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Abstract Background Anaemia among women of reproductive age (WRA) remains persistently high in Ghana, affecting 41% in 2022. Women in low-income communities in Ghana engaged in fish processing activities are at increased risk of anaemia due to inadequate diets, exposure to infectious pathogens, and pollutants. The Invisible Fishers (IFs) project was implemented among women fish processors in their reproductive age in Central and Volta regions of Ghana to mitigate anaemia. Despite the efficacy, feasibility and scalability of the intervention, the cost of implementing the intervention is unknown. The objective of this study was to estimate the costs of implementing the IFs project in Ghana. Methods We used micro-costing approach to analyse the costs of implementing the IFs project. Data were collected as part of a pilot randomized control trial with three interventions: Behaviour Change Communication (BCC), Strengthening Market Engagement of fish processors plus Behaviour Change Communication (SME + BCC), and Fish Smoking Technology and Practices plus Behaviour Change Communication (FST + BCC). The interventions were delivered to 60 women fish processors in the Central region and 60 in Volta region. The cost of the intervention was estimated from the societal perspective. Economic costs were categorized as direct costs (i.e. personnel, transportation, meetings, training, and monitoring) and indirect cost (i.e. value of productive time lost due to women and community volunteers’ participation in the activities of the IFs project). Results The FST + BCC had the highest average cost per beneficiary (US$11898.62), followed by the SME + BCC (US8962.93). The least expensive was the BCC (US$4651.93) over the intervention period of 18 months. Recurrent costs constituted the largest component of economic costs (98%). Key drivers of direct costs were personnel (58%), administrative expenses (14%), and transportation (7%). Conclusion There is a high cost for implementing interventions included in the IFs project. Planning and scaling -up of the interventions across larger populations could bring about economies of scale to reduce the average cost of the interventions.

Dicephalic parapagus conjoined twins, a rarely occurring form of conjoined twinning has poor prognosis and remains a significant cause of perinatal deaths. Since majority of cases of conjoined twins are not compatible with life, early and reliable detection with diagnostic medical imaging remains crucial for adequate patient counselling, medical and surgical management. We present a case of dicephalic parapagus twin gestation with associated congenital anomalies detected for the first time with ultrasound in the third trimester in a 29-year-old pregnant woman. An initial first trimester ultrasound at 14 weeks gestational age was unremarkable.Ultrasound fetal anatomical survey in the third trimester remains reliable for the detection of rare fetal anomalies such as dicephalic parapagus twins that might have been missed in earlier scans. Continuous efforts should therefore be made for the inclusion of detailed anatomical survey in the early third trimester; particularly in women with unremarkable earlier ultrasound scans and in those reporting late for obstetric care.

This study presents evidence on the effect of fiscal policies on poverty and inequality in Ghana for the 2017 fiscal year based on the Commitment to Equity (CEQ) assessment framework. Also, the CEQ framework was used to simulate the short-term distributional consequences (‘morning-after’ effects) of Ghana’s Free Senior High School (SHS) Policy and utility subsidies during the COVID-19 pandemic. We find that government spending and taxation in Ghana lowered inequality (Gini coefficient) by 5.94 percentage points. We also find a reduction in poverty rates, but this was mainly driven by in-kind benefits associated with public spending on health and more so education, without which poverty rate would have been higher. In its blanket form, the ‘morning-after’ effects of the Free SHS Policy was a marginal reduction in both inequality and poverty. We find further that in contrast to the effect of the blanket subsidy on water, the subsidies on electricity which had some elements of targeting reduced both poverty and inequality, but marginally. The findings underscore the need for more targeted subsidy and spending programmes to enhance their short-term poverty reduction and redistributive impacts.

AbstractThe emergence of digital financial systems, especially mobile money, has significantly changed the financial services space in sub-Saharan Africa in ways that promote financial inclusion among the poor, including those in rural communities. Focusing on mobile money, which is the main avenue for digital financial services for rural households in Ghana, this study investigates whether digital finance affects rural households’ livelihood diversification, using a nationally representative data on Ghana. Employing several econometric methods, including instrumental variable techniques to address potential endogeneity bias, the study finds mobile money to be positively associated with households’ choice of non-farm business as a livelihood option as well as their engagement in livestock production. However, we find a negative relationship between mobile money and diversification in crop production including the extent to which households engaged in the crop sector are able to diversify crop production. The implication is that when rural households have access to mobile money services, they produce fewer number of different crops while exploring non-farm activities and livestock production as additional livelihood options. The results underscore the need to address constraints that limit rural households’ access to digital financial tools, especially mobile money, in Ghana and in similar developing country contexts.

