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- ItemThe Effectiveness of an Enhanced Antenatal Care Service Package for the Control of Malaria and Anaemia in Pregnancy in Ghana(KNUST, 2015-11) Antwi, Gifty DufieABSTRACT Background Recommended efficacious interventions for malaria prevention and control during pregnancy have been implemented for over two decades yet malaria and anaemia prevalence during pregnancy remain high. This may be due to sub-optimal uptake of these interventions. Patient participation in their own health care improves health outcomes by improving adherence to treatment recommendations. We conceptualised that when pregnant women participated in their antenatal care it would improve their adherence to antenatal care recommendations and treatment and promote better health outcomes. Methods A cluster randomized controlled trial to assess the effectiveness of pregnant women’s participation in their antenatal care on the risk of malaria and anaemia during pregnancy, the risk of low birth weight and the risk of sub-optimal pregnancy outcomes was conducted. The study was conducted in 14 antenatal clinics (7 clinics per arm) in the Ejisu-Juaben Municipality and Sekyere-East District of the Ashanti Region of Ghana. The intervention consisted of staff showing pregnant women their malaria rapid test and haemoglobin colour scale test results to facilitate their participation in their care in addition to standard antenatal care. The feasibility and acceptability of this intervention to antenatal care staff and pregnant women were also assessed. 6 Results The overall mean age, gestational age and Hb concentration at baseline were 26.4yrs, 17.3 weeks and 11.0 g/dl respectively and similar in both groups; 10.7% had asymptomatic parasitaemia; 74.6% owned an ITN, only 48.8 % sleeping under it the night prior to enrolment. The adjusted risk ratio by 8 weeks of follow up in the intervention vs. control group was 0.97 (95% CI: 0.78-1.22) for anaemia and 1.17 (95% CI: 0.68-2.04) for parasitaemia. At 36-40 weeks gestation, the adjusted risk ratio was 0.92 (95% CI: 0.63-1.34) for anaemia and 0.83 (95% CI: 0.27-2.57) for parasitaemia in the intervention vs. control group. The adjusted risk ratio for low birth weight was 0.93 (95% CI: 0.44-1.97) while that for sub-optimal pregnancies was 0.77 (95% CI: 0.17- 3.52). Using the haemoglobin colour scale and malaria rapid test to facilitate participation within routine antenatal care was feasible and acceptable to the pregnant women and staff members. The pregnant women saw and believed the test results and felt motivated to take action to improve their health. Antenatal care staff and pregnant women perceived some improvement in pregnant women’s adherence to antenatal recommendations with regards to malaria and anaemia. Conclusion It was feasible and acceptable for pregnant women to participate in their antenatal care using the malaria rapid test and the haemoglobin colour scale. Their participation appeared to have potential benefit during pregnancy although clear evidence of a biologic effect was not found. The effect may have been diluted out by the concurrent introduction of malaria rapid tests into routine ANC during the time of the study and possible methodological and implementation challenges of the intervention. More research is thus recommended.
