Search

Mental illness-related stigma does not only emanate from the public but also within families of persons with mental illnesses. Familial mental illness stigma implies family members perpetuating stigma against their loved ones with mental illnesses. The aim of this review was to analyze the empirical literature on experiences of familial mental illness stigma in four countries. Using seven databases, we reviewed 133 empirical studies with 26 meeting the inclusion criteria. Each of the 26 studies spoke to various forms of familial mental illness stigma that potentially impact the self-esteem and self-worth of the affected person. Findings from this review show the existence of familial mental illness stigma in high-income countries, highlighting the need for evidence-based policies to safeguard affected persons at the family level. Close relatives stigmatizing their loved ones due to mental illnesses have contributed to the concealment of mental illness diagnoses within families, which often results in poor prognoses. Family members' understanding of mental illnesses is key in confronting the stigma associated with mental disorders in our communities, but this is contingent on continuous comprehensive familial program and education. Constant social support from community services and family members is essential in the recovery of persons with mental illnesses. This underscores the need for a stigma-free environment at all levels of society to ensure all-inclusiveness which calls for a comprehensive strategy that targets policy changes, public education, and media representations of mental health-related problems. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Mental illness stigma has been long acknowledged as a social problem that continues to persist and contribute to social exclusion of affected persons globally.Researchers have explored mental illness stigma in the general public and among health professionals, with little focus on stigma from family members and close relatives of persons with mental illnesses. What the paper adds to existing knowledge?: This study appears to be the first meta‐synthesis of familial mental illness stigma in high‐income countries.Family members or close relatives of persons with mental illnesses may be perpetrators of stigma. That is, the family may enact stigma of mental illness against their relative to "save face" or by avoiding or narrowing their social contacts.Familial stigma is harmful due to the likely disaffection it brings within one's home environment. Familial mental stigma from the existing literature seems to be a by‐product of public stigma and stigma by association What are the implications for practice?: Further research is necessary to look at the existence of familial mental illness stigma as well as available policies to reduce its impact on affected individuals in high‐income countries.Researchers in high‐income countries should endeavour to examine the relationship between familial, public and associative stigma to establish baseline metrics to inform future anti‐stigma programs seeking to reduce familial mental illness stigma. Introduction: Familial mental illness stigma is a pervasive issue but very subtle in high‐income countries. Familial mental illness stigma implies persons living with mental illnesses are discriminated against by their family members or close relatives. Aim/Question: This meta‐synthesis explored the experiences of familial stigma among individuals living with mental illnesses in high‐income countries, focusing on empirical literature, to understand the breadth of current literature and ways to reduce this form of stigma. Method: We conducted a meta‐synthesis through a structured search of qualitative data from six electronic databases (Sociological Abstract, CINAHL, Medline, PsycINFO, Google Scholar and Embase). Inclusion criteria comprised: empirical primary research, primary technique for data collection is qualitative, studies published in a peer‐reviewed journal in the English language between 2000 and 2020, studies reported on experiences of familial mental illness stigma, and studies conducted in high‐income countries. The exclusion criteria were as follows: all grey literature, studies not written in English and non‐peer‐reviewed, studies not focused on familial mental illness stigma, quantitative peer‐reviewed articles on the related concept and peer‐reviewed articles on the related topic before the year 2000. Results: The study identified only 28 peer‐reviewed articles on the topic within two decades. Concealment of familial stigma was found to be detrimental due to the potential for alienation within one's home environment. Disclosure and social contact within the family system were considered as critical interventions to provide some safety nets for individuals with mental illnesses. Discussion and implications for practice: The paucity of studies over the review period highlights the need for further attention to support optimal environments for persons living with mental illnesses. Families' understanding of the difficulties of mental illness stigma is vital to supporting the development of policies and interventions towards the avoidance of social exclusion within societies. Families should make concerted efforts to reduce stigma, and this includes within the family system. Education and training approaches around mental illness‐related stigma should involve individuals with lived experience and their families, as well as service providers and the general public. [ABSTRACT FROM AUTHOR]

