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Background and Aim.Ghana is one of the many Sub-Saharan African countries battling malaria. The disease is treated with orthodox medication as well as some home-grown remedies, mainly from plants. This study sought to identify these local remedies being marketed, focusing on the active ingredients being used. Methods. Pharmacy shops were randomly scouted and products were observed. The active ingredients were documented and their frequencies were determined. Results.Forty-four (44) plant species belonging to twenty-eight (28) families were recorded for the treatment of malaria in the survey. The predominant families were the Leguminosae and Meliaceae families. Cryptolepis sanguinolenta (Ghanaian quinine or yellow dye root) and Azadirachta indica (neem tree) were the most cited plants. Cryptolepis and neem tree were used 17 and 15 times, respectively, in the finished herbal products for treating malaria. Conclusion. Cryptolepis sanguinolenta and Azadirachta indica (neem tree) are important herbs for the treatment of malaria in Ghana. Locally manufactured herbal antimalarials are important for the treatment of malaria in urban and rural communities in Ghana.

This living systematic review by Allotey and colleagues (BMJ 2024; 384:067696) has been updated. For the latest update, visit doi:10.1136/bmj.2021-067696. The latest version of this living systematic review (update 1) includes 643 studies of which 343 are cohort studies and 300 case series and case reports. 2.7% of the babies born to mothers with SARS-CoV-2 infection tested positive with RT-PCR. Positivity rates varied between regions, being the highest in studies from Latin America and the Caribbean (8.5%). Severe maternal covid-19, maternal death, maternal postnatal infection, caesarean section, and preterm delivery are associated with SARS-CoV-2 positivity in offspring. Of the positive babies with data for the timing of exposure and type and timing of tests, 32 had confirmed mother-to-child transmission. The results confirm vertical transmission of SARS-CoV-2, although this is rare.

The leaves of three species of plants, i.e. Colophospermum mophane (Mophane), Sclerocarya birrea (Morula) and Terminalia sericea (Mogonono), were chemically analysed for dietary nutrients. The leaves were also fed to larvae of Imbrasia belina (Westwood), (Lepidoptera: Saturnudae), and the number of days taken for pupation was determined. The crude protein level in the leaves of the three plants was significantly different (P < 0.001) with C.mophane having the highest value of 16.9% (on dry matter basis, DM).Sclerocarya birrea and T. sericea had protein levels of 10.5% and 8.5% (DM basis) respectively. The energy levels followed the same trend as the protein levels and the values ranged from 17.1 to 22.9 kJ/g (DM basis). The organic content (weight loss after ignition) ranged from 93.5% to 95% (DM basis). The larvae assimilated about a third of the organic matter and half of the crude protein and energy in the leaves of mophane and S.birrea. The larvae stopped ingesting T. sericea and died within a few days after the commencement of the growth experiment. Older larvae (> 2nd instar) fed mophane leaves assimilated better than younger larvae (< 2nd instar). There was no difference in assimilation between the old and young larvae when fed mórula leaves. It is believed that the extensive veins of hard vascular tissues in mophane leaves can only be chewed sufficiently by the strong mandibles of the old larvae. C. mophane and S. birrea had a protein-energy ratio (P: E mg/kJ, a measure of quality of herbivore diet), of 8.5 and 7.5, respectively. All larvae fed leaves of mophane pupated before those fed S. birrea, indicating that C. mophane provides better nutrition for growth. This finding is consistent with the observation that adult moths prefer to lay their eggs on leaves of mophane even though they do not totally avoid S. birrea.

Manjulaa Narasimhan and colleagues argue that there is a pressing need for a clearer conceptualisation of self care to support health policy

Undertaking a consultancy for the World Health Organization in the Far East—an incredibly demoralising experience, which stopped me spending time with my young family. Doctors who are committed to mentoring students beyond just clinical skills, to help them to be well rounded human beings with a commitment to social justice and equity. Given increased patient mobility and chronic illness, it will be great when detailed medical histories can follow patients wherever they go, with whichever health professional they choose to consult.

