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Background: This study aimed to describe the characteristics of patients diagnosed with hepatocellular carcinoma (HCC) at the Komfo Anokye Teaching Hospital (KATH) in Ghana and to determine their treatment options per the Barcelona Clinic Liver Cancer (BCLC) algorithm. Methods: We reviewed the medical records of patients diagnosed with HCC at KATH in the period 2007-2013. Patient demographics, medical history, investigations, management, and outcome were extracted. BCLC staging was applied to determine their treatment options. Results were expressed as descriptive statistics. Results: The charts for 206/465 patients were available for review. The male:female ratio was 2:1 and mean age was 44.0 ± 14.5 years. Common presenting complaints were abdominal distension, abdominal pain, and jaundice. hepatitis B virus (HBV) positivity was 52 %. Almost all patients received only supportive treatment. None underwent surgery, ablation, or transarterial chemoembolization. BCLC staging could be completed for 118 patients. Using predicted INR values in cases without the result, < 8 % of patients were eligible for resection, transplantation, or ablation; 25-53 % were eligible for embolization or sorafenib therapy. Up to 72 % were eligible only for supportive care. Seventy-six percent of patients reviewed were discharged alive; 71 % of patients whose charts were not available died during an admission. Thus, of the 465-patient cohort, 50 % died in the hospital. Conclusions: The majority of HCC in our population is caused by HBV. Up to 61 % of patients may be eligible for curative treatment, transarterial chemoembolization, or sorafenib treatment. This percentage may be increased with a robust surveillance program for patients at increased risk for HCC. Hepatitis B vaccination must also be a public health priority. [ABSTRACT FROM AUTHOR]

Cyanidation is the most widely used technique for gold extraction worldwide. However, its efficiency in gold extraction has decreased due to gold association with base metals such as copper. Copper is known to form different complexes with cyanide depending on the pulp pH. These Cu-CN complexes deplete the pulp of free cyanide, thereby decreasing gold leaching. The study examined the application of diethylenetriamine (DETA) in cyanidation to minimise copper ions effect on gold cyanidation. Leaching tests performed in the presence of copper ions reduced gold recovery from 93% to 15% at a copper sulphate concentration of 1% and increased cyanide consumption by 10%. The introduction of DETA (between 0.2% and 1%) however restored gold recovery back to normal as the baseline without copper ions and also enabled gold extraction at a reduced cyanide strength. Based on the study, DETA could be used during gold–copper cyanide leaching to minimise the copper ion effect and enhance gold extraction. [ABSTRACT FROM AUTHOR]

Considerable land cover changes have occurred in the Luvuvhu catchment in northeastern South Africa in the past two decades. These changes are associated with human population growth and may be contributing to observed reductions in winter river baseflows and increased episodes of river drying within Kruger National Park. Six-class land cover maps of the catchment were created from 1978 (MSS) and 2005 (TM) Landsat imagery using an iterative technique. Results indicate a 1,000 km2 (12%) increase in Bare Ground between 1978 and 2005, with a concomitant decrease in shrubland and indigenous forest cover. Overall classification accuracy in the 2005 image was 80%. Classification was most accurate for Water and Pine classes (100 and 92%) and least accurate for Indigenous Forest (46%), primarily due to misclassification as Shrubland. These maps are suitable for land cover change and landscape modeling analyses, and can serve as baseline data for further research. [ABSTRACT FROM AUTHOR]

• The impact of innovation on economic growth among G7 and BRICS countries is studied. • A GMM panel vector autoregressive approach is used. • Patent and trademark as innovation variables have significant impacts on economic growth in both G7 and BRICS countries. • The impact of innovation is stronger in G7 than BRICS countries. The study aims to investigate the impact of innovation on economic growth among the G7 and BRICS countries. Our data was retrieved from the World Development Indicators database (World Bank 2019) from the period 2000-2017. Innovation is measured by R&D, patents, and trademarks. This research explored how GDP per capita reacts to a shock from R&D, patent, and trademark among G7 and BRICS countries. Stationarity tests are conducted through panel unit-roots tests. The authors employed a GMM style panel VAR estimator to investigate the phenomenon. Our results revealed that R&D, patent, and trademark as the determinants of innovation have a significant impact on GDP per capita also as a determinant of economic growth among G7 and BRICS countries. However, the impact is more among the G7 than the BRICS countries. The impulse response function of the panel VAR estimates shows that the impact of one standard deviation shock in R&D, patent, and trademark on GDP per capita varies from year one to year ten among these variables for both G7 and BRICS countries. [ABSTRACT FROM AUTHOR]