Background: Youth mental health challenges are an emerging and persistent global public health issue despite efforts for improvement. As part of a broader social innovation study to transform youth mental health systems, this scoping review assesses interventions that aim for systems‐level changes to improve the mental well‐being of transitional age youth (TAY) (15–25 years) in high‐income countries. Methods: The scoping review method of Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) was used. Seven health and social service databases were utilized with study inclusion criteria applied. Titles and abstracts were screened by two independent reviewers, and four members of the research team were involved in the review and thematic analysis of selected studies. Results: A total of 5652 peer‐reviewed articles were screened at the title and abstract level, of which 65 were assessed in full for eligibility, and 29 were included for final analysis. The peer‐reviewed articles and gray literature were based in seven different high‐income countries and published between 2008 and 2019. Four major themes to support youth mental health were identified in the literature: (a) improving transitions from youth to adult mental healthcare services; (b) moving care from institutions to the community; (c) general empowerment of youth in society; and (d) youth voice within the system. Inconsistent or limited systems‐level approaches to TAY mental health care were noted. Conclusions: There remains a need for innovative, evidence‐based approaches to improve TAY mental health care. [ABSTRACT FROM AUTHOR]

Mixed methods research has become an important approach to research worldwide. The combination of qualitative and quantitative research methods has made it possible for a deeper and broader understanding of multifaceted phenomena, thereby offering readers more confidence in research findings and conclusions. The use of mixed method designs became more established in the 1980s and early 1990s, but some controversies surrounding the approach remain. Nonetheless, experts in the field of mixed methods research have continued to work on the central premise that the use of qualitative and quantitative approaches, in combination, provides a better understanding of research problems than either approach alone. This concept paper discusses some of the known controversies around mixed methods with the aim of providing useful insights to emerging researchers interested in learning the methodology. [ABSTRACT FROM AUTHOR]

We assessed the challenges facing 29 women in their quest for maternal health services in the Shai Osudoku District of Ghana. In-depth, semi-structured interviews with health professionals and focus-group discussions with women on uptake of maternal health services were conducted. Findings showed inadequate human resources and logistics for maternal health care and transportation problems. Women whose pregnancies required specialized care at district or regional hospitals deliberately reported late to the community clinics in an advanced stage of labor to avoid referrals. Findings have implications for health policymakers, implementers, and researchers. [ABSTRACT FROM AUTHOR]

People living with mental illnesses and their families may conceal their conditions to avoid prejudice and discrimination. Stigma often prevents people from receiving adequate health care and other social support services which could exacerbate social and health consequences such as unemployment, homelessness, substance use, and compulsory hospitalization. In this paper, we discuss social contact as a promising anti-stigma strategy for enhancing social interactions among people with mental illnesses, their families, and those without mental illnesses. In particularly, we consider next steps for an approach that works to reduce the stigma-related burden of mental illness. For social contact to be effective in reducing mental illness stigma, it requires broad social buy-in as well as implementation within care systems. Engagement with this approach can be driven through diverse contact-based education using collaborative efforts of society, academic institutions, policy-makers, health professionals, media, and governments. Ultimately, this work aims to consider the next steps in enacting social contact as an anti-stigma strategy through direct interventions and contact-based education. The success of this approach requires pragmatic public policies to support its implementation. [ABSTRACT FROM AUTHOR]

While stories are a central focus in narrative inquiry to examine phenomena, storytelling deconstruct values, assumptions, and beliefs to challenge taken-for-granted meanings. The objective of this paper is to examine storytelling from the perspective of knowledge paradigms, methodology, quality criteria, and reflexivity. By recognizing the elements of stories sociality, temporality, and place, the scope of a qualitative narrative study is framed where factors are expressed, shaped, and enacted. Considerations of these elements can be linked with the critical paradigm and self-reflexivity for representing and designing narrative inquiry grounded in a set of ontological and epistemological assumptions. A significant contribution of this paper is to address a methodological approach in the form of narrative inquiry to better understand the meaning of stories as rooted expressions of participants' lived experiences. The implications of this study are to bring critical lens to worldviews that would better inform policy. [ABSTRACT FROM AUTHOR]

