Knowledge, attitudes, beliefs, behaviour and breast cancer screening practices in Ghana, West Africa

Breast cancer is both the most common cancer and the leading cause of cancer related death among women around the world. The incidence of the disease is generally considered higher among women in the developed countries than the developing countries; however, the mortality rates for women in the developing countries meet or exceed those of the developed world, indicating poorer prognosis (Pannuti et al., 2000; WHO, 2000; IARC, 2001; IARC, 2002; Anderson et al., 2003; Tannerberger et al., 2004). Ghanaian women, like many other women from the developing countries, have a low participation rate in breast cancer screening services. As a result, the disease is commonly diagnosed at late stages leading to a poor outcome with high mortality rates. Efforts toward reducing the mortality from breast cancer should be focused on implementing cost-effective public health strategies to improve early detection and appropriate treatment (Pannuti et al., 2000; WHO, 2000; IARC, 2001; IARC, 2002; Anderson et al., 2003, Tannerberger et al., 2004). The main objective of the study was to assess breast cancer related knowledge, attitudes, beliefs, behaviour and screening practices among Ghanaian women in the study areas. Investigating an issue such as the knowledge, attitude, belief and breast cancer screening practices is of great importance, not only in identifying obstacles to participation in breast screening and treatment, but also to guide the development of future health promotion programmes to improve breast cancer care in Ghana. The study was conducted in two phases, in Accra and Sunyani, both in Ghana. The first phase involved a total of 474 Ghanaian women aged between 40 and 70 years. Data collection was initially accomplished by using researcher-administered questionnaires, designed to obtain relevant socio-demographic characteristics, knowledge, attitudes, beliefs and practices towards breast cancer (Appendix iii pagel69). The questionnaire was pre-tested in a pilot study in Accra on 68 women before the major study. The second phase was accomplished by semi-structured interviews conducted on 10 breast cancer patients, 10 breast clinic attenders, 2 traditional healers and 3 Consultants, involved in breast cancer management in Ghana. Transcripts of the interviews appear in Appendices iv-vii page 178-231). Characteristics of the subjects that participated in the study are covered in the first part of the findings. The majority of the women who participated in the first phase, (49.2%) were between the ages of 40 - 45 years (table 6: 3: 2a page54). With regards to the education of the respondents, it was observed that in sum 85.9% of the respondents (table 6: 3: 3 page57) had received some level of education. On employment, the vast majority of respondents (74.3%) were engaged in the informal sector, 14.2% in the formal sector and 11.5% unemployed

Factors contributing to late presentation of breast cancer in Africa: a systematic literature review

Background: Over 50% of people diagnosed with breast cancer in most African countries present late and report to the hospital with advanced stage III and IV disease, a major reason for the poor survival rate. This study reviewed studies focusing on patient-related factors or reasons contributing to the late presentation or delayed diagnosis of breast cancer in Africa. Method: A rigorous literature search was conducted with search terms “Breast Neoplasms” AND “Late Presentation” OR “Delayed Diagnosis” AND “Africa” OR “the name of any of the African countries” within CINAHL, African Index Medicus, MEDLINE, Web of Science and PsycINFO electronic databases. Additional hand searching of reference lists of included articles was conducted. A thematic synthesis was conducted. Result: Of the eighty-two studies identified, nine were eligible and included in the review. Studies included were conducted in Egypt, Nigeria, Ghana, Kenya and Libya. The factors identified as contributing to late presentation of breast cancer among most African women were negative symptom interpretation, fear, belief in alternative medicine, social relations and networks, lack of trust and confidence in orthodox medicine, and access to healthcare. Conclusion: A complex matrix of factors were identified that contribute to the late presentation or delayed diagnosis of breast cancer among most African women. The orthodox medical system in most African countries is gradually losing their relationship and credibility because of false reassurance, frequent misdiagnosis and strike actions, which is leading to late presentation of breast cancer

