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Environmental pollution, particularly water contamination, is regarded as one of the most crucial global problems, where a semiconductor photocatalyst towards organic pollutant degradation driven by photocatalysis is a promising technique. Herein, novel Eu–TiO 2 –GO composites with excellent photocatalytic performance were fabricated via simple and green sol–gel technique. In addition, density functional theory (DFT) method was employed to investigate the electronic structure, stability and charge transfer of the composites. The experimental study revealed that the optimal performance was obtained with the Eu–TiO 2 –GO (0.6% Eu) composite, of which the apparent rate constant was about 19-folds higher than that of bulk TiO 2 because of the combined effects of better visible light absorbance and efficient separation of charge carriers. The efficiency of Eu–TiO 2 –GO (0.6% Eu) in the degradation of indigo carmine (IC) dye reached 96.78% in 60 min under light irradiation. Based on the DFT method, we observe an efficient electron–hole pair separation, a potential drop and an in-built polarised electric field at the interface of Eu–TiO 2 –GO composite. Remarkably, Eu–TiO 2 –GO composite was found to exhibit a stronger interfacial interaction, smaller interlayer distance and a larger redistribution of charge than TiO 2 –GO composite. The stability and reusability of Eu–TiO 2 –GO (0.6% Eu) composite as an effective solar photocatalyst was confirmed by five cycling tests of wastewater treatment. From radical quenching experiments, hydroxyl and superoxide radicals were the dominant active species for the photodegradation reaction of IC dye. All these findings may shed light on the intrinsic reasons for the improved degradation of pollutants. Graphic Abstract

Water pollution caused by the discharge of hazardous organic pollutants from the food, textile, leather and paper industries is becoming a task for sustainable development. Photocatalysis is considered to be an effective method for removing organic contaminants from dye wastewater. The photocatalytic activity of ZnO-based catalyst based on its ability to generate electron–hole pairs upon photoillumination is limited due to its wide bandgap. In this study, novel GO/Gd/ZnO composites with varying percentages (0.3–1%) of Gd were fabricated via a hydrothermal approach and their photocatalytic degradation processes and performance of indigo carmine (IC) dye were investigated under light irradiation. The chemical composition and morphological features of the prepared GO/Gd/ZnO composites were characterized by X-ray diffraction, scanning electron microscopy, transmission electron microscope, energy-dispersive spectroscopy, Brunauer–Emmett–Teller, Raman and Fourier–transform infrared spectroscopy. GO/Gd/ZnO composites show much higher photocatalytic performance with complete IC dye degradation within 30 min of irradiation than bulk ZnO and GO/ZnO composite. Moreover, the optimal performance was revealed by the GO/Gd/ZnO (0.6% Gd) composite (nearly 96% degradation of IC dye). Using density functional theory, we explore the potential drop across the interface, electronic and structural properties of GO/ZnO and GO/Gd/ZnO composites. The photodegradation rate of IC dye by GO/Gd/ZnO (0.6% Gd) composite was 7.65 and 2.94-fold higher than those of bulk ZnO and GO/ZnO composite. The capture experiments revealed ˙O 2 − and ˙OH as the main active radicals during the photodegradation process. The theoretical and experimental findings obtained in this study indicate that GO/Gd/ZnO photocatalyst has great potential application for eliminating environmental pollutants.