Although research to date has shown that there can be no health or sustainable development without good mental health, mental illness continues to significantly impact societies. A major challenge confronting people with mental illnesses and their families is the stigma that they endure. In this study, empirical literature was reviewed to assess policies and interventions that seek to reduce familial mental illness stigma across four countries. We used Arksey and O'Malley methodological framework, and a qualitative content analysis was employed to augment the descriptive data extracted. Seven studies published between 2000 and 2020 were analyzed. We propose herein three themes that align with interventions to reduce familial mental illness stigma: transformative education, sharing and disclosure, and social networking and support. The findings indicate that persuasive and purposeful education directed at the public to correct misconceptions surrounding mental illness, with attention to language, may help in reducing familial mental illness stigma. Disclosure of mental illness is encouraged among persons with mental illnesses and their families as a strategy to enhance mutual understanding. Social sharing also affords persons with mental illnesses opportunities to engage with their peers at different levels within the public sphere. Apart from these recommendations, we have noted a paucity of broad governmental-level policies and interventions to comprehensively address the negative attitudes of families toward their relatives. Future work must address this gap to identify effective interventions to create healthier and supportive environments that address familial mental illness stigma. [ABSTRACT FROM AUTHOR]

The global impact of COVID-19 pandemic cannot be quantified due to the erratic spread of the virus worldwide. One area of concern that has not been highlighted is the effect of COVID-19 on international students and their families. Majority of these students are found in the developed world, contributing substantially to the economic growth of their host nations, but they have been excluded from various financial packages rolled-out by these host governments. Health challenges awaiting these students could be dire if nothing is done to ameliorate the hardships under the current circumstances. Future research should look at the psycho-socio-economic impacts of COVID-19 among international students. [ABSTRACT FROM AUTHOR]

The lack of health infrastructure in developing countries to provide women with modern obstetric care and universal access to maternal and child health services has largely contributed to the existing high maternal and infant deaths. Access to basic obstetric care for pregnant women and their unborn babies is a key to reducing maternal and infants´ deaths, especially at the community-level. This calls for the strengthening of primary health care systems in all developing countries, including Ghana. Financial access and utilization of maternal and child health care services need action at the community-level across rural Ghana to avoid preventable deaths. Financial access and usage of maternal and child health services in rural Ghana is poor. Lack of financial access is a strong barrier to the use of maternal and child health services, particularly in rural Ghana. The sustainability of the national health insurance scheme is vital in ensuring full access to care in remote communities. [ABSTRACT FROM AUTHOR]

The antimicrobial activity of 2-naphtholic and phenolic azo compounds was determined against seven microbial species, Staphylococcus aureus (ATCC 25923), Streptococcus pyrogenes (clinical), and Enterococcus faecalis (ATCC 29212), Salmonella typhi (clinical), Pseudomonas aeruginosa (ATCC 27853), Escherichia coli (ATCC 251922), and Candida albicans (ATCC 10231), using the high-throughput spot culture growth inhibition assay (HT-SPOTi). The minimum inhibitory concentrations (MIC) were determined for the active azo dyes. All the azo compounds (A1–B4) were screened for anthelmintic activity against adult Ghanaian earthworms, Hyperiodrilus spp. As part of the systematic investigation for biological activity, all the azo compounds exhibited good antimicrobial activity against the seven human pathogenic microorganisms. All the compounds exhibited anthelminthic activity against adult Ghanaian earthworms, Hyperiodrilus spp. [ABSTRACT FROM AUTHOR]

