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Abstract Background Ghana introduced a free maternal healthcare policy within its National Health Insurance Scheme (NHIS) in 2008 to remove financial barriers to accessing maternal health services. Despite this policy, evidence suggests that women incur substantial out-of-pocket (OOP) payments for maternal health care. This study explores the underlying reasons for these persistent out-of-pocket payments within the context of Ghana’s free maternal healthcare policy. Methods Cross-sectional qualitative data were collected through interviews with a purposive sample of 14 mothers and 8 healthcare providers/administrators in two regions of Ghana between May and September 2022. All interviews were audio-recorded, transcribed and imported into the NVivo 14.0 software for analysis. An iteratively developed codebook guided the coding process. Our thematic data analysis followed the Attride-Sterling framework for network analysis, identifying basic, organising themes and global themes. Results We found that health systems and demand-side factors are responsible for the persistence of OOP payments despite the existence of the free maternal healthcare policy in Ghana. Reasons for these payments arose from health systems factors, particularly, NHIS structural issues – delayed and insufficient reimbursements, inadequate NHIS benefit coverage, stockouts and supply chain challenges and demand-side factors – mothers’ lack of education about the NHIS benefit package, and passing of cost onto patients. Due to structural and system level challenges, healthcare providers, exercising their street-level bureaucratic power, have partly repackaged the policy, enabling the persistence of out-of-pocket payments for maternal healthcare. Conclusions Urgent measures are required to address the structural and administrative issues confronting Ghana’s free maternal health policy; otherwise, Ghana may not achieve the sustainable development goals targets on maternal and child health.

Abstract Background There is a close link between the lack of electricity access and poverty indicators such as illiteracy, high infant mortality, lack of access to health care and malnutrition among others. Most rural farming communities in Ghana lack access to electricity due to the high cost of extending the grid to these communities. This lack of access tends to worsen the gap between urban and rural inhabitants regarding access to education, healthcare and development. Methods This study assessed the technical and theoretical potential of agricultural residues in providing electricity to off-grid communities. The study used crop production figures of maize, cassava, millet and groundnut in the Soma and Goyiri farming communities in the Sawla-Tuna-Kalba District to conduct an assessment of the theoretical and technical potential of residues from the crops. The production figures of these crops were obtained from the District Office of the Ministry of Food and Agriculture. Expected electricity demand of households, schools and health centers in the study communities were collected and employed for the projected load demand estimates. Results The study found that 312.23 MWh/day of electricity could be generated from the combined residues of maize, cassava, millet and groundnut from the two communities. This amount of electricity is capable of providing ~ 202 to 263 times the peak electricity demand of the studied communities. Out of the total electricity demand of the two communities, only about 91 kWh/day is needed for use in a school and Community Health Promotion and Services (CHPS) compound, implying that the electricity from crop residues can also help to improve education and health provision in the rural communities. Conclusion It is concluded that the potential of crop residues in meeting the electricity demand of off-grid communities is enormous. Hence, it must be considered in Ghana’s energy development plans to achieve universal electricity access.

Abstract Objective The immunisation programme in Zambia remains one of the most effective public health programmes. Its financial sustainability is, however, uncertain. Using administrative data on immunisation coverage rate, vaccine utilisation, the number of health facilities and human resources, expenditure on health promotion, and the provision of outreach services from 24 districts, we used Data Envelopment Analysis to determine the level of technical efficiency in the provision of immunisation services. Based on our calculated levels of technical efficiency, we determined the available fiscal space for immunisation. Results Out of the 24 districts in our sample, 9 (38%) were technically inefficient in the provision of immunisation services. The average efficiency score, however, was quite high, at 0.92 (CRS technology) and 0.95 (VRS technology). Based on the calculated level of technical efficiency, we estimated that an improvement in technical efficiency can save enough vaccine doses to supply between 5 and 14 additional districts. The challenge, however, lies in identifying and correcting for the sources of technical inefficiency.

Introduction Perinatal mortality is a major public health issue in sub-Saharan Africa, with Ghana experiencing consistently high rates. This poses challenges for achieving the maternal and child health-related sustainability development goals by 2030. While some studies have explored factors behind perinatal mortality in Ghana, a comprehensive analysis considering multifactorial predictors remains absent. This scoping review, guided by Anderson’s framework of healthcare utilisation, aims to address this. The primary objective is to map the predictors of perinatal mortality in Ghana using Anderson’s framework. It aims to identify interpersonal, social structural and health beliefs as predisposing factors; evaluate access to healthcare, social support and health literacy as enabling factors; and outline maternal and foetal conditions as need factors, concluding with identified knowledge gaps.Methods and analysis The Cochrane handbook for systematic reviews of interventions will be used to guide the conduct of this review. Four main electronic databases, PubMed, Web of Science, Scopus and Cumulative Index for Nursing and Allied Health Literature, will be searched. Eligible studies will be charted and synthesised, focussing on Anderson’s primary domains: predisposing factors, enabling factors and need factors. Studies published in the English language from January 2000 to June 2024 will be included in the study to cover the most recent factors associated with perinatal mortality in Ghana.Ethics and dissemination This review will rely on already published peer-reviewed articles and therefore will not require ethical approval. The review results will be disseminated through peer-reviewed scientific publications and annual health services review conferences in Ghana.PROSPERO registration number CRD42024564968.

