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Background Poststroke cognitive impairment is prevalent worldwide, with no satisfactory preventative therapeutic strategies. We report on the effect of a cardiovascular polypill on cognitive performance among recent stroke survivors. Methods and Results The SMAART (Stroke Minimization through Additive Anti‐atherosclerotic Agents in Routine Treatment) trial was a phase II randomized trial primarily assessing the polypill versus usual care for secondary prevention after a recent ischemic stroke. Participants allocated to the experimental arm were provided 2 Polycaps taken orally once a day for 12 months. A capsule of Polycap contained aspirin 100 mg, simvastatin 20 mg, hydrochlorothiazide 12.5 mg, ramipril 5 mg, and atenolol 50 mg. Participants in the usual care arm received standard secondary prevention therapy. We compared slopes of the trajectory of raw scores in the executive, language, memory, and visuospatial cognitive domains and aggregated cognitive scores over 12 months via a linear mixed‐effects model. We enrolled 148 eligible participants (n=74 in each arm) and 59 versus 64 participants in the polypill and usual care arms, respectively, at month 12. Compared with the usual care arm, the slopes of cognitive performance over 12 months in the polypill arm were steeper by 2.02 units (95% CI, 0.52–3.53), P=0.009 in executive domain, 1.88 units (95% CI, 0.42–3.34), P=0.012 in language domain, 2.60 (0.03–5.17), P=0.049 in memory domain, 0.55 (−0.80 to 1.91), P=0.42 in the visuospatial domain, and global cognitive performance 6.87 units (95% CI, 1.44–12.30), P=0.013. Conclusions The cardiovascular polypill is associated with a signal of better cognitive performance over 12 months among stroke survivors. Further definitive trials are warranted. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03329599.

Key Clinical Message It is important to consider DDMS as a differential diagnosis in any patient with early childhood onset of epilepsy. Early diagnosis and optimal management are key to reducing the disabling effect of DDMS.

Abstract This study examined factors affecting fishers' interest in participating in human immunodeficiency virus (HIV) testing at Elmina fishing community in the Central Region of Ghana. The study additionally inquired of respondents if they would be willing to submit to an HIV test and, if so, if they knew where to go for the test. The study also looked at the barriers that prevented fishers from getting tested for HIV. A cross‐sectional convergent parallel mixed‐method design was used to examine 385 fishers who were at least 18 years old and engaged in any form of fishing activity. Only about 9% of respondents reported having ever tested for HIV. Although the overall testing rate was low, the results indicate a higher testing rate in females than among males. Multivariate analysis shows that sex, age and type of fishing occupation are significant predictors of willingness to test for HIV among the study participants. Even though many people in the study location may know where to get tested for HIV, they are unwilling to do so. Many residents of the research area may be aware of where to get tested for HIV, but they are unwilling to go. This suggests a lack of enthusiasm due to misunderstandings and misconceptions about what HIV testing uptake entails. Additionally, stigmatization is a significant barrier to the acceptance of HIV testing in the study area and needs to be reduced by increased education.

Abstract Background and Aims Sexually transmitted infections (STIs) pose a considerable concern for global healthcare systems. We examined the prevalence and correlates of self‐reported STIs (SR‐STIs) among men and women in Papua New Guinea. Methods A total of 7,195 women and 4,069 men from Papua New Guinea who participated in the 2016–2018 Demographic and Health Survey were included in this study. Percentages were used to summarize the prevalence of SR‐STIs among men and women. A multivariable multilevel binary logistic regression was used to examine the correlates of SR‐STIs in men and women. Results An overall 5.9% and 4.6% prevalence of SR‐STIs were recorded among women and men, respectively, in Papua New Guinea. The odds of SR‐STIs were higher among women who ever tested for HIV (aOR = 2.47, CI: 1.80–3.39), those who had first sex below 20 years (aOR = 1.76, CI: 1.10–2.80), those who watched television less than once a week (aOR = 1.83, CI: 1.13–2.95) and those from the Highlands and Momase regions (aOR = 5.55, CI: 3.30–9.33) compared to their counterparts who never tested for HIV, who had their first sexual intercourse when they were 20 years and above, who did not watch television at all, and those from the Southern Region. For men, the odds of SR‐STIs were high among those who ever tested for HIV (aOR = 1.65, CI: 1.11–2.45), those with one (aOR= 2.08, CI: 1.05–4.14) and two or more (aOR = 3.77, CI: 1.49, 9.52) sexual partners excluding spouse in the 12 months preceding the survey, those living in the Highlands region (aOR = 2.52, CI: 1.48–4.29), and those living in communities with medium literacy level (aOR = 2.33, CI: 1.38–3.94) compared to their counterparts who had never tested for HIV, those with zero sexual partners excluding their spouse in the 12 months preceding the survey, those living in the Southern region, and those living in communities with low literacy levels. Conclusion We recommend that the National AIDS Council of Papua New Guinea through the National HIV and STI 2018–2022 Strategy program should be realigned to address these correlates and ensure that more sexual and reproductive health resources are provided to men and women in the Highlands and Momase regions.