Like many other women in the developing world, the practice of breast cancer screening among Ghanaian women is unsatisfactory. As a result, many cases are diagnosed at advanced stages leading to poor outcomes including mortalities. An understanding of the awareness and predictors of breast examination is an important first step that may guide the design of interventions aimed at raising awareness across the general population. This study aimed to explore the awareness, risk factors, and self-reported screening practices of breast cancer among female undergraduate students at the University of Health and Allied Sciences. This cross-sectional study was conducted among 385 female undergraduate students using a pre-tested questionnaire. Data were analysed using Stata Version 13.1 and presented using descriptive and inferential statistics comprising frequency, percentage, chi-square, and binary logistic regression. Odds ratios and 95% confidence intervals were computed to quantify the association between regular Breast-Self Examination (BSE) and socio-demographic characteristics of respondents. Seventy-three per cent of the students were aware of breast cancer, with social media being the most important source of information (64.4%). The prevalence of breast cancer risk factors varied from 1% of having a personal history of breast cancer to 14.3% for positive family history of breast cancer. Current use of oral pills/injectable contraceptives was confirmed by 13.2% of participants; 20% were current alcohol users and10.1% were physically inactive. Regarding breast examination, 42.6% performed BSE; 10.1% had Clinical Breast Examination (CBE), while 2.3% had undergone mammography in the three years preceding the study. Women who did not believe to be susceptible to breast cancer (AOR: 0.04; 95%CI: 0.02-0.09) and those who did not know their risk status (AOR: 0.02; 95%CI: 0.005-0.57) were less likely to perform regular BSE compared to those who displayed pessimism. Further, women with no religious affiliation had 0.11 (95%CI: 0.02-0.55) odds of examining their breast regularly compared to Christians. This study demonstrated moderate awareness of the modalities of breast cancer screening and the risk factors of breast cancer among the students. However, there exists a gap between awareness and practice of breast cancer screening, which was influenced by optimism in breast cancer risk perception and religion. Awareness campaigns and education should be intensified in the University to bridge this gap.

In an era of renewed commitment to accelerate the declines in Tuberculosis (TB) incidence and mortality, there is the need for National Tuberculosis Programmes (NTPs) to monitor trends in key indicators across a geographical location and to provide reliable data for direct measurement of TB incidence and mortality. In this context, we explored the trends of TB case detection, mortality and HIV co-infection, and examined the predictors of TB deaths in Ten districts of the Volta region of Ghana. We conducted a retrospective cohort study of all TB cases registered from 2013 to 2017 in 10 districts of the Volta Region of Ghana. Case detection rate (CDR) was computed as the ratio of the number of new and relapse TB case notified to NTP to the number of estimated incident TB cases in a given year. Case fatality rates were estimated using data from 2012-2016 cohort of TB patients. Simple and multiple logistic regression were used to identify predictors of TB deaths with odds ratios and 95% confidence intervals estimated. Overall, there were 3,735 new and relapse TB patients who commenced anti-TB treatment during the period, representing the case detection rate of 40.1% with district variations. The CDR remained stable during the 5 years. Of the total cases, HIV status was documented for 3,144 (84.2%), among whom, 712 (22.6%) were HIV positive. The TB/HIV co-infection was more prevalent among children under 15 years of age (30.1%), males (30.6%), treatment after lost to follow-up patients (33.3%), and smear-negative pulmonary TB patients (29.1%). The prevalence of TB/HIV co-infection did not significantly change over the years. The overall case fatality rate was 13% (n = 486), with considerable variation among HIV-positives and HIV-negative TB patients (21.8% and 11% respectively) (p<0.001) and among districts. TB/HIV co-infection, sputum smear-negative pulmonary TB and district of anti-TB treatment predicted TB mortality. TB case detection rate was low and remained stable during the study period, whereas co-infection with HIV and mortality rates were quite high, indicating the need for feasible strategies such as active case finding to improve case detection, and improved case management to reduce mortality.