Obesity, a global issue, is linked to cardiometabolic syndrome. Dietary modification is one of the recommended modes for managing cardiometabolic syndrome. Strawberries, a functional food, and kombucha, a fermented tea beverage, have gained attention for their health benefits. This study investigated the bioactive components of strawberry kombucha drink (SKD) and their effects on antioxidant activities and improving metabolic disorder markers. An in vitro experiment was performed to determine the effect of SKD on enzymatic parameters: lipase, α-glucosidase, and α-amylase activities. In addition, antioxidant activity using the DPPH method and quantification of the radical scavenging activity were also measured. Furthermore, untargeted metabolomic profiling of SKD and molecular docking simulation were conducted. The findings suggest that SKD, rich in secondary metabolites, can inhibit lipase, α-glucosidase, and α-amylase activities. It demonstrated in vitro anti-obesity, anti-diabetic, and antioxidant properties, potentially reducing metabolic and inflammatory issues. Thus, SKD could be a therapeutic beverage to alter metabolic issues associated with obesity. Nevertheless, further preclinical study is warranted to determine SKD’s potential in vivo.

Abstract Background Human papillomavirus (HPV) is a common sexually transmitted infection and the leading cause of cervical cancer. The HPV vaccine is a safe and effective way to prevent HPV infection. In Zambia, the vaccine is given during Child Health Week to girls aged 14 years who are in and out of school in two doses over two years. The focus of this evaluation was to establish the cost to administer a single dose of the vaccine as well as for full immunisation of two doses. Methods This work was part of a broader study on assessing HPV programme implementation in Zambia. For HPV costing aspect of the study, with a healthcare provider perspective and reference year of 2020, both top-down and micro-costing approaches were used for financial costing, depending on the cost data source, and economic costs were gathered as secondary data from Expanded Programme for Immunisation Costing and Financing Project (EPIC), except human resource costs which were gathered as primary data using existing Ministry of Health salary scales and reported time spent by different health cadres on activities related to HPV vaccination. Data was collected from eight districts in four provinces, mainly using a structured questionnaire, document reviews and key informant interviews with staff at national, provincial, district and health facility levels. Administrative coverage rates were obtained for each district. Results Findings show that schools made up 53.3% of vaccination sites, community outreach sites 30.9% and finally health facilities 15.8%. In terms of coverage for 2020, for the eight districts sampled, schools had the highest coverage at 96.0%. Community outreach sites were at 6.0% of the coverage and health facilities accounted for only 1.0% of the coverage. School based delivery had the lowest economic cost at USD13.2 per dose and USD 28.1 per fully immunised child (FIC). Overall financial costs for school based delivery were US$6.0 per dose and US$12.4 per FIC. Overall economic costs taking all delivery models into account were US$23.0 per dose and US$47.6 per FIC. The main financial cost drivers were microplanning, supplies, service delivery/outreach and vaccine co-financing; while the main economic cost drivers were human resources, building overhead and vehicles. Nurses, environmental health technicians and community-based volunteers spent the most time on HPV related vaccination activities compared to other cadres and represented the greatest human resource costs. Conclusions The financial cost of HPV vaccination in Zambia aligns favourably with similar studies conducted in other countries. However, the economic costs appear significantly higher than those observed in most international studies. This discrepancy underscores the substantial strain placed on healthcare resources by the program, a burden that often remains obscured. While the vaccine costs are currently subsidized through the generous support of Gavi, the Vaccine Alliance, it’s crucial to recognize that these expenses pose a considerable threat to long-term sustainability. Consequently, countries such as Zambia must proactively devise strategies to address this challenge.

Green entrepreneurial orientation (GEO) and green supply chain management (GSCM) have emerged as important strategic tools for environmental management. Integrating the sustainability capabilities of GEO with GSCM practices, such as green purchasing and green supply chain integration, is crucial for optimizing both environmental and commercial outcomes. Yet, how the interface of GEO and GSCM drives corporate environmental and financial performances remains underexplored. We draw on the Natural/Resource Based View to argue that the environmental and financial performance consequences of GEO may be channelled through green purchasing under varying conditions of green supplier and customer integration. We test our model using survey data from 225 SMEs in a sub-Saharan African country. We find a direct positive effect of GEO on the environmental but not on financial performance. Further results reveal that the environmental and financial performance benefits of GEO are more salient when channelled through green purchasing, particularly under greater levels of green supplier and customer integration. The theoretical and practical implications are discussed.

In Ghana, firewood and charcoal are converted to heat energy traditionally by devices that are inefficient and unsustainable. The use of these devices have devastating consequences on the climate and human health. This study designed, produced and evaluated a multi-feed biomass gasifier stove (MFGS) which relies on multiple types of biomass such as agricultural, industrial and forest waste as feedstock. The prototype of the MFGS was evaluated in the laboratory and the field to establish its level of efficiency and cleanliness. The MFGS recorded a maximum thermal efficiency and minimum CO emission of 35.8% and 0.23 g/min as compared to 30.0% and 2.32 g/min, respectively, recorded by the best Ghanaian traditional biomass stove (Gyapa). The total global warming impact recorded by the MFGS represent up to reduction of 99% of that of Gyapa making it a tool for fighting global warming and reducing the health risk of users of wood fuel in Ghana.