- ItemAntinociceptive, anti-inflammatory and anticonvulsant evaluation of the hydroethanolic leaf extract of calotropis procera (ait) r. Br. (apocynaceae)(KNUST, 2019-11) Obese, ErnestABSTRACT Pain, inflammation, and epilepsy remain a real and currently, a major problem in clinical medicine which requires new agents with improved efficacy for more effective therapy. Plant sources can serve as a basis for the search for these novel drugs. The analgesic, anti-inflammatory and anticonvulsant effects of hydroethanolic extract 70% v/v of Calotropis procera (CPE) which is widespread in Ghana and other tropical areas in the subregion was evaluated. A primary neurological assessment revealed that CPE has some central nervous system depressant and analgesic effects. It also showed impairment on motor coordination in the rotarod test. The extract potentiated duration of sleeping time in the pentobarbitone interaction test and analgesic properties were also further confirmed in the tail immersion test while it delayed pentylenetetrazole-induced convulsions. The anti-inflammatory assessment showed that CPE was able to significantly reduce both carrageenan-induced (F4,15=6.24, P=0.0105) and formalin-induced inflammation (F4,15=100.9, P<0.0001) in rats. The analgesic effects were demonstrated in the acetic acid-induced writhing and formalin-induced paw licking tests. Writhing induced by acetic acid was significantly reduced (F4,15=24.14, P<0.0001) on treatment with oral doses of CPE (30-300 mg/kg). The extract significantly inhibited both phase 1 and phase 2 states induced by injection of formalin (F4,60=12.21, P<0.0001) comparable to morphine, the standard analgesic used. The extract significantly attenuated hyper-nociception induced by tumour necrosis factor-alpha, interleukin 1β, bradykinin, and prostaglandin E2. The anti-nociceptive effect exhibited by CPE in the formalin test was reversed by systemic administration of naloxone and theophylline. The extract was further evaluated for anticonvulsant activity in rodents using animal models, picrotoxin–induced convulsions, strychnine-induced convulsions, and pilocarpine-induced status epilepticus. CPE (100–300 mg/kg) exhibited anticonvulsant effect against strychnine-induced clonic seizures by significantly reducing the duration (F6,20=4.196, P=0.0068) and frequency (F6,21=5.438, P=0.0016) of convulsions. The extract (100-300 mg kg-1) caused a profound dose-dependent delay in the onset of clonic convulsions induced by picrotoxin (F6,25=17.43, P<0.0001) and tonic convulsions (F6,20=43.45, P<0.0001) in mice. The duration of convulsions was reduced significantly (F6,19=41.71, P<0.0001). CPE (100-300 mg kg-1), showed profound anticonvulsant effect and protected against death induced the pilocarpine. ED50 (~ 0.1007) and Emax values calculated from the dose-response curves demonstrated that the extract was less potent than diazepam in reducing the duration and onset of convulsions but had comparable efficacies. Flumazenil – a GABAA receptor antagonist, did not reverse the onset or duration of convulsions produced by the extract in the picrotoxin-induced seizure model. Overall, the hydroethanolic leaf extract of Calotropis procera possesses analgesic, anti-inflammatory, and anticonvulsant properties.
- ItemPesticidal and germinating enhancing relevance of anthraquinones from cassia tora (LINN) seeds(KNUST, 2018-08) Mbatchou, Valentine ChiABSTRACT Vigna unguiculata Lam (Cowpea) seeds is the major essential leguminous crop cultivated in sub-Saharan Africa and occupies a greater area of land than any other legume. The leaves, green pods, green peas and dry grains of cowpea are eaten all over the continent in different dishes for being nutritious to both humans and animals. Callosobruchus maculatus (Cowpea weevils) are known to destroy up to about 70 % of the seeds in storage. Pre-treatment of the seeds before storage includes the use of neem oil and cinnamaldehyde but both have been observed on the field to be toxic to the seeds and also human health. Seeds treated in this way have shown very low germinability. Thus, alternative safe and ecofriendly pesticides are needed to replace these standard agents. Cassia tora is grown on farmlands alongside food crops in the South-West Region of Cameroon as a protectant to seeds/grains against insect pests. Therefore the present study sought to investigate its edible seeds for ecologically friendly pesticides against Callosobruchus maculatus (cowpea weevils) and its potential as enhancers of cowpea seed-germination and seedling-vigor as folklore suggest. The study also explores the most active C. tora seed extract and its constituents for larvicidal activity against Anopheles gambaei third-fourth instar larvae. The petroleum ether (pet-ether), ethyl acetate and methanol extracts of C. tora were tested for insecticidal, oviposition deterrent, feeding inhibition, germination and seedling vigor enhancement effect on cowpea seeds using neem oil and cinnamaldehyde reference compounds. Pet ether extract of C. tora seeds showed the highest insecticidal activity (LC50= 8.33±0.6 μg/mL) against adult weevils, followed by the ethyl acetate and methanol extracts respectively. The ethyl acetate showed the highest germination and seedling vigor enhancement effect. The ethyl acetate extract was selected and assessed for mosquito larvicidal activity against the larvae of the malaria vector Anopheles gambiae. It exhibited larvicidal activity that was comparable