Background and Objective Anaemia among pregnant women is a public health challenge in Ghana. Although there is a national programme of routine iron-folic acid (IFA) supplementation, coverage is suboptimal. The current study explored experiences and perceptions of anaemia prevention, and IFA use among pregnant women and antenatal care providers at two hospitals in Accra, Ghana, for enhancing the supplementation programme. Methods Utilizing a qualitative approach, 6 focus group discussions with 48 purposively selected pregnant women, and 10 in-depth interviews with care providers in two hospitals were conducted. Interviews were transcribed verbatim. Using both deductive and inductive approaches, priori themes that informed the design of the interview guides, and emerging codes from transcripts were used in data analysis. Results In both hospitals, pregnant women reported awareness of anaemia and identified poor quality diets and failure to take IFA as the predominant causes. Regular IFA supplementation, and consumption of fruits, vegetables, and animal-source foods were indicated as the main anaemia remedies by the pregnant women. Turkey berry, beetroot, and hibiscus flower were also reported as therapeutic remedies for anaemia. IFA use was linked with improved appetite, haemoglobin, and health status of mothers and their fetus. Both providers and pregnant women indicated that IFA is freely accessible through government facilities but may also be purchased. IFA supplements are recommended to be taken daily but three times for treatment; however, non-adherence to the recommended frequency was reported. This was attributed to adverse reactions including nausea and vomiting, unanticipated cost of increased appetite, forgetfulness to take IFA, misperceptions about adverse effects of IFA, transportation cost to access IFA, and long waiting time at hospitals. Community-level focused antenatal care, follow-up visits, and phone calls were reported by providers as strategies to improve IFA uptake. Community sensitization, enhanced access to IFA, and participatory approach to ANC services were suggested by pregnant women as strategies for improving IFA uptake. Conclusions Food insecurity and misperceptions about IFA should be addressed as part of efforts to address low IFA adherence and high maternal and child anaemia rates in Ghana.

Background: Mathematics holds a critical position within educational systems worldwide due to its extensive applications. At Dadieso Senior High School in Ghana, students consistently demonstrate low performance in mathematics, necessitating an investigation into potential determinants of academic achievement. Aim: This study aims to examine the impact of students' attitudes towards mathematics and the self-efficacy of mathematics teachers on students' mathematical achievements. Method: A descriptive-correlational research design was adopted, employing quantitative methods to analyze the relationships between students' attitudes, teachers' self-efficacy, and students' academic performance. The study sampled 218 students and 7 teachers, utilizing the Attitude towards Mathematics Inventory (ATMI), the Teacher Self-Efficacy Scale (TSES), and a Mathematics Achievement Test (MAT) for data collection. Results: The analysis revealed a moderate positive correlation between students' attitudes towards mathematics and their academic performance, indicating that positive attitudes are linked to better outcomes. Furthermore, a significant, albeit smaller, positive correlation was identified between teachers' self-efficacy and student achievement, highlighting the impact of teacher confidence on student success. Conclusion: Fostering positive attitudes towards mathematics among students is essential for improving academic performance. Likewise, enhancing teachers' self-efficacy substantially influences student achievement. These factors should be the focus of interventions aimed at enhancing mathematical outcomes in educational settings.

Ghana’s forest is fast depleting as a result of over-dependency on the traditionally known timber species and high demand for wood products for structural works. This study seeks to determine the chemical properties and basic density of Terminalia catappa wood and its potential for structural application. Three mature trees of Terminalia catappa were acquired based on the diameter at the breast height (dbh) greater than 40 cm. In this study 160 samples of wood were used for the chemical properties and density tests. Chemical analyses were performed by using the TAPPI standards. The study revealed that there were higher cellulose and hemicellulose contents in the sapwood than in heartwood, and in the branchwood than in stemwood. Lignin and extractives content were higher in the heartwood than in sapwood, and in the stemwood than in branchwood. The basic density of the sapwood ranged from 473 to 649 kg/m³ and in the heartwood from 444 to 579 kg/m³ being the highest in the base portion and the lowest in the branches. The difference in wood density, which is greater in the base area than the branches, emphasizes how crucial it is to take wood quality into account for the best possible use across various tree portions. The study also clarifies the wood's suitability for structural and non-structural uses. These findings have the potential to influence sustainable forest management strategies and encourage the use of alternative timber to supplement the resource base.

Abstract Background Cancer causes a major disease burden worldwide. This is increasingly being realised in low and middle-income countries, which account disproportionately for preventable cancer deaths. Despite the World Health Organization calling for governments to develop policies to address this and alleviate cancer inequality, numerous challenges in executing effective cancer policies remain, which require consideration of the country-specific context. As this has not yet been considered in Ghana, the aim of this review was to bring together and critique the social-environmental, health policy and system factors to identifying opportunities for future health policies to reduce cancer burden in the Ghanian context. A critical policy-focused review was conducted to bring together and critique the current health systems context relating to cancer in Ghana, considering the unmet policy need, health system and social factors contributing to the burden and policy advances related to cancer. Conclusion The findings highlight the changing burden of cancer in Ghana and the contextual factors within the socio-ecosystem that contribute to this. Policies around expanding access to and coverage of services, as well as the harmonization with medical pluralism have potential to improve outcomes and increase equity but their implementation and robust data to monitor their impact pose significant barriers.

Abstract Women in rural communities remain the most vulnerable population in accessing agricultural productive resources with dire implications for food security, malnutrition, and poverty. Effective agricultural and food-related policies should be based on a better understanding of the complex inter-relationship of how socioeconomic, demographic, gender, women empowerment, and geographical location indicators simultaneously affect access to agricultural productive resources and food security. The study quantified the level of inequality in access to agricultural productive resources and explored the mechanism through which socioeconomic status mediates the effect of geographic location on food security. This is a community-based cross-sectional study using a multi-stage stratified cluster random sampling design to generate a representative sample of the target population who live in coastal and non-coastal communities. The Gini inequality index, generalized structural equation models, multivariable modified Poisson and Negative binomial regression models were used. The inequality in access to agricultural productive resources was marginally higher among women than in men, higher in the coastal areas than in the non-coastal areas, and higher among women with low empowerment in agricultural production decision-making. The empowerment of women in agricultural decision-making was found to increase with age, as older women were more empowered to make decisions in agriculture. Approximately 17% [95% CI 15.6–18.6] of the population were food-secured (coastal = 13.9%, non-coastal communities = 20.7%). Socioeconomic status mediates the effect of living in coastal versus non-coastal rural communities on food security. To improve food security, the government should prioritize interventions geared toward improving women's access to productive agricultural resources. These interventions must consider gender-specific constraints, poverty alleviation schemes, legal framework, sociocultural factors, and decision-making power.