AbstractTo foster maize productivity and advance agricultural development, the Government of Ghana (GoG) has enacted several flagship programmes as a response to the pressing need to improve the sector. Planting for food and jobs (PFJ) is one such programme. This study investigates the impact of PFJ participation on maize productivity and income amongst maize farmers in northern Ghana. The study sampled 384 maize farmers. Cross-sectional data were collected and analysed using the probit model, propensity score matching, and Dolby robust estimator. The estimation shows that PFJ participation had a positive effect on maize productivity and farmers’ income. It was also observed that PFJ participation was influenced by gender, farming experience, education, access to credit, cooperative membership, and farm distance. Limited fertilizer access and restricted market access were the major challenges that militated against PFJ programme participation. Thus, Government of Ghana (GoG), through the Ministry of Food and Agriculture (MoFA), prioritised the provision of subsidised fertiliser to farmers who would otherwise struggle to purchase enough fertiliser to increase productivity and income. This could greatly reduce the impact of the crowding out phenomenon on the PFJ programme.

Restoring degraded forests has become a global concern due to the high levels of forest disturbance arising from farming, logging, and mining. This study, conducted in the degraded Tain II Forest Reserve landscape in Ghana, examined the effects of forest landscape restoration (FLR) on land cover changes and woody plant community structure in the area. The study combined remote sensing, plot sampling techniques, and structured interviews in data collection. Landsat images were used to establish the land cover changes in the landscape. Plant community structure was assessed within thirty 50 m by 50 m plots that were laid randomly in equal numbers in Natural Forest (NF), Natural Regeneration (NR), and Assisted Regeneration (AR) sites. Ecosystem services and socio-economic benefits of the FLR to the local community were also assessed. To compare site attributes, one-way ANOVA analysis was used. The results showed that forestland increased from 45 to 70 % while bare land and cropland declined consistently from over 50 % to 28 % and 5 % to 0.7 %, respectively, within 10-year study period. Woody plant species totaling 120 belonging to 34 families, compared to a baseline of 61 species and 24 families, were enumerated. The NF and NR sites had higher flora diversity than the AR sites. NF composition was less homogenous compared to the NR and AR. The majority of the community is perceived to have socioeconomically gained from ecosystem services and engagement in the FLR. Effective land governance, stakeholder participation, community-led fire control, and strategic interventions positively influenced the rate of forest restoration. The FLR influenced the land cover and species composition of the landscape. The findings highlight the importance of ecological, social, and economic considerations in FLR for sustainable outcomes for people and the environment. FLR stakeholders should collaborate in planning and implementation of forest restoration to ensure sustainable outcomes.

The objective of this work was to ascertain the nutritive value of six concentrate feedstuffs commonly used in guinea pig feed manufacturing through the substitution method. Six test diets were obtained by replacing the corresponding basal mixture with 40% corn, 50% barley, 45% wheat bran, 35% soybean meal, 30% pigeon pea, or 30% Leucaena leaf meal. Sixty-three guinea pigs were randomly assigned to one of the nine experimental diets (three basal diets and six test diets, with seven animals per diet). The animals were housed in individual cages and provided with feed and water ad libitum. Following a ten-day adaptation period, the feed intake and faeces excretion were monitored for a further five days. The digestible energy content, expressed as kcal/kg dry matter (±standard error), was 3857 ± 83 for corn, 3454 ± 68 for barley, 2911 ± 110 for wheat bran, 3855 ± 81 for soybean meal, 3105 ± 79 for pigeon pea, and 2972 ± 72 for Leucaena leaf meal. The apparent total tract digestibility of crude protein, expressed as % (±standard error) was 73.8 ± 4.9 for corn, 69.5 ± 4.6 for barley, 76.4 ± 3.6 for wheat bran, 88.4 ± 1.0 for soybean meal, 62.1 ± 1.9 for pigeon pea, and 68.0 ± 1.8 for Leucaena leaf meal. Further research is required to increase knowledge about these and other feedstuffs for guinea pigs.

Objectives To examine family planning through the community’s perception, belief system and cultural impact; in addition to identifying the determining factors for family planning uptake.Design A descriptive exploratory study.Setting Three communities were selected from three local government areas, each in the three senatorial districts in Ekiti State.Participants The study was conducted among young unmarried women in the reproductive age group who were sexually active as well as married men and women in the reproductive age group who are currently living with their partners and were sexually active.Main outcome measures Eight focus group discussions were conducted in the community in 2019 with 28 male and 50 female participants. The audio recordings were transcribed, triangulated with notes and analysed using QSR NVivo V.8 software. Community perception, beliefs and perceptions of the utility of family planning, as well as cultural, religious and other factors determining family planning uptake were analysed.Results The majority of the participants had the perception that family planning helps married couple only. There were diverse beliefs about family planning and mixed reactions with respect to the impact of culture and religion on family planning uptake. Furthermore, a number of factors were identified in determining family planning uptake—intrapersonal, interpersonal and health system factors.Conclusion The study concluded that there are varied reactions to family planning uptake due to varied perception, cultural and religious beliefs and determining factors. It was recommended that more targeted male partner engagement in campaign would boost family planning uptake.

Abstract Biodiversity loss is extreme in amphibians. Despite ongoing conservation action, it is difficult to determine where we stand in overcoming their extinction crisis. Among the most threatened amphibians are the 131 Neotropical harlequin toads. Many of them declined since the 1980s with several considered possibly extinct. Recently, more than 30 species have been rediscovered, raising hope for a reversing trend in the amphibian extinction crisis. We use past and present data available for harlequin toads (Atelopus), to examine whether the amphibian extinction crisis is still in an emergency state. Since 2004 no species has improved its population status, suggesting that recovery efforts have not been successful. Threats include habitat change, pathogen spread and climate change. More mitigation strategies need implementation, especially habitat protection and disease management, combined with captive conservation breeding. With harlequin toads serving as a model, it is clear that the amphibian extinction crisis is still underway.