Institutionalization of people living with mental illness has evolved over the years, especially in the 19th and early 20th century. This has created over crowdedness in various psychiatric institutions, specifically in low and-middle-income countries, including Ghana. The objective of this study is to use Bronfenbrenner's Social-Ecological Model (1979) to propose a process for deinstitutionalizing psychiatric services in Ghana while supporting a transition to community-based mental health care. Using the concept of Bronfenbrenner's Social-Ecological Model, this article explores some benefits and difficulties with the concept of deinstitutionalization with regards to mental health care services in Ghana. Individuals living with mental illness will be more comfortable in various communities in Ghana where education on stigmatization and discrimination is heightened to subsequently prevent it. Education and intervention policies are required to intensify the campaign to win the support of all people in the community. Residents of Ghana should learn to say no to stigma and discrimination among people living with mental illness. [ABSTRACT FROM AUTHOR]

Background: Vasectomy is one of the safest and inexpensive modern contraceptive methods but it remains relatively 'invisible' in Ghana. Support of women may be a significant incentive in influencing their partners to adopt vasectomy. Objective: To examine the perspectives of women on vasectomy as a contraceptive option. Materials and Methods: A cross-sectional survey was conducted among 298 women accessing long-term or permanent family planning methods at health facilities in three selected districts in the Central Region of Ghana. Pearson's Chi-square was used to test associations between variables and the attitudes of women towards vasectomy. A p-value of less than 0.05 was considered to be statistically significant. Results: Awareness of vasectomy was low (32%). About 66% of the women who became aware of vasectomy during the study would prefer their partners to go for vasectomy compared with 50% of those who were aware prior to the study. Women who would either not prefer vasectomy or support their partner's choice of vasectomy cited fear of impotency (39.6%). There was a statistically significant association (p<0.05) between ethnicity, previous contraceptive use, awareness of male methods, and preference for vasectomy instead of bilateral tubal ligation (BTL). A statistically significant association (p<0.05) was also found between age of participant, duration of marriage, religious affiliation, and the willingness of women to support their partner's choice of vasectomy. Conclusion: There is, therefore, the need for the involvement of women in the promotion of vasectomy through vigorous publicity and education. [ABSTRACT FROM AUTHOR]

Background: Utilization of maternal health care services is key to reducing the number of perinatal deaths and post-natal complications in sub-Saharan Africa. With a few exceptions, many studies that examine the use of maternal health services in sub-Saharan Africa have focused largely on individual-level explanations and have ignored the importance of contextual and community-level explanations. In Ghana, progress has been made in reducing maternal mortality ratio from 740/100,000 in the late 1990s to 319/100,000 in 2015 but these rates are still high. Our study focuses on impact of individual and community level-factors on maternal outcomes with the hope that it will inform public policy in Ghana. This approach highlights latent or unacknowledged aspects of fragility within health systems designed to improve maternal health and opportunities for improving uptake of services. Methods and findings: Using the 2014 Ghana Demographic and Health Survey, we examined the effects of individual and community-level factors on antenatal care, facility-based delivery, and post-natal care. Multilevel logistic regression models were used to examine the effects of individual and community-level factors on the outcome variables. Our analysis revealed that overall utilization of antenatal, facility-based delivery and post-natal care was substantial across the board; however, both individual and community-level factors were significant predictors of these maternal health outcomes. Wealthier and better educated women were more likely to use antenatal services and facility-based delivery; in contrast poor and uneducated women were more likely to use antenatal and postnatal care but not facility-based delivery. Additionally, use of National Health Insurance Scheme was statistically associated with the utilization of maternal health services. Conclusions: The findings point to areas where services can be better tailored to meet community-specific needs. Policy makers must consider factors such as educational levels and economic security at both individual and community-levels that shape women’s preferences and uptake of maternal health care in Ghana. [ABSTRACT FROM AUTHOR]