The study investigated teachers' mode of representations in linear equations in one variable, what accounts for teachers' choice of representations and students' representations preferences and effects of multiple representations--based instruction on studStud' achievement in linear equations in one variable. A quasi- experimental design was used with a sample size of 86 mathematics teachers and 159 students ( students in Junior High School 2) selected through purposive and convenient sampling technique respectively in the Bimbilla Municipal in the Northern Region of Ghana. The research instructions included: linear equations achievement test (pretest and post test, questionnaire, representations preference test ( RPT) and interview guide. The data collected we're analysed quantitatively and qualitatively. It was found that most teachers (66.3%) used algebraic expression everytime on teaching linear equations while few teachers used manipulatives, graphic and multiple representations due to reasons such as time, difficulty for students, lack of materials, lack of ideas,no relevance and many more. It was also found that most students 59(37.1%) had preferences for algebraic representation citing similar reasons of their preferences as what accounted for teachers' choice. The analysis of Covariance (ANCOVA) revealed a statistical significant difference between students' scores in linear equations achievement test in favour of multiple representations-based instructions, F(2,155)=10.20, P 0.05, n^2= 12. The major recommendation is that, multiple representations--based instruction should be used during instruction as well as improving teachers' knowledge on how to integrate untamunfam representations easily in linear equations in one variable.

Abstract Objective: To explore communities’ perspectives on the factors in the social food environment that influence dietary behaviours in African cities. Design: A qualitative study using participatory photography (Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary behaviours. Follow-up in-depth interviews allowed participants to tell the ‘stories’ of their photographs. Thematic analysis was conducted, using data-driven and theory-driven (based on the socio-ecological model) approaches. Setting: Three low-income areas of Nairobi (n 48) in Kenya and Accra (n 62) and Ho (n 32) in Ghana. Participants: Adolescents and adults, male and female aged ≥13 years. Results: The ‘people’ who were most commonly reported as influencers of dietary behaviours within the social food environment included family members, friends, health workers and food vendors. They mainly influenced food purchase, preparation and consumption, through (1) considerations for family members’ food preferences, (2) considerations for family members’ health and nutrition needs, (3) social support by family and friends, (4) provision of nutritional advice and modelling food behaviour by parents and health professionals, (5) food vendors’ services and social qualities. Conclusions: The family presents an opportunity for promoting healthy dietary behaviours among family members. Peer groups could be harnessed to promote healthy dietary behaviours among adolescents and youth. Empowering food vendors to provide healthier and safer food options could enhance healthier food sourcing, purchasing and consumption in African low-income urban communities.

Background: The second most prevalent age-related brain condition, Parkinson's disease (PD) is characterised by the loss of neurons in the substantia nigra pars compacta (SNpc). It is associated with symptoms like bradykinesia, stiffness, tremor, and impaired postural responses. Motor dysfunction, and neurochemical imbalance, are involved in the pathophysiology of PD. It has been hypothesised that trans cinnamaldehyde (TCA) a component of Traditional Chinese Medicine (TCM) can ameliorate Parkinson-like symptoms by altering the levels of different biochemical markers and reverse motor impairments. This research sought to determine the neuroprotective effect of TCA against the neurotoxicity caused by rotenone. Basic Procedure: Rotenone (1.5 mg/kg/day; s.c. for 35 days) was given to rats to induce Parkinson-like symptoms. TCA (5, 10, and 20 mg/kg) and concomitant treatment of TCA (5 mg/kg) with L-NAME (10 mg/kg) were given one hour prior to rotenone administration. Every week until the 35th day, behavioral parameters (muscle coordination, spontaneous motor movement and gait abnormalities) were assessed using rotarod, actophotometer, and narrow beam apparatus respectfully. Rats were decapitated on the 35th day, the striatum and cortex were isolated for biochemical tests. Main findings: Rotenone treatment reduced body weight, altered motor coordination and reduced the oxidative defense system. Treatment with TCA significantly improved the alterations in antioxidant levels as well as behavioral parameters. Furthermore, L-NAME (nitric oxide synthase inhibitor) in combination with TCA had a more significant effect as compared to TCA alone, signifying a possible drug interaction. Principal conclusion: TCA could be employed as an adjuvant in PD management.

