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Purpose: Population-based incidence rates of breast cancers that are negative for estrogen receptor (ER), progesterone receptor, and human epidermal growth factor receptor 2/neu (triple-negative breast cancer [TNBC]) are higher among African American (AA) compared with white American (WA) women, and TNBC prevalence is elevated among selected populations of African patients. The extent to which TNBC risk is related to East African versus West African ancestry, and whether these associations extend to expression of other biomarkers, is uncertain. Methods: We used immunohistochemistry to evaluate estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2/neu, androgen receptor and aldehyde dehydrogenase 1 (ALDH1) expression among WA (n = 153), AA (n = 76), Ethiopian (Eth)/East African (n = 90), and Ghanaian (Gh)/West African (n = 286) patients with breast cancer through an institutional review board–approved international research program. Results: Mean age at diagnosis was 43, 49, 60, and 57 years for the Eth, Gh, AA, and WA patients, respectively. TNBC frequency was higher for AA and Gh patients (41% and 54%, respectively) compared with WA and Eth patients (23% and 15%, respectively; P < .001) Frequency of ALDH1 positivity was higher for AA and Gh patients (32% and 36%, respectively) compared with WA and Eth patients (23% and 17%, respectively; P = .007). Significant differences were observed for distribution of androgen receptor positivity: 71%, 55%, 42%, and 50% for the WA, AA, Gh, and Eth patients, respectively (P = .008). Conclusion: Extent of African ancestry seems to be associated with particular breast cancer phenotypes. West African ancestry correlates with increased risk of TNBC and breast cancers that are positive for ALDH1.

Purpose: Breast cancer, the most common cancer worldwide, is the leading cause of cancer mortality in Ghanaian women. Previous studies find Ghanaian women are diagnosed at a younger age and at more advanced stages (III and IV), and have tumors with characteristics similar to African American women. We sought to remedy gaps in knowledge about breast cancer survival in Ghana and its relation to demographic and biologic factors of the tumors at diagnosis to assist in cancer control and registration planning. Methods: Individuals with a breast cancer diagnosis who sought care at Komfo Anokye Teaching Hospital from 2009 to 2014 were identified via medical records. Follow-up telephone interviews were held to assess survival. Kaplan-Meier plots and Cox proportional hazards models assessed survival associated with clinical and demographic characteristics. Results: A total of 223 patients completed follow-up and were analyzed. The median survival was 3.8 years. Approximately 50% of patients were diagnosed with grade 3 tumors, which significantly increased the risk of recurrence or death (hazard ratio [HR] for grade 2 versus 1, 2.98; 95% CI, 1.26 to 7.02; HR grade 3 v 1, 2.56; 95% CI, 1.08 to 6.07; P = .04). No other variables were significantly associated with survival. Conclusion: Higher tumor grade was significantly associated with shorter survival, indicating impact of aggressive biology at diagnosis on higher risk of cancer spread and recurrence. Contrary to prevailing notions, telephone numbers were not reliable for follow-up. Collecting additional contact information will likely contribute to improvements in patient care and tracking. A region-wide population-based active registry is important to implement cancer control programs and improve survival in sub-Saharan Africa.

Abstract Background Ghana introduced a free maternal healthcare policy within its National Health Insurance Scheme (NHIS) in 2008 to remove financial barriers to accessing maternal health services. Despite this policy, evidence suggests that women incur substantial out-of-pocket (OOP) payments for maternal health care. This study explores the underlying reasons for these persistent out-of-pocket payments within the context of Ghana’s free maternal healthcare policy. Methods Cross-sectional qualitative data were collected through interviews with a purposive sample of 14 mothers and 8 healthcare providers/administrators in two regions of Ghana between May and September 2022. All interviews were audio-recorded, transcribed and imported into the NVivo 14.0 software for analysis. An iteratively developed codebook guided the coding process. Our thematic data analysis followed the Attride-Sterling framework for network analysis, identifying basic, organising themes and global themes. Results We found that health systems and demand-side factors are responsible for the persistence of OOP payments despite the existence of the free maternal healthcare policy in Ghana. Reasons for these payments arose from health systems factors, particularly, NHIS structural issues – delayed and insufficient reimbursements, inadequate NHIS benefit coverage, stockouts and supply chain challenges and demand-side factors – mothers’ lack of education about the NHIS benefit package, and passing of cost onto patients. Due to structural and system level challenges, healthcare providers, exercising their street-level bureaucratic power, have partly repackaged the policy, enabling the persistence of out-of-pocket payments for maternal healthcare. Conclusions Urgent measures are required to address the structural and administrative issues confronting Ghana’s free maternal health policy; otherwise, Ghana may not achieve the sustainable development goals targets on maternal and child health.

Internet of Things (IoT) is a technology that has revolutionized various fields, offering numerous benefits, such as remote patient monitoring, enhanced energy efficiency, and automation of routine tasks in homes. However, unsecured IoT devices are susceptible to botnet-based attacks such as distributed denial of Service (DDoS). Conventional machine learning models used for detecting these attacks compromise data privacy, prompting the adoption of federated learning (FL) to improve privacy. Yet, most FL-based cyberattack detection models proposed for IoT environments do not address computational complexity to suit their deployment on resource-constrained IoT edge devices. This paper introduces an FL model with low computational complexity, designed for detecting IoT botnet attacks. The study employs feature selection and dimensionality reduction to minimize computational complexity while maintaining high accuracy. First, an extreme gradient boosting model, trained with repeated stratified k-fold cross-validation, is used to select the optimal features of the botnet dataset based on feature importance. Principal component analysis is then used to reduce the dimensionality of these features. Finally, a differentially private multi-layer perceptron is trained locally by four FL clients and aggregated through federated averaging (FedAvg) to form a global Mirai botnet attack detection model. The model achieved an accuracy, precision, recall, and F1-score of 99.93 %, an area under the curve of 1.0, and 8,612 floating-point operations, contributing to 87.34 % reduction in computational complexity compared to the previous work. The proposed model is well-suited for detecting botnet attacks in smart homes, smart grids, and environments where resource-constrained IoT edge devices are deployed.

Male participation in maternal healthcare is important for better-quality maternal health outcomes. This study assessed the trends and correlates of male participation in antenatal care (ANC), delivery and postnatal care (PNC) in the Jaman North District of Ghana. Longitudinal data from 2012 to 2019 on male involvement in maternal healthcare were extracted from health records. A cross-sectional survey was administered to a stratified random sample of 318 mothers, who registered for PNC in 2020. Line graphs were used to illustrate the trends of male participation, and binary logistic regression analysis used to identify the correlates of male participation. The results show consistently low rates of male participation in maternal healthcare, with relatively higher participation rates for delivery compared to ANC and PNC within 2012–2019. The prevalence of male participation in the survey was 52.52% for delivery, 31.76% for PNC and 23.58% for ANC. Male participation in ANC was associated with a higher likelihood (p