Heavy metal constituent of medicinal plants: a case study of Moringa oleifera Lam. from selected areas in Accra, Ghana

Background: Anthropogenic activities release metals into the environment that could be absorbed by plants and assimilate into herbal medicines. Objective: This study sought to correlate the outcome of anthropogenic activities that release metals into the environment with levels of metals in medicinal plants using the leaves of Moringa oleifera Lam. (M. oleifera)as a case study. Methods: Leaves of M. oleifera and soil around sampled plants were collected from three locations in the Accra Metropolis: a commercial area, an area with dense vehicular traffic, and a quasi-natural habitat. Samples were analyzed with Energy Dispersive X-ray Fluorescence (ED-XRF) spectroscopy for the presence and levels of arsenic (As), cobalt (Co), chromium (Cr), copper (Cu), nickel (Ni), lead (Pb), vanadium (V) and zinc (Zn). Statistical analyses were performed and the correlation between metal concentrations in leaves and soil was assessed using Spearman’s correlation coefficient. Results: Levels of metals in the leaves and soil samples varied with the site of sample collection. Levels of metals in leaves were significantly lower than permissible limits (p< 0.05) in herbal medicines. Translocation factor (TF) estimates indicated that the M. oleifera leaves exclude the metals under investigation irrespective of the site of collection. However, the TF > 1 in the case of Zn from the quasi-natural habitat signifying bioaccumulation in the leaves. Except forCo, the total concentration of each metal in the soil was not correlated with its concentration in the leaves. Conclusion: The concentration of sampled metals in the leaves and soil varied with the site of sampling and potentially with the anthropogenic activities that release metals into that environment.

Multilevel analysis of risk factors associated with severe underweight among children under 5 years: evidence from the 2014 Ghana Demographic and Health Survey

Background: Undernutrition among children <5yr. is a global public health problem, especially in developing countries like Ghana. Undernutrition increases the risk of child morbidity and mortality. There is paucity of data on household-level effects on severe underweight and associated factors. Objective: The study investigated the risk factors associated with severe underweight among children < 5yr.in Ghana and examined unobserved differences across households based on the 2014 Ghana Demographic and Health surveys (GDHS) data. Methods: Data from a population-based cross-sectional study was obtained from the 2014 Ghana Demographic and Health Survey. Data on 2720 children nested within 1972 households was extracted for analysis. Our regression analysis used data on 2716 children with complete data on the outcome and risk factors. Children with weight-for-age Z-score below -3 standard deviations were classified as severely underweight based on the 2006 WHO child growth standards. We applied random intercept multilevel logistic regression to examine whether severe underweight status in children differ across households while simultaneously identifying potential risk factors. Results: A total of 2720 children had valid weight-for-age z-score and 53 (1.95%) of them were identified as severely underweight. In the univariate model, child level variables such as multiple birth [odds ratio (OR), 4.03;95%confidence interval (CI): 1.85-8.76]and child born average (OR, 2.17;95%CI: 1.09-4.32) or small (OR, 4.08; 95%CI: 2.01-8.28) in size at birth are associated with increased odds of severe underweight. Maternal/household level variables such as increase in number of children below 5 yr. (OR, 1.61; 95%CI: 1.28-2.04), poorest households (OR, 4.85; 95%CI: 1.14-20.59) and increase in number of births in last 5 yr. (OR, 1.80, 95%CI: 1.24-2.60) were associated with increased odds of severe underweight. Increase in maternal years of education (OR, 0.89; 95%CI: 0.83-0.95) was associated with reduced odds of severe underweight. In the multilevel logistic model, only type of birth (OR, 1.61;95%CI: 1.28-2.04), size of child (average: OR, 2.12;95%CI: 1.04-4.33; small: OR, 3.87;95%CI: 1.80-8.33) at birth, and maternal education (OR, 0.92;95%CI: 0.84-1.00) were independently associated with severe underweight. There were no significant residual household-level variations in severe underweight status. Conclusion: Our findings suggest that improving maternal education, socioeconomic conditions of families, and family planning are critical in addressing severe underweight

Utilization of health facility delivery services in the Jomoro District of the Western Region of Ghana