Challenges related to sustainability, energy access, process efficiency, and cost of production in the extraction of palm oil make its energy analysis necessary in Ghana. This study determined the energy consumption patterns in palm oil mills in Ghana to ultimately enhance system efficiency and assess optimum production costs. In this study, data was collected among Palm Oil Processing facilities in Bono, Ashanti, Eastern and Western regions. The results found the average total energy consumption for the manual, semi-mechanised and highly mechanised extraction systems to be 122.5, 112.9, and 82.4 kJ/kg respectively. The net potential electricity from oil palm residue was estimated to be 299 kJ/kg which can be used for other operations. The mean total energy for the oil drying and pressing stages are identical across the systems. The minimum mean total energy is required at the threshing stage of the oil palm production process with which the manual system has the highest amount of energy whilst, the highly mechanized system requires the least average total energy for threshing. Policy makers should target increased level of mechanization since highly mechanized processing plants recorded lower energy demands.

Abstract Cassava (Manihot esculenta Crantz) is an essential stable food crop in Sub-Saharan Africa commonly consumed amongst the low-income communities in Africa. Though cassava roots and leaf have vast economic and commercial benefits, it produces cyanogenic glycosides, which are toxic and most often responsible for the bitter taste of some cassava cultivars. The study evaluates the cassava roots and leaves’ cyanogenic potential and dry matter content of the Genetic Gain Assessment trial grown in a different environment. It establishes the association between the cyanogenic potential (CNP) and the roots and leaves dry matter (DM). Genetic Gain Assessment (GGA) cassava genotypes (N = 400) selected for the Uniform Yield Trial (UYT) breeding stage were planted under IVS (Dry season in Inland Valley Hydromorphic area) and Upland (rain-fed conditions) in two locations of IITA Research Farms, namely; Ibadan (IVS and Upland) and Mokwa (Upland) in Nigeria. The CNP content of cassava leaves in IVS, Mokwa, and Upland ranged from 3.39 to 272.16 mg/100 g, 4.28 to 228.72 mg/100 g, and 13.13 to 127.39 mg/100 g, respectively. However, the respective CNP range in root samples across IVS, Mokwa, and Upland was 0.76–76.31 mg/100 g, 0.94–136.53 mg/100 g, and 2.37–47.11 mg/100 g. Also, the mean ± SD of DM content of leaves were 27.97 ± 3.01%, 28.81 ± 4.01%, and 13.65 ± 3.69%, respectively, in IVS, Mokwa, and Upland, while the root samples had mean ± SD of DM content of 38.09 ± 4.80%, 32.69 ± ,5.93% and 24.63 ± 5.07% respectively. Furthermore, location and genotype had a highly significant effect (p

BackgroundCommunity pharmacies are the first point of contact for most people seeking treatment for minor illnesses globally. In recent years, the role of community pharmacists has evolved, and they play a significant role in the delivery of public health interventions (PHIs) aimed at health promotion and prevention such as smoking cessation services, weight management services, HIV prevention, and vaccination. This review aims to explore the evidence on the factors that influence community pharmacists to take up the role of delivery of such interventions.MethodsThree electronic databases namely, Embase (1947-December 2023), Medline (1975-December 2023), and Scopus (1823-December 2023) were searched for relevant literature from the inception of the database to December 2023. Reference lists of included articles were also searched for relevant articles. A total of 22 articles were included in the review based on our inclusion and exclusion criteria. The data were analyzed and synthesized using a thematic approach to identify the factors that influence the community pharmacist's decision to take up the role of PHI delivery. Reporting of the findings was done according to the PRISMA checklist.FindingsThe search identified 10,927 articles of which 22 were included in the review. The main factors that drive the delivery of PHIs by community pharmacists were identified as; training and continuous education, remuneration and collaboration with other healthcare professionals. Other factors included structural and workflow adjustments and support from the government and regulatory bodies.ConclusionsEvidence from this review indicates that the decision to expand the scope of practice of community pharmacists is influenced by various factors. Incorporating these factors into the design of policies and public health programs is critical for the successful integration of community pharmacists in the delivery of broader public health to meet the rising demand for health care across health systems.

Capitation as a provider payment mechanism gained policy attention by the Ghana National Health Insurance Scheme (NHIS) in 2012 and was piloted in the Ashanti Region, Ghana. Recent studies revealed that the policy was suspended in 2017 due to inappropriate policy framing, actor contestations, unclear policy design characteristics, and an unfavorable political context. However, the NHIS still has interest in capitation as a provider payment option. Using the modified political process model, a prospective policy analysis was conducted to explore how to: i) appropriately reframe policy debates; ii) create political opportunities; and iii) mobilize resources to reattract policy attention to capitation in Ghana. Cross-sectional qualitative data were gathered in December, 2019 from semi-structured interviews with a purposive sample of 18 stakeholders and complemented with four community-level focus group discussions with 41 policy beneficiaries in the pilot region. All data were tape-recorded and transcribed. The analysis was thematic, using the NVivo 12 software. The results revealed that an appropriate reframing of the policy requires policy renaming, refinement of certain policy design characteristics (emergency care, capitation rates, choice and assignment of providers) and refocusing policy communication and advocacy on the health benefits of capitation instead of its cost containment intent. To create political opportunities for policy re-implementation, a politically sensitive approach with broader stakeholder consultations should be adopted. Policy advocacy and communication should be evidenced-based and led by politically neutral agents. An equitable capitation policy implementation requires resourcing health facilities, especially the lower-level facilities, with improved infrastructure, consumables, improved information management systems and well-trained personnel to enhance their service delivery capacities. The study concludes that there exists stakeholder interest in the capitation policy in Ghana and calls for an effective reframing, creation of political opportunities, and mobilization of needed resources to regain policy attention.