To appreciate and explore the potential use of coconut oil as substitute in chocolate this research was conducted. In achieving this, three different chocolates were formulated using varied amount of coconut oil (5–15%) as cocoa butter substitute. The formulated chocolate samples and a control were stored for 21 days to evaluate the kinetic reaction of oxidative stability and phenolic and flavonoid content, color and sensory properties. Results revealed that characterizations of oxidative reactions were dependent on coconut oil which had a positive correlation with free fatty acids, saponification and peroxide. Based on statistical tools such as coefficient of correlation (0.9879–0.9976), root mean square error (0.0176–0.3620) and reduced chi-square (1.5 × 10–4–0.1310), second-order polynomial model accurately predicted kinetic evolution of oxidative stability during storage. In conclusion, coconut oil could be used as cocoa butter replacer in chocolate formulation, however only 5% is recommended based on better mouthfeel, appearance and taste and enhanced polyphenolic content [ABSTRACT FROM AUTHOR]

Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care.Methods: Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability.Results: There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3-57 vs 0-9 stock-outs, respectively; p = 0.05), duration of stock-outs (median 171 vs 8 days, range 51-1268 vs 0-182 days, respectively; p = 0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p = 0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r2 = 0.72; p value for each covariate between 0.17-0.34).Conclusions: Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals. [ABSTRACT FROM AUTHOR]

• This paper analyses the differences between land ownership and administration in the context of land use planning in Ghana. • It highlights how the production of unsustainable urban spaces is influenced by land management and administration conflicts. • Findings show there is no distinction between customary land ownership and administration as traditional leaders exercise both functions. • Weak agency framework and coordination have contributed to poor integration customary land issues into land use planning. Global literature reporting on land governance indicates considerable differences between land ownership and land administration. Yet, in many Sub-Saharan African countries, particularly Ghana, this relationship is blurred in complex land governance regimes. An understanding of this relationship in Ghana's customary land sector – the dominant land ownership type – is critical in advancing urban land use planning and promoting effective urban management in this era of rapid urbanisation across Africa. Unfortunately, little is known about this relationship in the context of land use planning. Using Kumasi, a rapidly growing city in Ghana as a case study, the purpose of this paper is threefold: (i) to discuss the relationship between customary land ownership and administration in the context of land use planning, (ii) to explore institutional perspectives on sustainable land use planning; and (iii) to examine the implications of customary land ownership and administration on sustainable land use planning. Using a review of relevant land use planning documents on Ghana, and interviews with four urban planning agencies and four customary land owners (chiefs/traditional leaders) in Kumasi, findings indicate a demonstration of an unclear nature of legislative planning framework and a lack of focus on customary land ownership and administration system in urban land use planning. Despite planning laws (e.g., zoning guidelines) emphasising separation of ownership from administration, findings indicate no distinction between customary land ownership and land administration as the traditional leaders (the owners) administer the land via determination of land uses, arbitration of land disputes, and location determination of important community infrastructure and services. Evidence of repetitive and cumbersome nature of land administration by traditional owners and government planning agencies, weak agency framework and coordination challenges has contributed to limited progress of sustainable land use planning in the city. [ABSTRACT FROM AUTHOR]

