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Health system reforms across Africa, Asia and Latin America in recent decades demonstrate the value of health policy and systems research (HPSR) in moving towards the goals of universal health coverage in different circumstances and by various means. The role of evidence in policy making is widely accepted; less well understood is the influence of the concrete conditions under which HPSR is carried out within the national context and which often determine policy outcomes. We investigated the varied experiences of HPSR in Mexico, Cambodia and Ghana (each selected purposively as a strong example reflecting important lessons under varying conditions) to illustrate the ways in which HPSR is used to influence health policy. We reviewed the academic and grey literature and policy documents, constructed three country case studies and interviewed two leading experts from each of Mexico and Cambodia and three from Ghana (using semi-structured interviews, anonymized to ensure objectivity). For the design of the study, design of the semi-structured topic guide and the analysis of results, we used a modified version of the context-based analytical framework developed by Dobrow et al. (Evidence-based health policy: context and utilisation. Social Science & Medicine 2004;58:207-17). The results demonstrate that HPSR plays a varied but essential role in effective health policy making and that the use, implementation and outcomes of research and research-based evidence occurs inevitably within a national context that is characterized by political circumstances, the infrastructure and capacity for research and the longer-term experience with HPSR processes. This analysis of national experiences demonstrates that embedding HPSR in the policy process is both possible and productive under varying economic and political circumstances. Supporting research structures with social development legislation, establishing relationships based on trust between researchers and policy makers and building a strong domestic capacity for health systems research all demonstrate means by which the value of HPSR can be materialized in strengthening health systems.
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Política de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Gana , México , CambojaRESUMO
OBJECTIVE: The objective of this study was to explore how clinicians in low- and middle-income countries engage and support parents following newborn death. STUDY DESIGN: Qualitative interviews of 40 neonatal clinicians with diverse training were conducted in Addis Ababa, Ethiopia, and Kumasi, Ghana. Transcribed interviews were analyzed and coded through the constant comparative method. RESULTS: Three discrete themes around bereavement communication emerged. (1) Concern for the degree of grief experienced by mothers and apprehension to further contribute to it. This led to modified communication to shield her from emotional trauma. (2) Acknowledgment of cultural factors impacting neonatal loss. Clinicians reported that loss of a newborn is viewed differently than loss of an older child and is associated with a diminished degree of public grief; however, despite cultural expectations dictating private grief, interview subjects noted that mothers do suffer emotional pain when a newborn dies. (3) Barriers impeding communication and psychosocial support for families, often relating to language differences and resource limitations. CONCLUSIONS: Neonatal mortality remains the leading global cause of mortality under age 5, with the majority of these deaths occurring in low- and middle-income countries, yet scant literature exists on approaches to communication around end-of-life and bereavement care for neonates in these settings. We found that medical providers in Ghana and Ethiopia described structural and cultural challenges that they navigate following the death of a newborn when communicating and supporting bereaved parents.
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Luto , Humanos , Recém-Nascido , Feminino , Criança , Adolescente , Pré-Escolar , Gana , Etiópia , Pesar , Pais/psicologia , Pesquisa QualitativaRESUMO
The impact of access to financial services (AFS) and access to informal financial services (AIFS) on farmer income is examined in this study. After a multi-stage random sampling procedure, the study used a sample size of 478 people from two regions in Ghana. The endogenous treatment regression (ETR) model was used to account for selection bias while the unconditional quantile regression (UQR) model was used for a heterogenous analysis. The findings showed that education, financial literacy, IT access, farm size, and distance were all factors of access to financial services. Similarly, the findings revealed a positive and statistically significant link between household income and access to formal financial services. Similarly, there was a positive and significant association between access to informal financial services and household income. The findings showed that access to formal and informal financial services has different effects on household income. As a result, the effects of access to financial services on income varied by quantile. Based on the findings of the study, we developed policies to boost financial services accessibility as a means of increasing household income.