Recently, the usage of zebrafish for pain studies has increased in the past years, especially due to its robust pain-stimulated behaviors. Fin amputation has been demonstrated to induce a noxious response in zebrafish. However, based on the prior study, although lidocaine, the most used painkiller in zebrafish, has been shown to ameliorate amputated zebrafish behaviors, it still causes some prolonged effects. Therefore, alternative painkillers are always needed to improve the treatment quality of fin-amputated zebrafish. Here, the effects of several analgesics in recovering zebrafish behaviors post-fin amputation were evaluated. From the results, five painkillers were found to have potentially beneficial effects on amputated fish behaviors. Overall, these results aligned with their binding energy level to target proteins of COX-1 and COX-2. Later, based on their sub-chronic effects on zebrafish survivability, indomethacin, and diclofenac were further studied. This combination showed a prominent effect in recovering zebrafish behaviors when administered orally or through waterborne exposure, even with lower concentrations. Next, based on the ELISA in zebrafish brain tissue, although some changes were found in the treated group, no statistical differences were observed in most of the tested biomarkers. However, since heatmap clustering showed a similar pattern between biochemical and behavior endpoints, the minor changes in each biomarker may be sufficient in changing the fish behaviors.

Based on recent interest and on the importance of the ongoing climate change catastrophe, this article provides the basics of global carbon cycle modelling as required for the assessment of the degree of carbon neutrality of biomass energy, and its underlying dynamics. It is aimed at clarifying the question “Are biomass fuels carbon neutral?”. The “Combined Energy and Biosphere Model” (CEBM) computes annual carbon flows including growth and decay of plants on 2.5 × 2.5° grid elements of the continents’ surface and offers detailed results on the changes of after implementation of large-scale biomass energy strategies worldwide. The main (and possibly unexpected) effect is the long-term depletion of the soil organic compartment after extraction of biomass fuels. When comparing CEBM model runs using (i) biomass energy sources and (ii) carbon-free energy sources (such as solar or wind), it becomes quantitatively clear already on the theoretical level (i.e., even without taking into account efficiency losses) that biomass is only “half as carbon neutral” as ideally assumed, to express a rule of thumb—mainly because of soil carbon depletion. Still, biomass energy will play an important role when fighting global warming, even if efforts to lower energy demand are preferable as a fundamental strategy.

Abstract Background Community participation is essential for the successful implementation of primary health care programmes across the globe, including sub-Saharan Africa. The Community-based Health Planning and Services (CHPS) programme is one of the primary health care interventions in Ghana which by design and implementation heavily relies on community participation. However, there is little evidence to establish the factors enabling or inhibiting community participation in the Ghanaian CHPS programme. This study, therefore, explored the enabling and inhibiting factors influencing community participation in the design and implementation of the CHPS programme in the Builsa North Municipality in the Upper East Region of Ghana. Methods A qualitative approach, using a cross-sectional design, was employed to allow for a detailed in-depth exploration of the enabling and inhibiting factors influencing community participation in the design and implementation of the CHPS programme. The data were collected in January 2020, through key informant interviews with a stratified purposive sample of 106 respondents, selected from the 15 functional CHPS facilities in the Municipality. The data were audio-recorded, transcribed and manually analysed using thematic analysis. Results The results showed that, public education on the CHPS concept, capacity of the community to contribute material resources towards the construction of CHPS facilities, strong and effective community leadership provided by community chiefs and assembly persons, the spirit of volunteerism and trust in the benefits of the CHPS programme were the enablers of community participation in the programme. However, volunteer attrition, competing economic activities, lack of sense of ownership by distant beneficiaries, external contracting of the construction of CHPS facilities and illiteracy constituted the inhibiting factors of community participation in the programme. Conclusion Extensive public education, volunteer incentivization and motivation, and the empowerment of communities to construct their own CHPS compounds are issues that require immediate policy attention to enhance effective community participation in the programme.

Abstract Background Epidemiology of febrile illness in Uganda is shifting due to increased HIV treatment access, emerging viruses, and increased surveillance. We investigated the aetiology and outcomes of acute febrile illness in adults presenting to hospital using a standardized testing algorithm of available assays in at Arua and Mubende tertiary care hospitals in Uganda. Methods We recruited adults with a ≥ 38.0 °C temperature or history of fever within 48 h of presentation from August 2019 to August 2020. Medical history, demographics, and vital signs were recorded. Testing performed included a complete blood count, renal and liver function, malaria smears, blood culture, and human immunodeficiency virus (HIV). When HIV positive, testing included cryptococcal antigen, CD4 count, and urine lateral flow lipoarabinomannan assay for tuberculosis. Participants were followed during hospitalization and at a 1-month visit. A Cox proportional hazard regression was performed to evaluate for baseline clinical features and risk of death. Results Of 132 participants, the median age was 33.5 years (IQR 24 to 46) and 58.3% (n = 77) were female. Overall, 73 (55.3%) of 132 had a positive microbiologic result. Among those living with HIV, 31 (68.9%) of 45 had at least one positive assay; 16 (35.6%) had malaria, 14 (31.1%) tuberculosis, and 4 (8.9%) cryptococcal antigenemia. The majority (65.9%) were HIV-negative; 42 (48.3%) of 87 had at least one diagnostic assay positive; 24 (27.6%) had positive malaria smears and 1 was Xpert MTB/RIF Ultra positive. Overall, 16 (12.1%) of 132 died; 9 (56.3%) of 16 were HIV-negative, 6 died after discharge. High respiratory rate (≥ 22 breaths per minute) (hazard ratio [HR] 8.05; 95% CI 1.81 to 35.69) and low (i.e.,