The study is undertaken as a quality assurance exercise, to investigate the quality of milling plates available on the market by evaluating the metals released from them into food products in contact with them during comminution. Two locally manufactured and one imported milling plates were used in both dry and wet milling of maize samples collected from different geographical locations in the country (N = 12). Atomic Absorption Spectrometry and Instrumental Neutron Activation Analyser techniques were used to detect and quantify the metals present as contaminant in the flour samples over a seven-week period. While Na, Fe, Zn, Mn, Mg, Ca and Al were detected, As, Cd, Cu, Co, Pb and Ni were either absent or below detection limits. The concentrations of the metals were observed to decline with continuous use of milling plates, with Mg recording the highest of concentrations in each week and Mn, the vice versa. The results showed that the quality of the milling plates contributed to the levels of metals seen in the samples. In terms of the extent of contamination, the imported plate was deemed best of the three milling plates used whiles the two locally manufactured plates were comparable. Wet milling process was touted as better than dry milling in contributing to metal contamination of milled food products. Also, the maize samples collected from different places were shown to exhibit varying metal concentrations. The sample from Ejura-Sekyere Dumase was showed to be more contaminated than from other sources. When the flours were used to produce consumable foods, porridge and kenkey , the metal concentrations in them were comparable. The outcomes of the study show that education on sources of food contamination should be organized for stakeholders in the maize cultivation and processing industry and regulatory systems should also be strengthened to safeguard consumers' health. • AAS and INAA techniques used in the study produced comparable results for metals analysed. • Imported milling plate resulted in significantly lower levels of metal contamination than Local Plates 1 and 2. • Metal concentrations recorded initially were observed to decrease with time. • Maize samples collected from different geographical areas were shown to possess different levels of metal contamination, with Ejura-Sekyere Dumase recording the highest contaminations, followed by Begoro. • While wet milling process resulted in significantly lower levels of metal contamination to flours than dry milling, further processing to foods like porridge and kenkey did not contribute to the level of contamination. [ABSTRACT FROM AUTHOR]

Background: Social Health Insurance (SHI) is widely used by countries attempting to move toward Universal Health Coverage (UHC). While evidence suggests that SHI is a promising strategy for achieving UHC, low-income countries often struggle to implement and sustain SHI systems. It is therefore important to understand how SHI enrollees use health insurance and how it affects their health-seeking behavior. This paper examines how SHI affects patient decision-making regarding when and where to seek care in Kenya and Ghana, two countries with established SHI systems in sub-Saharan Africa.Methods: This paper draws from two datasets collected under the African Health Markets for Equity (AHME) program. One dataset, collected in 2013 and 2017 as part of the AHME qualitative evaluation, consists of 106 semi-structured clinic exit interviews conducted with patients in Ghana and Kenya. This data was analyzed using an inductive, thematic approach. The second dataset was collected internally by the AHME partner organizations. It derives from a cross-sectional survey of social franchise clients at three social franchise networks supported by AHME. Data collection took place from February - May 2018 and in December 2018.Results: Many clients appreciated that insurance coverage made healthcare more affordable, reported seeking care more frequently when covered with SHI. Clients also noted that the coverage gave them access to a wider variety of providers, but rarely sought out SHI-accredited providers specifically. However, clients sometimes were charged for services that should have been covered by insurance. Due to a lack of understanding of SHI benefits, clients rarely knew they had been charged inappropriately.Conclusions: Clients and providers would benefit from education on what is included in the SHI package. Providers should be monitored and held accountable for charging clients inappropriately; in Ghana this should be accompanied by reforms to make government financing for SHI sustainable. Since clients valued provider proximity and both Kenya and Ghana have a dearth of providers in rural areas, both countries should incentivize providers to work in these areas and prioritize accrediting rural facilities into SHI schemes to increase accessibility and reach. [ABSTRACT FROM AUTHOR]