O impacto do acesso a serviços financeiros (AFS) e acesso a serviços financeiros informais (AIFS) na renda do agricultor é examinado neste estudo. Após um procedimento de amostragem aleatória em vários estágios, o estudo utilizou uma amostra de 478 pessoas de duas regiões de Gana. O modelo de regressão de tratamento endógeno (ETR) foi usado para explicar o viés de seleção, enquanto o modelo de regressão quantílica incondicional (UQR) foi usado para uma análise heterogênea. Os resultados mostram que educação, alfabetização financeira, acesso a TI, tamanho da fazenda e distância foram fatores de acesso a serviços financeiros. Da mesma forma, os resultados revelaram uma ligação positiva e estatisticamente significativa entre a renda familiar e o acesso a serviços financeiros formais. Da mesma forma, houve associação positiva e significativa entre acesso a serviços financeiros informais e renda familiar. Os resultados mostram que o acesso a serviços financeiros formais e informais tem efeitos diferentes na renda familiar. Como resultado, os efeitos do acesso a serviços financeiros sobre a renda variaram por quantil. Com base nos resultados do estudo, desenvolvemos políticas para aumentar a acessibilidade dos serviços financeiros como forma de aumentar a renda familiar.
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Análise de Regressão , Fazendeiros , Renda/estatística & dados numéricosRESUMO
BACKGROUND: Maternity leave policies are designed to protect gender equality and the health of mothers in the workforce and their children. However, maternity leave schemes are often linked to jobs in the formal sector economy. In low- and middle-income countries a large share of women work in the informal sector, and are not eligible to such benefit. This is worrisome from a social justice and a policy perspective and suggests the need for intervening. Costing the implementation of potential interventions is needed for facilitating informed decisions by policy makers. METHODS: We developed and applied a costing methodology to assess the cost of a maternity leave cash transfer to be operated in the informal sector of the economy in Brazil and Ghana, two countries with very different employment structures and socioeconomic contexts. We conducted sensitivity analysis by modeling different numbers of weeks covered. RESULTS: In Brazil, the cost of the maternity cash transfer would be between 0.004% and 0.02% of the GDP, while in Ghana it would range between 0.076% and 0.28% of the GDP. The relative cost of rolling out a maternity intervention in Brazil is between 2.2 to 3.2 times the cost in Ghana depending on the benchmark used to assess the welfare measure. The differences in costs between countries was related to differences in labor market structure as well as demographic characteristics. CONCLUSIONS: Findings show how a standard methodology that relies on routinely available information is feasible and could assist policymakers in estimating the costs of supporting a maternity cash transfer for women employed in the informal sector, such intervention is expected to contribute to social justice, gender equity, and health trajectories.
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Setor Informal , Licença Parental , Brasil , Criança , Emprego , Feminino , Gana , Humanos , GravidezRESUMO
BACKGROUND: Significant inequalities still exist between low- and high-income countries regarding access to optimum emergency obstetric care including life-saving emergency caesarean section. These relationships are considerably stronger between population-based caesarean section rates and socio-economic characteristics with poorest households experiencing significant unmet needs persistently. OBJECTIVE: To explore the characteristics of women receiving emergency C-section using a new, validated definition in Ghana and the Dominican Republic. MATERIALS AND METHODS: This was a cross-sectional study conducted in Ghana and the Dominican Republic. Multivariable logistic regression analysis was used to determine women's characteristics associated with emergency C-section. RESULTS: This analysis included 2166 women who had recently delivered via C-section comprising 653 and 1513 participants from Accra and Santo Domingo, DR, respectively. Multivariable analyses showed that women, both in Ghana and the DR, were more likely to have an emergency C-section if they did not have a previous C-Section (adjusted Odds Ratio (aOR): 2.45, 95% CI [1.57-3.81]; and aOR: 15.5, 95% CI [10.5-22.90], respectively) and if they were having their first childbirth, compared to women with previous childbirth (aOR: 1.77, 95%CI [1.13-2.79]; and aOR: 1.46, 95%CI [1.04-2.04], respectively). Also, preterm birth was associated with significantly decreased likelihood of emergency C-section compared with childbirth occurring at term in both Ghana and the DR (aOR: 0.31, 95%CI [0.20-0.48]; and aOR: 0.43, 95%CI [0.32-0.58], respectively). Among the Ghanaian participants, having an emergency C-section was positively associated with being referred and negatively associated with being older than 35 years of age. Characteristics such as education, religion, marital status, and residence did not differ between women's emergency versus non-emergency C-section status. CONCLUSION: Emergency C-section was found to be significantly higher in women with no prior C-section or those having their first births but lower in those with preterm birth in both Ghana and the DR. Data from additional countries are needed to confirm the relationship between emergency C-section status and socio-economic and obstetric characteristics, given that the types of interventions required to assure equitable access to potentially life-saving C-section will be determined by how and when access to care is being denied or not available.
