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Abstract Background Despite comparatively low rates of COVID-19 admissions and recorded deaths in sub-Saharan Africa (SSA), the pandemic still had significant impact on health service utilization (HSU). The aim of this scoping review is to synthesize the available evidence of HSU in SSA during the pandemic, focusing on types of studies, changes in HSU compared with the pre-pandemic period, and changes among specific patient groups. Methods The scoping review was guided by the methodological framework for conducting scoping reviews developed by Arksey and O’Malley. We identified relevant studies through a search of PubMed (MEDLINE), Embase, Scopus, and Web of Science. We then provided a general descriptive overview of the extracted data focusing on the types of studies, patient groups, and change in HSU. Results We identified 262 studies reporting on HSU in 39 SSA countries. Studies were mainly quantitative (192; 73.3%), involving multiple centers (163; 62.2%), conducted in hospitals (205; 78.2%), and in urban settings (121; 46.2%). The median number of participants was 836.5 (IQR: 101.5–5897) involving 62.5% females. Most studies (92; 35.1%) focused on communicable diseases and mainly among outpatients (90; 34.2%). Maternal and child health studies formed the largest patient group (58; 22.1%) followed by people living with HIV (32; 12.2%). Change in HSU was reported in 249 (95.0%) studies with 221 (84.4%) studies reporting a decrease in HSU. The median decrease in HSU was 35.6% (IQR: 19.0–55.8) and median increase was 16.2% (IQR: 9.1–31.9). The patient group with the largest percentage decrease was cardiovascular diseases (68.0%; IQR: 16.7–71.1) and the lowest percentage decrease was in patients with infections (27.0%; IQR: 16.6–45.6). Conclusions A large body of literature is available on the effects of the pandemic on HSU in SSA. Most studies report decreases in HSU during the pandemic. However, patterns differ widely across disease categories, patient groups, and during different time periods of the pandemic.

Background Stroke survivors are at a substantially higher risk for adverse vascular events driven partly by poorly controlled vascular risk factors. Mobile health interventions supported by task shifting strategies have been feasible to test in small pilot trials in low-income settings to promote vascular risk reduction after stroke. However, real-world success and timely implementation of such interventions remain challenging, necessitating research to bridge the know-do gap and expedite improvements in stroke management. The Phone-based Interventions under Nurse Guidance after Stroke (PINGS-II) is a nurse-led mHealth intervention for blood pressure control among stroke survivors, currently being assessed for efficacy in a hybrid clinical trial across 10 hospitals in Ghana compared with usual care. This protocol aims to assess implementation outcomes such as feasibility, appropriateness, acceptability, fidelity, cost and implementation facilitators and barriers of the PINGS-II intervention.Methods and analysis This study uses descriptive mixed methods. Qualitative data to be collected include in-depth interviews and FGDs with patients who had a stroke on the PINGS-II intervention, as well as key informant interviews with medical doctors and health policy actors (implementation context, barriers and facilitators). Data will be analysed by thematic analysis. Quantitative data sources include structured questionnaires for clinicians (feasibility, acceptability and appropriateness), and patients who had a stroke (fidelity and costs). Analysis will include summary statistics like means, medians, proportions and exploratory tests of association including χ2 analysis.Ethics and dissemination Ethics approval was obtained from the Committee for Human Research Publication and Ethics at the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Voluntary written informed consent will be obtained from all participants. All the rights of the participants and ethical principles guiding scientific research shall be adhered to. Findings from the study will be presented in scientific conferences and published in a peer-reviewed scientific journal. A dissemination meeting will be held with relevant agencies of the Ghana Ministry of Health, clinicians, patient group representatives, and non-governmental organisations.

AbstractThis study explored the perspectives of community members on the management and ownership of freshwater resources. A mixed-method study was conducted targeting household heads, traditional leaders, and assembly members in communities surrounding the lake. Household heads (309), and 14 focus group discussions were used in the study. There were 46.9% and 29.4% of the respondents who perceived that the lake was owned by the government and the community (chiefs and the indigene) respectively. While 48.2% and 28.8% perceived the traditional authority and the government separately as the managers of the lake. The study found out that, the community perceives the Lake as their resource and hence their traditional leaders should have control over it with support from the government and other NGOs. This implies that activities carried out concerning the Lake should have the approval of people to avoid conflict and power struggles.