Objective: To examine factors influencing contraceptive use among women living with HIV/AIDS.Methods: The present cross-sectional study included a randomly selected sample of sexually active females aged 15-60 years who were living with HIV/AIDS and receiving care at the HIV Clinic, Korle Bu Teaching Hospital, Accra, Ghana, between September 1 and November 31, 2016. Data were collected via a structured interviewer-administered questionnaire.Results: Among 202 women who completed the survey, 50 (24.7%) were using contraceptives. Of the women using contraception, 39 (78%) were married and 6 (12%) were cohabiting. Twenty-eight (56%) reported that their primary sexual partners were HIV-positive, 14 (28%) had HIV-negative partners, and 8 (16%) did not know their partner's HIV status. Condoms were used by 42 (84%) women and the majority (41 [82%]) wanted to have more children; almost all (47 [94%]) had received counseling on contraceptive use. Overall, 133 (65.8%) and 45 (22.3%) women reported that they would prefer to share their family planning concerns with a doctor and nurse, respectively, at the HIV clinic.Conclusion: Women living with HIV/AIDS desired more children but preferred to share their family planning concerns with their clinician at the HIV clinic. Integrating HIV care and reproductive health services could help these women achieve childbearing goals safely. [ABSTRACT FROM AUTHOR]

Background: Hepatitis E virus is an emerging infection in Africa with poor maternal and foetal outcomes. There is scanty data on the sero-prevalence of HEV infection among pregnant women in Ghana. This study highlighted the prevalence and risk factors associated with HEV infection among pregnant women in Cape Coast Metropolis, Central Region of Ghana. Methods: A multicenter (3 selected sites) analytical cross sectional study involving 398 pregnant women in the Cape Coast metropolis was conducted. HEV (Anti-HEV IgG and Anti-HEV IgM) ELISA was performed. Sero-positive women had liver chemistries done and data collected on maternal and neonatal outcomes. Data analyses were performed using Stata version 13 software (STATA Corp, Texas USA). Results: Mean age was 28.01 (± 5.93) years. HEV sero-prevalence was 12.2% (n = 48) for IgG and 0.2% (n = 1) for IgM with overall of 12.3%. The odds of being HEV sero-positive for women aged 26–35 years was 3.1 (95% CI: 1.1–8.1), p = 0.02 and ≥36 years it was 10.7 (95% CI; 3.4–33.5), p = 0.0001. Living in urban settlement was associated with lowest odds of HEV infection {OR 0.4 (95% CI; 0.2–0.8), p = 0.01}. Factors with no statistical evidence of association include main source of drinking water and history of blood transfusion. The sero-prevalence of HEV IgG increased progressively across trimesters with the highest among women in their third trimester (55.3%). None of the 49 HEV sero-positive women had elevated ALT level. Ten (N = 41) of the neonates born to sero-positive women developed jaundice in the neonatal period. The mean birth weight was 3.1kg (SD 0.4). Conclusion: HEV sero-prevalence among pregnant women in the Cape Coast Metropolis is high enough to deserve more attention than it has received so far. It is therefore important to conduct further research on the potential impact on maternal and neonatal mortality and morbidity in Ghana. [ABSTRACT FROM AUTHOR]

A library of six compounds with new hybrids in a single molecule triazole ring attached to the phosphonium salts was synthesized. Click chemistry was, however, used to synthesize the 1-, 2-, and 3-triazole intermediates as a tether for the hybrid phosphonium salts. Their antibacterial activity against Gram-positive bacteria (Staphylococcus aureus and Enterococcus faecalis), Gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa), and Mycobacterium smegmatis mc2155 was determined using the HT-SPOTi assay. Compound 2 showed the most effective antimicrobial activity as it inhibited the growth of Pseudomonas aeruginosa and Staphylococcus aureus at 0.0125 µg/mL and 31.25 µg/mL, respectively. From the FICI data, compounds 2ET-TOL (2) and RABYL-TOL (4) successfully modulated the activities of amoxicillin against Pseudomonas aeruginosa and Staphylococcus aureus. All the test compounds exhibited a concentration-dependent biofilm formation inhibition against S. aureus, except P-Z (compound 6). Compounds P-MEOXY (1) and 2ET-TOL (2) exhibited mild activity against P. aeruginosa with compound 4 showing antimycobacterial activity at 500 µg/mL. [ABSTRACT FROM AUTHOR]