Background Delayed diagnosis of preeclampsia contributes to maternal morbidity and mortality. Patient-performed home blood pressure monitoring facilitates more frequent monitoring and earlier diagnosis. However, challenges may exist to implementation in low- and middle income-countries. Methods This cross-sectional mixed methods study evaluated obstetric doctors’ perspectives on the benefits of and barriers to the implementation of home blood pressure monitoring among pregnant women in Ghana. Participants were doctors providing obstetric care at Korle Bu Teaching Hospital. Electronic surveys were completed by 75 participants (response rate 49.3%), consisting of demographics and questions on attitudes and perceived benefits and challenges of home BP monitoring. Semi-structured interviews were completed by 22 participants to expand on their perspectives. Results Quantitative and qualitative results converged to highlight that the current state of blood pressure monitoring among pregnant women in Ghana is inadequate. The majority agreed that delayed diagnosis of preeclampsia leads to poor health outcomes in their patients (90.6%, n  = 68) and earlier detection would improve outcomes (98.7%, n  = 74). Key qualitative benefits to the adoption of home blood pressure monitoring were patient empowerment and trust of diagnosis, more quantity and quality of blood pressure data, and improvement in systems-level efficiency. The most significant barriers were the cost of monitors, lack of a communication system to convey abnormal values, and low health literacy. Overall, doctors felt that most barriers could be overcome with patient education and counseling, and that benefits far outweighed barriers. The majority of doctors (81.3%, n  = 61), would use home BP data to inform their clinical decisions and 89% ( n  = 67) would take immediate action based on elevated home BP values. 91% ( n  = 68) would recommend home BP monitoring to their pregnant patients. Conclusion Obstetric doctors in Ghana strongly support the implementation of home blood pressure monitoring, would use values to inform their clinical management, and believe it would improve patient outcomes. Addressing the most significant barriers, including cost of blood pressure monitors, lack of a communication system to convey abnormal values, and need for patient education, is essential for successful implementation.

Bats are likely natural hosts for a range of zoonotic viruses such as Marburg, Ebola, Rabies, as well as for various Corona- and Paramyxoviruses. In 2009/10, researchers discovered RNA of two novel influenza virus subtypes--H17N10 and H18N11--in Central and South American fruit bats. The identification of bats as possible additional reservoir for influenza A viruses raises questions about the role of this mammalian taxon in influenza A virus ecology and possible public health relevance. As molecular testing can be limited by a short time window in which the virus is present, serological testing provides information about past infections and virus spread in populations after the virus has been cleared. This study aimed at screening available sera from 100 free-ranging, frugivorous bats (Eidolon helvum) sampled in 2009/10 in Ghana, for the presence of antibodies against the complete panel of influenza A haemagglutinin (HA) types ranging from H1 to H18 by means of a protein microarray platform. This technique enables simultaneous serological testing against multiple recombinant HA-types in 5 μl of serum. Preliminary results indicate serological evidence against avian influenza subtype H9 in about 30% of the animals screened, with low-level cross-reactivity to phylogenetically closely related subtypes H8 and H12. To our knowledge, this is the first report of serological evidence of influenza A viruses other than H17 and H18 in bats. As avian influenza subtype H9 is associated with human infections, the implications of our findings from a public health context remain to be investigated.

Background Preeclampsia/eclampsia is a major cause of maternal morbidity and mortality worldwide, yet patients’ perspectives about their diagnosis are not well understood. Our study examines patient knowledge among women with preeclampsia/eclampsia in a large urban hospital in Ghana. Methods Postpartum women diagnosed with preeclampsia or eclampsia were asked to complete a survey 2–5 days after delivery that assessed demographic information, key obstetric factors, and questions regarding provider counseling. Provider counseling on diagnosis, causes, complications, and future health effects of preeclampsia/eclampsia was quantified on a 4-point scale (‘Counseling Composite Score’). Participants also completed an objective knowledge assessment regarding preeclampsia/eclampsia, scored from 0 to 22 points (‘Preeclampsia/Eclampsia Knowledge Score’ (PEKS)). Linear regression was used to identify predictors of knowledge score. Results A total of 150 participants were recruited, 88.7% (133) with preeclampsia and 11.3% (17) with eclampsia. Participants had a median age of 32 years, median parity of 2, and mean number of 5.4 antenatal visits. Approximately half of participants reported primary education as their highest level of education. While 74% of women reported having a complication during pregnancy, only 32% of participants with preeclampsia were able to correctly identify their diagnosis, and no participants diagnosed with eclampsia could correctly identify their diagnosis. Thirty-one percent of participants reported receiving no counseling from providers, and only 11% received counseling in all four categories. Even when counseled, 40–50% of participants reported incomplete understanding. Out of 22 possible points on a cumulative knowledge assessment scale, participants had a mean score of 12.9 ± 0.38. Adjusting for age, parity, and the number of antenatal visits, higher scores on the knowledge assessment are associated with more provider counseling (β 1.4, SE 0.3, p  < 0.001) and higher level of education (β 1.3, SE 0.48, p  = 0.008). Conclusions Counseling by healthcare providers is associated with higher performance on a knowledge assessment about preeclampsia/eclampsia. Patient knowledge about preeclampsia/eclampsia is important for efforts to encourage informed healthcare decisions, promote early antenatal care, and improve self-recognition of warning signs—ultimately improving morbidity and reducing mortality.