Road traffic collisions disproportionately impact Ghana and other low- and middle-income countries. This study explored road user perspectives regarding the magnitude, contributing factors, and potential solutions to road traffic collisions, injuries, and deaths. We designed a qualitative study of 24 in-depth interviews with 14 vulnerable road users (pedestrians, occupants of powered 2- and 3-wheelers, cyclists) and ten non-vulnerable road users in four high-risk areas in November 2022. We used a mixed deductive (direct content analysis) and inductive (interpretive phenomenological analysis) approach. In the direct content analysis, a priori categories based on Haddon's Matrix covered human, vehicle, socioeconomic environment, and physical environment factors influencing road traffic collisions, along with corresponding solutions. We used inductive analysis to identify emerging themes. Participants described frequent and distressing experiences with collisions, and most often reported contributing factors, implementation gaps, and potential solutions within the human (road user) level domain of Haddon's Matrix. Implementation challenges included sporadic enforcement, reliance on road users' adherence to safety laws, and the low quality of the existing infrastructure. Participants expressed that they felt neglected and ignored by road safety decision-makers. This research emphasizes the need for community input for successful road safety policies in Ghana and other low- and middle-income countries, calling for greater governmental support an action to address this public health crisis. We recommend the government collaborates with communities to adapt existing interventions including speed calming, footbridges, and police enforcement, and introduces new measures that meet local needs. [ABSTRACT FROM AUTHOR]

In the original article some funding information was inadvertently omitted. The complete funding information is as follows: [ABSTRACT FROM AUTHOR]

• This study aimed to elicit expert views on barriers to road safety goals, research gaps, and future action priorities. • Barriers included the poor regulation of commercial vehicles and the limited use of technology to enforce traffic laws. • The impact of increasing motorcycle (2- and 3-wheel) on injury burden is poorly understood. • There is a need for evaluations on the treatment of hazardous spots, road safety education, and towing of disabled vehicles. Implementation of evidence-based approaches to reduce the substantial health, social, and financial burdens of road traffic injuries and deaths in Ghana and other low-and-middle-income countries (LMICs) is vitally important. Consensus from national stakeholders can provide insight into what evidence to generate and which interventions to prioritize for road safety. The main objective of this study was to elicit expert views on the barriers to reaching international and national road safety targets, the gaps in national-level research, implementation, and evaluation, and the future action priorities. We used an iterative three-round modified Delphi process to generate consensus among Ghanaian road safety stakeholders. We defined consensus as 70% or more stakeholders selecting a specific response in the survey. We defined partial consensus (termed "majority") as 50% or more stakeholders selecting a particular response. Twenty-three stakeholders from different sectors participated. Experts generated consensus on barriers to road safety goals, including the poor regulation of commercial and public transport vehicles and limited use of technology to monitor and enforce traffic behaviors and laws. Stakeholders agreed that the impact of increasing motorcycle (2- and 3-wheel) use on road traffic injury burden is poorly understood and that it is a priority to evaluate road-user risk factors such as speed, helmet use, driving skills, and distracted driving. One emerging area was the impact of unattended/disabled vehicles along roadways. There was consensus on the need for additional research, implementation, and evaluation efforts of several interventions, including focused treatment of hazardous spots, driver training, road safety education as part of academic curricula, promotion of community involvement in first aid, development of strategically positioned trauma centers, and towing of disabled vehicles. This modified Delphi process with stakeholders from Ghana generated consensus on road safety research, implementation, and evaluation priorities. [ABSTRACT FROM AUTHOR]

Background: A multitude of operative trauma courses exist, most of which are designed for and conducted in high-resource settings. There are numerous barriers to adapting such courses to low- and low-middle-income countries (LMICs), including resource constraints and contextual variations in trauma care. Approaches to implementing operative trauma courses in LMICs have not been evaluated in a structured manner. Methods: We conducted a scoping review of the literature including databases (e.g., PubMed, Web of Science, EMBASE), grey literature repositories, and structured queries of publicly available course materials to identify records that described operative trauma courses offered since 2000. Results: The search identified 3,518 non-duplicative records, of which 48 relevant reports were included in analysis. These reports represented 23 named and 11 unnamed operative trauma courses offered in 12 countries. Variability existed in course format and resource requirements, ranging from USD 40 to 3,000 per participant. Courses incorporated didactic and laboratory components, which utilized simulations, cadavers, or live animals. Course content overlapped significantly but was not standardized. Data were lacking on course implementation and promulgation, credentialing of instructors, and standardized evaluation metrics. Conclusions: While many operative trauma courses have been described, most are not directly relatable to LMICs. Barriers include cost-prohibitive fees, lack of resources, limited data collection, and contextual variability that renders certain surgical care inappropriate in LMICs. Gaps exist in standardization of course content as well as transparency of credentialing and course implementation strategies. These issues can be addressed through developing an open-access operative trauma course for low-resource settings. [ABSTRACT FROM AUTHOR]