Abstract Background Despite significant improvements in its management, preeclampsia continues to be one of the frequent causes of postpartum readmission. Increased awareness of the risk factors for postpartum readmission is required to reduce its incidence and related complications. This study determined the prevalence and associated risk factors for postpartum readmission among women with preexisting preeclampsia in a Ghanaian population. Methods This hospital‐based retrospective study was conducted at the obstetrics and gynaecology units of Komfo Anokye Teaching Hospital in Ghana. We reviewed the medical records including sociodemographic and obstetric characteristics of preeclampsia patients. Statistical analyses were performed using Statistical Package for Social Sciences Version 26.0 and GraphPad Prism version 8.0. p‐Value

Conclusion: Group homes such as CHO positively impact the well-being and quality of life of persons with mental health and addiction problems while enhancing their independence and social integration for improved recovery outcomes.

Introduction. Stigma is noted to be one of the greatest barriers to the recovery of persons with mental health problems. Stigma has been acknowledged as both an individual and a social orchestration that has an overpowering impact on the social standing of marginalized persons in a society. This study examined the extant literature to ascertain if any evidence(s) suggested a relationship between perceived public attitudes, religious and cultural beliefs, and structural violence in perpetuating stigma against persons with mental illness. Method. We applied a five-step scoping review framework by Arksey and O’Malley to examine evidence in the literature that suggests relationships between perceptions, religious and cultural beliefs, and structural violence in perpetuating stigma. The researchers systematically conducted a literature search from six databases, including CINAHL, Ovid MEDLINE(R), ProQuest Dissertations & Theses Global, Sociology Collection, PsycINFO, and Sociological Abstracts, using search terms that included stigma, mental illness, perception, religious and cultural beliefs, and structural violence. Results. An initial search in six databases yielded 1223 articles. Checking in the Google Search engine yielded 30 more articles. After removing 25 duplicates, 1198 articles remained for title and abstract screening. After a full-text review, 1143 articles were removed. Overall, 30 articles were selected for data extraction. Thematic analysis of the extracted data resulted in three main themes. These include perceptions about mental illness, perceptions about stigma and discrimination, and forms of stigma perception. Conclusion. This study revealed that individual perceptions of public attitudes contributed to their construction of stigma. It is incumbent on everyone to play their part in mitigating all the negative outcomes that stigma brings, especially to persons with mental illness.

Abstract High cropping efficiency implies that high yields are obtained from reasonably sized trees. We studied the general and specific combining ability (GCA and SCA) of selected cashew clones of Brazilian (A), Beninese (BE), and Ghanaian (SG) background for cropping efficiency and nut weight in the early years of bearing. Using North Carolina II mating design, four clones were crossed as males to three best clones recommended for farmers. The 12 F1 progenies were evaluated in the field at Wenchi (2012–2018) for increase in trunk cross‐sectional area at the vegetative (TCSAv) and reproductive (TCSAr) stages, canopy spread in the east‐west (CSew) and north‐south (CSns) directions, nut yield (NY), nut weight (NW), and cropping efficiency (CE) using a randomized complete block design with three replications. Cropping efficiencies were in the range of 30.8–67.4 g/cm2/year while nut weight and nut yield varied from 5.9 to 10.5 g/year and 477.8 to 939.4 kg ha‐1 year‐1 in the fourth to sixth years after planting, respectively. The Beninese progenies outperformed the Brazilian progenies for cropping efficiency. GCA effects were more important than SCA effects. Narrow‐sense heritability ranged from 0.47 (CE) to 0.80 (NW). Canopy spread in the north‐south direction correlated (rg = 0.98; p ≤ .001) strongly with cropping efficiency at the genotypic level. Among males, BE203 showed positive GCA effects for cropping efficiency, TCSAv, and nut yield, whereas A2 and SG273 showed positive GCA effects for nut weight. Among females, SG287 showed negative GCA effects for TCSAr. Our study provides evidence that, cashew tree size and nut quality are under genetic control and the identified clones represent a suitable genetic resource pool to increase productivity.