to the positive control azadirachtin. It was then subjected to column chromatographic purification to study its bioactive compounds. The anthraquinones aurantio-obtusin, obtusin and a novel compound cassiatorin were isolated and assessed for various pesticidal activities. Aurantio-obtusin and cassiatorin showed comparable antifeedant activity as the reference compounds. Aurantio-obtusin and cassiatorin were the most effective enhancers of germination and vigor of the cowpea seeds and seedlings respectively when compared with the negative control. Cassia tora seed extracts and its anthraquinones aurantio – obtusin and obtusin possess larvicidal activity against Anopheles gambiae third-fourth instar larvae, and could serve as eco-friendly larvicides for control or management of mosquito population. Thus the present study gives credence to the folkloric use of C. tora seeds for crop/grain-protection from insect pest infestations as well as crop yield-enhancement. Unlike the reference drugs, C. tora seed extracts and isolated compounds were not toxic to the seeds and showed over 70% germination and seedling vigor enhancement activities. These activities are being reported in the plant (C. tora) for the first time. Even though the anthraquinones aurantio-obtusin and obtusin have been isolated from C. tora and other cassia species, this is the first report of their insecticidal, oviposition deterrent, antifeedant, germination and seedling vigor enhancement activities. A novel compound, 1, 3, 8-trihydroxy-2, 7-dimethoxy-6-methyl-9, 10-anthraquinone is being reported for the first time and is given the trivial name ‘cassiatorin’ in conformity with the naming of anthraquinones from Cassia species using their botanical origin.
- ItemMultiple markers for predicting preeclampsia in women with priori high risk.(KNUST, 2018-09) Seini, Mohammed MustaphaABSTRACT Background: Preeclampsia (PE) is a medical condition which arises in pregnancy and it is associated with high blood pressure and a concomitant significantly raised levels of proteinuria. It is a multi-organ system disease of pregnancy with unknown etiology. It is a maternal syndrome, characterized by high blood pressure, abnormal clotting, proteinuria and edema. PE negatively impacts on the renal system and other organs due to the release of some toxic factors from the placenta. The current study, sought to investigate the accuracy, sensitivity, specificity, reproducibility and cost effectiveness of multiple markers for the prediction of preeclampsia in women at high risk of developing Preeclampsia. Methods: A case - control study comprising of two hundred primigravidae, singleton and second trimester pregnant women with preeclampsia (case) age-matched with two hundred normotensive pregnant women in the same trimester (controls), were recruited from the Obstetrics and Gynaecology Departments of the Komfo Anokye Teaching Hospital, Kumasi and Ridge Regional Hospital, Accra, all in Ghana, between January and December, 2016. After ethical approval and informed consent were obtained, information on socio-demographic characteristics, medical history, booking visit and previous obstetric history were obtained by face-to-face interviews from the respondents and assessed through medical records. Blood pressure, anthropometric measurements, urine protein and micro albuminuria were measured and blood samples taken for magnesium, calcium, Hemoglobin, human chorionic gonadotropin, prolactin and Progesterone measurements. Results: The mean serum calcium and magnesium levels were significantly lower in the case group than the controls (1.53 ± 0.90, 2.36 ± 0.17) and (0.56 ± 0.08, 0.88 ± 0.08) respectively (p <0.001). The mean systolic, diastolic blood pressure, gestation at booking, microalbuminuria and BMI were significantly higher in the case group than the control (p <0.001). However, the mean hemoglobin (Hb) was significantly lower among the cases (10.01 ± 0.73) than the controls (13.76 ± 0.80) (p <0.001). There was no significant difference amongst the serum levels of progesterone, prolactin and β-hCG between the cases and the controls (p = 0.730, 0.903 and 0.930 respectively). Greater proportion of the studied participants were within the (26 – 35) years age range. Most of the cases had informal education. Prevalence of hypocalcaemia, hypomagnesaemia and anaemia were (51.75%), (50.0%) and (42.5%) respectively. Conclusion: The findings of this study have shown the clinical importance of early commencement of antenatal care (ANC). Early ANC ensures the screening begins early to identify women who are at risk of this condition and start treatment before it threatens the survival of both the mother and fetus. The results of this study have also shown that hormones such as BhCG, Prolactin and Progesterone are not good markers for screening pregnant women in the second trimester for preeclampsia. This study shows a significant reduction of serum calcium and magnesium levels in the women who had preeclampsia compared to the normotensives. This supports the hypothesis that hypocalcemia and hypomagnesaemia play a very significant role in the etiology of preeclampsia. Calcium and magnesium supplementation are needed in the prevention of preeclampsia especially in a developing country like Ghana. Furthermore, the results of this study shows that microalbuminuria plays an important role in the etiology of preeclampsia as all the pregnant women with PE have high levels of microalbuminuria.