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Cesárea , Nascimento Prematuro , Estudos Transversais , República Dominicana/epidemiologia , Feminino , Gana/epidemiologia , Humanos , Recém-Nascido , Parto , GravidezRESUMO
This study examined the determinants of financial literacy (FL) and its impact on access to financial services (AFS), using data collected from rural Ghana. A two-stage residual inclusion model is utilized to address the selection bias issue. The results showed that FL is affected by household heads' age, gender, education, asset ownership, homeownership, and economics education. The results revealed that FL is significant and positively related to AFS, but its square shows an inverse relation with saving mobilization. This indicated a non-linear relationship between FL and AFS. Moreover, we find that FL has a larger AFS impact for households with high-income and male household heads relative to their counterparts. The study recommended that the government can initiate the creation of a rural committee to educate rural residents on financial issues through radio broadcasting and meetings. Our findings highlighted the importance of FL on AFS in enhancing the welfare of rural households.
Este estudo examina os determinantes da educação financeira (FL) e seu impacto no acesso a serviços financeiros (AFS), usando dados coletados na zona rural de Gana. Um modelo de inclusão residual de dois estágios é utilizado para abordar a questão do viés de seleção. Os resultados mostram que a FL é afetada pela idade, sexo, educação, propriedade de ativos, propriedade e educação econômica dos chefes de família. Os resultados revelam que FL é significativo e positivamente relacionado ao AFS, mas seu quadrado mostra uma relação inversa com a mobilização de poupança. Isso indica uma relação não linear entre FL e AFS. Além disso, notou-se que o FL tem um impacto maior de AFS para famílias com alta renda e chefes de família do sexo masculino em relação às suas contrapartes. O estudo recomendou que o governo pode iniciar a criação de um comitê rural para educar os residentes rurais sobre questões financeiras por meio de radiodifusão e reuniões. Nossos resultados destacam a importância do FL no AFS para melhorar o bem-estar das famílias rurais.
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Apoio Financeiro , Economia Rural , EscolaridadeRESUMO
Abstract This paper focuses on the policy responses of Ghana's government with a focus on three areas: health, economic, and social. Ghana had made several policy interventions in these three areas. The study highlighted the adoption of the 3T-approach in health, CAP-20 in economics, and free water and subsidized electricity for citizens as social interventions. The study concludes that the measures undertaken by the Government of Ghana have yielded significant results even though some challenges with delivery mechanisms are identified. The available statistics as of October 25, 2020 on the COVID-19 situation in Ghana further affirm the gains.
Resumo Este trabalho se concentra nas respostas políticas do governo de Gana, com foco em três áreas: saúde, econômica e social, onde o país conduziu várias políticas públicas. O estudo destacou a adoção da abordagem 3T na saúde, CAP-20 na economia, e água gratuita e eletricidade subsidiada para os cidadãos como intervenções sociais. O estudo concluiu que as medidas implementadas pelo Governo de Gana produziram resultados significativos, identificando desafios relacionados aos mecanismos de entrega das políticas públicas. As estatísticas disponíveis em 25 de outubro de 2020 sobre a situação da COVID-19 em Gana confirmam os ganhos obtidos.
Resumen Este documento se concentra en las respuestas políticas del gobierno de Ghana con un enfoque en tres áreas; salud, económica y social, en las cuales el país condujo varias políticas públicas. El estudio destaca la adopción del enfoque 3T en salud, CAP-20 en economía y agua gratuita y electricidad subsidiada para los ciudadanos como intervenciones sociales. Asimismo, el estudio concluye que las medidas implementadas por el Gobierno de Ghana han arrojado resultados significativos, aunque se identifican algunos desafíos relacionados con los mecanismos de ejecución de las políticas públicas. Las estadísticas disponibles al 25 de octubre de 2020 sobre la situación de la COVID-19 en Ghana confirman los avances logrados.