Background: In the year 2000, member states of the United Nations pledged to work towards a three-quarters reduction in the 1990 maternal mortality ratio by 2015 in line with Millenium. Development Goal 5, but this could not be achieved. This pledge became imperative given the high maternal mortality being recorded, especially among developing countries. The high maternal deaths in developing countries have been attributed partly to the lack of access to skilled birth attendants during delivery. Objective: This study aimed to investigate factors that influence the utilization of health facility delivery services among pregnant women in the Jomoro District of the Western Region of Ghana. Methods: The study used data from a cross-sectional survey among women aged 18 - 49 yr. living in the Jomoro District of Ghana and had given birth between 2012 and 2016 (n = 374). The study participants were randomly selected from women who attended child welfare clinics on clinic days with their babies in eighteen communities. The study used a structured questionnaire to solicit for information about the women’s demographic and socio-economic characteristics, community characteristics and health systems factors likely to influence their decision to seek skilled delivery care as well as their experiences relating to their last delivery. Bivariate analyses were performed between the primary dependent variable and background characteristics of the respondents. Factors influencing the choice of place of delivery were estimated by multiple logistic regression analysis. Data analysis was performed using STATA Statistical Software, Release 14. Results: About 61.0% (n= 228/374) of the women had their last delivery at a health facility while the remaining 38.8% (n= 145/374) delivered at home without skilled assistance. In multivariate analysis, women aged 25 – 29 yr. were less likely to have a skilled delivery (aOR, 0.40; 95% CI: 0.17 - 0.93). Also, professional women had 4.77 odds of having skilled delivery (aOR, 4.77; 95% CI: 1.53 - 14.93). Distance to the nearest health facility also had a statistically significant association with skilled delivery. Women living at 10 – 19 km to a health facility were less likely to have a skilled delivery (aOR, 0.56; 95% CI: 0.32 - 0.97). In addition, the presence of a midwife at a health facility increased the odds of skilled delivery among women (aOR, 4.59; 95% CI: 2.47 - 8.55). Conclusion: Interventions aimed at increasing the uptake of delivery care services to achieve the SDG’s target on maternal mortality must consider improving the socio-economic wellbeing of women in addition to removing the physical and health system barriers impeding access and utilisation of delivery care services.

Uretero-vesical anastomotic stricture: a case report and review of management

Uretero-vesical anastomosis is the connection of the ureter to the urinary bladder at a new site to achieve unimpeded flow of urine from the ureters into the urinary bladder. A rare complication of this procedure is the development of stricture at the anastomotic site. This report is on a 62-yr. old female with one year history of left flank pain and a prior left uretero-vesical anastomosis done 14 years earlier. She had been managed for recurrent urinary tract infections, but the left flank pain was persistent. Abdominal and pelvic CT scan with intravenous urogram helped establish the diagnosis of uretero-vesical anastomotic stricture. This was successfully managed with endoscopic dilatation after retrograde placement of guide wire under fluoroscopy followed by serial dilation. In a patient presenting with flank pains after a previous uretero-vesical anastomosis, stricture at the anastomotic site is an important differential diagnosis. Endoscopic management is the preferred initial management which produces successful outcomes

Dopa-responsive dystonia or Segawa disease in Ghana: a case report

Dystonias are rare in childhood and consist of variably sustained twisting deformation of a limb or parts of a trunk. Dystonias can be considered primary because of a genetic disorder or secondary due to a central nervous system injury like cerebral palsy or medications. The rare dopa-responsive dystonia is often mistaken for cerebral palsy, stroke, localized limb trauma or conversion disorder. The aim of this report is to increase the awareness of a rare but eminently treatable type of dystonia known as dopa–responsive dystonia or Segawa disease. In this report a young girl with dystonia who was severely disabled and could not attend school was misdiagnosed as cerebral palsy for two years. After treatment with low dose L-dopa within 48 hours, a dramatic and sustained response with restoration of foot dystonia and mobility was observed. Recognition of L-dopa dystonia facilitates proper treatment and significant improvement in quality of life

Awareness and Knowledge of Final Year Health Science Students on Occupational Therapy in a Public University in Ghana.

Background: Occupational therapists play a major role in the healthcare team in the provision of holistic care to patients. Successful healthcare depends on collaboration and understanding among health professionals and recognition of each health professional’s role in a team. Objective: The study aimed to determine the awareness and knowledge of final-year health sciences students of the University of Ghana on occupational therapy(OT). Methods: A cross-sectional study was employed by means of a questionnaire with final year students in the Medicine, Nursing and Allied Health Professional programmes (physiotherapy, dietetics, radiography, and medical laboratory sciences) of the University of Ghana. Participants were randomly selected and requested to complete a questionnaire. Data was analysed using IBM SPSS Statistics, Version 23.0. Results: The results showed anoverall OT awareness of 94.66% (n = 195/206). About 35.0% (n = 69/206)of participant learned about OT as a health profession through other means rather than their academic curriculum. Collectively, participants demonstrated an average actual knowledge on OT services of 14.43 ± 3.17. The results also showed that, the importance participants accorded OT profession in the healthcare team did not depend on their knowledge on OT scope of practice (rs=0.162, p>0.05). Conclusion: Actions should be channelled towards enabling health science students to learn about OT and other health professions through their university curriculum. Furthermore, OT students should endeavour to sensitise fellow health science students on the unique roles and responsibilities of the OT profession in the healthcare team

Factors associated with birth injuries in neonates admitted to the neonatal intensive care unit: a retrospective study in a Ghanaian tertiary care setting