Abstract Background The use of unsafe materials to collect menstrual blood predisposes women and girls to infections. There is a paucity of literature on the utilization of reusable menstrual materials in sub-Saharan Africa. This study examined factors associated with the use of reusable menstrual management materials among women of reproductive age in Ghana. Findings from this study can inform menstrual health programmes and reproductive health policy to address menstrual hygiene and specific areas of emphasis. Methods We analysed secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey. Descriptive statistics were employed to compute frequencies and percentages, while Chi-square and complex sample Binomial Logistic Regression was conducted to identify factors associated with the use of reusable menstrual materials. Results Half (52%) of the respondents were below 30 years old; mean (± sd) = 30.7(9.0). Thirteen percent used reusable materials to collect menstrual blood during their last period. Women aged 45–49 years (AOR = 5.34; 95% CI 3.47–8.19) were 5 times more likely to manage menstruation with reusable materials compared with those aged 15–19 years (p

ObjectiveDietary patterns describe the dietary behaviour and habits of individuals. Unhealthy dietary patterns provide individuals with limited nutrients while increasing the risk of nutrition-related diseases. Unhealthy dietary patterns are high in urban areas, especially among low-income urban residents. This study examined dietary patterns in three low-income urban communities in Accra, Ghana, between 2011 and 2013.MethodsThis study used Wave 2 and 3 data from the Urban Health and Poverty Survey (EDULINK 2011 and 2013). The sample size was 960 in 2011 and 782 in 2013. Dietary pattern was examined using factor analysis and the NOVA food classification system. Summary statistics were computed for sociodemographic characteristics and diet frequency and pattern. Differences in dietary behaviours between 2011 and 2013 were also estimated. Three logistic regression models were computed to determine the predictors of dietary patterns.ResultsThe frequency of consumption of animal-source foods (ASF) and fruits was higher in 2013 compared with 2011. The intake of processed culinary ingredients (NOVA Group 2), processed foods (NOVA Group 3) and ultra-processed foods (NOVA Group 4) was higher in 2013 versus 2011. In 2013, 29% consumed ultra-processed foods compared to 21% in 2011. Three dietary patterns (rice-based, snack-based, and staple and stew/soup) were identified. About two out of every five participants consumed the food items in the rice (43%) and staple and sauce patterns (40%). The proportion of participants who consumed the food items in the snack pattern was 35% in 2011 but 41% in 2013. Respondents aged 25-34 and those with higher education often consumed the snack-based and rice-based dietary patterns. In 2013, participants in Ussher Town had a higher probability of consuming food items in the snack pattern than those living in Agbogbloshie.ConclusionsThis study found that between 2011 and 2013, more participants consumed ASFs, fruits, and processed foods. A complex interplay of personal and socio-cultural factors influenced dietary intake. The findings of this study mirror global changes in diet and food systems, with important implications for the primary and secondary prevention of NCDs. Health promotion programs at the community level are needed to address the increasing levels of processed food consumption.

Abstract Takotsubo cardiomyopathy (TC), an acute cardiac event is often associated with acute emotional stress, usually in the setting of cardiovascular risk factors. This case report attempts to review one of the triggers of TC beer potomania‐induce hyponatremia with imaging findings that shows the link between severe hyponatremia and TC.

Background: Ferulic acid is a polyphenolic phytoconstituent synthesized from the metabolism of amino acids phenylalanine and tyrosine found in fruits and vegetables. Neurodegenerative disorders have been a thorn in the flesh of neuroscientists owing in part to the increase in the aged population. Several drugs used in the management of these disorders are either ineffective or come with unbearable side effects. We present a review of ferulic acid focusing on leveraging its antioxidant property in an attempt to explain its role in neurodegenerative disorders. Basic procedure: data were obtained by perusing scientific databases including Web of Science and PubMed. It was realised that 18,000 articles were associated with ferulic acid from 1960-to 2022. We narrowed it down using the keywords neuroprotection, and antioxidant of which we had 239 articles. Main findings: results indicated that ferulic acid has wide neuropharmacological applications due to its antioxidant, anti-inflammatory, neuroprotective and antiapoptotic effects among others. The neuroprotective effect of ferulic acid has been studied in many diseases like Alzheimer's, Epilepsy, and Parkinson's disease. Principal conclusion: the neuroprotective potential of FA may be due to its ability to absorb active forms of oxygen and nitrogen and use redox-bearing compounds to regulate genetic expression including, encoding for antioxidant enzymes, the anti-apoptotic protein family Bcl-2, and pro-survival neurotrophic factors like BDNF. Its higher bioavailability and lipophilic nature make it a better drug candidate than other polyphenols for neurological disorders.

Abstract Background The determination of the shooting distance using gunshot residue (GSR) analysis is crucial in the investigation and reconstruction of firearm-related crimes. However, the conventional chemographic method for GSR analysis is destructive and has limited sensitivity and selectivity. While the spectroscopic method has potential in GSR analysis for crime investigation, there is a current lack of consistency in the spectroscopic results obtained for shooting distance estimation via GSR analysis. Addressing such limitations will enhance the forensic capabilities of law enforcement and provide an added advantage to crime laboratories during an investigation. It will also reinforce the use of such spectroscopic data in a criminal investigation. Main text We obtained all peer-reviewed articles relevant to shooting distance estimation from searching Scopus, Web of Science, PubMed, and Google Scholar databases. We specifically searched the databases using the keywords “shooting distance,” “range of fire,” “gunshot residue,” “firearm discharge residue,” and “firearm-related crime” and obtained 3811 records. We further filtered these records using a combination of two basic keywords “gunshot residue” and “shooting distance estimations” yielding 108 papers. Following a careful evaluation of the titles, abstracts, and full texts, 40 original peer-reviewed articles on shooting distance estimation via GSR analysis were included in the study. The forgoing included additional sources (n = 5) we obtained from looking through the reference lists of the forensic articles we found. Short conclusion This paper discusses the current scope of research concerning the chemographic and spectroscopic analysis of GSR for shooting distance estimation. It also examines the challenges of these techniques and provides recommendations for future research.

