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- ItemTelemedicine and maternal health outcomes in the Amansie West District, Ghana.(KNUST, 2017-11) Nuamah, Gladys BuruwaaABSTRACT Maternal health outcomes remain gruesome in less developed, middle and low income countries due to weak health systems, geographical barriers, socio-cultural and economic factors and shortage of health professionals. In Ghana and other parts of the world hit by high maternal mortality, there are consistent efforts aimed at addressing maternal mortality, however, the values of using information, communication and technology (ICT) in maternal healthcare delivery remain under exploited. This study was conducted to assess the use and influence of telemedicine on maternal health outcomes, obstetric referrals and health care seeking behavior of mothers to inform implementation of telemedicine in Ghana. A before and after study sandwiched by a prospective sub-study were conducted in the Amansie West district in Ashanti region of Ghana. The before (phase 1) and after study (phase 3) involved randomly selected 720 pregnant women while the prospective study (phase 2) involved 300 pregnant women diagnosed in second trimester (from ANC register) with no diseases, followed up from Antenatal Clinic (ANC) till completion of Post Natal Clinic (PNC) period which lasted for nine months. The baseline study was conducted before a district-wide implementation of telemedicine and an after study in 2017. The study participants served as their own controls with no comparison group. Both quantitative and qualitative data were collected using structured questionnaire, interview guides and observation checklist. The study spanned from February 2015 to January 2017. Trend analysis of maternal health outcomes from 2008 to 2016 was undertaken using data from DHIMS II to validate the findings from the surveys. Multiple regression models were used to estimate the influence of socio-economic status, access to healthcare and service quality on utilization of maternal healthcare and obstetric referrals on maternal outcomes. Differences in maternal outcomes in relation to experience with telemedicine were assessed using Chi-square (2 ) in r X n tables. The results showed a high level of acceptability of telemedicine among mothers and health workers, who also had positive perception of the influence of telemedicine on maternal healthcare. The positive influence of telemedicine on maternal outcomes was however not statistically significant. Proportion of women who had >3 antenatal care visits, access to skilled delivery and postnatal care were 68.5%, 41.1% and 33.6% at baseline and 43.6%, 59.6%; 59.0% at endline respectively. The mothers‟ socio-economic background and health access influenced their utilization of maternal healthcare, 21.7% and 6.4% of the women studied honoured referral by a community health worker to the next level of care in the baseline and endline studies respectively. Some of the pregnant women however refused referrals to the next level due to lack of money (58%) and lack of transport (17%), in the baseline study. Women who perceived their disease conditions as emergencies and severe were more likely to honour obstetric referral (OR=2.3; 95% CI=1.3, 3.9), baseline. Findings from this study suggest suboptimal utilization of maternal healthcare in the district. Clients‟ perception about severity of health condition and low income remain as barriers to healthcare seeking and disincentives to honour obstetric referrals in a setting with inequitable access to healthcare. Although telemedicine holds the promise of bridging these gaps for improved maternal healthcare, the programme is yet to substantiate its positive impact quantitatively on maternal health outcomes. Improving the socio-economic status and maternal health related promotion activities could improve the yield of telemedicine in the study area.
- ItemNovel Catalyst for the Conversion of Synthesis Gas to Fuel: A Computational Study.(KNUST, 2019-03) Menkah, Elliot SarpongAbstract Novel Catalyst for the Conversion of Synthesis Gas to Fuel: A Computational Study. First-principles density functional theory based calculations with a generalized gradient approximation (GGA) of the PBE exchange correlation functional have been used to study the interaction between noble metal, ruthenium (Ru), and base metal, nickel (Ni), as employed in the making of Ni-Ru bimetallic catalysts. To evaluate the consequences of forming bimetallic materials for catalytic and electronic applications, the electronic structure of nickel-ruthenium interface with low miller index surfaces of nickel have been investigated. The preferred sites and geometry con guration for ruthenium deposition/electroplating is determined and the work of adhesion which characterizes the strength of ruthenium adhesion to the nickel substrate is calculated. It's shown from the calculation of adhesion energies that ruthenium adatom forms the strongest contact with the (110) surface at a 5fold-hollow site, followed by the (111) surface at a 3fold-hcp site and then the (100) surface at a 4fold-site. The bimetallic composite a ords a bifunctional mechanism that thermodynamically favours CO