The importance of parameters such as material type, compacting pressure, particle size, and their interactions in the manufacturing of charred briquette fuel for industrial and domestic use cannot be overemphasized because they have a considerable impact on briquette performance. In investigating the aforementioned phenomena, the Box–Behnken​ Response Surface Design and ANOVA were used to analyze how briquette material type, particle size, compacting pressure and their interactions significantly influence the mechanical and combustion properties of charred briquettes made from palm kernel shells, corn cobs, sawdust, and rice husk. All three factors namely material type, compacting pressure and particle size, with all possible interactions are significant determinants of the relax densities and impact resistance of all the briquette samples. Meanwhile, water resistance of the sampled briquettes was significantly different for material type, pressure level as well as particle size, however, all factor interactions were insignificantly affected with palm kernel shell and rice husk recording the highest and lowest water resistance property. With regards to the combustion properties, apart from material type which significantly affected heating rate and specific fuel consumption, pressure and particle size together with all interactions did not have any significant influence on heating rate and specific fuel consumption. Finally, the findings provide a new perspective to investigate other agricultural residues which will diversify the energy resources of the country.

Abstract Background Ghana became the first African country to take delivery of the first wave of the AstraZeneca/Oxford vaccine from the COVAX facility. But why has this promising start of the vaccination rollout not translated into an accelerated full vaccination of the population? To answer this question, we drew on the tenets of a policy analytical framework and analysed the diverse interpretations, issue characteristics, actor power dynamics and political context of the COVID-19 vaccination process in Ghana. Methods We conducted a rapid online review of media reports, journal articles and other documents on debates and discussions of issues related to framing of the vaccination rollout, social constructions generated around vaccines, stakeholder power dynamics and political contentions linked to the vaccination rollout. These were complemented by desk reviews of parliamentary reports. Results The COVID-19 vaccination was mainly framed along the lines of public health, gender-centredness and universal health coverage. Vaccine acquisition and procurement were riddled with politics between the ruling government and the largest main opposition party. While the latter persistently blamed the former for engaging in political rhetoric rather than a tactical response to vaccine supply issues, the former attributed vaccine shortages to vaccine nationalism that crowded out fair distribution. The government’s efforts to increase vaccination coverage to target levels were stifled when a deal with a private supplier to procure 3.4 million doses of the Sputnik V vaccine collapsed due to procurement breaches. Amidst the vaccine scarcity, the government developed a working proposal to produce vaccines locally which attracted considerable interest among pharmaceutical manufacturers, political constituents and donor partners. Regarding issue characteristics of the vaccination, hesitancy for vaccination linked to misperceptions of vaccine safety provoked politically led vaccination campaigns to induce vaccine acceptance. Conclusions Scaling up vaccination requires political unity, cohesive frames, management of stakeholder interests and influence, and tackling contextual factors promoting vaccination hesitancy.

Small private irrigation (SPI) is a farmer-initiated irrigation which has the potential to increase the contribution of the overall irrigation sector to global food security. However, there is no much information about these systems for effective policies for regulation. This study compared the resource use productivities and environmental impacts of SPI systems to those of a government-led irrigation scheme (GIS) in Northern Ghana. The results showed that land productivity was higher in the SPI than in the GIS. Productivity per unit cultivated area was 2571.00 US$/ha under SPI while that of the GIS was 676.00 US$/ha. Output per unit command area was also two times higher in the SPI than in the GIS; that is 2571.00 US$/ha and 1113.00 US$/ha for SPI and GIS respectively. For water productivity, output per unit irrigation supply was 0.33 US$/m3 and 0.08US$/m3 for SPI and GIS respectively while output per unit water consumed by ET was 0.60 US$/m3 for SPI and 0.06 US$/m3 for the GIS. The results implied that the SPI schemes performed better in land and water productivities compared with the GIS which is attributed to higher yields and the selection of high valued crops by farmers under SPI. However, both irrigation system types at the time of this study did not cause significant deterioration to the water bodies and surrounding environment as the biochemical oxygen demand (BOD) values of nearby water bodies were less than 3.0–5.0 mg/l, which is considered as acceptable levels for drinking water by World Health Organisation (WHO) while salinity levels were also within acceptable limits (

The neocortex encodes complex and simple motor outputs in all mammalian species that have been tested. Given that changes in neocortical reorganization (and corresponding corticospinal output) have been implicated in long term motor recovery after stroke injury, there remains a need to understand this biology in order to expedite and optimize clinical care. Here, changes in the neocortical topography of complex and simple movement outputs were evaluated in mice following experimental middle cerebral artery occlusion (MCAo). Neocortical motor output was defined using long-duration parameters of intracortical microstimulation (LD-ICMS) based on area and spatial coordinates of separate motor output types to build upon our recent report in uninjured mice. LD-ICMS test sites that elicited complex (multi-joint) movement, simple (single skeletal joint) movement, as well as co-elicited FORELIMB + HINDLIMB responses were detected and recorded. Forelimb reaching behavior was assessed using the single pellet reaching (SPR) task. At 6 weeks post-surgery, behavioral deficits persisted and neocortical territories for separate movements exhibited differences in neocortical area, and spatial location, and differed between MCAo-Injured animals (i.e., the MCAo group) and Sham-Injured animals (i.e., the Control group). MCAo-Injury reduced neocortical area of complex movements while increasing area of simple movements. Limited effects of injury were detected for spatial coordinates of neocortical movements. Significant positive correlations were detected between final SPR performance and either area of complex retract or area of co-occurring FORELIMB + HINDLIMB sites.

