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Population-Based Tuberculosis Disease Prevalence Survey in Ghana: The Role and Lessons Learnt from the Laboratory  [PDF]
Kennedy Kwasi Addo, Samuel Ofori Addo, Christian Bonsu, Ezekiel Mensah, Sarah Edusei, Prosper Dedzo, Michael Amo Omari, Samuel Kudzawu, Honesty Ganu, Samuel Kumah Atiadevie, Frank Adae Bonsu
Journal of Tuberculosis Research (JTR) , 2019, DOI: 10.4236/jtr.2019.72009
Abstract: Background: Bacteriologically-confirmed tuberculosis (TB) cases used in calculating TB prevalence in a country are obtained through laboratory examination of sputum specimens. Objective: This article describes laboratory processing of specimens, results overview, conclusions and key lessons learnt from the perspective of laboratory personnel involved in the conduct of TB disease prevalence survey in Ghana in 2013. Methods: Symptoms screening and Chest X-ray suggestive of TB were used to select participants who produced sputum to confirm TB cases using microscopy, culture and Xpert® MTB/RIF assay (GeneXpert). Results: A total of 15,935 single and paired sputum specimens were received from eligible participants. About half of Ziehl-Nielsen (129/263) and Auramine O (122/246) stained smear positives were scanty positive. Culture positivity rate for Mycobacterium tuberculosis complex was 266/14,994 (1.7%) and 100/15,179 (0.7%) in Mycobacterial Growth Indicator Tube (MGIT) and Lowenstein-Jensen (LJ) media respectively; while non-tuberculous mycobacterium was 294/14,994 (1.96%) and 167/15,179 (1.1%). Total contamination rates in MGIT (5.4%) were higher than in LJ (1.7%). Prevalence of smear positive TB and bacteriologically confirmed TB among adult population (≥15 years) was estimated at 111 (95% CI: 76 - 145) and 356 (95% CI: 288 - 425) per 100,000 population respectively. Conclusions and Lessons Learnt: Direct supervision of specimen collection by well-trained laboratory personnel, timely transportation of specimens from field to laboratory, prompt specimen processing and use of electronic data management systems are essential for a reliable TB disease prevalence survey data. More importantly, strengthening human and logistical capacity of the laboratory must be of utmost priority.
Midwifery and Midwives Service Scheme: A Panacea for Improvement of Some Maternal and Neonatal Indices in Nigeria—A Brief Review  [PDF]
Prosper Adogu
Open Journal of Obstetrics and Gynecology (OJOG) , 2014, DOI: 10.4236/ojog.2014.47051

Introduction: Midwifery is the art of caring for women during childbearing. It is practiced throughout the world according to the norms, traditions and cultural practices found in each country. Maternal mortality in Nigeria is high but there are wide variations between the geopolitical zones of the country. Government has established the midwives service scheme (MSS) as part of efforts towards reversing the country’s unacceptably high maternal mortality trends. To improve these indices, the MSS in Nigeria engaged newly graduated unemployed and retired midwives to work temporarily in rural areas. The midwives are posted for twelve months to selected primary care facilities linked through a cluster model in which four such facilities with the capacity to provide basic essential obstetric care are clustered around a secondary care facility with the capacity to provide comprehensive emergency obstetric care. This brief review is an attempt at exploring the impact of the midwives service scheme on maternal and neonatal indices in Nigeria. Main content: The outcome of the MSS four years has been an improvement though unevenly and marginally, in these indices in the various geopolitical zones of Nigeria. Improvements have been noticed in maternal indices such as antenatal care attendance, women receiving two doses of tetanus toxoid and number of deliveries by skilled personnel. Also reduction in maternal and neonatal mortality has been observed over the years following introduction of the scheme. Major challenges however, include lack of essential drugs, poor accommodation facilities for MSS staff, irregular payment of their remuneration and lack of water/power supply to some designated facilities for the scheme. Recommendations and conclusions: It is therefore recommended that 24 hours availability of essential drugs at primary healthcare centers be maintained. This should happen in conjunction with regular payment of full entitlements and benefits and provision of secured, habitable and good accommodation for MSS staff. Finally, aggressive community mobilization should continue in order to engender community involvement and participation for sustainable program development.