- ItemAppropriate governance and financing model for household solid waste management in Ghana: implications for public health(KNUST, 2018-11) Boateng, Kofi SekyereABSTRACT Waste management is an important developmental issue globally, especially in Lower Middle-income countries like Ghana. In Ghana, it appears the key challenge in household solid waste management is appropriate governance and financing. This study assessed utilization of solid waste management (SWM) services in Ghana, the financing mechanisms, governance structure for managing solid waste and the willingness-to-pay for improved SWM services as an integral attribute of sustainable financing mechanism for SWM services in Ghana. This was a cross-sectional multi-center study and conducted in Ghana from January to August 2017, among 1560 households in four regional capitals in Ghana; Accra, Takoradi, Kumasi and Tamale. Data were collected using a structured questionnaire and an in-depth interview guide for clients, waste management service providers and key informants from the Assemblies. Logistic regression models were used to determine the factors associated with utilization of household solid waste management services and the predictors of willingness-to-pay for household solid waste management services in Ghana. The current governance structure was found to be weak; not inclusive, role conflict among, Municipal and District Assemblies, (MMDAs), staff and other actors, absence of public health dimension, and a single source funding (user charges). The overall level of utilization of SWM services was 55%, with difference across study sites; 53.9%, 53.2%, 70% and 42.9% in Takoradi, Tamale, Accra and Kumasi respectively (p<0.001). Other ways of house hold waste disposal methods included drop-off at communal container sites (21.7%) and burning or putting in dug pits (21.8%). Overall, 53.7% of the households were willing to make additional payment of (GHC10- GHC50) for improved services, with difference across study sites; 54.5%, 53.1%, 61.7% and 46.6% in Takoradi, Tamale, Accra and Kumasi respectively. User charge was mainly the available payment system and was fraught by default payments and inability to collect revenue. Utilization of household SWM services was associated with age, educational level, marital status, occupation, type of accommodation, type of residence, economic status and duration of stay at residence. Compared to those with no formal education, having tertiary education was associated with higher odd of utilization of SWM services (adjusted odds ratio aOR, = 1.60; 95% confidence interval CI, = 1.01-2.60). Urban residency was associated with higher odds of utilizing household SWM services compared to residing in a peri-urban area (aOR, =2.80; 95% CI, and 1.55-6.69). Willingness-to-pay for improved solid waste management was also predicted by educational level, marital status, type of employment and region of residence. Compared to women who had no formal education, having senior high school (aOR, 95%CI; 2.53; 1.48-4.30], post-secondary (aOR, 95% CI=1.97; 1.08, 3.60] and tertiary education (aOR, 95%CI; 3.30, 1.91, 5.69) were associated with higher odds of willingness-to-pay for improved SWM services. This study provides important evidence on important attribute for the establishment of appropriate governance and financing structure that facilitate willingness-to-pay for improved SWM services. Findings would contribute to efforts at finding sustainable ways for solid waste management service delivery in Ghana. It is therefore recommended that the proposed model for SWM is adopted and piloted in one of the metropolis for improved solid waste management.