Catholic University College of Ghana

ABSTRACT Mycobacterium ulcerans disease is common in some humid tropical areas, particularly in parts of West Africa, and current management is by surgical excision of skin lesions ranging from early nodules to extensive ulcers (Buruli ulcer). Antibiotic therapy would be more accessible to patients in areas of Buruli ulcer endemicity. We report a study of the efficacy of antibiotics in converting early lesions (nodules and plaques) from culture positive to culture negative. Lesions were excised either immediately or after treatment with rifampin orally at 10 mg/kg of body weight and streptomycin intramuscularly at 15 mg/kg of body weight daily for 2, 4, 8, or 12 weeks and examined by quantitative bacterial culture, PCR, and histopathology for M. ulcerans . Lesions were measured during treatment. Five lesions excised without antibiotic treatment and five lesions treated with antibiotics for 2 weeks were culture positive, whereas three lesions treated for 4 weeks, five treated for 8 weeks, and three treated for 12 weeks were culture negative. No lesions became enlarged during antibiotic treatment, and most became smaller. Treatment with rifampin and streptomycin for 4 weeks or more inhibited growth of M. ulcerans in human tissue, and it provides a basis for proceeding to a trial of antibiotic therapy as an alternative to surgery for early M. ulcerans disease.

This study examines some of the socioeconomic cost of treating 102 cases of Buruli ulcer between 1994 and 1996 at the St. Martin's Catholic Hospital in Agroyesum in the Amansie West district of the Ashanti region of Ghana. Seventy percent of the cases were children (up to 15 years of age). There was no sex difference in the distribution of cases. Hospitalization was prolonged (average = 186 days in 1994, 103 days in 1995, and 102 days in 1996) with no significant age and sex differences. There were 10 limb amputations, 12 patients were left with contracture deformities, one patient lost sight in one eye, and two died of sepsis and tetanus. The average total treatment cost per patient was $966.85 (62% indirect) in 1994, $706.08 (75% indirect) in 1995, and $658.74 (79% indirect) in 1996. With increasing number of cases, high treatment costs, and serious complications, urgent attention should be given to the disease in terms of control and research efforts aimed at early detection and treatment.

This paper examined the effect of work environment on job satisfaction with the spotlight on a merchant bank in Ghana. Among other objectives, the paper set out to ascertain the impact of physical and mental environment on employees’ performance, to know the overall satisfaction level of employees in the bank and study whether physical, social and psychological work environment affect job satisfaction. Stratified sampling technique was adopted to select the sample for the study. Questionnaire was used as the research instrument while Statistical Package for Social Science (SPSS) was employed to analyze the data gathered from the field study. Findings of the study indicated that most of the staff at the bank are satisfied with their work environment especially the physical ambiance. The paper concludes that the environment has a significant effect on employees’ satisfaction. The findings of the paper emphasize the need for management to improve the work environment of employees to boost productivity.