AbstractTo effectively shape healthcare outcomes and delivery, patient engagement has become increasingly important. It also has a significant impact on customer satisfaction and service quality. This study offers an introspective analysis of healthcare providers’ experiences and perceptions as it explores the relationship between patient engagement, service quality, and customer well-being. The study used a quantitative approach, and data were collected from a sample of 320 healthcare professionals working in different healthcare settings. The study adopted the snowball sampling technique to obtain the needed data for processing and analysis through PLS-SEM. The participants used in this study were Doctors and Nurses in public hospitals in Ghana. This study adds insights from the viewpoint of healthcare providers to the expanding body of literature on patient engagement, service quality, and customer well-being. The results highlight the significance of patient involvement in determining healthcare experiences and results, underscoring the necessity for healthcare institutions to adopt patient-centered care tenets and foster cooperative and empowered cultures. According to the findings, patient engagement fosters open communication, shared decision-making, and collaborative care, all of which are critical components of improving the service quality. To improve treatment adherence, improve health outcomes, and increase patient satisfaction, healthcare providers stress the value of giving patients the freedom to actively participate in their healthcare journey. Additionally, it has been shown that patient engagement enhances customer well-being by encouraging a sense of empowerment, independence, and control over one’s health.

AbstractThis study investigates the impact of social media on tourists’ destination decisions in a less digitalized economy through the lens of the uses and gratification theory. Data was collected from 428 local tourists sampled across various tourist destinations in Ghana (a sub-Sahara Africa) using a structured questionnaire. Analysis was carried out using variance-based PLS-SEM (Partial Least Square Structural Equation Modelling). The results show that tourist contentment, destination image, behavioral goals, and the availability of tourism information are driving forces of social media usage toward tourism destination decisions. The findings imply that tourism service providers should revise and incorporate the trending social media strategies to enhance their interaction with prospective visitors (customers) to increase their market share and become more competitive. This paper not only broadens the social media marketing literature but offers a comprehensive assessment of the integration of social media given the myriad of challenges besetting users and tourism service providers and discusses its impact in shaping tourist destination decisions in emerging and developing economies. Limitations and avenues for future research are discussed.

AbstractSocial media plays a crucial role in modern healthcare by promoting patient engagement, facilitating communication among professionals, and serving as a platform for health education and outreach. Its significance in healthcare delivery continues to grow as digital communication becomes increasingly integral to the industry’s efforts to improve healthcare outcomes. Nonetheless, existing studies have not adequately and empirically explored its impact in less digitalized economies. Thus, this study seeks to investigate the impact of social media on healthcare delivery systems in a less digitalized economic context. Leveraging the social media engagement theory, the study employs a partial least squares (PLS-SEM) approach to explore the impact of social media in Ghana’s healthcare system. Based on a purposely selected sample of 457 healthcare professionals from Ghana, the study found that using social media for crisis management, patient-doctor relationships, and information dissemination positively impacts healthcare systems. On the contrary, social media use for public relations activities did not have any significant impact on healthcare delivery. This study contributes to the growing literature on the affordances of social media in the circular economy towards improved healthcare delivery in emerging economies. The study offers a strategy for optimizing the use of social media within healthcare settings to foster enhanced healthcare outcomes, particularly a less digitalized economies.

AbstractWhile there is sufficient evidence from empirical studies that digital technologies are strategic resources for value creation, existing literature on the theme lacks general concepts that explore an organization’s strategic resources concerning digital orientations and transformation initiatives. This study hence builds on a resource-based view with digital orientation literature to conceptualize a novel strategic orientation concept to understand the attitude toward digital innovation integration among firms in an emerging and developing country. This study tests a new conceptual framework using survey data from 472 employees of small-to-medium-sized service-based firms and employing structural equation model analysis with a variance-based SEM approach. Our empirical results showed that IT infrastructural availability and digital innovation investment are significant organizational drivers that have a direct relationship with attitude toward digital innovation integration among firms whereas IT competencies, digital innovation management, and knowledge of digital innovation are not significant with attitude toward digital innovation integration. More importantly, our findings advance the literature on a firm’s strategic resources and bring the realms of strategy and digital orientation closer together. The study provides valuable insights for management and shareholders regarding the specific drivers that affect the adoption of digital technologies among service-based SMEs in emerging economies.

Addressing the increasing demand for accessible sign language learning tools, this paper introduces an innovative Machine Learning-Driven Web Application dedicated to Sign Language Learning. This web application represents a significant advancement in sign language education. Unlike traditional approaches, the application’s unique methodology involves assigning users different words to spell. Users are tasked with signing each letter of the word, earning a point upon correctly signing the entire word. The paper delves into the development, features, and the machine learning framework underlying the application. Developed using HTML, CSS, JavaScript, and Flask, the web application seamlessly accesses the user’s webcam for a live video feed, displaying the model’s predictions on-screen to facilitate interactive practice sessions. The primary aim is to provide a learning platform for those who are not familiar with sign language, offering them the opportunity to acquire this essential skill and fostering inclusivity in the digital age.