The desire to form monetary unions among regional blocs in Africa has necessitated the need to assess the degree of financial systems interdependencies in Africa economic blocs for their suitability to have harmonised economic policies of eventual monetary unions. In this regard, SADC has pursued policies to harmonise and integrate its financial system as a precursor to its intended monetary union. However, the ensuing risk among exchange rates of economies in SADC is presumed to rise during severe uncertainties. This study examines the degree of asymmetry and nonlinear directional causality between exchange rates in SADC in the frequency domain. We employ both the ensemble empirical mode decomposition (EEMD) and the Rényi effective transfer entropy techniques to investigate the multiscale information that might be disregarded and further quantify the directional flow of information. Analysis of the study is presented for four frequency-domains: high-, medium-, and low frequencies, representing short-, medium-, and long-terms, respectively, in addition to the residue (fundamental feature). We find a mixture of asymmetric and nonlinear bidirectional and unidirectional causality between exchange rates in SADC for the sampled period. The study reveals a significant positive information flow in the high frequency, but negative flow in the medium and low frequencies. In addition, we gauge a bidirectional significant negative information flow within all the 15 economies for the residue. This suggests a higher risk of uncertainties in exchange rates of SADC. Our findings for low probability events at multiscales have implications for the direction of the future of the SADC monetary union. This calls for further sustained policy harmonisation in the region.

This paper employed wavelet coherence and partial wavelet coherence to investigate the time-frequency effect of global economic policy uncertainty on the comovement of five agricultural commodities such as maize, oat, rice, soybean, and wheat using monthly data from January 1997 to December 2019. In general, we observed heterogeneity in comovement structures of the agricultural commodities market at different time-frequency scales which are profound at high frequencies from the bivariate wavelet coherence. The partial wavelet coherence analysis shows that global economic policy uncertainty is a driver of agricultural commodity market connectedness. This implies that extreme changes in economic policy uncertainty have the tendency to influence commodity price comovement. This poses risk to the stability of the agricultural commodities market, which requires the policymaker’s intervention to protect against the spillover risk contagion effect in uncertain times.

Introduction. The pathophysiology of malaria-related anaemia is not fully understood although increased destruction of parasitized and nonparasitized erythrocytes, as well as inadequate erythropoiesis, has been proposed. Circulating antierythropoietin (anti-EPO) antibodies have also been implicated in malaria and malaria-related anaemia in mice. However, studies on this association have not been investigated in humans. This study therefore determined the prevalence of anti-EPO antibody production and assessed its association with malaria and malaria-related anaemia in humans. Methods. A total of 86 children aged 1-10 years (57 children with malaria serving as the case group and 29 healthy children serving as control), all residents of Duayaw Nkwanta, Ghana, were recruited for this case-control study. Venous blood was collected for thick and thin films for malaria microscopy, full blood count by automated haematology analyzer, and antierythropoietin antibody and erythropoietin estimation by sandwich ELISA method. Results. Out of the 86 participants recruited, only 3 (3.5%) were positive for anti-EPO antibody; 2.3% of the case group; and 1.2% of the control group. There was no association between the cases and the controls in the production of anti-EPO antibodies. Erythropoietin concentration was significantly higher in malaria-related anaemic subjects (p=0.032). Conclusion. Antierythropoietin antibodies are not associated with malaria infection and malaria-related anaemia in humans. Erythropoietin concentration is associated with malaria-related anaemia.

In Ghana, sesame is cultivated in some districts of northern Ghana. Genotypes cultivated are land races that are low yielding leading to decline in production. There is the need for improvement of these land races to generate high yielding cultivars. Characterization of genetic diversity of the sesame land races will be of great value in assisting in parental lines selection for sesame breeding programmes in Ghana. Twenty-five sesame land races were collected from five districts in northern Ghana noted for sesame cultivation. Seeds collected were planted in three replicates in randomized complete block design and were evaluated for a number of morphological characters. Data collected were subjected to Principal Component Analysis (PCA) and a dendrogram showing similarity between the accessions were drawn. Data on number of capsules per plant, number of seeds per capsule, and plant height at flowering were subjected to analysis of variance using GenStat Discovery Edition 4. Molecular genetic diversity was assessed by using thirty eight SSR markers widely distributed across sesame genome to characterize the materials. Twenty-one out of the 38 primers were polymorphic. Cluster analyses using the Euclidean similarity test and a complete link clustering method were used to make a dendrogram out of the morphological data. Analysis of variance showed that capsule number was significantly different; a range of 54.9 and 146.7 was produced. The number of seeds per capsule varied significantly and the variation between highest and lowest accession in seed production was 33%. Plant height was also significantly different ranging from 60.6 to 94.1 cm. Using morphological traits the accessions clustered into two major groups and two minor groups and variation among accessions were 10-61%. On the other hand, SSR marker-based dendrogram revealed five major and two minor groups. It showed that variation among the accessions was low, 10-20%. Heterozygosity was 0.52, total alleles produced were 410, and average allele per locus was 19.52. Six accessions, C3, C4, S5, W1, W3, and W5 fell in five different clusters in the SSR dendrogram and in six clusters in the morphomolecular based dendrogram. These accessions were noted for high capsule number per plant and seeds number per capsule and are recommended for consideration as potential parental lines for breeding programme for high yield.

