Weather-index based crop insurance as a social adaptation to climate change and variability in the Upper West Region of Ghana: Developing a participatory approach

Climate change and variability are major challenges to rain-fed crop production in Africa. This paper presents a report on a pilot project to test a concept for operationalizing weatherindex crop insurance as a social adaptation to the climate change and variability problem in the Upper West Region of Ghana. An analysis of long-term weather variables showed rising temperature of 1.7 oC over a period of 53 years as well as major shifts in rainfall patterns. Farmers face a new reality that cannot be addressed with their indigenous knowledge alone. The weather-index based crop insurance concept discussed herein was developed by combined effort of University of Ghana, the German International Cooperation (GIZ) and the Ghana National Insurance Commission (NIC) since 2010. This development was carried out via their filial, the Ghana Agricultural Insurance Pool (GAIP). The proposed concept sought to link various agricultural stakeholders such weather technical persons, farmers, agricultural extension officer, input dealers and other aggregators, and financial institutions as well as the insurance industry and focused on a participatory farmer led approach. The piloting of the concept was supported by the Climate Change and Food Security (CCAFs) project and was tested in the years 2012 and 2013 using a theatrical drama sketch in two districts in the Upper West Region of Ghana: Jirapa and Lawra. It was observed that training of farmers in the basic principles of weather (data collection, interpretation, etc.) facilitated the discussions on drought insurance, adding to the body of evidence supporting participatory design tools. The aim of this paper is to record this process and to put the results into recent context, through discussing them through the lens of insurance operations and research in Ghana. Ensuing discussions showed that although all stakeholders considered the participatory design tools to be meritorious, a number of logistical challenges were identified that need to be addressed for effective scaling. The study also highlighted the high spatial variability of rainfall in the Upper West region of Ghana, showing the necessity of satellite-derived rainfall products. Finally, the framework suggested in this report highlights the complexity and the institutional structures required to implement an effective insurance. In effect, our simple study has exposed the complexities and intricacies that must be overcome in establishing a sustainable insurance scheme in Ghana

Burst abdomen in pregnancy: A proposed management algorithm

Management of the burst abdomen is complex due to the co-morbidities associated with it. When coupled with intraabdominal sepsis and pregnancy, it becomes even more difficult due to the ethical issues that have to be considered when managing both mother and child. Due to the paucity of literature on this subject, a management algorithm has been proposed which aims at tackling this delicate issue. However, the major consideration in the management of these cases is that decisions are to be made based on optimization of the condition of the mother.Keywords: Burst abdomen, pregnancy, management, algorithm, intra-abdominal sepsi

Technical Efficiency of Vegetable Farmers in Peri-Urban Ghana Influence and Effects of Resource Inequalities

Abstract: In Ghana, statistics indicate that women account for about 70% of total food production and are the most important actors in the food chain which begins from the farm production, market and intra household distribution of food. They play a lead role in post-harvest activities such as shelling of grains, storage, processing and marketing. They are also becoming increasingly visible in farm tasks which traditionally have been designated as male preserve. Despite the increasing central role of women in food production, they have much more limited access to resources than their male counterparts especially in the areas of education, land, agricultural extension services and access to credit, all of which combine to restrain their ability to increase productivity. This study was therefore undertaken toexamine the technical efficiency of male and female vegetable farmers in the Kumasi Metropolis using the stochastic production frontier model. Female vegetable farmers were found to be producing at high levels of inefficiency. The predicted efficiencies differed substantially from between 2 and 85 percent, with mean efficiency of 24 percent. The low mean efficiency index is an indication of inefficiencies in resource use. Also, female headed farms recorded a mean technical efficiency of 16.5 percent with a range between 2 and 66 percent. The male headed farms, on the other hand, showed a mean technical efficiency of 30.8 percent, and a range between 2 and 85 percent. The results imply that on the average, female vegetable farmers were relatively technically inefficient than their male counterparts. The paper concludes that since women farmers contribute immensely of domestic food supply in Ghana, it is important that efforts be made to build their capacity to produce efficiently