Metastatic spine tumors affect over 30% of patients who have been diagnosed with cancer. While techniques in surgical intervention have undoubtedly evolved, there are some pitfalls when spinal instrumentation is required for stabilization following tumor resection. However, the use of carbon fiber-reinforced polyetheretherketone (CFR-PEEK) implants has become increasingly popular due to improved radiolucency and positive osteobiologic properties. Here, we present a systematic review describing the use of CFR-PEEK-coated instrumentation in the oncologic population while identifying advantages and potential shortcomings of these devices. In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted in March 2022 to identify articles detailing the use of CFR-PEEK implants for spinal instrumentation in patients with primary and secondary spine tumors. The search was performed using the PubMed, Scopus, and Embase databases. An initial search returned a total of 85 articles among the three databases used. After the exclusion of duplicates and screening of abstracts, 21 full-text articles were examined for eligibility. Eleven articles were excluded due to not fitting our inclusion and exclusion criteria. Ten articles were subsequently eligible for full-text review. CFR-PEEK possesses a similar safety and efficacy profile to titanium implants but has distinct advantages. It limits artifact, increases early detection of local tumor recurrence, increases radiotherapy dose accuracy, and is associated with low complication rates (9.96%)–making it a promising alternative for the demands unique to the treatment/outcome of spinal oncologic patients. [ABSTRACT FROM AUTHOR]

Nematodes from the sediments of the Swartkops estuary in Port Elizabeth, South Africa were investigated at 10 selected sites along a salinity gradient in the subtidal region at neap tide. The relation between nematode density, genera, community structure and environmental parameters including concentrations of seven heavy metals, Mn, Ti, Cr, Pb, Fe, Sn and Zn in the sediment were investigated. The nematode community structure was significantly influenced by the chlorophyll a concentration and sediment particle-size distribution. The number of genera had significant negative correlation with chlorophyll a and two heavy metals, Fe and Zn in the sediment. The habitat preferences of the genera were also assessed. A combination of the Shannon-Wiener Diversity Index (H') and the Maturity Index (MI) proved to be very useful in assessing polluted or stressed sites. The nematode communities at sites which are affected by pollution, were found to be under stress according to the density, diversity and other indices used in this study. At sites where relatively higher heavy metal concentrations occurred, variation in the nematode densities and diversity were observed. Nematode community structure at polluted sites differed significantly (p < 0.05) from those at less or no polluted sites. Monhystera spp. and Theristus spp. were found to be colonizers, and thus indicator genera for polluted sediments in this study. [ABSTRACT FROM AUTHOR]

Report the statistical software that was used for data analysis.Round 195.8%4.58 ± 0.88--10bReport any modification of variables used in the analysis, along with reference (if available).Round 275%4.00 ± 1.1483.3%4.16±0.71-10cReport details about how missing data was handled. In the "Methods" section, our checklist provides a detailed explanation of initiating and developing the survey, including study design, data collection methods, sample size calculation, survey administration, study preparation, ethical considerations, and statistical analysis. Indeed, different studies have presented multiform patterns of survey designs and reported results in various non-systematic ways.[15]-[17] Evidence-based tools developed by experts could help streamline particular procedures that authors could follow to create reproducible and higher quality studies.[18]-[20] Research studies that have transparent and accurate reporting may be more reliable and could have a more significant impact on their potential audience.[19] However, that is often not the case when it comes to reporting research findings. Report target population, reported validity and reliability information, scoring/classification procedure, and reference links (if any).Round 278.2%4.00 ± 1.0472.7%4.055±0.96-5cProvide information on pretesting of the questionnaire, if performed (in the article or in an online supplement). [Extracted from the article]