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83–0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

Climate change is having a significant impact on weather variables like temperature, humidity, precipitation, solar radiation, daylight duration, wind speed, etc. These weather variables are key indicators that affect electricity demand and consumption. Hence, understanding the significance of weather elements on energy needs and consumption is important to be able to adapt, strategize, and predict the effect of the changing climate on the required energy of an organization. This study aims to investigate the relationship between changing weather elements and electricity consumption, employing Multivariate Linear Regression (MLR), Support Vector Regressions (SVR), and Artificial Neural Network (ANN) models to predict the effect of weather changes on energy consumption. The following approaches were engaged for this study: Creating a catalog of weather elements and parameters of energy need or its consumption; analyzing and correlating electrical power consumption to weather factors; and developing prediction models—MLR, SVR, and ANN to predict the significance of the change in the variables of weather on the electrical energy consumption. Among the weather variables considered, temperature emerged as the most influential factor affecting electricity consumption, displaying the highest correlation. The monthly total pattern for electricity use for the case study area followed a similar pattern as the mean apparent temperature. Of the three models (MLR, SVR, and ANN) developed in this study, the ANN model yielded the best predictive performance, with Mean Square Error (MSE), Mean Absolute Error (MAE), and Mean Absolute Percentage Error (MAPE) of 2.733%, 1.292%, and 4.66%, respectively. Notably, the ANN model outperformed the other models (MLR and SVR) by more than 20% across the predictive performance metrics employed.

This article aims to define and describe female genital anatomy, the changes that occur in the genitalia during growth and puberty, and during sexual response and intercourse. It elaborates the reasons for normal genital examination findings in most female children who have been sexually abused and explains why the absence of findings of genital trauma should not be used to challenge the credibility of the child's history of sexual abuse. [ABSTRACT FROM AUTHOR]

Purpose – This study investigates the determinants of digital census for population and housing census (PHC) program through the lens of performance expectancy, technology readiness, self-efficacy and hedonic motivation for the upliftment of a national data collection exercise and development of human resource management. Design/methodology/approach – A quantitative and qualitative research method was used to survey enumerators' responses from the PHC exercise during the COVID-19 period in Ghana. Based on the four determinants, a conceptual framework was developed consisting of eight proposed hypotheses tested through a structural equation model. Findings – The findings of the study indicate that technological readiness, self-efficacy and hedonic motivation significantly influence behavioural intention to adopt digital technologies for PHC training and data collection. Importantly, the authors identified four key themes relating to digital technologies in PHC – personal enablers, general enablers, inherent affordances (inherent possibilities by the user in relation to what the technology offers in context) and personal inhibitors. Originality/value – For research, this work systematizes antecedents from diverse research streams and validates their relative impact on government digital transformation for accurate data, thus providing a cohesive theoretical explanation of digital technologies in PHC. Due to the study's infancy in a developing country context, the findings provide a preliminary foundation and constructive insight for a digitalization plan conducive to people’s personality and technological readiness.

Abstract Background Cardiac distress may be viewed as a persistent negative emotional state that spans multiple psychosocial domains and challenges a patient’s capacity to cope with living with their heart condition. The Cardiac Distress Inventory (CDI) is a disease-specific clinical assessment tool that captures the complexity of this distress. In busy settings such as primary care, cardiac rehabilitation, and counselling services, however, there is a need to administer briefer tools to aid in identification and screening. The aim of the present study was to develop a short, valid screening version of the CDI. Methods A total of 405 participants reporting an acute coronary event in the previous 12 months was recruited from three hospitals, through social media and by direct enrolment on the study website. Participants completed an online survey which included the full version of the CDI and general distress measures including the Kessler K6, Patient Health Questionnaire-4, and Emotion Thermometers. Relationship of the CDI with these instruments, Rasch analysis model fit and clinical expertise were all used to select items for the short form (CDI-SF). Construct validity and receiver operating characteristics in relation to the Kessler K6 were examined. Results The final 12 item CDI-SF exhibited excellent internal consistency indicative of unidimensionality and good convergent and discriminant validity in comparison to clinical status measures, all indicative of good construct validity. Using the K6 validated cutoff of ≥ 18 as the reference variable, the CDI-SF had a very high Area Under the Curve (AUC) (AUC = 0.913 (95% CI: 0.88 to 0.94). A CDI-SF score of ≥ 13 was found to indicate general cardiac distress which may warrant further investigation using the original CDI. Conclusion The psychometric findings detailed here indicate that the CDI-SF provides a brief psychometrically sound screening measure indicative of general cardiac distress, that can be used in both clinical and research settings.