The natural pattern of progression of Parkinson's disease is largely unknown because patients are conventionally followed on treatment. As Parkinson's disease progresses, the true magnitude of the long-duration response to levodopa remains unknown, because it can only be estimated indirectly in treated patients. We aimed to describe the natural course of motor symptoms by assessing the natural OFF in consecutive Parkinson's disease patients never exposed to treatment (drug-naïve), and to investigate the effects of daily levodopa on the progression of motor disability in the OFF medication state over a 2-year period. In this prospective naturalistic study in sub-Saharan Africa, 30 Parkinson's disease patients (age at onset 58 ± 14 years, disease duration 7 ± 4 years) began levodopa monotherapy and were prospectively assessed using the Unified Parkinson's disease Rating Scale (UPDRS). Data were collected at baseline, at 1-year and 2-years follow-up. First-ever levodopa intake induced a significant improvement in motor symptoms (natural OFF versus ON state UPDRS-III 41.9 ± 15.9 versus 26.8 ± 15.1, respectively; P < 0.001). At 1-year follow-up, OFF state UPDRS-III score after overnight withdrawal of levodopa was considerably lower than natural OFF (26.5 ± 14.9; P < 0 .001). This effect was not modified by disease duration. At the 2-year follow-up, motor signs after overnight OFF (30.2 ± 14.2) were still 30% milder than natural OFF (P = 0.001). The ON state UPDRS-III at the first-ever levodopa challenge was similar to the overnight OFF score at 1-year follow-up and the two conditions were correlated (r = 0.72, P < 0.001). Compared to the natural progression of motor disability, levodopa treatment resulted in a 31% lower annual decline in UPDRS-III scores in the OFF state (3.33 versus 2.30 points/year) with a lower model's variance explained by disease duration (67% versus 36%). Using the equation regressed on pretreatment data, we predicted the natural OFF at 1-year and 2-year follow-up visits and estimated that the magnitude of the long-duration response to levodopa ranged between 60% and 65% of total motor benefit provided by levodopa, independently of disease duration (P = 0.13). Although levodopa therapy was associated with motor fluctuations, overnight OFF disability during levodopa was invariably less severe than the natural course of the disease, independently of disease duration. The same applies to the yearly decline in UPDRS-III scores in the OFF state. Further research is needed to clarify the mechanisms underlying the long-duration response to levodopa in Parkinson's disease. Understanding the natural course of Parkinson's disease and the long-duration response to levodopa may help to develop therapeutic strategies increasing its magnitude to improve patient quality of life and to better interpret the outcome of randomized clinical trials on disease-modifying therapies that still rely on the overnight OFF to define Parkinson's disease progression.

Because of the emergence of Buruli ulcer disease, the World Health Organization launched a Global Buruli Ulcer Initiative in 1998. This indolent skin infection is caused by Mycobacterium ulcerans. During a study of risk factors for the disease in Ghana, adequate excisional skin-biopsy specimens were obtained from 124 clinically suspicious lesions. Buruli ulcer disease was diagnosed in 78 lesions since acid-fast bacilli (AFB) were found by histopathologic examination. Lesions with other diagnoses included filariasis (3 cases), zygomycosis (2 cases), ulcerative squamous cell carcinomas (2 cases), keratin cyst (1 case), and lymph node (1 case). Thirty-seven specimens that did not show AFB were considered suspected Buruli ulcer disease cases. Necrosis of subcutaneous tissues and dermal collagen were found more frequently in AFB-positive specimens compared with specimens from suspected case-patients (p<0.001). Defining histologic criteria for a diagnosis of Buruli ulcer disease is of clinical and public health importance since it would allow earlier treatment, leading to less deforming sequelae.

Purpose The aim of this research is to assess the financial performance of the life insurance industry of an emerging economy. In particular the study delves into the major determinants of the profitability of the life insurance industry of Ghana. The study also examines the relationship among the three measures of insurers' profitability, which are investment income, underwriting profit and the overall (total) net profit. Design/methodology/approach The annual financial statements of ten life insurance companies covering a period of 11 years (2000‐2010) were sampled and analyzed through panel regression. Findings The findings indicate that whereas gross written premiums have a positive relationship with insurers' sales profitability, its relationship with investment income is a negative one. Also, the results showed that life insurers have been incurring large underwriting losses due to overtrading and price undercutting. The results further revealed a setting‐off rather than a complementary relationship between underwriting profit and investment income towards the enhancement of the overall profitability of life insurers. Practical implications The policy implications of this study for the stakeholders of the life insurance industry are enormous. For instance, insurers must have well‐resourced actuary departments to perform price validation of all policies in order to prevent over‐trading and price undercutting by insurance marketing agents. In addition, the intention of the NIC to adopt a risk‐based approach in its supervision is not only timely but a very significant move that will improve upon the accounting and records keeping standards of the industry as well as the governance and risk management structures of the sector. Social implications Being too obsessed with premium growth without adequate price validation can lead to self‐destruction such as huge underwriting losses. Large underwriting losses can lead to insurance insolvency during periods of cluster claims. Originality/value This study fulfills an urgent need to investigate the things that are crucial for the survival, growth and profitability of life insurers in an emerging economy.