An accurate and rapid reverse HPLC method has been developed and validated for the simultaneous quantification of lamivudine, nevirapine, and tenofovir disoproxil fumarate. Suitable separation was achieved on Phenomenex Synergi C18 (250 × 4.6 mm, 4 μm) using mobile phase, methanol (50%): ammonium acetate buffer (adjusted to pH 2.80) (40%): acetonitrile (10%) in an isocratic mode. The drugs were detected at 270 nm with a flow rate of 1.0 ml/min, and the retention times were found to be 3.26, 5.42, and 7.55 minutes for lamivudine, nevirapine, and tenofovir disoproxil fumarate, respectively. The developed method was validated per ICH guidelines. Good linearity was obtained within the concentration ranges of 10–59 µg/ml, 7–42 µg/ml, and 15–90 µg/ml with a correlation coefficient of not less than 0.990. The % RSD values for precision (intraday and interday) and accuracy studies were found to be less than 2%. The results obtained from quantitative analysis conform to USP content requirements for marketed tablet dosage forms, RICOVIR-LN, and tenofovir disoproxil fumarate/lamivudine tablets. The method is therefore useful for routine quality control of antiretroviral tablet dosage forms containing tenofovir disoproxil fumarate, lamivudine, and nevirapine. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via the original article. [ABSTRACT FROM AUTHOR]

Neonatal mortality is a significant problem in many low-resource countries, yet for every death there are many more newborns who suffer a life-threatening complication but survive. These “near-misses” are not well defined, nor are they well understood. This study sought to explore how health care providers at three tertiary care centers in Ghana (each with neonatal intensive care units (NICUs)) understand the term “near-miss.” Eighteen providers from the NICUs at three teaching hospitals in Ghana (Korle Bu Teaching Hospital in Accra, Komfo Anokye Teaching Hospital in Kumasi, and Cape Coast Teaching Hospital in Cape Coast) were interviewed in depth regarding their perceptions of neonatal morbidity, mortality, and survival. Near the end of the interview, they were specifically asked what they understood the term “near-miss” to mean. Participants included nurses and physicians at various levels and with varying years of practice (mean years of practice = 9.33, mean years in NICU = 3.66). Results indicate that the concept of “near-misses” is not universally understood, and providers differ on whether a baby is a near-miss or not. Providers disagreed on the utility of a near-miss classification for clinical practice, with some suggesting it would be helpful to draw their attention to those at highest risk of dying, with others suggesting that the acuity of illness in a NICU means any baby could become a ‘near-miss’ at any moment. Further efforts are needed to standardize the definitions of neonatal near-misses, including developing criteria that are able to be assessed in a low-resource setting. In addition, further research is warranted to determine the practical implications of using a near miss tool in the process of providing care in a resource-limited setting and whether it might be best reserved as a retrospective indicator of overall quality of care provided. [ABSTRACT FROM AUTHOR]

This paper provides an empirical assessment of the driving forces behind structural transformation in sub-Saharan Africa, and to further access the role of structural reforms in accounting for cross-country differences in transformation. Evidence from this paper reveals that country specific fundamentals, institutions and policy reforms as well as governance and fiscal reforms are the key drivers of transformation in the region. A set of policy strategies is proposed to engender sustained transformation and development in the region. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma is rarely associated with pregnancy and when it does there is poor prognosis for both the mother and the baby. There is paucity of evidence for best practice in hepatocellular carcinoma in pregnancy especially in the background of cirrhosis and decompensation. We present a 36 year old gravida 5 para 4 at 27 weeks gestation with hepatocellular carcinoma and main complaint of abdominal pain. She had chronic hepatitis B infection with hepatocellular carcinoma on a cirrhotic background. There were both clinical and laboratory features suggestive of liver decompensation. The pregnancy outcome was a fresh stillbirth with mother alive. This case report highlights the management dilemma of hepatocellular carcinoma in pregnancy on the background of decompensated liver cirrhosis and chronic hepatitis B infection. [ABSTRACT FROM AUTHOR]