This paper explores a little understood aspect of education labour markets, the tendency for teachers to simultaneously engage in both white-collar side-hustle and blue-collar or land-based entrepreneurial activities. The papers argues that teacher’s engagement in multiple activities such as moonlighting and agriculture in rural community enhances their income and this helps to compensate for wage differentials with their urban counterparts. This practice is also associated with teacher retention and community integration of teachers which is a common challenge relating to rural school staffing. We suggest that the phenomenon of non-education related teacher side-hustles, which are typically understood to be problematic, is a more complex issue and a practice which may have potential benefits for hard-to-staff schools.

Tacrolimus (FK506) is a common immunosuppressant that is used in organ transplantation. However, despite its importance in medical applications, it is prone to adverse side effects. While some studies have demonstrated its toxicities to humans and various animal models, very few studies have addressed this issue in aquatic organisms, especially zebrafish. Here, we assessed the adverse effects of acute and chronic exposure to tacrolimus in relatively low doses in zebrafish in both larval and adult stages, respectively. Based on the results, although tacrolimus did not cause any cardiotoxicity and respiratory toxicity toward zebrafish larvae, it affected their locomotor activity performance in light–dark locomotion tests. Meanwhile, tacrolimus was also found to slightly affect the behavior performance, shoaling formation, circadian rhythm locomotor activity, and color preference of adult zebrafish in a dose-dependent manner. In addition, alterations in the cognitive performance of the fish were also displayed by the treated fish, indicated by a loss of short-term memory. To help elucidate the toxicity mechanism of tacrolimus, molecular docking was conducted to calculate the strength of the binding interaction between tacrolimus to human FKBP12. The results showed a relatively normal binding affinity, indicating that this interaction might only partly contribute to the observed alterations. Nevertheless, the current research could help clinicians and researchers to further understand the toxicology of tacrolimus, especially to zebrafish, thus highlighting the importance of considering the toxicity of tacrolimus prior to its usage.

Fully convective M dwarfs typically remain rapidly rotating and magnetically active for billions of years, followed by an abrupt and mass-dependent transition to slow rotation and quiescence. A robust understanding of this process is complicated by difficulties in estimating M dwarf ages and potential dependencies on other variables such as birth environment or metallicity. To isolate the effect of mass, we consider M dwarfs in wide binaries. We identify 67 widely separated, fully convective (0.08–0.35 M _⊙ ) M dwarf binary systems using Gaia and measure the H α feature for each component. We classify the pairs into three categories: systems where both components are active, systems where both are inactive, and candidate transition systems, where one component is active and the other inactive. We gather higher-resolution spectra of the candidate transition systems to verify that their behavior does not result from an unresolved third component, yielding one new triple with surprising activity levels. Neglecting this triple, we find 22 active, 36 inactive, and eight transition pairs. Our results are consistent with the epoch of spindown for these binaries being primarily determined by mass, with mild second-order effects; we place a 1 σ upper limit of 0.5 Gyr or 25% on the dispersion in the mass-dependent spindown relation. Our findings suggest that the large dispersion in the spindown epoch previously observed for field stars of a given mass may stem from differences in birth environment, in addition to modest intrinsic stochasticity. We also see evidence that the wide binary population is dispersed over time due to dynamical processing.

Colistin is primarily used as a last resort antibiotic against highly resistant Gram-negative bacteria (GNB). Rising rates of colistin resistance, however, may limit future use of this agent. The anthelmintic drug niclosamide has been shown to enhance colistin activity in combination therapy, but a detailed structure–activity relationship (SAR) for niclosamide against GNB has yet to be studied. A series of niclosamide analogs were synthesized to perform an SAR, leading to the discovery of a lead compound that displayed comparable colistin-potentiating activity to niclosamide with reduced cytotoxicity. Overall, this work provides important insights into synthetic strategies for the future development of new niclosamide derivatives and demonstrates that toxicity to mammalian cells can be reduced while maintaining colistin potentiation.