This study evaluated the biomarker responses indicative of exposure to Benzo[a] Pyrene (B[ a ]P) in Mytilus galloprovincialis and Ruditapes decussatus. A significant increase of the total oxyradical scavenging capacity (TOSC) was observed after seven days of exposure to two concentrations of B[ a ]P (100 and 300 μg.L−1), in the digestive gland with the lowest concentration tested. The TOSC in the gills increased notably only after the exposure to 300 μg.L−1 of B[ a ]P. Interestingly, the superoxide dismutase (SOD) and catalase (CAT) activities in gills and digestive gland on one hand and glutathione S-transferase (GST) in gills in the other, were positively correlated with the concentration of B[ a ]P with a significant induction noticed at the highest concentration. In contrast, a significant increase of the GST activity was observed in the digestive gland following the exposure of bivalves to 100 μg.L−1. In pelagic (M. galloprovincialis) or benthic (R. decussatus) bivalves, the AChE activity decreased discernibly in digestive glands and gills with the increase of B[ a ]P concentrations as evidence of neurotoxic effects. In clams, the exposure to B[ a ]P was followed by a significant increase of Malondialdehyde level (MDA) in gills and digestive gland, this does not occur in gills of Mytilus galloprovincialis at the concentration of 100 μg.L−1. Overall, the results found seems to indicate that the mussel was more suitable as a predictor tool of toxicity of B[ a ]P. [Display omitted] • B[a]P induces phases I and II enzymes in Mytilus galloprovincialis and Ruditapes decussatus. • An inhibition of AChE activity was observed in R. decussatus (gills and digestive gland). • M. galloprovincialis biomarker responses to B[ a ]P were mostly higher than those of R. decussatus. [ABSTRACT FROM AUTHOR]

