Achievements and challenges of lymphatic filariasis elimination in Sierra Leone

BackgroundLymphatic filariasis (LF) is targeted for elimination in Sierra Leone. Epidemiological coverage of mass drug administration (MDA) with ivermectin and albendazole had been reported >65% in all 12 districts annually. Eight districts qualified to implement transmission assessment survey (TAS) in 2013 but were deferred until 2017 due to the Ebola outbreak (2014–2016). In 2017, four districts qualified for conducting a repeat pre-TAS after completing three more rounds of MDA and the final two districts were also eligible to implement a pre-TAS.Methodology/Principal findingsFor TAS, eight districts were surveyed as four evaluation units (EU). A school-based survey was conducted in children aged 6–7 years from 30 clusters per EU. For pre-TAS, one sentinel and one spot check site per district (with 2 spot check sites in Bombali) were selected and 300–350 persons aged 5 years and above were selected. For both surveys, finger prick blood samples were tested using the Filariasis Test Strips (FTS).For TAS, 7,143 children aged 6–7 years were surveyed across four EUs, and positives were found in three EUs, all below the critical cut-off value for each EU. For the repeat pre-TAS/pre-TAS, 3,994 persons over five years of age were surveyed. The Western Area Urban had FTS prevalence of 0.7% in two sites and qualified for TAS, while other five districts had sites with antigenemia prevalence >2%: 9.1–25.9% in Bombali, 7.5–19.4% in Koinadugu, 6.1–2.9% in Kailahun, 1.3–2.3% in Kenema and 1.7% - 3.7% in Western Area Rural.Conclusions/SignificanceEight districts in Sierra Leone have successfully passed TAS1 and stopped MDA, with one more district qualified for conducting TAS1, a significant progress towards LF elimination. However, great challenges exist in eliminating LF from the whole country with repeated failure of pre-TAS in border districts. Effort needs to be intensified to achieve LF elimination.     

Evaluation of Napier grass (Pennisetum purpureum) varieties for use as trap plants for the management of African stemborer (Busseola fusca) in a push–pull strategy

We evaluated eight Napier grass [Pennisetum purpureum Schumach (Poaceae)] varieties, used in various parts of eastern Africa as fodder, for their potential role as trap plants in the management of the African stemborer, Busseola fusca Füller (Lepidoptera: Noctuidae) through a push–pull strategy. Oviposition preference, larval orientation, settling, arrest and dispersal, feeding, mortality and survival, and development were determined for each of these varieties under laboratory and screen house conditions. Two‐choice tests showed that only two of the varieties tested (cv. Bana and cv. Uganda Hairless) were preferentially chosen by gravid female moths for oviposition over a susceptible maize variety, cv. Western Hybrid 502. Larval preference was, however, highly variable. Larval feeding by first instars on the maize leaves was more intense and significantly more than on leaves of all the Napier grass varieties evaluated. Food consumed and amounts assimilated by the third instars over a 24‐h period were not different among larvae fed on stems of maize and those fed on stems of the various Napier grass varieties. Larval survival was significantly lower on all the Napier grass varieties (below 3%) than on maize (about 44%). Similarly, larval development was about 2–3 weeks longer on majority of the Napier grass varieties. It was concluded that cv. Bana had potential for use as a trap plant in the management of B. fusca because it was more preferred by the moths for oviposition, equally preferred as maize by the larvae for orientation, settling, and arrest, and allowed minimal survival of the larvae. It can thus be used with such ‘push’ plants as Desmodium spp. (Fabaceae) in a ‘push–pull’ strategy, but the effectiveness of such a strategy would strictly depend on proper establishment and management of these companion plants.     

Optimum allocation of conservation funds and choice of conservation programs for a set of African cattle breeds

Although funds for livestock conservation are limited there is little known about the optimal allocation of conservation funds. A new algorithm was used to allocate Mio US$ 1, 2, 3, 5 or unlimited funds, discounted over 50 years, on 23 African cattle breeds conserved with four different possible conservation programs. Additionally, Mio US$ 1 was preferably allocated to breeds with special traits. The conceptional in situ conservation programs strongly involve breeders and give them part of the responsibility for the conservation of the breed. Therefore, the pure in situ conservation was more efficient than cryoconservation or combined in situ and cryoconservation. The average annual discounted conservation cost for a breed can be as low as US$ 1000 to US$ 4400 depending on the design of the conservation program and the economic situation of the country of conservation. The choice of the breeds and the optimal conservation program and the amount of money allocated to each breed depend on many factors such as the amount of funds available, the conservation potential of each breed, the effects of the conservation program as well as its cost. With Mio US$ 1, 64% of the present diversity could be maintained over 50 years, which is 13% more than would be maintained if no conservation measures were implemented. Special traits could be conserved with a rather small amount of the total funds. Diversity can not be conserved completely, not even with unlimited funds. A maximum of 92% of the present diversity could be conserved with Mio US$ 10, leaving 8% of the diversity to unpredictable happenings. The suggested algorithm proved to be useful for optimal allocation of conservation funds. It allocated the funds optimally among breeds by identifying the most suited conservation program for each breed, also accounting for differences in currency exchange rates between the different countries.     