Background: Individuals living with hypertension are at an increased risk of cardiovascular- and cerebrovascular-related outcomes. Interventions implemented at the community level to improve hypertension control are considered useful to prevent cardiovascular and cerebrovascular events; however, systematic evaluation of such community level interventions among patients living in low- and middle-income countries (LMICs) is scarce. Methods: Nine databases were searched for randomized controlled trials (RCTs) and cluster randomized control trials (cRCTs) implementing community level interventions in adults with hypertension in LMICs. Studies were included based on explicit focus on blood pressure control. Quality assessment was done using the Revised Cochrane Risk of Bias tool for randomized trials (ROBS 2). Results were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Fixed-effect meta-analyses were conducted for studies that reported continuous outcome measures. Results: We identified and screened 7125 articles. Eighteen studies, 7 RCTs and 11 cRCTs were included in the analysis. The overall summary effect of blood pressure control was significant, risk ratio = 1.48 (95%CI = 1.40–1.57, n = 12). Risk ratio for RCTs was 1.68 (95%CI = 1.40–2.01, n = 5), for cRCTs risk ratio = 1.46 (95%CI = 1.32–1.61, n = 7). For studies that reported individual data for the multicomponent interventions, the risk ratio was 1.27 (95% CI = 1.04–1.54, n = 3). Discussion: Community-based strategies are relevant in addressing the burden of hypertension in LMICs. Community-based interventions can help decentralize hypertension care in LMIC and address the access to care gap without diminishing the quality of hypertension control. Prospero: CRD42020194081

Clay minerals have different negative effects on the froth flotation process such as low adsorption of collectors on valuable minerals, increased pulp viscosity, and the reduction in recovery and grade concentrates of copper sulfides. This study aims to evaluate the use of polystyrene-based nanoparticles (NPs) for the froth flotation of chalcopyrite and their ability to mitigate the negative effect of montmorillonite on the recovery of this sulfide. The experimental stage consisted of preparing a type of polystyrene-based nanoparticle (St-CTAB-VI), which was analyzed by dynamic night scattering (DLS) to establish its hydrodynamic size. Then, the effect of NPs on chalcopyrite’s angle’s in the presence and absence of montmorillonite (15%) was evaluated and compared with the contact angle achieved using potassium amyl xanthate (PAX) and a mixture of PAX and NPs. In addition, zeta potential measurements were carried out to investigate the interactions between the chalcopyrite and the montmorillonite or the NPs under fixed concentrations and microflotation tests were performed employing different times to evaluate the chalcopyrite recovery in the presence of montmorillonite, using NPs and mixtures with PAX. Finally, turbidity analysis as a function of time was performed to evaluate the occurrence of sedimentation and flocculation phenomena in suspensions of 15% montmorillonite in the presence and absence of chalcopyrite, nanoparticles, and mixtures of NPs and PAX. The results indicated that the mixture of NPs and PAX contributed to increasing the contact angle of chalcopyrite in the presence of montmorillonite. This can be associated with the presence of molecular and nanometric collectors that generated a higher hydrophobicity on the chalcopyrite particles, contributing to reducing the presence of clay minerals on the mineral surface. In addition, the mixture of NPs and PAX promoted the generation of nanoparticles on the sulfide mineral surface, which helps to detach the slime and facilitate the bubble/mineral attachment step during flotation.

Aims: Reimers migration percentage (MP) is a key measure to inform decision-making around the management of hip displacement in cerebral palsy (CP). The aim of this study is to assess validity and inter- and intra-rater reliability of a novel method of measuring MP using a smart phone app (HipScreen (HS) app). Methods: A total of 20 pelvis radiographs (40 hips) were used to measure MP by using the HS app. Measurements were performed by five different members of the multidisciplinary team, with varying levels of expertise in MP measurement. The same measurements were repeated two weeks later. A senior orthopaedic surgeon measured the MP on picture archiving and communication system (PACS) as the gold standard and repeated the measurements using HS app. Pearson’s correlation coefficient (r) was used to compare PACS measurements and all HS app measurements and assess validity. Intraclass correlation coefficient (ICC) was used to assess intra- and inter-rater reliability. Results: All HS app measurements (from 5 raters at week 0 and week 2 and PACS rater) showed highly significant correlation with the PACS measurements (p < 0.001). Pearson’s correlation coefficient (r) was constantly over 0.9, suggesting high validity. Correlation of all HS app measures from different raters to each other was significant with r > 0.874 and p < 0.001, which also confirms high validity. Both inter- and intra-rater reliability were excellent with ICC > 0.9. In a 95% confidence interval for repeated measurements, the deviation of each specific measurement was less than 4% MP for single measurer and 5% for different measurers. Conclusion: The HS app provides a valid method to measure hip MP in CP, with excellent inter- and intra-rater reliability across different medical and allied health specialties. This can be used in hip surveillance programmes by interdisciplinary measurers. Cite this article: Bone Jt Open 2023;4(5):363–369.