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Humanos , Masculino , Feminino , Política Pública , Estratégias de Saúde , Pandemias , COVID-19RESUMO
Many smallholder farmers in developing countries grow multiple crop species on their farms, maintaining de facto crop diversity. Rarely do agricultural development strategies consider this crop diversity as an entry point for fostering agricultural innovation. This paper presents a case study, from an agricultural research-for-development project in northern Ghana, which examines the relationship between crop diversity and self-consumption of food crops, and cash income from crops sold by smallholder farmers in the target areas. By testing the presence and direction of these relationships, it is possible to assess whether smallholder farmers may benefit more from a diversification or a specialization agricultural development strategy for improving their livelihoods. Based on a household survey of 637 randomly selected households, we calculated crop diversity as well as its contribution to self-consumption (measured as imputed monetary value) and to cash income for each household. With these data we estimated a system of three simultaneous equations. Results show that households maintained high levels of crop diversity: up to eight crops grown, with an-average of 3.2 per household, and with less than 5% having a null or very low level of crop diversity. The value of crop species used for self-consumption was on average 55% higher than that of crop sales. Regression results show that crop diversity is positively associated with self-consumption of food crops, and cash income from crops sold. This finding suggests that increasing crop diversity opens market opportunities for households, while still contributing to self-consumption. Given these findings, crop diversification seems to be more beneficial to these farmers than specialization. For these diversified farmers, or others in similar contexts, interventions that assess and build on their de facto crop diversity are probably more likely to be successful.
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We conducted a comparative case study-based investigation of health sector strategies that were useful in expanding or establishing new abortion services. We selected geographically diverse countries from across the human development index if they had implemented new abortion laws, or changed interpretations of existing laws or policies, within the past 15 years (Colombia, Ethiopia, Ghana, Portugal, South Africa, and Uruguay). Factors facilitating the expansion of services include use of a public health frame, situating abortion as one component of a comprehensive reproductive health package, and including country-based health and women's rights organizations, medical and other professional societies, and international agencies and nongovernment organizations in the design and rollout of services. Task sharing and the use of techniques that do not require much infrastructure, such as manual vacuum aspiration and medical abortion, are important for rapid establishment of services, especially in low-resource settings. Political will emerged as the key factor in establishing or expanding access to safe abortion services.
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Aborto Induzido/legislação & jurisprudência , Atenção à Saúde/normas , Colômbia , Atenção à Saúde/legislação & jurisprudência , Países em Desenvolvimento , Etiópia , Feminino , Gana , Humanos , Segurança do Paciente , Portugal , Gravidez , África do Sul , Uruguai , Saúde da MulherRESUMO
Abstract Ghana is a West African country for which apparently there are limited scientometric studies. The objective of this study was to analyze the Ghanaian contribution to knowledge captured in the Thomson Reuters Science Citation Index Expanded (SCI-EXPANDED) database from 1936 - 2016. The following data were analyzed: document type, the language of publication, publication trend, Web of Science Subject Categories, Journals, international collaboration, institutions, authors, and highly cited articles. Indicators such as the total number of articles, first author articles, and corresponding author articles were applied to compare publication performance for collaborative countries and institutions. Also, number of single institute articles: number of nationally collaborative articles: number of internationally collaborative articles (S : N : I) were also used to compare publication characteristics of institutions in Ghana. Results showed that publication trend increased from 1998 to 2015, with researches focusing on health and medicine. PLoS One was the top productive journal, and the most collaborative country for Ghana articles was the USA. Contributions from the University of Ghana were ranked the top one institution for Ghana articles, and higher citation papers were found in international collaborations. In conclusion, the contribution to knowledge of Ghanaian authors is massive in the areas of public, environmental and occupational health and tropical medicine but the impact factor is higher for immunology, infectious diseases, and microbiology articles. Therefore, Ghanaian authors are encouraged to publish more articles in high impact factor journals with Thomson Reuters Scientific indexing in order to have their researches recognized by the existing international databases. Rev. Biol. Trop. 66(1): 106-121. Epub 2018 March 01.