Summary The rate of increase of humus carbon in soils rested under natural fallows has been calculated, assuming that the rate of decomposition of the humus carbon is proportional to the amount present, and that the rate of addition, by humification of litter and roots, remains constant. The rate of decomposition has been derived from a knowledge of the maximum humus level the soil attains under the fallow vegetation, and the rate of addition has been estimated from data on litter production. The rate of increase of nitrogen has also been calculated assuming that the C/N ratio in the soil remains constant. Under the native practice of shifting cultivation in forest the alternation of cropping and fallowing leads to relatively small fluctuations in soil humus at about 75 per cent. of the maximum level. The rates of increase of soil nitrogen at this level are between 20 and 50 lb. per acre per annum in forest and 4 and 10 lb. per acre per annum in savannah. Rates at other levels for which the assumptions made are valid may readily be calculated from the data presented. It is shown that provided vegetation re‐establishes itself rapidly a crop: fallow ratio of about 1:3 should maintain the humus level in forest soils at the 75 per cent. of equilibrium level, a result which accords well with experience.

Abstract Low-cost teak leaf litter powder (TLLP) was prepared as possible substitute for activated carbon. The feasibility of using the adsorbent to remove eosin yellow (EY) dye from aqueous solution was investigated through equilibrium adsorption, kinetic and thermodynamic studies. The removal of dye from aqueous solution was feasible but influenced by temperature, pH, adsorbent dosage and contact time. Variation in the initial concentration of dye did not influence the equilibrium contact time. Optimum adsorption of dye occurred at low adsorbent dosages, alkaline pH and high temperatures. Langmuir isotherm model best fit the equilibrium adsorption data and the maximum monolayer capacity of the adsorbent was 31.64 mg g −1 at 303 K. The adsorption process was best described by pseudo-second order kinetic model at 303 K. Boundary layer diffusion played a key role in the adsorption process. The mechanism of uptake of EY by TLLP was controlled by both liquid film diffusion and intraparticle diffusion. The values of mean adsorption free energy, E (7.91 kJ mol −1 ), and standard enthalpy, ΔH° (+13.34 kJ mol −1 ), suggest physical adsorption. The adsorption process was endothermic and spontaneous. Teak leaf litter powder is a promising low-cost adsorbent for treating wastewaters containing eosin yellow.

The soil nitrate content has been determined at fortnightly intervals on bare fallow plots and on plots under crops and natural vegetation in the forest and savannah regions of Ghana. Nitrifiable nitrogen, ammonium and soil moisture contents have also been determined. It has been found that the changes in nitrate content are related to changes in the content of nitrifiable nitrogen. During the dry season, a partial sterilization of the soil occurs and consequently the content of nitrifiable nitrogen rises. This nitrifiable nitrogen is slowly converted to nitrate in the dry season and rapidly converted once the rains commence. Nitrate is then lost from the soil by leaching and denitrification. Under bare fallow conditions leaching is the most important cause of nitrate loss, but it is probable that denitrification makes some contribution on cropped soils and those under permanent vegetation. There is no indication of microbial nitrate absorption under a crop. This is presumably due to the rapidity with which nitrate is lost by leaching and denitrification, and to the greater quantity of organic matter required in these free-draining tropical soils than in most temperate ones to produce an equivalent absorption of nitrate. The high levels of nitrate and nitrifiable nitrogen which are found under natural forest probably represent an equilibrium level typical of a cycle in which nitrogen fixation and nitrification as well as nitrate losses proceed very rapidly. Natural savannah grassland suppresses nitrogen mineralization in the field almost entirely, but the nitrifiable nitrogen content is at times high, in spite of the very high carbon/nitrogen ratio of the soil of over 20. This confirms the view that little nitrate absorption takes place in spite of the presence of what might be considered excess carbonaceous material. The suppression of mineralization under grass is considered due to an excretion of the plant roots which is toxic to the nitrification process. The failure of organic matter to build up in these savannah soils, although mineralization is suppressed, is most probably associated with their low general fertility.