Perception of risk for hypertension and overweight/obesity in Cape Coast, Ghana

Background: This study examined the association between perception of risk for hypertension and overweight/obesity.Design: Cross-sectional questionnaire-based surveySetting: Out-patient department of the Central Regional Hospital in Cape Coast, Ghana Participants: Adult men and women at least 18 years oldInterventions: NoneMain outcome measures: Perception of risk for hypertension, overweight/obesityResults: About 39% of the participants (N=400) were found to be overweight/obese, with disproportionally higher rates among women (50%) than men (28%). Results of the binary logistic regression models revealed a strong positive association (OR = 2.21, 95% CI =1.23, 3.96) between perception of risk for hypertension and overweight/obesity. Increasing age, high television exposure, female gender and being in a relationship were also noted to be associated with overweight/obesity. Conclusions: These findings highlight the need for the design of programmes to help individuals appreciate the reality of weight-related health risks, as well as the need to embrace lifestyles that promote healthy weight outcomes. Funding: Harvard Medical School Travelling Fellowship, Scholars in Medicine Office, Harvard Medical SchoolKeywords: overweight, obesity, risk, perception, hypertension, Cape Coast, Ghan

Institutional Voids, Economic Adversity, and Inter-firm Cooperation in an Emerging Market : The Mediating Role of Government R&D Support

Peer reviewedPostprin

Increasing the use of continuing professional development courses to strengthen trauma care in Ghana

Injury is a major cause of death and disability in Ghana. Strengthening care of the injured is essential to reduce this burden. Trauma continuing professional development (CPD) courses are an important component of strengthening trauma care. In many countries, including Ghana, their use needs to be more uniformly promoted. We propose lowcost strategies to increase the utilization of trauma CPD in Ghana, especially in district hospitals and higher need areas. These strategies include developing plans by regional health directorates and teaching hospitals for the regions for which they are responsible. Lists could be kept and monitored of which hospitals have doctors with which type of training. Those hospitals that need to have at least one doctor trained could be flagged for notice of upcoming courses in the area and especially encouraged to have the needed doctors attend. The targets should include at least one surgeon or one emergency physician at all regional or large district hospitals who have taken the Advanced Trauma Life Support (ATLS) (or locally-developed alternative) in the past 4 years, and each district hospital should have at least one doctor who has taken the Primary Trauma Care (PTC) or Trauma Evaluation and Management (TEAM) (or locally-developed alternatives) in the past 4 years. Parallel measures would increase enrollment in the courses during training, such as promoting TEAM for all medical students and ATLS for all surgery residents. It is important to develop and utilize more “home grown” alternatives to increase the long-term sustainability of these efforts, Keywords: trauma, injury, education, training, continuing professional developmentFunding: Non

Prevalence and genomic characterization of Salmonella isolates from commercial chicken eggs retailed in traditional markets in Ghana

Salmonella enterica are important foodborne bacterial pathogens globally associated with poultry. Exposure to Salmonella-contaminated eggs and egg-related products is a major risk for human salmonellosis. Presently, there is a huge data gap regarding the prevalence and circulating serovars of Salmonella in chicken eggs sold in Ghana. In this study, 2,304 eggs (pools of six per sample unit) collected from informal markets in Accra, Kumasi and Tamale, representing the three ecological belts across Ghana, were tested for Salmonella. Antimicrobial susceptibility testing and Whole Genome Sequencing (WGS) of the isolates were performed using standard microdilution protocols and the Illumina NextSeq platform, respectively. The total prevalence of Salmonella was 5.5% with a higher rate of contamination in eggshell (4.9%) over egg content (1.8%). The serovars identified were S. Ajiobo (n = 1), S. Chester (n = 6), S. Hader (n = 7), S. enteritidis (n = 2); and S. I 4:b:- (n = 8). WGS analysis revealed varied sequence types (STs) that were serovar specific. The S. I 4:b:- isolates had a novel ST (ST8938), suggesting a local origin. The two S. enteritidis isolates belonged to ST11 and were identified with an invasive lineage of a global epidemic clade. All isolates were susceptible to ampicillin, azithromycin, cefotaxime, ceftazidime, gentamicin, meropenem, and tigecycline. The phenotypic resistance profiles to seven antimicrobials: chloramphenicol (13%), ciprofloxacin (94%), and nalidixic acid (94%), colistin (13%), trimethoprim (50%) sulfamethoxazole (50%) and tetracycline (50%) corresponded with the presence of antimicrobial resistance (AMR) determinants including quinolones (gyrA (D87N), qnrB81), aminoglycosides (aadA1), (aph(3“)-Ib aph(6)-Id), tetracyclines (tet(A)), phenicols (catA1), trimethoprim (dfrA14 and dfrA1). The S. enteritidis and S. Chester isolates were multidrug resistant (MDR). Several virulence factors were identified, notably cytolethal distending toxin (cdtB gene), rck, pef and spv that may promote host invasion and disease progression in humans. The findings from this study indicate the presence of multidrug resistant and virulent strains of Salmonella serovars in Ghanaian chicken eggs, with the potential to cause human infections. This is a critical baseline information that could be used for Salmonella risk assessment in the egg food chain to mitigate potential future outbreaks