Resumen Ghana es un país del oeste de África para el cual aparentemente hay limitados estudios cienciométricos. El objetivo de este estudio fue analizar la contribución de Ghana al conocimiento capturado en la base de datos del Índice de Citación Expandido de Ciencia Thomson Reuters (SCI-EXPANDED) de 1936-2016. Se analizaron los siguientes datos: tipo de documento, lenguaje de la publicación, tendencia de la publicación, categorías temáticas de Web of Science, revistas, colaboración internacional, instituciones, autores y artículos frecuentemente citados. Los indicadores como el número total de artículos, artículos de primer autor y artículos de autor de correspondencia se aplicaron para comparar el rendimiento de publicación de países e instituciones colaboradoras. También la cantidad de artículos de una institución: la cantidad de artículos de colaboración nacional: la cantidad de artículos de colaboración internacional (S:N:I) se utilizaron para comparar las características de publicación de las instituciones de Ghana. Los resultados muestran que la tendencia de publicación incrementó de 1998 al 2015 con investigaciones enfocadas en salud y medicina. PLoS One fue la revista más productiva y el país más colaborador para los artículos de Ghana fue EE.UU. Las contribuciones de la Universidad de Ghana se clasificaron como los mejores artículos de Ghana y los artículos con mayores citaciones fueron los de colaboración internacional. En conclusión, la distribución del conocimiento de autores Ghaneses es masiva en las áreas público, ambiental y salud ocupacional y medicina tropical pero el factor de impacto es más alto en artículos de inmunología, enfermedades infecciosas y microbiología. Por lo tanto, los autores Ghaneses están alentados a publicar más artículos en revistas de alto factor de impacto con el Índice de Citación Expandido de Ciencia Thomson Reuters para que sus publicaciones sean reconocidas por las bases de datos internacionales existentes.
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Se realizó un estudio analítico-observacional, de casos y controles, no pareado, de 150 pacientes atendidos en consulta externa del Hospital Municipal Ho de la República de Ghana durante un año (de 2013 a 2014), de los cuales 50 padecían hipertensión arterial (casos) y 100 no eran hipertensos (controles), con vistas a determinar el grado de asociación causal entre los factores de riesgo y la aparición de esta enfermedad. Se validaron estadísticamente las variables mediante la oportunidad relativa, con un intervalo de confianza de 95 por ciento; la prueba de la X² de Mantel-Haenszel y el riesgo atribuible en expuesto porcentual, para determinar el factor de mayor impacto en dicha población. En la serie predominaron los pacientes del sexo masculino, mayores de 40 años, expuestos a riesgos tan importantes como la obesidad y el sedentarismo, que mostraron una significativa asociación como causa de hipertensión arterial, con mayor impacto del primero
An analytic-observational cases and controls non paired study of 150 patients assisted in the outpatient service of Ho Municipal Hospital in the Republic of Ghana was carried out during one year (from 2013 to 2014), of which 50 suffered from hypertension (cases) and 100 were not hipertensive (controls), aimed at determining the degree of causal association between the risk factors and the emergence of this disease. Variables were statistically validated by means of the odds ratio, with a 95 percent confidence interval; the Mantel-Haenszel chi square test and the attributable risk in exposed percentage, to determine the factor of more impact in this population. In the series there was a prevalence of the patients from the male sex, older than 40 years, exposed to risks so important as obesity and physical inactivity that showed a significant association as cause of hypertension, with higher impact of the first one
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fatores de Risco , Hipertensão/epidemiologia , Estudo Observacional , GanaRESUMO
ABSTRACT The medium term development plan of Ghana proposed modernization of agriculture to lead the way in transforming the economy. Providing irrigation infrastructure and enhancing farmer access to farm machinery were major interventions proposed. In line with this, the government has been investing in irrigation infrastructure as well as importing farm machinery under various programmes in recent years. This study analyzed access and intensity of mechanization by rice farmers in southern Ghana. The Shai-Osudoku and Ketu North Districts were purposively selected and a total of 360 farmers were randomly sampled from 16 rice growing communities. In general, the results of the descriptive statistics revealed that about 74 % of farmers were still cultivating rice with considerably low level of mechanization. The double hurdle model was employed to estimate the determinants of access to mechanization and the intensity of mechanization. The empirical results of tier one of the double huddle model revealed that size of land, access to credit, availability of farm machinery, expenditure on labour, agrochemical expenditure, the square of age, and gender positively influenced access to mechanization. Seed expenditure, age and district locations negatively influenced access to mechanization. The empirical results of the tier two of the double hurdle model revealed that distance from farm to nearest mechanization centre, rice income, non-farm income and experience were significant variables that positively influenced intensity of mechanization. Land ownership and household size negatively influenced intensity of mechanization. These results have implications for capacity building and government support for rice farmers in southern Ghana.