activation on Ni-Ru 0.06 ML coverage and even stronger on 1ML Ni-Ru coverage when both are compared to that of the nickel monometallic system. A systematic study of carbon monoxide hydrogenation on ruthenium-Monolayer-Covered-fcc-Ni-(111), Ru-MLC-fcc-Ni-(111), was undertaken towards the formation of long chain hydrocarbons according to the Fischer-Tropsch Synthesis. The interaction of reactant molecules such as CO and H2 as well as dissociated fragments were investigated. Methanol species and ethylene radical, both of which are precursors to chemical fuel production, CH2-CH2 (Eads = -705.57 kJmol1) are intermediate species of the FT synthesis on the bimetallic system, Ru- MLC-fcc-Ni-(111). The search for alternative source of energy has also drawn interest in energy production via directly fed fuel cells technology of which there exists di erent kinds of cells which vary in catalytic material for the anode and fuel source. A viable kind of the variations, which mitigates high cost from commonly made platinum-based fuel cells, yet improves fuel cell performance is Direct Hydrazine Fuel Cells with nickel catalyst as the anode. Density functional theory calculations, with a correction for the long-range interactions, of the adsorption of hydrazine (N2H4) on the Ni (110), (100), and (111) surfaces, both defect-free planes and surfaces containing point defects in the form of adatoms and vacancies is undertaken. Several low-energy adsorption structures for hydrazine on the perfect and defective surfaces have been identi ed and compared. The hydrazine molecule is shown to interact with the Ni surfaces mainly through the lone-pair of electrons located on the N atoms, forming either monodentate or bidentate bonds with the surface. The strength of N2H4 adsorption on the perfect surfaces is found to be directly related to their stability, i.e. it adsorbs most strongly onto the least stable (110) surface via both N atoms in a gauche-bridge con guration (Eads = -1.43 eV), followed by adsorption on the (100) where it also binds in gauche-bridge con gurations (Eads = -1.27 eV), and most weakly onto the most stable (111) surface via one N-Ni bond in a trans-atop con guration (Eads = -1.18 eV). The creation of point defects in the form of Ni adatoms and vacancies provides lowercoordinated Ni sites, allowing stronger hydrazine adsorption. Analysis into the bonding nature of N2H4 onto the Ni surfaces reveals that the adsorption is characterized by strong hybridization between the surface Ni d-states and the N p-orbitals, which is corroborated by electron density accumulation within the newly formed N-Ni bonding regions.
- ItemMalaria transmission dynamics and insecticide resistance of malaria vectors in the Kassena-Nankana Districts of Ghana(KNUST, 2016-02) Asoala, VictorABSTRACT Plasmodium falciparum malaria is a serious tropical disease that causes more than one million deaths each year, mostly in Africa. It is transmitted by a range of Anopheles mosquitoes. Progress in global malaria control over the past decade is largely gained through investments in vector control; especially insecticide treated mosquito nets (ITNs). ITNs have been used extensively in the Kassena Nankana districts (KND) of Ghana for over two decades. This study aimed to investigate the intensity of malaria transmission and resistance status of vector populations in KND, relate these data to historical patterns of transmission intensity and determine whether the presence of insecticide resistance has an effect on malaria transmission in KND. Anopheles gambiae s.l. was the predominant Anopheles which constituted 68.82% (95% CI 68.18 - 69.45) (N=13938). Anopheles funestus constituted 10.97% (95% CI 10.55 – 11.41) (N=2222) whilst An. pharoensis and An. rufipes constituted the rest of 20. 21% (95% CI 19.66 - 20.77), (N=4092). Molecular analysis of the An. gambiae s.l. revealed only An. gambiae s.s. as sibling species, mainly of Anopheles coluzzii (M-form). Anopheles biting started early, peaked around 10.00pm and continued to the early hours of the morning. Plasmodium falciparum sporozoite infectivity results revealed active transmission by An. gambiae s.s.as early as 8pm and serious transmission occurred towards the early hours of the morning because of combined infective biting by both An. gambiae s.s and An. funestus. There was marked temporal variations in malaria intensity estimated as the entomological inoculation rate (EIR) with the irrigated zone experiencing the highest during the year. Compared to what was reported over a decade ago, the intensity of transmission has reduced by 66.7% from 418 to 139 infective bites/man/year. Results of the study indicated high phenotypic resistance to the insecticide classes tested. High frequencies of the Knock down resistance (kdr) and vi Ace-1R alleles (responsible for pyretroid/DDT and carbamate /organophosphate resistance respectively) including the N1575Y allele (reported to enhance resistance to pyrethroids) was observed. The variations observed in biting patterns, transmission intensity and the high insecticide resistance observed in the main malaria vector has important consequences for the success of the widely used insecticide-based strategies in KND.