BackgroundIntake of unhealthy foods is linked to the onset of obesity and diet-related non-communicable diseases (NCDs). Availability of unhealthy (nutritionally poor) foods can influence preference, purchasing and consumption of such foods. This study determined the healthiness of foods sold at modern retail outlets- supermarkets and mini-marts in the Greater Accra Region of Ghana.MethodsAll modern retail outlets located in six districts of Greater Accra were eligible. Those < 200 m2 of floor area and with permanent structures were categorized as mini-marts; and those ≥200 m2 as supermarkets. Shelf length of all available foods were measured. Healthiness of food was determined using two criteria - the NOVA classification and energy density of foods. Thus, ultra-processed foods or food items with >225 kcal/100 g were classified as unhealthy. The ratio of the area occupied by unhealthy to healthy foods was used to determine the healthiness of modern retail outlets.ResultsOf 67 retail outlets assessed, 86.6% were mini-marts. 85.0% of the total SHELF area was occupied by foods categorized as unhealthy (ranging from 9,262 m2 in Ashiaman Municipality to 41,892 m2 in Accra Metropolis). Refined grains/grain products were the most available, occupying 30.0% of the total food shelf space, followed by sugar-sweetened beverages (20.1% of total shelf space). The least available food group–unprocessed staples, was found in only one high income district, and occupied 0.1% of the total food shelf space. Retail outlets in two districts did not sell fresh fruits or fresh/unsalted canned vegetables. About two-thirds of food products available (n = 3,952) were ultra-processed. Overall, the ratio of ultra-processed-to-unprocessed foods ranged from 3 to 7 with an average (SD) of 5(2). Thus, for every healthy food, there were five ultra-processed ones in the studied retail outlets.ConclusionThis study reveals widespread availability of ultra-processed foods in modern retail outlets within the selected districts. Toward a healthier food retail environment, public health and food regulators, in partnership with other stakeholders need to institute measures that improve availability of healthy foods within supermarkets and mini-marts.

Abstract Evidence on the individual‐level drivers of dietary behaviours in deprived urban contexts in Africa is limited. Understanding how to best inform the development and delivery of interventions to promote healthy dietary behaviours is needed. As noncommunicable diseases account for over 40% of deaths in Ghana, the country has reached an advanced stage of nutrition transition. The aim of this study was to identify individual‐level factors (biological, demographic, cognitive, practices) influencing dietary behaviours among adolescent girls and women at different stages of the reproductive life course in urban Ghana with the goal of building evidence to improve targeted interventions. Qualitative Photovoice interviews (n = 64) were conducted in two urban neighbourhoods in Accra and Ho with adolescent girls (13–14 years) and women of reproductive age (15–49 years). Data analysis was both theory‐ and data‐driven to allow for emerging themes. Thirty‐seven factors, across four domains within the individual‐level, were identified as having an influence on dietary behaviours: biological (n = 5), demographic (n = 8), cognitions (n = 13) and practices (n = 11). Several factors emerged as facilitators or barriers to healthy eating, with income/wealth (demographic); nutrition knowledge/preferences/risk perception (cognitions); and cooking skills/eating at home/time constraints (practices) emerging most frequently. Pregnancy/lactating status (biological) influenced dietary behaviours mainly through medical advice, awareness and willingness to eat foods to support foetal/infant growth and development. Many of these factors were intertwined with the wider food environment, especially concerns about the cost of food and food safety, suggesting that interventions need to account for individual‐level as well as wider environmental drivers of dietary behaviours.

IntroductionThe advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively affects their food acquisition and consumption. We examined the extent and nature of food and beverage advertising around primary and junior high schools in Ghana's most populous and urbanized region, Greater Accra.Materials and methodsOutdoor advertisements for foods and beverages within a 250 m road network distance of 200 randomly sampled schools were geocoded. For each food and beverage advertisement, information was collected on the setting, type, size, and number of product types featured in the advertisement. Promotional techniques (promotional characters and premium offers) used in advertisements were documented. Advertised foods and beverages were classified using the INFORMAS and NOVA food classification systems.ResultsA total of 5,887 advertisements were identified around the schools surveyed, 42% of which were for foods and beverages. Advertisements were most prevalent at food outlets (78% of all food advertisements), but also along roads and on non-food structures. Overall, 70% of food advertisements featured non-core/unhealthy products, while 12 and 14% had core/healthy and miscellaneous (including soup cubes, seasonings, and tea) products. About 4% of food advertisements had only a product/brand name or logo displayed. One out of two of the foods and beverages advertised were ultra-processed foods, 30% processed, 3% processed culinary ingredients, and 17% unprocessed or minimally processed foods. Sugar-sweetened beverages were the most advertised food product type (32%). Promotional characters were found on 14% of all food advertisements (most–69% were cartoons or manufacturer's characters), while 8% of all food advertisements had premium offers (including price discounts and gift/collectables).ConclusionsThere is an abundance of unhealthy food advertisements around primary and junior high schools in the Greater Accra Region. Policy actions such as restricting the promotion of unhealthy foods in children's settings are needed to protect pupils from such advertising practices.