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Newcastle Disease (ND) has been identified as a major constraint to local poultry production with its impact being felt more in rural poultry production which forms about 80% of Ghana poultry population. However documented evidence on ND virus activity in rural poultry in Ghana is still lacking. Hence, this study was conducted to evaluate the level of circulating antibodies against ND using the Haemagglutination Inhibition (HI) technique. Sera collected from unvaccinated 292 chickens and 153 guinea fowls randomly selected from households and a live bird market in Kumasi and its environs were evaluated for Newcastle disease virus antibodies. Results showed 81.8 % (239/292) of local chickens and 24.2 % (37/153) of guinea fowls tested positive for ND antibodies. Comparison was made between the seroprevalence of ND antibodies in household and live bird market as well as between sexes. Significantly higher prevalence rate (p 0.05) was observed with chickens sampled from households compared to those from the live bird market. Higher ranges of titers were also observed in chickens from households than those from live bird markets. The presence of ND antibodies in these unvaccinated local chickens and guinea fowls indicated the presence of the virus amongst the rural poultry population, hence aneed for improvement in vaccine campaignand delivery against ND for rural poultry especially with the use of thermostable and improved oral or feed-based vaccine delivery systems.
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Animais , Galinhas/fisiologia , Galinhas/virologia , Testes de Inibição da Hemaglutinação , Testes de Inibição da Hemaglutinação/veterinária , Vírus da Doença de Newcastle/crescimento & desenvolvimento , Vírus da Doença de Newcastle/fisiologiaRESUMO
Newcastle Disease (ND) has been identified as a major constraint to local poultry production with its impact being felt more in rural poultry production which forms about 80% of Ghana poultry population. However documented evidence on ND virus activity in rural poultry in Ghana is still lacking. Hence, this study was conducted to evaluate the level of circulating antibodies against ND using the Haemagglutination Inhibition (HI) technique. Sera collected from unvaccinated 292 chickens and 153 guinea fowls randomly selected from households and a live bird market in Kumasi and its environs were evaluated for Newcastle disease virus antibodies. Results showed 81.8 % (239/292) of local chickens and 24.2 % (37/153) of guinea fowls tested positive for ND antibodies. Comparison was made between the seroprevalence of ND antibodies in household and live bird market as well as between sexes. Significantly higher prevalence rate (p 0.05) was observed with chickens sampled from households compared to those from the live bird market. Higher ranges of titers were also observed in chickens from households than those from live bird markets. The presence of ND antibodies in these unvaccinated local chickens and guinea fowls indicated the presence of the virus amongst the rural poultry population, hence aneed for improvement in vaccine campaignand delivery against ND for rural poultry especially with the use of thermostable and improved oral or feed-based vaccine delivery systems.(AU)
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Animais , Vírus da Doença de Newcastle/crescimento & desenvolvimento , Vírus da Doença de Newcastle/fisiologia , Galinhas/fisiologia , Galinhas/virologia , Testes de Inibição da Hemaglutinação , Testes de Inibição da Hemaglutinação/veterináriaRESUMO
Inadequate vitamin A (VA) nutrition continues to be a major problem worldwide, and many interventions being implemented to improve VA status in various populations need to be evaluated. The interpretation of results after an intervention depends greatly on the method selected to assess VA status. To evaluate the effect of an intervention on VA status, researchers in Cameroon, India, Indonesia, Mexico, Senegal and Zambia have used serum retinol as an indicator, and have not always found improvement in response to supplementation. One problem is that homeostatic control of serum retinol may mask positive effects of treatment in that changes in concentration are observed only when status is either moderately to severely depleted or excessive. Because VA is stored mainly in the liver, measurements of hepatic VA stores are the gold standard for assessing VA status. Dose response tests such as the relative dose response (RDR) and the modified relative dose response (MRDR), allow a qualitative assessment of VA liver stores. On the other hand, the use of the vitamin A-labeled isotope dilution (VALID) technique, (using 13C or 2H-labeled retinyl acetate) serves as an indirect method to quantitatively estimate total body and liver VA stores. Countries including Cameroon, China, Ghana, Mexico, Thailand and Zambia are now applying the VALID method to sensitively assess changes in VA status during interventions, or to estimate a populations dietary requirement for VA. Transition to the use of more sensitive biochemical indicators of VA status such as the VALID technique is needed to effectively assess interventions in populations where mild to moderate VA deficiency is more prevalent than severe deficiency.