Maternal Determinants of Birth Weight in Northern Ghana

Objectives

Weight at birth is usually considered as an indicator of the health status of a given society. As a result this study was designed to investigate the association between birth weight and maternal factors such as gestational weight gain, pre—pregnancy BMI and socio—economic status in Northern Ghana.

Methods

The study was a facility-based cross-sectional survey conducted in two districts in the Northern region of Ghana. These districts were purposively sampled to represent a mix of urban, peri—urban and rural population. The current study included 419 mother-infant pairs who delivered at term (37–42 weeks). Mother’s height, pre-pregnancy weight and weight changes were generated from the antenatal records. Questionnaires were administered to establish socio-economic and demographic information of respondents. Maternal factors associated with birth weight were examined using multiple and univariate regressions.

Results

The mothers were generally well nourished before conception (Underweight 3.82%, Normal 57.76%, Overweight 25.06% and Obesity 13.37%) but approximately half of them could not gain adequate weight according to Institute of Medicine recommendations (Low weight gain 49.64%, Adequate weight gain 42.96% and Excessive weight gain 7.40%). Infants whose mothers had excess weight gain were 431g (95% CI 18–444) heavier compared to those whose mothers gained normal weight, while those whose mothers gained less were 479g (95% CI -682– (-276) lighter. Infants of mothers who were overweight and obese before conception were 246g (95% CI 87–405) and 595g (95% CI 375–815) respectively heavier than those of normal mothers, whereas those whose mothers were underweight were 305g (95% CI -565 –(-44) lighter. The mean birth weight observed was 2.98 ± 0.68 kg.

Conclusion

Our findings show that pre-pregnancy body mass index and weight gain during pregnancy influence birth weight. Therefore, emphasis should be placed on counseling and assisting pregnant women to stay within the recommended weight gain ranges.     

Experiences with the Mass Distribution of LPG Stoves in Rural Communities of Ghana

Household air pollution (HAP) is a leading cause of morbidity and mortality worldwide. To limit HAP exposure and environmental degradation from biomass fuel use, the Government of Ghana promotes liquefied petroleum gas (LPG) use in rural Ghana via the Rural LPG program (RLP). We assessed the experiences of the RLP in 2015, 2 years after its launch. A mixed methods approach was used involving Focus Group Discussions (19) and in-depth interviews (25). In addition, a survey questionnaire was administered to elicit socio-demographic characteristics, household cooking practices and stove use patterns of 200 randomly selected respondents. At about 9 months after LPG acquisition,?<?5% of LPG beneficiaries used their stoves. Some of the reasons ascribed to the low usage of the LPG cookstoves were financial constraints, distance to LPG filling point and fear of burns. Community members appreciate the convenience of using LPG. Our results underscore a need for innovative funding mechanisms contextualized within an overall economic empowerment of rural folks to encourage sustained LPG use. It emphasizes the need for innovative accessibility interventions. This could include establishing new LPG filling stations in RLP beneficiary districts to overcome the barriers to sustained LPG use.     

Diet and Physical Activity for the Prevention of Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic Policy Review

Background

Diet-related noncommunicable diseases (NCDs) are increasing rapidly in low- and middle-income countries (LMICs) and constitute a leading cause of mortality. Although a call for global action has been resonating for years, the progress in national policy development in LMICs has not been assessed. This review of strategies to prevent NCDs in LMICs provides a benchmark against which policy response can be tracked over time.

Methods and Findings

We reviewed how government policies in LMICs outline actions that address salt consumption, fat consumption, fruit and vegetable intake, or physical activity. A structured content analysis of national nutrition, NCDs, and health policies published between 1 January 2004 and 1 January 2013 by 140 LMIC members of the World Health Organization (WHO) was carried out. We assessed availability of policies in 83% (116/140) of the countries. NCD strategies were found in 47% (54/116) of LMICs reviewed, but only a minority proposed actions to promote healthier diets and physical activity. The coverage of policies that specifically targeted at least one of the risk factors reviewed was lower in Africa, Europe, the Americas, and the Eastern Mediterranean compared to the other two World Health Organization regions, South-East Asia and Western Pacific. Of the countries reviewed, only 12% (14/116) proposed a policy that addressed all four risk factors, and 25% (29/116) addressed only one of the risk factors reviewed. Strategies targeting the private sector were less frequently encountered than strategies targeting the general public or policy makers.