ABSTRACT Punch biopsy specimens from Mycobacterium ulcerans disease lesions were used to compare the sensitivities and specificities of direct smear, culture, PCR, and histopathology in making a diagnosis of M. ulcerans disease in a field setting. PCR for the insertion element IS 2404 was modified to include uracil- N -glycosylase and deoxyuridine triphosphate instead of deoxythymidine triphosphate to reduce the risk of cross contamination. The “gold standard” for confirmation of clinically diagnosed Buruli ulcer was a definite histological diagnosis, a positive culture for M. ulcerans , or a smear positive for acid-fast bacilli (AFB), together with a possible histological diagnosis. For 70 clinically diagnosed cases of M. ulcerans disease, the modified PCR was 98% sensitive and gave a rapid result. The sensitivities of microscopy, culture, and histology were 42%, 49%, and 82%, respectively. The use of a 4-mm punch biopsy specimen was preferred to a 6-mm punch biopsy specimen since the wound was less likely to bleed and to need stitching. Given adequate technical expertise and the use of controls, the PCR was viable in a teaching hospital setting in Ghana; and in routine practice, we would recommend the use of Ziehl-Neelsen staining of biopsy specimens to detect AFB, followed by PCR, in AFB-negative cases only, in order to minimize costs. Histology and culture remain important as quality control tests, particularly in studies of treatment efficacy.

Attainder was the most solemn penalty known to the common law. Attainder for treason was followed not only by the most savage and brutal corporal penalties and the forfeiture of all possessions, but in addition the corruption of blood passing to all direct descendants, in other words, by the legal death of the family. Before proceeding to an examination of the effects of parliamentary acts of attainder in the late fifteenth and early sixteenth centuries it is necessary first of all to define the scope of forfeiture for treason as it affected landed property. Bracton's classic definition of forfeiture had involved for the traitor ‘the loss of all his goods and the perpetual disinheritance of his heirs, so that they may be admitted neither to the paternal nor to the maternal inheritance’. Feudal opinion had always been very much opposed to the stringency of this conception and the Edwardian statute De Donis Conditionalibus, confirmed implicitly by the treason statute of 1352, had protected entailed estates from the scope of forfeiture, thus leaving only the fee simple and the widow's dower within the scope of the law. The wife's own inheritance or any jointure which had been made for her, because they ante-dated her husband's treason, as distinct from her right to dower which did not, were not liable to ultimate forfeiture—though a married woman could claim them only when ‘her time came according to the common law’, that is after the death of her husband when she ceased to be ‘femme couvert’. This equitable principle was confirmed by a statute of the Merciless Parliament of 1388 which, however, included for the first time the rule that lands held to the use of a traitor were also included in the scope of forfeiture. Thus, by 1388, of the lands held by a traitor (as distinct from the wife's inheritance and jointure), only those held in fee tail fell outside the scope of the treason laws. This loophole was closed by Richard II in 1398 when Parliament declared forfeit entailed estates as well as lands held in fee simple and to the use of a traitor, thus reverting with one exception to Bracton's view of forfeiture.

Access to point-of-care (POC) diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs) and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings.