Applying SNP marker technology in the cacao breeding programme in Ghana

In this investigation 45 parental cacao plants and five progeny derived from the parental stock studied were genotyped using six SNP markers to determine off-types or mislabeled clones and to authenticate crosses made in the Cocoa Research Institute of Ghana (CRIG) breeding programme. Investigation was based on the 5\u2019 nuclease SNPassay using Illustra Hot Start mix Ready-To-Go PCR strips and BioTek FLx800TBP Fluorescence Microplate Reader. In a group of six cacao plants labeled as PA150 clones and another five labeled as Pound7, one clone in each group was unambiguously determined as off-type or mislabeled. Similarly, in a cohort of 23 PA7 "clones", four genotypes were differentiated. Cross-checking the fidelity of five progeny from the parental stock under study, it was established that no errors were made in the crossing. The most significant outcome of this study, however, was that out of the four categories of 23 PA7 candidate parental trees only one category can be comparable to the reference clone in the International Cacao Germplasm collection, Trinidad (ICG,T); thus informing the need for further work to find the correct clone among these for the breeding programme. It was thus concluded that thissimple yet cutting-edge genotyping procedure can be used in applied cocoa breeding programmes in a cocoa producing country. This work represents a first step in the genotypic characterisation of the CRIG germplasm collection and Seed Gardens.Au cours de cette recherche, 45 plants de cacao parentaux et 5 descendants d\ue9rivant du stock parental ont \ue9t\ue9 g\ue9notyp\ue9 en utilisant 6 marqueurs SNP, afin de d\ue9terminer les clones mal \ue9tiquet\ue9s et d\u2019authentifier les croisements effectu\ue9s dans le programme d\u2019am\ue9lioration de l\u2019Institut de Recherche sur le Cacao au Ghana (CRIG). Cette \ue9tude a \ue9t\ue9 bas\ue9e sur les 5' nucl\ue9ases SNP en utilisant des bandes PCR "Hot Start mix Ready-To-Go PCR strips" et un Lecteur Microplat \ue0 Fluorescence "BioTek FLx800TBP". Au sein d\u2019un groupe de six plants de cacao \ue9tiquet\ue9 PA150 et d\u2019un autre groupe de cinq \ue9tiquet\ue9 Pound 7, il a \ue9t\ue9 d\ue9termin\ue9 sans ambigu\ueft\ue9 qu\u2019un clone par groupe \ue9tait mal \ue9tiquet\ue9. De fa\ue7on similaire, quatre g\ue9notypes diff\ue9rents ont \ue9t\ue9 identifi\ue9s dans une m\ueame cohorte de clones 23PA7. En v\ue9rifiant la fid\ue9lit\ue9 de cinq descendants issus du stock parental \ue9tudi\ue9, il a \ue9t\ue9 \ue9tabli qu\u2019aucune erreur n\u2019avait \ue9t\ue9 faite lors du croisement. Le r\ue9sultat le plus significatif de cette \ue9tude a \ue9t\ue9 que, sur quatre cat\ue9gories de 23 candidats PA7 de souches parentales, une seule pouvait \ueatre comparable au clone de r\ue9f\ue9rence dans la collection Internationale du Germoplasme de Cacao, Trinidad (ICG,T), d\ue9montrant ainsi la n\ue9cessit\ue9 de travaux suppl\ue9mentaires pour d\ue9terminer le clone exact parmi ceux \ue9voqu\ue9s pr\ue9c\ue9demment. Il a ainsi \ue9t\ue9 conclu que cette m\ue9thode avant-gardiste de g\ue9notypage, pourtantsimple, peut \ueatre utilis\ue9e dans les programmes appliqu\ue9s d\u2019am\ue9lioration du cacao dans un pays producteur. Ce travail repr\ue9sente une premi\ue8re \ue9tape dans la caract\ue9risation g\ue9n\ue9tique de la collection du germoplasme CRIG et jardins semenciers

The impact of SNP fingerprinting and parentage analysis on the effectiveness of variety recommendations in cacao

Published online: 26 April 2015Evidence for the impact of mislabeling and/or pollen contamination on consistency of field performance has been lacking to reinforce the need for strict adherence to quality control protocols in cacao seed garden and germplasm plot management. The present study used SNP fingerprinting at 64 loci to examine the diversity, labeling errors and parentage in 2551 trees obtained from six seed gardens, breeders clone collection and single-cross progenies and a sample of farmers’ trees in Ghana. Clone mislabeling was pervasive, both within the seed garden clones and among clones of the breeders’ active collection. Among the seed garden clones, mislabeled trees were assigned to other parental clones used in the seed garden, pointing to labeling errors prior to planting as the principal cause of mislabeling. Among the breeders’ clone collection, both homonymous and synonymous mislabeling were identified in addition to trees with unique genotypes. This implicates pre-planting labeling errors and rootstocks overtaking budded scions. Parentage analysis supported the Amelonado ancestry of farmers’ varieties but with significant contribution of Upper Amazon introductions. Parentage of recently developed clones and of progenies of controlled crosses showed evidence of both pollen contamination and effects of mislabeled parents. The observed patterns of unexpected parentage had direct effects on the consistency of the variety performance between trials and increased within-plot variability for families with mixed ancestry. The results provide a strong basis for mainstreaming SNP fingerprinting in cacao breeding programs to improve the efficiency of the variety development process.Evidence for the impact of mislabeling and/or pollen contamination on consistency of field performance has been lacking to reinforce the need for strict adherence to quality control protocols in cacao seed garden and germplasm plot management. The present study used SNP fingerprinting at 64 loci to examine the diversity, labeling errors and parentage in 2551 trees obtained from six seed gardens, breeders clone collection and single-cross progenies and a sample of farmers’ trees in Ghana. Clone mislabeling was pervasive, both within the seed garden clones and among clones of the breeders’ active collection. Among the seed garden clones, mislabeled trees were assigned to other parental clones used in the seed garden, pointing to labeling errors prior to planting as the principal cause of mislabeling. Among the breeders’ clone collection, both homonymous and synonymous mislabeling were identified in addition to trees with unique genotypes. This implicates pre-planting labeling errors and rootstocks overtaking budded scions. Parentage analysis supported the Amelonado ancestry of farmers’ varieties but with significant contribution of Upper Amazon introductions. Parentage of recently developed clones and of progenies of controlled crosses showed evidence of both pollen contamination and effects of mislabeled parents. The observed patterns of unexpected parentage had direct effects on the consistency of the variety performance between trials and increased within-plot variability for families with mixed ancestry. The results provide a strong basis for mainstreaming SNP fingerprinting in cacao breeding programs to improve the efficiency of the variety development process.Evidence for the impact of mislabeling and/or pollen contamination on consistency of field performance has been lacking to reinforce the need for strict adherence to quality control protocols in cacao seed garden and germplasm plot management. The present study used SNP fingerprinting at 64 loci to examine the diversity, labeling errors and parentage in 2551 trees obtained from six seed gardens, breeders clone collection and single-cross progenies and a sample of farmers’ trees in Ghana. Clone mislabeling was pervasive, both within the seed garden clones and among clones of the breeders’ active collection. Among the seed garden clones, mislabeled trees were assigned to other parental clones used in the seed garden, pointing to labeling errors prior to planting as the principal cause of mislabeling. Among the breeders’ clone collection, both homonymous and synonymous mislabeling were identified in addition to trees with unique genotypes. This implicates pre-planting labeling errors and rootstocks overtaking budded scions. Parentage analysis supported the Amelonado ancestry of farmers’ varieties but with significant contribution of Upper Amazon introductions. Parentage of recently developed clones and of progenies of controlled crosses showed evidence of both pollen contamination and effects of mislabeled parents. The observed patterns of unexpected parentage had direct effects on the consistency of the variety performance between trials and increased within-plot variability for families with mixed ancestry. The results provide a strong basis for mainstreaming SNP fingerprinting in cacao breeding programs to improve the efficiency of the variety development process