Solution Concepts and New Optimality Conditions in Bilevel Multiobjective Programming  [PDF]
Francisque Fouodji Dedzo, Laure Pauline Fotso, Calice Olivier Pieume
Applied Mathematics (AM) , 2012, DOI: 10.4236/am.2012.330196
Abstract: In this paper, new sufficient optimality theorems for a solution of a differentiable bilevel multiobjective optimization problem (BMOP) are established. We start with a discussion on solution concepts in bilevel multiobjective programming; a theorem giving necessary and sufficient conditions for a decision vector to be called a solution of the BMOP and a proposition giving the relations between four types of solutions of a BMOP are presented and proved. Then, under the pseudoconvexity assumptions on the upper and lower level objective functions and the quasiconvexity assumptions on the constraints functions, we establish and prove two new sufficient optimality theorems for a solution of a general BMOP with coupled upper level constraints. Two corollary of these theorems, in the case where the upper and lower level objectives and constraints functions are convex are presented.
Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana)
Bruno Marchal, McDamien Dedzo, Guy Kegels
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-787
Abstract: A realist case study design was used to analyse how specific management practices might contribute to improving the performance of an urban district hospital in Ho, Volta Region, in Ghana. Mixed methods were used to collect data, including document review, in-depth interviews, group discussions, observations and a review of routine health information.At Ho Municipal Hospital, the management team dealt with the crisis engulfing the ailing urban district hospital by building an alliance between hospital staff to generate a sense of ownership with a focus around participative problem analysis. The creation of an alliance led to improving staff morale and attitude, and contributed also to improvements in the infrastructure and equipment. This in turn had a positive impact on the revenue generating capacity of the hospital. The quick turn around in the state of this hospital showed that change was indeed possible, a factor that greatly motivated the staff.In a second step, the management team initiated the development of a strategic plan for the hospital to maintain the dynamics of change. This was undertaken through participative methods and sustained earlier staff involvement, empowerment and feelings of reciprocity. We found that these factors acted as the core mechanisms underlying the changes taking place at Ho Municipal Hospital.This study shows how a hospital management team in Ghana succeeded in resuscitating an ailing hospital. Their high commitment management approach led to the active involvement and empowerment of staff. It also showed how a realist evaluation approach such as this, could be used in the research of the management of health care organisations to explain how management interventions may or may not work.Over the last 20 years, a number of strategies aimed at improving the performance of health services have been implemented in low- and middle-income countries (LMIC). Each strategy has had its specific perspective and focused on one particular is
A realist evaluation of the management of a well- performing regional hospital in Ghana
Bruno Marchal, McDamien Dedzo, Guy Kegels
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-24
Abstract: We developed a realist evaluation framework for hypothesis formulation, data collection, data analysis and synthesis of the findings. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews.We found that the human resource management approach (the actual intervention) included induction of new staff, training and personal development, good communication and information sharing, and decentralised decision-making. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. Teamwork, recognition and trust emerged as key elements of the organisational climate. Interviewees reported high levels of organisational commitment. The analysis unearthed perceived organisational support and reciprocity as underlying mechanisms that link the management practices with commitment.Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). We also identified a number of practical difficulties and priorities for further methodological development.This case suggests that a well-balanced HRM bundle can stimulate organisational commitment of health workers. Such practices can be implemented even with narrow decision spaces. Realist evaluation provides an appropriate approach to increase the usefulness of case studies to managers and policymakers.In the wake of the numerous global health initiatives, the health workforce of low
Study of Multi-Origin Hazards and Assessment of Associated Risks in the Lefo Caldera (Bamenda Volcano, Cameroon Line)  [PDF]
Zangmo Tefogoum Ghislain, Nkouathio David Guimolaire, Kagou Dongmo Armand, Gountie Dedzo Merlin, Kamgang Pierre
International Journal of Geosciences (IJG) , 2014, DOI: 10.4236/ijg.2014.511107
Abstract: The Bamenda Volcano (BV) (2621 m) is a stratovolcano situated in the Cameroon Line (CL). BV includes Mount Lefo (2534 m) which is situated on its southern slopes and contains one elliptical caldera (3 × 4 km). This caldera is propitious to farming and breeding activity. Despite these profitable assets, Lefo caldera (LC) is an amphitheater of the occurrence of multi-origin hazards that have direct or indirect impacts on the biodiversity and human patrimony. The most present hazards are those of meteorological origin. Numerous combined factors (steepest slopes, heavy rainfalls, weathered state of volcanic products…) rule these hazards. These factors gave rise to the occurrence of landslides, gullies erosion and rock falls which occur precisely on caldera northern and eastern rims. Hazards of anthropogenic origin are based on the destruction of the vegetation cover by the population for dealing, firewood and building issues. Moreover, during the breeding activity, the cattle covers the caldera throughout the day; this unevens the topography and destroys the meadow. Hazards of volcanological origin are not yet occurring in LC; but the recent Lake Monoun (1984) and Nyos (1986) CO2 eruptions, mount Cameroon eruptions (1999 and 2000) and mount Oku Lake event (2011) which are close to the BV and, the age of 0 Myr of basalt, constitutes a subject of controversy toward the reactivation of the Cameroonian hotspot faults. The assessment of risks in LC was based on the average income of breeding activity and house investment. The economy of LC is valued at about US$527472.527. The level of such risk will be important in case of loss of human beings and the destruction of geomorphosites’ values. In order to reduce the level of looses in this zone, hazard and risks maps are provided in this paper as well as some recommendations.