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Técnicas de Diluição do Indicador , Marcação por Isótopo , Vitamina A/metabolismo , Humanos , Fígado/metabolismo , Estado Nutricional , Deficiência de Vitamina A/epidemiologiaRESUMO
This paper is the result of a visit by Brazilian researchers to Ghana, with the aim of improving understanding of the relationship between traditional healers and conventional health practices, specifically in relation to tuberculosis. Through this exploratory visit, this group of researchers promoted by the Edital Pro Africa (CNPq) had an opportunity to learn about, reflect on, and discuss the different social, economic and cultural realities and contexts that have led to the different health conditions and forms of healthcare in Ghana. Besides the direct relationship between the social and economic conditions of the country and the health of its population, it was also concluded that there is a clear distancing, in the Ghanaian reality, between the traditional healers and the conventional system, in terms of culture and modes of operation, each constituting isolated systems with little or no collaboration between them.The visit enabled us to see the difficulties involved in managing TB, including diagnosis, treatment, monitoring and co-infection with HIV. The majority of patients with TB only go to hospital after several attempts at self-medication, due to the non-specificity of the principal symptoms, and also to the trust in the traditional medicine. Initiatives to encourage research into medicinal plants in Ghana are seeking partnerships with developed countries, but not always with clear or secure national interests. For the traditional healers, there are high hopes that the information gathered by researchers from the local universities, on the plants and traditional methods they use, will result in affirmation and recognition of their practices, but they complain strongly that they receive no feedback on the research carried out.
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OBJECTIVES: To determine the frequency of Metabolic syndrome (MetS) in stage-2 hypertension and to assess the influence of MetS components over target organ damage (TOD) in Ghanaian patients. METHODS: Forty adult patients with stage-2 hypertension were enrolled in a cross-sectional study developed at the Police Hospital, Accra, between 1st February 2009 and 31st January 2010. Diagnosis of MetS was based on The National Cholesterol Education Program in Adult Treatment Panel Revised in 2005 criteria. The alterations on the heart, aortic and carotid arteries, retina, and kidneys were evaluated through the clinical examination including retinal funduscopy, chest X-Ray, ECG, and serum creatinine quantification. The Brain CT-scan was performed on the patients with clinical cerebrovascular disease manifestations. RESULTS: MetS was diagnosed in 25 cases (62.5%); female sex revealed significant association with MetS (OR, 4.88; 95% CI, 1.19-19.94; P=0.027). Ninety-five percent of patients had TOD. Coronary disease was associated with MetS (OR, 4.43; 95% CI, 1.026-19,27; P=0.047) and diabetes mellitus as single MetS component (OR, 14.00; 95% CI, 1.56-125.61; P=0.018). A positive significant correlation was shown of age with cerebrovascular disease (r=0.381; P=0.015) and coronary disease (r=0.623; P=0.000). Non-significant correlation or association (P>0.05) was shown between number of MetS components and number of TOD. CONCLUSIONS: In stage-2 hypertension patients a high frequency of MetS with a risk increase in female sex was observed. This stage hypertension is for itself an individual risk to develop cardiovascular disease with high frequency none related with MetS, although coronary disease risk was increased in diabetic patients.