Globally, the COVID-19 pandemic has brought attention to the impact of negative patient outcomes on healthcare providers. In Ghana, obstetric providers regularly face maternal and neonatal mortality, yet limited research has focused on provision of mental health support for these providers. This study sought to understand how obstetric providers viewed seeking mental health support after poor clinical outcomes, with a focus on the role of mental health stigma. Participants were 52 obstetric providers (20 obstetrician/gynecologists and 32 midwives) at two tertiary care hospitals in Ghana. Five focus groups, led by a trained facilitator and lasting approximately two hours, were conducted to explore provider experiences and perceptions of support following poor maternal and neonatal outcomes. Discussions were audiotaped and transcribed verbatim, then analyzed qualitatively using grounded theory methodology. Most participants (84.3%, N=43) were finished with training, and 46.2% (N=24) had been in practice more than 10 years. Emerging themes included pervasive stigma associated with seeking mental health care after experiencing poor clinical outcomes, which was derived from two overlapping dimensions. First, societal-level stigma resulted from a cultural norm to keep emotions hidden, and the perception that psychiatry is equated with severe mental illness. Second, provider-level stigma resulted from the belief that healthcare workers should not have mental health problems, a perception that mental health care is acceptable for patients but not for providers, and a fear about lack of confidentiality. Despite many providers acknowledging negative mental health impacts following poor clinical outcomes, these additive layers of stigma limited their willingness to engage in formal mental health care. This study demonstrates that stigma creates significant barriers to acceptance of mental health support among obstetric providers. Interventions to support providers will need to respect provider concerns without reinforcing the stigma associated with seeking mental health care.

As future photocatalyst require high activity and structural stability, the demand for high-performance photocatalyst that increases photocatalytic conversion efficiency is of significant interest. In this study, Ce–ZrO 2 –GO nanocomposite was fabricated by a co-precipitation technique and used for the photocatalytic degradation of eosin yellow (EY) dye under visible light irradiation. A hybrid DFT calculation was employed to analyse the electronic properties and the underlying mechanism of the observed photoactivity. The as-prepared Ce–ZrO 2 –GO (0.3% Ce) nanocomposite showed enhanced photodegradation of EY dye, which was about 15.98-fold higher than pure ZrO 2 . The enhanced performance of Ce–ZrO 2 –GO nanocomposite for EY dye degradation is due to the synergistic effect between the GO sheets and Ce–ZrO 2 . From the computational study, Ce ion could act as an electron mediator to capture the photoinduced electrons from ZrO 2 to restrain the recombination rate of charge carriers. Testing with different scavengers showed that hydroxyl radicals play a major contribution to the degradation of EY dye with a pseudo first-order reaction kinetics. Total Organic Carbon analysis showed 76% mineralisation of EY dye over Ce–ZrO 2 –GO (0.3% Ce) nanocomposite, which is photostable and its efficiency remained almost the same after five cycles without any photocorrosion. The present study could offer an alternative approach to develop highly efficient photocatalysts for organic pollutant degradation using metal ion as a mediator to enhance charge migration, activity and structural stability of the nanocomposite. Graphical Abstract A series of Ce–ZrO 2 –GO nanocomposite were employed as a photocatalytic to degrade eosin yellow dye from wastewater. The present study offers an alternative approach to develop highly efficient photocatalysts for organic pollutant degradation using Ce ion as a mediator to enhance charge migration, activity and structural stability of the nanocomposite.