INTRODUCTION: This population-based study aimed to fill the knowledge gap on Human Papillomavirus (HPV) prevalence and associated sociodemographic risk factors of the general population in the North Tongu District, Ghana. These results are needed to guide cervical cancer prevention efforts, as the leading type of female cancers. METHODS: A cross-sectional study including 2002 women in the North Tongu District, Ghana investigated HPV prevalence and associated sociodemographic risk factors. Women were recruited by geographical distribution through the local community-based health system and samples collected using a self-sampling device. For HPV genotyping BSGP5+/6+-PCR with Luminex-MPG readout was used. Multivariate logistic regression analyzed sociodemographic risk factors for HPV positivity. RESULTS: Of 2002 self-collected samples, 1943 were eligible, contained sufficient DNA and provided valid HPV genotyping results. Prevalence of single high risk HPV types was 32.3% and of multiple high risk types 9.7%. The five most common detected HPV types were HPV16 (7.4%; 95%CI: 6.3-8.7), HPV52 (7.2%; 95%CI: 6.1-8.5), HPV35 (4.8%; 95%CI: 3.9-5.8), HPV59 (4.7%; 95%CI: 3.8-5.8), HPV56 (3.9%; 95%CI: 3.1-4.8). Highest prevalence was observed among women aged 18-24 years, while age 25-54 years was inversely associated with high risk HPV positivity in multivariate analysis. Sociodemographic risk factors identified were i) having any sexual partner, ii) more partners increased the odds for high risk HPV positivity, iii) independently from this marital status, in particular not being married. DISCUSSION & CONCLUSION: Most importantly, the high risk HPV prevalence detected from this study is higher than estimates reported for Western Africa. This needs be considered, when deciding on the cervical cancer screening algorithms introduced on a wider scale. Follow-up and triage, depending on the methods chosen, can easily overburden the health system. Self-sampling worked well and provided adequate samples for HPV-based screening. Women with increasing number of sexual partners and not being married were found to have higher odds of being high risk HPV positive, therefore could be a higher prioritized screening target group.

The study recognized the worth of understanding the how’s of handling censoring and censored data in survival analysis and the potential biases it might cause if researchers fail to identify and handle the concepts with utmost care. We systematically reviewed the concepts of censoring and how researchers have handled censored data and brought all the ideas under one umbrella. The review was done on articles written in the English language spanning from the late fifties to the present time. We googled through NCBI, PubMed, Google scholar and other websites and identified theories and publications on the research topic. Revelation was that censoring has the potential of biasing results and reducing the statistical power of analyses if not handled with the appropriate techniques it requires. We also found that, besides the four main approaches (complete‐data analysis method; imputation approach; dichotomizing the data; the likelihood‐based approach) to handling censored data, there were several other innovative approaches to handling censored data. These methods include censored network estimation; conditional mean imputation method; inverse probability of censoring weighting; maximum likelihood estimation; Buckley‐Janes least squares algorithm; simple multiple imputation strategy; filter algorithm; Bayesian framework; β ‐substitution method; search‐and‐score‐hill‐climbing algorithm and constraint‐based conditional independence algorithm; frequentist; Markov chain Monte Carlo for imputed data; quantile regression; random effects hierarchical Cox proportional hazards; Lin’s Concordance Correlation Coefficient; classical maximum likelihood estimate. We infer that the presence of incomplete information about subjects does not necessarily mean that such information must be discarded, rather they must be incorporated into the study for they might carry certain relevant information that holds the key to the understanding of the research. We anticipate that through this review, researchers will develop a deeper understanding of this concept in survival analysis and select the appropriate statistical procedures for such studies devoid of biases.

OBJECTIVE: To investigate the problems, benefits, feasibility, and sustainability of implementation of WHO guidelines on management of severe malnutrition. METHODS: A postal survey invited staff from 12 African hospitals to participate in the study. Five hospitals were evaluated and two were selected to take part in the study: a district hospital in South Africa and a mission hospital in Ghana. At an initial visit, an experienced paediatrician reviewed the situation in the hospitals and introduced the principles of the guidelines through a participatory approach. During a second visit about six months later, the paediatrician reviewed the feasibility and sustainability of the introduced changes and helped find solutions to problems. At a final visit after one year, the paediatrician reassessed the overall situation. FINDINGS: Malnutrition management practices improved at both hospitals. Measures against hypoglycaemia, hypothermia, and infection were strengthened. Early, frequent feeding was established as a routine practice. Some micronutrients for inclusion in the diet were not locally available and needed to be imported. Problems were encountered with monitoring of weight gain and introducing a rehydration solution for malnutrition. CONCLUSION: Implementation of the main principles of the WHO guidelines on severe malnutrition was feasible, affordable, and sustainable at two African hospitals. The guidelines could be improved by including suggestions on how to adapt specific recommendations to local situations. The guidelines are well supported by experience and published reports, but more information is needed about some components and their impact on mortality.