BackgroundWorkers are exposed to workplace hazards which increase their risk of occupational injury. Data on occupational injuries and associated factors are important for planning and informing national policy regarding workplace health and safety. This study sought to estimate the prevalence and factors associated with occupational injuries among workers in an industrial city in Ghana.MethodsA community-based cross-sectional survey was conducted among 459 workers in the Tema industrial enclave in Ghana from 22nd December 2020 to 27th February 2021. Participants were recruited using a two-stage sampling technique. Eight communities were randomly selected from twenty-five communities in the first stage while households in each community were randomly selected in the second stage. Data on socio-demographic characteristics, occupational health and safety and occupational injuries were collected. Logistic regression was used to examine the relationship between occupational injuries and associated factors.ResultsThe mean age of the workers was 33.9 (±6.8) years with a range of 21-53 while over 18.1% of them were working at the Port and Harbour. The prevalence of occupational injury among the workers in the preceding twelve months was 64.7%. The mechanism of injury was mainly the use of working tools (45.8%) and hot surfaces, substances or chemicals (14.1%). Being a casual staff (AOR: 2.26, 95%CI: 1.04-4.92), working at Port and Harbour (AOR: 3.77, 95%CI: 1.70-8.39), no health and safety training (AOR: 2.18, 95%CI: 1.08-4.39), dissatisfaction with health and safety measures (AOR: 4.31, 95%CI: 2.12-8.78) and tertiary education (AOR: 0.03, 95%CI: 0.01-0.10) were significantly associated with occupational injuries.ConclusionThe prevalence of occupational injuries in this study was high. Promoting machine tools' safety, health and safety training, and satisfaction with health and safety measures through rewarding workers who do not sustain injuries could be key to employees' health and safety.

Introduction The COVID-19 pandemic has been marked by a massive death toll. However, the overall effect of the pandemic, including potential unintended negative impacts of some control measures, on mortality remains poorly understood in low-income and lower middle-income countries (LLMICs). This review aims to summarise the available literature on excess mortality in LLMICs, focusing on the methods and data sources used in estimating excess mortality and the drivers of excess mortality.Methods and analysis We will review the available literature and report results in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis. Searches will be conducted in PubMed, Embase, Web of Science, Cochrane Library, Google Scholar and Scopus. All published studies that report on the estimates of excess mortality in populations of LLMICs will be included. This will include those with a publication date from 2019 onwards and those with at least a 1-year non-COVID-19 period as the comparator in the estimation of excess mortality during the pandemic. There will be no language restrictions on the search. The meta-analysis will include studies with extractable data on excess mortality, methods, population size, and observed and expected deaths. We will use the Mantel-Haenszel method to estimate the pooled risk ratio with 95% CIs.Ethics and dissemination As there is no primary data collection, there is no requirement for ethical review. The results will be disseminated through peer-reviewed journal publication and conference presentations.PROSPERO registration number CRD42022378267.

ABSTRACTWalking is a fundamental mode of transport for many people globally, with immense health and environmental benefits. However, increased walking is associated with an increased risk of road traffic crashes and injuries, especially where traffic enforcement is poor, and pedestrians could easily be distracted. Despite this, a plethora of evidence exists on driver distraction; however, there is a dread of evidence of pedestrian distraction (i.e. distracted walking), particularly in Africa. This paper uses a quantitative methodology to examine the predictors of distractive activities to walking in Accra, Ghana. The study surveyed 400 pedestrians within Accra’s Central Business District (CBD). A questionnaire was deployed via Kobo Toolkit and Jamovi was used in analysing the data. The study observed that three of the top four distractive activities to walking were digital devices-related (e.g. the use of mobile phones). We found that listening to music, making, receiving phone calls, and conversing with other people while walking are the main distractive activities. The binary logistic regression model found sex, age, level of education, occupation, reasons for walking, weekly time for walking and time for common trips as significant predictors of distractive activities to walking.