Introduction: Hawthorne effect refers to changes in clinician behavior in response to being observed. It has been minimally evaluated in trauma and surgical research, especially in low- and middle-income countries (LMICs)., Methods: We used data from the first (control) phase of a randomized clinical trial in Ghana (2020-21). Trained observers were stationed in emergency units in eight non-tertiary hospitals to observe the achievement of key performance indicators (KPI) (KPIs) of trauma care. We hypothesized that the observers' presence would create a Hawthorne effect, resulting in clinicians (doctors, nurses) performing above their usual level, with performance highest immediately after the observers were introduced, and with performance then declining over time toward the usual baseline., Results: We enrolled 2067 injured patients. Achievement of 13 out of 16 KPIs declined significantly over the 14 months after the introduction of observers. For example, airway assessment declined from 77% initially to 60% at the end of the phase (p < 0.001). Chest examination declined from 66% to 31% (p < 0.001). Distal pulses checked declined from 45% to 7% (p < 0.001). The slope of decline in KPI achievement ranged from 0.8%/month (mobility assessed) to 15.9%/month (distal pulses checked)., Conclusions: The decline in KPI achievement over time is consistent with the hypothesis that clinicians performed above their usual level just after the observers were introduced, with performance then declining toward the usual baseline. This study is among the first to provide quantitative data on the Hawthorne effect for trauma research in LMICs. These data are useful for the design of future observational studies and clinical trials., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Background: We sought to determine the achievement of key performance indicators (KPIs) of initial trauma care at non-tertiary hospitals in Ghana during on-hours (8AM-5PM weekdays) compared to off-hours (nights, weekends, and holidays). We also sought to assess the effectiveness of a standardized trauma intake form (TIF) with built-in decision support prompts to improve care and to assess whether this effectiveness varied between on-hours and off-hours., Methods: A stepped-wedge cluster randomized trial was performed with research assistants directly observing trauma care before and after introducing the TIF at emergency units of eight hospitals for 17.5 months. Differences in KPIs and mortality were assessed using multivariable logistic regression and generalized linear mixed regression., Results: Management of 4,077 patients was observed; 1,126 (28 %) during on-hours and 2,951(72 %) during off-hours. At baseline, four of 20 KPIs were performed significantly more often during off-hours. TIF improved care during both on- and off-hours. Seventeen KPIs improved during on-hours and 18 KPIs improved during off-hours. After TIF, six KPIs were performed more often during on-hours, but differences, though significant, were small (1-5 %). Examples of KPIs which were performed more often during on-hours after TIF included: airway assessment (99 % for on-hours vs. 98 % for off-hours), evaluation for intra-abdominal bleeding (91 % vs. 87 %), and spine immobilization for blunt trauma (90 % vs. 85 %) (all p < 0.05). At baseline, mortality among seriously injured patients (Injury Severity Score >9) was higher during on-hours (27 %) compared to off-hours (17 %, p = 0.047). TIF lowered mortality for seriously injured patients during both on-hours (27 % before TIF, 8 % after, p = 0.027) and during off-hours (17 % before, 7 % after, p = 0.004). After TIF, mortality among seriously injured patients was equal between on- and off-hours (8 % vs. 7 %, NS)., Conclusions: At baseline, KPIs of trauma care were slightly better during off-hours compared with on-hours, and mortality was lower among seriously injured patient during off-hours. A quality improvement initiative (the TIF) using built-in decision support prompts improved care strongly in both on- and off-hours and eliminated the mortality difference between on- and off-hours. Use of similar decision support prompts during initial trauma care should be promoted widely in other low- and middle-income countries., Competing Interests: Declaration of competing interest The authors of the manuscript titled “Differences in trauma care between on-hours and off-hours and responsiveness to a trauma intake form with decision support prompts in Ghana: A stepped-wedge cluster randomized trial” declare no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Road safety authorities in high-income countries use geospatial motor vehicle collision data for planning hazard reduction and intervention targeting. However, low-income and middle-income countries (LMICs) rarely conduct such geospatial analyses due to a lack of data. Since 1991, Ghana has maintained a database of all collisions and is uniquely positioned to lead data-informed road injury prevention and control initiatives., Methods: We identified and mapped geospatial patterns of hotspots of collisions, injuries, severe injuries and deaths using a well-known injury severity index with geographic information systems statistical methods (Getis-Ord Gi*)., Results: We identified specific areas (4.66% of major roads in urban areas and 6.16% of major roads in rural areas) to target injury control. Key roads, including National Road 1 (from the border of Cote D'Ivoire to the border of Togo) and National Road 6 (from Accra to Kumasi), have a significant concentration of high-risk roads., Conclusions: A few key road sections are critical to target for injury prevention. We conduct a collaborative geospatial study to demonstrate the importance of addressing data and research gaps in LMICs and call for similar future research on targeting injury control and prevention efforts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Although road traffic injuries and deaths have decreased globally, there is substantial national and sub-national heterogeneity, particularly in low- and middle-income countries (LMICs). Ghana is one of few countries in Africa collecting comprehensive, spatially detailed data on motor vehicle collisions (MVCs). This data is a critical step towards improving roadway safety, as accurate and reliable information is essential for devising targeted countermeasures., Methods: Here, we analyze 16 years of police-report data using emerging hot spot analysis in ArcGIS to identify hot spots with trends of increasing injury severity (a weighted composite measure of MVCs, minor injuries, severe injuries, and deaths), and counts of injuries, severe injuries, and deaths along major roads in urban and rural areas of Ghana., Results: We find injury severity index sums and minor injury counts are significantly decreasing over time in Ghana while severe injury and death counts are not, indicating the latter should be the focus for road safety efforts. We identify new, consecutive, intensifying, and persistent hot spots on 2.65% of urban roads and 4.37% of rural roads. Hot spots are intensifying in terms of severity and frequency on major roads in rural areas., Conclusions: A few key road sections, particularly in rural areas, show elevated levels of road traffic injury severity, warranting targeted interventions. Our method for evaluating spatiotemporal trends in MVC, road traffic injuries, and deaths in a LMIC includes sufficient detail for replication and adaptation in other countries, which is useful for targeting countermeasures and tracking progress., (© 2024. The Author(s).)

Background: The experiences of trauma patients referred from Ghanaian non-tertiary hospitals for definitive care at higher levels is not well-known. Understanding the motivations of injured patients who do not attend their referral for definitive management may inform interventions to improve injury outcomes., Methods: This study is a follow-up survey of participants of a larger study involving initial management of injured patients presenting to 8 non-tertiary hospitals in Ghana from October 2020 to March 2022. Injured patients referred to higher levels of care were surveyed by phone using a structured questionnaire and patients who could not be reached were excluded. The main outcome was referral non-attendance and differences between patients who attended the referral and those who did not were determined with chi squared tests. Variables with intergroup differences were included in a multivariable logistic regression. Open-ended survey responses were analyzed using thematic content analysis., Results: Of 335 referred patients surveyed, 17 % did not attend the referral. Factors associated with referral non-attendance included being male (Adjusted odds ratio (AOR)=2.70, p = 0.013), sustaining a fracture (AOR=2.83, p = 0.003), and having less severe injury (AOR 2.84, p = 0.017). Primary drivers of referral non-attendance included financial problems (59 %), family influence (45 %), and lack of transportation (20 %). The majority of patients (77 %) not attending the referral sought treatment from traditional healers, citing lower cost, faster service, and a perception of equivalent outcomes. Reported facilitators of referral attendance included positive hospital staff experiences and treatment while barriers included higher hospital costs, lack of bed space, and poor interhospital communication., Conclusions: An important proportion of injured patients in Ghana do not attend referrals for definitive management, with many seeking care from traditional healers. Our study identified possible targets for interventions aimed at maintaining the continuum of hospital-based care for injured patients in order to improve outcomes., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors.)