BACKGROUND: Globally there are about 3.3million children under the age of 15 years living with HIV. Of this number, 88% live in sub-Saharan Africa. In Ghana, an estimated 33,000 children were said to be living with the HIV infection in 2012. Lack of disclosure adversely affects the well-being of the child, including access to paediatric HIV treatment and care and adherence to treatment. However, the greatest psychosocial challenges that parents and caregivers of HIV-infected children face is disclosure of HIV status to their infected children. This study sought to determine the prevalence of and the barriers to the disclosure of HIV status to infected children and adolescents in Lower Manya-Krobo District in Ghana. METHODS: A cross sectional study with a sample of 118 caregivers of HIV infected children and adolescents aged 4-19 years attending three HIV clinics in the Lower Manya Krobo District, and 10 key informants comprising of healthcare workers and HIV volunteer workers involved in the provision of care to infected children and their families. RESULTS: The prevalence of disclosure was higher. Main barriers to disclosure identified in this study included age of child, perceived cause of HIV, stigma attached to HIV, child's inability to keep diagnosis to self and fear of psychological harm to child. CONCLUSION: There is the need for the Ghana Health Service in conjunction with the Ghana Aids Commission and the National Aids Control Programme to develop comprehensive context-based disclosure guidelines.

The purpose of the study was to ascertain the dominant parenting styles of parents in the study area and their influence on children’s social development. The study utilised a sample of 480 basic school pupils who were in their adolescent stage and 16 teachers. The survey study employed a structured interview schedule and a questionnaire for the data collection. The study instruments were pre-tested to establish their validity and reliability. The results of the study revealed that the majority of the parents were perceived to adopt authoritative parenting styles in the upbringing of their children. It was also revealed that parenting style has influence on students’ social development. It is inferred that authoritative parenting based on reasoning, understanding, consensus and trust resulted in pro-social behaviour while authoritarian parenting based on strict rules, force, threat, verbal and physical punishments resulted in anti-social behaviour. It is, therefore, recommended that parents should endeavour to adopt authoritative parenting style to enable their children and wards to develop pro-social behaviour. The significance of the study is that the results would help parents, guardians, teachers and school authorities to understand and appreciate the relationship between parenting style and children’s social development. Parents, in particular, would be fascinated by the findings of the study to employ authoritative parenting style to aid their children to be socially competent, a virtue required for personal life and work ethos. DOI: 10.5901/ajis.2013.v2n3p123

Purpose This paper aims to examine the value relevance of accounting information from an emerging country perspective. Design/methodology/approach The study adopts Ohlson (1995) Price model to examine the extent to which accounting information explain variation in stock prices of listed firms on the Ghana Stock Exchange. Findings The study reveals that earnings and book value of equity exhibit a positive and significant relationship in stock prices. Earnings explain higher variation in stock market values on the Ghana Stock Exchange compared to book value of equity. The study however finds that despite the introduction of the International Financial Reporting Standards in Ghana, the value relevance of book value and earnings have declined significantly over the period 2005-2014. Research limitations/implications A key implication is that regulators of capital markets, standards setters and accounting practitioners need to consistently improve upon the quality of financial reporting disclosures which will boost the confidence of users in their reliance on financial statements as the basis for choosing among alternative use of scarce resources. The authors adopted only the price model in testing the hypotheses. However, to provide comprehensive understanding of value relevance of accounting information, future studies can combine both the price and the return models. Originality/value The authors extend prior literature in the Ghanaian context with recent data. Finally, the study adds to the efficient market hypothesis by showing how share prices reflect accounting information produced by Ghanaian firms.