AbstractDespite collaborative efforts by the government and the private sector in the provision of health facilities in Ghana, a substantial proportion of communities in rural Ghana still have poor access to primary health care. Employing a case study research design, this study presents an overview of the geographic distribution of healthcare facilities in Kpandai District and access to primary health care. Focus group discussions and interviews were conducted with randomly selected households, opinion leaders, healthcare and in-charges of health facilities to ascertain their perception of accessibility to health services. Geographic Information System (GIS) (ArcMap) was used to model the spatial distribution of health facilities. Spatially, 139 communities representing 50.5% of the communities are not accessible health facilities per World Health Organization and Ghana Health Service Survive distance threshold to health centers and Community-based Health Planning and Services (CHPS), and hospitals, respectively. Ideally, this implies that the majority of the population have to travel for more than 5 km to access health care services. This study found that the poor spatial distribution of health facilities has negative implications on access to primary health care in the district. Poor conditions of roads were a major barrier to the household’s accessibility to district hospitals. In addition to this, the availability, affordability, adequacy and acceptability which are major determinants of access to primary health care delivery were found to be fairly good. These findings have implications for the realization of the United Nations’ health-related Sustainable Development Goals.

AbstractThe changing trend in the circular economy has pushed most firms to be competitive in their business activities using emerging technology. SMEs in recent times are increasingly leveraging technologies such as social media to enhance their interactions with their customers, increase their reach and become competitive. Despite this, SMEs in the manufacturing sector in developing economies are often underexplored in literature in their resolve to leverage social media to improve their performance and sustainability. This research explores the integration of social media in SME manufacturing firms’ activities toward their performance and sustainability in developing countries. Drawing on relevant literature and the social media engagement theory, we employed a questionnaire survey to collect data from 417 managers/staff of SME manufacturing firms in Ghana, using PLS-SEM techniques for the analysis. Research findings revealed that social media integration proved a direct positive correlation with SME manufacturing firms’ performance. Additionally, it was revealed that social media utilization has a positive and significant effect on SME manufacturing firms’ performance. The findings further show that social media usage assists SME firms’ performance and fosters their sustainability. It is concluded that SMEs should incorporate social media marketing strategies for firms’-customer relationships and internal and external collaboration. By implication, this study offers practitioners and researchers knowledge regarding social media integration among SMEs in emerging economies.

AbstractSocial media is constantly changing the business landscape across all economic sectors. Given this, small and medium enterprises (SMEs) are leveraging this to give their businesses a new trend. In emerging economies, however, the rate of adoption and integration of social media among small and medium enterprises appears to have lagged due to a multitude of factors. Drawing on the technology organization and environment (TOE) framework, the purpose of this study was to investigate the factors affecting social media application adoption and their impact on SMEs’ sustainability in Ghana’s context. Data was collected from 430 managers of SMEs in Ghana using a structured questionnaire and analyzed using a PLS-SEM. Findings revealed that cost-effectiveness, customer pressure, employees’ competence, financial resource availability, and leaders’ support positively influence social media adoption, while social media adoption also impacts SME firms’ sustainability. A negative effect was, however, observed for factors like industry pressure, perceived complexity, relative advantage, and perceived compatibility. This study contributes to the rising deployment of social media by businesses to improve their competitiveness. The implications of the research are also discussed.

AbstractThe services sector continues to play a major role in the transformation of economies. For instance, the tourism sub-sector, which is a key segment of the service sector has become one of the major contributors to economic transformation in developing economies. Given this prospect, stern competition has been created among tourism firms across the globe. However, the tourism sectors in most developing countries continue to grapple with competitive pressure challenging their competitive sustainability. Drawing on the theory of change, the purpose of this paper is to investigate factors that drive the competitive sustainability of small and medium enterprises in the tourism sector in Ghana. Data was collected from 310 SMEs in the tourism sector through the administration of a structured questionnaire and analyzed using Partial Least Square Structural Equation Modelling. The results show that price sensitivity, site maintenance, and entrepreneurial competency have a positive and significant effect on the competitive sustainability of small and medium enterprises in the tourism sector. By implications, the paper provides managers of tourism facilities with an encompassing mechanism aimed at improving tourism sites, enhancing the entrepreneurial competencies of staff, and adopting pricing strategies to enhance the competitive sustainability of the tourism sector from a developing country’s perspective. The study advances theories on tourism competitive sustainability.