Chemical and Geological Control on Surface Water within the Shade River Watershed in Southeastern Ohio  [PDF]
Prosper Gbolo, Dina L. López
Journal of Environmental Protection (JEP) , 2013, DOI: 10.4236/jep.2013.41001

The under-sampled middle and western branches of Shade River Watershed (SRW) in SE Ohio were investigated as part of the Ohio University—U.S. Environmental Protection Agency (EPA) STAR grant. This project was for monitoring the quality of watersheds in Ohio and classifying them according to their physical, chemical, and biological conditions. Water samples, as well as field parameters, were taken at twenty-two sites for chemical analyses. The ions analyzed included Ca, Mg, Na, Fe, Mn, Al, NO3, SO4, HCO3, and total PO4, while the field parameters measured included pH, dissolved oxygen (DO), total dissolved solids (TDS), electrical conductivity (EC), and alkalinity. To assess the water quality within the SRW, the analyzed ions and field parameters were compared to the USEPA criteria for the survival of aquatic life. Analytical results showed that the watershed is dominated by Ca-HCO3waters with DO, Fe, Mn, and PO4being the main causes of impairment within the streams. The relatively elevated concentrations of manganese and less extent iron may be associated with the local geology and the acidic nature of the soils. The high alkalinity and calcium concentrations are due to the limestone geology. The elevated phosphate concentration may be due to anthropogenic sources, fertilizers, or contributions from phosphorus-rich bedrock that differs geochemically from other areas.

High prevalence of syphilis among demobilized child soldiers in Eastern Congo: a cross-sectional study
Raphael Senga, Prosper Lutala
Conflict and Health , 2011, DOI: 10.1186/1752-1505-5-16
Abstract: Screening of syphilis using the rapid plasma reagin test and the Treponema pallidum hemagglutination assay was conducted in three transit sites of soldier reintegration in 2005. The Fisher Exact probability test was used to compare results.The prevalence of syphilis was found to be 3.4%, with almost equal distribution in respect to sex, location.Syphilis continues to be highly prevalent in demobilized child soldiers in Eastern Congo. Syphilis screening tests are recommended.Syphilis and to some extent other sexually transmitted infections (STIs) are a major public health issue for soldiers during periods of conflict. In the Democratic Republic of Congo (Congo), these have been exacerbated by widespread sexual violence. Child soldiers are particularly vulnerable due to several factors: incomplete maturation, low social conditions, use as sexual workers by superiors, and their promiscuous environment. During World Wars I and II and subsequent armed conflicts throughout the world, syphilis has played an unprecedented role in soldier morbidity [1]. The Congo, with almost two decades of armed conflicts, is characterized by widespread sexual violence [2,3]. In the Congo and other African countries, recruitment of child soldiers has been largely practiced despite its war-crime characterization as defined by the Rome Statute of the International Criminal Court [4].As a war nears its end, disarmament, demobilization, and reinsertion (DDR) of combatants is a compulsory post-conflict step. In the Congo, all child soldiers undergo this process, which allows soldiers who desire, or who are children, to return to civilian life. At the transit camp soldiers undergo compulsory syphilis testing. To prevent possible spread of the disease upon reintegration, those who test positive undergo treatment.Despite a number of studies dealing with syphilis prevalence in various contexts, to our knowledge, little is known about syphilis prevalence in demobilized soldiers, and particularly in c
Use of a CME workshop to introduce and promote the specialty of Family Medicine in Ethiopia
Prosper M. Lutala
African Journal of Primary Health Care & Family Medicine , 2011, DOI: 10.4102/phcfm.v3i1.226
Abstract: How to cite this article: Lutala P.M. Use of a CME workshop to introduce and promote the specialty of Family Medicine in Ethiopia. Afr J Prm Health Care Fam Med. 2011;3(1), Art. #226, 2 pages. doi:10.4102/phcfm. v3i1.226
Multivariate disriminants
Prosper Harrison B.
EPJ Web of Conferences , 2010, DOI: 10.1051/epjconf/20100402001
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