BACKGROUND: Cervical cancer is the leading and most common female cancer among women in Ghana. Although there are screening methods to detect premalignant lesions for treatment, screening coverage in Ghana is 2.8% and late presentation of cases complicates treatment efforts. This study examined the sociodemographic, clinical and histological characteristics associated with late presentation of cervical cancer cases attending Gynecological Oncology care at Catholic Hospital, Battor. METHODS: One hundred and fifty-seven medical records of confirmed cases of cervical cancer reporting to the Outpatient Obstetrics and Gynecology Department between 2012 and 2016 were reviewed. Relevant data were retrieved using abstraction forms. Socio demographic variables investigated were level of education attained, marital status, National Health Insurance Scheme membership, employment status, place of residence and distance from hospital. Clinical variables included intermenstrual/postmenopausal bleeding, previous screening history, previous smoking history, age at menarche and number of children. Histological variables included subtypes of tumour and characteristics of tumour. Pearson's chi-square test and logistic regression analysis were used to determine correlates of late stage at presentation with cervical cancer. Sensitivity analysis was performed to assess the effect of missing data. RESULTS: Approximately two-thirds (65.97%) of the cases presented in advanced stages of cervical cancer. Level of education, age at menarche and previous screening history were included in a regression model and adjusted for age. Age at menarche (n = 66) was eliminated from the model after sensitivity analysis. Among the remaining variables, only previous screening history was predictive of late stage at presentation of cervical cancer cases. Previously unscreened cases of cervical cancer were nearly four times more likely to present late, compared to those who had been screened previously (OR 3.91; 95% CI 1.43-10.69). No association was observed with sociodemographic and histological characteristics. CONCLUSION: Lack of previous screening was associated with late presentation of cervical cancer at Catholic Hospital, Battor. Efforts to promote early cervical cancer screening should be intensified and future studies may explore an association with age at menarche.

BACKGROUND: In Ghana, limited evidence exists about the geographical accessibility to health facilities providing tuberculosis (TB) diagnostic services to facilitate early diagnosis and treatment. Therefore, we aimed to assess the geographic accessibility to public health facilities providing TB testing services at point-of-care (POC) in the Upper East Region (UER), Ghana. METHODS: We assembled detailed spatial data on all 10 health facilities providing TB testing services at POC, and landscape features influencing journeys. These data were used in a geospatial model to estimate actual distance and travel time from the residential areas of the population to health facilities providing TB testing services. Maps displaying the distance values were produced using ArcGIS Desktop v10.4. Spatial distribution of the health facilities was done using spatial autocorrelation (Global Moran's Index) run in ArcMap 10.4.1. We also applied remote sensing through satellite imagery analysis to map out residential areas and identified locations for targeted improvement in the UER. RESULTS: Of the 13 districts in the UER, 4 (31%) did not have any health facility providing TB testing services. In all, 10 public health facilities providing TB testing services at POC were available in the region representing an estimated population to health facility ratio of 125,000 people per facility. Majority (60%) of the health facilities providing TB testing services in the region were in districts with a total population greater than 100,000 people. Majority (62%) of the population resident in the region were located more than 10 km away from a health facility providing TB testing services. The mean distance ± standard deviation to the nearest public health facility providing TB testing services in UER was 33.2 km ± 13.5. Whilst the mean travel time using a motorized tricycle speed of 20 km/h to the nearest facility providing TB testing services in the UER was 99.6 min ± 41.6. The results of the satellite imagery analysis show that 51 additional health facilities providing TB testing services at POC are required to improve geographical accessibility. The results of the spatial autocorrelation analysis show that the spatial distribution of the health facilities was dispersed (z-score = - 2.3; p = 0.02). CONCLUSION: There is poor geographic accessibility to public health facilities providing TB testing services at POC in the UER of Ghana. Targeted improvement of rural PHC clinics in the UER to enable them provide TB testing services at POC is highly recommended.