The study assessed the actors along the Cashew value chain and their influence in making the income derived from cashew sustainable. Primary data for the study were collected from 210 actors using a structured questionnaire. The gross margin and the Herfindahl-Hirschman Index (HHI) were used to determine the revenue margin and market competitiveness (concentration) among the various actors along the cashew value chain. The results revealed that most of the actors were male and had between 6-10 years of experience in cashew production. Also, the actors’ resort to loans in financing their operations was an interest rate of 24%. Producers had the lowest net margin on revenue of 16.95%, and they indicated that fluctuation in pricing and bushfires were challenges faced in production. Purchasing clerks pointed out that inadequate storage facilities and the high cost of transportation were their challenges. Moreover, processors indicated that lack of government support, high interest on loans, and low demand for processed cashew nuts were their challenges. According to cashew nuts exporters, their significant challenges are high cost of transport and high cost of storage facilities. Furthermore, the Herfindahl-Hirschman index showed that the cashew industry in the study area was highly concentrated. The study recommended that government efforts should be focused on developing a cashew Development Board to enhance marketing and price regulation.

This article interrogates the effect of mobile money on households’ access to credit services. It also compares the mobile money effect with the effect of owning account in other financial institutions (excluding commercial banks), and explores complementarity effects between them as well as heterogeneity effects across gender and locality of residence. Using treatment effect models and observational data from the seventh round of the Ghana Living Standards Surveys, the results generally show that mobile money increases the probability of applying for credit but has no effect on the amount of credit received. The effect on credit application is only found among households that also own accounts in other financial institutions, except for male headed households, of whom we observe a significant effect among those that own only mobile money accounts. The complementary effect of mobile money to the effect of other financial institutions on credit application are higher for male headed households and households in rural communities than their respective counterparts. These results are robust to different treatment effect estimators including the doubly robust augmented inverse probability estimator and the inverse probability regression adjustment estimator with several controls including health shocks in their outcome models. The findings call into question the extent to which mobile money facilitates the provision of inclusive financial services beyond serving as a tool for payments and savings. The findings bear significant policy implications with regards to how to broaden the financial inclusion impact of mobile money.

In theory, teacher knowledge predicts instructional practice, thus impacting student outcomes. When it comes to knowledge to teach elementary-grade reading, most previous surveys have focused on knowledge essential for word reading development; few surveys have provided a picture of educator knowledge to teach both word reading and language comprehension. This article describes the development and validation of the Teacher Understanding of Literacy Constructs and Evidence-Based Instructional Practices (TULIP) survey, which assesses teacher knowledge in the domains of (a) phonological awareness, (b) phonics, decoding, and encoding, (c) reading fluency, (d) oral language, and (e) reading comprehension. The TULIP survey was created using an iterative development process involving a systematic review of research, expert review of items, field testing, and a pilot study. A validation study of the resulting TULIP survey was conducted with a sample of 313 in-service elementary-grade teachers of reading. Confirmatory factor analyses revealed that both one-factor and five-factor models of the survey had acceptable fit. The overall TULIP scale had good reliability, and subscales representing knowledge within specific literacy domains had acceptable reliability (with the oral language subscale having lower reliability than the other four subscales). Knowledge overall and within each literacy domain was significantly related to education level, such that teachers with more education had higher scores.

Children who live in under-resourced communities and attend under-resourced schools deserve access to high-quality teachers and educational opportunities to support their success and well-being. This study emerged from a professional development (PD) for urban teachers working in such schools, to expand educational opportunities for elementary students through outdoor science teaching. Engaging frameworks of communities of practice (CoP) and critical pedagogy of place (CPP), this critical ethnographic study investigates how urban elementary teachers engage in discourse about critical issues of place. Additionally, the investigation seeks to understand how a CoP supports such discourse. The primary data for this study were multiple sets of researcher field notes collected from participant teachers during virtual spring and in-person summer PD. Over the course of the PD, participants shifted from viewing their outdoor teaching spaces with a deficit perspective to an asset-focused one. As they visited one another's teaching sites, the CoP the teachers were a part of created opportunity for discourse about social justice linked to issues of place within their particular school neighborhoods. The ability of urban elementary teachers to connect social justice to issues of place and to the teaching of science has implications for countering the injustice that characterizes many urban communities in the USA and elsewhere.

Objective: Growing evidence suggests digital interventions may provide neurocognitive benefits for children with ADHD. This study aimed to investigate the efficacy of a digital attention intervention in children with ADHD. Method: In this double-blind randomized controlled trial 55 children with ADHD (5-9 years) were allocated to the intervention (N=28) or control program (N=27). Both programs were delivered via touchscreen tablets at home 5 days a week for 5 weeks. The primary outcome was change in the Test of Variables of Attention (TOVA) Attention Comparison Score (ACS) from pre- to post-intervention. Results: Participants who received the intervention had significantly greater improvements in the TOVA ACS from pre- to post-intervention than those in the control (p<0.044). No intervention effects were observed on secondary outcomes assessing executive functioning, ADHD symptoms, or functional impairment. Conclusion: Collectively these findings provide insufficient evidence for the implementation of digital attention interventions for children with ADHD.

While information and communication technologies (ICT) have proven to be useful in boosting agricultural production and productivity, regardless of the geographical location, much of the discussion on ICT and their impact focus on the global north, with deficient literature on the global south. The limited account of the global south shows mixed conclusions on the impact of information and communication technologies on agricultural production, with most studies focusing on crop production, as a proxy for agricultural production, leaving out livestock production. Animated by this concern, this article explores the impact of ICTs on agricultural production (crop and livestock) in Africa using panel data from 32 African countries and the panel autoregressive distributed lag model as the estimation technique. We find that individuals using internet significantly increased crop production in the long run. Specifically, a percentage increase in internet patronage increases crop production by 0.071% but significantly decreases the livestock production index, both in the short and long run. Mobile phone subscriptions had a significant negative impact on crop production in the long run but had a significant positive impact on livestock production in the long run. Fixed phone subscriptions significantly increased crop production in the long run but significantly decreased livestock production index in the long run. The findings show bidirectional causality between crop production and internet patronage, livestock production and individuals using internet, crop production and mobile cellular subscription, crop production and net national income, and rural population and both crop and livestock production. We recommend that governments in Africa increase funding investment in digital technologies to foster increased agricultural production while addressing structural challenges that constrain increased access to digital agricultural technologies. It might be useful if governments in sub-Saharan Africa (SSA) incentivize the telecommunication companies to extend digital coverage to rural areas through tax rebates and holidays to encourage rural inclusion in the digital space to bridge the digital divide.