Conclusions

This review indicates the disconnection between the burden of NCDs and national policy responses in LMICs. Policy makers urgently need to develop comprehensive and multi-stakeholder policies to improve dietary quality and physical activity. Please see later in the article for the Editors'' Summary     

Evaluating Farmers’ Knowledge of Shade Trees in Different Cocoa Agro-Ecological Zones in Ghana

Shade trees are an integral part of most cocoa growing systems across the world. This study assesses farmers’ local knowledge of shade trees at two locations in Ghana with different climatic conditions and vulnerability to climate change. Akumadan is located in the northern dry part of the cocoa belt representing marginal conditions for cocoa cultivation, whereas Asankragua is located in the southern wet part, more ecologically favorable for cocoa cultivation. Inventories were conducted to assess the abundance of species, their structural characteristics and benefits to cocoa systems. Results show that cocoa farmers have detailed knowledge on the functions of shade trees in cocoa systems and prefer species that provide specific needs according to the location. However, abundance of species in a location does not necessary translate into beneficial impacts on cocoa productivity. In the drier part of the cocoa belt, income diversification through shade trees is an adaptation strategy to the increasingly marginal conditions for cocoa production, which has led to the high proportion of fruit trees among the most abundant species. In contrast, farmers in the southern part of the cocoa belt select shade trees for their high cocoa compatibility. Adaptation strategies for cocoa farmers should therefore promote species that best accommodate farmers’ economic, agronomic and environmental needs.     

The Economic Burden of Meningitis to Households in Kassena-Nankana District of Northern Ghana

Objective

To estimate the direct and indirect costs of meningitis to households in the Kassena-Nankana District of Ghana.

Methods

A Cost of illness (COI) survey was conducted between 2010 and 2011. The COI was computed from a retrospective review of 80 meningitis cases answers to questions about direct medical costs, direct non-medical costs incurred and productivity losses due to recent meningitis incident.

Results

The average direct and indirect costs of treating meningitis in the district was GH¢152.55 (US$101.7) per household. This is equivalent to about two months minimum wage earned by Ghanaians in unskilled paid jobs in 2009. Households lost 29 days of work per meningitis case and thus those in minimum wage paid jobs lost a monthly minimum wage of GH¢76.85 (US$51.23) due to the illness. Patients who were insured spent an average of GH¢38.5 (US$25.67) in direct medical costs whiles the uninsured patients spent as much as GH¢177.9 (US$118.6) per case. Patients with sequelae incurred additional costs of GH¢22.63 (US$15.08) per case. The least poor were more exposed to meningitis than the poorest.

Conclusion

Meningitis is a debilitating but preventable disease that affects people living in the Sahel and in poorer conditions. The cost of meningitis treatment may further lead to impoverishment for these households. Widespread mass vaccination will save households'' an equivalent of GH¢175.18 (US$117) and impairment due to meningitis.     

Yield loss at the different growth stages in soybean due to insect pests in Ghana

Insecticide protection at the vegetative, reproductive or both vegetative and reproductive (complete) crop growth stages and untreated control was used to assess yield loss due to insect pests at the different growth stages of soybean in Ghana from 2007–2009. The objectives were to determine the economic importance of the two major insect pest guilds in soybean, viz. defoliators and pod feeders, and when to apply control measures for maximum benefit. The defoliators recorded were Podagrica spp., Ootheca mutabilis (Shalberg), Zonocerus variegatus L., Sylepta derogata F., Spodoptera littoralis Boisduval, Amsacta spp. and Helicoverpa armigera Hübner. The pod feeders recorded were the pod-sucking bugs (PSBs) Riptortus dentipes F., Thyanta sp. Aspavia armigera F., Nezara viridula L. and Dysdercus völkeri Schmidt. Generally, insect densities, pod and seed damage were lower while seed yields were significantly greater and similar in plots that were protected at the reproductive stage against PSBs and those protected at both vegetative and reproductive stages. Yield loss ranged between 25.8 and 42.8% in untreated plots, 11.1 and 34.3% in plots that were protected at the vegetative stage, and 5.2 and 11.3% in plots that were protected at the reproductive stage. There was a consistent negative correlation between yield and numbers of PSBs as well as pod and seed damage. These results showed that PSBs that attack soybean at the reproductive stage were the most important insect pests limiting soybean yield in Ghana.