Accidental release of gaseous or liquid effluents is a critical issue and of a greater concern to the nuclear industry when it comes to the protection of the public and the environment. The emphasis becomes paramount when the release involves particulate of radiation particles. This paper provides a comprehensive insight report on an account of a research investigation carried out in addressing a radiological safety issue of Ghana’s Miniature Neutron Source Reactor (MNSR) during its core conversion project. The amounts of Strontium-90 (Sr-90) and Krypton-85 (Kr-85) effluents presumably released from the reactor hall to the surroundings and the consequential emission radiation to the working area within a 200 m radius were analyzed for a six-month working period. The objective was to estimate specifically the approximate total effective dose equivalent (TEDE) of Sr-90 and Kr-85 by considering a conjectural accident scenario using a well-recognized and user-friendly known atmospheric dispersion model before the preparatory period. The maximum TEDE value recorded at a ground deposition value of 4.6E − 01 kBq/m2 was approximately 1.80E − 02 mSv and 4.90E − 4 mSv for Sr-90 and Kr-85, respectively, at a maximum distance of 0.1 km from the source. The estimated dose values recorded were found to be within the recommended regulatory safety limits of 50 mSv for onsite workers and 1 mSv for the general public. No adverse effect was experienced with respect to human health and the environment.

Objective. Peripheral sensory neuropathy (PSN) is among microvascular complications of diabetes that make patients prone to ulceration and amputation. Arterial stiffness is a predictor of cardiovascular diseases and microvascular complications associated with diabetes. We investigated the association between PSN and arterial stiffness, measured as aortic pulse wave velocity (PWVao) and cardio-ankle vascular index (CAVI). Method. In a case-control design, arterial stiffness was measured in 240 diabetes patients and 110 nondiabetic control. Large-fibre nerve function was assessed by vibration perception threshold (VPT) using a neurothesiometer. PSN was defined as the VPT > 97.5th percentile from age- and gender-adjusted models in nondiabetic controls. Results. The overall prevalence of PSN was 16.6% in the entire study participants. Compared to non-PSN participants, PSN patients had higher levels of PWVao (9.5 ± 1.7 versus 8.7 ± 1.2 m/s, p=0.016) and CAVI (8.4 ± 1.3 versus 7.6 ± 1.1, p=0.001). In multiple regression models, VPT was associated with PWVao (β=0.14, p=0.025) and CAVI (β=0.12, p=0.04). PSN patients had increased odds of CAVI (OR = 1.51 (1.02–2.4), p=0.043), but not PWVao (OR = 1.25 (0.91–1.71), p=0.173). Conclusion. PWVao and CAVI were associated with VPT and PSN in diabetes patients in Ghana. Patients having PSN have increased odds of CAVI, independent of other conventional risk factors.

This study determined noncompliance to antihypertensive therapy (AHT) and its associated factors in a Ghanaian population by using the health belief model (HBM). This descriptive cross-sectional study conducted at Kintampo Municipality in Ghana recruited a total of 678 hypertensive patients. The questionnaire constituted information regarding sociodemographics, a five-Likert type HBM questionnaire, and lifestyle-related factors. The rate of noncompliance to AHT in this study was 58.6%. The mean age (SD) of the participants was 43.5 (±5.2) years and median duration of hypertension was 2 years. Overall, the five HBM constructs explained 31.7% of the variance in noncompliance to AHT with a prediction accuracy of 77.5%, after adjusting for age, gender, and duration of condition. Higher levels of perceived benefits of using medicine [aOR=0.55(0.36-0.82),p=0.0001] and cue to actions [aOR=0.59(0.38-0.90),p=0.0008] were significantly associated with reduced noncompliance while perceived susceptibility [aOR=3.05(2.20-6.25), p