BackgroundProfessional society guidelines are evidence-based recommendations intended to promote standardized care and improve health outcomes. Amid increased recognition of the role racism plays in shaping inequitable healthcare delivery, many researchers and practitioners have critiqued existing guidelines, particularly those that include race-based recommendations. Critiques highlight how racism influences the evidence that guidelines are based on and its interpretation. However, few have used a systematic methodology to examine race-based recommendations. This review examines hypertension guidelines, a condition affecting nearly half of all adults in the United States (US), to understand how guidelines reference and develop recommendations related to race.MethodsA systematic scoping review of all professional guidelines on the management of essential hypertension published between 1977 and 2022 to examine the use and meaning of race categories.ResultsOf the 37 guidelines that met the inclusion criteria, we identified a total of 990 mentions of race categories. Black and African/African American were the predominant race categories referred to in guidelines (n = 409). Guideline authors used race in five key domains: describing the prevalence or etiology of hypertension; characterizing prior hypertension studies; describing hypertension interventions; social risk and social determinants of health; the complexity of race. Guideline authors largely used race categories as biological rather than social constructions. None of the guidelines discussed racism and the role it plays in perpetuating hypertension inequities.DiscussionHypertension guidelines largely refer to race as a distinct and natural category rather than confront the longstanding history of racism within and beyond the medical system. Normalizing race as a biological rather than social construct fails to address racism as a key determinant driving inequities in cardiovascular health. These changes are necessary to produce meaningful structural solutions that advance equity in hypertension education, research, and care delivery.

Abstract Background Suboptimal breastfeeding practices are driven by multiple factors. Thus, a multi-sectoral approach is necessary to design and implement appropriate policies and programs that protect, promote, and support breastfeeding. Methods This study used Net-Map, an interactive social network interviewing and mapping technique, to: a) identify key institutional actors involved in breastfeeding policy/programs in Ghana, b) identify and describe links between actors (i.e., command, dissemination, funding, and technical assistance (TA)), and c) document actors influence to initiate or modify breastfeeding policy/programs. Ten experts were purposively selected from relevant institutions and were individually interviewed. Interview data was analysed using social networking mapping software, Gephi (version 0.9.2). Results Forty-six unique actors were identified across six actor categories (government, United Nations agencies, civil society, academia, media, others), with one-third being from government agencies. Dissemination and TA links accounted for two-thirds of the identified links between actors (85/261 links for dissemination; 85/261 for TA). Command links were mainly limited to government agencies, while other link types were observed across all actor groups. Ghana Health Service (GHS) had the greatest in-degree centrality for TA and funding links, primarily from United Nations Children’s Fund (UNICEF) and development partners. The World Health Organization, UNICEF, Ministry of Health, and GHS had the highest weighted average relative influence scores. Conclusions Although diverse actors are involved in breastfeeding policy and programming in Ghana, GHS plays a central role. United Nations and donor agencies are crucial supporters of GHS providing breastfeeding technical and financial assistance in Ghana.

This study is the first to provide information on the parasite fauna of Sardinella maderensis along the coasts of Benin and Ghana, and the first to investigate the potential use of parasites as biological tags in fish population studies in the area. It may thus serve as a starting point for upcoming studies. From February to June 2021, a total of 200 S. maderensis were sampled from the fishing port of Cotonou (Benin) and the Elmina landing site (Ghana). The prevalence and abundance of each parasite were recorded. The following are the outcomes of this study: Parasite species, such as Parahemiurus merus, Mazocraeoides sp. and Hysterothylacium fortalezae, were recorded along the coasts of Benin and Ghana, while Anisakis sp(p). and Tentacularia coryphaenae were only recorded along the coast of Benin. Parahemiurus merus was the most prevalent and abundant among all the parasites recorded. Anisakis sp(p). and T. coryphaenae were selected as having potential in the stock identification of S. maderensis. Both parasites were only recorded along the coast of Benin at a low prevalence. As a result, examinations of more S. maderensis from each location for these parasites may justify their use in stock identification studies.