Lymphatic Vascularisation and Involvement of Lyve-1+ Macrophages in the Human Onchocerca Nodule

Onchocerciasis, caused by the filarial nematode Onchocerca volvulus, is a parasitic disease leading to debilitating skin disease and blindness, with major economic and social consequences. The pathology of onchocerciasis is principally considered to be a consequence of long-standing host inflammatory responses. In onchocerciasis a subcutaneous nodule is formed around the female worms, the core of which is a dense infiltrate of inflammatory cells in which microfilariae are released. It has been established that the formation of nodules is associated with angiogenesis. In this study, we show using specific markers of endothelium (CD31) and lymphatic endothelial cells (Lyve-1, Podoplanin) that not only angiogenesis but also lymphangiogenesis occurs within the nodule. 7% of the microfilariae could be found within the lymphatics, but none within blood vessels in these nodules, suggesting a possible route of migration for the larvae. The neovascularisation was associated with a particular pattern of angio/lymphangiogenic factors in nodules of onchocerciasis patients, characterized by the expression of CXCL12, CXCR4, VEGF-C, Angiopoietin-1 and Angiopoietin-2. Interestingly, a proportion of macrophages were found to be positive for Lyve-1 and some were integrated into the endothelium of the lymphatic vessels, revealing their plasticity in the nodular micro-environment. These results indicate that lymphatic as well as blood vascularization is induced around O. volvulus worms, either by the parasite itself, e.g. by the release of angiogenic and lymphangiogenic factors, or by consecutive host immune responses

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Parasite-derived microRNAs in host serum as novel biomarkers of helminth infection.

BACKGROUND: MicroRNAs (miRNAs) are a class of short non-coding RNA that play important roles in disease processes in animals and are present in a highly stable cell-free form in body fluids. Here, we examine the capacity of host and parasite miRNAs to serve as tissue or serum biomarkers of Schistosoma mansoni infection. METHODS/PRINCIPAL FINDINGS: We used Exiqon miRNA microarrays to profile miRNA expression in the livers of mice infected with S. mansoni at 7 weeks post-infection. Thirty-three mouse miRNAs were differentially expressed in infected compared to naïve mice (>2 fold change, p<0.05) including miR-199a-3p, miR-199a-5p, miR-214 and miR-21, which have previously been associated with liver fibrosis in other settings. Five of the mouse miRNAs were also significantly elevated in serum by twelve weeks post-infection. Sequencing of small RNAs from serum confirmed the presence of these miRNAs and further revealed eleven parasite-derived miRNAs that were detectable by eight weeks post infection. Analysis of host and parasite miRNA abundance by qRT-PCR was extended to serum of patients from low and high infection sites in Zimbabwe and Uganda. The host-derived miRNAs failed to distinguish uninfected from infected individuals. However, analysis of three of the parasite-derived miRNAs (miR-277, miR-3479-3p and bantam) could detect infected individuals from low and high infection intensity sites with specificity/sensitivity values of 89%/80% and 80%/90%, respectively. CONCLUSIONS: This work identifies parasite-derived miRNAs as novel markers of S. mansoni infection in both mice and humans, with the potential to be used with existing techniques to improve S. mansoni diagnosis. In contrast, although host miRNAs are differentially expressed in the liver during infection their abundance levels in serum are variable in human patients and may be useful in cases of extreme pathology but likely hold limited value for detecting prevalence of infection