Introduction: Frequent reassessment of injured patients is an important component of trauma and emergency care. How frequently such reassessment is done in African hospitals has been minimally addressed. We sought to address this gap, as well as to assess the effectiveness of a standardized trauma intake form (TIF) to improve assessment and reassessment rates., Methods: We undertook a stepped-wedge cluster randomized trial with research assistants observing trauma care before and after introducing the TIF at emergency units of eight non-tertiary Ghanaian hospitals for 17.5 months. Differences in seven key performance indicators (KPIs) of assessment and reassessment were evaluated using generalized linear mixed regression. KPIs included: respiratory rate, heart rate, blood pressure, level of consciousness, mobility, temperature, and oxygen saturation., Results: Management of 4077 patients was observed: 2067 before TIF initiation and 2010 after. In the before period, completion of KPIs of initial assessment ranged from 55% (oxygen saturation) to 88% (level of consciousness). KPIs for reassessment for patients still in the EU after 30 min ( n = 1945, in before period) were much lower than for initial assessment, ranging from 10% (respiratory rate and oxygen saturation) to 13% (level of consciousness). The TIF did not significantly improve performance of any KPI of assessment or reassessment. Similar patterns pertained for the subgroup of seriously injured patients (Injury Severity Score ≥9)., Conclusion: At non-tertiary hospitals in Ghana, performance of KPIs of initial assessment were mostly adequate, but with room for improvement. Performance of KPIs for reassessment were very low, even for seriously injured patients. The intervention (trauma intake form) did not impact reassessment rates, despite previously having been shown to impact many other KPIs of trauma care. Potential avenues to pursue to improve reassessment rates include other quality improvement efforts and increased emphasis on reassessment in training courses., Competing Interests: The authors declared no conflicts of interest., (© 2024 The Authors. Published by Elsevier B.V. on behalf of African Federation for Emergency Medicine.)

Background: This study aimed to determine the effectiveness of a standardized trauma intake form (TIF) to improve achievement of key performance indicators (KPIs) of initial trauma care among injured children, compared to adults, at non-tertiary hospitals in Ghana., Methods: A stepped-wedge cluster randomized trial was performed with research assistants directly observing the management of injured patients before and after introducing the TIF at emergency units of 8 non-tertiary hospitals for 17.5 months. Differences in outcomes between children and adults in periods before and after TIF introduction were determined with multivariable logistic regression. Differences in outcomes among children after TIF introduction were determined using generalized linear mixed regression., Results: Management of 3889 injured patients was observed; 757 (19%) were children <18 years. Trauma care KPIs at baseline were lower for children compared to adults. Improvements in primary survey KPIs were observed among children after TIF introduction. Examples include airway assessment [279 (71%) to 359 (98%); adjusted odds ratio (AOR): 74.42, p = 0.005)] and chest examination [225 (58%) to 349 (95%); AOR 53.80, p = 0.002)]. However, despite these improvements, achievement of KPIs was still lower compared to adults. Examples are pelvic fracture evaluation [children: 295 (80%) vs adults: 1416 (88%), AOR: 0.56, p = 0.001] and respiratory rate assessment (children: 310 (84%) vs adults: 1458 (91%), AOR: 058, p = 0.030)., Conclusions: While the TIF was effective in improving most KPIs of pediatric trauma care, more targeted education is needed to bridge the gap in quality between pediatric and adult trauma care at non-tertiary hospitals in Ghana and other low- and middle-income countries., Type of Study: Stepped-wedged cluster randomized controlled trial., Level of Evidence: I., Competing Interests: Conflicts of interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)