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Background: In developing countries, hospitalized burn victims are at high risk of nosocomial infections caused by Staphylococcus aureus. Risk factors include poor infection control practices, prolonged hospitalisation and limited capacity for laboratory microbiological analyses. These problems are compounded by widespread use of antibiotics that drives the spread of multidrug resistant bacteria.Methods: During the study period (November 2014-June 2015), nasal and invasive S. aureus isolates were collected consecutively from patients and healthcare workers (HCWs) within the burn unit of the Reconstructive Plastic Surgery and Burn Center of Korle Bu Teaching Hospital in Ghana. Antibiotic prescription, antibiotic susceptibility and bacterial typing were used to assess antibiotic pressure, antibiotic resistance, and possible transmission events among patients and HCWs.Results: Eighty S. aureus isolates were obtained from 37 of the 62 included burn patients and 13 of the 29 HCWs. At admission, 50% of patients carried or were infected with S. aureus including methicillin resistant S. aureus (MRSA). Antibiotic use per 100 days of hospitalization was high (91.2 days), indicating high selective pressure for resistant pathogens. MRSA isolates obtained from 11 patients and one HCW belonged to the same spa-type t928 and multi-locus sequence type 250, implying possible transmission events. A mortality rate of 24% was recorded over the time of admission in the burn unit.Conclusion: This study revealed a high potential for MRSA outbreaks and emergence of resistant pathogens amongst burn patients due to lack of patient screening and extended empirical use of antibiotics. Our observations underscore the need to implement a system of antibiotic stewardship and infection prevention where microbiological diagnostics results are made available to physicians for timely and appropriate patient treatment.

The World Health Organization's World Report on Disability underscores the need to identify and address barriers that limit people with disabilities from having access to services. Wylie, McAllister, Davidson, and Marshall (2013) consider the impact of that report on people with communication disabilities (PWCD). Over the past 5 years, the authors have worked together in Ghana to address the needs of PWCD. With only about 10 university-trained speech-language pathologists (SLPs) in Ghana, the barriers to PWCD receiving services are quite high. The authors are working together and with others to establish the first speech-language pathology program in Ghana. The authors also work to identify ways to share with PWCD and their families knowledge and skills on how to improve the communicative function of PWCD. In doing so, the authors have learned valuable lessons about the role of an SLP, especially when considering under-served PWCD, lessons that are applicable to both Majority and Minority World co...