Abstract Background Public sector strategies to promote insecticide-treated net (ITN) access have resulted in increased ITN ownership across sub-Saharan Africa. However, the current status of the private sector distribution channel for nets has not been fully explored. This multi-country study explored the prevalence of net purchases and the characteristics of households that had purchased nets and used such nets in sub-Saharan Africa. Methods Data from recent Malaria Indicator Survey (MIS) or Demographic and Health Survey (DHS) in 16 countries were analysed to explore the prevalence of purchased nets. Purchased nets were defined as nets obtained from shops/markets or pharmacies. Additional sub-analysis of factors associated with ownership and use of purchased nets was conducted in seven countries with over 10% of nets reported as purchased. Key outcomes included: prevalence of purchased nets out of all nets, household ownership of a purchased net, and whether a purchased net was used the previous night. Analytical methods included country level tests of association and multivariable logistic regressions. Results Among all nets, the proportion of purchased nets in the study countries ranged from 0.8 to 32.7% and most (median = 77%) of these purchased nets were ITNs. Although the private nets are presumed to be from the retail, non-public sector, the prevalence of treated purchased nets suggests that some purchased nets may be “leaked” ITNs from public sector distributions, and thus, may be an informal sector rather than part of the formal “private sector”. Urban, wealthier households as well as those with educated heads were more likely to own purchased nets. Use of such nets was, however, lower in wealthier households. In addition, net use was higher in households owning insufficient nets for their family size, and when the nets were newer than 24 months. Conclusion The formal and informal private sector have played a role in bolstering net access rates in some settings. Study findings can help relevant malaria control stakeholders gain insight on the contribution of purchased nets on their overall ITN strategy, identify potential target populations for private sector nets as well as inform the design and distribution of private sector insecticide-treated nets that appeal to their target groups.

Hematopoietic cells play a crucial role in the adult retina in health and disease. Monocytes, macrophages, microglia and myeloid angiogenic cells (MACs) have all been implicated in retinal pathology. However, the role that hematopoietic cells play in retinal development is understudied. The temporal changes in recruitment of hematopoietic cells into the developing retina and the phenotype of the recruited cells are not well understood. In this study, we used the hematopoietic cell-specific protein Vav1 to track and investigate hematopoietic cells in the developing retina. By flow cytometry and immunohistochemistry, we show that hematopoietic cells are present in the retina as early as P0, and include microglia, monocytes and MACs. Even before the formation of retinal blood vessels, hematopoietic cells localize to the inner retina where they eventually form networks that intimately associate with the developing vasculature. Loss of Vav1 lead to a reduction in the density of medium-sized vessels and an increased inflammatory response in retinal astrocytes. When pups were subjected to oxygen-induced retinopathy, hematopoietic cells maintained a close association with the vasculature and occasionally formed ‘frameworks’ for the generation of new vessels. Our study provides further evidence for the underappreciated role of hematopoietic cells in retinal vasculogenesis and the formation of a healthy retina.

Background: This study describes the rationale, adaptation, and final protocol of a project developed to address the increase in obesity and nutrition-related non-communicable diseases (NR-NCDs) in Ghana. Code-named the Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) project, it aims to measure and support public sector actions that create healthy food marketing, retail, and provisioning environments for Ghanaian children using adapted methods from the International Network for Food and Obesity/NCDs Research Monitoring and Action Support (INFORMAS).Methods: The protocol for this observational study draws substantially from the INFORMAS' Food Promotion and Food Provision Modules. However, to appraise the readiness of local communities to implement interventions with strong potential to improve food environments of Ghanaian children, the MEALS4NCDs protocol has innovatively integrated a local community participatory approach based on the community readiness model (CRM) into the INFORMAS approaches. The setting is Ghana, and the participants include health and nutrition policy-makers, nutrition and food service providers, consumers, school authorities, and pupils of Ghanaian basic schools.Results: The study establishes a standardized approach to providing implementation science evidence for the prevention of non-communicable diseases (NCDs) in Ghana. It demonstrates feasibility and the innovative application of the INFORMAS expanded food promotion and food provision modules, together with the integration of the CRM in a lower-middle income setting.Conclusion: The research will facilitate the understanding of the processes through which the INFORMAS approach is contextualized to a lower-middle income African context. The protocol could be adapted for similar country settings to monitor relevant aspects of food environments of children.

Access to quality education for all children is important for achieving the Sustainable Development Goals especially in Africa. However, information and communication technologies (ICTs) and access to electricity have continued to be burning issues hindering access to quality education in Africa. However, empirical evidence on the impact of ICTs and access to electricity on primary education in Africa is rare. This paper, therefore, investigates the impacts of information and communication technologies and access to electricity on the education of children in Africa. The study used rich data on primary school enrolment, education expenditure, access to electricity, fixed broadband subscriptions, fixed telephone subscriptions, mobile cellular subscriptions, and individuals using the internet in Africa obtained from the World Development Indicators. Leveraging on panel autoregressive distributed lag model, we find that fixed broadband subscriptions, mobile cellular subscriptions, individuals using the internet, and access to electricity exert significant impacts on school enrolment in Africa. We find from the Granger causality test result a unidirectional causality between school enrolment and mobile phone subscription. Furthermore, we identified bidirectional causalities between school enrolment and access to electricity, education expenditure, fixed telephone subscriptions, fixed broadband subscriptions, and individuals using the internet. We conclude that information and communication technologies improve education in Africa.

This study examined the heterogeneity of literacy profiles for adolescents with and without a specific learning disability (SLD) in the U.S. state of Florida Student subgroups displaying common patterns of performance in word-level skills and reading comprehension were identified through latent profile analysis. Results indicate most of the total sample demonstrated below-average performance in one or both areas with word-level skill difficulties being more common than difficulties in reading comprehension alone. Changes in reading performance by profile over time (Grades 6-8) were examined through a latent transition analysis revealing consistent patterns in the SLD sample and variable patterns in the typically developing sample. Resulting profiles were utilized to predict performance on an end-of-year broad reading comprehension measure indicating very little change in performance over time. Findings suggest large numbers of adolescents with concurrent word-level and reading comprehension difficulties likely need sustained intervention in word-level skills to support their reading comprehension.