Background: A birth injury is structural damage or functional deterioration of the neonate’s body due to a traumatic incident at birth. The prevalence and the type of birth injury vary from place to place. There is paucity of data on the prevalence of birth injuries in Ghana. Objective: The study aimed to determine the prevalence and factors associated with birth injury in neonates admitted in a tertiary institution in Northern Ghana. Methods: This was a quantitative retrospective study carried out on neonates admitted to the neonatal intensive care unit (NICU) of the Tamale Teaching Hospital between January 2018 through December 2019. Results: Out of 5590 neonates admitted to the NICU, 205 were noted to have various forms of birth injury corresponding to a prevalence of 3.66%(37 per 1000 neonates admitted to our unit). Majority were male (n=123/205, 60.0%), most deliveries occurred in the study hospital(n=143/205, 69.75%), and spontaneous vaginal delivery accounted for 70.73% (n=145/205). Extracranial injuries (n=146/221, 66.06%) were the most common form of birth injury. Next was musculoskeletal injuries (n=41/221, 18.55%) with humeral fractures (n=15/221, 6.78%) being the most frequent in this category. Among the neonates with birth injuries there were 23 deaths recorded (11.22%) all but one of whom had associated birth asphyxia. Birth injuries were significantly associated with place of delivery(p=0.029). Out-born babies were more likely to have extracranial injuries (adjusted odds ratio,5.10; 95% CI: 1.53-16.94;p=0.008). Conclusion: Extracranial injuries were the most common in this study. Place of delivery was significantly associated with birth injuries. Building the capacity of health care professionals is essential to reduce incidence of birth injuries. Some of these injuries can be avoided if high risk pregnancies are referred early to institutions that have the resources and skill to deliver such babies.

Dominant correlates of depressive disorders and effects on quality of life among older adults in low- and middle-income countries: Further analysis of WHO study on Global Ageing and Adult Health

Background: Poor quality of life (QoL) disrupts social functioning, fulfilment of basic needs, and is associated with depressive disorder (DD). Objective: We answered the question of whether there is a common risk factor for DD across six low- and middle-income countries (LMICs) and determined whether this risk factor can be ranked consistently as the most important predictor of DD in all six LMICs. We estimated the effect of DD on QoL for each country and meta-analyzed the results to generate a pooled effect estimate of DD on QoL in the six LMICs. Methods: We used data from the WHO Study on Global Ageing and Adult Health (SAGE). This study involved a total of 35,164 older adults aged ≥ 50 yr. in six LMICs: China, 13,408; Ghana, 4,305; India, 7,108; Mexico, 2,309; Russian Federation, 3,763; and South Africa, 3,842. We conducted an extensive literature review to select the list of 58 potential risk factors associated with DD. We used double selection Least Absolute Shrinkage and Selection Operator Poisson regression model to identify country-specific risk factors associated with DD. Weighted dominance analysis (WDA) was performed to determine the most important risk factor of DD. To estimate the effect of DD on QoL, we used inverse probability weighting Poisson regression adjustment for each country, and meta-analysis techniques for a pooled estimate of the overall effect. Results: The risk factors for DD were generally country specific. However, asthma was the most common and the most important predictor of DD across all six SAGE countries. In Ghana, the prevalence of DD among older adults who have been diagnosed with asthma or have experienced symptoms of asthma in the 12 months preceding the survey was 14 times that among those without asthma or asymptomatic of asthma [Adjusted Prevalence Ratio (aPR), 14.46, 95% confidence interval (CI): 10.47 - 19.97; p < 0.001]. Similarly, it was 14 times in South Africa (aPR, 14.6; 95% CI: 8.18 - 26.14; p < 0.00) but in Mexico, it was 4 times (aPR, 4.39; 95% CI: 3.00 - 6.42; p < 0.001) and in China (aPR, 5.99; 95% CI: 4.32 - 8.31; p < 0.001) and Russia (aPR, 5.90; 95% CI: 3.9 - 9.0; p < 0.001), it was 6 times. In India, it was 5 times (aPR=5.1; 95% CI: 4.3 - 6.0; p < 0.001. Generally, there was evidence of 8% increase in poor QoL due to the presence of DD (Pooled estimate, 0.08; 95% CI: 6.0 – 12; p < 0.001). Specifically, in China, there was evidence of 12% increase in poor QoL that could be attributed to DD (prevalence difference (PD), 0.12; 95% CI: 0.07 - 0.18; p < 0.001). In India (PD, 0.08; 95% CI: 0.04 - 0.13; p < 0.01) and Russian Federation (PD, 0.08; 95% CI: 0.01 - 0.15; p < 0.01), there was evidence of 8% increase in poor QoL. Although, there was some increase in poor QoL in Mexico, Ghana, and South Africa due to DD, the increase was not statistically significant. Conclusion: Although different factors could explain the prevalence of DD among older adults in the six LMICs, it was evident that asthma patients amongst this population were at a higher risk of DD. Clinical evaluation and potential diagnosis and treatment of DD among older adults who present with asthma could potentially enhance their QoL