Abstract Background The literature on dolutegravir (DTG)-based HIV treatment has focused on assessing therapeutic efficacy particularly with regard to viral load suppression. However, little empirical attention has been devoted to understanding the effects of DTG on quality of life, in particular sexual health and functioning in PLHIV. This study focused on understanding patient experiences of sexual dysfunction, after transition to DTG-based regimens in Rwenzori region in Mid-Western Uganda. Methods We adopted a qualitative exploratory research design. Between August and September 2021, we conducted sixteen in-depth interviews and six focus group discussions (48 participants) with patients reporting ‘new’ sexual dysfunction after transition to DTG-based regimens at seven health facilities in mid-Western Uganda. Data were analyzed by thematic approach. Results Decreased libido was reported in both sexes of patients within weeks of transition to DTG-based regimens. Diminished interest in sex was more frequently reported among women while men complained of a marked reduction in the frequency of sex. Women reported loss of psycho-social attraction to their long-term male partners. Erectile dysfunction was common among men in this sample of patients. Patients described their experiences of sexual dysfunction as an affront to their socially-constructed gender identities. Patients described tolerating sexual adverse drug reactions (ADRs) as a necessary tradeoff for the extension in life granted through antiretroviral therapy. A number of women reported that they had separated from their spouses as a result of perceived drug-induced sexual dysfunction. Marital strife and conflict arising from frustration with sexual-partner dysfunction was frequently reported by participants in both sexes. Several participants indicated experiencing insecurity in their heterosexual relationships due to difficulties in sexual functioning. Conclusion Sexual dysfunction following transition to DTG-based regimens is common in both sexes of PLHIV, who indicated that they had no prior experience of difficulties in sexual health. Our findings demonstrate that sexual ADRs negatively impact self-esteem, overall quality of life and impair gender relations. DTG-related sexual health problems merit increased attention from HIV clinicians. Further research is warranted to assess the prevalence of DTG-associated sexual dysfunction in patients in Uganda.

How is it ever possible to experience such a cruel war in Europe? Why has Ukraine been attacked by Russia? What are the credible details? Why did international institutions fail to prevent tensions from becoming cruel? What are the sociocultural roots and the underlying paradigms of this conflict? To what extent was it planned? Based on over a hundred concrete press references, this article answers these questions as much as possible and suggests a way out in a brief concluding fourth section. Apart from encouraging individual responsibility (single soldiers or commanders) and national responsibility (generating paradigms and narratives of collective identities), it is useful to perceive a level of planetary responsibility that cares for effective in-time rescue in derailed disastrous situations, namely when institutions and procedures fail to keep peace. UN bodies and OSCE exist but have not been fully effective. The article thus calls for effective functioning of systems at the individual, national and global levels. Editor’s Note: The views expressed in this article represent the personal views of its author, rather than the official position of the World Academy of Art and Science.

Introducción: la biocompatibilidad es un factor decisivo para el éxito de una terapia endodoncica. Objetivo: evaluar la citotoxicidad de cinco materiales de uso endodóntico mediante la prueba de Artemia Salina. Método: se diseñó un estudio experimental in vitro, empleando Artemia salina, para evaluar la biocompatibilidad de los cementos Grossman, CaOH, AH-Plus, MTA y TheraCal-LC con observaciones a 24 y 48 horas. Resultados: los resultados indican que el cemento Grossman presenta un 100% de toxicidad a las 24 horas, mientras que los demás materiales muestran valores menores al 30%, reflejando un comportamiento biocompatible, sin embargo, a las 48 horas, CaOH y TheraCal-LC presentan una toxicidad mayor al 30%, mientras que AH-Plus y MTA continúan con valores -menores del 30%. Los datos fueron analizados con un Modelo lineal generalizado con distribución de errores binomial, un análisis de devianza, y la prueba de comparación múltiple de Fisher con corrección Bonferroni. Se hizo un análisis independiente para las 24 y 48 horas, bajo un nivel de significancia α=5%, se encontraron diferencias significativas a las 48 horas entre TheraCal-LC y AH-Plus y MTA. Conclusión: se concluye que el cemento Grossman presentó un alto grado de toxicidad, mientras que AH-Plus y MTA mostraron la mayor biocompatibilidad

Abstract Background The perinatal period is often characterized by specific fear, worry, and anxiety concerning the pregnancy and its outcomes, referred to as pregnancy-related anxiety. Pregnancy-related anxiety is uniquely associated with negative maternal and child health outcomes during pregnancy, at birth, and early childhood; as such, it is increasingly studied. We examined how pregnancy-related anxiety is measured, where measures were developed and validated, and where pregnancy-related anxiety has been assessed. We will use these factors to identify potential issues in measurement of pregnancy-related anxiety and the geographic gaps in this area of research. Methods We searched the Africa-Wide, CINAHL, MEDLINE, PsycARTICLES, PsycINFO; PubMed, Scopus, Web of Science Core Collection, SciELO Citation Index, and ERIC databases for studies published at any point up to 01 August 2020 that assessed pregnancy-related anxiety. Search terms included pregnancy-related anxiety, pregnancy-related worry, prenatal anxiety, anxiety during pregnancy, and pregnancy-specific anxiety, among others. Inclusion criteria included: empirical research, published in English, and the inclusion of any assessment of pregnancy-related anxiety in a sample of pregnant women. This review is registered on PROSPERO (CRD42020189938). Results The search identified 2904 records; after screening, we retained 352 full-text articles for consideration, ultimately including 269 studies in the review based on the inclusion and exclusion criteria. In total, 39 measures of pregnancy-related anxiety were used in these 269 papers, with 18 used in two or more studies. Less than 20% of the included studies (n = 44) reported research conducted in low- and middle-income country contexts. With one exception, all measures of pregnancy-related anxiety used in more than one study were developed in high-income country contexts. Only 13.8% validated the measures for use with a low- or middle-income country population. Conclusions Together, these results suggest that pregnancy-related anxiety is being assessed frequently among pregnant people and in many countries, but often using tools that were developed in a context dissimilar to the participants’ context and which have not been validated for the target population. Culturally relevant measures of pregnancy-related anxiety which are developed and validated in low-income countries are urgently needed.