as well as vital organs (i.e. bladder and rectum), for low dose rate (LDR) brachytherapy at Komfo Anokye Teaching Hospital and justify the need for incident learning system. Method: Forty (40) patients with invasive cervical cancer were treated with LDR brachytherapy equipment (A Curietron Cesium Manuel (AMRA)-France, CA 98.22) to point 'A' at doses ranging from 30 to 35 Gy. Adult patients selected for the study ranged from 25 to 60 years simulated. For each patient, orthogonal images of anterior-posterior (AP) and (LAT) were taken by positioning the patient on the Varian Acuity Simulator Couch at 00 and 900, respectively, and two sets of orthogonal images (before and after treatment), in each case, were considered. The treatment was then planned using the AP and LAT images obtained based on the four arrangements used, namely 1-2-5, 1-3-5, 1-4-5, and 1-5. The treatment planning system used for the study was the Prowess Panther system 4.6. Results: The dosage disparity at point 'A' was determined to be 1.16 per cent, which is highly commendable compared to previous research that established dose variations of 2%, 35%, 8%, and 20%. In this study, the dosage variation at point B was 0.75 per cent. The bladder and rectum had average alterations of 2.32 per cent and 0.30 per cent, respectively. Conclusion: The difference observed between prescribed, and deposited dosage was 2.11 per cent for quality assurance and incident learning reasons. Unrealistic expectations, reliance on reminders and quick remedies, and faults in the systemic view of failure were discovered and addressed as managerial issues. It is critical not to underestimate these difficulties because they are frequently significantly more severe than the technical issues being addressed. Incident issues were not recorded per patients under review, but near misses and non-conformance were observed. The geometric variances between the Intracavitary Brachytherapy Treatment (ICBT) applicators and the essential organs change during the treatment process, resulting in dosage changes. Does variance is within the required standard limits; it can be stated that Komfo Anokye Teaching Hospital's practice satisfies the international standard and is an intrusion into the Directorate Incident Learning System

Excess mortality during the COVID-19 pandemic in low-income and lower middle-income countries: protocol for a systematic review and meta-analysis

Introduction The COVID-19 pandemic has been marked by a massive death toll. However, the overall effect of the pandemic, including potential unintended negative impacts of some control measures, on mortality remains poorly understood in low-income and lower middle-income countries (LLMICs). This review aims to summarise the available literature on excess mortality in LLMICs, focusing on the methods and data sources used in estimating excess mortality and the drivers of excess mortality. Methods and analysis We will review the available literature and report results in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis. Searches will be conducted in PubMed, Embase, Web of Science, Cochrane Library, Google Scholar and Scopus. All published studies that report on the estimates of excess mortality in populations of LLMICs will be included. This will include those with a publication date from 2019 onwards and those with at least a 1-year non-COVID-19 period as the comparator in the estimation of excess mortality during the pandemic. There will be no language restrictions on the search. The meta-analysis will include studies with extractable data on excess mortality, methods, population size, and observed and expected deaths. We will use the Mantel-Haenszel method to estimate the pooled risk ratio with 95% CIs. Ethics and dissemination As there is no primary data collection, there is no requirement for ethical review. The results will be disseminated through peer-reviewed journal publication and conference presentations

Does the data tell the true story? : A modelling assessment of early COVID-19 pandemic suppression and mitigation strategies in Ghana

Acknowledgments Most of this work was undertaken from April to July 2020 during the early phase of the COVID-19 pandemic in Ghana. We are grateful to have risen to the call to national duty to support Ghana’s national response to the pandemic during this particularly challenging time. We are grateful to two anonymous peer-reviewers who provided useful feedback which improved the paperPeer reviewedPublisher PD

Fighting Antimicrobial Resistance:Development and Implementation of the Ghanaian National Action Plan (2017-2021)

In recent years, Ghana has been recognised as a leading player in addressing antimicrobial resistance (AMR) in Africa. However, based on our literature review, we could not ascertain whether the core elements of the national action plan (NAP) were implemented in practice. In this paper, we present a qualitative analysis of the development of AMR-related policies in Ghana, including the NAP. We conducted 13 semi-structured expert interviews to obtain at a more thorough understanding of the implementation process for the AMR NAP and to highlight its accomplishments and shortcomings. The results show that AMR policies, as embodied in the NAP, have led to an extended network of cooperation between stakeholders in many political fields. Broadly, limited allocation of financial resources from the government and from international cooperation have been deplored. Furthermore, the opportunity for using the NAP in mainstreaming the response to the threat of AMR has not been seized. To the general public, this remained hidden behind a number of other relevant health topics such as infection prevention, veterinary services and pharmaceutical regulation. As a One Health (OH) challenge, developing countries could integrate AMR NAPs into other health and environmental programmes to improve its implementation in practice

Bacterial etiology of sexually transmitted infections at a STI clinic in Ghana; use of multiplex real time PCR

Background: Most sexually transmitted infection (STI) management efforts focus on the syndromic approach to diagnose and treat patients. However, most women with STIs have been shown to be entirely asymptomatic, or if symptoms exist, are often missed when either clinical or conventional bacteriologic diagnostic tools are employed.Methods: We assessed the performance of a multiplex real time PCR assay to describe other potential pathogens that could be missed by conventional bacteriological techniques in 200 women attending a routine STI clinic in Kumasi, Ghana.Results: Although a total 78.00% of the women were asymptomatic, 77.1% of them tested positive for at least one bacterial STI pathogen. Mycoplasma genitalium was the most commonly detectable pathogen present in 67.5% of all women. Of those testing positive, 25.0% had single infections, while 38.0% and 19.5% had double and triple infections respectively. Altogether, 86.54% and 90.91% of the symptomatic and asymptomatic women respectively tested positive for at least one pathogen (p<0.05). There were no significant associations (p<0.05) between the clinical manifestations of the symptomatic women and the pathogens detected in their samples.Conclusions: Our study confirmed the importance of complementing the syndromic approach to STI management with pathogen detection and most importantly recognise that STIs in women are asymptomatic and regular empirical testing even for both symptomatic and asymptomatic patients is critical for complete clinical treatment.Funding: EOD (Ellis Owusu-Dabo Research working group, KCCR)Keywords: Etiology, Syndromic, Sexually Transmitted Infections, Multiplex real time PC

Commentary on COVID-19 Vaccine Hesitancy in sub-Saharan Africa

This research was funded in part by the Bill and Melinda Gates Foundation (Grant number: OPP1075938-PEARL Program Support) awarded to Jerome Nyhalah Dinga.Peer reviewedPublisher PD

The African snakebite Alliance

The goal to reduce the burden of snakebite envenoming is challenged by the gaps in evidence for clinical care and public health. These evidence gaps and the absence of a strong network are illustrated by bibliometrics. The African Snakebite Alliance is a multidisciplinary group focusing on research themes which will generate evidence needed to shape policy and practice

Embed capacity development within all global health research

Summary box • All countries, including low- and middle-income countries, need robust health research capacity • The research capacity gap between global North and South is closing too slowly, and governments, funders, and academic institutions are not investing sufficiently to bridge this chasm • With two examples from collaborative research projects in sub-Saharan Africa, we illustrate how capacity development can be an integrated part of a joint research effort supported by all involved institutions • We advocate that research capacity development be valued as highly as evidence generation and be embedded in all global health researc