The WHO recommends pregnant women attend antenatal clinic at least three times during pregnancy; during the first, second and third trimesters. During these visits, an array of clinical and laboratory tests is conducted. The information obtained plays an important role not only in the management and care of pregnancy, but also guides policies targeted at addressing pregnancy-induced health challenges. This study therefore presents laboratory and clinical information of pregnant women at their first antenatal visits. The study was cross-sectional in design which retrospectively reviewed laboratory and clinical data of pregnant women attending their first antenatal clinic (ANC) at the Comboni Hospital, Volta region, Ghana. The data reviewed included information on hemoglobin level, hemoglobin phenotype, malaria diagnostics, Human Immunodeficiency Virus test (HIV), glucose-6-phosphate dehydrogenase (G6PD) deficiency, Hepatitis C Virus (HCV) test, Hepatitis B Virus (HBV) test, Syphilis test, blood pressure, age, urine glucose, and urine protein. The hemoglobin level was assayed with a hemoglobinometer. Qualitative lateral flow chromatographic immunoassay techniques were used to diagnose the HIV, HCV, HBV, syphilis, and malaria status of the pregnant women. Urine dipstick was used assay for the urine protein and urine glucose, whilst the methemoglobin test was used for the G6PD deficiency and alkaline hemoglobin electrophoresis for hemoglobin phenotype. Data on demographic, anthropometric and vital signs such as age, weight and blood pressure were also collected. Descriptive statistics were performed. Frequency and percentages were used to describe the categorical variables and means and standard deviations used to describe the continuous variables. Hemoglobin S(Hb S) was found in 12.8% of the women with 73.4% having hemoglobin levels below 11.5g/dl. On G6PD deficiency, 1.6% and 0.8% were partially and fully defective respectively. Also, urine protein (1.2%) and glucose (0.4%) were detected. The prevalence of HBV, HCV and malaria were 4.4%, 3.6% and 2.4%, respectively. Anemia in pregnancy was high among the study sample. Malaria and hepatitis infections were observed in the study sample. Policies on maternal health should be targeted at providing better nutritional options, that can enhance the hemoglobin level during pregnancy. Pregnant women should benefit from enhanced surveillance for HIV, HBV, HCV, and syphilis.

Power imbalances are embedded across funding opportunities, research management and coordination, knowledge production and transfer, access to training resources and most technical and political aspects of global health.1 The current pandemic, which has further highlighted these inequities, is an opportunity to acknowledge and rectify these gaps.2 The changes needed include ensuring that partnerships between HIC and LMIC institutions are equitable and that benefits from those arrangements accrue equally to all parties. Overcoming the research to policy gap is critical to addressing health challenges.3 However, knowledge generated and reported in scientific publications is largely inaccessible to LMIC researchers even when they play a significant role in the research process.4 HIC research institutions should provide free access to their academic libraries to their LMIC partners. [...]research findings must be shared with equity, fairness, and respect for the work of LMIC and HIC collaborators. Research has shown that LMIC representation in first and last author positions is low, even when all necessary data almost exclusively has been collected and produced by local staff in their own country.9 Whenever needed, HIC institutions should provide senior support and training in article writing as well as ensure fair and equitable authorship of research papers between participating scientists from LMICs and HICs.

Antenatal care of women with epilepsy is varied. The association of epilepsy and antiepileptic drug exposure with pregnancy outcomes needs to be quantified to guide management. We did a systematic review and meta-analysis to investigate the association between epilepsy and reproductive outcomes, with or without exposure to antiepileptic drugs. We searched MEDLINE, Embase, Cochrane, AMED, and CINAHL between Jan 1, 1990, and Jan 21, 2015, with no language or regional restrictions, for observational studies of pregnant women with epilepsy, which assessed the risk of obstetric complications in the antenatal, intrapartum, or postnatal period, and any neonatal complications. We used the Newcastle-Ottawa Scale to assess the methodological quality of the included studies, risk of bias in the selection and comparability of cohorts, and outcome. We assessed the odds of maternal and fetal complications (excluding congenital malformations) by comparing pregnant women with and without epilepsy and undertook subgroup analysis based on antiepileptic drug exposure in women with epilepsy. We summarised the association as odds ratio (OR; 95% CI) using random effects meta-analysis. The PROSPERO ID of this Systematic Review's protocol is CRD42014007547. Of 7050 citations identified, 38 studies from low-income and high-income countries met our inclusion criteria (39 articles including 2 837 325 pregnancies). Women with epilepsy versus those without (2 809 984 pregnancies) had increased odds of spontaneous miscarriage (OR 1·54, 95% CI 1·02–2·32; I2=67%), antepartum haemorrhage (1·49, 1·01–2·20; I2=37%), post-partum haemorrhage (1·29, 1·13–1·49; I2=41%), hypertensive disorders (1·37, 1·21–1·55; I2=23%), induction of labour (1·67, 1·31–2·11; I2=64%), caesarean section (1·40, 1·23–1·58; I2=66%), any preterm birth (<37 weeks of gestation; 1·16, 1·01–1·34; I2=64%), and fetal growth restriction (1·26, 1·20–1·33; I2=1%). The odds of early preterm birth, gestational diabetes, fetal death or stillbirth, perinatal death, or admission to neonatal intensive care unit did not differ between women with epilepsy and those without the disorder. A small but significant association of epilepsy, exposure to antiepileptic drugs, and adverse outcomes exists in pregnancy. This increased risk should be taken into account when counselling women with epilepsy. EBM CONNECT Collaboration.