AbstractDigital technologies are essential tools that Service-based firms can integrate into their business to transform their operations. However, in the emerging countries’ perspective, research on the application of digital orientation among Service-based firms is less researched. This poses questions to scholars why the adoption of digital orientation is quite low among developing economies. The purpose of this article is to examine the impediments to digital orientation among Service-based firms in emerging and developing countries. Inspired by a resource-based view, a survey using a structured questionnaire was administered to 466 respondents (management and employees) of Service-based firms via a convenience sampling method in Ghana. Findings revealed that the knowledge gap, cost burden, and upgrading of technology positively and significantly create the gap in digital orientation among Service-based firms. The authors admonished that Service-based firms should 'be orient' on the use of digital technologies through appropriate training programs to enhance its adoption. The study again recommends practitioners of Service-based firms cultivate the habit of investing in human and technical capacities to optimize the benefits of the evolution of digital technologies. Limitations and future research directions are discussed.

Background Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be led by local stakeholders, performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.

Abstract Background Approximately two million Ghanaians suffer from mental disorders including depression. The WHO defines it as an illness characterized by constant sadness and loss of interest in activities that a person usually enjoys doing and this condition is the leading cause of mental disorders; however, the burden of depression on the aged population is fairly unknown. A better appreciation of depression and its predictors is necessary to design appropriate policy interventions. Therefore, this study aims to assess the prevalence and correlates of depression among older people in the Greater Kumasi of the Ashanti region. Methods A cross-sectional study design with a multi-stage sampling approach was employed to recruit and collect data from 418 older adults aged 60 years and above at the household level in four enumeration areas (EAs) within the Asokore Mampong Municipality. Households within each EAs were mapped and listed by trained resident enumerators to create a sampling frame. Data was collected electronically with Open Data Kit application over 30 days through face-to-face interaction using the Geriatric Depression Scale (GDS). The results were summarized using descriptive and inferential statistics. A multivariable logistics regression using a forward and backward stepwise approach was employed to identify the predictors of depression in the study sample. All analyses were performed using STATA software version 16, and the significance level was maintained at a p-value 80 years), and lower economic class respondents. The rate was 43.4% for both consumers of alcohol and smokers with a history of stroke (41.2%) and taking medication for chronic conditions (44.2%). The predictors of depression in our study were being single, low class [aOR = 1.97; 95% CI = 1.18–3.27] and having other chronic conditions [aOR = 1.86; 95% CI = 1.59–4.62], and the inability to manage ones’ own affairs [aOR = 0.56; 95% CI = 0.32–0.97]. Conclusion The study provides data that can inform policy decisions on the care of the elderly with depression in Ghana and other similar countries, confirming the need to provide support efforts towards high-risk groups such as single people, people with chronic health conditions, and lower-income people. Additionally, the evidence provided in this study could serve as baseline data for larger and longitudinal studies.

Abstract Background Morbidity and mortality from road traffic crashes are steadily increasing globally and they remain a major public health challenge. This burden is disproportionately borne by low-and middle-income countries, especially Sub-Saharan Africa where motorcycle helmet use is low and where there are challenges of affordability and availability of standard helmets. We sought to assess the availability and cost of helmets in retail outlets in northern Ghana. Methods A market survey of 408 randomly sampled automobile-related retail outlets in Tamale, northern Ghana was conducted. Multivariable logistic regression was used to identify factors associated with helmet availability and gamma regression was used to identify factors associated with their cost. Results Helmets were available in 233 (57.1%) of surveyed retail outlets. On multivariable logistic regression, street vendors were 48% less likely and motorcycle repair shops 86% less likely to sell helmets than automobile/motorcycle shops. Outlets outside the Central Business District were 46% less likely to sell helmets than outlets inside that district. Nigerian retailers were five times more likely to sell helmets than Ghanaian retailers. Median helmet cost was 8.50 USD. Helmet cost decreased by 16% at street vendors, 21% at motorcycle repair shops, and 25% at outlets run by the owner. The cost increased by older age of retailer (1% per year of age), education level of retailer (12% higher for secondary education, 56% higher for tertiary education, compared to basic education), and sex (14% higher for male retailer). Conclusion Motorcycle helmets were available in some retail outlets in northern Ghana. Efforts to improve helmet availability should address outlets in which they are less commonly sold, including street vendors, motorcycle repair shops, outlets run by Ghanaians, and outlets outside the Central Business District.