- ItemEfficacy, safety and tolerability of Dihydroartemisinin-Piperaquine for treatment of uncomplicated falciparum malaria in pregnancy in Ghana.(KNUST, 2016-06) Osarfo, JosephPrimarily, the study’s original contribution to knowledge is in providing evidence of the safety and efficacy of dihydroartemisinin-piperaquine (DHA-PPQ) use in pregnant women from a clinical trial. DHA-PPQ has potential for use as treatment for uncomplicated malaria in pregnancy. However, there is a paucity of safety data on the use of this drug combination in pregnancy and only two studies have reported its use in pregnancy so far. Additionally, the prevalence of parasite mutations underscoring reported reduced susceptibility to ACTs and SP was assessed to help rationalize drug policy. The diagnostic performance of First Response® malaria rapid diagnostic test (RDT) and perceptions associated with clinical trial participation were assessed in Ghanaian pregnant women to help fill knowledge gaps in these areas. Second and third trimester pregnant women with asymptomatic parasitaemia were randomized to receive DHA-PPQ and artesunate-amodiaquine (ASAQ) in a non- inferiority trial and followed up on days 1, 2, 3, 7, 14, 28 and 42 after start of study treatment, at delivery and 6 weeks post-partum for adverse events, haematological and parasitological outcomes and neonatal morbidity and mortality data. Mutations at the Pfcrt, Pfmdr1, Pfdhfr and Pfdhps genes were investigated using polymerase chain reaction and antigen-antibody reaction-based methods. Results of RDTs at screening were compared to peripheral blood film microscopy used as reference standard. Pregnant women’s perceptions of participating in clinical trials were obtained from in-depth interviews with women who participated in the trials and those who did not. Overall parasitological efficacy for DHA-PPQ was 91.6% (95%CI: 86.7, 95.1) by day 28 and 89.0% (95%CI: 83.6. 93.0) by day 42 in the per protocol population. Efficacy estimates in both arms were comparable. DHA-PPQ was non-inferior to ASAQ with respect to parasite clearance in both analyses populations. There were no harms associated with the use of DHA-PPQ in the second and third trimesters and it fewer adverse events than ASAQ; anorexia (12.0% vs 22.3%; p=0.007), vomiting (19.5% vs 29.4%; p=0.02), dizziness (14.5% vs 26.6%; p=0.003) and general weakness (38.5% vs 62.5%; p<0.0001). Tolerability was high as no participant left the study on account of adverse events experienced. There were no overall changes in white blood cell and differential counts. Close to 90% of parasite isolates from the infected pregnant women were wild type at the Pfcrt gene with a similar prevalence of Pfmdr1 N86 alleles. The Pfdhfr/Pfdhps quintuple mutation containing the 540E allele, known to underlie marked SP resistance, was not observed. Participation in clinical trials appeared to be motivated mainly by anticipated health benefits and trust in the research team especially if they are also health workers. Study women were comfortable with blood sampling in their homes but preferred hospital-based sampling better as it supposedly assures blood samples will be used for desired purposes. They conceptualized treatment-emergent adverse events as independent entities that should be separated from drugs. Dihydroartemisinin-piperaquine is deemed safe and as effective as ASAQ when used to treat uncomplicated malaria during pregnancy. The study results are expected to contribute to evidence that will guide a policy decision on the use of DHA-PPQ use in pregnant women. The predominance of Pfcrt K76 suggests the possibility of using chloroquine again in pregnancy but this will have to be in combination with another antimalarial. The predominance of Pfcrt K76 and Pfmdr1 N86 alleles appear to suggest early declining susceptibility to artemether-lumefantrine, an artemisininbased combination treatment currently used in pregnancy. Strengthened targeting of ACT treatment through more dedicated malaria infection testing using tools such as RDTs and monitoring are required. Researchers planning similar studies in pregnant women in the study area need to emphasize transportation to health facilities for blood sampling and potential health benefits.