Applying SNP marker technology in the cacao breeding programme in Ghana

In this investigation 45 parental cacao plants and five progeny derived from the parental stock studied were genotyped using six SNP markers to determine off-types or mislabeled clones and to authenticate crosses made in the Cocoa Research Institute of Ghana (CRIG) breeding programme. Investigation was based on the 5’ nuclease SNPassay using Illustra Hot Start mix Ready-To-Go PCR strips and BioTek FLx800TBP Fluorescence Microplate Reader. In a group of six cacao plants labeled as PA150 clones and another five labeled as Pound7, one clone in each group was unambiguously determined as off-type or mislabeled. Similarly, in a cohort of 23 PA7 "clones", four genotypes were differentiated. Cross-checking the fidelity of five progeny from the parental stock under study, it was established that no errors were made in the crossing. The most significant outcome of this study, however, was that out of the four categories of 23 PA7 candidate parental trees only one category can be comparable to the reference clone in the International Cacao Germplasm collection, Trinidad (ICG,T); thus informing the need for further work to find the correct clone among these for the breeding programme. It was thus concluded that thissimple yet cutting-edge genotyping procedure can be used in applied cocoa breeding programmes in a cocoa producing country. This work represents a first step in the genotypic characterisation of the CRIG germplasm collection and Seed Gardens.Au cours de cette recherche, 45 plants de cacao parentaux et 5 descendants dérivant du stock parental ont été génotypé en utilisant 6 marqueurs SNP, afin de déterminer les clones mal étiquetés et d’authentifier les croisements effectués dans le programme d’amélioration de l’Institut de Recherche sur le Cacao au Ghana (CRIG). Cette étude a été basée sur les 5' nucléases SNP en utilisant des bandes PCR "Hot Start mix Ready-To-Go PCR strips" et un Lecteur Microplat à Fluorescence "BioTek FLx800TBP". Au sein d’un groupe de six plants de cacao étiqueté PA150 et d’un autre groupe de cinq étiqueté Pound 7, il a été déterminé sans ambiguïté qu’un clone par groupe était mal étiqueté. De façon similaire, quatre génotypes différents ont été identifiés dans une même cohorte de clones 23PA7. En vérifiant la fidélité de cinq descendants issus du stock parental étudié, il a été établi qu’aucune erreur n’avait été faite lors du croisement. Le résultat le plus significatif de cette étude a été que, sur quatre catégories de 23 candidats PA7 de souches parentales, une seule pouvait être comparable au clone de référence dans la collection Internationale du Germoplasme de Cacao, Trinidad (ICG,T), démontrant ainsi la nécessité de travaux supplémentaires pour déterminer le clone exact parmi ceux évoqués précédemment. Il a ainsi été conclu que cette méthode avant-gardiste de génotypage, pourtantsimple, peut être utilisée dans les programmes appliqués d’amélioration du cacao dans un pays producteur. Ce travail représente une première étape dans la caractérisation génétique de la collection du germoplasme CRIG et jardins semenciers

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this