Assuntos
HDL-Colesterol/sangue , LDL-Colesterol/sangue , Hipertensão/sangue , Síndrome Metabólica/sangue , Triglicerídeos/sangue , Adulto , Idoso , Biomarcadores/sangue , Índice de Massa Corporal , Doenças Cardiovasculares/sangue , Estudos Transversais , Feminino , Gana/epidemiologia , Hospitais , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Incidência , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade Abdominal/sangue , Polícia , Fatores de Risco , Índice de Gravidade de Doença , Circunferência da CinturaRESUMO
Se efectuó un estudio de desarrollo tecnológico en la Universidad para Estudios del Desarrollo, en especial la Escuela de Medicina y Ciencias de la Salud de Tamale (Northern Region, Ghana), de enero a marzo del 2010, mediante la confección de un software educativo nombrado NEUROEVAL, que incluía el contenido impartido sobre el sistema nervioso central en las clases prácticas de Anatomía y serviría para la autoevaluación de los estudiantes, previo al examen final de cada sección. La eficacia del software se validó mediante encuestas a usuarios (n=15) y expertos (n=7), los cuales coincidieron al evaluarlo como útil (93,7 y 100,0 %, respectivamente). En cuanto a su diseño, los usuarios lo hallaron funcional y comprensible, mientras que los expertos refirieron que era simple. El contenido fue valorado como importante para ambos grupos. En fin, el aporte de esta herramienta informática al proceso docente fue satisfactorio.
A technological development study was conducted at the University for Development Studies, especially School of Medicine and Health Sciences of Tamale (Northern Region, Ghana) from January to March 2010, by means of an educational software named NEUROEVAL, including the content imparted on the central nervous system in Anatomy practical classes and it would serve for the self-evaluation of students before the final examination of each section. The effectiveness of the software was validated through users (n =15) and experts (n=7) surveys, who agreed to evaluate it as useful (93.7% and 100.0%, respectively). On terms of design, users found it functional and comprehensible, while experts reported that it was simple. The content was valued as important for both groups. Finally, the contribution of this computer tool to the educational process was satisfactory.
RESUMO
Se realizó un estudio descriptivo y observacional sobre las funciones del personal docente sobre todo en calidad de tutores en la enseñanza de contenidos biomédicos en la Escuela de Medicina y Ciencias de la Salud de Tamale (Ghana), desde 2008 hasta 2011, a partir del aprendizaje basado en la solución de problemas. Entre las principales dificultades identificadas, las cuales nunca superaron las ventajas, figuraron: motivar más la participación de los estudiantes en la clase, escuchar las inquietudes de los alumnos, así como preguntar e investigar acerca del proceso de razonamiento de los educandos, cuyos porcentajes fluctuaron desde 43,3 hasta 40,0, en ese orden; sin embargo, el interés por la aplicación de este método continúa aumentando en las nuevas universidades médicas del mundo con necesidades de desarrollo.
A descriptive and observational study on the teaching staff `s activities, mainly as tutors in biomedical contents teaching was carried out at the School of Medicine and Health Sciences in Tamale (Ghana), from 2008 to 2011, taking into account the learning based on the solution to problems. Among the main identified difficulties, which never overcame the advantages, there were: to motivate more the participation of the students in the class, to listen the concerns of the students, as well as to ask and to investigate about the process of reasoning of the students, whose percentages fluctuated from 43.3 to 40.0, in that order; however, the interest for the implementation of this method is increasing in the new medical universities of the world with development needs.
RESUMO
Improving the quality of obstetric care is an urgent priority in developing countries, where maternal mortality remains high. The feasibility of criterion-based clinical audit of the assessment and management of five major obstetric complications is being studied in Ghana and Jamaica. In order to establish case definitions and clinical audit criteria, a systematic review of the literature was followed by three expert panel meetings. A modified nominal group technique was used to develop consensus among experts on a final set of case definitions and criteria. Five main obstetric complications were selected and definitions were agreed. The literature review led to the identification of 67 criteria, and the panel meetings resulted in the modification and approval of 37 of these for the next stage of audit. Criterion-based audit, which has been devised and tested primarily in industrialized countries, can be adapted and applied where resources are poorer. The selection of audit criteria for such settings requires local expert opinion to be considered in addition to research evidence, so as to ensure that the criteria are realistic in relation to conditions in the field. Practical methods for achieving this are described in the present paper.