Introduction The COVID-19 pandemic has exposed weaknesses in health systems of many countries, including those in sub-Saharan Africa. Despite comparatively low rates of COVID-19 admissions and deaths in sub-Saharan Africa, the pandemic still had a significant impact by disrupting health service utilisation (HSU). The aim of this scoping review is to synthesise the available evidence on HSU in sub-Saharan Africa during the COVID-19 pandemic, especially focusing on (1) changes in HSU compared with the prepandemic period, (2) changes in HSU among particular patient groups studied and (3) identifying factors determining changes in HSU as a result of the COVID-19 pandemic.Method and analysis The scoping review will be guided by the methodological framework for conducting scoping reviews developed by Arskey and O’Malley. We will identify relevant studies on HSU in sub-Saharan Africa during the COVID-19 pandemic using PubMed (MEDLINE), Embase, Scopus and Web of Science databases from 1 December, 2019 to 31 March 2023. We will search grey literature, government and organisational websites for reports and conference proceedings. Included studies will be restricted to those reported in English or French. Two reviewers will independently screen articles at the title and abstract stage for inclusion into full text screening. We will provide a general descriptive overview, tabular summaries and content analysis for the extracted data.Ethics and dissemination Ethical approval is not required for the conduct of the scoping review. We will disseminate our findings via open access peer-reviewed journals and scientific presentations. Our scoping review findings will help to determine the feasibility of a subsequent systematic review (and meta-analysis) on HSU during the COVID-19 pandemic.

Given the enormous global impact of the COVID-19 pandemic, outbreaks of highly pathogenic avian influenza in Canada, and manifold other zoonotic pathogen activity, there is a pressing need for a deeper understanding of the human-animal-environment interface and the intersecting biological, ecological, and societal factors contributing to the emergence, spread, and impact of zoonotic diseases. We aim to apply a One Health approach to pressing issues related to emerging zoonoses, and propose a functional framework of interconnected but distinct groups of recommendations around strategy and governance, technical leadership (operations), equity, education and research for a One Health approach and Action Plan for Canada. Change is desperately needed, beginning by reorienting our approach to health and recalibrating our perspectives to restore balance with the natural world in a rapid and sustainable fashion. In Canada, a major paradigm shift in how we think about health is required. All of society must recognize the intrinsic value of all living species and the importance of the health of humans, other animals, and ecosystems to health for all.

In a bid to discovering novel antibiotics to combat growing trend of multi-drug resistance strains of Salmonella typhi, 48 new pyridine derivatives with significant inhibitory activities against the aforementioned bacterium were subjected to molecular docking against DNA gyrase protease of the bacterium, drug likeness evaluation and pharmacokinetics profiling. All the 48 leads displayed better binding affinity values when compared with Amoxicillin, Ciprofloxacin, Ceftriaxone, Ampicillin, and chloramphenicol, the standard antibiotics used herein for quality assurance. Furthermore, the majority of the compounds were, however, screened out due to their poor pharmacokinetics profiles and drug-likeness. Only five compounds emerged as the most promising leads and they include C4 with binding affinity of -8.0 kcal/mol, C8 (-8.6 kcal/mol), C9 (-8.1 kcal/mol), C26 (-8.3 kcal/mol), and C27 (-8.0 kcal/mol). These compounds not only displayed better binding affinity when compared with the reference antibiotics but also exhibit different modes of interactions with the target protease of the bacterium making them more potent and drug like. Toxicity evaluation of the leads also revealed that the compounds are neither tumorigenic nor mutagenic. In view of the excellent binding affinity, high pharmacokinetics profile and positive drug-likeness of the novel ligands, we recommend these promising compounds for in vitro and in vivo studies in order to discover novel antibiotics that could curb the dangerous trend of multiple drug resistance by Salmonella typhi.

Abstract Background Postoperative stereotactic radiosurgery (SRS) is a standard management option for patients with resected brain metastases. Preoperative SRS may have certain advantages compared to postoperative SRS, including less uncertainty in delineation of the intact tumor compared to the postoperative resection cavity, reduced rate of leptomeningeal dissemination postoperatively, and a lower risk of radiation necrosis. The recently published ASCO-SNO-ASTRO consensus statement provides no recommendation for the preferred sequencing of radiotherapy and surgery for patients receiving both treatments for their brain metastases. Methods This multicenter, randomized controlled trial aims to recruit 88 patients with resectable brain metastases over an estimated three-year period. Patients with ten or fewer brain metastases with at least one resectable, fulfilling inclusion criteria will be randomized to postoperative SRS (standard arm) or preoperative SRS (investigational arm) in a 1:1 ratio. Randomization will be stratified by age (