- ItemComparative Clinical Study of Mist Amen Fevermix and Edhec Malacure: Two Polyherbal Products used for the Treatment of uncomplicated malaria in Ghana against Artemether/Lumefantrine(2020-11) Turkson, Bernard Kofi; https://orcid.org/0000-0002-4990-7725The use of herbal medicinal products for the treatment of malaria an infectious and a life threatening disease, has increased globally. However, inadequate scientific studies, questions about the quality, safety and efficacy of such herbal products have been raised. On the other hand, the reduced sensitivity of the malaria parasites to artemisinin-based combination therapies is also of concern. There is therefore the need for new antimalarial medications including those from alternative sources such as herbal medicinal products. In this study, methods for the quality control of Mist Amen Fevermix and Edhec Malacure, two polyherbal antimalarial products used in Ghana for the management of uncomplicated malaria was undertaken. The development of the quality parameters for the test samples was based on phytochemical, physicochemical, chromatographic and spectroscopic methods. The set parameters were found to be sufficient to evaluate Mist Amen Fevermix and Edhec Malacure, and can be used as reference standards for the quality control purposes. Qualitative phytochemical screening and fingerprinting were undertaken based on standard analytical methods. The antiplasmodial activity was assessed in vitro by using field isolates of Plasmodium falciparum with SYBR® Green assays to measure parasite growth inhibition. Thermo Elemental M5 Atomic Absorption Spectrophotometer (AAS) fitted with Graphite furnace and an auto sampler was used to determine the heavy metal contents of the herbal products. The herbal samples were evaluated for microbial load by using the appropriate culture media. In vivo antiparasitic activity in mice was assessed using the Rane’s curative method using ANKA strain of Plasmodium berghei parasites. A comparative clinical study was done to assess the safety and effectiveness of the test samples at the Tafo Government Hospital, Kumasi after Committee on Human Research, Publication and Ethics approval. Male and female patients aged 15-45 years with clinically established malaria were treated with Mist Amen Fevermix and Edhec Malacure, at the specified doses of 45 mls (0.1063 g) and 30 mls (0.0521 g) three times daily after meals for three days. Basic phytochemical screening of the two products indicated the presence of the following phytochemicals: alkaloids, saponins, tannins, phytosterols and flavonoids. From the data, it was established that Mist Amen Fevermix and Edhec Malacure complied with the pharmacopoeial standards after testing for microbes. The following heavy metals were present in Mist Amen Fevermix and Edhec Malacure: Fe, Ni, K, Zn, Hg, Cu, Mn, Cr, Cd, Pb, Fe, Cu, K and Na. Ni was below detectable limit in Edhec Malacure. The phytochemical screening of the products revealed the presence of alkaloid flavonoid, tannin, steroid and saponin. The HPLC method was validated for linearity, limits of detection and quantification, precision and accuracy. The test products were found not to have been adulterated with lumefantrine, artemether and quinine. The test herbal products showed in vitro and in vivo antiplasmodial activities against Plasmodium falciparum and Plasmodium berghei parasites. Inhibitory concentration (IC50) values for Edhec Malacure was 70.89 ng/ml and that of Mist Amen Fevermix was 112.5 ng/ml. Edhec Malacure suppressed 76.17% of parasitaemia while Mist Amen Fevermix suppressed 69.03% of parasitaemia. Edhec Malacure demonstrated curative chemo suppressive potentials of 80.93% at the dose of 2.234 mgkg-1 and Mist Amen Fevermix % suppression was 69.03% at a dose of 4.56mg/kg-1. Both products demonstrated antiplasmodial activity in human red blood cells. The clinical evaluation of the test samples showed that Mist Amen Fevermix exhibited a statistically significant difference between the mean malaria parasite load recorded at the first visit and those recorded at the second visit, t(23) = 4.59, p =0 .000. Similarly, there was a significant difference between the mean parasite count recorded on the second visit and the third visit, t(6) = 1.49, p =0 .187. No difference were recorded for the third and fourth visits t(3) = 1.00, p =0 .391. Edhec Malacure also exhibited a significant difference in efficacy between the mean malaria parasite count recorded at the first visit and those recorded at the second visit, t(26) =3.77, p =0 .001. Similarly, there is a statistically significant difference between malaria parasite count at the second visits and third visits, t(16) = 1.74, p =0 .100. This shows the significant effectiveness of the products. Kidney and liver panel as well as full blood count and vital signs were within normalviii reference range at the end of the 28-day study and thus established the safety of Mist Amen Fevermix and Edhec Malacure in the treatment of uncomplicated malaria. The results support claims that Mist Amen Fevermix and Edhec Malacure may be useful antimalarial agents. This study has demonstrated the in vitro and in vivo antiplasmodial activities of Mist Amen Fevermix and Edhec Malacure, and suggests that, the products have promising antimalarial activity. The in vivo findings showed that Mist Amen Fevermix and Edhec Malacure are relatively safe for oral administration at doses tested. In addition, the study supports the use of Mist Amen Fevermix and Edhec Malacure, two polyherbal products for the treatment of uncomplicated malaria. Both products achieved a comparable clinical treatment outcome to the reference control medication artemether/lumefantrine.